scholarly journals Process evaluation of integrated diabetes management at primary healthcare facilities in Pakistan: a mixed-methods study

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101612 ◽  
Author(s):  
Muhammad Amir Khan ◽  
John D Walley ◽  
Saima Ali ◽  
Rebecca King ◽  
Shaheer Ellahi Khan ◽  
...  
Keyword(s):  
Integrated Care ◽  
Process Evaluation ◽  
Diabetes Care ◽  
Service Providers ◽  
Health Facilities ◽  
Care Providers ◽  
Phone Calls ◽  
Healthy Activity ◽  
Clinical Records

BackgroundIntegrated care for diabetes and associated conditions at primary level health facilities can make care available to a much larger population, especially in rural areas.AimThis process evaluation was to understand how the authors' integrated care was implemented and experienced by the care providers and patients, and to inform modifications prior to province-wide scale-up.Design & settingThe mixed-method study was conducted as part of a cluster randomised trial on integrated diabetes care at 14 public health facilities.MethodThe care practices were assessed by analysing the routine clinical records of 495 registered patients with diabetes. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.ResultsThe intervention and the study were implemented as intended under routine conditions in rural health centres. Key service processes effectively delivered included: skill-based training; screening and diagnostic tests; treatment card records; and the additional case management as per desk guide, including monitoring progress in glucose and weight at follow-up consultations, and mobile phone calls to help adherence. However, social and cultural factors affected clients' ability to change lifestyles, especially for women. The intervention effect was limited by the short study follow-up of only 9 months.ConclusionIntegrated diabetes care was feasible, both for providers and patients, and potentially scalable at primary care facilities under routine conditions in Pakistan. Additional operational interventions are required for sustained drug supplies, supervision, in-service training, and to address the social challenges to healthy activity and eating, especially for women.

scholarly journals Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation

BJGP Open ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. bjgpopen18X101632 ◽  
Author(s):  
Muhammad Amir Khan ◽  
Muhammad Ahmar Khan ◽  
John D Walley ◽  
Nida Khan ◽  
Faisal Imtiaz Sheikh ◽  
...  
Keyword(s):  
Public Health ◽  
Integrated Care ◽  
Low Income ◽  
Service Providers ◽  
Health Facilities ◽  
Public Healthcare ◽  
Care Providers ◽  
Asthma Care ◽  
Public Health Facilities ◽  
Clinical Records

BackgroundIn Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) and asthma are 2.1% and 4.3% respectively, and existing care is grossly lacking both in coverage and quality. An integrated approach is recommended for delivering COPD and asthma care at public health facilities.AimTo understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.Design & settingThe mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities.MethodThe care practices were assessed by analysing the clinical records of n = 451 asthma and n = 313 COPD patients. Semi-structured interviews with service providers and patients were used to understand their care experiences. A framework approach was applied to analyse and interpret qualitative data.ResultsUtilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients had severe airway obstruction. The practice of prescribing inhalers differed between intervention and control arms. Patient non-adherence to follow-up visits remained a major treatment challenge (though attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking.ConclusionThe integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.

scholarly journals Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101613 ◽  
Author(s):  
Muhammad Amir Khan ◽  
John D Walley ◽  
Nida Khan ◽  
Muhammad Ahmar Khan ◽  
Saima Ali ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Low Income ◽  
Service Providers ◽  
Randomised Trial ◽  
Lifestyle Changes ◽  
Urban Setting ◽  
Care Providers ◽  
Care Intervention ◽  
Low Middle Income Countries ◽  
Clinical Records

BackgroundIn Pakistan about 18% of all adults are affected by hypertension, and only one in eight of the prevalent cases have their hypertension controlled. As in many other low-middle income countries, a public–private partnership approach is being considered for delivering non-communicable disease care in urban areas.AimThis process evaluation was undertaken to understand how an integrated care intervention was experienced by the care providers and patients, and to inform modifications before possible scaling.Design & settingThe mixed-methods study was conducted as part of a cluster randomised trial on integrated hypertension care at 26 private clinics.MethodThe care practices were assessed by analysing the clinical records of 1138 registered patients with hypertension. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.ResultsDistrict-led objective selection and context-sensitive staff training helped to get the clinics engaged in partnership working. About one-third of patients with hypertension had associated diabetes or renal compromise. The prescription of drugs is influenced by multiple non-clinical considerations of providers and patients. Many doctors allowed the use of home-based remedies as supplements to the prescribed allopathic drugs. Female patients faced more challenges in managing lifestyle changes. The intervention improved adherence to follow-up visits, but patient attrition remained a challenge.ConclusionThe integrated hypertension care intervention at private clinics is feasible, and leads to improved diagnosis and treatment in low-income country urban setting. The authors recommend continued implementation research and informed scaling of hypertension care at private clinics.

scholarly journals A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

2016 ◽  
Vol 7 ◽  
pp. JCM.S39766 ◽  
Author(s):  
Noriko Satoh-Asahara ◽  
Hiroto Ito ◽  
Tomoyuki Akashi ◽  
Hajime Yamakage ◽  
Kazuhiko Kotani ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Diabetes Care ◽  
Clinical Pathways ◽  
Coping Resources ◽  
Care Providers ◽  
Depression Care ◽  
Patients With Diabetes ◽  
And Coping ◽  
Levels Of Integration

Purpose Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. Method We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. Results Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. Conclusion A new PHR may be suitable for comorbid patients with diabetes and depression.

scholarly journals Availability of Safe Second-Trimester Abortion Services in Health Facilities in Accra, Ghana

2021 ◽  
Author(s):  
Fred Yao Gbagbo ◽  
Renee Aku Sitsofe Morhe ◽  
Emmanuel Komla Senanu Morhe
Keyword(s):  
Service Providers ◽  
Social Stigma ◽  
Clinical Care ◽  
Internal Validity ◽  
Health Facilities ◽  
Accurate Information ◽  
Second Trimester ◽  
Care Providers ◽  
Trimester Abortion ◽  
Second Trimester Abortion

Abstract Background Despite a liberal abortion law, access to safe second trimester abortion services in Ghana are challenging for many women. This study sought to examine providers, methods employed, cost, and other determinants of availability of second-trimester abortion services in health facilities in Accra, Ghana in 2019 to inform policy and program decisions. Methods A two-stage mixed quantitative and qualitative study designs were employed in the conduct of this study. The first stage was a short interaction of the mystery client with a clinical care provider to identify health facilities that provide second trimester induced abortion, the cost, and referral practices, where the facility did not have the service. The second stage was in-depth interviews of second-trimester abortion care providers and non-providers in various health facilities. For internal validity, it also explored the procedure cost, referral, and other practices at the health facilities included in the study, independent of what was captured in the mystery client survey. Results Second-trimester abortion services in Accra, Ghana are widely unavailable even in most facilities that provided abortion services. Referral policies and practices indicated by the service providers at various facility levels were inadequate. Criminalization of the procedure, social stigma, and fear of complications are the main factors that adversely influence the availability of second-trimester abortion in health facilities in Accra. Conclusions Albeit increasing demand for second-trimester abortion in health facilities in Accra, services are not readily available due to the ambiguity of the law, its interpretation, and limited flow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services.

scholarly journals Management of services in total quality management implemented and non-implemented health facilities

2021 ◽  
Vol 6 (4) ◽  
pp. 689-696
Author(s):  
Muhsina Begum ◽  
Ashees Kumar Saha ◽  
Sheuly Begum ◽  
Nasima Akhter ◽  
Pritikona Borua ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Management ◽  
Total Quality Management ◽  
Health Care Providers ◽  
Service Providers ◽  
Health Facilities ◽  
Working Environment ◽  
Care Providers ◽  
Total Quality ◽  
Medical College

5S-CQI-TQM is a management technique that is aimed at bringing satisfaction of staff as well as the patients through improvement of working environment. A cross-sectional comparative study was carried out among 226 respondents who were selected purposively from the selected study place from 1st January to 31st December 2017. Among 226 respondents, 113 were taken from Dhaka Medical College and another 113 were taken from Mugdha Medical College. Among 113 respondents, 56 respondents were health care providers and 57 respondents were health care receivers. The purpose of this study to compare the management of services in Total Quality Management implemented (Dhaka Medical College and Hospital) and non-implemented (Mugdha Medical College and Hospital) health facilities. A Semi-structured interviewer administered questionnaire and an observational check list were developed to collect the data. Separate questionnaire was used for health care providers and health care receivers. The statistical analysis was conducted using SPSS (statistical package for social science) version 20 statistical software. Significant statistical differences were found between TQM implemented and TQM non-implemented hospital regarding workload (p=0.043), hospital authority always seriously consider staff’s suggestions for the improvement of quality of service (p<0.001), employees always respect to each other in the hospital (p<0.001) and 35 (62.5%) service providers expressed satisfactory opinion regarding management of the hospital. Asian J. Med. Biol. Res. December 2020, 6(4): 689-696

Factors affecting the embedding of integrated primary–secondary care into a health district

2020 ◽  
Vol 26 (3) ◽  
pp. 216 ◽  
Author(s):  
Geoffrey K. Mitchell ◽  
Charlotte E. Young ◽  
Tina Janamian ◽  
Kylie M. Beaver ◽  
Joanne L. K. Johnson ◽  
...  
Keyword(s):  
Health Service ◽  
Integrated Care ◽  
Process Evaluation ◽  
Information Exchange ◽  
Secondary Care ◽  
Advisory Group ◽  
Routine Practice ◽  
Care Providers ◽  
Specialist Care ◽  
Structured Interviews

With the aging population, the tide of chronic disease is rising with attendant increases in health service need. Integrated care and patient-centred approaches, which established partnerships between a regional Hospital and health service (HHS), the local primary health network and local general practitioners (GPs), were identified as exemplars of an approach needed to support growing community health needs. This paper summarises the findings from a process evaluation of four GP–specialist care integration programs with the aim of identifying recommendations for embedding integrated GP–specialist care into routine practice within the HHS. The process evaluation of the integration programs drew on input from a multidisciplinary expert advisory group and data collected through face-to-face semi-structured interviews with key stakeholders, as well as surveys of participating GPs and patients. Overarching findings were identified and grouped under six themes: interdisciplinary teamwork; communication and information exchange; the use of shared care guidelines or pathways; training and education; access and accessibility; and funding. Within each theme, key challenges and enablers emerged. The findings of this study highlight benefits and challenges associated with the establishment of integrated care between primary and secondary care providers, leading to the development of key recommendations for routine integration.

scholarly journals Why Do Some Ethiopian Women Give Birth at Home after Receiving Antenatal Care? Phenomenological Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Yohannes Mehretie Adinew ◽  
Netsanet Abera Assefa ◽  
Yimenu Mehretie Adinew
Keyword(s):  
Antenatal Care ◽  
Interpretative Phenomenological Analysis ◽  
Phenomenological Study ◽  
Care Service ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Care Providers ◽  
Skilled Attendance ◽  
At Home

Background. In Ethiopia, majority (62%) of pregnant women receive at least one antenatal follow-up, yet only 26% give birth in health facility. Understanding factors underlying this high uptake of antenatal care and low institutional delivery service is critical. Women had antenatal care follow-up means; by default they have access to health facilities. Thus, why do some give birth at home even after receiving antenatal care? Methods. Fourteen key informant interviews and six focused group discussions were held among purposively selected women who gave birth in the last 12 months without skilled attendance after receiving antenatal care. The study explored women’s perspectives on maternity care, care providers, and factors that influence place of delivery. Interpretative phenomenological analysis was used to examine various behaviors and beliefs of respondents. Results. Study participants described range of experiences and beliefs that made them give birth at home after receiving antenatal care at health facilities. Four themes emerged from women’s description: poor counseling during antenatal care service, traditions, early pregnancy symptoms, and lack of planning in advance for childbirth. Conclusion. Poor counseling during antenatal care is deterring women from seeking skilled attendance at birth. Thus, healthcare providers need to stress necessity of facility based delivery care during antenatal follow-up counseling.

Transition of Patients to and from Insulin Degludec: A Clinical Challenge

2019 ◽  
Vol 105 (6) ◽  
pp. e2294-e2298 ◽  
Author(s):  
Irl B Hirsch ◽  
Boris Draznin
Keyword(s):  
Correct Answer ◽  
Diabetes Care ◽  
Insulin Dose ◽  
Daily Practice ◽  
Unintended Consequences ◽  
Insulin Degludec ◽  
Care Providers ◽  
Clinical Challenge ◽  
Clinical Scenarios

Abstract With appearance of new insulins on the market, new clinical challenges, much like unintended consequences, came into light in our daily practice. One of the most pressing issues has become an issue of switching patients to and from newer insulins in various clinical situations. A proper switch from 1 medication to another requires understanding of pharmacokinetics (PK) and pharmacodynamics (PD) of both drugs. Unfortunately, there is no research in this area and, as a result, there are no guidelines nor is there even a consensus. We present 5 clinical scenarios in which the patients were transitioned to or from insulin degludec. Because there are no data and no current consensus, we have polled 200 diabetes care providers soliciting their opinion as to how they would handle these clinical situations. Our poll of endocrinologists revealed multiple approaches as well as elements of confusion among providers. Even though all answers, summarized following each case, might be reasonable, and there might not be a single correct answer, we wish to express our opinion that is based on PK and PD of these insulins. Because there is more than 1 correct way of implementing these transitions, we urge our colleagues to institute a very close follow-up of these patients with frequent adjustments of insulin dose to avoid stacking with potential hypoglycemia.

scholarly journals The influence of linkages, feedback mechanisms, and caregiver mobility on immunization follow-up visits in Lideta sub-city of Addis Ababa, Ethiopia: a qualitative study

2021 ◽  
Vol 19 (S2) ◽  
Author(s):  
Thewodros Zewde ◽  
Alula Teklu ◽  
Diriba Bedada ◽  
Yoseph Tsehaye
Keyword(s):  
Addis Ababa ◽  
A Priori ◽  
Feedback System ◽  
Urban Slum ◽  
Text Messages ◽  
Health Facilities ◽  
Phone Calls ◽  
Health Centres ◽  
Immunization Services

Abstract Background Losing children to follow-up is one of the major barriers identified in Ethiopia’s immunization programme. In many urban slum areas like Lideta sub-city, Addis Ababa, several demand- and supply-side factors affect the follow-up visits for routine immunization services, so this study aimed to explore the influence of linkages, a feedback mechanism, and caregiver mobility on immunization follow-up visits. Methods The study team employed a qualitative method and conducted 30 in-depth interviews with caregivers, 26 interviews with key informants, and five focus group discussions with health officials and decision-makers. A deductive content and thematic analysis was carried out by importing the transcripts into OpenCodes, applying the a priori codes, and identifying new codes and themes. Results The linkages among health facilities included those from hospitals to health centres, from hospitals to hospitals, and from health centres to health centres within and outside the sub-city. Using these linkages, most vaccinators transfer caregivers without providing multi-dose vial (MDV) vaccines, mainly bacille Calmette–Guérin (BCG) and measles-containing vaccines (MCV), “to minimize wastage” and thus successfully reduce vaccine wastage rates; yet most caregivers wasted their time, energy, and money travelling from one health facility to another. Despite some efforts to transfer caregivers using “transferal slips” and informal phone calls to vaccinators’ friends, unfortunately, there was no formally established system for obtaining feedback about the arrival of caregivers and continuation of the follow-up visits. Overall, the transfer process lacked uniformity, used various approaches, and was not systematic. Conclusions Transferal of caregivers for the sake of minimizing wastage of MDV vaccines without checking the vaccination schedules of the receiving health facilities, using various informal types of tools and approaches, along with a poor follow-up and feedback system, were major identified challenges which cost caregivers extra money, energy, and time in getting timely immunization services. Therefore, the Federal Ministry of Health should strengthen the linkages among facilities, ensure the establishment of formal communications by developing guidelines and standardized tools – transferal slips and approaches – and initiate a fast feedback provision system using SMS text messages.

scholarly journals The Influence of Linkages, Feedback Mechanisms, and Caregivers’ Mobility on Immunization Follow-Up Visits in Lideta Sub-City of Addis Ababa, Ethiopia: A Qualitative Study

2021 ◽  
Author(s):  
Thewodros Zewde Shay ◽  
Alula Meresa Teklu ◽  
Diriba Bedada Hunde ◽  
Yoseph Tsehaye Sultan
Keyword(s):  
Addis Ababa ◽  
A Priori ◽  
Feedback System ◽  
Urban Slum ◽  
Text Messages ◽  
Health Facilities ◽  
Health Centers ◽  
Phone Calls ◽  
Immunization Services

Abstract BackgroundLosing children to follow-up is one of the major barriers identified in Ethiopia’s immunization program. In many urban slum areas like Lideta sub-city, Addis Ababa, several demand- and supply-side factors affect the follow-up visits for routine immunization services, so this study aimed to explore the influence of linkages, a feedback mechanism, and caregivers' mobility on immunization follow-up visits.MethodsThe study team employed a qualitative method and conducted 30 in-depth interviews with caregivers, 26 interviews with key informants, and five focus group discussions with health officials and decision-makers. A deductive content and thematic analysis was carried out by importing the transcripts into OpenCodes, applying the a priori codes, and identifying new codes and themes.ResultsThe linkages among health facilities included those from hospitals to health centers, from hospitals to hospitals, and from health centers to health centers within and outside of the sub-city. Using these linkages, most vaccinators transfer caregivers without providing multi-dose vial (MDV) vaccines, mainly BCG and MCV, ‘to minimize wastage’ and thus successfully reduce vaccine wastage rates; yet most caregivers wasted their time, energy, and money traveling from one health facility to another. Despite some efforts to transfer caregivers using ‘transferal slips’ and informal phone calls to vaccinators’ friends, unfortunately, there was no formally established system for getting feedback about the arrival of caregivers and continuation of the follow-up visits. Overall, the transfer process lacked uniformity, used various approaches, and was not systematic.ConclusionsTransferal of caregivers for the sake of minimizing wastage of MDV vaccines without checking the vaccination schedules of the receiving health facilities, using various informal types of tools and approaches, along with a poor follow-up and feedback system were major identified challenges, which cost caregivers extra money, energy, and time in getting timely immunization services. Therefore, the Federal Ministry of Health should strengthen the linkages among facilities, ensure the establishment of formal communications by developing guidelines and standardized tools—transferal slips and approaches—and initiate a fast feedback provision system using SMS text messages.

Sign in / Sign up

Export Citation Format

Share Document