Do baseline characteristics and treatments account for geographical disparities in the outcomes of patients with newly diagnosed atrial fibrillation? The prospective GARFIELD-AF registry

ObjectiveIn patients with newly diagnosed atrial fibrillation (AF), do baseline risk factors and stroke prevention strategies account for the geographically diverse outcomes.DesignGlobal Anticoagulant Registry in the FIELD-Atrial Fibrillation is a prospective multinational non-interventional registry of patients with newly diagnosed AF (n=52 018 patients).SettingInvestigator sites (n=1317) were representative of the care settings/locations in each of the 35 participating countries. Treatment decisions were all determined by the local responsible clinicians.ParticipantsThe patients (18 years and over) with newly diagnosed AF had at least 1 investigator-determined stroke risk factor and patients were not required to meet specific thresholds of risk score for anticoagulant treatment.Main outcomes and measuresObserved 1-year event rates and risk-standardised rates were derived.ResultsRates of death, non-haemorrhagic stroke/systemic embolism and major bleeding varied more than three-to-four fold across countries even after adjustment for baseline factors and antithrombotic treatments. Rates of anticoagulation and antithrombotic treatment varied widely. Patients from countries with the highest rates of cardiovascular mortality and stroke were among the least likely to receive oral anticoagulants. Beyond anticoagulant treatment, variations in the treatment of comorbidities and lifestyle factors may have contributed to the variations in outcomes. Countries with the lowest healthcare Access and Quality indices (India, Ukraine, Argentina, Brazil) had the highest risk-standardised mortality.ConclusionThe variability in outcomes across countries for patients with newly diagnosed AF is not accounted for by baseline characteristics and antithrombotic treatments. Residual mortality rates were correlated with Healthcare Access and Quality indices. The findings suggest the management of patients with AF needs to not only address guideline indicated and sustained anticoagulation, but also the treatment of comorbidities and lifestyle factors.Trial registration numberNCT01090362.

Assessing the Challenges and Coping Strategies Adopted by Street Children of School Going Age in the Tamale Metropolis: Policy Implications

Children form the foundation of every society. They are expected to be trained, supported and guided to become responsible to the society. In Ghana, the 1992 constitution (Article 28, clause 1), the children’s Act (Act 560) and the Child Rights Regulations 2002 (LI.1705) are among the measures put in place to promote the wellbeing of children in the country. However, there are significant numbers of children who are living in many city streets in Ghana including the Tamale metropolis. These street children are living the life that has the tendency to affect their physical and mental development. This paper examines the challenges street children in Tamale face and their coping strategies. It also explores various policy options to ensure their continuous education. The study used a case study design to collect both qualitative and quantitative data. Findings of the research show that street children encounter challenges related to accommodation, education, sexual abuse, health, security, and malnourishment and in some cases death. The paper also found that street children adopt variety of strategies including relying on self-medication, hawking and the formation of networks to cope with the various challenges they encounter on the street. However, the education of these children is a big challenge. It is in the light of this, that the paper calls on relevant key stakeholders to put in serious efforts towards tackling the education of street children and child streetism in the Tamale metropolis to ensure access and quality of education of these children.

Use of Information Technology in evaluation of access and quality Primary Health Care in Brazil: qualitative study (Preprint)

BACKGROUND The increased applicability of information technology for evaluating health policies, programs, and care requires advancements in understanding trends, influences, its use by evaluators, and the implications for quality standards of evaluation. OBJECTIVE This study aimed to assess the applicability of information technology in evaluation the Access and quality of primary health care in Brazil considering international quality standards. METHODS We conducted a qualitative case study during the External Evaluation of Brazil’s National Program for Improving Primary Care Access and Quality. Data collection consisted of interviews, focus groups, and document analysis. Seven technicians from the Ministry of Health and 47 researchers from various high education and research institutions across the country participated in the study. Data were categorized using the software Atlas.ti, according to the quality standards of the Joint Committee on Standards for Education Evaluation, followed by Bardin’s content analysis. RESULTS Results related to feasibility, thematic scope, field activity management, standardized data collection, data consistency, and transparency, demonstrate improvements and opportunities for advancements in evaluation mediated by the use of Information Technology, favoring the emergence of new practices and remodeling of existing ones, taking into account the multiple components required by the complex assessment of access and quality in primary health care. Difficulty in operating, inoperative system, and lack of investment in equipment and human resources are challenges to increase the effectiveness of information technology in evaluation. CONCLUSIONS The strategic and intelligent use of information technology offered evaluators a greater opportunity to stakeholder engagement, to insert different organizational, operational, and methodological components, capable of triggering influences and confluences, with connections in collaborative and synergistic networks to increase the quality and allow the development of a more consistent and efficient evaluation with greater possibility of incorporating the results into public health policies.

Data Exploration of Social Determinants of Health, Health Access and Quality in a Global Health Setting

Diseases have no borders, and global health operates from both within and beyond. Global health informatics can adopt an assets-oriented approach to mitigate concerns by maximizing global health data, principles, and resources combined with geographic information systems’ use case mapping. This exploratory study utilizes an assets-oriented approach to analyze four global social determinants of health indicators, including Skilled Birth Attendance, Measles Immunization Coverage, Education (Female), and the Healthcare Access and Quality Index in relation to countries’ income and geographical region. Data were extracted and analyzed from two publicly available datasets. Positive trends and variations were detected among all variables aggregated by countries’ income category and geographical region. These findings pinpoint potential health assets that the discipline of nursing can leverage to build healthier global health communities.

P-B01 First Inventory of Access and Quality of Metabolic Surgery across Europe

Background Europe consists of 51 independent countries. Variation in healthcare regulations results in differing challenges faced by patients and professionals. The obesity pandemic has multiple health, economic and social implications. However, metabolic surgery is not universally accessible, with significant variations in its provision. This study aimed to gain insight into compliance with international guidelines; the accessibility and barriers to surgery; patient pathways and qualitor indicators of both metabolic and body contouring surgery after weight loss in different European countries. Methods This study was initiated during the European Obesity Academy (EOA). Expert representatives in the metabolic field from all 51 European countries were sent a novel, 37-item, electronic self-administered online questionnaire on their data and experiences from the previous year exploring accessibility to and quality indicators for metabolic surgery and body contouring surgery after weight loss. The survey tool was peer-reviewed by experienced researchers and piloted by fifteen experienced researchers with a spread of seniority and specialty. Content and face validity were ensured by peer-review and the piloting process. 45 completed responses were collected. Results 68% of countries had eligibility criteria for metabolic surgery; 59% adhered to these. 46% had reimbursement criteria for metabolic surgery. 41% had eligibility criteria for plastic surgery and 31% reimbursement criteria. Average tariffs for a metabolic procedure varied (€800-€ 16000). MDTs were mandated in 78%, with team members varying significantly. Referral practises differed. In 45% metabolic surgery is performed by pure metabolic surgeons. 23% had a metabolic training program. Access to metabolic surgery was rated poor/ very poor in 33%. 35% had a bariatric registry. 24% required a minimum procedure number for metabolic centres; varying from 25 to 200 procedures. Conclusions This is the first study to describe accessibility and quality data on metabolic and body contouring surgery from most European countries. There are myriad differences between European countries in terms of accessibility to metabolic surgery. Lack of funding, education and structure fuels this disparity. We hope this study will impact standardisation of access and quality indicators for metabolic and body contouring surgery across European countries, as well as be a springboard for further evaluation of international metabolic surgery practices.

Assisted Living Administrators' Views of Palliative Care

As many older adults with progressive chronic conditions choose to age-in-place in assisted living (AL) communities, external healthcare workers (e.g., those who provide palliative care) increasingly support AL staff in caring for residents with complex health needs. Palliative care is a branch of healthcare dedicated to preserving quality of life by attending to the physical, mental, and spiritual needs of individuals with chronic, life-threatening diseases and is well suited to manage AL residents’ progressive medical conditions. However, AL residents and their care partners often face barriers to accessing palliative care. Using data from a larger 5-year NIA-funded study, we examined AL administrator knowledge and use of palliative care in seven AL communities around the Atlanta metropolitan area that were racially, ethnically, and socioeconomically diverse. Findings from thematic analysis of semi-structured interviews with 16 administrators indicated that 15 of 16 administrators were familiar with palliative care. A minority of administrators clearly distinguished palliative care from hospice services and conceptualized it as a “bridge” to hospice services. Administrators emphasized how palliative care assists communities in caring for health concerns in-house rather than having to send residents to the hospital. Despite their positive view of palliative care, administrators described infrequent use of palliative services in their communities. Findings show that although none of the AL communities integrate palliative care with their service offerings, AL administrators see value in palliative care for their residents. We provide recommendations for improving palliative care access and quality of life for AL residents at end of life.