Showing papers on "Health management system published in 2020"

Health Observation App for COVID-19 Symptom Tracking Integrated With Personal Health Records: Proof of Concept and Practical Use Study.

Abstract: Background: As a counter-cluster measure to prevent the spread of the infectious novel coronavirus disease (COVID-19), an efficient system for health observation outside the hospital is urgently required Personal health records (PHRs) are suitable for the daily management of physical conditions Importantly, there are no major differences between the items collected by daily health observation via PHR and the observation of items related to COVID-19 Until now, observations related to COVID-19 have been performed exclusively based on disease-specific items Therefore, we hypothesize that PHRs would be suitable as a symptom-tracking tool for COVID-19 To this end, we integrated health observation items specific to COVID-19 with an existing PHR-based app Objective: This study is conducted as a proof-of-concept study in a real-world setting to develop a PHR-based COVID-19 symptom-tracking app and to demonstrate the practical use of health observations for COVID-19 using a smartphone or tablet app integrated with PHRs Methods: We applied the PHR-based health observation app within an active epidemiological investigation conducted by Wakayama City Public Health Center At the public health center, a list is made of individuals who have been in close contact with known infected cases (health observers) Email addresses are used by the app when a health observer sends data to the public health center Each health observer downloads the app and installs it on their smartphone Self-observed health data are entered daily into the app These data are then sent via the app by email at a designated time Localized epidemiological officers can visualize the collected data using a spreadsheet macro and, thus, monitor the health condition of all health observers Results: We used the app as part of an active epidemiological investigation executed at a public health center During the investigation, 72 close contacts were discovered Among them, 57 had adopted the use of the health observation app Before the introduction of the app, all health observers would have been interviewed by telephone, a slow process that took four epidemiological officers more than 2 hours After the introduction of the app, a single epidemiological officer can carry out health observations The app was distributed for free beginning in early March, and by mid-May, it had been used by more than 20,280 users and 400 facilities and organizations across Japan Currently, health observation of COVID-19 is socially recognized and has become one of the requirements for resuming social activities Conclusions: Health observation by PHRs for the purpose of improving health management can also be effectively applied as a measure against large-scale infectious diseases Individual habits of improving awareness of personal health and the use of PHRs for daily health management are powerful armaments against the rapid spread of infectious diseases Ultimately, similar actions may help to prevent the spread of COVID-19

Measuring Italian citizens' engagement in the first wave of the COVID-19 pandemic containment measures: A cross-sectional study.

Abstract: Background In January 2020, the coronavirus disease 2019 (COVID-19) started to spread in Italy. The Italian government adopted urgent measures to slow its spread. Enforcing compliance with such measures is crucial in order to enhance their effectiveness. Engaging citizens in the COVID-19 preventive process is urgent today both in Italy and around the world. However, to the best of our knowledge, no previous studies have investigated the role of health engagement in predicting citizens’ compliance with health emergency containment measures. Method An online survey was administered between February 28 and March 4, 2020 on a representative sample of 1000 Italians. The questionnaire included a measure of health engagement (Patient Health Engagement Scale), a 5-item Likert scale ranging from 1 to 7, resulting in 4 positions that describe the psychological readiness to be active in one’s own health management, and a series of ad hoc items intended to measure citizens’ perceived susceptibility and severity of the disease, orientation towards health management, trust in institutional bodies, health habits and food consumption. To investigate the relationship between health engagement and these variables, ANOVA analysis, logistic regression and contingency tables with Pearson’s chi-squared analysis have been carried out. Results Less engaged people show higher levels of perceived susceptibility to the virus and severity of the disease; they are less trustful of scientific and healthcare authorities, they feel less self-effective in managing their own health—both in normal conditions and under stress—and are less prone to cooperate with healthcare professionals. Low levels of health engagement also are associated with a change in the usual purchase behavior. Conclusions The Patient Health Engagement model (PHE) provides a useful framework for understanding how people will respond to health threats such as pandemics. Therefore, intervention studies should focus on raising their levels of engagement to increase the effectiveness of educational initiatives intended to promote preventive behaviors.

A privacy protection method for health care big data management based on risk access control

Abstract: With the rapid development of modern information technology, the health care industry is entering a critical stage of intelligence. Faced with the growing health care big data, information security issues are becoming more and more prominent in the management of smart health care, especially the problem of patient privacy leakage is the most serious. Therefore, strengthening the information management of intelligent health care in the era of big data is an important part of the long-term sustainable development of hospitals. This paper first identified the key indicators affecting the privacy disclosure of big data in health management, and then established the risk access control model based on the fuzzy theory, which was used for the management of big data in intelligent medical treatment, and solves the problem of inaccurate experimental results due to the lack of real data when dealing with actual problems. Finally, the model is compared with the results calculated by the fuzzy tool set in Matlab. The results verify that the model is effective in assessing the current safety risks and predicting the range of different risk factors, and the prediction accuracy can reach more than 90%.

Reorganizing and integrating public health, health care, social care and wider public services: a theory-based framework for collaborative adaptive health networks to achieve the triple aim:

Abstract: ObjectivePopulation health management (PHM) refers to large-scale transformation efforts by collaborative adaptive health networks that reorganize and integrate services across public health, healt...

Perspectives of Patients, Health Care Professionals, and Developers Toward Blockchain-Based Health Information Exchange: Qualitative Study

Abstract: Background: Although the electronic health record system adoption rate has reached 96% in the United States, implementation and usage of health information exchange (HIE) is still lagging behind. Blockchain has come into the spotlight as a technology to solve this problem. However, there have been no studies assessing the perspectives of different stakeholders regarding blockchain-based patient-centered HIE. Objective: The objective of this study was to analyze the awareness among patients, health care professionals, and information technology developers toward blockchain-based HIE, and compare their different perspectives related to the platform using a qualitative research methodology. Methods: In this qualitative study, we applied grounded theory and the Promoting Action on Research Implementation in the Health Service (PARiHS) framework. We interviewed 7 patients, 7 physicians, and 7 developers, for a total of 21 interviewees. Results: Regarding the leakage of health information, the patient group did not have concerns in contrast to the physician and developer groups. Physicians were particularly concerned about the fact that errors in the data cannot be easily fixed due to the nature of blockchain technology. Patients were not against the idea of providing information for clinical trials or research institutions. They wished to be provided with the results of clinical research rather than being compensated for providing data. The developers emphasized that blockchain must be technically mature before it can be applied to the health care scene, and standards of medical information to be exchanged must first be established. Conclusions: The three groups’ perceptions of blockchain were generally positive about the idea of patients having the control of sharing their own health information. However, they were skeptical about the cooperation among various institutions and implementation for data standardization in the establishment process, in addition to how the service will be employed in practice. Taking these factors into consideration during planning, development, and operation of a platform will contribute to establishing practical treatment plans and tracking in a more convenient manner for both patients and physicians. Furthermore, it will help expand the related research and health management industry based on blockchain.

Post-Acute COVID-19 Rehabilitation Network Proposal: From Intensive to Extensive and Home-Based IT Supported Services.

Abstract: Management of COVID-19 post-acute syndrome is an emerging health issue in rehabilitation. This article aims to present a proposal, based on the principles of clinical governance, health management and information technology (IT), and to respond to the need for a structured organization model for post-acute COVID-19 rehabilitation. The authors present a regional-based model of a network of clinicians and healthcare managers using a dedicated IT platform to achieve both effectiveness and efficiency objectives, to ensure coordination of the available resources and the most appropriate rehabilitative treatment for patients. The proposed post-acute COVID-19 rehabilitation network has been designed according to the model of a clinical management project within the Italian national healthcare system, and its context is an easily adjustable model for the European healthcare systems. The authors base the project on current laws and scientific guidelines in rehabilitation in Italy and in Europe and use the SWOT analysis technique to assess the proposal feasibility. The primary aims of the project are: (1) standardizing the minimum assessment tools of post-COVID-19 patients with disabilities; (2) ensuring an individual rehabilitation project for each patient with international classification of functioning, disability and health (ICF) coding and (3) reporting the activity performance with appropriate indicators. The secondary aims are: (1) developing educational programs for patients and care givers also aimed at acquiring better empowerment and positive behavior; (2) creating a regional database for data collection and (3) improving IT, and specifically tele-rehabilitation, as a suitable approach during the COVID-19 emergency and also in the future. Expected results are: continuum of care; effectiveness, efficacy and appropriateness in the delivery of rehabilitation treatments through a standardized minimum assessment and the wording of the individual rehabilitation project and a precise reporting of performance indicators to measure the effectiveness of clinical activities and the satisfaction of patients and caregivers. The assessment of results will be analyzed at three and six months to implement corrective actions according to the concept of continuous improvement of the Deming cycle. The IT remote approach allows the patient to meet the needs of proximity of care and empowerment, and, at the same time, to contain the spread of infection. This project could have a significant healthcare impact ensuring a more efficient and effective management of the demand of rehabilitation post-acute COVID-19, expanding the professional skills of the rehabilitation team members, improving both clinical and process data, in addition to optimal allocation of available economic resources.

Development, implementation and evaluation of a management specialization course in oncology using blended learning.

Abstract: Identifying effective methods for safeguarding the efficient functioning of the healthcare system contributes significantly towards establishing a successful healthcare organization. Consequently, quality management programs are currently being implemented in healthcare as a vital strategy for patient care. Quality management encompasses protocols and guidelines in decision-making and in the evaluation of processes and treatment flowcharts, data analysis and health indicators, and addresses improvement in the interaction between different health professionals. Qualifying health professionals to perform quality management has represented a barrier to implementing a well-structured management system. Indeed, the pathway to qualifying health managers is often poorly outlined, with clear gaps in the definition of their competencies, training and career plans. Therefore, studies and education-related actions aimed at qualifying health professionals in management are vital if health services of excellence are to be established. The present study aimed to plan, develop, implement and evaluate a management specialization course in oncology using blended learning. Following approval by the institution’s internal review board, the study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). The Analysis, Design, Development, Implementation and Evaluation (ADDIE) model was used to plan, develop, implement and evaluate the course. Data were collected as the course participants who had concluded all the modules evaluated the program. A management course in oncology, consisting of ten sequential modules, was developed and implemented between March 2018 and February 2019. The course consisted of monthly face-to-face encounters, each with 12 h of activities, and distance education using a virtual learning environment. Each module was presented by a specialist on the subject in question. After the end-of-course conclusion work had already been handed in and evaluated by the tutors, the participants completed a form to assess the course using Kirkpatrick’s training evaluation model. A management course in oncology was developed using the ADDIE model. A high degree of satisfaction was found among the participants regarding improvements in their management skills and their professional behavior. The expectation is that this initiative will ultimately improve healthcare and reduce costs, as well as encourage further innovative educational actions for health professionals.

Ensure Healthy Lives and Promote Well-Being for All at All Ages

Abstract: The development and operation of mining projects is associated both with health opportunities and with health risks for the workforce, as well as project-affected communities. Thus, mining has strong links to SDG 3, “Ensure healthy lives and promote well-being for all at all ages”, which is closely interlinked with all the other SDGs, representing determinants of health. Disease prevention and promotion of good health and wellbeing can only be achieved if a diverse group of stakeholders are partnering together. Consequently, companies need to adopt comprehensive health management systems that clarify the role and responsibilities of the different stakeholders. Internally, mining operations need to be committed to work across departments for improving long-term health outcomes, and not just focus on preventing adverse incidents.

Factors That Influence Data Use to Improve Health Service Delivery in Low- and Middle-Income Countries

Abstract: Background Health service delivery indicators are designed to reveal how well health services meet a community's needs. Effective use of the data can enable targeted improvements in health service delivery. We conducted a systematic review to identify the factors that influence the use of health service delivery indicators to improve delivery of primary health care services in low- and middle-income settings. Methods We reviewed empirical studies published in 2005 or later that provided evidence on the use of health service delivery data at the primary care level in low- and middle-income countries. We searched Scopus, Medline, the Cochrane Library, and citations of included studies. We also searched the gray literature, using a separate strategy. We extracted information on study design, setting, study population, study objective, key findings, and any identified lessons learned. Results Twelve studies met the inclusion criteria. This small number of studies suggests there is insufficient evidence to draw reliable conclusions. However, a content analysis identified the following potentially influential factors, which we classified into 3 categories: governance (leadership, participatory monitoring, regular review of data); production of information (presentation of findings, data quality, qualitative data); and health information system resources (electronic health management information systems, organizational structure, training). Contextual factors and performance-based financing were also each found to have a role; however, discussing these as mediating factors may not be practical in terms of promoting data use. Conclusion Scant evidence exists regarding factors that influence the use of health service delivery indicators to improve delivery of primary health care services in low- and middle-income countries. However, the existing evidence highlights some factors that may have a role in improving data use. Further research may benefit from comparing data use factors across different types of program indicators or using our classification as a framework for field experiments.

Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana.

Abstract: INTRODUCTION District health managers play a pivotal role in the delivery of basic health services in many countries, including Ghana, as they are responsible for converting inputs and resources such as, staff, supplies and equipment into effective services that are responsive to population needs. Weak management capacity among local health managers has been suggested as a major obstacle for responsive health service delivery. However, evidence on district health managers' competencies and its association with health system performance is scarce. AIM To examine managerial capacity among district health managers and its association with health system performance in six districts in the Eastern Region of Ghana. METHODS Fifty-nine district health managers' in six different performing districts in the Eastern Region of Ghana completed a self-administered questionnaire measuring their management competencies and skills. In addition, the participants provided information on their socio-demographic background; previous management experience and training; the extent of available management support systems, and the dynamics within their district health management teams. A non-parametric one-way analysis was applied to test the association between management capacity and district performance, which was measured by 17 health indicators. RESULTS Shortcomings within different aspects of district management were identified, however there were no significant differences observed in the availability of support systems, characteristics and qualifications of district health managers across the different performing districts. Overall management capacity among district health managers were significantly higher in high performing districts compared with lower performing districts (p = 0.02). Furthermore, district health managers in better performing districts reported a higher extent of teamwork (p = 0.02), communication within their teams (p<0.01) and organizational commitment (p<0.01) compared with lower performing districts. CONCLUSION The findings demonstrate individual and institutional capacity needs, and highlights the importance of developing management competencies and skills as well as positive team dynamics among health managers at district level.

Measuring Italian Citizens’ Engagement in the First Wave of the COVID-19 Pandemic Containment Measures: A Cross-sectional Study

Abstract: Background In January 2020, the coronavirus disease 2019 (COVID-19) started to spread in Italy. The Italian government adopted urgent measures to hold its spread. Enforcing compliance to such measures is crucial in order to enhance their effectiveness. Engaging citizens in the COVID-19 preventive process is today urgent in Italy and around the world. However, to the best of our knowledge, no previous studies have investigated the role of health engagement in predicting citizens’ compliance to health emergency containment measures. Method An online survey was administered between February 28th and March 4th 2020 on a representative sample of 1000 Italians. The questionnaire included a measure of Health Engagement (PHE-S) and a series of ad hoc items intended to measure both affective and behavioral responses of the citizens to the emergency in terms of perceived susceptibility to and severity of the disease, orientation towards health management, change in habits and in purchases. To investigate the relationship between Health Engagement and these variables, a series of ANOVAs, Logistic regressions and crosstabs have been carried out. Results Less engaged people show higher levels of perceived susceptibility to the virus and of severity of the disease; they trust less scientific and healthcare authorities, they feel less self-effective in managing their own health - both in normal conditions and under stress - and are less prone to cooperate with healthcare professionals. Low levels of Health Engagement are also associated with a change in the usual purchase behavior. Conclusions The Patient Health Engagement Model (PHE) provides a useful framework for understanding how people will respond to health threats such as pandemics. Therefore, intervention studies should focus on particular groups and on raising their levels of engagement to increase the effectiveness of educational initiatives devoted to promote preventive behaviors.

The social return on investment of a new approach to heart failure in the Spanish National Health System.

Abstract: Aims We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. Methods and results A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast-type SROI method, with a 1-year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well-being, improve pharmacological adherence and self-care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well-being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to €548m and yield a social return of €1932m, that is, €3.52 for each euro invested. Conclusions The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF.

Challenges and prospects for implementation of community health volunteers' digital health solutions in Kenya: a qualitative study.

Abstract: The value of digital health technologies in delivering vital health care interventions, especially in low resource settings is increasingly appreciated. We co-developed and tested a decision support mobile health (m-Health) application (app);with some of the forms used by Community Health Volunteers (CHVs) in Kenya to collect data and connected to health facilities. This paper explores the experiences of CHVs, health workers and members of Sub-County Health Management Teams following implementation of the project. Data were collected in December 2017 through in-depth interviews and focus group discussions with CHVs and key informant interviews with health care workers and health managers in Kamukunji sub-County of Nairobi, Kenya. Data coding and analysis was performed in NVivo 12. Regarding users and health managers’ perceptions towards the system; three main themes were identified: 1) variations in use, 2) barriers to use and 3) recommendations to improve use. Health workers at the private facility and some CHVs used the system more than health workers at the public facilities. Four sub-themes under barriers to use were socio-political environment, attitudes and behaviour, issues related to the system and poor infrastructure. A prolonged health workers’ strike, the contentious presidential election in the year of implementation, interrupted electricity supply and lack of basic electric fixtures were major barriers to use. Suggestions to improve usage were: 1) integration of the system with others in use and making it available on users’ regular phones, and 2) explore sustainable motivation models to users as well as performance based remuneration. The findings reveal the importance of considering the readiness of information and communication technologies (ICT) users before rollout of ICT solutions. The political and sociocultural environment in which the innovation is to be implemented and integration of new solutions into existing ones is critical for success. As more healthcare delivery models are developed, harnessing the potential of digital technologies, strengthening health systems is critical as this provides the backbone on which such innovations draw support.

Measuring what matters - information systems for management of chronic disease in primary healthcare settings in low and middle-income countries: challenges and opportunities.

Abstract: Effective health information systems are essential to the delivery of high-quality community-based care for chronic disease which will be needed to address the changing healthcare needs of populations in low and middle-income country settings. Health management information systems (health service data collected at facility level) and electronic health records (data organised by individual patients) may support the measurement-based, collaborative approach that is central to the chronic care model, which has been adopted as the basis for task-shared models of care for mental health and non-communicable disease. We used the performance of routine information systems management to guide our commentary on the evidence-base about information systems to support chronic care. We found that, despite an appetite for using the information to support decision-making around service planning, this rarely happens in practice, reasons include that data is not perceived to be of good quality or fit for purpose. There is often a mismatch between technology design and the availability of specialised knowledge and infrastructure. However, when data collection is designed in collaboration with local stakeholders, there is some evidence of success, demonstrated by completion and accuracy of data forms. Whilst there are global targets for the development of health information systems and progress on these is undoubtedly being made, indicators for chronic disease are seldom prioritised by national governments and there is insufficient decentralisation to facilitate local data-driven decision-making. Our recommendations for future research and development, therefore, focus upon the need to integrate context into the design of information systems: through building strong multisectoral partnerships, ensuring newly developed indicators are well aligned to service models and using technology that is a good fit with local infrastructure. This approach will be necessary if information systems are to deliver on their potential to drive improvements in care for chronic disease.

A Personalized Health Monitoring System for Community-Dwelling Elderly People in Hong Kong: Design, Implementation, and Evaluation Study.

Abstract: Background: Telehealth is an effective means to assist existing health care systems, particularly for the current aging society. However, most extant telehealth systems employ individual data sources by offline data processing, which may not recognize health deterioration in a timely way. Objective: Our study objective was two-fold: to design and implement an integrated, personalized telehealth system on a community-based level; and to evaluate the system from the perspective of user acceptance. Methods: The system was designed to capture and record older adults’ health-related information (eg, daily activities, continuous vital signs, and gait behaviors) through multiple measuring tools. State-of-the-art data mining techniques can be integrated to detect statistically significant changes in daily records, based on which a decision support system could emit warnings to older adults, their family members, and their caregivers for appropriate interventions to prevent further health deterioration. A total of 45 older adults recruited from 3 elderly care centers in Hong Kong were instructed to use the system for 3 months. Exploratory data analysis was conducted to summarize the collected datasets. For system evaluation, we used a customized acceptance questionnaire to examine users’ attitudes, self-efficacy, perceived usefulness, perceived ease of use, and behavioral intention on the system. Results: A total of 179 follow-up sessions were conducted in the 3 elderly care centers. The results of exploratory data analysis showed some significant differences in the participants’ daily records and vital signs (eg, steps, body temperature, and systolic blood pressure) among the 3 centers. The participants perceived that using the system is a good idea (ie, attitude: mean 5.67, SD 1.06), comfortable (ie, self-efficacy: mean 4.92, SD 1.11), useful to improve their health (ie, perceived usefulness: mean 4.99, SD 0.91), and easy to use (ie, perceived ease of use: mean 4.99, SD 1.00). In general, the participants showed a positive intention to use the first version of our personalized telehealth system in their future health management (ie, behavioral intention: mean 4.45, SD 1.78). Conclusions: The proposed health monitoring system provides an example design for monitoring older adults’ health status based on multiple data sources, which can help develop reliable and accurate predictive analytics. The results can serve as a guideline for researchers and stakeholders (eg, policymakers, elderly care centers, and health care providers) who provide care for older adults through such a telehealth system.

'Building on shaky ground'-challenges to and solutions for primary care guideline implementation in four provinces in South Africa: a qualitative study.

Abstract: Objectives Clinical guidelines support evidence-informed quality patient care. Our study explored perspectives of South African subnational health managers regarding barriers to and enablers for implementation for all available primary care guidelines. Design We used qualitative research methods, including semistructured, individual interviews and an interpretative perspective. Thematic content analysis was used to develop data categories and themes. Setting We conducted research in four of nine South African provinces with diverse geographic, economic and health system arrangements (Eastern Cape, Western Cape, KwaZulu-Natal, Limpopo). South Africa is a middle-income country with high levels of inequality. The settings represented public sector rural and peri-urban health facilities. Participants Twenty-two participants with provincial and district health management roles, that comprised implementation and/or training on primary care guidelines, were included. Results Participants recommended urgent consideration of health system challenges, particularly financial constraints, impacting on access to the guidelines themselves and to medical equipment and supplies necessary to adhere to guidelines. They suggested that overcoming service delivery gaps requires strengthening of leadership, clarification of roles and enhanced accountability. Participants suggested that inadequate numbers of skilled clinical staff hampered guideline use and, ultimately, patient care. Quality assurance of training programmes for clinicians—particularly nurses—interdisciplinary training, and strengthening post-training mentorship were recommended. Furthermore, fit-for-purpose guideline implementation necessitates considering the unique settings of facilities, including local culture and geography. This requires guideline development to include guideline end users. Conclusions Guidelines are one of the policy tools to achieve evidence-informed, cost-effective and universal healthcare. But, if not effectively implemented, they have no impact. Subnational health managers in poorly resourced settings suggested that shortcomings in the health system, along with poor consultation with end users, affect implementation. Short-term improvements are possible through increasing access to and training on guidelines. However, health system strengthening and recognition of socio-cultural–geographic diversity are prerequisites for context-appropriate evidence-informed practice.

Health management committee strengthening and community mobilisation through women’s groups to improve trained health worker attendance at birth in rural Nepal: a cluster randomised controlled trial

Abstract: Engaging citizens and communities to make services accountable is vital to achieving health development goals. Community participation in health management committees can increase public accountability of health services. We conducted a cluster randomised controlled trial to test the impact of strengthened health management committees (HMCs) and community mobilisation through women’s groups on institutional deliveries and deliveries by trained health workers in rural Nepal. The study was conducted in all Village Development Committee clusters in the hills district of Makwanpur (population of 420,500). In 21 intervention clusters, we conducted three-day workshops with HMCs to improve their capacity for planning and action and supported female community health volunteers to run women’s groups. These groups met once a month and mobilised communities to address barriers to institutional delivery through participatory learning and action cycles. We compared this intervention with 22 control clusters. Prospective surveillance from October 2010 to the end of September 2012 captured complete data on 13,721 deliveries in intervention and control areas. Analysis was by intention to treat. The women’s group intervention was implemented as intended, but we were unable to support HMCs as planned because many did not meet regularly. The activities of community based organisations were systematically targeted at control clusters, which meant that there were no true ‘control’ clusters. 39% (5403) of deliveries were in health institutions and trained health workers attended most of them. There were no differences between trial arms in institutional delivery uptake (1.45, 0.76–2.78) or attendance by trained health workers (OR 1.43, 95% CI 0.74–2.74). The absence of a true counterfactual and inadequate coverage of the HMC strengthening intervention impedes our ability to draw conclusions. Further research is needed to test the effectiveness of strengthening public accountability mechanisms on increased utilisation of services at delivery. Current Controlled Trials ISRCTN99834806. Date of registration:28/09/10.

Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis.

Abstract: Background: Rising criticism about the risks associated with the use of mobile health apps necessitates a critical perspective to assess the use of these apps. A cost-benefit approach involving several moderating factors can be used to detect technology effects and individual-level push and pull factors related to health attitudes, lifestyle, and health management behaviors. Objective: We introduce a cost-benefit perspective to examine how health attitudes related to mobile health apps and health situational factors (health crises, health changes, and hospitalization) affect the likelihood of adopting lifestyle and health management behaviors among app users. Methods: The analysis is based on individuals’ reported use of mobile health apps. The sample included 1495 US adults aged over 18 years who were contacted by landline or cellphone. A total of 50.96% (762/1495) of the participants were women. A set of logistic regression models was used to predict lifestyle and health management behaviors among users considering variations in the extent of use, health attitudes, health situation, and socioeconomic characteristics. Results: The findings indicate that the proposed models were reasonably adequate. In all, 88.76% (1327/1495) of the cases were correctly classified regarding lifestyle behaviors, but only 71.97% (1076/1495) of the cases were correctly classified regarding health management behaviors. Although a large percentage of individuals changed their attitudes following the use of mobile health apps, only a small proportion adopted health management behaviors. The use of mobile health apps affected up to 67.95% (1016/1495) of the users for consultation and 71.97% (1076/1495) of the users for decision making. The model was effective for 88.76% (1327/1495) of the cases regarding lifestyle behaviors but only 71.97% (1076/1495) regarding health management behaviors. The moderating effect of regular use of mobile health apps significantly affects lifestyle (Wald=61.795; B=2.099; P<.005) but not health management behaviors (Wald=12.532; B=0.513; P=.01). These results collectively indicate that the use of mobile health apps for health management is partially effective. Conclusions: The use of mobile health apps is a main route to instigate the process of health empowerment and shape health attitudes. However, an accurate assessment of the effectiveness of mobile health apps necessitates distinguishing between lifestyle and health management behaviors and adopting a cost-benefit approach because individuals facing health concerns, such as a chronic disease, health emergency, health crisis, or health change, consider their affordances and situational effects. These moderators generate a push and pull framework in the decision-making process that balances the costs and benefits of use.

The physician and professionalism today: challenges to and strategies for ethical professional medical practice.

Abstract: Medicine in the twenty-first century Imagine that physicians could multiply their impact on people’s health and improve community health whilst tailoring the delivery of care to each individual patient. The ambit of the present supplement is to say how, with a public health insight into medical practice and physicians’ professionalism. But clouds obscure the future of the medical profession. Artificial intelligence (AI) threatens to make it obsolete. The commoditisation of care undermines ethics. Bureaucracy is infiltrating practice. Worldwide, cultures are turning materialistic. However, some physicians are resisting these trends. In spite of being well paid, the suicide rate of physicians in the United States is the highest of all occupations, almost twice the national average, and higher than in the military [1]. Taking decisions against one’s intimate convictions partly explains that [2]. To help doctors surmount this existential crisis and resist harsh intangible work conditions, this collection of articles gives them reasons to believe in the survival of medicine as a profession. To do so, the series elaborates on the changes needed in medical culture to keep medical practice as a sacred art, concentrating on what AI does not do or does not do well, especially ethical thinking. With such cultural changes, physicians would impose on AI design the function to support professional endeavour and undermine the opposite process that transforms professionals in technicians. To remain in control, the doctor’s intelligence, emotions, knowledge, communication, ethics, and creativity will have to surpass those of AI, not only in delivering biopsychosocial, ethical care but also in another, insufficiently explored domain that is, in improving collective health with clinical medicine. Since taxes finance doctors, societies are entitled to demand them to optimise their impact on collective health whilst tailoring healthcare to the patient’s individual needs as much as possible. To meet the practicalities of such a paradoxical norm, the series advocates and delineates the practical and theoretical integration of clinical and public health practice to meet the challenges that medicine faces to survive as a profession, be they financial, political, managerial, or socio-cultural. In practice, clinicians need to think and act whilst bearing in mind community health stakes a duty, the importance of which has been clearly demonstrated by the Covid-19 crisis. Conversely, public health physicians must improve clinical healthcare whilst tackling population health risks. Updating the physician’s commitment and medical theory is necessary because dual clinical/public health medical practice is a scientific requirement to optimise the physician’s impacts on individual and collective health. We adopted the following definitions in collective health.

Health Risk Assessment Indicators for the Left-Behind Elderly in Rural China: A Delphi Study

Abstract: In China, many young and middle-aged rural residents move to urban areas each year. The rural elderly are left behind. The number of the rural left-behind elderly is increasing with urbanization, but it is unclear which indicators can be used to assess their health condition. The health risk assessment index system was developed to improve the health level of the rural left-behind elderly. A two-round web-based Delphi process was used to organize the recommendations from fifteen Chinese experts in geriatrics, health management, social psychology who participated in this study. Meaningfulness, importance, modifiability, and comprehensive value of the health risk assessment indicators in the index system were evaluated. The effective recovery rates of the two-round Delphi were 86.67% and 92.31%, respectively. The judgement coefficient and the authority coefficient were 0.87 and 0.82, respectively. The expert familiarity was 0.76. Ultimately, the health risk assessment index system for the rural left-behind elderly consisted of five first-level indicators, thirteen second-level indicators, and sixty-six third-level indicators. The final indicators can be used to evaluate the health of the rural left-behind elderly and provide the basis for additional health risk interventions.

Mobile Applications for Health Management in Indonesia

Abstract: Health is the most important thing in life, if someone is stricken with a disease then that person cannot perform activities optimally. Likewise, with employees in the company many losses will be experienced because it cannot work optimally. Then in an age that is as sophisticated as it is today, the submission of medical check-up results is still using the conventional method, which is printed on sheets of paper. The risk of these results can be lost or damaged becomes even greater, given the data is very important. Health Management is a website-based application that was formed with the aim to assist companies in managing the health of their employees and assist in ordering employee's annual medical check-up. The results of this study are Health Mobile application has been running smoothly, this can be seen from the results of the black box testing done. Health applications can provide healthy lifestyle advice and record health activities that have been carried out. Health applications can help users save health data and simplify the process reimbursement of health funds. Display health applications are comfortable to see and easily understood by users.

District-Level Health Management and Health System Performance: The Ethiopia Primary Healthcare Transformation Initiative.

Abstract: Background Despite a wide range of interventions to improve district health management capacity in low-income settings, evidence of the impact of these investments on system-wide management capacity and primary healthcare systems performance is limited. To address this gap, we conducted a longitudinal study of the 36 rural districts (woredas), including 229 health centers, participating in the Primary Healthcare Transformation Initiative (PTI) in Ethiopia. Methods Between 2015 and 2017, we collected quantitative measures of management capacity at the district and health center levels and a primary healthcare key performance indicator (KPI) summary score based on antenatal care (ANC) coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We conducted repeated measures analysis of variance (ANOVA) to assess (1) changes in management capacities at the district health office level and health center level, (2) changes in health systems performance, and (3) the differential effects of more vs less intensive intervention models. Results Adherence to management standards at both district and health center levels improved during the intervention, and the most prominent improvement was achieved during district managers’ exposure to intensive mentorship and education. We did not observe similar patterns of change in KPI summary score. Conclusion The district health office is a valuable entry point for primary healthcare reform, and district- and facility-level management capacity can be measured and improved in a relatively short period of time. A combination of intensive mentorship and structured team-based education can serve as boh an accelerator for change and a mechanism to inform broader reform efforts.

A postgraduate course for the decision taking in the Public Health context.

Abstract: Background. The health education manager must be agreeing with the fact that the education and the health are untouchable economic goods supporting the labor productivity. The professional growing across different courses forms contribute to raise the human develop quality and increase the labor productivity too. All health education managers must understand how take decisions based in the economic knowledge. Objective. Design a postgraduate course for the decision taking in the Public Health context. Materials and methods. As theorical methods were utilized the inductive – deductive, analysis and synthesis and the comparative. As empiric method was utilized the bibliographic research. Conclusion. Was made a single course focused in health manager for the taking decision process. This course takes account the constant needs from health managers respect to the postgraduate education and the possible application from the Health Economy in the health management process.

Mental health education in Australian paramedic curricula – A scoping review

Abstract: IntroductionMental health represents a growing concern for health services in Australia. Paramedics are increasingly becoming the first point-of-contact for patients experiencing an acute mental health episode. Despite this increasing prevalence of cases there is an established body of literature outlining that paramedics feel inadequately trained to manage these patients. AimThis research aimed to identify how the management of acutely unwell mental health patients is included in paramedic curricula in Australia. MethodsA scoping review methodology was used in association with a thematic analysis of university learning outcomes related to mental health education for Bachelor of Paramedic programs in Australia. It was identified that there are considerable discrepancies between university learning outcomes for mental health education of paramedics. DiscussionMental health management of patients is not integrated throughout curricula, with most students only being exposed to mental health education once in their degree usually as a theoretical subject with no specific mental health practice placement. Further, the existence of discrepancies regarding mental health management education between paramedic courses creates an unequal minimum standard of education among graduating paramedic students. ConclusionGiven the prevalence of mental health cases and the special powers that paramedics have to manage these cases, as well as the fact that mental health does not discriminate between jurisdictions (ie. patients present and should be managed similarly in all states and territories), the authors argue that special consideration by the profession should be given to mandating a consistency in mental health management education across all paramedic Bachelor degree programs.

Service-learning in response to the coronavirus disease 2019 pandemic: Emerging lessons from the Department of Family Medicine and Public Health at the University of Botswana.

Abstract: The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted many lives worldwide. Training programmes in academic institutions have also been affected by the pandemic. Teaching and learning family medicine and public health medicine in the COVID-19 era require adjustments to training activities. At the University of Botswana, the pandemic presented an opportunity to steer training programmes in the Department of Family Medicine and Public Health Medicine more towards service-learning. The department collaborated with the Ministry of Health and Wellness as well as the District Health Management teams in the national response to the pandemic as essential service providers. The increased demands for service provision were balanced with educational opportunities for trainees during the COVID-19 public health emergency. Including structured ongoing reflections for trainees involved in the COVID-19 response helps to connect service and the academic curriculum.

Health and Economics of Lifestyle Medicine Strategies.

Abstract: The cost of medical care in the United States is increasing at an unsustainable rate. The lifestyle medicine (LM) approach is essential to influence the root causes of the growing chronic disease burden. LM addresses health risk factors in primary, secondary, and tertiary prevention of developing disease rather than limiting resources and medical expenditures on acute care and reacting to illness, injury, and disease. Employers have much to gain financially from such an approach due to their status as the payer of health care costs for their employees, and as the recipient of productivity gains among their employees. This article discusses LM programs delivered at the worksite, including important findings from the University of Michigan Health Management Research Center. Examples of evidenced-based population LM interventions are summarized for physical activity, weight management, and nutrition programs that address chronic diseases such as cardiovascular disease, cancer, and diabetes mellitus. These approaches have the potential to reduce health care cost trends, increase employee performance/productivity, and improve patient health outcomes.

Development of an IoT-Based Health Promotion System for Seniors

Abstract: With a reducing fertility rate and the increase in life expectancy in Taiwan, the changing structure of the population has pushed Taiwan into an aged society. The demand for elderly care environments is rapidly increasing. However, to prevent an illness for the elderly is better than to treat it. Monitoring of an individual’s health is required as a periodic activity. Using wireless technology combined with physiological measurement techniques and home care equipment can assist elderly individuals to promote health and the health care service at home. In this research, a wireless sensor network has been adopted to develop context aware health promotion for an elderly-care system. The system is divided into three subsystems: the IoT-based physiological information subsystem, the context awareness-based service subsystem, and the elderly nutrition diet and health promotion subsystem. In this system, users also can select an Aging Diet Module or an Aging Exercise Module in our app. After the user selects the Aging Diet Module, the system will record and give suggestions. Moreover, the system can integrate long-term elderly diet and exercise records, and then, assist elderly to complete personal nutrition assessment and health management. The research goal is to construct a health promotion system utilizing IoT technology. In this paper, the system’s functions and implementation approaches are introduced.

MEMO Box: Health Assistant for Depression With Medicine Carrier and Exercise Adjustment Driven by Edge Computing

Abstract: According to the report by the World Health Organization, depression, as the leading disabling disease in the world, has aroused widespread social concern. However, the shortage of medical and nursing staff in psychiatry conflicts with the rising nursing needs of depressed patients. First, depression is a chronic mental illness, its cure course is relatively long, and stable drug treatment and healthy living habits are keys to the curing process. Second, the disease feature where depression patients have stronger emotional needs and more sensitive mental states is ignored in existing health monitoring systems. In consideration of the above two aspects, a health management assistant is proposed in this paper, called MEMO box system, that focuses on emotion and takes smart medicine box as carrier. Specifically, the MEMO box system is composed of electronic medicine box and smart applications of phones, and electronic medicine box can collect the multi-mode data of patients, including their medication behaviors, daily activities, physical exercise data, and so on, which provides a data basis for the health assistant. Emotion recognition and sports detection algorithms are deployed in the edge cloud, which enables health service requests from patients to get quick response. With the cooperation of hardware and software in this system, patients are urged to take medicines on time to effectively control their conditions, and emotion cognition and exercise adjustment recommendation can be realized for depression patients through physiological data, thus providing patients with empathic sports recommendations.