Utilising digital health to improve medication-related quality of care for hypertensive patients:An integrative literature review

BACKGROUND Hypertension or high blood pressure is considered as a significant contributor and risk factor to many serious conditions,approximately 1.13 billion people have hypertension globally.However,the integrated technologies can upscale health provisions and improve the effectiveness of the healthcare system.WHO has recommended that the digital health interventions(DHIs)and the Health System Challenges should be used in tandem in addressing health.AIM To summarise the outcomes from a range of research which investigated the use of DHI to improve the medication-related quality of care(MRQOC)for hypertensive patients.METHODS An integrative literature review was undertaken in October 2019 using the Medline,Cumulative Index of Nursing and Allied Health Literature,and Scopus databases for publications in English with no date limit.RESULTS In total,18433 participants were included in this review from 28 studies meeting the eligibility criteria.There were 19 DHI identified within eight countries:Australia,Canada,India,South Korea,Lebanon,Pakistan,the United Kingdom,and the United States of America.The DHI were provided as community-based,clinical-based and home-based program through mobile phone,mobile health system,short message service,and telehealth,digital medicine,and online healthcare(web-based).The mean age of participants was 59 ranging from 42 to 81 years with an average mean systolic blood pressure of 143.3 mmHg at baseline,ranging from 129.0 mmHg to 159.0 mmHg.The proportion of male participants ranged from 13.9%to 92.0%.Eighteen interventions showed evidence of reduction in blood pressure and improvement of self-management in relation to medication adherence and blood pressure control.The reduction of systolic blood pressure ranged between 1.9 mmHg and 26.0 mmHg,with a mean of 10.8 mmHg.The digital health was found positively associated with the MRQOC for hypertensive patients such as improvement in medication adherence and medication management;better blood pressure control;maintaining followups appointment and self-management;increasing access to healthcare particularly among patients living in rural area;and reducing adverse events.However,some interventions found no significant effect on hypertensive care.The follow up duration varied between 2 mo and 18 mo with an average attrition rate of 10.1%,ranging from 0.0%to 17.4%.CONCLUSION Utilising digital health innovation for hypertensive care in different settings with tailored interventions positively impacted on MRQOC leading to an improvement of patient outcomes and their quality of life.Nevertheless,inconclusive findings were found in some interventions,and inconsistent outcomes between DHI were noted.A future research and evidence-based DHI for hypertension or chronic diseases should be developed through the evidenceto-decision framework and guidelines.

Quality of care in patients with inflammatory bowel disease from a public health center in Brazil

BACKGROUND Inflammatory bowel diseases(IBDs)are chronic diseases that demand continuous interaction between patients and healthcare providers.Quality of care(QoC)is a factor that contributes to a patient’s adherence to treatment and its success.AIM To evaluate QoC in patients from a single IBD reference center.METHODS This cross-sectional study included 133 patients from a single Brazilian IBD public health center.QoC was evaluated through the QoC Through the Eyes of Patients with IBD(QUOTE-IBD)questionnaire(based on patient perspectives),which measures eight dimensions of care.We compared QoC among patients with Crohn’s disease and ulcerative colitis and analyzed the clinical and psychological factors associated with QoC satisfaction.Clinical evaluations assessed disease characteristics,quality of life,anxiety,and depression levels.RESULTS Sixty-nine patients with Crohn’s disease and 64 with ulcerative colitis were interviewed.The mean age was 37.26 years±13.05 years,and 63.91%of the patients were women.The mean duration of the disease was 8.44 years±7.59 years,where most patients were in remission(70.31%of patients with ulcerative colitis and 62.32%with Crohn’s disease).The total QoC score of the sample was 8.61 years±1.31 points,indicating that the QoC provided by the center was unsatisfactory.According to univariate logistic regression,patients with Crohn’s disease had higher satisfaction rates than those with ulcerative colitis[odds ratio(OR):2.746;95%confidence interval(CI):1.360-5.541;P=0.0048]and patients on infliximab(OR:2.175;95%CI:1.037-4.562;P=0.0398).CONCLUSION Patients from the IBD public center reported good doctor-patient relationships,but had problems related to the healthcare structure.Evaluation of healthcare centers is of paramount to improve QoC for the patients involved.

Quality of Care in Family Planning Program in China

Objective To sum up the theory of quality care according to the experience of EP program in China. Methods The author summarized the QOC theory and draw on its experiences and strength in family planningprogram in China. Results The theory facilitated the earnest program of the population and family planning program during the tenth five-year plan period, benefited the realization of the innovation of system and mechanism in population and family planning work, and the creation of a nice population environment for the healthy social and economic development in China. Conclusion The development of QOC has displayed a conspicuous theory in China＇s family planning program.

Relationship of Job Satisfaction with Perceived Organizational Support and Quality of Care among Saudi Nurses

Background: Both, job satisfaction with quality of provided health care is considered the main issue which directly influences the health care field because if nurses do not give the quality care to their patients then the patient dissatisfaction increased. Job satisfaction is defined as the extent of workers’ contentedness with their job, either they like the job or individual aspects or facets of jobs, such as type of work or regulation. Objective: To assess nurses’ job satisfaction and perceived organizational support with their effect on quality of provided health care in Saudi Arabia. Methods: Nurses in Saudi Arabia governmental hospitals during the period from 1st March to 30th April 2020 were invited and consecutively included. Data were collected using online questionnaire. Results: The study included 355 nurses with their ages ranged from 25 to 55 years old. Females were 216 (60.8%) of the total participants. Exact of 267 (75.2%) nurses reported that they like the type of work they do, 245 (69%) provided with satisfactory equipment to accomplish my task. There was a significant relation between organizational support and job satisfaction with their effect on quality of care. Conclusion: Organizational support positively affected nonsatisfaction which in turn positively affected quality of delivered care.

Application of Specialized Group Management in the Quality Control of Perioperative Nursing

Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating room management was adopted from July 2019 to June 2020,and specialized group management was adopted from July 2020 to June 2021.The surgeon’s satisfaction,surgical nurses’core professional competence,and surgical patients’satisfaction were obtained through surveys and the results were analyzed.Results:Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Besides,surgical nurses’core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation(P<0.05).Lastly,surgical patients’satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Conclusion:Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.

Effectiveness of quality of care for patients with type 2 diabetes in China:findings from the Shanghai Integration Model(SIM)

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai,China.A total of 173235 patients with type 2 diabetes in 2017 were included in the analysis.Profiles of risk factors and intermediate outcomes were determined.The patients had a mean age of 66.43±8.12(standard deviation(SD))years and a mean diabetes duration of 7.95±5.53(SD)years.The percentage of patients who achieved the target level for HbA_(1c)(<7.0%)was 48.6%.Patients who achieved the target levels for blood pressure(BP)<130/80 mmHg and low-density lipoprotein-cholesterol(LDL-c)<2.6 mmol/L reached 17.5%and 34.0%,respectively.A total of 3.8%achieved all three target levels,and the value increased to 6.8%with an adaptation of the BP target level(<140/90 mmHg)for those over 65 years.Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels:male,young age,short diabetes duration,low body mass index,macrovascular complications,no microvascular complications,prescribed with lipid-lowering medication,and no prescription of antihypertensive medication.In conclusion,nearly 50%and one-third of the patients with diabetes met the target levels for HbA_(1c)and LDL-c,respectively,with a low percentage achieving the BP target level.The percentage of patients who achieved all three target levels needs significant improvement.

The Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) instrument: Psychometric properties and staff views of the quality of forensic psychiatric services in Sweden

The aim of the present study was to evaluate the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) and to describe the perceived quality of psychiatric care among forensic inpatient service staff. A sample of 348 forensic inpatient staff from 18 forensic wards in Sweden participated in the study. A confirmatory factor analysis revealed a seven-factor structure with item loadings > 0.50 on expected factors, indicating adequate psychometric properties. The staff’s ratings of quality of care were high, 94% being positive. The highest ratings were found for the secluded-environment dimension and the lowest for the secure-environment dimension. Several factors influenced the ratings of quality of care, for instance, staff’s time to perform their duties and staff’s age. It is concluded that the QPC-FIPS can give valuable information about staff’s perceptions of the quality of care provided at inpatient forensic psychiatric care services, which can be used to identify areas for quality improvement. Use of the QPC-FIPS is an easy and inexpensive way to evaluate quality in forensic inpatient care, preferably in conjunction with the QPC-FIP instrument developed for forensic inpatients and covering the same items and dimensions.

Associations of centralization with health care quality for gastric cancer patients receiving gastrectomy in China

Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high vs.low:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.

Logical framework of quality of care in family planning in China:client-centered approach

The year 2018 marks the 40th anniversary of China’s reforms and opening to the world.As an important part of the overall reform effort,reform of the national family planning program,begun in the 1990s as a pilot project focused on quality of care,has achieved historic and significant results.The pilot project,conducted by the State Family Planning Commission of China in a few select areas,was a response to the 1994 International Conference on Population and Development in Cairo,as well as to a range of social and economic changes in China.To achieve quality of care,the pilot project adopted a client-centered approach to refocus China’s family planning efforts on client needs and rights,informed choice of contraceptives and the provision of better quality services.After nearly 10 years of trials,the successful experiences of the pilot project served as the basis of a family planning program reform rolled out nationwide.This paper uses a logic framework approach to review the main activities,outputs,and impacts of the pilot project.The paper argues that the quality of care project not only developed a model that facilitated reorientation of China’s earlier family planning efforts,but has also provided experiences and lessons that can serve as references for the implementation of“Healthy China 2030”in the future.

Factor Structure and Psychometric Properties of the Danish Adaptation of the Instrument Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS)

There is a need for an internationally standardized and psychometrically tested instrument to measure the perceptions of staff members on the quality of forensic inpatient care provided. The aim of the present study was to adapt the Swedish instrument Quality of Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) to the Danish context and to evaluate its psychometric properties and factor structure in this context. All permanently employed staff members at all 27 forensic inpatient wards in Denmark were invited to answer the Danish version of the QPC-FIPS. In total, 641 staff members participated, resulting in a response rate of 80%. The Danish version of the QPC-FIPS showed adequate psychometric properties and excellent goodness of fit of the hypothesised factor structure. Hence, the Danish QPC-FIPS is an excellent instrument for evaluating quality of forensic inpatient care both in clinical practice and in cross-cultural research. The members of staff generally reported that the care provided to patients was of high quality. The quality of the forensic-specific dimension was rated the highest, followed by the support, secluded environment, encounter, discharge and participation. The quality of the secure environment dimension was perceived to be the worst. The QPC-FIPS includes important aspects of staff members’ assessments of quality of care and offers a simple and inexpensive way to evaluate psychiatric forensic inpatient care. The QPC-FIPS can be used together with the Quality of Psychiatric Care-Forensic In-Patient (QPC-FIP) instrument, which covers the same items and dimensions as the QPC-FIPS, to identify patients’ and staff members’ views on quality of care and to improve the quality of forensic psychiatric care and benchmarking.

A path for diagnosis and therapy of colon cancer: a continuous quality improvement

Objective： Prognosis of colorectal cancer strongly depends on stage at diagnosis, which can be cured in most cases at an early stage. The results were supported by different screening programmes. Few data concerning analysis of different phases of Colorectal Cancer Program were reported in literature. The aim of this study is to analyze ＂step by step＂, from a longitudinal type, the Colorectal Cancer Program, active at our Institution, verifying compliance with standards of care.Methods： We compared two different populations during the same period： patients referring to our Clinical Oncology Unit coming from Regional Colorectal Cancer Screening Program and the other population that was not in any Colorectal Cancer Program.Results： Considering patients from the Regional Colorectal Cancer Screening Program（19 patients, corresponding to 24.0% of the general case study）, 3（15.8%） were deceased and 16（84.2%） were alive without evidence of the disease（NED）. Concerning patients that are not coming from Regional Colorectal Cancer Screening Program（61 patients, corresponding to 76.0% of the general case study）, 9（14.8%） were deceased, 43（70.5%） were NED, 8（13.1%） were alive with metastases and 1（1.6%） was lost during follow-up（PFU）. Conclusions： On the basis of this experience, we concluded for high-quality care for both populations. Any critical point should be carefully analyzed in order to implement quality of care.

Holistic care model of time-sharing management for severe and critical COVID-19 patients

The rapid global outbreak of coronavirus disease 2019(COVID-19)and the surge of infected patients have led to the verge of exhaustion of critical care medicine resources worldwide,especially with regard to critical care staff.A holistic care model on time-sharing management for severe and critical COVID-19 patients is proposed,which includes formulation of individualized care objectives and plans,identification of care tasks in each shift and making detailed checklist,and management of quality of care.This study was conducted in the COVID-19 treatment center of Harbin,Heilongjiang Province.The data collected from the treatment center were recorded and analyzed.From the results we can deduce that it is especially suitable for non-intensive care unit(non-ICU)nurses to adapt care management mode of ICU as soon as possible and ensure the quality and efficiency of care during the epidemic.The holistic care model on time-sharing management for severe and critical cases with COVID-19 proposed based on our daily work experiences can assist in improving the quality and efficiency of care,thus reducing the mortality rate of patients in ICU.

The Role of Health Inequality in the Maternal Health Services Provided by Public Institutions in Mexico

This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.

Unlicensed Personnel’s Experience of Digital Signing for Medication Administration in Municipal Healthcare

Aim: To describe unlicensed personnel’s experience of digital signing lists via a smartphone application for the distribution of medication in municipal healthcare in Western Sweden. Design: A qualitative and quantitative design was used. Methods: The study included 48 unlicensed personnel, 28 of whom answered an open-ended questionnaire, while an additional 20 volunteered for individual interviews. The material was analysed by qualitative content analysis. Results: The results indicate that digital signing lists via a smartphone application are feasible, and efficient and facilitate the work. However, some aspects negatively affected the sense of security, meetings with patients and quality of care, such as an insufficient internet signal in some rural areas, difficulty remembering the password, as well as the change of focus from patient to smartphone. To improve quality of care and the meeting with the patient, it is crucial that the technology works and that unlicensed personnel develop technical skills.