Does a public single payer system deliver integrated care? A national survey study among professional stakeholders in Denmark

Background: Integrated health care delivery is a goal of health care systems; to date there has been limited information on the integration of medical care in practice. Purpose: To examine and compare perceptions of clinical integration and to identify associated strategic, cultural, technical and structural factors. Design and setting: A national survey addressed to: all county administrative managers (n=15); all hospital managers (n=44); and randomized selected samples of hospital department physician managers (n=200) and general practitioners (n=700) in Denmark. Results: Several initiatives have been implemented in Denmark to integrate care. Nevertheless, most physicians agree that only half of all patients experience well coordinated pathways. Clinical integration is a strategic priority at the managerial levels, but this is not visible at the functional levels. Financial incentives are not used to encourage coordination. The information communication technology to facilitate clinical integration is perceived to be inadequate. Conclusion: The scope for improvement is high due to the structural composition of the system. Increased managerial stewardship, alignment of the financial incentives, and expanded use of information communication technology to link sub-organisations will be a way to move the system forward to meet its explicit goal of providing an integrated delivery of services

Measurement of integrated healthcare delivery: a systematic review of methods and future research directions

Background: Integrated healthcare delivery is a policy goal of healthcare systems. There is no consensus on how to measure the concept, which makes it difficult to monitor progress. <br><br> Purpose: To identify the different types of methods used to measure integrated healthcare delivery with emphasis on structural, cultural and process aspects. <br><br> Methods: Medline/Pubmed, EMBASE, Web of Science, Cochrane Library, WHOLIS, and conventional internet search engines were systematically searched for methods to measure integrated healthcare delivery (published – April 2008). <br><br> Results: Twenty-four published scientific papers and documents met the inclusion criteria. In the 24 references we identified 24 different measurement methods; however, 5 methods shared theoretical framework. The methods can be categorized according to type of data source: a) questionnaire survey data, b) automated register data, or c) mixed data sources. The variety of concepts measured reflects the significant conceptual diversity within the field, and most methods lack information regarding validity and reliability. <br><br> Conclusion: Several methods have been developed to measure integrated healthcare delivery; 24 methods are available and some are highly developed. The objective governs the method best used. Criteria for sound measures are suggested and further developments should be based on an explicit conceptual framework and focus on simplifying and validating existing methods

Fænomenet Hillary

Intet resum

Access to healthcare and alternative health-seeking strategies among undocumented migrants in Denmark

<p>Abstract</p> <p>Background</p> <p>As in many European countries, undocumented migrants in Denmark have restricted access to healthcare. The aim of this study is to describe and analyse undocumented migrants' experiences of access to healthcare, use of alternative health-seeking strategies; and ER nurses' experiences in encounters with undocumented migrants.</p> <p>Methods</p> <p>Qualitative design using semi-structured interviews and observations. The participants included ten undocumented South Asian migrants and eight ER nurses.</p> <p>Results</p> <p>Undocumented migrants reported difficulties accessing healthcare. The barriers to healthcare were: limited medical rights, arbitrariness in healthcare professionals' attitudes, fear of being reported to the police, poor language skills, lack of network with Danish citizens, lack of knowledge about the healthcare system and lack of knowledge about informal networks of healthcare professionals. These barriers induced alternative health-seeking strategies, such as self-medication, contacting doctors in home countries and borrowing health insurance cards from Danish citizens. ER nurses expressed willingness to treat all patients regardless of their migratory status, but also reported challenges in the encounters with undocumented migrants. The challenges for ER nurses were: language barriers, issues of false identification, insecurities about the correct standard procedures and not always being able to provide appropriate care.</p> <p>Conclusions</p> <p>Undocumented migrants face formal and informal barriers to the Danish healthcare system, which lead to alternative health-seeking strategies that may have adverse effects on their health. This study shows the need for policies and guidelines, which in accordance with international human rights law, ensure access to healthcare for undocumented migrants and give clarity to healthcare professionals.</p

Issues to Consider When Measuring and Applying Socioeconomic Position Quantitatively in Immigrant Health Research

The relationship between migration and health is complex, yet, immigrant-related inequalities in health are largely influenced by socioeconomic position. Drawing upon previous findings, this paper discusses issues to consider when measuring and applying socioeconomic position in quantitative immigrant health research. When measuring socioeconomic position, it is important to be aware of four aspects: (1) there is a lack of clarity about how socioeconomic position should be measured; (2) different types of socioeconomic position may be relevant to immigrants compared with the native-born population; (3) choices of measures of socioeconomic position in quantitative analyses often rely on data availability; and (4) different measures of socioeconomic position have different effects in population groups. Therefore, caution should be used in the collection, presentation, analyses, and interpretation of data and researchers need to display their proposed conceptual models and data limitations as well as apply different approaches for analyses

Warum wird im extramuralen Pflegebereich noch auf Papier dokumentiert und wie kann das geändert werden?

Die folgende Arbeit untersucht die hinderlichen Faktoren bei der Einführung von elektronischen Dokumentationssystemen im extramuralen Pflegebereich. Durch eine ausführliche Literaturrecherche werden die Anforderungen und Aufgaben an die Dokumentation beschrieben und die aktuellen Erkenntnisse aus dem Einsatz elektronischer Dokumentation zusammengefasst. Auf Basis des ITAM und des PARiSH Modell wird ein Leitfaden erstellt, mit dessen Hilfe ExpertInnen der Pflege und des Managements des Hilfswerk Österreich und der MIK OG (Wien) zur elektronischen Dokumentation befragt werden. Aus den Ergebnissen dieser Leitfadeninterviews werden die Faktoren beschrieben, die Implementation von elektronischen Dokumentationssystemen verhindern. Nach der Auswertung der Interviews zeigte sich, dass sich die allgemein hinderlichen Faktoren aus der Literatur ebenfalls für den extramuralen Bereich zutreffen. So sind vor allem die Finanzierung der Umstellung und die Unterstützung des Pflegeprozesses sowie die Heterogenität des Pflegepersonals entscheidende Faktoren bei der Einführung von elektronischen Dokumentationssystemen

Quality of life in children and youth with cerebral palsy

Istraživanje je obuhvatilo primenu generičkog upitnika (Kiddy-KINDL, Kid-KINDL, Kiddo-KINDL i verzije za roditelje Kiddy-KINDL i KINDL), bolest-specifičnog upitnika (CPQOL-Child i CPQOL-verzija za roditelje), kao i upitnika za procenu porodičnog kvaliteta života dece sa cerebralnom paralizom (Family quality of life survey. Main caregivers of people with intellectual or developmental disabilities). Analizom je obuhvaćeno 70. dece i omladine sa cerebralnom paralizom i njihovih roditelja. Kvalitet života dece sa CP uzrasta 4-17 godina, ispitan generičkim upitnikom ne pokazuje statistički značajne razlike u svim ispitivanim domenima bez obzira na nivo motoričkog onesposobljenja prema GMFCS. Kvalitet života sa aspekta roditelja ispitan generičkim upitnikom pokazuje da deca uzrasta 3-6 godina sa CP nivoa I-II prema GMFCS, imaju statistički značajno bolji kvalitet života u domenu zdravstvenog i emocionalnog stanja, samopoštovanja i socijalnog života, dok deca uzrasta 7-17 godina imaju statistički značajno bolji kvalitet života samo u domenu emocionalnog stanja. Ova razlika se može objasniti činjenicom da su roditelji starije dece sa CP prošli kroz proces prihvatanja bolesti tokom vremena. Kvalitet života dece sa CP uzrasta 8-12 godina, ispitan bolest-specifičnim upitnikom ne pokazuje statistički značajne razlike u svim ispitivanim domenima bez obzira na nivo motoričkog onesposobljenja prema GMFCS. Kvalitet života sa aspekta roditelja ispitan bolest-specifičnim upitnikom pokazuje da deca uzrasta 4-12 godina sa CP nivoa I-II prema GMFCS, imaju statistički značajno bolji kvalitet života u domenima: socijalno blagostanje i prihvatanje, osećanje o funkcionisanju, učešće i fizičko zdravlje, kao i bol i uticaj invalidnosti. Nema razlike u stavu deteta i roditelja u domenima kvaliteta života mereno generičkim upitnikom. Međutim, upotrebom bolest-specifičnog upitnika dobija se podatak da roditelji ocenjuju kvalitet života deteta značajno lošije u domenima: osećaj o funkcionisanju, kao i učešće i fizičko zdravlje. Roditelji dece sa CP nivoa I-II prema GMFCS navode bolji kvalitet porodičnog života u odnosu na roditelje dece nivoa III-V prema GMFCS, ali bez statističke značajnosti. Analizom ispitivanih dimenzija domena u sumarnoj skali utvrđeno je da je roditeljima najvažnija dimenizija značaj porodičnog kvaliteta života. Ostale ispitivane dimenzije domena (mogućnost, inicijativa, postignuće, stabilnost i zadovoljstvo) bile su niže ocenjene u odnosu na dimenziju značaj, a međusobno su bile ujednačene. Za procenu kvaliteta života kod dece sa CP ipak se preporučuje upotreba bolest-specifičnog upitnika u cilju detektovanja domena od interesa, kako bi se pravovremenom akcijom zdravstenih profesionalaca, podrškom na nivou zajednice, kao i društva u celini, uklonile poteškoće i omogućio kvalitetan život detetu sa cerebralnom paralizom i njegovoj porodici.The study included the use of generic questionnaire (Kiddy-KINDL, Kid-KINDL, Kiddo-KINDL versions for parents Kiddy-KINDL and KINDL), a disease-specific questionnaire (CPQOL-Child and CPQOL-version for parents), as well as the questionnaire for evaluation of family quality of life of children with cerebral palsy (FQOL-DD). The analysis included 70 children and youth with cerebral palsy and their parents. The quality of life of children with CP aged 4-17 years, examined by a generic questionnaire, shows no statistically significant differences in any investigated domains regardless of the level of motor disability according to GMFCS. The quality of life from the parent aspect obtained by the generic questionnaire shows that children aged 3-6 years with CP levels I-II GMFCS, had a significantly better quality of life related to health and emotional status, self-esteem and social life, while children aged 7-17 years had a significantly better quality of life only in the domain of emotional state. This difference can be explained by the fact that parents of older children with CP had the time to pass through the process of accepting the disease. The quality of life of children with CP aged 8-12 years, examined by the disease-specific questionnaire, shows no statistically significant differences in any investigated domains regardless of the level of motor disability according to GMFCS. The quality of life from the parent aspect according to the disease-specific questionnaire shows that children aged 4 -12 years with CP levels I-II GMFCS had a significantly better quality of life in following domains: social well-being and acceptance, feeling of functioning, participation and physical health, as well as the pain impact and disability. There is no difference in the attitude of the child and parents in the domains of quality of life as measured by the generic questionnaire. However, by using disease-specific questionnaires it is clear that parents assess the quality of life of the child significantly worse in the following domains: a sense of functioning, of participation and physical health. Parents of children with CP levels I-II GMFCS report better quality of family life in comparison to the parents of children with level III-V GMFCS, but without statistical significance. By the analysis of the dimensions of domains tested in the aggregate scale it was found that for parents the most important dimension was the family quality of life. Other tested dimensions of domains (the ability, initiative, achievement, stability and satisfaction) were assessed lower in comparison to the dimension of the importance, and they were equable. For assessment of the quality of life in children with CP the use of disease-specific questionnaires is recommended in order to detect domains of interest, with the aim to introduce timely action of health professionals, support at the community level and in a society as a whole, as well as to remove difficulties and facilitate quality of life for the children with cerebral palsy and their families

Quality of life in children and youth with cerebral palsy

Istraživanje je obuhvatilo primenu generičkog upitnika (Kiddy-KINDL, Kid-KINDL, Kiddo-KINDL i verzije za roditelje Kiddy-KINDL i KINDL), bolest-specifičnog upitnika (CPQOL-Child i CPQOL-verzija za roditelje), kao i upitnika za procenu porodičnog kvaliteta života dece sa cerebralnom paralizom (Family quality of life survey. Main caregivers of people with intellectual or developmental disabilities). Analizom je obuhvaćeno 70. dece i omladine sa cerebralnom paralizom i njihovih roditelja. Kvalitet života dece sa CP uzrasta 4-17 godina, ispitan generičkim upitnikom ne pokazuje statistički značajne razlike u svim ispitivanim domenima bez obzira na nivo motoričkog onesposobljenja prema GMFCS. Kvalitet života sa aspekta roditelja ispitan generičkim upitnikom pokazuje da deca uzrasta 3-6 godina sa CP nivoa I-II prema GMFCS, imaju statistički značajno bolji kvalitet života u domenu zdravstvenog i emocionalnog stanja, samopoštovanja i socijalnog života, dok deca uzrasta 7-17 godina imaju statistički značajno bolji kvalitet života samo u domenu emocionalnog stanja. Ova razlika se može objasniti činjenicom da su roditelji starije dece sa CP prošli kroz proces prihvatanja bolesti tokom vremena. Kvalitet života dece sa CP uzrasta 8-12 godina, ispitan bolest-specifičnim upitnikom ne pokazuje statistički značajne razlike u svim ispitivanim domenima bez obzira na nivo motoričkog onesposobljenja prema GMFCS. Kvalitet života sa aspekta roditelja ispitan bolest-specifičnim upitnikom pokazuje da deca uzrasta 4-12 godina sa CP nivoa I-II prema GMFCS, imaju statistički značajno bolji kvalitet života u domenima: socijalno blagostanje i prihvatanje, osećanje o funkcionisanju, učešće i fizičko zdravlje, kao i bol i uticaj invalidnosti. Nema razlike u stavu deteta i roditelja u domenima kvaliteta života mereno generičkim upitnikom. Međutim, upotrebom bolest-specifičnog upitnika dobija se podatak da roditelji ocenjuju kvalitet života deteta značajno lošije u domenima: osećaj o funkcionisanju, kao i učešće i fizičko zdravlje. Roditelji dece sa CP nivoa I-II prema GMFCS navode bolji kvalitet porodičnog života u odnosu na roditelje dece nivoa III-V prema GMFCS, ali bez statističke značajnosti. Analizom ispitivanih dimenzija domena u sumarnoj skali utvrđeno je da je roditeljima najvažnija dimenizija značaj porodičnog kvaliteta života. Ostale ispitivane dimenzije domena (mogućnost, inicijativa, postignuće, stabilnost i zadovoljstvo) bile su niže ocenjene u odnosu na dimenziju značaj, a međusobno su bile ujednačene. Za procenu kvaliteta života kod dece sa CP ipak se preporučuje upotreba bolest-specifičnog upitnika u cilju detektovanja domena od interesa, kako bi se pravovremenom akcijom zdravstenih profesionalaca, podrškom na nivou zajednice, kao i društva u celini, uklonile poteškoće i omogućio kvalitetan život detetu sa cerebralnom paralizom i njegovoj porodici.The study included the use of generic questionnaire (Kiddy-KINDL, Kid-KINDL, Kiddo-KINDL versions for parents Kiddy-KINDL and KINDL), a disease-specific questionnaire (CPQOL-Child and CPQOL-version for parents), as well as the questionnaire for evaluation of family quality of life of children with cerebral palsy (FQOL-DD). The analysis included 70 children and youth with cerebral palsy and their parents. The quality of life of children with CP aged 4-17 years, examined by a generic questionnaire, shows no statistically significant differences in any investigated domains regardless of the level of motor disability according to GMFCS. The quality of life from the parent aspect obtained by the generic questionnaire shows that children aged 3-6 years with CP levels I-II GMFCS, had a significantly better quality of life related to health and emotional status, self-esteem and social life, while children aged 7-17 years had a significantly better quality of life only in the domain of emotional state. This difference can be explained by the fact that parents of older children with CP had the time to pass through the process of accepting the disease. The quality of life of children with CP aged 8-12 years, examined by the disease-specific questionnaire, shows no statistically significant differences in any investigated domains regardless of the level of motor disability according to GMFCS. The quality of life from the parent aspect according to the disease-specific questionnaire shows that children aged 4 -12 years with CP levels I-II GMFCS had a significantly better quality of life in following domains: social well-being and acceptance, feeling of functioning, participation and physical health, as well as the pain impact and disability. There is no difference in the attitude of the child and parents in the domains of quality of life as measured by the generic questionnaire. However, by using disease-specific questionnaires it is clear that parents assess the quality of life of the child significantly worse in the following domains: a sense of functioning, of participation and physical health. Parents of children with CP levels I-II GMFCS report better quality of family life in comparison to the parents of children with level III-V GMFCS, but without statistical significance. By the analysis of the dimensions of domains tested in the aggregate scale it was found that for parents the most important dimension was the family quality of life. Other tested dimensions of domains (the ability, initiative, achievement, stability and satisfaction) were assessed lower in comparison to the dimension of the importance, and they were equable. For assessment of the quality of life in children with CP the use of disease-specific questionnaires is recommended in order to detect domains of interest, with the aim to introduce timely action of health professionals, support at the community level and in a society as a whole, as well as to remove difficulties and facilitate quality of life for the children with cerebral palsy and their families