Mapping the Locations of Medical Specialists in the Ministry of Health's Hospitals in Malaysia by Specialty, Subspecialty and Area of Interest.

Mapping the distribution of medical specialists in the Ministry of Health (MOH) Malaysia facilities is expected to be more complex as the demand for specialty and subspecialty services increases in the future. A more robust and definitive gap analysis is needed to facilitate planning and resource allocation. The Medical Development Division developed a master list of framework of specialties, subspecialties and areas of interest, and Specialist Database Module in the Medical Programme Information System (MPIS) as tools to facilitate mapping of services. Relational database of specialists' location, facilities, workload, population profile and other relevant parameters were developed to provide data visualisation in specific dashboard. Needs versus supply ratio is proposed as one of parameters to visualise specialised medical services distribution by geographical localities.

Blockchain technology and raft consensus for secure physician prescriptions and improved diagnoses in electronic healthcare systems.

With electronic healthcare systems undergoing rapid change, optimizing the crucial process of recording physician prescriptions is a task with major implications for patient care. The power of blockchain technology and the precision of the Raft consensus algorithm are combined in this article to create a revolutionary solution for this problem. In addition to addressing these issues, the proposed framework, by focusing on the challenges associated with physician prescriptions, is a breakthrough in a new era of security and dependability for the healthcare sector. The Raft algorithm is a cornerstone that improves the diagnostic decision-making process, increases confidence in patients, and sets a new standard for robust healthcare systems. In the proposed consensus algorithm, a weighted sum of two influencing factors including the physician acceptability and inter-physicians' reliability is used for selecting the participating physicians. An investigation is conducted to see how well the Raft algorithm performs in overcoming prescription-related roadblocks that support a compelling argument for improved patient care. Apart from its technological benefits, the proposed approach seeks to revolutionize the healthcare system by fostering trust between patients and providers. Raft's ability to communicate presents the proposed solution as an effective way to deal with healthcare issues and ensure security.

Public Perceptions of the Australian Health System During COVID-19: Findings From a 2021 Survey Compared to Four Previous Surveys.

BACKGROUND: This study examines the perceptions of the Australian public canvassed in 2021 during the COVID-19 pandemic about their health system compared to four previous surveys (2008, 2010, 2012 and 2018). METHODS: In 2021, a nationwide online survey was conducted with a representative sample of Australians (N = 5100) recruited via market research panels. The results were compared to previous nationwide Australian survey samples from 2018 (N = 1024), 2012 (N = 1200), 2010 (N = 1201) and 2008 (N = 1146). The survey included questions consistent with previous polls regarding self-reported health status and overall opinions of, and confidence in, the Australian health system. RESULTS: There was an increase in the proportion of respondents reporting positive perceptions at each survey between 2008 and 2021, with a significantly higher proportion of respondents expressing a more positive view of the Australian healthcare system in 2021 compared to previous years (χ2(8, N = 9645) = 487.63, p < 0.001). In 2021, over two-thirds of respondents (n = 3949/5100, 77.4%) reported that following the COVID-19 pandemic, their confidence in the Australian healthcare system had either remained the same (n = 2433/5100, 47.7%) or increased (n = 1516/5100, 29.7%). Overall, respondents living in regional or remote regions, younger Australians (< 45 years) and women held less positive views in relation to the system. In 2021, the most frequently identified area for urgent improvement was the need for more healthcare workers (n = 1350/3576, 37.8%), an area of concern particularly for Australians residing in regional or remote areas (n = 590/1385, 42.6%). CONCLUSIONS: Irrespective of disruptions to the Australian healthcare system caused by the COVID-19 pandemic, Australians' perceptions of their healthcare system were positive in 2021. However, concerns were raised about inadequate workforce capacity and the cost of healthcare, with differences identified by age groups and geographical location. PATIENT OR PUBLIC CONTRIBUTION: Health consumer representatives from the Consumers Health Forum of Australia contributed to the co-design, deployment, analysis and interpretation of the results of this survey. J.A. and L.W. from the Consumers Health Forum of Australia contributed to the development of the paper.

Dynamic resectorization to improve utility of healthcare systems.

Balancing is an essential challenge in healthcare systems that requires effective strategies. This study aims to address this crucial issue by suggesting a practical approach. We show the potential of balancing a regional healthcare system to improve its utility. We consider a regional healthcare system comprising multiple hospitals with different sizes, capacities, quality of service, and accessibility. We define a utility function for the system based on the sectorization concept, which endeavors to form a balance between hospitals in terms of essential outputs such as waiting times and demands. The dynamic nature of the system means that this balance degrades over time, necessitating periodic sectorization, which is called resectorization. Our methodology stands out for incorporating resectorization as a dynamic strategy, enabling more flexible and responsive adaptations to continuously changing healthcare needs. Unlike previous studies, based on a system-oriented approach, our resectorization scenarios include the periodic closure of some hospitals. This enables us to enhance both the capacity and quality of healthcare facilities. Furthermore, in contrast to other studies, we investigate the states of diminishing demand throughout the resectorization process. To provide empirical insights, we conduct a simulation using data from a real-world case study. Our analysis spans multiple time periods, enabling us to dynamically quantify the utility of the healthcare system. The numerical findings demonstrate that substantial utility improvements are attainable through the defined scenarios. The study suggests a practical solution to the critical challenge of balancing issues in regional healthcare systems.

An Analysis of Referrals Done by Primary Care Centers to Tertiary Care Institutions.

Background and aim Primary care is an important element for every healthcare system around the world. Providing and optimizing the connection between the primary care centers and advanced clinical centers is a key concept for a well-functioning healthcare system. Our aim in this study was to analyze and review the referral data of primary care centers located in Ankara, Türkiye. Materials and methods We collected the entire referral data from the primary care centers, totaling 8,746 patients between January 1, 2019 and December 31, 2023 by using emergency medical services (EMS) transfer in Ankara. Demographic data, call reasons, transfer centers and transfer-related characteristics of the patients were recorded retrospectively, grouped by year, using EMS data. Results Our findings have shown that most of the referrals were made for Turkish citizens with 8,360 (95.6%) (p<0.001). Healthcare centers located in inner city had the most referrals made with 7,087 (81.0%) (p<0.001). Majority of the referrals were made by physicians in family healthcare centers with 6,583 (75.3%) (p<0.001) with chest pain being the most common diagnosis for referral initiation with 1,429 (16.3%) (p<0.001). This was followed by trauma, with 1,172 (13.4%) (p<0.001). Most common cause for trauma was falls with 613 (52.3%) (p<0.001). Conclusion Our data revealed important elements of local referral patterns. According to our data, majority of the referrals were made by inner city healthcare facilities. Family healthcare centers formed most of the referral requests. For this reason, strengthening these centers is important to prevent unnecessary resource use and delays.

A Cross-Sectional Study of Emergency Care Services During the COVID-19 Pandemic: A Multicenter Study of Healthcare Staff Perspectives.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted various aspects of healthcare services, including emergency care services. Healthcare staff face mental issues and physical exertion when caring for patients potentially infected with COVID-19. Understanding the experiences and perspectives of emergency department (ED) healthcare staff during the COVID-19 pandemic is essential to inform evidence-based interventions and strategies to mitigate the impact on emergency care services. This study aims to investigate the experiences of ED healthcare staff regarding emergency care services during the COVID-19 pandemic, thus providing valuable insights into the challenges faced. MATERIALS AND METHODS: This study utilized a cross-sectional study design. Data were collected from 256 ED healthcare staff working in nine different hospitals located in Turkey between November 15, 2021, and December 30, 2021. Data were analyzed using descriptive statistics. RESULTS: A total of 256 participants were included in the study. Of the participants, 58.6% were nurses, 19.5% were ED doctors, and 21.9% were emergency medical technicians. In addition, 67.2% of the participants were infected with COVID-19, and almost all of them (94.1%) were psychologically affected by the pandemic process. It was found that 85.2% of ED healthcare staff felt excluded by society due to being healthcare staff and 71.9% had to be separated from their families. Nurses were separated from their families at the highest rate (78%) during this period. CONCLUSION: More than half of the ED healthcare staff had problems accessing protective equipment and were separated from their families during the pandemic due to the risk of COVID-19 transmission. Although the number of ED visits decreased because of restrictions at the beginning of the pandemic, ED visits increased again with the abolition of restrictions.

[Stigma in homelessness and health care: reflections from a Housing First program in Barcelona, Spain]. / Estigma en personas sin hogar y atención en salud: reflexiones desde un programa Housing First en Barcelona, España.

The experience of homelessness is associated with strong stigmatization processes, which are often reflected in the treatment received from professionals and the healthcare system itself. This article aims to analyze the experiences of participants in a program for homeless individuals in Barcelona called Primer la Llar within the healthcare system, and how the stigma they suffer affects the care processes. This program follows the Housing First model, a social intervention that proposes providing housing without preconditions to individuals with long histories of street living, who suffer from severe mental disorders and/or addictions. Based on individual interviews with 20 participants conducted between 2016 and 2020, it is observed that in certain cases, entering the program, having housing availability, support from professionals, and the development of their own strategies had positive effects on improving their health, although they continue to perceive discriminatory attitudes in some medical settings. It is suggested that the transformation regarding stigmatization be understood broadly, affecting individuals, institutions, and society as a whole.

El tránsito por el sinhogarismo está asociado a procesos de fuerte estigmatización que, en muchas ocasiones, tienen su reflejo en el trato que reciben por parte de las y los profesionales y del propio sistema de atención en salud. Este artículo tiene como objetivo analizar las experiencias que tuvieron en el sistema sanitario las y los participantes de un programa para personas sin hogar en Barcelona llamado Primer la Llar, y cómo el estigma que sufren estas personas llega a condicionar los procesos de atención. Dicho programa sigue el modelo Housing First, una intervención social que propone la entrada a una vivienda sin condiciones previas a personas con largas trayectorias de vida en la calle, que sufren trastornos mentales graves y/o adicciones. A partir de entrevistas individuales con 20 participantes, realizadas entre 2016 y 2020, se observa que, en determinados casos, el ingreso en el programa, la disponibilidad de una vivienda, el soporte de profesionales y el desarrollo de estrategias propias tuvieron efectos positivos en la mejora de su salud, aunque continúan percibiendo actitudes discriminatorias en algunos espacios médicos. Se plantea la necesidad de que la transformación respecto a la estigmatización sea entendida en un sentido amplio, en las personas, en las instituciones y en la sociedad.

Vaccine communication strategies among healthcare workers as a reflection of the Israeli Ministry of Health's communication strategies before and after the COVID-19 pandemic.

Background: Healthcare workers play a central role in communicating information to the public regarding vaccines. Most of the literature has focused on healthcare workers' hesitancy and doubts about getting the flu vaccine themselves. However, few studies have dealt with how they perceive their role in communicating information regarding vaccines, especially following the COVID-19 pandemic. Objectives: (1) To identify the communication strategies used by the Israeli Ministry of Health regarding vaccines during epidemic crises (before and after the COVID-19 pandemic); (2) To identify the communication strategies used by healthcare workers regarding vaccines before and after the COVID-19 pandemic. Methods: A qualitative study based on in-depth interviews was conducted among healthcare workers and used a semi-structured protocol as a research tool. A total of 18 healthcare workers were sampled using purposeful and snowball sampling. Results: Despite healthcare workers' perception that there has been a decrease in trust in the Israeli Ministry of Health among the public following the COVID-19 outbreak, they still rely on the Israeli Ministry of Health as their primary source of information and use the same communication strategies (such as fear appeals and correcting information) as of the Israeli Ministry of Health to communicate with the public, healthcare providers, and other relevant stakeholders. Conclusion: Healthcare workers have been shaped by the professional socialization processes within the health system, leading to a predominant reliance on established communication strategies and informational channels. This reliance underscores the importance of evolving these methods to better engage with the public. To address this, there is a compelling need to innovate and adopt new communication techniques that emphasize effective dialogue and transparent interactions. By doing so, healthcare professionals can ensure that their outreach is not only informative but also responsive to the diverse needs and preferences of the community.

In a Strained Healthcare System, Patients with Advanced COPD Struggle to Access the Needed Support from the Healthcare Professionals - A Qualitative Study.

This study aimed to explore the self-management strategies of Danish patients living with advanced Chronic Obstructive Pulmonary Disease (COPD), with a particular focus on their daily life and their interactions with the respiratory outpatient clinic. Data were collected through semi-structured interviews with 11 patients with COPD affiliated with a Danish respiratory outpatient clinic. The data were thematically analyzed as suggested by Braun & Clarke. The analysis revealed one overarching theme, three main themes, and six subthemes. The overarching theme 'In a strained healthcare system patients with COPD struggle to access needed support to be able to self-manage their disease' revolved around the challenges that patients face in an overburdened healthcare system as they seek support to effectively self-manage their condition. The three main themes were: (1) Only physical symptoms provide legal access to the respiratory outpatient clinic, (2) For patients, the measurements serve as indicators of their health status and overall well-being, (3) Healthcare professionals' skills and not the mode of contact matters to the patients. Healthcare professionals should be aware that the rhetoric surrounding a busy healthcare system with a stressed-out staff also affects patients. Patients with COPD may be particularly sensitive to this message and try to avoid burdening the healthcare system further by setting aside their own needs. However, this approach can lead to neglecting symptoms of deterioration and mental symptoms, which increase the risk of disease progression and subsequent risk of hospital admission.

An Exploration of Satisfaction with Mental Health Counseling Services in Western Australia Among Sexuality and Gender Diverse Youth.

Clinically significant psychological distress affects approximately 29.3% of Australian adolescents and 80.6% of sexuality and/or gender diverse youth (SGD-Y). Often, SGD-Y experience inadequate access and lower satisfaction with mental health services, stemming from age- and sexuality and/or gender diversity-status. Accordingly, exploration of factors affecting SGD-Y's access to, and satisfaction with, mental health services is critical. Using a social constructionist lens, we explored factors supporting SGD-Y's satisfaction with mental health services, and how these needs are or could be met. Seven LGBTQA+ youth aged 15 to 21 who received counseling in Western Australia in the last year, recruited via a university student participant pool and community organizations, participated in semi-structured interviews via video-conference, phone call, or SMS. Reflexive thematic analysis was inductively applied to participants' verbatim accounts. Satisfaction was tied to participants' sense of control over their healthcare-system experiences, shaped by four themes: person-centered support during the service-access process, resources to guide the search for services, confidence in therapists, and healthcare-system organization. Practices and policies supporting SGD-Y's self-determination during their service access may allow for empowering and personally meaningful therapeutic experiences. Developers of policies and initiatives may need to adopt a systems approach to foster SGD-Y's self-determination as they access services.

[Vasectomy of finances sidelines politicians' promises of 24/7 services]. / Vasektomie der Finanzen lenkt 24/7-Leistungsversprechen der Politik aufs Abstellgleis.

The German healthcare system is outdated, no longer reflects reality and needs to be reformed. In addition to a lack of ideas, there is a lack of courage and will to implement necessary reforms. Where will current developments lead us? When it comes to financing the healthcare system, immense challenges await political decision-makers. Demographic change is already posing major problems for healthcare today. Parallel to the increase in the number of patients, the time that physicians have available for their patients has been decreasing for years. Ultimately, social change and the increase in part-time employment mean that there is significantly less money available. Patient dissatisfaction is increasing as expectations are not being met. While hospitals receive financial support, the outpatient sector has been left empty-handed for years. As financial investors are forcing their way into outpatient care, the focus must be prevented from being purely on maximizing profits. Thus, a reorganization of the healthcare system is necessary.

Estimating the Carbon Footprint of Healthcare in the Canton of Geneva and Reduction Scenarios for 2030 and 2040.

Switzerland, a wealthy country, has a cutting-edge healthcare system, yet per capita, it emits over one ton of CO2, ranking among the world's most polluting healthcare systems. To estimate the carbon footprint of the healthcare system of Geneva's canton, we collected raw data on the activities of its stakeholders. Our analysis shows that when excluding medicines and medical devices, hospitals are the main greenhouse gas emitter by far, accounting for 48% of the healthcare system's emission, followed by nursing homes (20%), private practice (18%), medical analysis laboratories (7%), dispensing pharmacies (4%), the homecare institution (3%), and the ambulance services (<1%). The most prominent emission items globally are medicines and medical devices by far, accounting for 59%, followed by building operation (19%), transport (11%), and catering (4%), among others. To actively reduce Geneva's healthcare carbon emissions, we propose direct and indirect measures, either with an immediate impact or implementing systemic changes concerning medicine prescription, building heating and cooling, low-carbon means of transport, less meaty diets, and health prevention. This study, the first of its kind in Switzerland, deciphers where most of the greenhouse gas emissions arise and proposes action levers to pave the way for ambitious emission reduction policies. We also invite health authorities to engage pharmaceutical and medical suppliers in addressing their own responsibilities, notably through the adaptation of procurement processes and requirements.

Chronic Kidney Disease Eligible for SGLT2 Inhibitors Through the Integration of Italian Administrative and Primary Care Data.

Background. Patients with chronic kidney disease (CKD) can be successfully treated with sodium-glucose cotransporter-2 inhibitors (SGLT2-Is), regardless of diabetes. Fondazione Ricerca e Salute's (ReSD) administrative and Health Search's (HSD) primary care databases were combined in the Database Consortium ReS-HS to quantify and describe patients with CKD potentially eligible for SGLT2-Is and assess costs charged to the Italian National Health Service (SSN). Methods. Patients aged ≥18 with CKD and estimated glomerular filtration rate (eGFR) <60 ml/min in 2018, without dialysis and/or renal transplantation, were included. HSD was used to develop and validate algorithms for estimating eGFR, based on covariates, within the ReSD. Comorbidities, dispensed drugs, and direct healthcare costs were assessed. Results. In 2018, 66,297 (5.0% of HSD population) and 211,494 (4.4% of ReSD population) patients with CKD potentially eligible for SGLT2-Is were identified (females ≥58%). Prevalence increased with age with a peak at 75-84 years. Within HSD and ReSD cohorts, respectively: 31.0% and 41.5% had diabetes; in the observation periods, >82% and >96% received ≥1 pharmacological treatment, of which ≥50% and ≥25% received cardiovascular/blood agents and antidiabetics, respectively. From ReSD, mean per capita direct SSN cost was € 3,825 (CI 95%, € 3,655-€ 4,000): 50.1% due to hospitalizations, and 40.2% to pharmaceuticals (31.6% to cardiovascular drugs and 10.1% to antidiabetics). Conclusion. The Database Consortium ReS-HS methodology found 5% of adult SSN beneficiaries with CKD potentially eligible for SGLT2-Is bringing with them a high cardio-metabolic burden which increases the risk of CKD progression.

Key Considerations for Designing Clinical Studies to Evaluate Digital Health Solutions.

Evidence of clinical impact is critical to unlock the potential of digital health solutions (DHSs), yet many solutions are failing to deliver positive clinical results. We argue in this viewpoint that this failure is linked to current approaches to DHS evaluation design, which neglect numerous key characteristics (KCs) requiring specific scientific and design considerations. We first delineate the KCs of DHSs: (1) they are implemented at health care system and patient levels; (2) they are "complex" interventions; (3) they can drive multiple clinical outcomes indirectly through a multitude of smaller clinical benefits; (4) their mechanism of action can vary between individuals and change over time based on patient needs; and (5) they develop through short, iterative cycles-optimally within a real-world use context. Following our objective to drive better alignment between clinical evaluation design and the unique traits of DHSs, we then provide methodological suggestions that better address these KCs, including tips on mechanism-of-action mapping, alternative randomization methods, control-arm adaptations, and novel end-point selection, as well as innovative methods utilizing real-world data and platform research.

Female Attendings in University Clinics of Surgery in Germany: A Scoping Analysis of an Ongoing Disparity.

INTRODUCTION:  Gender-based discrimination, particularly in healthcare, affects women's roles and opportunities, including in surgery where they remain underrepresented in leadership positions. The extent to which such discrimination is prevalent in attending positions is unclear. METHODS:  The publicly available records of 48 universities and university-associated hospitals in Germany were extracted to quantify gender ratios among attending surgeons and head surgeons in the fields of visceral, vascular, cardiac, thoracic, pediatric, orofacial, neuro-, trauma, and plastic surgery. Statistical analysis, including Chi-Square tests and Student's t-test, was used to analyze the data. RESULTS:  Among the 367 department heads, 353 (96.2%) were male and 14 (3.8%) were female. Among the 2,366 attendings, 1,854 (78.4%) were men and 512 (21.6%) were women. These differences were significant (χ²=64.95, p<0.001, odds ratio=0.14, 95% confidence interval=0.08-0.25). Departments being led by a female department head were not more likely to employ female attendings (χ²=0.379, p=0.538, odds ratio=1.17, 95% confidence interval=0.70-1.96). CONCLUSION:  German surgical departments in University Hospitals have significant gender disparities, with women underrepresented at higher levels. This may negatively affect patient outcomes. To tackle the problem, further research is needed to fully understand the issue.

Lack of Public Awareness and Prehospital Care in Severe Trauma Patients: The Weakest Link in the Indian Healthcare System.

INTRODUCTION: Management of trauma involves both in-hospital and prehospital care. The level of prehospital care plays a vital role in trauma management. Low- and middle-income countries are still in the nascent stages of development of their emergency medical services (EMS) systems. Also, there have been insufficient studies assessing the availability and level of prehospital care in developing nations such as India. Therefore, we decided to study the level of awareness and prehospital care given to severe trauma patients. MATERIALS AND METHODS: We conducted this prospective observational study at the emergency department of Fortis Hospital, Noida, Uttar Pradesh, in Northern India. All adults between ages 18 and 85 years presenting with severe trauma (immediate life- or limb-threatening conditions requiring emergent intervention) were included. We measured the primary outcome in terms of why people did not avail EMS. We measured secondary outcomes in terms of intervention done in patients coming to us via EMS. RESULTS: Out of 101 patients, 89 (88.12%) were transported to Fortis Hospital through non-EMS, whereas only 12 (11.88%) patients were transported by EMS. We found the difference to be statistically significant. The major reason given for not summoning advanced trauma care services in patients was a lack of awareness about the potential benefits of EMS (n = 64 [72%]), followed by a lack of availability (n = 24 [27%]), and financial reasons (n = 1 [1.1%]). CONCLUSION: We conclude that the level of awareness about EMS for severe trauma patients was found to be low in our study. There is a need for an awareness-creation program across the nation to fill this gap.

Delirium in the US: Results from 2023 cross-sectional World Delirium Awareness Day prevalence study.

IMPORTANCE: Delirium is an acute brain dysfunction associated with an increased risk of mortality and future dementia. OBJECTIVES: To describe the prevalence of clinically documented delirium in the United States on World Delirium Awareness Day 2023. DESIGN: Sub-analysis of a prospective, cross-sectional, online, international survey. SETTING: All healthcare settings were eligible with the exception of operating rooms and outpatient clinics. PARTICIPANTS: Healthcare clinicians, administrators, and researchers completed the survey. MAIN OUTCOME AND MEASURE: Prevalence of clinically documented delirium at 8:00 a.m. and 8:00 p.m. on March 15, 2023. Secondary outcomes were related to healthcare delivery. Descriptive statistics are reported. Differences between unit types (non-ICU vs ICU) were examined for all outcomes. RESULTS: Ninety-one hospital units reported on 1,318/1,213 patients. The prevalence of clinically documented delirium was 16.4% (n=216/1,318) at 8:00 a.m., 17.9% (n=217/1,213) at 8:00 p.m. (p= 0.316) and significantly differed between age groups, reported discipline, unit, and hospital types. Significant differences were identified between non-ICU and ICU settings in the use of delirium-related protocols, non-pharmacologic and pharmacologic management, educational processes, and barriers to evidence-based delirium care. CONCLUSION: To our knowledge, this is the first epidemiologic survey of clinically documented delirium across two time points in the U.S.. Delirium remains a significant burden and challenge for healthcare systems. The high percentage of units using delirium management protocols suggests administrator and clinician awareness of evidence-based strategies for its detection and mitigation. We provide recommendations for future studies and quality improvement projects to improve clinical recognition and management of delirium.

Integrating Syrian refugees into Lebanon's healthcare system 2011-2022: a mixed-method study.

INTRODUCTION: The Lebanese government estimates the number of Syrian refugees to be 1.5 million, representing 25% of the population. Refugee healthcare services have been integrated into the existing Lebanese health system. This study aims to describe the integration of Syrian refugee health services into the Lebanese national health system from 2011 to 2022, amid an ongoing economic crisis since 2019 and the COVID-19 pandemic. METHODS: This paper employs a mixed-methods approach drawing upon different data sources including: 1- document review (policies, legislation, laws, etc.); 2- semi-structured interviews with policymakers, stakeholders, and health workers; 3- focus group discussions with patients from both host and refugee populations; and 4- health systems and care seeking indicators. RESULTS: Although the demand for primary health care increased due to the Syrian refugee crisis, the provision of primary health care services was maintained. The infusion of international funding over time allowed primary health care centers to expand their resources to accommodate increased demand. The oversupply of physicians in Lebanon allowed the system to maintain a relatively high density of physicians even after the massive influx of refugees. The highly privatized, fragmented and expensive healthcare system has impeded Syrian refugees' access to secondary and tertiary healthcare services. The economic crisis further exacerbated limits on access for both the host and refugee populations and caused tension between the two populations. Our findings showed that the funds are not channeled through the government, fragmentation across multiple financing sources and reliance on international funding. Common medications and vaccines were available in the public system for both refugee and host communities and were reported to be affordable. The economic crisis hindered both communities' access to medications due to shortages and dramatic price increases. CONCLUSION: Integrating refugees in national health systems is essential to achieve sustainable development goals, in particular universal health coverage. Although it can strengthen the capacity of national health systems, the integration of refugees in low-resource settings can be challenging due to existing health system arrangements (e.g., heavily privatized care, curative-oriented, high out-of-pocket, fragmentation across multiple financing sources, and system vulnerability to economic shocks).

Uncovering multi-level mental healthcare barriers for migrants: a qualitative analysis across China, Germany, Netherlands, Romania, and South Africa.

BACKGROUND: Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population. METHODS: Adhering to a qualitative research paradigm, the study centers on stakeholders' perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach. RESULTS: The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants. CONCLUSIONS: This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers' capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.

Experiences of co-producing person-centred and cohesive clinical pathways in the national system for knowledge-based management in Swedish healthcare: a qualitative study.

BACKGROUND: When the 21 Swedish county councils decided to collaborate in the creation of a national system for knowledge-based management, patient participation was mandatory. Patient and next-of-kin representatives (PR) co-produced person-centred and cohesive clinical pathways together with healthcare professionals (HPR). Research on co-production in healthcare at the national level is scarce. The aim of this study is to explore experiences of patient participation from the perspectives of both PRs and HPRs when co-producing clinical pathways within the Swedish nationwide healthcare system for knowledge-based management. METHODS: A qualitative study was conducted. A strategic sample of nine PRs and eight HPRs were interviewed individually between August 2022 and January 2023 using a semi-structured interview guide. We analysed data using an inductive content analysis. RESULTS: Three main categories were identified: (1) Finding appropriate patient representativeness; (2) Working methods that facilitate a patient perspective; and (3) Influence of the patient perspective in the clinical pathways. CONCLUSIONS: The study demonstrates the importance of patient and next-of-kin participation in the construction of clinical pathways at the national level. The results provide a platform for further research on patient participation on the national level and add to studies on if and how patient participation on this level has an impact on how the clinical pathways are put into practice at the micro level, and the support provided at the meso level. The study contributes to the growing body of literature studying patient participation and co-production. TRIAL REGISTRATION: Region Örebro County ID 276,940. An advisory opinion was obtained from the Swedish Ethical Review Authority (2021-05899-01).