Demand for hospital emergency departments: a conceptual understanding

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to infl uence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs. DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand. RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship. CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model

The demand for health care in South Africa

Supply-side solutions to health-care provision dominate the South African debate about health care. These solutions are often premised on views that health resources are too concentrated in the private health sector – which supposedly serves only a small minority of the population – and thus public sector provision needs to be expanded. We argue that this rests on a lack of understanding of the nature of the demand for health services. This paper estimates the determinants of the demand for health care using a multinomial logit estimation. It is found that three categories of factors influence the demand for health care. Firstly, demographic and locational variables are significant (e.g. income group, race and where the respondent lives). Secondly, the characteristics of the care provided are important (e.g. cost and distance from the respondent). Finally, the characteristics of the illness (such as its severity) are important. Overall, private health care plays a surprisingly large role in the health care decisions of all South Africans – even poor respondents reveal a clear preference for private health care, despite constraints of money and access. This dominance of the demand for private health care is likely to increase with rising incomes, or if all health services were to receive a similar subsidy (e.g. from mooted medical insurance-type schemes). On a policy level, this would indicate that greater attention should perhaps be given to health demand in considering policy alternatives.health care, South Africa

Long Term Care in Romania

The increasing life expectancy and the alarming growth in the incidence of chronic illness make long term care services in high demand and in dire need of change and innovation. As part of the ANCIEN initiative, which aims to comprise a database of European approaches for dealing with long term care, this document creates an overview of the health systems organized in Romania which target individuals with long term care needs. The method of governance, the people’s needs and the available services are presented herein. For the most part, the services provided in this field are covered through the efforts of the family of those in need and are therefore difficult to quantify or analyze. Public services are either insufficient (in terms of quality or accessibility) and the moral stigma associated to using them prevents families from making this choice. However, due to a high demand and a low supply of high quality LTC services, the private market of nursing homes has exploded in the last few years, funded either privately, through NGOs or external donations. The quality and number of available services has greatly improved but the accessibility is still low. At this moment, Romania still does not have an integrated long term care system neither from the legal or the organization of services being offered. There are social and medical services that are run, provided and legislated independently. The current national strategy is to coordinate these services and to create an integrated system with multidisciplinary teams which would include different types of medical specialists and nurses but still maintain and improve the services offered formally or informally as a home based care package

Unmet Needs of Unaccompanied Minors from Central America: Perceptions of Professionals from Multiple Sectors

Background: In recent years, there has been a significant influx of Central American youth who cross the U.S.-Mexico border without a parent or legal guardian. While federal procedures are established to oversee the treatment and placement of unaccompanied minors, less is known about the needs of unaccompanied minors and available services afterthey are placed in appropriate custody. Methods: Purposive and strategic sampling of professionals from medical, social work, education and legal fields was conducted. Fourteen informants were recruited across the U.S. for confidential semi-structured interviews, which were audio recorded and transcribed in 2016 to 2017. Standard anthropological methods were employed, including immersion and crystallization techniques that incorporated within-case and across-case analytic strategies. Results: Recruited informants had previous or current direct experience working with immigrant minors for three or more years in addition to extensive public health experience. Unaccompanied minors were described as predominantly adolescent boys, ranging from 2 to 18 years old. Children faced unmet mental, medical and psychosocial needs that are interconnected and largely unmet due to children’s legal status and ineligibility to access services in most jurisdictions. The most pressing challenge affecting the health of youth was their immigration status. Across sectors,informants revealed an imbalance between the growing demand for services, including legal counsel, and the limited supply of professionals and well-funded services to meet children’s complex needs. Informants emphasized the value of trauma-informed practice, Spanish language proficiency, child-informed practice and intercultural awareness and humility towards their clients as key features of equipped professionals working with this vulnerable population. Regardless of sector, professionals emphasized the importance of culturally-informed care to immigrant youth. Building these skills is associated with greater confidence to provide services to unaccompanied minors, many of whom have experienced as significant burden of childhood trauma. Conclusions: The health needs of unaccompanied minors are complex and span across medical, social work, education, and legal fields. Interdisciplinary collaboration is needed to address the challenges faced by unaccompanied minors in their efforts to integrate themselves into their new communities and promote their resilience. Promising initiatives include co-location of inter-sector services for increased access and efficiency of services and development of professional trainings and resources for professionals in sectors that serve this population

Facilitating Well-Rounded Clinical Experience for Psychiatric Nurse Practitioner Students

There is a steady increase in demand for mental health services and a lack of providers. Recent societal changes resulting from the COVID-19 pandemic have increased these needs. Psychiatric mental health nurse practitioners (PMHNP) are well suited to offer these services. High-quality clinical PMHNP student experiences are based on well-rounded curricula in a variety of clinical settings. Meeting the need for clinical education and finding high-quality preceptors is especially challenging during the pandemic due to the lack of preceptors and access to care for in-person services. Creative approaches are needed to meet student clinical experience needs

“Render a service worthy of me”: A qualitative study of factors influencing access to LGBTQ-specific health services

For a half-century, LGBTQ-specific health services have sought to address the unmet health care needs of LGBTQ people in the U.S. However, there is a dearth of research examining factors that influence LGBTQ care-seekers’ reasons for choosing LGBTQ-specific services and their experiences accessing care. This interview-based study explored factors that facilitate and inhibit access to LGBTQ-specific health services among a sample of 40 LGBTQ adults in a major U.S. city. Using framework analysis, emergent themes were organized into supply- and demand side factors, guided by Levesque et al.’s (2013) framework for patient-centered health care access. Supply-side factors included provider empathy and affirmation, provider knowledge, comprehensive care, and provider based stigma. Demand-side factors included care-seeker\u27s willingness for self-disclosure, care-seeker beliefs placing primacy on health needs over LGBTQ identities, contentment with general providers, a lack of knowledge for service identification, and perceptions of ability to pay. Social aspects of care seeking were also identified, including desires for social belonging, collective self-esteem, and community solidarity. Findings suggest opportunities to enhance the fit between health care policy, LGBTQ-specific provider characteristics, and care-seeker needs, particularly for multiply marginalized LGBTQ communitie

Perceptions and Demand for Health Insurance services offered under National Health Insurance Fund (NHIF) Scheme among Civil Servants in Tanzania

This paper examines the perceptions and demand for health insurance services offered under NHIF scheme in Tanzania. It examines the perceptions of civil servants, the factors influencing perceptions and their implications to the demand for health insurance services. The study used a cross sectional survey design which allowed collection of data in a particular place at once and within a short time. A sample of 250 civil servants from two strata (secondary school teachers and National Audit Office of Tanzania (NAOT) employees constituting 117 and 133 respectively) was obtained using stratified random sampling technique. The study used descriptive and econometric techniques to analyse the data. The results indicate that age, marital status and education have an influence on the perceptions of the quality of health services. Furthermore, sex, education and distance were found to influence the perceptions on the availability of health services. For the demand for health insurance services, age, sex, education, waiting time and perception on the quality of health services were found to be significant. Moreover, the findings show that most of the respondents (75.6 percent) reported poor health services offered under NHIF scheme. This means majority of the civil servants in Tanzania receive relatively poor health services at the accredited health facilities. The study recommends a review of the Act 8 of 1999 that established NHIF scheme in order to make civil servants enjoy the freedom of choosing the health insurance scheme of their test. It is imperative for the scheme to improve the quality of health services rendered in order to encourage new entrants and preserve customers’ royalty. The services offered should be not only inviting and attractive but also should meet the customers’ needs. To achieve this, the scheme should allow all accredited health facilities with the capacity (in terms of both material and human resources) to offer the services to NHIF customers. Keywords: Health Insurance Services, civil servants, quality of health services, employees’ perceptions, demand for health insurance servic

From "best practice" to "best fit": a framework for designing and analyzing pluralistic agricultural advisory services

"Agricultural advisory services play an important role in supporting the use of the agricultural sector as an engine of pro-poor growth and enabling small farmers to meet new challenges, such as accessing export markets, adopting environmentally sustainable production techniques, and coping with HIV/AIDS and other health challenges that affect agriculture...There is now renewed interest in agricultural advisory services in many countries.... The questions under debate include: What should be the roles of the public sector, private sector, and civil society? How can we ensure that agricultural advisory services are demand-driven and meet the diverse information needs of farmers? How can advisory services be made efficient and financially sustainable? How can we ensure that female farmers, the poor, and other marginalized groups have access to agricultural advisory services?" from Authors' SummaryAgricultural extension work, Pro-poor growth, Capacity strengthening,

Prison health in NHS Greater Glasgow & Clyde : A health needs assessment 2012

Scotland has one of the highest rates of imprisonment in Western Europe and the prison population is rising [1]. In the last decade the average daily prison population in Scotland increased by 27% [1]. The burden of physical and mental illness in the prison population is high; disproportionately so when compared to the general population [2]. This has variably been attributed to socioeconomic disadvantage and lifestyle and behavioural factors such as substance misuse, smoking and poor nutrition which are common in the prison population [2,3]. Prisoners suffer from multiple deprivation [2,3]. Many are a product of the care system, have experienced physical, emotional or sexual abuse and have difficulties forming and maintaining relationships. Levels of educational attainment are low and unemployment high. Homelessness is common. Prior to incarceration prisoners rarely engage with health care services in the community; during imprisonment demand for health care services is high [3,6,7]. Traditionally health care services in Scottish prisons were provided by the Scottish Prisons Service (SPS). On 1st November 2011 responsibility for the provision of health care to prisoners was transferred from SPS to the National Health Service (NHS). The aim of the transfer was to ensure that prisoners received the same standard of care and range of services as offered to the general population according to need. The guiding principle is that of ‘equivalence’ of care. The aim of this Health Needs Assessment (HNA) was to provide a systematic baseline assessment of the health and health care needs of prisoners in NHS Greater Glasgow and Clyde (NHSGGC) and to identify gaps in the current service provision to inform service future planning and development. It focuses on the two operational publicly owned prisons within NHSGGC: HMP Barlinnie and HMP Greenock. A third prison, HMP Low Moss, falls under the remit of NHSGGC but it was under renovation at the time of this HNA. Information about the prison population was drawn from published literature and reports provided by staff from the Justice and Communities Directorate of the Scottish Government. Information about the prisons from HMP Inspectorate reports, direct observation and interviews with members of staff in each prison. To fully understand the level and nature of existing services a service mapping was undertaken jointly with nominated staff from the prison health teams using direct observation and extensive staff and prisoner interviews and focus groups. Overall the findings are in line with other national and international studies on prison health. Despite characteristic differences between the prisons within NHSGGC there was a high level of consensus amongst both prisoners and staff groups about health needs and priorities. The report acknowledges the thoughtful contribution of prison staff and the positive approach to improving health services that they expressed. This has impacted on the formation of recommendations that both validate existing approaches and identify opportunities and 10 priorities for health gain. In addition to more fundamental changes they identify opportunities for quick wins that do not require significant financial outlay