Hospital accreditation: Driving best outcomes through continuity of midwifery care? A scoping review

ProblemContinuity of midwifery care models are the gold standard of maternity care. Despite being recommended by the Australian Health Ministers’ Advisory Council, few women in Australia have access to such models.BackgroundExtensive research shows that if all women had access to continuity of midwifery care, maternal and neonatal outcomes would improve. Hospital accreditation, the main national safety and quality system in Australia, aims to encourage and enable the translation of healthcare quality and safety standards into practice.AimThis paper explored the realities and possibilities of a health care accreditation system driving health service re-organisation towards the provision of continuity of midwifery care for childbearing women.MethodsA scoping review sought literature at the macro (policy) level. From 3036 records identified, the final number of sources included was 100:73 research articles and eight expert opinion pieces/editorials from journals, 15 government/accreditation documents, three government/accreditation websites, and one thesis.FindingsTwo narrative themes emerged: (1) Hospital accreditation: ‘Here to stay’ but no clear evidence and calls for change. (2) Measuring and implementing quality and safety in maternity care.DiscussionRegulatory frameworks drive hospitals’ priorities, potentially creating conditions for change. The case for reform in the hospital accreditation system is persuasive and, in maternity services, clear. Mechanisms to actualise the required changes in maternity care are less apparent, but clearly possible.ConclusionsStructural changes to Australia’s health accreditation system are needed to prioritise, and mandate, continuity of midwifery care.     

The need for improved emotional support: A pilot online survey of Australian women’s access to healthcare services and support at the time of miscarriage

ProblemWomen need improved emotional support from healthcare professionals following miscarriage.BackgroundSignificant psychological morbidity can result following miscarriage and may be exacerbated by poor support experiences. Women frequently report high levels of dissatisfaction with healthcare support at this time.AimThis study was developed to pilot a survey aimed at exploring women’s access to healthcare services and support at the time of miscarriage.MethodsWomen over 18 years, residing in Australia, who had experienced a miscarriage in the past two years completed a 29-item online survey.FindingsA total of 399 women completed the survey. Two key findings arose: 1) More than half of women (59%) were not offered any information about miscarriage or pregnancy loss support organisations or referral/access to counselling services at the time of miscarriage, despite almost all reporting they would have liked various forms of support from items listed 2) More than half (57%) did not receive follow up care, or emotional support at this time, beyond being asked how they were coping emotionally. Other findings showed 3) Women accessed various healthcare services at the time of miscarriage and 4) Women often saw a general practitioner at the time of miscarriage despite having a private obstetrician.ConclusionThere is clear mismatch between the support women want at the time of miscarriage and the care they receive from healthcare professionals. Despite considerable structural barriers, it seems likely there is scope within healthcare professionals’ usual practice for improved support care through simple measures such as increased acknowledgement, information provision and referral to existing support services.     

The measurement of structural ageing – an axiomatic approach

Contraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policies on contraceptive access by identifying and reviewing empirical literature, which is then presented and discussed using Levesque et al.’s (2013) healthcare access framework. A scoping review was conducted to identify empirical studies (N = 96) examining the impact of recent federal policy (passed from 2009 to 2019) on contraceptive access. Most identified studies examined the role of the Affordable Care Act (n = 53) and Title X of the Public Health Service Act (n = 25), showing many benefits of both policies for contraceptive access, particularly through improved affordability, availability, and appropriateness of contraceptive care. Other identified studies examined the impact of policies funding abstinence-only sex education (n = 2) and the Teen Pregnancy Prevention Program (n = 3), military policies related to the availability of contraception (n = 1), guidelines for quality contraceptive care (n = 3), Title IX of the Education Amendments (n = 4), the Violence Against Women Act (n = 1), and the Veterans Access, Choice, and Accountability Act (n = 4). Through increased outreach efforts, normalising of care, availability of services, cost subsidies, and provider competencies, recent federal policy has, overall, enhanced contraceptive access across the dimensions of healthcare access. Numerous policy and practice gaps and needs are identified, and future directions for research, policy, and practice are suggested.

     

Active Duty Military Personnel Presenting for Care at a Gay Men's Health Clinic

ABSTRACT

Under the “Don't Ask, Don't Tell, Don't Pursue, Don't Harass” Department of Defense policy, gay men and women are allowed to serve in the military, but they are not allowed to disclose their sexual orientation. This study was performed to determine the incidence of active duty military personnel seeking care at a Gay Men's Health Clinic. Nine percent of the clients, who had served between June and August 2002, were active duty U.S. Navy sailors. They all expressed fears of being discharged from the military when asked why they did not access military healthcare. The “DADTDPDH” policy breeds distrust between men who have sex with men (MSM) service-members and their healthcare provider and this ensures inadequate healthcare.     

Women from migrant and refugee backgrounds’ perceptions and experiences of the continuum of maternity care in Australia: A qualitative evidence synthesis

BackgroundWomen who were born overseas represent an increasing proportion of women giving birth in the Australian healthcare system.ProblemWomen from migrant and refugee backgrounds have an increased risk of poor pregnancy and birth outcomes, including experiences of care.AimTo understand how women from migrant and refugee backgrounds perceive and experience the continuum of maternity care (pregnancy, birth, postnatal) in Australia.MethodologyWe conducted a qualitative evidence synthesis, searching MEDLINE, CIHAHL, and PsycInfo for studies published from inception to 23/05/2020. We included studies that used qualitative methods for data collection and analysis, that explored migrant/refugee women’s experiences or perceptions of maternity care in Australia. We used a thematic synthesis approach, assessed the methodological limitations of included studies, and used GRADE-CERQual to assess confidence in qualitative review findings.Results27 studies met the inclusion criteria, representing women in Australia from 42 countries. Key themes were developed into 24 findings, including access to interpreters, structural barriers to service utilisation, experiences with health workers, trust in healthcare, experiences of discrimination, preferences for care, and conflicts between traditional cultural expectations and the Australian medical system.ConclusionThis review can help policy makers and organisations who provide care to women from migrant and refugee backgrounds to improve their experiences with maternity care. It highlights factors linked to negative experiences of care as well as factors associated with more positive experiences to identify potential changes to practices and policies that would be well received by this population.     

Gender Differences in Activity of Daily Living of the Elderly in Rural China: Evidence from Chaohu

ABSTRACT

Using data from a sample survey, “Well-being of the elderly in Anhui province, China,” this paper studies the effects of health, economic and family factors on the activities of daily living (ADLs) as measures of disability for elderly men and women. The objective is to explore reasons for gender differences in ADLs in rural China. Our results suggest that higher incidence rates of chronic diseases, lower cognitive ability, as well as heavier household and daily care burdens of females, are the main factors leading to a higher prevalence of ADL disability for the female elderly.     

Mobile Internet Use and Multidimensional Poverty: Evidence from A Household Survey in Rural China

The impact of specific living conditions on the population of geographically and socially segregated Roma settlements in Eastern Slovakia is considerable. They are characterized by high unemployment, lower education, poor housing and sanitary conditions, a poor quality of life, which all affects significantly their higher mortality rates and worse health status. In this paper we try to approach the problem of adverse mortality conditions and health with a deeper demographic insight. The fundamental goal of the paper is to analyse mortality in the population from Roma settlements over the past two decades using complex demographic methods such as life tables, direct standardization with the objective of eliminating differences in the age structure, single and multi-dimensional decomposition of age, sex and causes of death. We also analyse mortality using the concept of avoidable mortality. The results obtained from Roma settlements confirmed significantly worse mortality rates for both sexes. In addition, it appears that the disparities between them and the majority population are growing over time. The primary reason is the higher mortality of the youngest children and persons at post-reproductive age. Basically, all main chapters of the causes of death shorten the life expectancy of persons from Roma settlements, but cardiovascular diseases have the greatest negative impact. Conclusions obtained from the avoidable mortality analysis point to problems related to the accessibility and quality of health care, as well as the lack of interest of population from Roma settlements in their own health, along with the need for more targeted prevention and screening campaigns in this environment. Although the answers of respondents from Roma settlements to their own health confirm the deteriorating quality of health, increasing morbidity and the degree of restriction of normal daily activities with increasing age, they also point to some problems associated with the use of this approach.

     

Understanding pathways leading to stillbirth: The role of care-seeking and care received during pregnancy and childbirth in Kabul province,Afghanistan

BackgroundThe underlying pathways leading to stillbirth in low- and middle-income countries are not well understood. Context-specific understanding of how and why stillbirths occur is needed to prioritise interventions and identify barriers to their effective implementation and uptake.AimTo explore the contribution of contextual, individual, household-level and health system factors to stillbirth in Afghanistan.MethodsUsing a qualitative approach, we conducted semi-structured in-depth interviews with women and men that experienced stillbirth, female elders, community health workers, healthcare providers, and government officials in Kabul province, Afghanistan between October-November 2017. We used thematic analysis to identify contributing factors and developed a conceptual map describing possible pathways to stillbirth.FindingsWe found that low utilisation and access to healthcare was a key contributing factor, as were unmanaged conditions in pregnancy that increased women’s risk of complications and stillbirth. Sociocultural factors related to the treatment of women and perceptions about medical interventions deprived women of interventions that could potentially prevent stillbirth. The quality of care from public and private providers during pregnancy and childbirth was a recurring concern exacerbated by health system constraints that led to unnecessary delays; while environmental factors linked to the ongoing conflict were also perceived to contribute to stillbirth. These pathways were underscored by social, cultural, economic factors and individual perceptions that contributed to the three-delays.DiscussionEfforts are needed at the community-level to facilitate care-seeking and raise awareness of stillbirth risk factors and the facility-level to strengthen antenatal and childbirth care quality, ensure culturally appropriate and respectful care, and reduce treatment delays.     

The perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women: An ethnographic study

BackgroundAcross the globe, many women including economic and humanitarian migrants receive inadequate antenatal care. Understanding the difficulties that migrant women encounter when accessing maternity care, including the approach of health professionals, is necessary because inadequate care is associated with increasing rates of morbidity and mortality. There are very few studies of migrant women’s access to and experience of maternity services when they have migrated from a low- to a middle-income country.AimTo examine the perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women, and to describe women’s experiences of their encounters with health professionals providing maternity care in Ranong Province in southern Thailand.MethodsEthnography informed the study design. Individual interviews were conducted with 13 healthcare professionals and 10 Burmese women before and after birth. Observations of interactions (130 h) between health care providers and Burmese women were also conducted. Data were analysed using thematic analysis.FindingsThe healthcare professionals’ practices differed between the antenatal clinics and the postnatal ward. Numerous barriers to accessing culturally appropriate antenatal care were evident. In contrast, the care provided in the postnatal ward was woman and family centered and culturally sensitive. One overarching theme, “The system is in control’ was identified, and comprised three sub-themes (1) ‘Being processed’ (2) ‘Insensitivity to cultural practices’ and, (3) ‘The space to care’.Discussion and conclusionsThe health system and healthcare professionals controlled the way antenatal care was provided to Burmese migrant women. This bureaucratic and culturally insensitive approach to antenatal care impacted on some women’s decision to engage in antenatal care. Conversely, the more positive examples of woman-centered care evident after birth in the postnatal ward, can inform service delivery.     

“Who's afraid?”: Attitudes of midwives to the use of information and communication technologies (ICTs) for delivery of pregnancy-related health information

BackgroundUsage rates for information and communication technologies (ICTs) in healthcare have been increasing in recent years, but often lag behind general usage rates for populations as a whole. Research into such differential rates of ICT use across different segments of the population has identified a number of possible causal factors that limit usage.AimThe research investigated midwives’ attitudes and experiences of ICT use to identify potential causal factors that encourage or inhibit their usage in antenatal care.MethodsSemi-structured interviews, focus groups and short surveys were conducted with midwives who provide antenatal education at an Australian metropolitan hospital. Thematic and statistical analyses were used to interpret the data.FindingsAlthough midwives recognised the potential benefits of using ICTs to deliver pregnancy-related health information many had reservations about their use in everyday work. These reservations centred on lack of training in use of ICTs, the perceived legal risks associated with social media, potential violations of patient privacy, misdiagnosis and misunderstandings between midwife and client.ConclusionMidwives face a number of barriers to effective use of ICTs in healthcare including material access, skills access, usage access and motivational access. Motivational access appears to be a key concern due to the high perception of risk associated with social media in particular. Reducing the motivational barriers through a range of interventions with midwifery staff may assist in overcoming other barriers to ICT use in antenatal care. Further research is required to determine whether these findings are generalisable to other healthcare contexts.     

Creating Welcoming Spaces for Lesbian,Gay, Bisexual,and Transgender (LGBT) Patients: An Evaluation of the Health Care Environment

ABSTRACT

Health outcomes are affected by patient, provider, and environmental factors. Previous studies have evaluated patient-level factors; few focusing on environment. Safe clinical spaces are important for lesbian, gay, bisexual, and transgender (LGBT) communities. This study evaluates current models of LGBT health care delivery, identifies strengths and weaknesses, and makes recommendations for LGBT spaces. Models are divided into LGBT-specific and LGBT-embedded care delivery. Advantages to both models exist, and they provide LGBT patients different options of healthcare. Yet certain commonalities must be met: a clean and confidential system. Once met, LGBT-competent environments and providers can advocate for appropriate care for LGBT communities, creating environments where they would want to seek care.     

Facilitators of prenatal care access in rural Appalachia

BackgroundThere are many providers and models of prenatal care, some more effective than others. However, quantitative research alone cannot determine the reasons beneficial models of care improve health outcomes. Perspectives of women receiving care from effective clinics can provide valuable insight.MethodsWe surveyed 29 women receiving care at a rural, Appalachian birth center in the United States with low rates of preterm birth. Semi-structured interviews and demographic questionnaires were analyzed using conventional qualitative content analysis of manifest content.FindingsInsurance was the most common facilitator of prenatal access. Beneficial characteristics of the provider and clinic included: personalized care, unrushed visits, varied appointment times, short waits, and choice in the type and location of care.ConclusionThere is a connection between compassionate and personalized care and positive birth outcomes. Women were willing to overcome barriers to access care that met their needs. To facilitate access to prenatal care and decrease health disparities, healthcare planners, and policy makers need to ensure all women can afford to access prenatal care and allow women a choice in their care provider. Clinic administrators should create a welcoming clinic environment with minimal wait time. Unrushed, woman-centered prenatal visits can increase access to and motivation for care and are easily integrated into prenatal care with minimal cost.     

Expenditure Decentralization and Citizen Satisfaction with Healthcare: Evidence from Urban China

There has been considerable debate whether fiscal decentralization improves the provision of public goods. Based on individual-level data from a nationally representative survey and county-level data from national compendiums of financial statistics and demographic statistics, this study analyzes the effect of expenditure decentralization on citizen satisfaction with public healthcare in urban China. The results indicate a significantly positive effect of expenditure decentralization on citizen satisfaction with public healthcare. We also find evidence that the impact of decentralization is associated with residency status. Further investigation highlights the importance of local economic development in realizing the potential gains from a decentralized system. This study suggests that decision-making at lower levels of government is more responsive to local needs and that the efficiency gains of decentralization are not necessarily accompanied by equitable distribution of welfare.

     

China’s Demographic Future Under the New Two-Child Policy

China implemented the two-child policy in 2016, however, potential impacts of this new policy on its population reality have not been adequately understood. Using population census data and 1% population sampling data during the period of 1982–2015, this study develops a fertility simulation model to explore the effects of the two-child policy on women’s total fertility rate, and employs Cohort Component Method in population projections to examine China’s demographic future with different fertility regimes. The fertility simulation results reveal that the two-child policy will make significantly positive effects on China’s total fertility rate through increasing second births, leading to a sharp but temporary increase in the first 5 years after the implementation of the new policy. In addition, population projections using simulated total fertility rates show that the Chinese population would reach its peak value around the middle 2020s and be faced with the reduction of labor force supply and rapid aging process, featured with remarkable increases in both size and share of the elderly population. The findings suggest that the two-child policy would undoubtedly affect China’s fertility rates and demographic future; however, the effects are mild and temporary.

     

中国老年人口的养老意愿及其城乡差异——基于中国老年社会追踪调查数据的分析

老年人的养老意愿是建立养老服务体系必须考虑的重要方面.文章根据中国人民大学2014年"中国老年社会追踪调查"数据,分析我国老年人的养老意愿及其影响因素.采用多分类Logit回归模型比较城市和农村老年人的居住意愿.分析发现城市老年人的居住意愿受个体、家庭、社区三类因素的共同影响,呈现多元化特点,而对农村老年人居住意愿有显著影响的因素则基本集中于家庭因素.结果表明城市老年人更趋向于独立居住或入住养老机构,而农村老年人对社会养老服务的需求更取决于家庭成员的态度和支持程度.     

The Potential Impact of Discrimination Fears of Older Gays,Lesbians, Bisexuals and Transgender Individuals Living in Small- to Moderate-Sized Cities on Long-Term Health Care

ABSTRACT

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

城市社区养老服务质量评价--基于粗糙集方法的数据挖掘

客观公正的养老服务质量评价对完善社区养老体系建设有重要意义。本文基于粗糙集的研究方法,分别从生活照料、医疗护理、安全保障、精神慰藉以及社会参与五个维度对显著影响社区养老服务质量评价的指标进行了约简,进而确定质量评价体系的指标和权重,并对吉林市22个社区养老服务的质量进行了评价。结果显示,质量评价平均水平介于“一般”和“比较满意”之间;年龄越高的老年人对社区养老服务质量评价越低;社区养老建设试点小区的评分显著高于非试点小区。由此可见,我国社区养老试点建设已经取得明显成效,但亟须进一步推行和完善。     

The Impact of Different Types of Resource Transfers on Individual Wellbeing: An Analysis of Quality of Life Using CASP-12

This paper uses data for Spain from the Survey of Health, Ageing and Retirement in Europe (release 2.3.1) to model the determinants of the quality of life of the elderly, paying special attention to their intergenerational relations. The aim is to study CASP-12 (a social functional index) and explore the effect of interdependency in terms of the transfer of the resources of time and money between the elderly and other family members. To do so, we estimate a latent class model to explore the determinants of wellbeing. This allows us to distinguish between two different subpopulations, whose quality of life is modeled in different ways and who potentially would require different types of public care policies.