Integrated Healthcare and the Dilemma of Public Health Emergencies

Goniewicz, Krzysztof; Carlström, Eric; Hertelendy, Attila; Burkle, Frederick M.; Goniewicz, Mariusz; Lasota, Dorota; Richmond, John; Khorram‐Manesh, Amir

doi:10.3390/su13084517

Cited by 34 publications

(29 citation statements)

References 81 publications

(97 reference statements)

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“…Experience shows that implementing these actions reduces the number of preventable deaths. However, such programs will always struggle to match the impact of an established Public Health system [66].…”

Section: The Public Health Response Of the Foreign Aid Sectormentioning

confidence: 99%

The Influence of War and Conflict on Infectious Disease: A Rapid Review of Historical Lessons We Have Yet to Learn

Goniewicz¹,

Burkle

Horne

et al. 2021

Sustainability

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Armed conflicts degrade established healthcare systems, which typically manifests as a resurgence of preventable infectious diseases. While 70% of deaths globally are now from non-communicable disease; in low-income countries, respiratory infections, diarrheal illness, malaria, tuberculosis, and HIV/AIDs are all in the top 10 causes of death. The burden of these infectious diseases is exacerbated by armed conflict, translating into even more dramatic long-term consequences. This rapid evidence review searched electronic databases in PubMed, Scopus, and Web of Science. Of 381 identified publications, 73 were included in this review. Several authors indicate that the impact of infectious diseases increases in wars and armed conflicts due to disruption to surveillance and response systems that were often poorly developed to begin with. Although the true impact of conflict on infectious disease spread is not known and requires further research, the link between them is indisputable. Current decision-making management systems are insufficient and only pass the baton to the next unwary generation.

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Section: The Public Health Response Of the Foreign Aid Sectormentioning

confidence: 99%

The Influence of War and Conflict on Infectious Disease: A Rapid Review of Historical Lessons We Have Yet to Learn

Goniewicz¹,

Burkle

Horne

et al. 2021

Sustainability

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“…Healthcare professionals must deliver care and services consistent with ethical standards in all routine scenarios [30,37,55,56,[58][59][60][61][62][63]. However, during a disaster or war, ethical dilemmas can intensify further under crisis standards of care when complex decisions must be executed to use and allocate resources and to "do best for the most" [56,60,64].…”

Section: Discussionmentioning

confidence: 99%

Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review

Khorram‐Manesh

Goniewicz²,

Phattharapornjaroen

et al. 2022

Sustainability

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Civilian–military collaboration in humanitarian crises has been encouraged globally; however, little is known about their diverse ethical viewpoints towards challenging and critical situations, which may cause difficulties in the partnership, and influence the outcomes of their mutual activities. The aim of this study was to identify the diversity of viewpoints and ethical decision-making during exceptional circumstances among civilian and military populations from two different countries, each with diverse background and healthcare organization structures. Possible scenarios, based on a systematic review of the literature, were introduced to Swedish and Polish civilian and military healthcare providers. Variations in the participants’ viewpoints and approaches to ethical decision-making were analyzed according to their characteristics, organizational belonging, and nationality. There were differences between both populations but also within the military and civilian groups, respectively. One significant factor influencing ethical viewpoints was participants’ nationality. Differences in ethical viewpoints between multiagency organizations should be considered in planning and implementation of future transdisciplinary and international collaboration in disaster and emergency management. Further studies and renewed educational initiatives are necessary to validate these differences and to navigate civilian–military as well as other multinational partnerships.

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“…While several methods/models are available to calculate future bed numbers [ 5 , 6 , 7 , 77 ], experience shows that the calculation is fraught with problems, hidden assumptions, and subtle pressure from the perceived policy ideal that still fewer beds will be needed in the future [ 3 , 76 ]. In addition, international health care systems have their own unique expressed demand for hospital beds where nursing home beds, same day care, care at home, hospital avoidance programs in the elderly, new technology, and integrated care can all substitute for acute beds [ 2 , 77 , 78 , 79 , 80 , 81 ].…”

Section: Discussionmentioning

confidence: 99%

A Model to Compare International Hospital Bed Numbers, including a Case Study on the Role of Indigenous People on Acute ‘Occupied’ Bed Demand in Australian States

Jones¹

2022

IJERPH

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Comparing international or regional hospital bed numbers is not an easy matter, and a pragmatic method has been proposed that plots the number of beds per 1000 deaths versus the log of deaths per 1000 population. This method relies on the fact that 55% of a person’s lifetime hospital bed utilization occurs in the last year of life—irrespective of the age at death. This is called the nearness to death effect. The slope and intercept of the logarithmic relationship between the two are highly correlated. This study demonstrates how lines of equivalent bed provision can be constructed based on the value of the intercept. Sweden looks to be the most bed-efficient country due to long-term investment in integrated care. The potential limitations of the method are illustrated using data from English Clinical Commissioning Groups. The main limitation is that maternity, paediatric, and mental health care do not conform to the nearness to death effect, and hence, the method mainly applies to adult acute care, especially medical and critical care bed numbers. It is also suggested that sensible comparison can only be made by comparing levels of occupied beds rather than available beds. Occupied beds measure the expressed bed demand (although often constrained by access to care issues), while available beds measure supply. The issue of bed supply is made complex by the role of hospital size on the average occupancy margin. Smaller hospitals are forced to operate at a lower average occupancy; hence, countries with many smaller hospitals such as Germany and the USA appear to have very high numbers of available beds. The so-called 85% occupancy rule is an “urban myth” and has no fundamental basis whatsoever. The very high number of “hospital” beds in Japan is simply an artefact arising from “nursing home” beds being counted as a “hospital” bed in this country. Finally, the new method is applied to the expressed demand for occupied acute beds in Australian states. Using data specific to acute care, i.e., excluding mental health and maternity, a long-standing deficit of beds was identified in Tasmania, while an unusually high level of occupied beds in the Northern Territory (NT) was revealed. The high level of demand for beds in the NT appears due to an exceptionally large population of indigenous people in this state, who are recognized to have elevated health care needs relative to non-indigenous Australians. In this respect, indigenous Australians use 3.5 times more occupied bed days per 1000 deaths (1509 versus 429 beds per 1000 deaths) and 6 times more occupied bed days per 1000 population (90 versus 15 beds per 1000 population) than their non-indigenous counterparts. The figure of 1509 beds per 1000 deaths (or 4.13 occupied beds per 1000 deaths) for indigenous Australians is indicative of a high level of “acute” nursing care in the last months of life, probably because nursing home care is not readily available due to remoteness. A lack of acute beds in the NT then results in an extremely high average bed occupancy rate with contingent efficiency and delayed access implications.

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Integrated Healthcare and the Dilemma of Public Health Emergencies

Cited by 34 publications

References 81 publications

The Influence of War and Conflict on Infectious Disease: A Rapid Review of Historical Lessons We Have Yet to Learn

The Influence of War and Conflict on Infectious Disease: A Rapid Review of Historical Lessons We Have Yet to Learn

Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review

A Model to Compare International Hospital Bed Numbers, including a Case Study on the Role of Indigenous People on Acute ‘Occupied’ Bed Demand in Australian States

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