Banking on health: Personal records and information exchange

Consumer demand for personal health records (PHRs) and the capabilities provided by regional health information organizations (RHIOs) will change healthcare, just as automatic teller machines have changed banking. The PHR is predicated on the existence of electronic medical records (EMRs) and electronic health records (EHRs). Patient and consumer principles guiding the development of the PHR reflect issues of access, control, privacy, and security. Working models illustrate the variations of RHIOs and PHRs possible and suggest the benefits that electronic information exchange can accrue for healthcare and healthcare consumers. Today both the private and public sectors are working to define the issues involved in efforts that are now taking place and that will transform healthcare. Consumers are ready for the type of changes that will improve healthcare quality.     

加快农村卫生人才引进培养促进农村卫生持续健康发展

2009年新医改以来,各级政府加大了对农村卫生的投入,农村卫生得到了前所未有的发展。但是农村卫生人才总体数量不足、学历层次不高、人员结构不合理已经成为制约农村卫生进一步发展的瓶颈。主要原因在于人才培养渠道不通畅,引进政策不宽松;待遇偏低,激励机制没有形成;工作条件较差,生活环境艰苦。建议以“扩大总量,盘活存量,优化结构,提升素质”为目标,建立部门协同合作、医学教育培养、科学用人、人才激励、投入保障、对口合作交流6大机制,造就一批适应基本卫生制度建设需要的农村卫生人才队伍。     

Health and Sickness Absence in Denmark: A Study of Elderly-Care Immigrant Workers

The objective of this study is to investigate patterns of sickness absence in light of health status among immigrants. Cross-sectional data from 2005 was used and the study population consisted of 3,121 healthcare assistants and healthcare helpers working in the elderly-care sector in Denmark. A multinomial logistic regression was employed to investigate the relationship between health indicator, sickness absence and being an immigrant. Our findings show that, on one hand, immigrants have worse health status, but on the other, they have significantly lower sickness absence than their Danish counterparts, even after factors such as age and gender are controlled for. The results show that the relationship between being an immigrant and sickness absence differs according to health status. Our findings are in line with Steer and Rhode’s theoretical framework, according to which attendance to work is a function of ability and motivation to be at work.     

Employer-sponsored health insurance and the gender wage gap

During prime working years, women have higher expected healthcare expenses than men. However, employees’ insurance rates are not gender-rated in the employer-sponsored health insurance (ESI) market. Thus, women may experience lower wages in equilibrium from employers who offer health insurance to their employees. We show that female employees suffer a larger wage gap relative to men when they hold ESI: our results suggest this accounts for roughly 10% of the overall gender wage gap. For a full-time worker, this pay gap due to ESI is on the order of the expected difference in healthcare expenses between women and men.     

American Health Information Management Association. Position statement. Issue: quality management and improvement in healthcare reform

Healthcare providers have long been proponents of high quality, cost-efficient patient care services. The healthcare reform plan proposed by President Clinton acknowledges these long-standing priorities through the formation of a nationwide healthcare Quality Management Program. Implementation of an effective Quality Management process in all sectors of healthcare services will require dedication and innovation from all members of the healthcare team, including health information management professionals. Providers must accept responsibility for collecting reasonable data to develop reliable and statistically valid quality and performance measures. Healthcare consumers must shoulder the responsibility of interpreting the data accurately and using it responsibly. The American Health Information Management Association (AHIMA) and the members of its Quality Assurance Section are committed to working with applicable state and federal agencies, professional associations, and accrediting agencies to achieve the quality and performance measurement objectives of healthcare reform. Through these alliances, AHIMA and the Quality Assurance Section can assist the nation's healthcare providers, health plans, health alliances, and consumers in making sound judgments about quality and cost.     

Communicating with healthcare providers

Studies of risk communication have identified healthcare providers, especially physicians, as the source of information most trusted by the public on issues of environmental health. Nothing in medical, nursing or most healthcare provider training actually prepares practitioners to play this role and healthcare providers are generally more oriented toward treatment and medical care than prevention and public health. Healthcare providers require education in order to play this role but rarely seek it. Gaps in the knowledge of professional on the issue of Cryptosporidium illustrate the problem. For members of the professional water community, communicating with healthcare providers is best done when messages are delivered in familiar settings, such as hospital Grand Rounds (a universal format for teaching conferences) and provided in a narrative (case-based) form but gaining access is difficult if the topic is not obviously clinical in nature. In addition to being a critically important target group itself, public health professionals are easier to reach and may mediate good working relationships with medical practitioners. We suggest a strategy for water utilities based on partnerships with academic public health and providing education through well-recognized formats in continuing medical and nursing education.     

Communicating with healthcare providers

Studies of risk communication have identified healthcare providers, especially physicians, as the source of information most trusted by the public on issues of environmental health. Nothing in medical, nursing or most healthcare provider training actually prepares practitioners to play this role and healthcare providers are generally more oriented toward treatment and medical care than prevention and public health. Healthcare providers require education in order to play this role but rarely seek it. Gaps in the knowledge of professional on the issue of Cryptosporidium illustrate the problem. For members of the professional water community, communicating with healthcare providers is best done when messages are delivered in familiar settings, such as hospital Grand Rounds (a universal format for teaching conferences) and provided in a narrative (case-based) form but gaining access is difficult if the topic is not obviously clinical in nature. In addition to being a critically important target group itself, public health professionals are easier to reach and may mediate good working relationships with medical practitioners. We suggest a strategy for water utilities based on partnerships with academic public health and providing education through well-recognized formats in continuing medical and nursing education.     

Front‐line perspectives on ‘joined‐up’ working relationships: a qualitative study of social prescribing in the west of Scotland

Cross‐sector collaboration has been promoted by government policies in the United Kingdom and many western welfare states for decades. Literature on joint working has focused predominantly on the strategic level, neglecting the role of individual practitioners in putting ‘joined‐up working’ into practice. This paper takes the case of ‘social prescribing’ in the west of Scotland as an instance of joined‐up working, in which primary healthcare professionals are encouraged to refer patients to non‐medical sources of support in the third sector. This study draws on social capital theory to analyse the quality of the relationships between primary healthcare professionals and third sector practitioners. Eighteen health professionals and 15 representatives of third sector organisations participated in a qualitative interview study. Significant barriers to collaborative working were evident. The two stakeholder groups expressed different understandings of health, with few primary healthcare professionals considering non‐medical sources of support to be useful or relevant. Health professionals were mistrustful of unknown third sector organisations, and concerned about their accountability for referrals that were not successful or positive for the patient. Third sector practitioners sought to build trust through face‐to‐face interactions with health professionals. However, primary healthcare professionals and third sector practitioners were not connected in effective networks. We highlight the ongoing imbalance of power between primary healthcare professionals and third sector organisations. Strategic collaborations should be complemented by efforts to build shared understandings, trust and connections between the diverse front‐line workers whose mutual co‐operation is necessary to achieve effective joined‐up working.     

Coordination among healthcare levels: systematization of tools and measures

Improving healthcare coordination is a priority in many healthcare systems, particularly in chronic health problems in which a number of professionals and services intervene. There is an abundance of coordination strategies and mechanisms that should be systematized so that they can be used in the most appropriate context. The present article aims to analyse healthcare coordination and its instruments using the organisational theory. Coordination mechanisms can be classified according to two basic processes used to coordinate activities: programming and feedback. The optimal combination of mechanisms will depend on three factors: the degree to which healthcare activities are differentiated, the volume and type of interdependencies, and the level of uncertainty. Historically, healthcare services have based coordination on skills standardization and, most recently, on processes standardization, through clinical guidelines, maps, and plans. Their utilisation is unsatisfactory in chronic diseases involving intervention by several professionals with reciprocal interdependencies, variability in patients' response to medical interventions, and a large volume of information to be processed. In this case, mechanisms based on feedback, such as working groups, linking professionals and vertical information systems, are more effective. To date, evaluation of healthcare coordination has not been conducted systematically, using structure, process and results indicators. The different strategies and instruments have been applied mainly to long-term care and mental health and one of the challenges to healthcare coordination is to extend and evaluate their use throughout the healthcare continuum.     

Health literacy as an empowerment tool for low-income mothers

Health literacy commonly refers to the extent to which one can access and accurately interpret healthcare information. Statistics reveal that limited health literacy is prevalent among those of lower socioeconomic status. When working with low-income mothers, it is recommended in this article that healthcare professionals operationalize a broader conceptualization of health literacy than assessment of reading levels and translating knowledge of risk factors for illness and disease. Nutbeam's continuum of functional, interactive, and critical health literacy directs healthcare professionals to expand their health education mandate to encompass equipping low-income mothers with the necessary knowledge and skills to gain control over their lives and optimize the healthy development of their children. Tenets from social cognitive theory, principles from interdependence theory, and strategies from Freire's empowerment education model are integral to successful progression along Nutbeam's health literacy continuum.     

Access and utilisation of social and health services as a social determinant of health: the case of undocumented Latin American immigrant women working in Lleida (Catalonia,Spain)

Although Spain has social and healthcare systems based on universal coverage, little is known about how undocumented immigrant women access and utilise them. This is particularly true in the case of Latin Americans who are overrepresented in the informal labour market, taking on traditionally female roles of caregivers and cleaners in private homes. This study describes access and utilisation of social and healthcare services by undocumented Latin American women working and living in rural and urban areas, and the barriers these women may face. An exploratory qualitative study was designed with 12 in‐depth interviews with Latin American women living and working in three different settings: an urban city, a rural city and rural villages in the Pyrenees. Interviews were recorded, transcribed and analysed, yielding four key themes: health is a tool for work which worsens due to precarious working conditions; lack of legal status traps Latin American women in precarious jobs; lack of access to and use of social services; and limited access to and use of healthcare services. While residing and working in different areas of the province impacted the utilisation of services, working conditions was the main barrier experienced by the participants. In conclusion, decent working conditions are the key to ensuring undocumented immigrant women's right to social and healthcare. To create a pathway to immigrant women's health promotion, the ‘trap of illegality’ should be challenged and the impact of being considered ‘illegal’ should be considered as a social determinant of health, even where the right to access services is legal.     

From ‘if-then’ to ‘what if?’ Rethinking healthcare algorithmics with posthuman speculative ethics

This article discusses the role that algorithmic thinking and management play in health care and the kind of exclusions this might create. We argue that evidence-based medicine relies on research and data to create pathways for patient journeys. Coupled with data-based algorithmic prediction tools in health care, they establish what could be called health care algorithmics—a mode of management of healthcare that produces forms of algorithmic governmentality. Relying on a critical posthumanist perspective, we show how healthcare algorithmics is contingent on the way authority over bodies is produced and how predictive health care algorithms can reproduce inequalities of the worlds from which they are made, centreing possible futures on existing normativities regulated through algorithmic biopower. In contrast to that, we explore posthuman speculative ethics as a way to challenge understanding of ‘ethics’ and ‘care’ in healthcare algorithmics. We suggest some possible avenues towards working speculative ethics into health care while still being critically attentive to algorithmic modes of management and prediction in health care.     

Health needs of prisoners in England and Wales: the implications for prison healthcare of gender, age and ethnicity

This paper aims to provide evidence of the healthcare needs of prisoners in relation to gender, age and ethnicity, drawing from a larger systematic overview of the policy and research literature concerning primary care nursing in prisons in England and Wales. The literature overview shaped the initial stages of a research project funded by the Department of Health to examine the views and perspectives of prisoners and nurses working in prisons, and to identify good primary care nursing in the prison environment. At total of 17 databases were searched using search terms related to primary healthcare in prisons (health, nurs*, primary care, healthcare, family medicine, prison*, offender*, inmate*) with terms truncated where possible in the different databases. Following this, a sifting phase was employed using inclusion/exclusion criteria to narrow and focus the literature perceived as relevant to the research questions. All papers were critically appraised for quality using standardised tools. Findings from the literature overview show that prisoners are more likely to have suffered some form of social exclusion compared to the rest of society, and there are significantly greater degrees of mental health problems, substance abuse and worse physical health in prisoners than in the general population. Women, young offenders, older prisoners and those from minority ethnic groups have distinct health needs compared to the prison population taken as a whole, with implications for the delivery of prison healthcare, and how these needs are met effectively and appropriately.     

A review of the application of health economics to health and safety in healthcare

A literature review is described which aimed to evaluate economic evaluations of health and safety interventions in healthcare. Severe limitations in the methodological rigor of nearly all the published work were identified. Most effort had been invested in costing studies, which are not economic evaluations in their own right. Problems were identified with valuing benefits in health and safety because they frequently take many years to emerge and are difficult to measure. Understanding of economic techniques within the health and safety professions was limited, resulting in wide-ranging assumptions being made as to the positive economic impact of health and safety interventions. Reasons for this are explored and include the subjective benefits of intervention programmes being so impressive and the likelihood of economic savings so great that there have been few demands for objective data. Healthcare managers, health economists, and health and safety professionals have not traditionally worked together and have inherent misunderstandings of each other roles. The review concludes that the aim of future research should be to assist the National Health Service (NHS) to make valid decisions about health and safety investment and risk control methods. This should be done with the aim of improving the health of those affected by or working within the healthcare sector.     

Investigating police officers' perceptions of their role in pathways to mental healthcare

In the United Kingdom, one‐in‐four individuals with mental health problems access mental healthcare with police involvement. However, little is known about police officers' perceptions of their role in pathways to services. The aim of this study was to examine UK police officers' views and experiences of their involvement in mental healthcare, focusing on decision‐making in emergency situations. Using volunteer sampling, we recruited 15 police officers from a large metropolitan conurbation in the North West of England. Semi‐structured interviews, including a vignette depicting a mental health emergency, were used to elicit data. Interviews were transcribed verbatim and analysed at the manifest level using thematic analysis, yielding three main themes: ‘Doing What's Right’, ‘Challenges of Working Together’ and ‘Training versus Experience’. Our findings indicate that, while police officers believe they have a duty of care to protect people in mental health emergencies, they sometimes lack relevant knowledge, skills and confidence in decision‐making. Challenges associated with multi‐agency working were also perceived as impeding officers’ ability to effectively manage these emergencies. Our findings suggest that strengthening multi‐agency working and improving training might positively influence police officers' views of their role and maximise their contribution to improving emergency mental healthcare.     

Can social firms contribute to alleviating the economic burden of psychiatric disabilities for the public healthcare system?

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job‐seekers. Two complementary datasets were used: a self‐report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ‐5D‐5L), the severity of psychiatric symptoms (18‐item Brief Symptom Inventory) and self‐declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision‐making.     

Interpreters' subjective experiences of interpreting for refugees in person and via telephone in health and behavioural health settings in the United States

Interpreters, whether in person or via telephonic means, are used in healthcare settings to aid communication between clinicians and clients when the same language is not shared. Refugees seeking health and behavioural healthcare often have multiple needs and experiences of trauma that can complicate the provision of services. Little is known about the interpreters' experiences in providing in‐person and telephonic interpreting for refugees. This qualitative study sought to understand the subjective experiences of interpreters in providing in‐person and telephone interpretations to refugees in healthcare settings in the United States. Constant comparative analysis was used to analyse the transcribed, audio‐taped individual, semi‐structured interviews of 36 interpreters. These interviews were conducted between July 2013 and July 2014. Two themes were identified: (i) the importance for the interpreter to develop trust with the client; and (ii) working with refugees requires more attention from the interpreter. The interpreters of this study describe experiencing additional challenges in working with refugees versus other clients. Recommendations based on the findings are made.     

The impact of work-related risk on nurses during the SARS outbreak in Hong Kong

Severe acute respiratory syndrome (SARS) is a highly infectious disease, with high potential for transmission to close contacts, particularly among healthcare workers. This is the first systematic study investigating hospital nurses' physical and psychological health status and the kinds of healthcare used-stratified by the level of contact with SARS patients-during the 2003 outbreak in Hong Kong. Nurses in moderate-risk areas appeared to have more stress symptoms than those working in high-risk areas. It is essential to design hospital support systems and occupational health policy to promote the psychological well-being of nurses during future outbreaks of emerging infections.     

A collaborative evidence-based approach to making healthcare a healthier place to work

It is increasingly well documented that a collaborative problem-solving approach is more effective in addressing workplace health concerns than an adversarial approach. Combining this with strategies based on good evidence is key to success. On this premise, a trial was conducted in British Columbia, beginning in July 1999, based on a collaborative approach in which healthcare workers and managers work together to identify and implement evidence-based initiatives to improve the health and working conditions of healthcare workers.     

Development and application of an in-house health care program to improve the physical and mental health of working mothers: A pilot study

Abstract

Working mothers experience a lot of physical and mental stress due to their various roles in the home and in society. However, because of the many demands on their time, they sometimes struggle to manage these health concerns effectively on their own. To fill some of these gaps in healthcare access it is necessary to implement a program that can help manage the health of working mothers within a company. The authors of this study aim to identify quality of life and mental health problems common among working mothers and to determine the effects of an in-house health care program to manage those problems. Fourteen female participants who are working and have children were recruited and measurement of health-related quality of life, degree of depression and anxiety and pain intensity were taken. Participants were then enrolled in an in-house health care program for 8 weeks. The in-house health care program, consisted of physical therapy, psychiatrist consulting, and group education. After the program concluded, all of the dependent values were improved. Therefore, this in-hose health care program has shown to be effective for improving the mental health and quality of life of working mothers.