Spelling suggestions: "subject:"healthcare"" "subject:"healthecare""
71 |
Ethical and legal considerations in the relationship between medical scheme and memberSnoyman, Howard 09 January 2012 (has links)
South African medical schemes (health insurance or
medical aid) companies offer insurance to the general
public in the form of a multitude of different schemes.
Each scheme has its own unique range of benefits, but
certain exclusions apply across the board in respect of all
schemes operated by a medical aid. In this research
report, I investigate the rationale and necessity, as well
as some of the ethical and legal implications of numerous
notable exclusions. I further make relevant
recommendations with respect to their application within
the legal and ethical framework of the South Africa’s
Consumer Protection Act, No. 68 of 2010.
|
72 |
Access to health care in South Africa: an ethical and human rights obligationMeyer, Ellenore Dorette 15 October 2010 (has links)
MSc (Med), (Bioethics and Health Law), Faculty of Health Sciences, University of the Witwatersrand / Access to health care is a constitutionally recognized right, under section 27
of the South African Constitution. Fifteen years post the first democratic
election in South Africa the realization of this right is the focus of this research
report. In 1997 the South African Human Rights Commission (SAHRC), a
statutory body assigned to evaluate the realization of access to health care,
held a public enquiry into the matter. The report was released in early 2009.
The public health care system was found to be in a „lamentable state‟. South
Africa faces a number of challenges that complicate the progressive
realization of access to health care . For example, the country is currently in
recession; the HIV / AIDS statistics is among the highest in the world placing a
huge burden on public health; South Africa has the highest income inequality
globally and the gap between public and private health care, with regards to
affordability and quality of service remains a great concern. A way of
addressing this problem is to engage ethical principles such as beneficence,
non-maleficence, autonomy and (distributive) justice. Each of these in
application can argue a case for the moral obligation to initiate a more
effective national health care system. Rawls1 (1999) emphasized the
centrality of justice in consideration of the bio-medical principles.
1 Rawls, J. 1999. A Theory of Justice. Revised edition. Cambridge, Mass.: Harvard
University Press., 1971. Oxford: Clarendon Press, 1972.
The principle of justice and its derivative, distributive justice, is of importance
when making a moral argument for equal access to health care for all. Farmer
and Campos (2004:28) rightly asks2: “What does it mean, for both bioethics
and human rights, when a person living in poverty is able to vote, is protected
from torture or from imprisonment without due process, but dies of untreated
AIDS? What does it mean when a person with renal failure experiences no
abuse of his or her civil and political rights, but dies without ever having been
offered access to dialysis, to say nothing of transplant?” There is a need for
ethicists to become more involved in arguments pertaining to the inequalities
in distribution of social goods.
Legislation and case law in South Africa also affirm the right to access health
care services and have as their grounding normative ethical tenets. The
recommendations made by the SAHRC, together with the planned national
health insurance aimed at addressing the gap between public and private
health care, can only become a reality through successful implementation of a
monitored process based on ethical principles. There is a need for a practical
implementation of current ethico-legal and human rights principles through
every phase of the health care system to serve as monitors to ensure the
success of this guaranteed right that so few people have genuinely seen
realized. The findings of the SAHRC, together with the response from the
Department of Health, serve as a basis for planning towards successful
2 Farmer, P. and Campos, N.G. 2004. Rethinking Medical Ethics: A view from below.
In: Developing World Bioethics, 4 (1), 17-41
implementation of an equitable health service system that is of an excellent
standard. To aid in this process an ethical framework could be of use to
assess the policies formed along the way as well as the practical
implementation thereof. This research report is an analysis of current
literature and data available on access to health care in South Africa in light of
human rights and ethical arguments for its provision. The aim is to reflect on
the realization of greater access to health care since 1994, identifying current
hampering factors in achieving this and proposing a broad set of guidelines
that can be applied to the reform process already underway in South African
health care.
|
73 |
Exploring the municipal ward based primary health care outreach teams implementation in the context of primary health care re-engineering in GautengMunshi, Shehnaz January 2017 (has links)
A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of:
Master of Public Health (MPH)
School of Public Health
Faculty of Health Sciences
University of the Witwatersrand
19 June 2017 / Background
In order to achieve the Millennium Development Goals, South Africa embarked on a strategy in 2011 to re-engineer its Primary Health care (PHC) system. This included the creation of Ward-based Outreach Teams (WBOTs). Each team comprises six community health workers (CHWs) led by a professional nurse linked to a clinic. The national guidelines prescribe that each municipal ward should have at least one WBOT to improve access to health care and strengthen the decentralised district health system. Implementation of the WBOT policy has varied across the country.
Methodology
This qualitative study explored WBOT staff and manager views on initial WBOT implementation in the Ekurhuleni health district. Research methods included five focus group discussions with CHWs; 14 in-depth interviews with team leaders and managers; and ethnographic observations. Using the framework analysis approach, data were coded based on themes relevant to the National Implementation Research Network’s (NIRN) Implementation Drivers’ Framework, including: competency, leadership and organizational drivers of the initial implementation processes. The context in which implementation occurred was also an important theme, as derived from the NIRN formula for successful implementation.
Results
There were significant weaknesses underscoring the current implementation of WBOTs in the district. The experiences of WBOT staff and managers illustrate that competence to perform the ideal roles was compromised by poor staff selection, inadequate training and limited coaching. CHWs complained of precarious working conditions, payment delays and uncertainty of employment contracts. Within the community context, CHWs experienced both positive and negative attitudes from the community and clinic staff from inter alia: traditional beliefs; stigma; and, the perception that CHWs were increasing clinic workloads. Despite this, CHWs valued their expanded role, including the ability to refer to services beyond the clinic such a social services, police and home affairs, and felt motivated by the impact of their work in the communities they serve.
Weak organisational processes, compounded by poor planning, budgeting and rushed implementation, resulted in problems with procurement of resources. The lack
of support for robust data management led to poor data verification, quality and use for decision-making.
Communication challenges revealed leadership deficiencies at the national and implementation levels. This led to confusion about the ownership of the programme and poor integration of WBOT into the service delivery package in traditional clinic settings. Conflicting departmental mandates (between provincial and municipal departments), fragmented leadership and accountability, all lack of insight into the policy objectives and a disabling and ill-prepared context, constrained efforts of WBOTs at the local level. This also affected the embeddedness and acceptance of the programme in clinics and the community, impacting on implementation fidelity.
Conclusion
Sustainable systemic change requires clear, detailed planning guidelines, defined leadership structures, budgetary commitments, and continuous communication strategies. Furthermore, successful change is dependent on the on-going commitment to human resources development and capacity building, including investment in supervision, quality training, organisational support and competent staff. This study highlights the critical importance of organisational readiness that includes health systems and actor readiness when implementing policies across decentralised systems. Furthermore, adaptation to local contexts must be heeded in policy processes. This study further illustrates that in order to re-engineer PHC, to achieve the vision and values set out by the Alma Ata Declaration, and, to strengthen outreach services across relevant sectors, participation of all relevant actors in the implementation process. / MT2017
|
74 |
Comparison of maternal and neonatal profiles and outcomes between referred and self-referred patients delivered at the Ganyesa District HospitalMosedi, Abigail Thumeka 11 January 2012 (has links)
BACKGROUND: Maternal health care in South Africa is based on the District
Health System model which includes public health facilities (such as primary
health care clinics, community health centers and district hospitals) as well as
private health facilities. The majority of uncomplicated deliveries are expected
to happen at community health centers and only complicated cases are
expected to be referred to district hospitals. But in reality, the majority of
deliveries in a health district happen in district hospitals. This often results in
increasing utilisation of resources and decreased quality of care at these
hospitals. The Ganyesa District Hospital, situated in Dr Ruth Segomotsi
Mompati District in the North West Province has been facing similar
challenges. Although the Hospital has been collecting routine information for
the District Health Information System, it has never been analysed
systematically to understand the impact of the current referral system on the
performance of this Hospital.
Aims: To compare maternal and neonatal profiles and outcomes between
referred and self-referred patients delivered at the Ganyesa District Hospital
during one year study period (1st April 2008 to 31st March 2009).
Methodology: The setting of this study was Ganyesa District Hospital, in the
Dr Ruth Segomotsi Mompati District in the North West Province. A Cross
sectional study design was used utilising retrospective data, from the Hospital
information systems. The MS excel software based data extraction tool was
designed to obtain data from Hospital Information System. The variables used
for this study included socio-demographic and clinical profiles of patients. A
comparative statistical analysis were done to compare the profile of two
groups of patients: (Referred and Self-referred)
Results: The majority of the subjects were black. Most of the patients were,
single and unemployed. The majority of the patients were multigravidae. The
most common past and current medical disorders were diabetes and
pregnancy induced hypertension (PIH). The prevalence of pre-term deliveries
of the subjects was 14.8%. The majority of the subjects delivered normally
(86.5%) followed by CS (13.2%). The majority of CSs were performed as emergency. PIH and previous CS were common maternal indications whereas
fetal distress and mal-presentation were common fetal indications. Prolonged
labour and Intra-partum haemorrhage were common maternal complications
whereas fetal distress and fresh still-birth were common fetal complications.
There were 26 (4.3%) post-partum maternal complications. There were 3
(4.6%) deaths during this period among the patients (Maternal mortality rate of
501/ 100,000).
The incidence of low birth weight (less than 2.5 kg) was 23%. The fresh and
macerated stillbirths and low Apgar score were common neonatal
complications.
The majority of the patients (374, 62.5%) arrived after-hours. The majority of
the patients arrived by ambulance (87.3%). The median distance between
places of residence and PHC facilities (Clinic and CHC) was 12 km. The
median distance between places of residence and the Hospital was 45 km.
There were no significant differences in socio-demographic (age, ethnicity,
marital and employment status) and obstetric profiles (gravidity, prevalence of
past medical disorders and antenatal disorders, prevalence of pre-term
deliveries, mode of deliveries, intra-partum or post-partum complications and
maternal outcomes.) between referred and self-referred patients. The two
groups were not significantly different in terms of birth weight, the incidence of
low birth weight, and Apgar scores (at 1 minute and 10 minutes) and neonatal
complications.
More referred patients arrived after hours in comparison to self-referred
patients More referred patients arrived with ambulance in comparison to selfreferred
patients. The self-referred patients stayed closer to health facilities.
This was probably the reason these patients decided to come to Hospital
instead of going to their nearby PHC clinics.
Conclusion: Findings of this study will be reported to the district and
provincial department of health and hopefully will be used for improvement of
maternal health services in the Dr Ruth Segomotsi Mompati District.
|
75 |
A Study to Examine the Relationship between Hospital Mergers and Patient ExperienceAttebery, Tim 28 February 2019 (has links)
<p> Since 2009, the United States has experienced another wave of hospital mergers. Consequently, health systems are getting larger and increasing their market concentration. How patients benefit from hospital consolidation remains an open issue for policy-makers, economists, health care executives, community leaders, politicians, government agencies, and others. One measure of healthcare consolidation’s impact, and its potential benefit/detriment, is how mergers affect patient experience, which, since 2007, has been measured by the standardized HCAHPS instrument. </p><p> Hundreds of studies conducted over the past 50 years have found mergers trigger an internal, socially-disruptive effect in the first 12 to 24 months following the event as the two merging organizations attempt to blend cultures, restructure job assignments, implement merger-related efficiencies, and achieve the overall strategic goals that brought about the merger. Consequently, organizational performance may decline in the short-term as the merger-related changes and accompanying upheaval move through the organization and get resolved. </p><p> Many researchers have evaluated the impact of hospital mergers on quality, safety, access, costs, pricing, and profits. However, no research study has examined the relationship between hospital mergers and patient satisfaction or patient experience. This research attempted to fill that gap with a quasi-experimental design using an interrupted time-series study. Cross-sectional, aggregate mean values of four different HCAHPS ratings (overall, physician communication, nurse communication, and staff responsiveness) of 99 merged/acquired hospitals were compared to that of 99 matched hospitals over a six-year time period (three year prior to the merger and three years post-merger). Fixed effects difference-in-differences testing was applied to evaluate and compare the post-merger rate of change in HCAHPS ratings between the two hospital groups. </p><p> This study revealed a negative relationship between some elements of a hospital’s HCAHPS performance and merger status (i.e., completed a merger in the last 12 to 24 months or not). Specifically, a negative relationship was found between the merger group and two of the four HCAHPS domains (overall and nurse communications). Furthermore, a significant difference was found among the merged/acquired hospitals with respect to merger type. Hospitals that were acquired performed worse than hospitals that were part of a merger-of-equals. With the exception of the nurse domain, negative differences were resolved three years after the event. </p><p> Findings from this study will guide and inform hospital administrators, health system boards, state and federal government regulations and policies, and others across a wide spectrum of healthcare industry stakeholders.</p><p>
|
76 |
Antiquated paperwork processes in hospitals: the problems and solutions with health information technology systemsYoon, Andrew Minjae 22 January 2016 (has links)
BACKGROUND. The United States healthcare system is one of the most expensive in the world, equaling approximately one trillion dollars. However, the quality of healthcare is low, as indicated by mortality rates, prevalence of diseases, rates of readmission to hospitals, dissatisfaction rates, and much more. One of the inefficiencies in the healthcare system that is causing errors and a decline in patient care to occur is the current paperwork system. Physicians and nurses spend much more time taking care of patient paperwork rather than giving direct treatment to patients themselves, and it's been shown that patient dissatisfaction levels rise and errors occur more frequently as a result of current physician/nurse workload. In order to change from paperwork to electronic files, hospitals must invest the time and money to look for alternative mechanisms that would decrease turn-around time of paperwork completion by leveraging digital solutions. A study was carried out to observe log back of paperwork by counting the amount of papers for each physician before and after an electronic email message intervention.
RESULTS. The results were as expected: a simple email message did not drastically affect the amount of paperwork back log by residents, and numbers stayed consistent throughout. More than 50% of patient paperwork for residents in year 1 and 3 was more than 28 days old, which signifies the lack of paperwork availability and accessibility to the residents while off-site.
CONCLUSION. Addressing the problem of paperwork burden to residents requires alternative solutions that include changing the entire paperwork system to a paperless, electronic system. Other solutions that require less effort, time and cost are possible, such as an email reminder as was done in this study, but will most likely not be as effective as switching to a paperless system that allows for physician-patient communication on a more consistent basis even though they may be off site. These changes would significantly improve quality of patient care as well as decrease administrative costs and waste.
|
77 |
Improving the Transition of Care for Psychiatric Patients Moving from Inpatient to Outpatient Psychiatric Healthcare SettingsPhillips, Martha A. 11 April 2019 (has links)
<p>Abstract
The aim of this quality improvement (QI) project was to explore whether the
implementation of an enhanced telephone reminder system improved the rate of attendance at
initial follow-up appointment and medication adherence. A total of 86 patients, discharged
from inpatient psychiatric units with a follow-up within 7 days of discharge, were eligible to
receive the enhanced telephone contact reminder and follow-up text. A preliminary
retrospective chart review was conducted to collect historical data on medication and
attendance adherence. A prospective interventional design was used to implement the QI
project.
Patients received telephone contact within 24-72 hours of discharge and text message
reminder strategies. A medication adherence assessment was completed at telephone contact
and at initial follow-up appointment. An analysis of the data examined the impact of the
TCM strategy on patient?s rate of adherence to medication and initial follow-up
appointments. Descriptive analysis assessed the frequency of medication adherence in
retrospective and implementation data. Inferential statistics analyzed factors of association
such as prior clinic services and rate of attendance at follow-up appointment.
In the retrospective chart review (n=57), data revealed a 28% attendance rate and an
81% medication adherence at the follow-up appointment, with no statistical difference in a
145
history of prior series on attendance. Implementation data on medication adherence at
telephone contact and at first follow-up appointment revealed a 61.5% medication adherence
rate at telephone contact and 80% adherence rate at first follow-up appointment. The
predictor value of a prior history of service on attendance at first follow-up appointment
revealed no statistically significant difference. The project, however, resulted in clinically
significant benefits that promoted individual patients? medication-taking behaviors and
decisions to attend follow-up appointments, and improved clinical practices at the BHC.
|
78 |
Checklist Training Model| A Comparison of Time, Investment, and Job Function KnowledgeCoker, Christopher J. 12 April 2019 (has links)
<p> This quantitative study was an evaluation of the effectiveness of the online Training Home software program, designed for use with a national nonprofit business model. This study was undertaken because nonprofits have a difficult time resourcing training. If the Training Home program can deliver a comprehensive training program for minimal cost, then a nonprofit will be better able to deliver on the nonprofit’s stated mission. For this study, six research questions centered on measuring the helpfulness of the program, the difference in job function training, improved knowledge of a national nonprofit, and perception of the Training Home program between those that had and or had not used the program. Additionally, cost per unit of training, the number of training vignettes delivered, time spent in training, ease of use by supervisors, and staff ratings of the effectiveness of the training home program. The population studied was the 450 staff at one affiliate of the national nonprofit. This staff group consisted of a mix of genders, ages, and education levels. This study used archival data gathered over the 2013, 2014, and 2015 calendar years and was analyzed using multivariate regression and descriptive analyses. The cost and number of training vignettes delivered in a 24-month period were compared to determine whether the Training Home program was a more cost-effective delivery model than the prior system for the year before the study. Analyses indicate that the Training Home program delivered more training to staff at a lower cost per unit of training when compared to the units of training delivered in the prior model. Supervisors and staff reported the program to be effective in knowledge management and tracking and the training of all staff. The study had positive results for the sample studied. It would be beneficial for any future studies to expand the sample size into other geographic regions.</p><p>
|
79 |
Does Implementing a Quality Improvement Practice Decrease Falls on the Medical Wards?Thierry, Linda 29 March 2019 (has links)
<p> <b>Rationale/Background:</b> Fall prevention is a paramount and lifesaving healthcare initiative. The investigation of interventions for the prevention of falls may lead to a decrease in injuries and promotion of superlative care for patients hospitalized in an acute healthcare environment. </p><p> <b>Purpose: </b>The purpose of this quantitative correlational direct practice improvement (DPI) project is to determine the relationship between the implementation of a fall prevention training program and changes in fall rates over a period over three months. </p><p> <b>Theoretical Framework:</b> The Neuman system model served as the theoretical foundation for this project. The model presents a holistic approach to patient at-risk for falling and guides bedside nursing care, assess stressors, safety needs, and environmental factors suggest potential indicators linked to fall-risk patients. </p><p> <b>Project Method and Design:</b> A quantitative method and correlational design was used to investigate the impact of the intervention. The intervention involved training for a total 28 nurses (N = 28) on two wards. The final data collection included fall rates for 56-patients (N = 56). </p><p> <b>Data Results:</b> The control ward had a fall rate of nearly twice as high than the ward who received the intervention. There is a statistically significant reduction in fall rates on the intervention ward (p = 0.04). </p><p> <b>Implications:</b> Based on the findings of this project, a fall education training program supported safety through a reduction of falls. The training program was adopted as a part of standard education for the site. </p><p>
|
80 |
Data-Driven Decision-Making for Medications Management ModalitiesJanuary 2019 (has links)
abstract: One of the critical issues in the U.S. healthcare sector is attributed to medications management. Mismanagement of medications can not only bring more unfavorable medical outcomes for patients, but also imposes avoidable medical expenditures, which can be partially accounted for the enormous $750 billion that the American healthcare system wastes annually. The lack of efficiency in medical outcomes can be due to several reasons. One of them is the problem of drug intensification: a problem associated with more aggressive management of medications and its negative consequences for patients.
To address this and many other challenges in regard to medications mismanagement, I take advantage of data-driven methodologies where a decision-making framework for identifying optimal medications management strategies will be established based on real-world data. This data-driven approach has the advantage of supporting decision-making processes by data analytics, and hence, the decision made can be validated by verifiable data. Thus, compared to merely theoretical methods, my methodology will be more applicable to patients as the ultimate beneficiaries of the healthcare system.
Based on this premise, in this dissertation I attempt to analyze and advance three streams of research that are influenced by issues involving the management of medications/treatments for different medical contexts. In particular, I will discuss (1) management of medications/treatment modalities for new-onset of diabetes after solid organ transplantations and (2) epidemic of opioid prescription and abuse. / Dissertation/Thesis / Doctoral Dissertation Industrial Engineering 2019
|
Page generated in 0.051 seconds