"E-križobolja" - stjecanje znanja o bolnom sindromu putem modernih informacijskih tehnologija

Stjecanje znanja o bolnim sindromima u donjem dijelu kralježnice, koristeći suvremene mogućnosti digitalne komunikacije putem informacijskih tehnologija, upućuje na korištenje naziva "e-križobolja". Križobolja je zdravstvena poteškoća mnogih ljudi razne životne dobi. Razvoj informacijskih tehnologija omogućio je otvoreni pristup stjecanju medicinskog znanja i za korisnike koji nemaju medicinsko obrazovanje. Cilj ovoga rada je putem pregleda literature utvrditi i analizirati mogućnosti korištenja modernih tehnologija u svrhu samopomoći kod križobolje, te neovisno o tome i ispitati kakvi su stavovi bolesnika o korištenju informacijske tehnologije i mogućnosti digitalne komunikacije putem interneta. U istraživanju je sudjelovalo 120 ispitanika prosječne životne dobi 49,25 godina koji su koristili fizioterapijske tretmane u Krapinskim Toplicama. Provedena je analiza rezultata anketnog upitnika o korištenju informacijskih tehnologija i digitalne komunikacije u svrhu korištenja za samopomoć, te napretka u stjecanju novih znanja koja se odnose na križobolju. U ovom radu pregledom literature utvrđeno je da zemlje članice EU, uključujući Hrvatsku uspostavljaju već godinama sustav e-medicine, prateći i prilagođavajući se napretku moderne tehnologije, a rezultati upućuju na to da ispitanici koriste suvremene tehnologije i oblike digitalnih komunikacija u svrhu usvajanja novih znanja i njihove primjene, kako bi postigli bolje rezultate liječenja. Rezultati ukazuju da se stavovi o korištenju informacijskih tehnologija ne razlikuju u odnosu na spol (p > 0,05), pozitivan stav opada s porastom životne dobi, a viša razina obrazovanja iskazuje veće povjerenje u liječenje povjereno zdravstvenom stručnjaku. Na osnovu rezultata proizlazi potreba za uvođenjem dostupnih informacija o bolnom sindromu izdanih od strane stručne i kompetentne osobe

AIDS

Objective:The aim of this study was to evaluate the effectiveness of five intervention strategies - patient navigation, appointment help/alerts, psychosocial support, transportation/appointment accompaniment, and data-to-care on HIV care outcomes among persons with HIV (PWH) who are out of care (OOC).Design:A systematic review with meta-analysis.Methods:We searched CDC\u2019s Prevention Research Synthesis (PRS) Project\u2019s cumulative HIV database to identify intervention studies conducted in the U.S., published between 2000 and 2020 that included comparisons between groups or prepost, and reported at least one relevant outcome (i.e., re-engagement or retention in HIV care, and viral suppression). Effect sizes were meta-analyzed using random-effect models to assess intervention effectiveness.Results:Thirty-nine studies reporting on 42 unique interventions met the inclusion criteria. Overall, intervention strategies are effective in improving re-engagement in care [odds ratio (OR) = 1.79; 95% confidence interval (95% CI): 1.36 \u2013 2.36, k = 14), retention in care (OR = 2.01; 95% CI: 1.64 \u2013 2.64, k = 22), and VS (OR = 2.50; 95% CI: 1.87 \u2013 3.34, k =27). Patient navigation, appointment help/alerts, psychosocial support, and transportation/appointment accompaniment improved all three HIV care outcomes. Data-to-care improved re-engagement and retention but had insufficient evidence for viral suppression.Conclusions:Several strategies are effective for improving HIV care outcomes among PWH who are out of care. More work is still needed for consistent definitions of OCC and HIV care outcomes, better reporting of intervention and cost data, and identifying how best to implement and scale-up effective strategies to engage and retain OOC PWH in care and reach the ending the HIV epidemic goals.CC999999/ImCDC/Intramural CDC HHSUnited States

Health information technology interventions enhance care completion, engagement in HIV care and treatment, and viral suppression among HIV-infected patients in publicly funded settings.

BackgroundThe National HIV/AIDS Strategy (NHAS) emphasizes the use of technology to facilitate coordination of comprehensive care for people with HIV. We examined the effect of six health information technology (HIT) interventions in a Ryan White-funded Special Projects of National Significance (SPNS) on care completion services, engagement in HIV care, and viral suppression.MethodsInterventions included use of surveillance data to identify out-of-care individuals, extending access to electronic health records to support service providers, use of electronic laboratory ordering and prescribing, and development of a patient portal. Data from a sample of electronic patient records from each site were analyzed to assess changes in utilization of comprehensive care (prevention screening, support service utilization), engagement in primary HIV medical care (receipt of services and use of antiretroviral therapy), and viral suppression. We used weighted generalized estimating equations to estimate outcomes while accounting for the unequal contribution of data and differences in the distribution of patient characteristics across sites and over time.ResultsWe observed statistically significant changes in the desired direction in comprehensive care utilization and engagement in primary care outcomes targeted by each site. Five of six sites experienced statistically significant increases in viral suppression.DiscussionThese results provide additional support for the use of HIT as a valuable tool for achieving the NHAS goal of providing comprehensive care for all people living with HIV. HIT has the potential to increase utilization of services, improve health outcomes for people with HIV, and reduce community viral load and subsequent transmission of HIV

Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review.

In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. 'Linkage' studies utilized 11 different outcome definitions, while 'retention' studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework

Fatores que condicionam a retenção nos cuidados de saúde das pessoas com infeção por VIH: revisão sistemática da literatura

RESUMO - Introdução: A infeção por VIH continua a ter uma prevalência e incidência elevadas em todo o mundo. Para se conseguirem melhores resultados em saúde e garantir a supressão virológica, é essencial que as pessoas infetadas mantenham uma vigilância periódica e permanente nos cuidados de saúde, desde o momento do seu diagnóstico. Objetivos: Identificar os fatores que condicionam positiva e negativamente a retenção nos cuidados de saúde das pessoas com infeção por VIH. Metodologia: Realizou-se uma revisão sistemática da literatura com resultados nas bases de dados B-On, PubMed, ScienceDirect e Google Académico. Selecionaram-se os artigos publicados entre 2011 e 2016, com metodologia observacional, realizados em países desenvolvidos e que analisaram os fatores que condicionam a retenção nos cuidados de saúde das pessoas adultas com infeção diagnosticada por VIH. Resultados: Doze artigos cumpriram os critérios de inclusão, todos estudos de coorte. De acordo com os resultados estatisticamente significativos dos estudos analisados, identificaram-se como fatores mais associados à retenção nos cuidados de saúde o sexo masculino, as idades mais velhas, a etnia caucasiana, os homens que têm sexo com homens ou o tratamento com TARc. A não retenção nos cuidados de saúde apresentou maior associação com o sexo feminino, idades mais jovens, etnia negra e categorias de transmissão heterossexual ou pela injeção intravenosa de drogas. Discussão/Conclusões: Existe alguma consistência na evidência científica de que determinadas características demográficas, sociais e clínicas influenciem a retenção nos cuidados de saúde, permitindo-se assim determinar grupos de risco e diferenciar a prestação de cuidados de saúde para prevenir perdas de acompanhamento.ABSTRACT - Introduction: HIV infection continues to have high prevalence and incidence worldwide. In order to achieve better health outcomes and to ensure viral suppression, it is essential to maintain periodic and permanent health surveillance of infected persons, since their diagnosis. Objectives: To identify which factors affect positively and negatively retention in care for HIV infected people. Methods: A systematic review was conducted obtaining results in the B-On, PubMed, ScienceDirect and Google Scholar databases. The selected articles were published between 2011 and 2016, had observational methodology, were conducted in developed countries and analyzed the factors conditioning retention in care in the diagnosed HIV infected adult population. Results: Twelve articles met the inclusion criteria, all cohort studies. According to the statistically significant results of the studies analyzed, the factors generally associated with retention in care were male sex, older ages, white ethnicity, men who have sex with men or treatment with cART. Non-retention in health care showed primarily an association with female sex, younger ages, black ethnicity and heterosexual or intravenous injection of drugs as transmission risk factors. Discussion/Conclusions: There is some consistency in the scientific evidence that certain demographic, social, and clinical characteristics influence retention in health care, thus allowing to identify risk groups and to differentiate care delivery to prevent losses to follow-up

Assessing the readiness of public healthcare facilities to adopt health information technology (hit)/e-health: a case study of Komfo Anokye Teaching Hospital, Ghana

Most health information technology (HIT)/e-Health initiatives in developing countries are still in project phases and few have become part of routine healthcare delivery due to the lack of clear implementation roadmap. Ghana has been piloting a number of e-Health initiatives, which have not guaranteed a sustainable implementation of such systems. The objective of this research study was to explore the information technology (IT) readiness of public healthcare institutions (primary, secondary and tertiary) in Ghana to adopt e-Health in order to develop a standard HIT/e-Health readiness assessment model. For a population of 28,678,251 people there are only 2,615 medical doctors on the Ministry of Health’s (MoH) payroll as at 2013 and 1818 public hospitals. Consequently, the doctor to population ratio is extremely low as compared to other developing countries, which falls far below the WHO revised standard of 1:600. Under these circumstances there is evidence in developed countries that adoption of health informatics technologies can contribute to improving the situation. An extensive review of literature on e-health in developing countries has identified a general lack of adoption due to a lack of readiness to incorporate the technology into the healthcare environment. Literature provides myriad but fragmented models/frameworks of health information technology (HIT)/e-Health adoption readiness assessment limited measuring tools to assess factors of HIT readiness. This risks the outcomes of HIT/e-Health readiness assessment, which eventually limits knowledge about the strategic gaps warranting the need for the implementation of HIT/e-Health systems in public healthcare institutions in Ghana. Whiles previous studies acknowledge the existence of HIT readiness assessment factors, there exist very limited measuring items for these factors. Simply put, there is not just limited studies on HIT readiness assessment, but there is also no standard guiding readiness assessment model. This study has identified the lack of standard assessment model/framework as well as their accompanying measuring tools for effective outcomes as major gaps. Thus, there was the need for gaining a deeper understanding of existing readiness factors and their applicability in the context of the readiness of public healthcare facilities in Ghana and how they promote or impede HIT/e-Health adoption in order to develop standard HIT readiness assessment model, which comprises readiness factors and most importantly their measuring tools. This study used a mixed method approach, specifically the exploratory sequential design (the exploratory design) where the outcome of qualitative data collected from 13 senior health CIOs and leaders of e-Health initiatives in Ghana analysed built to quantitative data collection instrument. The survey instrument was used to collect quantitative data from 298 clinical and non-clinical staff (Administration/Management leadership) Komfo Anokye Teaching Hospital (KATH) in a form of case study to confirm the findings of the initial exploratory study. This was because the mixed method is rooted in the pragmatism of philosophical assumptions, which guide the direction of the collection and analysis of data and the mixture of qualitative and quantitative approaches in many phases of the research process. Furthermore, mixed research methods design strategy provides a powerful mechanism for IS researchers in dealing with the rapidly changing environment of ICT. An initial standard regression analysis using IBM SPSS version 23 established that five factors (Technology readiness (TR); Operational resource readiness (ORR); Organizational cultural readiness (OCR); Regulatory policy readiness (RPR); and Core readiness (CR)) and 63 indicators (measuring tools) promote and/or impede HIT/e-Health adoption readiness in public healthcare facilities in Ghana. Consequently, these factors were used in developing a standard HIT readiness assessment model. Whiles these five factors all proved to have strong association with the dependent variable Health Information Technology readiness (HITR) in the standard regression, (R2 = 0.971) the findings of a latter PLS-SEM, an advanced regression analysis deployed suggest that Regulatory policy readiness (RPR) and remarkably Core readiness (CR) did not impact on the readiness of KATH to adopt e-Health/HIT. As many public healthcare organizations in Ghana have already begun the process of implementing various HIT/e-Health systems without any reliable HIT/e-Health regulatory policy in place, there is a critical need for reliable HIT/e-Health regulatory policies (RPR) and some improvement in HIT/e-Health strategic planning (core readiness). The final model (R2 = 0.558 and Q2= 0.378) suggest that TR, ORR, and OCR explained 55.8% of the total amount of variance in health information technology/e-Health readiness in the case of KATH, partially supporting the hypotheses of this study. Although no formal hypotheses were proposed for the relationships/effects, which exist between exogenous/independent constructs in the model structure, the SmartPLS3 model path analysis did show that there exist such relationships. For instance, the significant paths from regulatory policy readiness (RPR) to organizational resource readiness (ORR) (t = 23.891; Beta = 0.774) and from technological readiness (TR) to operational resource readiness (ORR) (t = 11.667; Beta = 0.624) obtained from SmartPLS3 bootstrap procedure indicate the presence of mediation. Fit values (SRMR = 0.054; NFI = 0.739). Generally, the GoF for this SEM are encouraging and can substantially be improved when public healthcare facilities in Ghana intending to implement HIT/e-Health pay equal attention to relevant regulatory policies and strategic planning. The readiness assessment model developed this study essentially offers a useful basis for healthcare organizations to enhance the conditions under which HIT/eHealth is launched in order to achieve successful and sustainable adoption with particularly attention being paid to HIT/e-Health regulatory policies and strategic planning. When evaluations such as this are carried out effectively, there could be a circumvention of large losses in money effort and time, delays and disappointments among planners, staff and users of services whiles facilitating the process of change in the institutions and communities involved. This study was conducted with selected subjects and selected public healthcare facilities in the southern cities/parts of Ghana. Therefore, a replication or transfer of this study to other parts of Ghana especially the rural areas and the private healthcare environment should consider the potential differences resulting from varying cultural, socioeconomic and political backgrounds since healthcare is a much-institutionalised industry. The same caution must be exercise when replicating this study in other developing countries and across the globe

Assessing the readiness of public healthcare facilities to adopt health information technology (hit)/e-health: a case study of Komfo Anokye Teaching Hospital, Ghana

Most health information technology (HIT)/e-Health initiatives in developing countries are still in project phases and few have become part of routine healthcare delivery due to the lack of clear implementation roadmap. Ghana has been piloting a number of e-Health initiatives, which have not guaranteed a sustainable implementation of such systems. The objective of this research study was to explore the information technology (IT) readiness of public healthcare institutions (primary, secondary and tertiary) in Ghana to adopt e-Health in order to develop a standard HIT/e-Health readiness assessment model. For a population of 28,678,251 people there are only 2,615 medical doctors on the Ministry of Health’s (MoH) payroll as at 2013 and 1818 public hospitals. Consequently, the doctor to population ratio is extremely low as compared to other developing countries, which falls far below the WHO revised standard of 1:600. Under these circumstances there is evidence in developed countries that adoption of health informatics technologies can contribute to improving the situation. An extensive review of literature on e-health in developing countries has identified a general lack of adoption due to a lack of readiness to incorporate the technology into the healthcare environment. Literature provides myriad but fragmented models/frameworks of health information technology (HIT)/e-Health adoption readiness assessment limited measuring tools to assess factors of HIT readiness. This risks the outcomes of HIT/e-Health readiness assessment, which eventually limits knowledge about the strategic gaps warranting the need for the implementation of HIT/e-Health systems in public healthcare institutions in Ghana. Whiles previous studies acknowledge the existence of HIT readiness assessment factors, there exist very limited measuring items for these factors. Simply put, there is not just limited studies on HIT readiness assessment, but there is also no standard guiding readiness assessment model. This study has identified the lack of standard assessment model/framework as well as their accompanying measuring tools for effective outcomes as major gaps. Thus, there was the need for gaining a deeper understanding of existing readiness factors and their applicability in the context of the readiness of public healthcare facilities in Ghana and how they promote or impede HIT/e-Health adoption in order to develop standard HIT readiness assessment model, which comprises readiness factors and most importantly their measuring tools. This study used a mixed method approach, specifically the exploratory sequential design (the exploratory design) where the outcome of qualitative data collected from 13 senior health CIOs and leaders of e-Health initiatives in Ghana analysed built to quantitative data collection instrument. The survey instrument was used to collect quantitative data from 298 clinical and non-clinical staff (Administration/Management leadership) Komfo Anokye Teaching Hospital (KATH) in a form of case study to confirm the findings of the initial exploratory study. This was because the mixed method is rooted in the pragmatism of philosophical assumptions, which guide the direction of the collection and analysis of data and the mixture of qualitative and quantitative approaches in many phases of the research process. Furthermore, mixed research methods design strategy provides a powerful mechanism for IS researchers in dealing with the rapidly changing environment of ICT. An initial standard regression analysis using IBM SPSS version 23 established that five factors (Technology readiness (TR); Operational resource readiness (ORR); Organizational cultural readiness (OCR); Regulatory policy readiness (RPR); and Core readiness (CR)) and 63 indicators (measuring tools) promote and/or impede HIT/e-Health adoption readiness in public healthcare facilities in Ghana. Consequently, these factors were used in developing a standard HIT readiness assessment model. Whiles these five factors all proved to have strong association with the dependent variable Health Information Technology readiness (HITR) in the standard regression, (R2 = 0.971) the findings of a latter PLS-SEM, an advanced regression analysis deployed suggest that Regulatory policy readiness (RPR) and remarkably Core readiness (CR) did not impact on the readiness of KATH to adopt e-Health/HIT. As many public healthcare organizations in Ghana have already begun the process of implementing various HIT/e-Health systems without any reliable HIT/e-Health regulatory policy in place, there is a critical need for reliable HIT/e-Health regulatory policies (RPR) and some improvement in HIT/e-Health strategic planning (core readiness). The final model (R2 = 0.558 and Q2= 0.378) suggest that TR, ORR, and OCR explained 55.8% of the total amount of variance in health information technology/e-Health readiness in the case of KATH, partially supporting the hypotheses of this study. Although no formal hypotheses were proposed for the relationships/effects, which exist between exogenous/independent constructs in the model structure, the SmartPLS3 model path analysis did show that there exist such relationships. For instance, the significant paths from regulatory policy readiness (RPR) to organizational resource readiness (ORR) (t = 23.891; Beta = 0.774) and from technological readiness (TR) to operational resource readiness (ORR) (t = 11.667; Beta = 0.624) obtained from SmartPLS3 bootstrap procedure indicate the presence of mediation. Fit values (SRMR = 0.054; NFI = 0.739). Generally, the GoF for this SEM are encouraging and can substantially be improved when public healthcare facilities in Ghana intending to implement HIT/e-Health pay equal attention to relevant regulatory policies and strategic planning. The readiness assessment model developed this study essentially offers a useful basis for healthcare organizations to enhance the conditions under which HIT/eHealth is launched in order to achieve successful and sustainable adoption with particularly attention being paid to HIT/e-Health regulatory policies and strategic planning. When evaluations such as this are carried out effectively, there could be a circumvention of large losses in money effort and time, delays and disappointments among planners, staff and users of services whiles facilitating the process of change in the institutions and communities involved. This study was conducted with selected subjects and selected public healthcare facilities in the southern cities/parts of Ghana. Therefore, a replication or transfer of this study to other parts of Ghana especially the rural areas and the private healthcare environment should consider the potential differences resulting from varying cultural, socioeconomic and political backgrounds since healthcare is a much-institutionalised industry. The same caution must be exercise when replicating this study in other developing countries and across the globe