BACKGROUND: Prenatal healthcare is likely to prevent adverse outcomes, but an adequate review of utilization and its determinants is lacking.OBJECTIVE: To review systematically the evidence for the determinants of prenatal healthcare utilization in high-income countries.METHOD: Search of publications in EMBASE, CINAHL and PubMed (1992-2010). Studies that attempted to study determinants of prenatal healthcare utilization in high-income countries were included. Two reviewers independently assessed the eligibility and methodological quality of the studies. Only high-quality studies were included. Data on inadequate use (i.e. late initiation, low-use, inadequate use or non-use) were categorized as individual, contextual and health behaviour-related determinants. Due to the heterogeneity of the studies, a quantitative meta-analysis was not possible.RESULTS: Ultimately eight high-quality studies were included. Low maternal age, low educational level, non-marital status, ethnic minority, planned pattern of prenatal care, hospital type, unplanned place of delivery, uninsured status, high parity, no previous premature birth and late recognition of pregnancy were identified as individual determinants of inadequate use. Contextual determinants included living in distressed neighbourhoods. Living in neighbourhoods with higher rates of unemployment, single parent families, medium-average family incomes, low-educated residents, and women reporting Canadian Aboriginal status were associated with inadequate use or entering care after 6 months. Regarding health behaviour, inadequate use was more likely among women who smoked during pregnancy.CONCLUSION: Evidence for determinants of prenatal care utilization is limited. More studies are needed to ensure adequate prenatal care for pregnant women at risk.
Objective: To report the study protocol and baseline characteristics of a prospective cohort study to evaluate longitudinal recovery trajectories of patients recovering from COVID-19 who have visited a primary care allied health professional. Design: Report of the protocol and baseline characteristics for a prospective cohort study with a mixed-methods approach. Patients: Patients recovering from COVID-19 treated by primary care dietitians, exercise therapists, occupational therapists, physical therapists and/or speech and language therapists in the Netherlands. Methods: The prospective study will measure primary outcome domains: participation, health-related quality of life, fatigue, physical functioning, and costs, at baseline, 3, 6, 9 and 12 months. Interviews, on the patients’ experiences with allied healthcare, will be held with a subsample of patients and allied health professionals. Results: The cohort comprises 1,451 patients (57% female, mean age 49 (standard deviation 13) years). Preliminary results for the study cohort show that 974 (67%) of the participants reported mild/moderate severity symptoms during the infection period and patients reported severe restrictions in activities of daily living compared with previous research in other patient populations. Both quantitative and qualitative, will provide insight into the recovery of patients who are treated by allied health professionals. Conclusion: In conclusion, this will be the first comprehensive study to longitudinally evaluate the recovery trajectories and related costs of patients recovering from COVID-19 who are treated by allied health professionals in the Netherlands. This study will provide evidence for the optimal strategy to treat patients recovering from COVID-19 infection, including which patients benefit, and to what extent, from treatment, and which factors might impact their recovery course over time. The preliminary results of this study demonstrated the severity of restrictions and complaints at the start of therapy are substantial.
Abstract: The typical structure of the healthcare sector involves (specialist) intertwined practices co-occurring in formal or informal networks. These practices must answer to the concerns and needs of all related stakeholders. Multimorbidity and the need to share knowledge for scientific development are among the driving factors for collaboration in healthcare. To establish and keep up a permanent collaborative link, it takes effort and understanding of the network characteristics that must be governed. It is not hard to find practices of Network Governance (NG) in a variety of industries. Still, there is a lack of insight in this subject, including knowledge on how to establish and maintain an effective healthcare network. Consequently, this study's research question is: How is network governance organized in the healthcare sector? A systematic literature study was performed to select 80 NG articles. Based on these publications the characteristics of NG are made explicit. The findings demonstrate that combinations of governance style (relational versus contractual governance) and governance structure (lead versus shared governance) lead to different network dynamics. Furthermore, the results show that in order to comprehend how networks in the healthcare sector emerge and can be regulated, it is vital to understand the current network type. Additionally, it informs us of the governing factors. Zie https://www.hbo-kennisbank.nl/details/sharekit_han:oai:surfsharekit.nl:e4f8fa3a-4af8-42ef-b2dd-c86d77b4cec6
MULTIFILE
English: This living lab aims to support the creation, development and implementation of next generation concepts for sustainable healthcare logistics, with special attention for last mile solutions. Dutch healthcare providers are on the verge of a transition towards (more) sustainable business models, spurred by e.g., increasing healthcare costs, ongoing budget cuts, tight labor market conditions and increasing ecological awareness. Consequently, healthcare providers need to improve and innovate their business model and underlying logistics concept(s). Simultaneously, many cities are struggling with congestion in traffic, air quality and liveability in general. This calls for Last Mile Logistics (LML) concepts that can address challenges like effective and efficient resource planning, scheduling and utilization and, particularly, sustainability goals. LML can reduce environmental and social impact by decreasing emissions, congestion and pollution through effectively consolidating in-flows of goods and providing innovative solutions for care, wellbeing and related services. The research and initiatives in the living lab will address the following challenges: reducing the ecological footprint, reducing (healthcare-related) costs, improving service quality, decreasing loneliness of frail citizens and improving the livability of urban areas (reducing congestion and emissions). Given the scarcity and fragmentation of knowledge on healthcare logistics in organizations the living lab will also act as a learning community for (future) healthcare- and logistics professionals, thereby supporting the development of human capital. By working closely with related stakeholders and using a transdisciplinary research approach it is ensured that the developed knowledge and solutions deliver a contribution to societal challenges and have sound business potential.
English: This living lab aims to support the creation, development and implementation of next generation concepts for sustainable healthcare logistics, with special attention for last mile solutions. Dutch healthcare providers are on the verge of a transition towards (more) sustainable business models, spurred by e.g., increasing healthcare costs, ongoing budget cuts, tight labor market conditions and increasing ecological awareness. Consequently, healthcare providers need to improve and innovate their business model and underlying logistics concept(s). Simultaneously, many cities are struggling with congestion in traffic, air quality and liveability in general. This calls for Last Mile Logistics (LML) concepts that can address challenges like effective and efficient resource planning, scheduling and utilization and, particularly, sustainability goals. LML can reduce environmental and social impact by decreasing emissions, congestion and pollution through effectively consolidating in-flows of goods and providing innovative solutions for care, wellbeing and related services. The research and initiatives in the living lab will address the following challenges: reducing the ecological footprint, reducing (healthcare-related) costs, improving service quality, decreasing loneliness of frail citizens and improving the livability of urban areas (reducing congestion and emissions). Given the scarcity and fragmentation of knowledge on healthcare logistics in organizations the living lab will also act as a learning community for (future) healthcare- and logistics professionals, thereby supporting the development of human capital. By working closely with related stakeholders and using a transdisciplinary research approach it is ensured that the developed knowledge and solutions deliver a contribution to societal challenges and have sound business potential.
