Exploring Global Demands for Integrating Social Aspects into Community Healthcare: A Literature Review

Aging and crises like pandemics and climate change are global concerns that affect community environments. These social and natural changes influence people’s health worldwide. Aging impacts human health, including physical and mental aspects, and increases the need for care. Recent crises have affected not only the elderly but also younger populations, necessitating further efforts to develop a systematic community strategy. The goal of such a strategy is to maintain or enhance people’s well-being. As we face aging and crises like pandemics and climate change, it becomes essential to consider health holistically and globally, taking into account the community environment and social determinants without boundaries. The present study aimed to explore the necessary aspects of incorporating social determinants into clinical practice, enabling healthcare providers to view health from a holistic and planetary perspective. This approach facilitates the development of integrated community strategies. The study reviewed literature from PubMed, MEDLINE, and CINAHL databases, focusing on medicine, health, and welfare. An electronic search for English-language articles in peer-reviewed journals was conducted up to July 2024, using search terms such as “holistic health,” “planetary health,” and “social determinants.” Eight articles were identified through the search. After excluding three based on their titles, abstracts, and full texts, five articles were selected. The research focused on three areas: perceiving health in ecosystems, considering health-related policy in clinical situations, and addressing health in primary care settings. This study emphasizes the need for further research on innovative, integrated community strategies in the context of a globally aging society, focusing on non-medical aspects like pandemics, climate change, and social determinants to achieve a holistic and planetary understanding of people’s health. It suggests that understanding the social aspects of ecosystems in clinical settings, through interdisciplinary collaboration, is crucial for developing systematic community strategies for people’s well-being life in medical, health, and welfare contexts.

The Development of Community-Based Family Healthcare: A Cross-Sectional Study in Haidian, Beijing, China

The outbreak of Covid-19 affects China’s health delivery system, and the current status of primary health services after the Covid-19 pandemic is not yet clear. To further explore the current status of demands of family health services, we conducted a cross-sectional survey, in the community of Haidian District, Beijing. Chi-square test analysis and multivariate logistic regression models were used to identify factors influencing residents’ demands for family healthcare services. Results show that population of married (OR = 3.108), living with parents (OR = 2.171), degree of Junior high school and above (OR = 7.250) and high school (OR = 7.670), Annual income: 0 - 56,000 (OR = 3.680) and 72,001 - 88,000 (OR = 1.690) have significant demands for family health care. The approach to building primary health services in Haidian District is worth promoting, but it is also important to pay attention to the health inequalities that can occur when patients are moved down to the grassroots level. .

Community Based Health Insurance in India: Prospects and Challenges

The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.

Online Healthcare Community Interaction Dynamics

With the increasing dilemma of the rapid global demand for healthcare services(often in the presence of limited resources),how to creatively allocate and use healthcare resources across a widespread population has become a salient issue.Online healthcare communities(OHCs)are regarded as a potential ICT-based partial solution.In contrast to traditional healthcare,online doctor-patient interaction is unlimited in terms of time and space limitations while an OHC is exposed to the whole community.These characteristics are key to achieving synergistic doctor-patient interaction and community development in the longer term.In order to explore the nature of doctor-patient interaction dynamics in an OHC,we systematically investigate doctor-patient interaction dynamics from the dual perspectives of doctor and patient.Our doctor-patient interaction dual-cycle model has been built based on six doctor-patient interaction processes(i.e.,searching,choosing,knowledge sharing,providing,receiving and balancing).According to our dual-cycle model,four key managerial issues in OHC(information asymmetry,incentive mechanisms,service delivery processes and interaction mechanisms)have been identified as examples.Discussion and directions for future research,with challenges as well as opportunities,have been elaborated.A broad view with fruitful research potential is ensured and new theories and methods ultimately provide implications for effectively and efficiently allocating scarce healthcare resources to a broader population.

A study on the health service demands and influence factors among elderly people based on a community survey in Western China

Objective:To investigate the health service demands and to analyze influencing factors among elderly people based on a community survey in Guilin,China.Methods:A random sampling was used to investigate 366 elderly people in a community using a Health-Care-Needs questionnaire,which was designed by The Western Nursing Alliance research team in China.This survey was used to understand the basic situation,financial condition,health condition,self-care abilities,pension plan,and care services demands of the elderly residing at home.Additionally,this article analyzed the influencing factors contributing to the obtained results.Results:The top 3 nursing needs were security needs(1.61±0.45 points),health education needs(1.54±0.57 points),and respect and self-development needs(1.13±0.64 points).Logistic multifactor regression analysis showed that gender,monthly income,lack of exercise,activities of daily living(ADL)scores,methods of medical payment,and pension plan were independent factors affecting elderly nursing needs.Conclusions:The home-based health services supply for elders did not meet their needs.Therefore,a comprehensive approach considering multifactors such as gender,income,exercise,self-care ability,medical expense payments,and supporting preferences should be considered to address the complex needs of health care.

Implementation of a virtual multicenter gastrointestinal tumor board to reduce cancer disparities in Argentina

Given the increasing complexity of cancer care,multidisciplinary tumor boards have become essential in daily clinical oncology practice.The Project Extension for Community Healthcare Outcomes(ECHO)initiative developed an innovative telementoring model using a"hub and spoke"design consisting of a team of experts(hub)that offers a full service to multiple participants(the spokes)during regularly scheduled sessions discussing patients'clinical cases.The Alexander Fleming Cancer Institute in Buenos Aires was the first hub in Latin America to implement Project ECHO for gastrointestinal tumors.In our 3-year experience,80 patients from 37 centers were evaluated within Project ECHO and a range of three to five cases were discussed in each meeting.From our perspective,the impact of this novel approach was a remarkable strategy to reduce care disparities by equalizing access to high-quality medical knowledge in a multidisciplinary environment for medical discussions.Additionally,it was shown to have a cost-effective impact directly on the patients and the local health system,since relevant costs were saved after unnecessary treatments,studies and travel expenses were avoided.

Shareholding Networks for Care in Rural Thailand: Experiences of Older Persons and Their Family Members

Most members of the older population in Thailand live in rural areas while their children live in cities. With the joint family system separated, elderly Thai persons often have to care for themselves, and opportunities for them to get involved in community care remain limited. In response, the aim of this study was to describe older persons’ and their family members’ experiences with shareholding networks for the care of older people in rural Thailand. Paired interviews with five older persons and five of their family members were conducted, and collected data were subjected to content analysis, which yielded results organized around two themes: older persons’ outsider status and disregard for older persons’ individuality. Whereas the theme of outsider status describes shortcomings in healthcare encounters, the theme of disregard for individuality describes the lack of engagement of authorities and caregivers in older persons’ care. In that sense, the concept of participation emerged as a framework for understanding interviewees’ experiences. Given findings from local authorities, older individuals and their family members should engage in dialogue in order to support healthcare based on shared understanding.

Navigating Interoperability in Disaster Management:Insights of Current Trends and Challenges in Saudi Arabia

In this rapid review,we critically scrutinize the disaster management infrastructure in Saudi Arabia,illuminating pivotal issues of interoperability,global cooperation,established procedures,community readiness,and the integration of cuttingedge technologies.Our exploration uncovers a significant convergence with international benchmarks,while pinpointing areas primed for enhancement.We recognize that continual commitments to infrastructural progression and technology adoption are indispensable.Moreover,we underscore the value of robust community involvement and cross-border collaborations as key factors in bolstering disaster response capabilities.Importantly,we spotlight the transformative influence of emerging technologies,such as artificial intelligence and the Internet of Things,in elevating the effectiveness of disaster management strategies.Our review champions in all-encompassing approach to disaster management,which entails harnessing innovative technologies,nurturing resilient communities,and promoting comprehensive disaster management strategies,encapsulating planning,preparedness,response,and recovery.As a result of our analysis,we provide actionable recommendations to advance Saudi Arabia's disaster management framework.Our insights are timely and crucial,considering the escalating global focus on disaster response in the face of increasing disaster and humanitarian events.

Pre hospital medical services and paramedic engagement in Australian health care - Improving the pathways of care through collaborative action

Paramedics Australasia(PA)is the national body representing paramedics engaged in delivery of pre hospital emergency health care.PA is thus uniquely positioned to provide insights into the role of pre hospital medicine in the continuum of care.Every day in Australia,patients are placed at risk of harm within the health-care system.These risks are particularly notable in pre hospital care where paramedics must often tend for patients under adverse operating conditions and per-form interventions that carry significant risks.Paramedics must make clinical judgements that may profoundly affect patient outcomes-often with no access to patient history.Pre hospital medicine has changed dramatically in recent years.Paramedic practice has evolved as a unique discipline combining medicine,public health and public safety.Contemporary pre hospital medical care is now provided by professionally qualified practitioners.These developments have been built on a strong evidence base demonstrating the capacity to enhance patient outcomes through appropriate clinical interventions.Paramedics and pre hospital service providers alike have had to overcome many challenges in this journey,not the least being the education,recruitment and retention of a professional workforce and the difficulties in funding the infrastructure upon which to build a comprehensive emergency response capability.The PA vision for pre hospital medicine is based on the premise that it is an essential part of primary health care and that its seamless integration into health care will better meet patient needs that might otherwise remain unfulfilled.Paramedics can provide a variety of community health services that are crucial in the provision of more comprehensive care,especially in rural and remote communities.PA has endorsed the philosophical approach to health care outlined in the 15 National Health and Hospitals Reform Commission Health Care Principles,and recommends the translation of those principles into the pre hospital medicine environment.Given those principles it is inexplicable how paramedics have remained unrecognised as health professionals and pre hospital medicine has been ignored as part of the health care reform process.Embracing the National Health and Hospitals Reform Commission principles should see pre hospital medicine forming not only part of the local health care system but also meshed into the fabric of the community.There should be community engagement in the assessment and evaluation of pre hospital medicine care and the regulation of practitioners under a national system of professional registration.These processes will better enable the benefits of holistic care to be realised.Despite the excellence and dedication of the paramedic workforce,PA recognises that formidable challenges remain in health care delivery.These include issues of equality and access,demographic coverage,safety and quality,as well as other workforce and resource issues that affect patient outcomes.Paramedics can assist in identifying and resolving many of these issues.Australia’s health system should provide suitably rapid pre hospital medical responses with levels of care appropriate to the circumstances of each patient.Paramedics moreover hold competencies that can provide prevention,evaluation,care,triage,referral and health advisory services that can be mobilised to enhance community healthcare resources.Access to professional paramedic services should thus form an integral part of the care regime available to the community.This should be an inter-professional model of healthcare practice founded on contributions from a dynamic mixture of professional expertise at all stages of the patient journey.In PA’s view,the virtual absence of references to the role and funding of paramedic services as a key component of the health care system at a national level is a grave oversight.A nationally driven policy perspective is needed that integrates pre hospital medicine into the health system.Fulfilling the PA vision of health care requires significant change in the way paramedic services are funded and administered.It will need advice from the best available minds and committed leadership within government and the health professions to bring the already demonstrated benefits of paramedic practice to the community.Many issues need to be addressed including:(a)Sustainable funding models under national access and equity principles;(b)Education,clinical training,staff recruitment and retention;(c)Safety and quality standards and the minimisation of patient risk;(d)Extended community care models in remote and low-volume settings;(e)Clinical governance,service accreditation and practitioner registration;(f)Adequacy of evidentiary data collection to assess patient outcomes,support service evaluation and underpin research;and(g)Infrastructure integration including communication networks and dynamic referral to manage external events and cope with capacity constraints.PA strongly believes that these issues cannot be considered in isolation.Pre hospital medicine practitioners must be involved in contributing their expertise in conjunction with other health professionals so as to create a seamless system of best practice care beginning at the point of need-the patient.To fulfil that promise PA has outlined a vision for the delivery of pre hospital medicine as part of an integrated health care system.Only by incorporating the input of paramedic clinicians into that national policy and operational arena can the best patient outcomes be achieved.