Workplace health culture and trust in the occupational health office: A descriptive study of meatpacking workers.

INTRODUCTION: Worker trust in employer-provided occupational health services has not been explored in essential industries, such as meatpacking. The purpose of this study was to describe workplace health culture and trust in the occupational health office and highlight meatpacking workers' experiences with the occupational health office. METHODS: Meatpacking workers were surveyed between February 2021 and October 2022. Descriptive statistics and nonparametric tests were used to explore trust across demographic variables, including workplace health culture. Thematic analysis was used to examine the short-answer qualitative data. RESULTS: Among workers who completed surveys (n = 731), health culture was rated low (M = 1.3 (0.73); possible range 0-3). Trust in the occupational health office was also rated low (M = 8.2 (5.06); possible range 0-20). Workers' descriptions of interactions with the occupational health office were mostly unfavorable (287 negative opinion units; 97 positive opinion units) and primarily focused on quality of care, communication, the supervisor as gatekeeper to health services, and the prioritization of company interests. CONCLUSION: Meatpacking worker health may be improved by building worker trust in the occupational health office. Suggested strategies include enhanced communication, protection of confidentiality, prioritization of worker well-being, and promotion of a stronger health culture in plants and throughout the industry. Supporting workers without a regular healthcare provider to establish a relationship with a primary care provider of their choice is also recommended.

Executive summary: Quality standards of care units for people with sexual and gender diversity.

Comprehensive biopsychosocial care for people with gender incongruence (ICD 11) who are transgender (trans) or gender diverse is a complex process in which the quality of the medical transition can only be guaranteed after a multidisciplinary approach, through teams that integrate professionals with training and experience not only in medicine but also in diversity and gender identity. Based on this, the Gonad, Identity and Sexual Differentiation working group of the Spanish Society of Endocrinology and Nutrition (GT-GIDSEEN) has established minimum care requirements that aim to guarantee adequate health care for these people by professionals. A position paper has been produced and is available at https://www.seen.es/portal/documentos/estandares-calidad-gidseen-2024.

Association of persistent poverty and U.S. News and World Report hospital rankings among patients undergoing major surgery.

BACKGROUND: We sought to determine the association of persistent poverty on patient outcomes relative to US News World Report (USNWR) rankings among individuals undergoing common major surgical procedures. METHODS: Medicare beneficiaries who underwent AAA repair, CABG, colectomy, or lung resection were identified. Multivariable logistic regression was used to evaluate the relationship between care at USNWR hospitals, county-level duration of poverty (never-high poverty (NHP); intermittent high poverty (IHP): persistent-poverty (PP)) and 30-day mortality. RESULTS: Among 916,164 beneficiaries, individuals residing in PP neighborhoods who received surgical care at ranked hospitals had lower risk-adjusted 30-day mortality (5.89% vs 8.89%; p â€‹< â€‹0.001). On multivariable analysis, 30-day mortality was lower at ranked hospitals across all poverty categories with greatest decrease among patients from PP regions (NHP: OR-0.91, 95%CI0.87-0.95; IHP: OR-0.78, 95%CI0.69-0.88; PP: OR-0.69, 95%CI0.57-0.83; p â€‹< â€‹0.001). CONCLUSION: Receipt of surgical care at top-ranked hospitals was associated with improvement in postoperative mortality, especially among patients residing in persistent poverty..

Perception Of Patient Safety Culture At The Primary Care Level: The Case Of The Community Health Centre Ljubljana.

Background: Patient safety is a crucial element of quality healthcare, and endeavours to enhance it are vital for attaining universal health coverage and improving patient outcomes. This study aimed to evaluate the perception of patient safety culture among staff at the Community Health Centre Ljubljana (CHCL). Methods: A cross-sectional study was conducted in December 2022. All CHCL staff (N=1,564) from different professional groups were invited to participate in an anonymous electronic survey using the validated Slovenian version of the "Medical Office Survey on Patient Safety Culture" (MOSPSC). Mean percent positive scores for all items in each composite were calculated. Results: The final sample included 377 participants (response rate, 24.1%), most of whom were women (91.5%, N=345) with different professional profiles. The mean age of the participants was 44.5 years (SD 11.1) with a mean work experience of 20.1 years (SD 12.1). The percentage of positive overall MOSPSC composite scores was 59.6%. A strong patient safety culture perception was identified in the following dimensions: Information exchange with other settings (93.5%), Organisational learning (90.2%), List of patient safety and quality issues (88.1%), Patient care tracking/follow-up (76.2 %) and Teamwork (75.0%). Weak patient safety culture was identified in the dimensions of Work pressure and pace (10.7%), Leadership support for patient safety (27.1%), Communication openness (40.9%), Office processes and standardisation (48.2%) and Overall ratings on quality and patient safety (49.4%). Conclusions: CHCL leadership should address weaknesses, redesign processes, and implement strategies to reduce patient safety incidents. Establishing a just culture that encourages employees to report errors fosters transparency and facilitates learning from errors.

Stakeholders' Perspectives on the Quality of End-of-Life Health Care Services for Chronic Obstructive Airways Disease: A Focus Group Study.

Introduction: Delivery of end-of-life care for severe chronic obstructive pulmonary disease (COPD) has been hampered by an unpredictable disease trajectory and poor integration of health care and social services. Objective: To critically explore the perspectives, values, and experiences of stakeholders in COPD end-of-life healthcare services in a large district in Aotearoa New Zealand. Design: Focus groups analysed utilising critical theory and Actor-Network Theory. Methods: Stakeholders in end-of-life COPD healthcare services were purposively sampled from a large healthcare network in Canterbury, Aotearoa New Zealand to participate in seven focus groups (bereaved carers, community-based health professionals, non-Maori, non-Pacific patients, and support people (two groups), Maori patients, supporters and health professionals, Pacific patients, support people and health professionals, and hospital-based health professionals). Participants discussed end-of-life care services for people with COPD. Transcripts were coded utilising descriptive and structural coding to develop themes related to provision of quality care. Participants were positioned as experts. We considered how the themes arising supported and disrupted the healthcare network for end-of-life COPD. Results: Five themes related to quality of care for end-of-life COPD were identified: compassion, competence, community, commitment, and collaboration. The absence of any of these five themes required for quality care led to power imbalances within healthcare systems. Power inequities created disconnection among stakeholders which then disrupted commitment, community, and collaboration. A dysfunctional healthcare network impeded compassion between stakeholders and did not support their competence, leading to lower quality care. All five themes were identified as essential to delivery of high-quality end-of-life care in COPD. Conclusion: Stakeholders' perspectives of end-of-life care for COPD identified of core features of a health system network that enabled or impeded the actions of stakeholders and allocation of resources to provide quality care.

Approaches to clinical guideline development in healthcare: a scoping review and document analysis.

BACKGROUND: Over the past decade, an industry has emerged around Clinical Practice Guideline (CPG) development in healthcare, which has increased pressure on guideline-producing organisations to develop CPGs at an accelerated rate. These are intended to improve the quality of care provided to patients while containing healthcare costs and reducing variability in clinical practice. However, this has inadvertently led to discrepancies in CPG recommendations between health organisations, also challenging healthcare providers who rely on these for decision-making and to inform clinical care. From a global perspective, although some countries have initiated national protocols regarding developing, appraising and implementing high-quality CPGs, there remains no standardised approach to any aspect of CPG production. METHODS: A scoping review of the literature and document analysis were conducted according to Joanna Brigg's Institute methodology for scoping reviews. This comprised two qualitative methods: a comprehensive review of the literature (using CINAHL, Scopus and PubMeD) and a document analysis of all national and international guideline development processes (manual search of health-related websites, national/international organisational health policies and documents). RESULTS: A set of clear principles and processes were identified as crucial to CPG development, informing the planning, implementation and dissemination of recommendations. Fundamentally, two common goals were reported: to improve the quality and consistency of clinical practice (patient care) and to reduce the duplication or ratification of low-grade CPGs. CONCLUSIONS: Consultation and communication between CPG working parties, including a wide range of representatives (including professional organisations, regional and local offices, and relevant national bodies) is essential. Further research is required to establish the feasibility of standardising the approach and disseminating the recommendations.

A qualitative study on community perceptions on quality of healthcare services they received in the Malaria Elimination Demonstration Project in district Mandla, India.

BACKGROUND: The utilization and impact of the healthcare services depend on the perceived quality, appropriateness, ease of availability, and cost of the services. This study aimed to understand the community's perception of the quality of healthcare services delivered as part of the Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India. METHODS: The study used qualitative techniques to analyze the community perceptions that emerged from the participants' narratives during the Focus Group Discussions (FGDs) and in-depth Interviews with Key Informants (IKIs) on the promptness and quality of healthcare service delivery, the behaviour of MEDP staff, Information, Education and Communication, and Behavioural Change Communication activities, coordination with community members and other health personnel, and capacity building of healthcare workers and the community. RESULTS: 36 FGDs and 63 IKIs with 419 respondents were conducted in nine blocks of district Mandla. Overall, 97% to 100% of beneficiaries associated MEDP with regularity and prompt service delivery, availability of diagnostics and drugs, friendly behaviour, good coordination, and community mobilization to enhance treatment-seeking behaviour. CONCLUSIONS: The study's findings highlighted the importance of building and maintaining the community's participation and promoting the demand for optimal utilization of healthcare services inside the village to promptly achieve the malaria elimination goal.

Racial identification represents significant risk factor for healthcare disparity among patients with severe bronchopulmonary dysplasia treated with tracheostomy.

OBJECTIVES: To characterize the patient population with severe bronchopulmonary dysplasia (BPD) requiring tracheostomy in a large tertiary level 4 neonatal intensive care unit (NICU) and to identify potential targets for improvement in the delivery of high-quality healthcare. METHODS: An IRB-exempt but IRB-registered retrospective review of medical records. Study inclusion criteria: patients treated for severe BPD with tracheostomy under 2 years of age in our tertiary referral center NICU. Control group criteria: 4-year aggregate NICU patient demographics. Basic demographics, maternal history, clinical data points, and outcomes variables were collected. RESULTS: There was a statistically significant difference between the two groups in only one variable: racial identification (p-value = 0.036). All data points were then analyzed against racial identification, and statistically significant differences appeared in 4 categories: 1) illicit drug use, 2) birth head circumference and length, 3) days to readmission, and 4) child opportunity index scores. There was not a statistically significant difference in any other maternal characteristics or medical comorbidities, NICU length of stay, age at tracheostomy, or decannulation status. CONCLUSION: The incidence of our tracheostomy in infants with severe BPD was significantly higher (p = 0.036) in the subjects whose families identified as racially African American or Black, a marked contrast to our general NICU population and our overall tracheostomy population. The timing of the first readmission to the hospital was shorter for Caucasian or White infants compared to African American or Black infants. COI demonstrated statistically significantly poorer resources for African American or Black infants compared to White infants with tracheostomy. All other perinatal and outcome measurements did not differ significantly between the two racial groups. This suggests that this racial disparity is present and needs further investigation to better assess its impact on risk and outcomes as we develop pathways for high-quality healthcare delivery.

STORK: Collaborative Online Monitoring of Pregnancies Complicated with Gestational Diabetes Mellitus.

Background: A novel digital platform, named STORK, was developed in the COVID-19 pandemic when clinic visits were restricted. A study of its clinical use during the pandemic was conducted. The study aims to advance the state of the art in monitoring and care of pregnancies complicated with gestational diabetes mellitus (GDM) via online collaboration between patients and care providers. Methods: This study involved 31 pregnant women diagnosed with GDM and 5 physicians. Statistical comparisons were made in clinic-visit frequency and adverse outcomes between the STORK group and a historical control group of 32 women, compatible in size, demographics, anthropometrics and medical history. Results: The average number of submitted patient measurements per day was 3.6±0.4. The average number of clinic visits was 2.9±0.7 for the STORK group vs. 4.1±1.1 for the control group (p<0.05). The number of neonatal macrosomia cases was 2 for the STORK group vs. 3 for the control group (p>0.05); no other adverse incidents. Conclusions: The patient compliance with the pilot use of STORK was high and the average number of prenatal visits was reduced. The results suggest the general feasibility to reduce the average number of clinic visits and cost, with enhanced monitoring, case-specific adaptation, assessment and care management via timely online collaboration.

Challenges influencing proper implementation of quality health care referral system in Kaloleni Sub-county, Kilifi County in Kenya.

The reason behind having referral system in Kenya is to have proper distribution of effective health care services to all Kenyans as well as linking and integrating medical services across all levels of healthcare. In Kenya, most of levels of health care lacks specialized manpower and equipment, proper communication strategies, knowledge on referral system and skilled health workers to deal with referral system. Therefore, this study addresses the challenges influencing the proper implementation of quality referral system of health care in Kaloleni sub-county, Kilifi County in Kenya. Specifically, investigating gaps by the health workers, knowledge and communication factors on implementation of quality health care referral system. A cross-sectional research design was used targeting health care workers in public health care facilities. Self- administered questionnaires were used to obtain quantitative data. The data was cleaned, coded and analyzed using SPSS V. 22. The inferential statistics discussed finding from Chi-square showing the significance between independent and dependent variables. According to the results, Communication gap with p(0.18) showed to have more significant variable affecting the quality referral system followed by knowledge factor with significant of p(0.499) and finally Nurse's skills with significant ofp(0.99).

Assessment of Emergency Department Satisfaction Level in Saudi Arabia General Hospital.

Background and objectives: An overcrowded emergency department (ED) cannot meet the patients' growing demand. This situation harms employees' performance and, alternatively, causes anxiety and dissatisfaction among patients since the quality of healthcare outcomes fall below their expectations. This study aimed at improving and validating a scale for assessing patient satisfaction in the ED. Methods: In this study, 134 participants from Wadi Al-Dawasir General Hospital were enrolled using a convenient sampling technique. A cross-sectional survey was conducted using 5-point Likert scales. Results: All tested hypotheses showed statistical significance (P < 0.05). Our results show that male employees were more satisfied compared with their female counterparts. Furthermore, Saudi employees were more satisfied with the health services than non-Saudi ones. Conclusion: The findings of this study brought to the fore that patients and their families were satisfied with the healthcare services and their quality. This means better service delivery played a crucial role in enhancing satisfaction levels. Nevertheless, this study also highlights that overcrowding is a significant problem for healthcare organizations. Wadi al-Dawasir General Hospital's ED should continually improve its quality to meet the growing needs of its clients.

Digital health for quality healthcare: A systematic mapping of review studies.

Objective: To systematically catalogue review studies on digital health to establish extent of evidence on quality healthcare and illuminate gaps for new understanding, perspectives and insights for evidence-informed policies and practices. Methods: We systematically searched PubMed database using sensitive search strings. Two reviewers independently conducted two-phase selection via title and abstract, followed by full-text appraisal. Consensuses were derived for any discrepancies. A standardized data extraction tool was used for reliable data mining. Results: A total of 54 reviews from year 2014 to 2021 were included with notable increase in trend of publications. Systematic reviews constituted the majority (61.1%, (37.0% with meta-analyses)) followed by scoping reviews (38.9%). Domains of quality being reviewed include effectiveness (75.9%), accessibility (33.3%), patient safety (31.5%), efficiency (25.9%), patient-centred care (20.4%) and equity (16.7%). Mobile apps and computer-based were the commonest (79.6%) modalities. Strategies for effective intervention via digital health included engineering improved health behaviour (50.0%), better clinical assessment (35.1%), treatment compliance (33.3%) and enhanced coordination of care (24.1%). Psychiatry was the discipline with the most topics being reviewed for digital health (20.3%). Conclusion: Digital health reviews reported findings that were skewed towards improving the effectiveness of intervention via mHealth applications, and predominantly related to mental health and behavioural therapies. There were considerable gaps on review of evidence on digital health for cost efficiency, equitable healthcare and patient-centred care. Future empirical and review studies may investigate the association between fields of practice and tendency to adopt and research the use of digital health to improve care.

Outpatients' satisfaction with healthcare services received at a district hospital in Botswana.

Objectives: To investigate patient satisfaction regarding healthcare services at a district hospital. The research question was: what is the level of patient satisfaction regarding service delivery? Design: An observational cross-sectional descriptive study conducted in September 2019. Settings: A district hospital in Botswana serving a population of 90 000. Outpatients from the Eye clinic, Casualty and Outpatient Department, Sexual Reproductive Health clinic and Infectious Diseases Control Centre were selected for the study. Participants: 240 stable outpatients over 17 years selected through consecutive sampling participated voluntarily after giving informed consent. Main outcome measures: The level of satisfaction was measured using 19 questions on five-point Likert scales ranging from strongly disagree 1, disagree 2, unsure 3, agree 4 to strongly agree 5. A binary outcome was created into satisfied and unsatisfied using the mean score as the cut-off point. Age, gender, employment, education and departments were independent variables. Results: 65% (95% CI: 58-71%) were satisfied but unsatisfied with: doctor's politeness (66.9%; 95% CI: 60-73%), explaining (67.8%; 95% CI: 61-73%), privacy (65.6%; 95% CI: 59-72%), skills (67.4%; 95% CI: 61-73%), confidence (67.4% 95% CI: 61-73%), compassion (66.5%; 95% CI: 60-72%) and waiting time (49.2%; 95% CI: 42-57%). Department visited predicted satisfaction (p=0.002); those from the Eye clinic and Sexual Reproductive Health clinic were satisfied compared to others. Conclusion: Satisfaction was generally high but lower regarding specified services and departments visited. There is a need for targeted interventions. Studies are needed to explore reasons for lower satisfaction in Casualty, Outpatient Department and Infectious Diseases Control Centre. Funding: None declared.

Patients' perception of service quality in a healthcare not-for-profit organisation

Service organisations should be aware of those elements that are perceived as excellent quality and incorporate these as part of their service offering. However, a not-for-profit (NPO) healthcare organisation consists of a diverse group of stakeholders who have different perspectives and interests. Service quality therefore requires a multidimensional definition that comprehends all their needs and expectations.Methods: Perceived service quality experienced by patients was measured by completion of the Service Performance (SERVPERF) questionnaire. A total of 111 patients completed the questionnaire across three mobile clinics supported by an NPO.Results: The research results suggested that service quality at the mobile clinics was of a very high standard, with no meaningful differences between clinics, age groups or gender. However, the responses had very little variance and could have been subjected to response bias or extreme bias. The absence of a comparator organisation could also have had an influence on responses given by respondents. Conclusion: Healthcare service organisations should strive towards maintaining high standards and engage in continuous measurement and improvement of their service quality as part of their quality management process. By measuring the current level of service experienced by patients, insights have been identified where adjustments might have a positive effect on perceived value. Future research recommendations include suggestions to increase the sample population, taking the service setting into account and further studies to confirm the validity and reliability of solicited service quality questionnaires in a NPO setting.

Inclusión de la práctica colaborativa interprofesional para la promoción y prevención de la salud bucal / Inclusion of interprofessional collaborative practice for the promotion and prevention of oral health / Inclusão da prática interprofissional colaborativa para a promoção e prevenção da saúde bucal

Resumen Las actividades de promoción y prevención en Salud son relevantes en la Atención Primaria; no obstante, las relacionadas con el Programa de Salud Oral, en Chile, aparecen asociadas a los programas preventivos y no formando parte de ellos, situación que también ocurre en otros países. La presente revisión tiene como objetivos evidenciar las actuales políticas y lineamientos internacionales que indican que se debe propender a una Práctica Colaborativa Interprofesional para una mejor calidad en la atención; y proponer un trabajo interprofesional donde las acciones de promoción y prevención en Salud Bucal se incluyan en los programas preventivos existentes. La Práctica Colaborativa Interprofesional ocurre cuando los miembros del equipo de salud se organizan, planifican, gestionan y proporcionan servicios integrales de salud, evitando la fragmentación de los cuidados. Esto se logra estructurando las competencias comunes, colaborativas y específicas. El trabajo interdependiente permite complementar conocimientos y habilidades que contribuyen a cumplir con las políticas de Calidad de la Atención y Triple Meta en salud. De modo que, se proponen estrategias de trabajo en promoción y prevención de Salud Bucal a incorporar y ejecutar en los diversos programas preventivos ya existentes a lo largo del ciclo vital. En conclusión, es necesario un cambio de paradigma en la atención bucodental donde el foco ya no esté en el programa sino en el individuo, familia y comunidad para lograr una salud integral. Resulta relevante compartir experiencias de atención interprofesional y a incorporar la Educación Interprofesional y Practica Colaborativa en el proceso formativo de las futuras generaciones.

Abstract Health prevention and promotion actions are relevant in primary care; nevertheless, those related to the Oral Health Program in Chile are associated with preventive programs and are not part of them, which occurs in other countries as well. The objectives of this review are to display the current international policies and guidelines that indicate that an Interprofessional Collaborative Practice should be promoted for a better quality of care as well as to propose interprofessional work including promotion and prevention actions in Oral Health in the existing preventive programs. Interprofessional Collaborative Practice occurs when members of the health team organize, plan, manage and provide integral health services, avoiding fragmentation of care. This is achieved by structuring common, collaborative, and specific competencies. Interdependent work allows complementing knowledge and skills that contribute to comply with the policies of Quality of Care and Triple Aim in health. Therefore, work strategies in oral health promotion and prevention are proposed to be incorporated and implemented in the various preventive programs already in place throughout the life cycle. In conclusion, there is a need for a paradigm shift in oral health care, where the focus is no longer on the program but on the individual, family, and community to achieve comprehensive health. Finally, it becomes relevant to share experiences of interprofessional care, and incorporating Interprofessional Education and Collaborative Practice in the formative process of future generations.

Resumo As atividades de promoção e prevenção da saúde são relevantes na Atenção Básica; no entanto, aqueles relacionados ao Programa de Saúde Bucal no Chile aparecem associados aos programas preventivos e não fazem parte deles, situação que também ocorre em outros países. A presente revisão visa demonstrar as atuais políticas e diretrizes internacionais que indicam que uma Prática Interprofissional Colaborativa deve ser promovida para uma melhor qualidade de atendimento; e propor um trabalho interprofissional onde as ações de promoção e prevenção em Saúde Bucal estejam incluídas nos programas preventivos existentes. A Prática Colaborativa Interprofissional ocorre quando os membros da equipe de saúde organizam, planejam, gerenciam e prestam serviços de saúde integrais, evitando a fragmentação do cuidado. Isso é conseguido através da estruturação de competências comuns, colaborativas e específicas. O trabalho interdependente permite complementar conhecimentos e competências que contribuem para o cumprimento das políticas de Qualidade da Assistência e Triplo Objetivo em saúde. Assim, são propostas estratégias de trabalho na promoção e prevenção da Saúde Bucal a serem incorporadas e executadas nos diversos programas preventivos já existentes ao longo do ciclo vital. Conclui-se que é necessária uma mudança de paradigma na higiene bucal, onde o foco não seja mais o programa, mas sim o indivíduo, a família e a comunidade para o alcance da saúde integral. É relevante compartilhar experiências de cuidado interprofissional e incorporar a Educação Interprofissional e a Prática Colaborativa no processo de formação das futuras gerações.

Assessing organizational culture in public mental healthcare service organizations.

PURPOSE: The purpose of this paper is to investigate aspects of organizational culture among the nursing staff of public mental health services organizations in Cyprus. Specifically, highlights are provided of possible differences on the attitudes of nurses regarding actual and desired aspects of organizational culture with respect to demographic characteristics such as gender, years of service and experience. DESIGN/METHODOLOGY/APPROACH: A descriptive explanatory type survey study was conducted in all public mental health services organizations of Cyprus. Specifically, a questionnaire was given to a representative sample of the nursing population, and data were collected and analyzed. The survey questionnaire was based on the organizational culture profile (OCP) methodology. Statistical analysis was carried out using correlational analysis, t-tests and analysis of variance (ANOVA). FINDINGS: Results showed that there are significant discrepancies between the actual organizational culture and what is desired by staff members of public mental health services organizations in Cyprus. Further, significant differences are identified between actual and desired organizational culture moderated by the type of work, which is determined by the workplace. ORIGINALITY/VALUE: Even though, organizational culture is a major research topic little has been done in the context of public mental healthcare organizations. Further, for the case of Cyprus, it is the first time that such a study is carried out. The results presented in this paper may provide the foundation for measures to be taken for improving the existing operation of public mental healthcare organizations.

Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings.

OBJECTIVE: Number of People Living with Human Immune-deficiency Virus in Ghana is over 300,000 and unmet need for antiretroviral therapy is approximately 60%. This study sought to determine the quality of antiretroviral therapy services in selected ART sites in Ghana using the input-process-outcome approach. METHODS: This is a descriptive cross-sectional case study that employed modified normative evaluation to assess quality of antiretroviral therapy services in the Oti and Volta regions of Ghana among People Living with HIV (n = 384) and healthcare providers (n = 16). The study was conducted from 11 March to 9 May 2019. RESULTS: Resources for managing HIV clients were largely available with the exception of viral load machines, reagents for CD4 counts, and antifungals such as Fluconazole and Cotrimoxazole. Patients enrolled on antiretroviral therapy within 2 weeks was 71% and clients retained in care within 2 weeks of enrolment was 90%. Approximately 26% of enrolled clients recorded viral load suppression; 33% of People Living with HIV who were not insured with the National Health Insurance Scheme paid for some antiretrovirals and cotrimoxazole. Adherence to ART and Cotrimoxazole were 95% and 88%, respectively, using pill count on their last three visits. Time spent with clinical team was among the worst rated (mean = 2.98, standard deviation = 0.54) quality indicators by patients contrary to interpersonal relationship with health provider which was among the best rated (mean = 3.25, standard deviation = 0.41) indicators. CONCLUSION: Observed quality care gaps could potentially reverse gains made in HIV prevention and control in Ghana if not addressed timely; an important value addition of this study is the novel application of input-process-outcome approach in the context of antiretroviral therapy services in Ghana. There is also the need for policy dialogue on inclusion of medications for prophylaxis in antiretroviral therapy on the National Health Insurance Scheme to promote adherence and retention.

Impact assessment of accreditation in primary and secondary public health-care institutions in Kerala, India.

BACKGROUND: Accreditation has become a benchmark for health-care organizations that require huge investment and effort. The impact of accreditation in health-care delivery needs to be assessed. OBJECTIVES: The study aimed to assess the impact of accreditation on the quality of public healthcare delivery in primary and secondary healthcare settings in Kerala. METHODS: This cross-sectional study was conducted from July 2017 to July 2018 among 621 in-patients in medical wards at accredited (312) and nonaccredited (309) primary (community health center) and secondary (general, women and children, and taluk level hospitals) public health-care facilities. Ten constructs such as physical facility, admission services, patient centeredness, accessibility of medical care, financial matters, professionalism, staff services, medical quality, diagnostic services, and patient satisfaction were used in the study. Nonaccredited and accredited hospitals were compared using Median and Kruskal-Wallis test using SPSS version 22, with a set significance level of P ≤0 .05. RESULTS: The median score of constructs of accredited primary health-care facilities in the Structure, Process, and Outcome domains are higher than the nonaccredited hospitals. There are significant differences between the scores of these three domains in accredited and nonaccredited primary health-care institutions but absent in secondary care institutions. CONCLUSION: If accreditation has to bring the embedded quality, structural, and procedural aspects of health-care facilities must be improved. Structural upgradation of a health-care facility alone cannot guarantee patient satisfaction. Accreditation process must be perceived as a tool for holistic and continuous transformation of a health-care facility overarching infrastructural and interpersonal domains.

Physicians' satisfaction with clinical referral laboratories in Rwanda.

BACKGROUND: The quality of laboratory services is crucial for quality of patient care. Clinical services and physicians' decisions depend largely on laboratory test results for appropriate patients' management. Therefore, physicians' satisfaction with laboratory services is a key measurement of the quality service that stresses impactful laboratory service improvement to benefit patients. OBJECTIVE: To assess physicians' satisfaction and perspectives on the quality of services in clinical referral laboratories in Rwanda. METHODS: A cross-sectional survey among physicians from four referral hospitals with closed-ended questionnaire and one general open-ended question. A five-point Likert scale rating was used to measure satisfaction. Descriptive, ordered logistic regression, and thematic analysis were used. RESULTS: In total, 462 of 507 physicians (91% response rate) participated in the study. Overall mean satisfaction was 3.2 out of 5, and 36.2% of physicians were satisfied (satisfied and strongly satisfied) with laboratory services. In four service categories out of 17, the physicians' satisfaction was over 50%. The categories were: reliability of results (69.9%), adequacy of test reports (61.9%), laboratory staff availability (58.4%), and laboratory leadership responsiveness (51.3%). Lowest satisfaction was seen for routine test turnaround time (TAT) (19.3%), in-patient stat (urgent) test TAT (27%), communication of changes such as reagent stock out, new test (29%), and missing outpatient results (31%). Eighty-four percent answered that test TAT was not communicated, and 73.4% lacked virology diagnostics. Pediatricians, internists, and more experienced physicians were less satisfied. While ineffective communication, result delays, and service interruption were perceived as dissatisfying patterns, external audits were appreciated for improving laboratory services. CONCLUSION: Availing continuously laboratory tests, timely result reporting, and effective communication between laboratories and clinicians would increase physicians' satisfaction and likely improve the quality of health care. Laboratory staff participation in clinical meetings and ward rounds with physicians may address most of the physicians' concerns.