Sustainable Health Care Systems: An International Study

In many countries, the operation of the healthcare system is an important political issue and any changes to healthcare provision are often fiercely resisted by many stakeholders and can prove difficult to implement. Such changes to the organization and/or financing of healthcare may be necessitated by factors such as the continuing increase in service demands, the development of new medical science advances and the impact of financial and economic austerity across the globe. This paper considers how well the existing healthcare systems in eleven countries and across several continents are coping with various challenges, and looks at potential best practices. The general conclusion is that many such healthcare systems are unsustainable in the longer term and are in urgent need of reform

Meeting the Escalating Demands for Health and Social Care Services of Elderly Populations in Developing Countries: a Strategic Perspective

Population ageing is a phenomenon affecting developed and developing countries alike and represents a major global challenge. This paper is concerned with the impact of ageing populations, in developing countries, on the future provision of health and social care services to the growing elderly population. As well as reviewing previous research and available data, the paper presents the findings of a series of qualitative interviews with policy makers and clinicians in a small number of developing countries in various parts of the world. The paper argues that developing countries cannot expect to see major increases in financial resources available to health and social care for the foreseeable future. Thus, the key issue is establishing how best the available public funding for delivering health and social care services to the elderly can best be used to maximize public value at a time when public services around the world face ongoing austerity measures. The paper focuses on a number of key strategic themes to achieve this which are as follows: the strengthening of public health infrastructure and capabilities; the reconfiguration of existing health systems; a stronger focus on elderly medicine as a distinct specialty; a strengthened role for mobile healthcare, particularly in rural areas; the development of models of generic health and social care assistants; the promotion of community based social care; the utilization of appropriate public/ private health care partnerships

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Managing and Reforming Modern Public Services: The Financial Management Dimension

As government borrowing and debt reaches record levels, public services, for the first time in over 30 years of unprecedented growth in spending, face the prospect of real cuts in their funding In these challenging times, Managing and Reforming Modern Public Services; The Financial Management Dimension shows you how to manage the financial resources of public services most effectively drawing on best practice from both public and private sectors Managing and Reforming Modern Public Services; The Financial Management Dimension considers all public service organisations from central government and local government to trusts and charities with a particular focus on health and education

Sustainable Health Services: An international study

SUSTAINABLE HEALTHCARE SYSTEMS: AN INTERNATIONAL STUDY 5 The funding and configuration of sustainable healthcare continues to attract controversy around the world. In many countries the operation of the healthcare system is an important political issue and any proposed changes to meet emerging challenges are often fiercely resisted and can prove difficult to implement. This report highlights the importance of the issue and reveals how well the existing healthcare systems in 11 countries (Australia, Abu Dhabi, Canada, England, France, Germany, Ghana, India, Malawi, New Zealand, United States) are coping with the challenges of today and tomorrow. Although healthcare systems vary enormously between countries in the way they are configured and financed, the research highlighted that most face similar challenges, such as changing demographics, especially ageing, together with high levels of preventable illness. The changing medical, demographic, technological and economic conditions are creating additional demands on healthcare services at a time when the public are seeking further improvements in both the quality of services provided and scope of treatments available