Aligning emergency care with global health priorities

Background

The availability of resources, knowledge, and will to expand access to high-quality emergency care in low- and middle-income countries has made strong progress in recent years. While the possibility for intervention has improved, the need has only grown more pressing. What remains is for us, the people who practice and support emergency care delivery on a regular basis, to pull these elements together and present a cohesive call to action for leaders to prioritize the development of emergency care. This advocacy should coalesce around two high-level commitments: the Sustainable Development Goals and Universal Health Coverage. Emergency care has not been a traditional tool that policy makers rely on to improve health and development; however, we can show that it is actually critical to achieving these goals. Making this case has become possible with the availability of evidence that shows emergency health conditions contribute to a substantial portion of the disease burden, emergency care interventions are high-impact, and the interventions can be implemented without a substantial increase in resources.

Main body

There is a growing understanding of the burden of disease in low- and middle-income countries and how 54% or 24.3 million deaths are amenable to emergency care systems. There are a group of diseases that are time sensitive and show improved outcomes with good emergency care systems. Alongside an improving scientific underpinning to emergency care, there is growing policy recognition. While there is no direct mention of emergency care in the Sustainable Development Goals document, many goals, such as reductions in infant and maternal deaths, deaths due to non-communicable diseases, road traffic injuries and violence, improving resilience of climate change, universal coverage, and safe/sustainable urban environments are not achievable without developing, sustaining, and improving the quality of emergency care systems.

Conclusion

To take emergency care to the next level, we must capitalize on the growing understanding of the disease burden of emergent conditions, along with the increasing evidence of the high-impact and low-cost of emergency care interventions. Linking these messages to widely accepted policy priorities like the SDGs and UHC will increase attention towards the development of emergency care systems, which potentially could save lives.

     

Including African Americans in health care research

The inclusion of minority populations, particularly African Americans (AAs), in health care research has been and continues to be challenging. Including AAs in health care research will address the health disparities observed between Caucasian and AA populations and may reduce the disparities in disease incidence and prevalence between these groups. To include more AAs in health care research, the research team must strive to build relationships, linkages, and mutual respect with the target AA community they wish to study.     

Frequency and priority of pain patients' health care use

BACKGROUND: Increased health care use by pain patients is largely due to conditions other than their identified pain condition, but the kinds of services accounting for increased service use are poorly understood. This study assesses reasons for health care visits of pain patients versus controls, and compares characteristics of pain patients who differ in frequency and priority of service use. METHODS: The study samples included consecutive, primary care back pain (N=807), headache (N=831), and temporomandibular disorder pain (N=372) patients who were interviewed by telephone. Subsequently, age-sex matched controls with a primary care visit in the 6 months before the matched case's pain visit were identified. Over the following 3 years, diagnostic codes for health care visits were classified based on the Oregon Prioritized List of Health Services and case-control differences in major classes of care were compared. Pain patients differing in frequency and priority of service use were compared on measures of pain severity, chronicity, and psychosocial dysfunction. RESULTS: Pain patients' increased health care use was sustained over 3 years. Increased utilization was largely due to symptomatic and ill-defined conditions, lower priority chronic disease, lower and higher priority acute disease, and mental health care. About one-half of the pain patients (vs. one-third of the controls) were frequent health care users. About one-third of the pain patients (vs. one-sixth of the controls) were frequent users who predominantly used medical care for lower priority conditions, and this difference accounted for most of the case-control difference in the prevalence of high users. Pain patients with frequent health care use had more severe pain and greater psychosocial dysfunction than pain patients with less frequent health care use. Among frequent users, pain patients who predominantly used services for lower priority conditions did not differ on measures of pain severity, chronicity, or somatization when compared with frequent users who typically used services for higher priority conditions. CONCLUSIONS: The kind of problems explaining heightened service use of pain patients is more varied and complex than previously understood. These results call for increased attention to the implications of health care providers responding to presenting complaints as if each were a unique problem, without bringing continuity or an integrating perspective to patients' overall experience and management of illness.     

全局式护理模式在老年急性骨关节炎病人急诊护理中的应用

[目的]探讨全局式护理模式在老年急性骨性关节炎病人护理中的应用效果。[方法]将2011年9月—2013年9月在我院治疗的60例老年急性骨关节炎病人随机分成观察组和对照组,每组30例,观察组按照全局护理模式护理,对照组按照常规护理模式护理。[结果]观察组住院时间短于对照组,满意度高于对照组,手术后3个月、6个月HSS评分高于对照组。[结论]全局式护理模式能缩短老年骨关节炎病人住院时间,提高病人满意度及生活质量。     

Patient care management as a global nursing concern

Effective and efficient patient management is important in all health care environments because it influences clinical and financial outcomes as well as capacity. Design of care management processes is guided by specific principles. Roles (e.g., case management) and tools (e.g., clinical paths) provide essential foundations while attention to outcomes anchors the process.     

Introducing a new model of emergency department-based mental health care

This article highlights the importance of the three-phase process used to develop and implement an emergency department-based, mental health nurse practitioner (MHNP) outpatient service in a teaching hospital in Sydney. Australia. The project included a feasibility study and a model refinement phase followed by implementation and pilot evaluation. Support for the initiative was secured through early engagement with relevant stakeholders, from exploring the potential for the proposal through to pilot evaluation. Preliminary findings from the pilot study are presented. The authors propose that the project succeeded by emphasising a nursing model of practice.     

Integrating reproductive health into emergency response assessments and primary health care

War-affected populations often are displaced for years. When primary health care is focused on the acute conditions that often present in the emergency phase of a complex emergency, insufficient attention often is directed towards other evolving needs of the population. Their reproductive health, psychosocial health, and problems with chronic diseases may be overlooked even after the situation stabilizes. This article examines currently available resources for conducting rapid assessments of health needs and services during complex emergencies. Their respective strengths and weaknesses are discussed, particularly for assessing a population's reproductive health needs, and for fostering the integration of reproductive health and primary health-care services, and for designing health services delivery. When more specific indicators are included in a needs assessment tool, the likelihood that the assessment results will influence the design and scope of the health program is increased. Needs assessments for primary health care that incorporate reproductive health indicators will assist health officials to integrate these services, and thus, use staff and facilities more efficiently, and will highlight areas of opportunity for providing services.