Bmc Health Serv Res
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Bmc Health Serv Res · Jul 2020
Availability, accessibility, and quality of adolescent Sexual and Reproductive Health (SRH) services in urban health facilities of Rwanda: a survey among social and healthcare providers.
Adolescents are still getting pregnant and contracting Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs) in Rwanda as elsewhere. Quality and comprehensive SRH services and information for adolescents is valuable for adolescents' wellbeing. This study aimed at understanding SRH services providers' viewpoints on accessibility, availability, and quality of SRH services provided to adolescents in selected cities of Rwanda. ⋯ SRH services in Rwanda are available for the general population and are not specifically designed for adolescents. These SRH services seem to be fairly accessible to adolescents with insufficient quality as adolescents themselves do not get to be fully involved in service provision among other aspects of quality SRH as stated by the World Health Organization (WHO). Therefore, there is a need to improve the present quality of these services to meet adolescents' needs in an urban setting.
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Bmc Health Serv Res · Jul 2020
Social inequalities in cervical cancer screening: a discrete choice experiment among French general practitioners and gynaecologists.
Cervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners' (GPs) and gynaecologists' preferences for actions designed to reduce screening inequalities. ⋯ French practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.
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Bmc Health Serv Res · Jul 2020
Too much or too little opioids to patients receiving opioid agonist therapy in Norway (2013-2017): a prospective cohort study.
Dispensations of opioid analgesics to patients on opioid agonist therapy (OAT) may increase the risk of overdoses. The current study's objectives are to investigate the dispensation rates and mean daily doses of dispensed opioid analgesics among patients who received OAT opioids in Norway during 2013-2017 and evaluate whether discontinuing OAT opioids affects the dispensed dose of opioid analgesics. ⋯ Reducing the dispensation of opioid analgesics can be achieved by increasing the OAT opioid dose for patients on a low OAT dose, and by extending the period needed to taper off the OAT opioid dose at discontinuation.
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Bmc Health Serv Res · Jul 2020
Randomized Controlled TrialPACE-IT study protocol: a stepped wedge cluster randomised controlled trial evaluating the implementation of telehealth visual assessment in emergency care for people living in residential aged-care facilities.
Transfer of residential aged-care facility (RACF) residents to Emergency Departments (ED) is common, risky and expensive. RACF residents who present to ED are more likely to have hospital readmissions, longer stays and face major risks related to hospital acquired complications. Aged Care Emergency services (ACE) is a nurse led, protocol- guided, telephone RACF/ED outreach model that has been shown to be effective in reducing hospitalisation and length of hospital stay for RACF residents in the Hunter New England Local Health District, New South Wales (NSW). The Partnerships in Aged-Care Emergency services using Interactive Telehealth (PACE-IT) project enhances ACE by incorporating interactive video assessment and consultation. The PACE-IT project's primary aim is to assess whether augmentation of ACE services through the addition of protocol-guided interactive Visual Telehealth Consultation (VTC) for clinical decision-making, plus telephone follow-up, reduces RACF resident transfers to ED. ⋯ If shown to be effective, the intervention has the potential to improve the clinical care and quality of life for residents. Findings will provide high level evidence that will inform sustainable change and broad translation into practice across NSW. It will show how the change has been achieved and highlight success factors for scalability and sustainability. It will inform review of processes, the development of policy and guidelines that will integrate PACE-IT into existing service models in NSW.
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Bmc Health Serv Res · Jul 2020
Associations between stressors and difficulty sleeping in critically ill patients admitted to the intensive care unit: a cohort study.
Patients admitted to the intensive care unit (ICU) experience sleep disruption caused by a variety of conditions, such as staff activities, alarms on monitors, and overall noise. In this study, we explored the relationship between noise and other factors associated with poor sleep quality in patients. ⋯ Patient quality of sleep in the ICU is associated with environmental factors such as noise and artificial lighting, as well as biological factors related to anxiety and pain. The noise level in the ICU is twice that recommended by international guides. Given the stronger influence of environmental factors, the use of earplugs or sleeping masks is recommended. The longer the hospital stay, the less these factors seem to affect patients' sleep quality.