Developing a new understanding of enabling health and wellbeing in Europe: harmonising health and social care delivery and informatics support to ensure holistic care

Europe faces significant challenges to its health and care services due to demographic change, being at the beginning of a large and continuing rise in the number and proportion of older citizens, while advances in healthcare mean that an increasing number of these and other adults will have enduring chronic health conditions. But for all citizens with actual or potential health problems, the maintenance of optimal health depends not just on healthcare services, but on support for nutrition, hygiene, mobility and shopping, socialisation, warm dry housing and other aspects of daily living, as without these health will be compromised and deteriorate. This demand surge is happening at a time when Information and Communication Technologies (ICT) are increasingly being used in other service sectors to enable consumer customisation and better resource management. An objective for all health systems, and for patients, is to minimise hospital stays and maximise care at home, but hitherto the practical need to observe the patient's state of health has extended hospital stays. Similarly there is a drive to minimise for quality of life and economic reasons admission to long-term institutional care and instead extend support to enable living at home. Traditionally any support needed by an individual has normally been provided by family members, often assisted by the local community, while social services have been the fall back provider when the family cannot support, either by direct provision or by mobilising specific services such as delivered hot meals. Housing agencies and other bodies have also had an important role. However, other demographic changes are significantly reducing the capacity of families to provide daily ongoing support. This means that health services are increasingly providing long-term monitoring and support to those living with chronic disease and frailty, while social services are increasingly needed to provide ongoing support. Many individual citizens are necessarily in receipt of both health and social care support, yet in all but a very few European countries these services are provided quite independently one from another, with minimal day to day liaison. A number of drivers for change are now necessitating significant change, and the social sciences have a key role to play in enabling successful progress. At a macro level, across Europe the combination of the economic downturn and the demographic-led increase in demand means that health and social care services are under ever increasing pressures, while constant growth of services is not affordable nor will the labour market support ever continuing expansion. This paper presents the case for systematic research activity in the social sciences, at European and national levels, to further the interlinked citizen- focused objectives of:close integration at delivery level of health care and social care support of individual's health, personalisation of care delivery including reasonable accommodation of individual choice, ensuring effective use of ICT applications based on user acceptability, bringing processes of consent, delegation, representation, coordination and privacy into the electronic era, ensuring respect for and teamwork with formal carers and the informal care team, ensuring equity in an electronic era regardless of digital literacy, assets and connectivity, examining stable and sustainable models of trusted infrastructure provision, establishing governance, authentication, management, and sustainability principles

Migration and Health Systems performance in low- and middle- income countries

Increased migration is one of the main challenges impacting on health system performance. The World Health Organisation (WHO) framed responsiveness, fair financing, and equity as the intrinsic goals of a health system. In line with this framework, we attempted to map existing research on migration and health system performance. A qualitative systematic review was conducted. We followed the processes indicated for evidence mapping synthesis reviews, which included choosing the scope and research topic, searching, and selecting evidence, reporting findings, and identifying the evidence. We improved the primary review by first performing a brief scoping review, which served as the analytical basis for the systematic review extraction process. Articles found during the scoping review were evaluated again during the bigger systematic review phase. We refined the study's eligibility criteria as well as the data extraction items. Seventy-two articles were considered for the review. Out of this total (55/72) were published between 2016 and 2021. Our analysis showed fairness in financing, weak governance and leadership, the absence of a universally acceptable definition of migration, limited access of migrants to healthcare, equity, health worker attitude towards migrants, dignity, and health care quality to migrants as key challenges that affect health system performance. The mapping exercise shows more literature on migration and health system performance, but also shows gaps requiring urgent attention, including integration of the health system goals in implementing health interventions. We conclude that countries are recognising the challenges of migration on health system performance. Migration is slowly being included in national health policies in low- and middle- income countries, however challenges to implementation of such policies exist. Migration is recognised as a human right and the ethical obligation of health institutions. More agenda setting and funding for bridging work on migration and health system performance is recommended

An ontology co-design method for the co-creation of a continuous care ontology

Ontology engineering methodologies tend to emphasize the role of the knowledge engineer or require a very active role of domain experts. In this paper, a participatory ontology engineering method is described that holds the middle ground between these two 'extremes'. After thorough ethnographic research, an interdisciplinary group of domain experts closely interacted with ontology engineers and social scientists in a series of workshops. Once a preliminary ontology was developed, a dynamic care request system was built using the ontology. Additional workshops were organized involving a broader group of domain experts to ensure the applicability of the ontology across continuous care settings. The proposed method successfully actively engaged domain experts in constructing the ontology, without overburdening them. Its applicability is illustrated by presenting the co-created continuous care ontology. The lessons learned during the design and execution of the approach are also presented

Evidence of School Nursing Impact: Applying the Omaha System to Individual Healthcare Plans (IHPs) to Document Nursing Services and Demonstrate Student Outcomes

School nurses are the health safety net for children and youth including the one in five who have chronic health conditions. As health care providers in a non-health system, school nurses are challenged to legitimize their role by showing impact on the health and education of children and youth. The Omaha System is a standardized nursing language that has the capacity to document nursing assessment, intervention and client outcomes and is used in clinical and community settings. This study examined the feasibility of using the Omaha System in the school setting. While there would be significant logistical hurdles and a steep learning curve, expert school nurses found the Omaha System to be workable and potentially useful in their practice

Access and utilization of public and private Primary Health Care among adults and elderly people with chronic condition(s) in Albania

The burden of disease due to Non-Communicable Diseases (NCDs) is globally on the rise. Primary Health Care (PHC) services can contribute to NCD control and hold an important role. This dissertation provides insights into patient access and the perceived quality of care among 23 public and five private providers in two regions of Albania. Additionally, healthcare-seeking behaviors and Out-of-Pocket payment of the population suffering from NCDs were investigated through a household survey among nearly 1000 chronically ill. The findings show that users of public and private providers have similar views on the quality of non-clinical care. However, prompt attention and coordination of care need additional improvement. While most elderly people visited a PHC to initiate treatment (and follow-up) of their chronic conditions, adults (aged 18–59) initiated and sought regular NCD care at a hospital level through self-referral, bypassing PHC services. Out-of-pocket payments by NCD patients remain important and relate principally to purchasing prescribed drugs. Fostering the health literacy of patients and caregivers in NCD prevention, management, and control through the PHC level is essential, along with establishing well-structured referral mechanisms. Active engagement of local decision-makers is needed

An overview of the research evidence on ethnicity and communication in healthcare

• The aim of the present study was to identify and review the available research evidence on 'ethnicity and communication' in areas relevant to ensuring effective provision of mainstream services (e.g. via interpreter, advocacy and translation services); provision of services targeted on communication (e.g. speech and language therapy, counselling, psychotherapy); consensual/ participatory activities (e.g. consent to interventions), and; procedures for managing and planning for linguistic diversity

An Exploration of Trends in Patient Health Data Safety Concerns: Does Heterogeneity Matter?

There have been ongoing discussions on threats to patients' electronic health information/records (EHR). This study aims to examine the 1) trend in electronic data safeguard concerns and 2) factors associated with such perceptions. Using the Health Information National Trends Survey (HINTS) data from 2014, 2017, and 2018, the study analyzed 7527 patients (representing approximately, 175 million US adult subjects) for their perceptions on information safeguard and withholding information from providers due to privacy/security. About 24%, 24%, and 15% respondents reported not confident about data safeguard in 2014, 2017, and 2018, respectively. A large population is not firmly confident about data safety and many would withhold information. Although there is a significant trend in improvement of safeguard concerns, there is patient characteristics-related heterogeneity and there are communication quality effects on adverse outcomes of privacy/security concerns. The results will be useful for improving patient utilization of EHRs benefiting patients or healthcare systems

The challenges of urban family physician program over the past decade in Iran: a scoping review and qualitative study with policy-makers

Introduction: Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods: This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (Organization, financing, payment, regulation, and behavior).  Results: The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion: Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran