Delivery Of Health Care

提供卫生保健
  • 文章类型: Journal Article
    The recent surge in Internet growth has significantly altered how residents obtain health information and services, underscoring the need to investigate its impact on healthcare perceptions. However, current studies often fail to distinguish between Internet use and involvement, as well as the diverse range of healthcare stakeholders, resulting in incomplete and inconsistent understanding. To address this, this study utilized data from the 2018 China Family Panel Study (CFPS 2018), categorizing attitudes toward healthcare into three dimensions: doctor trust, satisfaction with medical institutions, and perception of systemic healthcare issues. Employing propensity score matching (PSM) to control for thirteen confounding variables, this study examined the Internet\'s impact on public attitudes toward healthcare among similar demographic, psychological, and health-related variables. Results revealed that both Internet use and involvement affect residents\' attitudes toward healthcare to some extent, with involvement having a more pronounced effect. While Internet use increased the perception of systemic healthcare issues, Internet involvement enhanced doctor trust, yet reduced satisfaction with medical institutions and exaggerated the perception of systemic healthcare issues. These findings have significant theoretical and practical implications. They enhance the comprehension of diverse levels and purposes of Internet use, thereby advancing our knowledge of its multi-faced influence on public attitudes toward healthcare. Furthermore, they offer insights for medical institutions to improve service quality, assist Internet media in optimizing information delivery, and illuminate the implications for residents who effectively use the Internet to assess health information.
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  • 文章类型: Journal Article
    背景:越来越多的研究正在研究医疗保健系统如何应对越来越多的移民和由此产生的患者超多样性。本文的目的是从医疗保健专业人员和跨文化调解员的角度,确定和解释在向捷克共和国的乌克兰战争难民提供医疗保健方面的沟通障碍。
    方法:探索性案例研究基于对一线卫生专业人员的半结构化访谈的定性分析:20名医生和10名护士。第二个数据来源是两个焦点小组,旨在从陪同难民到保健设施的跨文化调解人的角度捕捉沟通问题。使用六阶段主题编码对访谈笔录和FG进行了分析。
    结果:调查确定了与交流障碍有关的五个主要主题:(1)语言障碍和口译,(2)文化障碍,(3)捷克共和国和乌克兰对健康和医疗保健系统的不同期望,(4)对难民和移民的偏见和消极态度以及不道德行为;(5)缺乏对患者权利的认识。
    结论:大量移民的到来凸显了该系统的缺陷,这些缺陷可能会影响其他弱势群体和普通人群。其中包括许多卫生专业人员缺乏一般的沟通技巧和法律意识,这是发展以患者为中心的护理的障碍。跨文化调解员的参与从根本上改善了卫生专业人员与(不仅是)移民患者之间的沟通。然而,有必要在医疗体系中合法锚定和界定跨文化中介者的地位。
    与跨文化调解员合作,这些调解员解释了乌克兰难民患者的广泛经历,并且具有作为移民或移民来源患者的个人经验,有助于形成研究问题,促进研究参与和丰富证据解释。具有多元文化背景和与难民背景的人合作经验的研究人员参与了研究设计和分析。
    BACKGROUND: A growing body of research is examining how healthcare systems are responding to the increasing numbers of migrants and the resulting superdiversity of patients. The aim of this article is to identify and explain communication barriers in the provision of healthcare to Ukrainian war refugees in the Czech Republic from the perspectives of healthcare professionals and intercultural mediators.
    METHODS: The exploratory case study is based on a qualitative analysis of semi-structured interviews with frontline health professionals: 20 with doctors and 10 with nurses. The second source of data is two focus groups aimed at capturing communication problems from the perspective of intercultural mediators who accompany refugees to health facilities. The interview transcripts and FGs were analysed using six-stage thematic coding.
    RESULTS: The survey identified five main themes related to barriers to communication: (1) language barriers and interpreting, (2) cultural barriers, (3) differing expectations of health and the healthcare systems in the Czech Republic and Ukraine, (4) prejudices and negative attitudes and unethical behaviour towards refugees and migrants and (5) lack of awareness of patient rights.
    CONCLUSIONS: The arrival of large numbers of migrants has highlighted deficiencies in the system that may affect other vulnerable groups and the general population. These include the lack of general communication skills and legal awareness among many health professionals, which are barriers to the development of patient-centred care. The involvement of intercultural mediators fundamentally improves communication between health professionals and (not only) migrant patients. Nevertheless, it is necessary to legally anchor and define the position of intercultural mediators within the healthcare system.
    UNASSIGNED: Collaboration with intercultural mediators who interpreted the extensive experiences of Ukrainian refugee patients and also have personal experience as migrant or migrant-origin patients contributed to shaping research questions, facilitating study participation and enriching evidence interpretation. Researchers with multicultural backgrounds and experience with working with people from refugee backgrounds were involved in the study design and analysis.
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  • 文章类型: Journal Article
    背景:作为一个新出现的概念和二十一世纪的产物,卫生信息治理正在迅速扩展。医疗行业信息治理的必要性是显而易见的,鉴于健康信息的重要性和当前管理它的需求。本范围审查的目的是确定健康信息治理的维度和组成部分,以发现这些因素如何影响医疗保健系统和服务的增强。
    方法:PubMed,Scopus,WebofScience,ProQuest和GoogleScholar搜索引擎从开始到2024年6月进行了搜索。方法学研究质量使用CASP清单对选定的文件进行评估。尾注20用于选择和审查文章和管理参考资料,MAXQDA2020用于内容分析。
    结果:共37份文件,包括18次审查,9项定性研究和10项混合方法研究,通过文献检索确定。根据调查结果,六个核心类别(包括卫生信息治理目标,优势和应用,原则,组件或元素,角色、责任和流程)和48个子类别被确定,以形成一个统一的总体框架,包括所有提取的维度和组件。
    结论:根据本范围审查的结果,卫生信息治理应被视为各国卫生系统改善和实现目标的必要条件,特别是在发展中国家和不发达国家。此外,鉴于2019年冠状病毒病(COVID-19)大流行在不同国家的不良影响,组织健康信息治理模型的开发和实施,国家和国际层面是紧迫的关切。研究人员可以将当前的发现用作开发健康信息治理模型的综合模型。这项研究的一个可能的限制是我们对某些数据库的访问有限。
    BACKGROUND: As a newly emerged concept and a product of the twenty-first century, health information governance is expanding at a rapid rate. The necessity of information governance in the healthcare industry is evident, given the significance of health information and the current need to manage it. The objective of the present scoping review is to identify the dimensions and components of health information governance to discover how these factors impact the enhancement of healthcare systems and services.
    METHODS: PubMed, Scopus, Web of Science, ProQuest and the Google Scholar search engine were searched from inception to June 2024. Methodological study quality was assessed using CASP checklists for selected documents. Endnote 20 was utilized to select and review articles and manage references, and MAXQDA 2020 was used for content analysis.
    RESULTS: A total of 37 documents, including 18 review, 9 qualitative and 10 mixed-method studies, were identified by literature search. Based on the findings, six core categories (including health information governance goals, advantages and applications, principles, components or elements, roles and responsibilities and processes) and 48 subcategories were identified to form a unified general framework comprising all extracted dimensions and components.
    CONCLUSIONS: Based on the findings of this scoping review, health information governance should be regarded as a necessity in the health systems of various countries to improve and achieve their goals, particularly in developing and underdeveloped countries. Moreover, in light of the undesirable effects of the coronavirus disease 2019 (COVID-19) pandemic in various countries, the development and implementation of health information governance models at organizational, national and international levels are among the pressing concerns. Researchers can use the present findings as a comprehensive model for developing health information governance models. A possible limitation of this study is our limited access to some databases.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:2019年冠状病毒病(COVID-19)大流行对医疗保健系统造成了全球重大破坏,被迫在医疗服务方面做出快速改变。这场大流行需要美国民用医疗保健部门和军事卫生系统(MHS)之间更紧密的合作,产生新的和加强的伙伴关系,最终可以使国家的公共卫生和医疗保健受益。在这项研究中,我们试图了解在COVID-19大流行期间,MHS与民用部门合作的全方位伙伴关系,并为未来汲取教训。
    方法:我们对MHS政策制定者和顾问进行了重要的线人访谈,从2020年3月到2022年12月隶属于MHS的项目经理和提供商。使用主题分析和开放编码方法得出关键主题。
    结果:我们在2022年12月至2023年3月之间进行了28次访谈。大流行期间,MHS通过诸如“扭曲速度行动”之类的努力与联邦和地方医疗保健当局以及私营部门实体合作。还确定了未来大流行的经验教训和建议,包括对生物监测系统的投资以及行为和社会科学的整合。
    结论:在COVID-19大流行期间,MHS迅速建立并促进了与公共和私营部门的关键伙伴关系。大流行的经验表明,虽然MHS是国家的有用资源,它还受益于与各种组织的合作,机构和私营公司。继续发展这些伙伴关系对于协调,有效应对未来的流行病。
    BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused significant global disruptions to the healthcare system, which was forced to make rapid changes in healthcare delivery. The pandemic necessitated closer collaboration between the US civilian healthcare sector and the military health system (MHS), resulting in new and strengthened partnerships that can ultimately benefit public health and healthcare for the nation. In this study, we sought to understand the full range of partnerships in which the MHS engaged with the civilian sector during the COVID-19 pandemic and to elicit lessons for the future.
    METHODS: We conducted key informant interviews with MHS policymakers and advisers, program managers and providers who were affiliated with the MHS from March 2020 through December 2022. Key themes were derived using thematic analysis and open coding methods.
    RESULTS: We conducted 28 interviews between December 2022 and March 2023. During the pandemic, the MHS collaborated with federal and local healthcare authorities and private sector entities through endeavours such as Operation Warp Speed. Lessons and recommendations for future pandemics were also identified, including investment in biosurveillance systems and integration of behavioural and social sciences.
    CONCLUSIONS: The MHS rapidly established and fostered key partnerships with the public and private sectors during the COVID-19 pandemic. The pandemic experience showed that while the MHS is a useful resource for the nation, it also benefits from partnering with a variety of organizations, agencies and private companies. Continuing to develop these partnerships will be crucial for coordinated, effective responses to future pandemics.
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  • 文章类型: Journal Article
    背景:卫生政策和系统研究(HPSR)是一种生成卫生系统和政策级证据的多学科方法。设置HPSR议程被认为是绘制和确定政策和具有成本效益的研究课题的有效策略,但是它在发展中国家的实践是有限的。本文旨在在埃塞俄比亚进行一项合作的卫生政策和系统研究优先事项设定工作。
    方法:世界卫生组织的计划,工具,发布,并使用评估(PIPE)框架和Delphi技术进行优先级设置练习。PIPE模型用于引导从计划到评估的优先级设置过程,而Delphi技术用于进行评级和排名练习,目的是达成共识。在HPSR议程设置中使用了两轮专家小组研讨会,并辅以在线调查,评级和排名目的。使用世卫组织卫生系统构建模块作为基础框架,以确定和优先考虑HPSR主题。
    结果:在8个主题下,确定了32个子主题和182个HPSR主题。确定的研究主题包括领导力管理和治理,卫生政策,健康信息系统,医疗保健融资,卫生人力资源,医疗产品和供应,服务交付和交叉问题。
    结论:确定了重点关注国家健康优先问题的优先HPSR主题。已确定的主题已与决策者以及学术和研究机构共享。确定的优先主题的证据生成将指导未来的研究工作,并改善循证决策实践,卫生系统绩效和国家卫生目标和指标。
    BACKGROUND: Health policy and systems research (HPSR) is a multi-disciplinary approach of generating health system and policy-level evidence. Setting HPSR agendas is considered as an efficient strategy to map and identify policy and cost-effective research topics, but its practice in developing countries is limited. This paper aimed to conduct a collaborative health policy and system research priority-setting exercise in Ethiopia.
    METHODS: The WHO\'s plan, implement, publish, and evaluate (PIPE) framework and the Delphi technique were used to conduct the priority-setting exercise. The PIPE model was used to lead the priority-setting process from planning to evaluation, while the Delphi technique was used to run the rating and ranking exercise with the aim of reaching a consensus. Two rounds of expert panel workshops supplemented with an online survey were used for the HPSR agenda setting, rating and ranking purposes. Groups were formed using the WHO health system building blocks as a base framework to identify and prioritize the HPSR topics.
    RESULTS: Under 8 themes, 32 sub-themes and 182 HPSR topics were identified. The identified research themes include leadership management and governance, health policy, health information system, healthcare financing, human resource for health, medical products and supply, service delivery and cross-cutting issues.
    CONCLUSIONS: Priority HPSR topics focussing on national health priority issues were identified. The identified topics were shared with policymakers and academic and research institutions. Evidence generation on the identified priority topics will guide future research endeavours and improve evidence-informed decision-making practice, health system performance and national health goals and targets.
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  • 文章类型: Journal Article
    背景:自2006年以来,台湾积极发展医疗旅游业。2013年,政府试图通过将医疗旅游纳入自由经济试验区来加强这一部门。尽管勉强错过了标记,该倡议未能成为法律。这项定性研究致力于辨别影响将医疗旅游纳入台湾自由经济试验区的议程设定过程的相关因素。
    方法:通过半结构化访谈和对政策文件的全面审查,对自由经济试验区内医疗旅游合法化的政策进行了全面审查。使用目的性和雪球采样技术战略性地选择关键线人。主题分析用于仔细检查所收集的数据,并在Kingdon的多个流的框架内进行组织。
    结果:在问题流中,在国家健康保险计划下,不断增加的财务压力和成本控制压力长期以来一直驱使医疗保健提供者在医疗旅游中寻求进一步的机会。台湾扩大医疗旅游的现有障碍包括外交紧张(特别是两岸关系),公众对医疗商业化的担忧,减少了他们获得医疗服务的机会,法律和语言障碍。在政策流中,支持国民健康保险的特许经营费等因素,允许的示范医疗旅游景点和服务数量有限,外国医务人员的津贴,管理家庭医生的法规,示范的重要性,regulation,和认证,以及对中国投资的限制,被强调了。政治流突出了政府支持等因素,反对党的反对,来自学术界和非政府组织的公众关注和批评,和医学院的怀疑。
    结论:承认在颁布《自由经济试验区特别法》的医疗旅游条款方面面临的公认挑战,并强调领导层的政治意愿,可行的政策解决方案仍然难以捉摸。尽管存在通过该法案的机会之窗,随着公众的担忧将这一问题从国家议程中排除,这一情况有所减弱。台湾案件强调了对问题进行细致考虑的必要性,提出的解决方案,和政治动态,以实现成功的政策制定。
    BACKGROUND: Since 2006, Taiwan has actively pursued the development of its medical tourism industry. In 2013, the government sought to bolster this sector by integrating medical tourism into the Free Economic Pilot Zones. Despite narrowly missing the mark, the initiative failed to materialize into law. This qualitative study endeavors to discern the pertinent factors influencing the agenda-setting process for incorporating medical tourism into the Free Economic Pilot Zones in Taiwan.
    METHODS: A comprehensive examination of policies concerning the legitimation of medical tourism within the Free Economic Pilot Zones was undertaken through semi-structured interviews and a thorough review of policy documents. Key informants were strategically selected using purposive and snowball sampling techniques. Thematic analysis was applied to scrutinize the amassed data and organize it within the framework of Kingdon\'s multiple streams.
    RESULTS: In the problem stream, increasing financial strains and cost containment pressures under the National Health Insurance program have long driven health care providers to seek further opportunities in medical tourism. The existing barriers to expanding medical tourism in Taiwan included diplomatic tensions (specifically cross-strait relations), public concerns about commercialization of medical care and reduced their access to care, and legal and language barriers. Within the policy stream, factors such as franchise fees to support national health insurance, limited number of demonstration medical tourism sites and services allowed, the allowance of foreign medical personnel, regulations governing domestic physicians, the importance of demonstration, regulation, and accreditation, as well as restrictions on investment from China, were emphasized. The politics stream highlights factors such as governmental support, opposition from opposing parties, public concerns and critics from academia and non-governmental organizations, and skepticism from medical faculties.
    CONCLUSIONS: Acknowledging the recognized challenges in enacting the medical tourism provision of the Free Economic Pilot Zones Special Act and emphasizing the political will of leadership, a viable policy solution remained elusive. Although a window of opportunity existed for the passage of the bill, it waned as public concerns sidelined the issue from the national agenda. The Taiwan case underscores the necessity for meticulous consideration of issues, proposed solutions, and political dynamics to achieve successful policy enactment.
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  • 文章类型: Journal Article
    背景:上消化道肿瘤(UGIC)越来越普遍。预后差,长期影响显著,UGIC对癌症患者及其非正式护理人员提出了重大的调整挑战。然而,这些非正式护理人员的支持性护理需求在很大程度上是未知的.这项对定性研究的系统综述基于UGIC患者非正式护理人员的经验,综合并批判性地评估了当前的证据。
    方法:进行了JoannaBriggs研究所的系统评价。在四个数据库中进行了搜索(MEDLINE,PsycINFO,Embase,CINAHL)从数据库开始到2021年2月。纳入的研究探索了被诊断患有原发性食道癌的个体的非正式照顾者的经验,胃,胰腺,胆管,胆囊,或者肝脏。对研究的资格进行独立筛选,并由两名评审员对纳入的研究进行质量评估。使用元聚合提取和合成数据。
    结果:本综述包括19篇论文,并提取了328个发现。这些被分为16个类别,包括三个调查结果:(1)UGIC护理人员负担;UGIC护理人员承担广泛的责任,尤其是患者的饮食,因为消化受到UGIC的严重影响。(2)照顾者负担的调解员;UGIC的性质,以照顾者的破坏性生活变化为特征,被确定为照顾者负担的调解人。(3)照顾者负担的后果:UGIC照顾者的经历是由未满足的需求塑造的,缺乏信息和社会交往的普遍下降。
    结论:这篇综述的结果表明,卫生服务需要进行文化转变。建议照顾UGIC患者对照顾者的生活质量产生不利影响,与其他癌症护理人群相似,因此,他们应该更好地作为共同客户纳入护理计划和执行,将他们纳入关于患者诊断的讨论中,治疗方案,和潜在的副作用。
    BACKGROUND: Upper gastrointestinal cancers (UGICs) are increasingly prevalent. With a poor prognosis and significant longer-term effects, UGICs present significant adjustment challenges for individuals with cancer and their informal caregivers. However, the supportive care needs of these informal caregivers are largely unknown. This systematic review of qualitative studies synthesises and critically evaluates the current evidence base on the experience of informal caregivers of individuals with UGIC.
    METHODS: A Joanna Briggs Institute systematic review was conducted. Searches were performed in four databases (MEDLINE, PsycINFO, Embase, CINAHL) from database inception to February 2021. Included studies explored experiences of informal caregivers of individuals diagnosed with primary cancer of the oesophagus, stomach, pancreas, bile duct, gallbladder, or liver. Studies were independently screened for eligibility and included studies were appraised for quality by two reviewers. Data were extracted and synthesised using meta-aggregation.
    RESULTS: 19 papers were included in this review, and 328 findings were extracted. These were aggregated into 16 categories across three findings: (1) UGIC caregiver burden; UGIC caregivers undertake extensive responsibilities, especially around patient diet as digestion is severely impacted by UGICs. (2) Mediators of caregiver burden; The nature of UGICs, characterised by disruptive life changes for caregivers, was identified as a mediator for caregiver burden. (3) Consequences of caregiver burden: UGIC caregivers\' experiences were shaped by unmet needs, a lack of information and a general decline in social interaction.
    CONCLUSIONS: The findings of this review suggest the need for a cultural shift within health services. Caregiving for UGIC patients is suggested to adversely affect caregivers\' quality of life, similarly to other cancer caregiving populations and therefore they should be better incorporated as co-clients in care-planning and execution by including them in discussions about the patient\'s diagnosis, treatment options, and potential side effects.
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  • 文章类型: Journal Article
    This integrative review aims to identify the mental health care measures that were produced during the COVID-19 pandemic. This research was conducted on three databases (SciELO, PubMed, and LILACS) with the following descriptors in Portuguese, English, and Spanish: \"SAÚDE MENTAL\" or \"SALUD MENTAL\" or \"MENTAL HEALTH\" AND \"COVID-19\" from 2020 to 2021. In total, 3,451 articles were found, 43 of which were analyzed. Most measures were digital, stemmed from public institutions, focused on the local perspective, and were integrated with the public health care system. This study discusses the models of care in mental health based on measures to cope with the COVID-19 pandemic. It also discusses the Brazilian health care system, reiterating its resilience. In conclusion, digital measures occurred most often. This study suggest the evaluation of the accessibility of this mental health care model for most vulnerable groups. Finally, this research reinforces the importance of the Brazilian health care system for public health and access to information to cope with the COVID-19 pandemic.
    A presente revisão integrativa tem por objetivo identificar os arranjos de cuidado em saúde mental que foram implementados no enfrentamento à pandemia de COVID-19. Realizou-se busca em três bases de dados (SciELO, PubMed e LILACS), em português, inglês e espanhol, com os descritores “SAÚDE MENTAL” or “SALUD MENTAL” or “MENTAL HEALTH” AND “COVID-19”, no período de 2020 a 2021. Foram encontrados 3.451 artigos, sendo 43 selecionados para análise. Em relação ao cuidado em saúde mental, os principais arranjos identificados foram os digitais, de natureza pública, desenvolvidos na esfera municipal e com integração com a rede de saúde. Os modelos de cuidado em saúde mental para o enfrentamento da pandemia são discutidos a partir dos tipos de arranjo produzidos nesse contexto sanitário emergencial e crítico. Apresenta-se, ainda, um recorte da realidade encontrada no Sistema Único de Saúde (SUS), reiterando sua resiliência. Concluiu-se que os arranjos digitais foram os mais usados e que há necessidade de investigar a acessibilidade deste modelo para populações com maior vulnerabilidade social. Reafirma-se a importância do SUS para o enfrentamento da COVID-19 e no acesso a informações de saúde.
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  • 文章类型: Editorial
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