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Objectives: To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil., Methods: This survey included 1042 DSCs (Response rate = 94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ-CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI)., Results: Of all the DSCs (n = 1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR = 1.01, 95% CI, 1.01-1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ-CEO result (RR = 1.01 95% CI 1.01-1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR = 1.06, 95% CI; 1.01-1.10); those that received support for planning and organizing the work scheme (RR = 1.03, 95% CI; 1.01-1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR = 1.06, 95% CI; 1.01-1.10) or without confirmatory documentation (RR = 1.06, 95%CI; 1.02-1.11); those whose team periodically performed self-assessment processes, using the Ministry of Health's formal self-assessment (AMAQ in Portuguese) (RR = 1.04, 95% CI; 1.02-1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR = 1.02, 95% CI; 1.01-1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR = 0.98, 95% CI; 0.96-0.99)., Conclusions: Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives., (© 2021 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Objectives: The principal aim of this study was to identify whether the Newcastle Satisfaction with Nursing Scales (NSNS) could be used on cancer patients., Methods: This was a descriptive, cross-sectional study carried out on cancer patients (n = 298)., Results: We found that a majority of cancer patients were around 50 years old (hospitalized patients [HP]: 49.5 ± 14.9; chemotherapy outpatients [COP]: 49.4 ± 12.7), were female (HP: 74%; COP: 63.5%), and had received education at least up to elementary level (HP: 70%; COP: 80%). Breast cancer was the principal type of cancer (>34%) in both groups (HP and COP). The groups were comparable in age, sex distribution, place of origin, educational qualification, and type of cancer. Among HP, the experience and satisfaction scales of the NSNS showed good internal consistency (n = 235, α >0.9, r > 0.7), while among COP, only the satisfaction scale showed good internal consistency (n = 62, α = 1.00). Most patients' perceptions (level of satisfaction) of hospitalization and chemotherapy services were positive (98% and 97%, respectively)., Conclusion: An NSNS instrument specifically designed for ambulatory care cancer patients is necessary for it to be useful in assessing cancer patients' perception of nursing care. This will help improve the quality of care in Mexico.The presence of cancer by itself could modify the patients' satisfaction level. Further large-scale studies are required to investigate the patients' perceptions of nursing care using the NSNS on different cancer patient groups., (© 2021 Rodríguez-Herrera C et al.)

The pay-for-value movement could justify rewarding-and punishing-doctors based on quality scores., Problem: Hardly anyone likes the current ways quality is measured, especially physicians. Few believe that Medicare's Merit-based Incentive Payment System (MIPS) will clear things up. In fact, it might cause more confusion.

Background: In recent years, the information environment for patients to learn about physician quality is being rapidly changed by Web-based ratings from both commercial and government efforts. However, little is known about how various types of Web-based ratings affect individuals' choice of physicians., Objective: The objective of this research was to measure the relative importance of Web-based quality ratings from governmental and commercial agencies on individuals' choice of primary care physicians., Methods: In a choice-based conjoint experiment conducted on a sample of 1000 Amazon Mechanical Turk users in October 2016, individuals were asked to choose their preferred primary care physician from pairs of physicians with different ratings in clinical and nonclinical aspects of care provided by governmental and commercial agencies., Results: The relative log odds of choosing a physician increases by 1.31 (95% CI 1.26-1.37; P<.001) and 1.32 (95% CI 1.27-1.39; P<.001) units when the government clinical ratings and commercial nonclinical ratings move from 2 to 4 stars, respectively. The relative log odds of choosing a physician increases by 1.12 (95% CI 1.07-1.18; P<.001) units when the commercial clinical ratings move from 2 to 4 stars. The relative log odds of selecting a physician with 4 stars in nonclinical ratings provided by the government is 1.03 (95% CI 0.98-1.09; P<.001) units higher than a physician with 2 stars in this rating. The log odds of selecting a physician with 4 stars in nonclinical government ratings relative to a physician with 2 stars is 0.23 (95% CI 0.13-0.33; P<.001) units higher for females compared with males. Similar star increase in nonclinical commercial ratings increases the relative log odds of selecting the physician by female respondents by 0.15 (95% CI 0.04-0.26; P=.006) units., Conclusions: Individuals perceive nonclinical ratings provided by commercial websites as important as clinical ratings provided by government websites when choosing a primary care physician. There are significant gender differences in how the ratings are used. More research is needed on whether patients are making the best use of different types of ratings, as well as the optimal allocation of resources in improving physician ratings from the government's perspective., (©Niam Yaraghi, Weiguang Wang, Guodong (Gordon) Gao, Ritu Agarwal. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.03.2018.)

Objectives The use of technology in healthcare to manage patient records, guide diagnosis, and make referrals is termed electronic healthcare. An electronic health record system called Lightwave Health Information Management System (LHIMS) was implemented in 2018 at Cape Coast Teaching Hospital (CCTH). This study evaluated the impact of LHIMS on the quality of healthcare data at CCTH, focusing on the extent to which its use has enhanced the main dimensions of data quality. Methods Structured questionnaires were administered to doctors at CCTH to enquire about their opinions about the present state of LHIMS as measured against the parameters of interest in this study, mainly the dimensions of quality healthcare data and the specific issues plaguing the system as reported by respondents. Results Most doctors found LHIMS convenient to use, mainly because it made access to patient records easier and had to some extent improved the dimensions of quality healthcare data, except for comprehensiveness, at CCTH. Major challenges that impeded the smooth running of the system were erratic power supply, inadequate logistics and technological drive, and poor internet connectivity. Conclusions LHIMS must be upgraded to include more decision support systems and additional add-ons such as patients’ radiological reports, and laboratory results must be readily available on LHIMS to make patient health data more comprehensive.

Objective: To evaluate and characterize the quality of ophthalmic care offered in an outpatient service unit of the SUS secondary care according to the perception of users and/or those responsible for these users. Methods: A cross-sectional study of analytical prevalence was carried out among users assisted from September 2019 to March 2020, in one of the six ophthalmic care services offered by the SUS, in the municipality of Vitória da Conquista (BA), Brazil. Demographic and socioeconomic conditions, as well as self-perception of health, were evaluated. The characteristics and quality levels of ophthalmic health care were also evaluated. Data collection took place through a telephone interview. Results: A total of 389 users and/or guardians participated in the study. Participants reported high levels of satisfaction, considering the questions that make up the instrument’s construct. Compromised quality levels were observed in relation to the freedom to choose their eye care provider (n=154; 39.7%). Lower levels of satisfaction were associated with the variables male gender (OR=1.66; 95%CI=1.04-2.65; p=0.033) and self-reported white race (OR=6.89; 95%CI=4, 00-11.86; p=0.000). Conclusion: Users reported good levels of satisfaction with eye health care. There were greater chances of lower levels of satisfaction among men and among those with a self-reported white race. [ABSTRACT FROM AUTHOR]

ObjectivesWe investigated associations between full Electronic Medical Record (EMR) system adoption and drug use in healthcare organizations (HCOs) to explore whether EMR system features such as electronic prescribing, medicines reconciliation, and decision support, might be related to drug use by using the relevant nation-wide data.MethodsThe study design was cross-sectional. Survey data of the level of adoption of EMR systems were collected for the Organization for Economic Co-operation and Development benchmarking information and communication technologies (ICT) study between November 2013 and January 2014, in Korea. Survey respondents were hospital chief information officers and medical practitioners in primary care clinics. From the national health insurance administrative dataset, two outcomes, the rate of antibiotic prescription and polypharmacy with ≥6 drugs, were extracted.ResultsWe found that full EMR adoption showed a 16.1% lower antibiotic drug prescription than partial adoption including paper-based medical charts in the hospital only (p = 0.041). Between EMR adoption status and polypharmacy prescription, only those clinics which fully adopted EMR showed significant associations with higher polypharmacy prescriptions (36.9%, p = 0.001).ConclusionsThe findings suggested that there might be some confounding effects present and sophisticated ICT may provide some benefits to the quality of care even with some mixed results. Although a negative relationship between full EMR system adoption and antibiotic drug use was only significant in hospitals, EMR system functions searching drugs or listing specific patients might facilitate antibiotic drug use reduction. Positive relationships between full EMR system adoption and polypharmacy rate in general hospitals and clinics, but not hospitals, require further research.

Background: Growing literature has demonstrated that patients admitted to hospital during weekends tend to have less favourable outcomes, including increased mortality, compared with similar patients admitted during weekdays. Major policy interventions such as the 7-day services programme in the UK NHS have been initiated to reduce this weekend effect, although the mechanisms behind the effect are unclear. Here, we propose a mixed methods review to systematically examine the literature surrounding the magnitude and mechanisms of the weekend effect. Methods: MEDLINE, CINAHL, HMIC, EMBASE, EthOS, CPCI and the Cochrane Library were searched from Jan 2000 to April 2015 using terms related to 'weekends or out-of-hours' and 'hospital admissions'. The 5404 retrieved records were screened by the review team, and will feed into two component reviews: a systematic review of the magnitude of the weekend effect and a framework synthesis of the mechanisms of the weekend effect. A repeat search of MEDLINE will be conducted mid-2016 to update both component reviews. The systematic review will include quantitative studies of non-specific hospital admissions. The primary outcome is the weekend effect on mortality, which will be estimated using a Bayesian random effects meta-analysis. Weekend effects on adverse events, length of hospital stay and patient experience will also be examined. The development of the framework synthesis has been informed by the initial scoping of the literature and focus group discussions. The synthesis will examine both quantitative and qualitative studies that have compared the processes and quality of care between weekends and weekdays, and explicate the underlying mechanisms of the weekend effect. Discussion: The weekend effect is a complex phenomenon that has major implications for the organisation of health services. Its magnitude and underlying mechanisms have been subject to heated debate. Published literature reviews have adopted restricted scopes or methods and mainly focused on quantitative evidence. This proposed review intends to provide a comprehensive and in-depth synthesis of diverse evidence to inform future policy and research aiming to address the weekend effect. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. METHODS: Patient evaluations were derived from a series of Quote (QUality of care Through patients' Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intraclass correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 - Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. FINDINGS: Intra-class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients' problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider's understanding of patients' problems and responsiveness according to WHO. CONCLUSIONS: Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO's performance measures of health care systems.

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJETIVO: Caracterizar o cuidado pré-natal em uma amostra representativa de mães, identificando o serviço de saúde onde estas realizaram o acompanhamento da gestação e os motivos que as levaram a escolher este local. MÉTODOS: Estudo transversal, realizado nos meses de março e abril de 1997, nas quatro principais maternidades de Pelotas, RS, através de entrevista a 401 mães no pós-parto imediato. RESULTADOS: Fizeram acompanhamento pré-natal, em um posto de saúde 51% das mães, sendo a proximidade geográfica o critério mais freqüentemente referido para tal escolha (46,8%). Para 85% das mães, o serviço de saúde mais próximo de casa era um posto de saúde. No entanto, 52,2% dessas não utilizaram esse local para as consultas pré-natais alegando a má qualidade do atendimento (37,4%). Conforme referido pelas mães, entre os procedimentos de rotina do pré-natal recomendados pelo programa de saúde da rede pública, incluindo a promoção do aleitamento materno, apenas a imunização anti-tetânica foi realizada mais freqüentemente nos postos do que nos demais locais. CONCLUSÕES: Tendo em vista a expressiva utilização da rede pública para o acompanhamento pré-natal, necessitam ser implementados investimentos em educação continuada dos profissionais, com ênfase no cumprimento de normas técnicas pré-estabelecidas.OBJECTIVE: To describe the prenatal care delivered to a representative sample of mothers, identifying the health care facility they attended and to explore the reasons that led them to choose that specific health facility. METHOD: A cross-sectional study was conducted at four maternity hospitals in Pelotas, in Southern Brazil, from March to April 1997. A total of 401 mothers were interviewed at the hospital, immediately after delivery. RESULTS: The majority of mothers (51%) were followed up at a primary health care facility (PHCF). The main reported reason for choosing a PHCF was its geographic accessibility (46.8%). For 85% of the mothers, the nearest health service was a PHCF. However, 52.2% of them did not attend the consultations at this setting mainly because of a supposed low quality care (37.4%). Except for immunization with tetanus toxoids, all other usual prenatal care procedures recommended by the local health ministry, including promotion of breastfeeding, were performed less frequently at the PHCF than in other health care settings. CONCLUSION: Given the high coverage of the public prenatal care program, efforts should be made to improve the quality of care delivered to pregnant women, mainly by encouraging health professionals, especially doctors, to follow the established guidelines.

Objectives: In quality of care research, the balanced incomplete block (BIB) design is regularly claimed to have been used when eval-uating complex interventions. In this article, we reflect on the appropriateness of using this design for evaluating complex interventions. Study Design and Setting: Literature study using PubMed and handbooks. Results: After studying various articles on health services research that claim to have applied the BIB and the original methodological literature on this design, it became clear that the applied method is in fact not a BIB design. Conclusion: We conclude that the use of this design is not suited for evaluating complex interventions. We stress that, to prevent improper use of terms, more attention should be paid to proper referencing of the original methodological literature. [ABSTRACT FROM AUTHOR]

Abstract: Healthcare delivery in the 21st Century is rapidly changing. The combination of political pressures and ensuing infrastructure changes across health delivery models can sometimes make the patient feel a neglected, although vital part of the equation. Putting the patient at the heart of high quality care focuses on the need for patient feedback and clinical evaluation through a variety of different media. Clinical audit is an implicit part of this aim, and it is as applicable to all osteopathic clinicians. The aim is to recognise audit and evaluation as an opportunity rather than a threat to clinical autonomy thereby benefitting both patients and clinicians. This Masterclass will describe the development of clinical audit, the stages involved in the process, how to identify where changes can be desirable, how to implement those changes, and the often forgotten vital stage of re-audit to identify how those changes have had an effect on the delivery of care. [Copyright &y& Elsevier]

Primary health care strategy has been adopted by Health Social Security from Peru (EsSalud) to achieve its corporate goals. Objective: To assess the compliance of the primary health care strategy and the user satisfaction degree in an EsSalud primary care center. Material and Methods: A cross-sectional descriptive study design was conducted. Two surveys were applied to 240 randomly selected users. User satisfaction degree was measured considering the structure, processes and outcomes of the center. We measured the compliance of three attributes of primary care: accessibility, comprehensiveness and continuity. Results: 61.7% of users showed medium general satisfaction and 23.3% high general satisfaction. The users were satisfied or very satisfied with 5 parameters: geographical accessibility (99.8%), infrastructure (66.6%), hours care (61%), problem solving (52.5%) and diagnostic tests (51.3%). 47% of users showed medium satisfaction with care received in the center. The lowest degree of satisfaction was found with the waiting times for outpatient clinic care (29.1%) and emergency care (7.5%). About Primary care Attributes, accessibility (55.8%) and continuity (55%) showed a medium compliance, comprehensiveness was perceived as a low compliance (51.7%). Conclusions: The satisfaction degree with the center and the compliance of the primary care attributes were medium. [ABSTRACT FROM AUTHOR]

Objective: to develop and validate an instrument to measure users' satisfaction of rehabilitation services. Methods: literature review to identify main construct domains, elaboration of items, pilot testing to reduce the number of items and redefinition of the questionnaire. The face and content validity were established by rehabilitation specialists. The questionnaire was applied to 85 users of rehabilitation services. The analysis was performed using a principal component factor analysis followed by a varimax rotation, then, the Scree test was used to select significant components and to estimate reliability and validity of the instrument, also Cronbach's alpha coefficient and the split-half test were ascertained. Results: the final version of the questionnaire consisted of 24 questions. Eighty-five patients answered the questionnaire that was completed in ten minutes on average. The principal components factor analysis and the Scree test detected 8 significant components. Internal consistency of the instrument had a coefficient Cronbach's alpha of 0.80 which was considered as acceptable, and the reliability, by means of the split-half test showed an alpha of 0.72 and 0.69 respectively. Conclusions: The instrument to evaluate user's satisfaction of rehabilitation services showed to be valid and reliable. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)