#### INQUIRY: The Journal of Health Care Organization, Provision, and Financing

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ISSN / EISSN : 0046-9580 / 1945-7243
Total articles ≅ 2,099
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Jantra Keawpugdee, , Chukiat Viwatwongkasem, Plernpit Boonyamalik, Kwanjai Amnatsatsue
Published: 25 May 2021
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 58

Abstract:
Hospital readmission of stroke elderly remains a need for detecting preventable risks. This study aims to develop a Readmission Stroke Screening Tool or RRST. The mixed research design was employed, phase1; systematic reviews from 193 articles extracting to be 14 articles, 9 experts’ consensus, and try out the RRST Internal consistency; IOC = .93, ICC = between .93 and .56, phase 2; Data collecting 150 of strokes patients in the stroke units during 2019 to 2020; 30 nurses employed the RRST to screen stroke elderly before discharge. Statistical analysis, Exploring Principal Factor Analysis to test the best predictor factor, and Confirmatory Factor Analysis to test the model identity were employed. Results: The multi-domain RRST; 4 factors: Intra, inter, and external factors of patients can predict the hospital readmission of Stroke elderly at a high level in 28 days. The ADL: Activities in the Daily life domain was the highest level of predicting (Eigen Value = 6.76, 1.15, Variances = 79.19%) significantly. 53.3% of user nurses reflected; the RRST tool’s effectiveness was achievable in usefulness, benefit, accuracy, and easy to use; however, the rest users identified to improve the RRST easier and quicker. Conclusion; The new RRST; can predict the high-risk readmission effectively = 92.5%. User nurses satisfied the RRST predicted quality. the multi-domain RRST could be detecting the Thai Stroke’s high-risk group for reducing avoidable risks, suggestion; more effort will be investigated prospectively in readmission by expanded volume of the Asian’ Stroke elderly for increasing accuracy predicting and extended tool quality utilized standard scored correctly
Mina Kabiri, Alison Sexton Ward, Abhilasha Ramasamy, , Rahul Ganguly, , Tracy Zvenyach, James R. Baumgardner, Dana P. Goldman
Published: 29 January 2021
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 58; https://doi.org/10.1177/0046958021990516

Abstract:
While substantial public health investment in anti-smoking initiatives has had demonstrated benefits on health and fiscal outcomes, similar investment in reducing obesity has not been undertaken, despite the substantial burden obesity places on society. Anti-obesity medications (AOMs) are poorly prescribed despite evidence that weight loss is not sustained using other strategies alone. We used a simulation model to estimate the potential impact of 100% uptake of AOMs on Medicare and Medicaid spending, disability payments, and taxes collected relative to status quo with negligible AOM use. Relative to status quo, AOM use simulation would result in Medicare and Medicaid savings of $231.5 billion and$188.8 billion respectively over 75 years. Government tax revenues would increase by $452.8 billion. Overall, the net benefit would be$746.6 billion. Anti-smoking efforts have had substantial benefits for society. A similar investment in obesity reduction, including broad use of AOMs, should be considered.
Xincai Zhao, Rong Xu, Yonggang Wang, Wanhu Zhu, Haiyan Hu, Zan Shen, Cheng Guo,
Published: 1 January 2021
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 58; https://doi.org/10.1177/00469580211009662

Abstract:
Pharmacists are health care professionals who are actively involved in identifying and solving drug-related problems (DRPs) in neoplasm patients. However, the effectiveness of pharmaceutical services at outpatient clinic for neoplasm patients have not been reported in China. This study aims to describe and investigate the impacts of pharmacists-managed oncology outpatient clinic on ambulatory neoplasm patients. We performed a descriptive, prospective study from June 6, 2018 to June 6, 2020. Firstly, we established a pharmacists-managed oncology outpatient clinic and a Pharmacists Work System of Medication Therapy Management (MTM) software with the cooperation of oncologists, pharmacists and software engineers in 2018. Subjects were neoplasm patients who visited the pharmacists-managed outpatient clinic. The pharmacists performed a comprehensive assessment of the patient’s medication and made planned interventions based on the DRPs identified. A total of 215 eligible patients with 707 visits were enrolled and recorded in the MTM software. A total of 316 DRPs (1.47 per patient) were identified. Adverse reactions, non-adherence, untreated indication, and drug interactions were the leading DRPs. 261 (82.6%) of the identified DRPs had been confirmed as resolved and 104 (78.2%) of adverse reactions were improved following pharmacist interventions and 2 to 3 course follow-up. Of the 382 planned interventions, 345 (90.3%) were accepted by patients or physicians. This is the first pharmacists-managed oncology outpatient clinic to describe the type of DRPs in neoplasm patients and evaluate the effectiveness of pharmacist interventions in China. Pharmacist interventions were efficacious in resolving DRPs and improving adverse reactions. We confirmed that pharmacists have an important role in ambulatory neoplasm patients care.
, Yanfei Jin, Hui Chen, María F. Jiménez-Herrera
Published: 1 January 2021
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 58; https://doi.org/10.1177/0046958021996499

Abstract:
Moral distress (MD) has become a seriously negative problem experienced by healthcare professionals, especially clinical nurses. Early and accurate detection of MD by the validated and reliable instrument is critically important to further develop an effective intervention strategy. We performed the current systematic review to comprehensively summarize the evidence of instruments for the detection of MD in clinical nurses. The research design was a systematic literature review. We assigned 2 investigators to independently search potential studies in PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI) from their inception to June 2020. We used data extraction table extracting essential information, and the modified critical appraisal tool evaluating the reliability and validity of eligible instruments. Finally, we qualitatively summarized results of all included instruments. No ethical approval was required because this systematic review was performed based on published studies. We included 16 eligible studies covering 10 original and 6 revised or modified instruments for the final analysis. The overall quality of all instruments was moderate because test-retest reliability was inadequately examined in most instruments. Of 16 instruments, MDS-revised (MDS-R) was broadly validated and employed in different working or cultural settings. Meanwhile, it also extensively expands to specifically detect MD. Moreover, other instruments including moral distress risk scale (MDSR) and moral distress thermometer (MDT) should be further validated and utilized because it covered the gap missed by most instruments. Although several instruments have been made available for clinical nurses, some of them have inadequate psychometric properties test, especially test-retest reliability evaluation. Meanwhile, most of them have not be validated and employed in other working or cultural settings. We therefore suggested further studies to validate the psychometric properties of existing instruments and then employed instruments with high reliability and validity to detect MD in clinical nurses.
Ing-Chung Huang, Pey-Lan Du, , Ting-Yu Liu, Tsai-Fei Lin, Wei-Chang Huang
Published: 1 January 2021
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 58; https://doi.org/10.1177/00469580211007217

Abstract:
Increasing patient loyalty through improved health care quality and patient–provider relationships becomes the key factor in medical providers’ successes. This study explored the mediated relationship of patients’ perceived value, patient commitment, and patient loyalty and the moderating effect of patient trust on the mediated relationship. A cross-sectional research design was adopted. Mediation and moderated mediation were tested using the PROCESS macro v3.5 for the SPSS supplement. Convenience sampling was used for the distribution of questionnaires to members of the public with experience of seeking medical attention in Taiwan. Among the 254 valid questionnaires recovered, 59.4% of the respondents were male, 38.6% were married, 90.2% were in the 20 to 49 year age range, and 54.7% had a bachelor’s degree or above. This study indicated a significant mediated relationship among patients’ perceived value of medical services, commitment to the patient–provider relationship, and patient loyalty. Furthermore, when the patient demonstrated higher levels of trust in a healthcare provider, the relationship of perceived value, commitment, and patient loyalty was also enhanced. This study discussed and demonstrated the effect of perceived value, trust, and commitment on patient loyalty. The research suggests that improving patient loyalty benefits sustainable operation of medical providers and the treatment effects for patients.
Song Yi Lee, Jung Ah Lee, Hee Jung Chung, Hyun-Jin Kim, Yu Cheon Kim,
Published: 1 January 2021
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 58; https://doi.org/10.1177/00469580211010429

Abstract:
Rehabilitation exercise is effective for improving the health of persons with physical disabilities. However, there are limited studies on their perception of exercise equipment use. The purpose of this study was to investigate the subjectivity to understand the types of perceptions of individuals with physical disabilities regarding the use of exercise equipment in South Korea. This study used Q-methodology. A literature review and focus group interviews with individuals with physical disabilities were conducted to construct Q-Population. Q-statements were selected from the Q-population, after which Q-sorting was executed by P-sample. The results indicated 4 perception types: (1) “Independent user,” (2) “Practical user,” (3) “Motivational user,” and (4) “Convenience user.” Recommendations were provided for developing exercise equipment for use by individuals with physical disabilities. This study revealed 4 perception categories and the findings have strong potential to contribute to the development of proper services and the effective utilization of exercise equipment for individuals with physical disabilities.
Christian Mbilinyi, Deus Buma, Solobi Ngasa, Rose Maingu, Betty Maganda, Wellu Kaali, Mtoke Uledi, Bryceson Mkinga, Bruno Njonjo, Jumanne Amiri, et al.
Published: 1 January 2021
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 58; https://doi.org/10.1177/0046958021999934

Abstract:
Understanding models of pharmacy education and practice in low-to-middle income countries (LMIC) can drive best practices and resource utilization. However, there is a paucity of literature in this setting. The purpose of this report is to describe the length and breadth of pharmacy education and training in Tanzania as well as pharmacy practice models at 3 institutions. Lessons learned and implications for global pharmacy practice described herein aim to advance the profession and pharmacists’ impact in LMIC settings. The Muhimbili campus is located in Dar es Salaam, the largest city in Tanzania, a LMIC in East Africa, and is comprised of 3 institutes and a health professions school. Despite variance in patient populations, all Muhimbili institutions have developed pharmacy services in outpatient and inpatient pharmacies, central pharmacy stores, intensive care units, and operating theaters. Unique pharmacy practice areas result from a variance in patient populations serviced and include services in pharmacovigilence/drug information, compounding, oncology, nephrology, and emergency departments. Medication availability and the complexity and time commitment of patient billing are consistent challenges, and multidisciplinary collaboration a common strength across the 3 institutions. Pharmacists at Muhimbili perform innovative and critical functions to support optimal patient care tailored to specific patient populations. The detailed review of these services can serve as a model for pharmacy practice at other health systems in LMIC and beyond.
Lilanthi Balasuriya, Seth A. Berkowitz, Hilary K. Seligman
Published: 1 January 2021
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 58; https://doi.org/10.1177/00469580211005190

Abstract:
It is thought that childhood food insecurity rates increased to 18 million impacted children in 2020. In response, innovative policy solutions from the Supplemental Nutrition Assistance Program (SNAP) and the Pandemic Electronic Benefit Transfer (P-EBT) were swiftly implemented. These innovations must serve as catalysts to create the next generation of food safety net programs. These include the removal of administrative barriers to enrollment, the use of streamlined procedures to access food, the expansion of P-EBT to daycare and childcare centers, and the uncoupling of receipt of benefits from physical presence in schools. Critical gaps also remain. SNAP benefit amounts are often too low, leaving many families ineligible. More realistic benefit amounts are needed, such as those used in the USDA’s Moderate Cost Food Plan. Eligibility cut-offs exclude many food insecure families. Better alignment of SNAP eligibility with income levels that substantially increase food insecurity risk are critical. Lastly, creating slower phase-out periods for benefits as incomes rise is essential. Additionally, food insecurity continues to disproportionately impact racial and ethnic minority populations and low-income households. These deeply rooted inequalities in access to nutrition play an important role in driving health disparities, including obesity, hypertension, diabetes, and other chronic comorbidities and must be further examined. Changes to SNAP and the P-EBT program illustrate how innovative, broad-scale policy solutions can expeditiously support the nutritional needs of families with children. While pandemic-inspired innovation offers critical lessons for designing the next generation of nutrition assistance, there remain gaps that can perpetuate disparities in access to food and health. As a community of medical providers, we must advocate for broader, more inclusive policies to support those facing food insecurity. The future depends on it.