Objective:This study aimed to explore the existing knowledge about midwives’views and experiences of providing care for women in the context of task shifting.Methods:We conducted a qualitative systematic review using...Objective:This study aimed to explore the existing knowledge about midwives’views and experiences of providing care for women in the context of task shifting.Methods:We conducted a qualitative systematic review using meta-ethnography to describe the views and experiences of midwives on providing care in the context of task shifting.Comparative textual analysis of published qualitative studies involved translation of first-order key concepts and meanings from included studies to generate second-and third-order concepts.A grid was made to identify core findings and compare them reciprocally.Results:Thirty-six qualitative studies met the inclusion criteria.The literature comprised of 32 first key concepts.Eight second-order constructs emerged,and three third-order interpretations were generated.The three overarching themes were:(1)midwives perceived themselves as providing culturally competent and high quality women-centered care;(2)they valued their profession but saw it as complex and challenging;(3)as health professionals,they reported a variety of organizational,cultural,and professional barriers to providing women-centered care.Conclusions:While performing a specific task in the task shifting context,midwives perceived their crucial roles and responsibilities,along with achieved value and reward.However,due to a range of existing barriers,the caring task posed great challenges in completely implementing women-centered care.It is essential for systems to identify and eliminate these barriers early,to consider midwives’emotional well-being,and to develop overall strategies to better support the midwifery workforce.Policy makers and administrators should establish a supportive environment to facilitate midwives to perform women-centered caring tasks in more effective and efficient ways.展开更多
Background: Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid and lower-level cadres limit access to effective contraceptive m...Background: Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid and lower-level cadres limit access to effective contraceptive methods in many settings. Task sharing and task shifting are strategies that can be adopted to increase uptake of health services including family planning. Methods: We collected data through online survey, key informant interviews and focused grouped discussions with an intervention group and that implemented the task sharing and task shifting policy guidelines and a control group that did not implement the policy. A total of 434 questionnaires were filled by health workers’ in primary health care facilities to assess effectiveness of task sharing and task shifting on the uptake of family planning services including its strengths and challenges. The questionnaire was designed with the aim of getting data on services provided by the cadres on effectiveness (number of clients, increase in use of methods, access to services), how they perceive these tasks, the bottlenecks and facilitating factors associated with the practice of task sharing and task shifting. Results: We found out that the task sharing and task shifting can expand and increase access to services as stated by 95% of the respondents. Most community health workers provided more of the family planning services at 45% with only 5% of the services of family planning being provided by medical officers. 98% of family planning services were integrated with other services. Task shifting was beneficial to the health care providers as well as the clients and the success of task sharing and task shifting depended on training, supportive supervision and a regulated environment through policies. Conclusion: The study shows that formalized task sharing and task shifting can increase health service uptake especially when community health workers are involved to provide services in the community. This leads to increased service provision, equivalent health professional performance across cadres and patient outcomes in the provision of family planning services.展开更多
Background and Aims:The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection(HCV)is inefficient in absorbing the approximately 3 million patients awaiting treatment in the ...Background and Aims:The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection(HCV)is inefficient in absorbing the approximately 3 million patients awaiting treatment in the United States.Task shifting—whereby specialist physicians screen patients for treatment eligibility but on-treatment monitoring is devolved to more abundant non-physician clinicians—achieves non-inferior treatment outcomes with second generation direct-acting antivirals(2^(nd)Gen DAAs),may increase treatment capacity,and may facilitate greater treatment access.We determined the cost effectiveness of 2^(nd)Gen DAAs with respect to interferon-based first-generation DAAs(1^(st)Gen DAAs)within a task-shifted treatment model.Methods:Using a previously described decision-analytic Markov structure,we modeled a hypothetical cohort of 1,000 patients with HCV genotype 1 infection over a lifetime horizon,based upon our outreach clinic's HCV treatment protocol.Treatment-naive and treatment-experienced HCV cohorts were modeled separately,based upon our outr8each clinic's demographics.Treatment response to 2^(nd)Gen DAAs was modeled based on our outreach clinic's data.Adverse events,utility,costing,and transition probabilities were sourced from the literature.Results:Driven by improved effectiveness and safety,as well as an expected increase in treatment capacity,2^(nd)Gen DAAs treatment monitored by non-physician clinicians was projected to improve health outcomes and be dominant from a cost-effective perspective versus that of 1^(st)Gen DAAs.Trends were consistent across all assessed patient subpopulations.Conclusions:Based on an assumption of increased treatment capacity accompanying a task-shifted treatment model,2^(nd)Gen DAAs-based treatment was cost effective and cost saving as compared to 1^(st)Gen DAAs-based treatment for all HCV patient subgroups assessed.展开更多
The mental health effects of the coronavirus disease 2019(COVID-19)pandemic may shape population health for many years to come.Failure to address the mental health issues stemming from the pandemic is likely to prolon...The mental health effects of the coronavirus disease 2019(COVID-19)pandemic may shape population health for many years to come.Failure to address the mental health issues stemming from the pandemic is likely to prolong its impact.The COVID-19 pandemic has created a significant global challenge and,in lower-income countries,even a disruption of mental health services.Given our experience with previous pandemics,the present COVID-19 crisis can be expected to cause psychological trauma,and steps are needed to address this issue proactively.Policies focusing on the long-term mental health consequences of COVID-19 may equal the importance of those currently seeking to mitigate its physical effects.The implications of the GOVID-19 pandemic for mental health call for a greater focus on the needs of those with mental disorders and on mental health issues affecting health care workers and the general public.Timely preventive and therapeutic mental health care is essential in addressing the psychosocial needs of populations exposed to the pandemic.In addition to specialist care,"task-shifting"and digital technologies may provide cost-effective means of providing mental health care in lower-income countries worldwide as well as in higher-income countries with mental health services overwhelmed by the effects of the COVID-19 pandemic.In view of the ever-increasing pressure on global health systems resulting from the COVID-19 pandemic,adopting and adapting"task-shifting",i.e.,the delegation of psychotherapeutic interventions to trained non-specialists,as an element of the provision of mental health services,is overdue.Digital technologies can be used to enhance social support and facilitate resilience to the detrimental mental health effects of the pandemic;they may also offer an efficient and cost-effective way to provide easy access to mentalhealth care.展开更多
基金The study was funded by the National Natural Science Foundation of China(Grant No.71874030).
文摘Objective:This study aimed to explore the existing knowledge about midwives’views and experiences of providing care for women in the context of task shifting.Methods:We conducted a qualitative systematic review using meta-ethnography to describe the views and experiences of midwives on providing care in the context of task shifting.Comparative textual analysis of published qualitative studies involved translation of first-order key concepts and meanings from included studies to generate second-and third-order concepts.A grid was made to identify core findings and compare them reciprocally.Results:Thirty-six qualitative studies met the inclusion criteria.The literature comprised of 32 first key concepts.Eight second-order constructs emerged,and three third-order interpretations were generated.The three overarching themes were:(1)midwives perceived themselves as providing culturally competent and high quality women-centered care;(2)they valued their profession but saw it as complex and challenging;(3)as health professionals,they reported a variety of organizational,cultural,and professional barriers to providing women-centered care.Conclusions:While performing a specific task in the task shifting context,midwives perceived their crucial roles and responsibilities,along with achieved value and reward.However,due to a range of existing barriers,the caring task posed great challenges in completely implementing women-centered care.It is essential for systems to identify and eliminate these barriers early,to consider midwives’emotional well-being,and to develop overall strategies to better support the midwifery workforce.Policy makers and administrators should establish a supportive environment to facilitate midwives to perform women-centered caring tasks in more effective and efficient ways.
文摘Background: Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid and lower-level cadres limit access to effective contraceptive methods in many settings. Task sharing and task shifting are strategies that can be adopted to increase uptake of health services including family planning. Methods: We collected data through online survey, key informant interviews and focused grouped discussions with an intervention group and that implemented the task sharing and task shifting policy guidelines and a control group that did not implement the policy. A total of 434 questionnaires were filled by health workers’ in primary health care facilities to assess effectiveness of task sharing and task shifting on the uptake of family planning services including its strengths and challenges. The questionnaire was designed with the aim of getting data on services provided by the cadres on effectiveness (number of clients, increase in use of methods, access to services), how they perceive these tasks, the bottlenecks and facilitating factors associated with the practice of task sharing and task shifting. Results: We found out that the task sharing and task shifting can expand and increase access to services as stated by 95% of the respondents. Most community health workers provided more of the family planning services at 45% with only 5% of the services of family planning being provided by medical officers. 98% of family planning services were integrated with other services. Task shifting was beneficial to the health care providers as well as the clients and the success of task sharing and task shifting depended on training, supportive supervision and a regulated environment through policies. Conclusion: The study shows that formalized task sharing and task shifting can increase health service uptake especially when community health workers are involved to provide services in the community. This leads to increased service provision, equivalent health professional performance across cadres and patient outcomes in the provision of family planning services.
文摘Background and Aims:The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection(HCV)is inefficient in absorbing the approximately 3 million patients awaiting treatment in the United States.Task shifting—whereby specialist physicians screen patients for treatment eligibility but on-treatment monitoring is devolved to more abundant non-physician clinicians—achieves non-inferior treatment outcomes with second generation direct-acting antivirals(2^(nd)Gen DAAs),may increase treatment capacity,and may facilitate greater treatment access.We determined the cost effectiveness of 2^(nd)Gen DAAs with respect to interferon-based first-generation DAAs(1^(st)Gen DAAs)within a task-shifted treatment model.Methods:Using a previously described decision-analytic Markov structure,we modeled a hypothetical cohort of 1,000 patients with HCV genotype 1 infection over a lifetime horizon,based upon our outreach clinic's HCV treatment protocol.Treatment-naive and treatment-experienced HCV cohorts were modeled separately,based upon our outr8each clinic's demographics.Treatment response to 2^(nd)Gen DAAs was modeled based on our outreach clinic's data.Adverse events,utility,costing,and transition probabilities were sourced from the literature.Results:Driven by improved effectiveness and safety,as well as an expected increase in treatment capacity,2^(nd)Gen DAAs treatment monitored by non-physician clinicians was projected to improve health outcomes and be dominant from a cost-effective perspective versus that of 1^(st)Gen DAAs.Trends were consistent across all assessed patient subpopulations.Conclusions:Based on an assumption of increased treatment capacity accompanying a task-shifted treatment model,2^(nd)Gen DAAs-based treatment was cost effective and cost saving as compared to 1^(st)Gen DAAs-based treatment for all HCV patient subgroups assessed.
文摘The mental health effects of the coronavirus disease 2019(COVID-19)pandemic may shape population health for many years to come.Failure to address the mental health issues stemming from the pandemic is likely to prolong its impact.The COVID-19 pandemic has created a significant global challenge and,in lower-income countries,even a disruption of mental health services.Given our experience with previous pandemics,the present COVID-19 crisis can be expected to cause psychological trauma,and steps are needed to address this issue proactively.Policies focusing on the long-term mental health consequences of COVID-19 may equal the importance of those currently seeking to mitigate its physical effects.The implications of the GOVID-19 pandemic for mental health call for a greater focus on the needs of those with mental disorders and on mental health issues affecting health care workers and the general public.Timely preventive and therapeutic mental health care is essential in addressing the psychosocial needs of populations exposed to the pandemic.In addition to specialist care,"task-shifting"and digital technologies may provide cost-effective means of providing mental health care in lower-income countries worldwide as well as in higher-income countries with mental health services overwhelmed by the effects of the COVID-19 pandemic.In view of the ever-increasing pressure on global health systems resulting from the COVID-19 pandemic,adopting and adapting"task-shifting",i.e.,the delegation of psychotherapeutic interventions to trained non-specialists,as an element of the provision of mental health services,is overdue.Digital technologies can be used to enhance social support and facilitate resilience to the detrimental mental health effects of the pandemic;they may also offer an efficient and cost-effective way to provide easy access to mentalhealth care.
