Mobile Health Platform to Augment Integrated Behavioral Health Care: Pilot in a Large Health System (Preprint)

BACKGROUND Digital and mobile technologies have potential to improve the delivery and scale of integrated care models. OBJECTIVE We aimed to assess acceptability and feasibility, preliminary clinical outcomes, and implementation barriers of a mobile health platform used to augment an existing integrated behavioral health program. METHODS The mobile platform was used by three behavioral health care managers responsible for coordinating disease management in six primary care practices. 89 of 245 individuals (36%) who were referred by their PCP for behavioral health services consented to app-augmented behavioral health care. The mobile health platform functions included chat communication, monthly depression self-report assessments, and psychoeducational content. RESULTS The clinical improvement rate in our sample was 72% although follow-up assessments were only available for 49% of participants. At least one action in the mobile app was completed by 87% of participants (n=78; median=7; IQR=12, 0-130). Behavioral health care managers cited increased documentation burden and language as barriers to use. CONCLUSIONS Our pilot of mobile technology in collaborative care highlights important implementation barriers. Future research should systematically evaluate the implementation of digital and mobile health technology in collaborative care.

Family and Psychosocial Considerations in Critical Care

This chapter discusses the expanding movement to humanize critical care and intensive care settings. An international perspective is provided with regard to how patients, families, and professionals, along with health care managers and authorities, can redesign health care systems to overcome the obstacles of dehumanization in hospitals and health centers, with social interest at the core. The authors maintain that caring for all parties, including the family, that coexist in the health care system is critical to building an excellent and effective service.

Facilitators and barriers in prevention of cardiovascular disease in Limpopo, South Africa: a qualitative study conducted with primary health care managers

Background In the Southern African countries, cardiovascular disease burden is increasing and the second most prevalent cause of death after infectious diseases. The sustainable primary prevention of cardiovascular disease is associated with the engagement of facilitators that support it and hindered by barriers that undermine the support of a healthy lifestyle at the community level. The purpose of the study was to investigate facilitators and barriers at the level of primary health care facilities, on prevention of cardiovascular disease in Limpopo Province of South Africa. Methods This study is an exploratory and descriptive qualitative design, where open-ended key informant interviews were conducted among 20 primary health care managers conveniently sampled in their respective health care facilities. Coding and analysis were done using the thematic analysis method with the assistance of Atlas ti qualitative software. Results Various facilitators for the prevention of CVD were identified in this study. One of such facilitators is the availability and adherence to CVD treatment guidelines in the district. Other facilitators included top-down health education programme; collaboration with schools, traditional and religious leaders; the use of modern technology; and a structured healthcare system. Barriers were also identified as poor infrastructural development; shortage of medical supplies and equipment; lack of health promotion activities; shortage of nurses and other health care personnel; and poor accessibility to primary health care services. Conclusion This study has identified barriers and facilitators that may be harnessed to improve cardiovascular disease prevention, care, and management in a rural setting in South Africa. The facilitators should be strengthened, and barriers identified redressed. Trial registration number: REC-0310111-031.

The Study of the Awareness of Healthcare Workers on Organizational Aspects of Vaccination

Aim. To analyze the awareness of healthcare workers on the organization of vaccination. Materials and Methods. In 2018 – 2019 sociological survey was conducted among 1384 healthcare workers from 4 Ukrainian regions: 353 primary care physicians, 233 specialized medical care doctors, 88 healthcare managers, 700 nurses, and 10 others. Results. Gaps in the knowledge and beliefs of health professionals associated with the organization of vaccination were founded: less than half of the surveyed health workers understand that vaccination is carried out with any certified vaccine, regardless of the country of origin; a significant part of respondents tend to prescribe drugs not recommended by international guidelines (53.6%), antihistamines (15.9%) and anti-inflammatory (8.0%) drugs before vaccination; do not know about the possibility of doing several vaccinations in one visit (47.3%) and that the cold chain breach affects the effectiveness of the vaccine (52.4%). It was found that the most knowledgeable about the organization of immunoprophylaxis of the population are the health care managers and medical personnel who have passed special training on vaccination vs the least informed specialized medical care doctors. Conclusions. It is necessary to develop a set of scientifically based measures to improve the awareness of health professionals about the organization of vaccination in order to improve the coverage of the population with immunoprophylaxis.

Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned

OBJECTIVE: To investigate, within a private health insurance, the ordering frequency and the costs related to inappropriate TM test orders. METHODS: This study analyzed data regarding TM requests within a private health insurance between 2010 and 2017. Patients included in this analysis were ≥ 50 years old, had available medical records, and had at least 1 TM tested within the study period. Tests were considered inappropriate when TMs were used in screening for neoplasms, ie, when there was no previous diagnosis. We evaluated data regarding age, sex, the ordering physician’s medical specialty, and test costs. RESULTS: Between 2010 and 2017, 1,112 TM tests were performed and increased from 52 to 262 per year. Our sample consisted mostly of women (69.50%) with a mean age of 59.40 (SD, 8.20) years. Most orders were inappropriate (87.80%) and represented 79.40% of all expenses with TM tests. Cardiology professionals were the medical specialty that requested the most TM tests (23.90%), followed by internal medicine specialists (22.70%) and gynecologists (19.20%). CONCLUSIONS: We observed a high percentage of inappropriate test orders in the study period, resulting in elevated costs. Studies of this nature deserve the attention of health care managers, and interventions should be performed in order to reduce the inappropriate use of TM tests in clinical practice.

Management Accounting

Healthcare institutions are business systems that provide different medical products and services to improve the health and quality of life of users of products and services. First of all, this is reflected in the differing complexities of the business, but also of the products and services they offer, as well as the different costs they cause. Thus, some products or services cause high indirect costs, while others require higher direct costs. For health care managers to make the right business decisions, they must continually have timely, quality and truthful information at their disposal. This information is provided by the management accounting of the institutions. This paper aims to present management accounting activities that enable the acquisition of information necessary for decision making.

Evidence-Based Practice in Primary Health Care From The Managerial Point of View: – A National Survey

Background: The vast availability of and demand for evidence in modern primary health care forces clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary health care managers play a key role in implementing these governing documents. Thus, the aim of this article was to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary health care managers.Methods: The study utilized a quantitative method based on a national survey of primary health care managers. The study population was recruited nationally from Sweden and consisted of 186 respondents. The data were analysed using empirically constructed themes and validated using factor analysis. To determine the statistical significance in making comparisons, the chi-square test was utilized. Associations between variables were calculated using Spearman’s correlation. All tests were two-sided, and the significance level was set to 0.05.Results: A majority (97%) of managers stated there was an impact of guidelines and policy documents on primary health care; 84% of managers could see a direct influence in daily practices. Most of the managers (70%) stated that some adaptation had to be made when new evidence was introduced. The managers emphasised the importance of keeping themselves updated and open to new information about work routines (96%). Conclusions: Evidence-based practice has a fundamental impact on Swedish primary health care. The study illustrated a nearly unanimous response about evidence influencing daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date can be seen as a direct result of this. An information-dense organization such as a primary health care organization would have much to gain from cooperation with regional information resources such as clinical libraries.Trial registration: Not applicable.