1
|
Orser BA, Wilson CR. Canada needs a national strategy for anesthesia services in rural and remote regions. CMAJ 2021; 192:E861-E863. [PMID: 32719023 DOI: 10.1503/cmaj.200215] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Beverley A Orser
- Department of Anesthesiology and Pain Medicine (Orser), University of Toronto; Department of Anesthesia (Orser), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Family Medicine (Wilson), Queen's University, Kingston, Ont
| | - C Ruth Wilson
- Department of Anesthesiology and Pain Medicine (Orser), University of Toronto; Department of Anesthesia (Orser), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Family Medicine (Wilson), Queen's University, Kingston, Ont.
| |
Collapse
|
2
|
Kurtz Landy C, Sword W, Kathnelson JC, McDonald S, Biringer A, Heaman M, Angle P. Factors obstetricians, family physicians and midwives consider when counselling women about a trial of labour after caesarean and planned repeat caesarean: a qualitative descriptive study. BMC Pregnancy Childbirth 2020; 20:367. [PMID: 32552758 PMCID: PMC7301440 DOI: 10.1186/s12884-020-03052-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Repeat caesarean sections (CSs) are major contributors to the high rate of CS in Canada and globally. Women's decisions to have a planned repeat CS (PRCS) or a trial of labour after CS (TOLAC) are influenced by their maternity care providers. This study explored factors maternity care providers consider when counselling pregnant women with a previous CS, eligible for a TOLAC, about delivery method. METHODS A qualitative descriptive design was implemented. Semi-structured, one-to-one in-depth telephone interviews were conducted with 39 maternity care providers in Ontario, Canada. Participants were recruited at 2 maternity care conferences and with the use of snowball sampling. Interviews were audio recorded and transcribed verbatim. Data were uploaded into the data management software, NVIVO 10.0 and analyzed using qualitative content analysis. RESULTS Participants consisted of 12 obstetricians, 13 family physicians and 14 midwives. Emergent themes, reflecting the factors maternity care providers considered when counselling on mode of delivery, were organized under the categories clinical/patient factors, health system factors and provider preferences. Maternity care providers considered clinical/patient factors, including women's choice … with conditions, their assessment of women's chances of a successful TOLAC, their perception of women's risk tolerance, women's preferred delivery method, and their perception of women's beliefs and attitudes about childbirth. Additionally, providers considered health system factors which included colleague support for TOLAC and time needed to mount an emergency CS. Finally, provider factors emerged as considerations when counselling. They included provider preference for PRCS or TOLAC, provider scope of practice, financial incentives and convenience related to PRCS, past experiences with TOLAC and PRCS and providers' perspectives on risk of TOLAC. CONCLUSION The findings highlight the multiplicity of factors maternity care providers consider when counselling women. Effectively addressing clinical, health care system and personal factors that influence counselling may help decrease non-medically indicated PRCS.
Collapse
Affiliation(s)
- Christine Kurtz Landy
- Faculty of Health, School of Nursing, York University, HNES 312A, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Wendy Sword
- McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Jackie Cramp Kathnelson
- Faculty of Health, York University, HNES 312A, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Sarah McDonald
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Anne Biringer
- Department of Family and Community Medicine, University of Toronto, Ada Slaight and Slaight Family director of Family Medicine Maternity Care, Toronto, Canada
- Ray D Wolfe Department of Family Medicine, Sinai Health System, 60 Murray St, Toronto, Ontario, M5T 1L9, Canada
| | - Maureen Heaman
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Pam Angle
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| |
Collapse
|
3
|
Lee HY, Yoon NH, Oh J, Park JS, Lee JK, Moon JR, Subramanian SV. Are "Obstetrically Underserved Areas" really underserved? Role of a government support program in the context of changing landscape of maternal service utilization in South Korea: A sequential mixed method approach. PLoS One 2020; 15:e0232760. [PMID: 32374772 PMCID: PMC7202644 DOI: 10.1371/journal.pone.0232760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The Korean government has been providing financial support to open and operate the maternal hospital in Obstetrically Underserved Areas (OUAs) since 2011. Our study aims to assess the effectiveness of the government-support program for OUAs and to suggest future directions for it. METHODS We performed sequential-mixed method approach. Descriptive analyses and multi-level logistic regression were performed based on the 2015 Korean National Health Insurance claim data. Data for the qualitative analysis were obtained from in-depth interviews with health providers and mothers in OUAs. RESULTS Descriptive analyses indicated that the share of babies born in the hospitals located in the area among total babies ever born from mothers residing in the area (Delivery concentration Index: DCI) was lower in government-supported OUAs than other areas. Qualitative analyses revealed that physical distance is no longer a barrier in current OUAs. Mothers travel to neighboring big cities to seek elective preferences only available at specialized maternal hospitals rather than true medical need. Increasing one-child families changed the mother's perception of pregnancy and childbirth, making them willing to pay for more expensive services. Concern about an emergency for mothers or infants, especially of high-risk mothers was also an important factor to make mothers avoid local government-supported hospitals. Adjusted multi-level logistic regression indicated that DCIs of government-supported OUAs were higher than the ones of their counterpart areas. CONCLUSION Our results suggest that current OUAs do not reflect reality. Identification of true OUAs where physical distance is a real barrier to the use of obstetric service and focused investment on them is necessary. In addition, more sophisticated performance indicator other than DCI needs to be developed.
Collapse
Affiliation(s)
- Hwa-Young Lee
- Department of Global Health and Population, Takemi program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Nan-Hee Yoon
- Department of Health Administration, Hanyang Cyber University, Seoul, Republic of Korea
| | - Juhwan Oh
- Department of Medicine of Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Koo Lee
- Center for Healthy Society and Education, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J. Robin Moon
- Bronx Partners for Health Communities New York City, Bronx, NY, United States of America
| | - S. V. Subramanian
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| |
Collapse
|
4
|
Vaughan L, Edwards N. The problems of smaller, rural and remote hospitals: Separating facts from fiction. Future Healthc J 2020; 7:38-45. [PMID: 32104764 PMCID: PMC7032574 DOI: 10.7861/fhj.2019-0066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Smaller hospitals internationally are under threat. The narratives around the closure of smaller hospitals, regardless of size and location, are all constructed around three common problems - cost, quality and workforce. The literature is reviewed, demonstrating that there is little hard evidence to support the contention that hospital merger/closure solves these problems. The disbenefits of mergers and closures, including loss of resources, increased pressure on neighbouring organisations, shifting risk from the healthcare system to patients and their families, and the threat hospital closure represents to communities, are explored. Alternative structures, policies and funding mechanisms, based on the evidence, are urgently needed to support smaller hospitals in the UK and elsewhere.
Collapse
|
5
|
Orser BA, Wilson CR, Rotstein AJ, Iglesias SJ, Spain BT, Ranganathan P, MacDonald WA, Ng V, O'Leary S, Lafontaine A. Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries. Anesth Analg 2020; 129:294-300. [PMID: 30855341 DOI: 10.1213/ane.0000000000004083] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.
Collapse
Affiliation(s)
- Beverley A Orser
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - C Ruth Wilson
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Stuart J Iglesias
- Department of Family Medicine, University of British Columbia, Bella Bella, British Columbia, Canada
| | - Brian T Spain
- Department of Anaesthesia and Perioperative Medicine, Royal Darwin Hospital, Flinders University, Darwin, Australia
| | - Pavithra Ranganathan
- Department of Anesthesiology, West Virginia University, Morgantown, West Virginia
| | - William A MacDonald
- Faculty of Medicine, Discipline of Family Medicine, Memorial University, St John's Newfoundland, Canada
| | - Victor Ng
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan O'Leary
- Department of Anesthesia and Pain Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alika Lafontaine
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
Schubert N, Evans R, Battye K, Gupta TS, Larkins S, McIver L. International approaches to rural generalist medicine: a scoping review. HUMAN RESOURCES FOR HEALTH 2018; 16:62. [PMID: 30463580 PMCID: PMC6249972 DOI: 10.1186/s12960-018-0332-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Contemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was to review the literature relevant to rural generalist medicine. METHODS A scoping review was undertaken to answer the broad question 'What is documented on rural generalist medicine?' Literature from January 1988 to April 2017 was searched and, after final eligibility filtering (according to established inclusion and exclusion criteria), 102 articles in English language were included for final analysis. RESULTS Included papers were analysed and categorised by geographic region, study design and subject themes. The majority of articles (80%) came from Australia/New Zealand and North America, reflecting the relative maturity of programmes supporting rural generalist medicine in those countries. The most common publication type was descriptive opinion pieces (37%), highlighting both a need and an opportunity to undertake and publish more systematic research in this area. Important themes emerging from the review were: Definition Existing pathways and programmes Scope of practice and service models Enablers and barriers to recruitment and retention Reform recommendations There were some variations to, or criticisms of, the definition of rural generalist medicine as applied to this review, although this was only true of a small number of included articles. Across remaining themes, there were many similarities and consistent approaches to rural generalist medicine between countries, with some variations reflecting environmental context and programme maturity. This review identified recent literature from countries with emerging interest in rural generalist medicine in response to problematic rural health service delivery. CONCLUSIONS Supported, coordinated rural generalist medicine programmes are being established or developed in a number of countries as part of an integrated response to rural health and workforce concerns. Findings of this review highlight an opportunity to better share the development and evaluation of best practice models in rural generalist medicine.
Collapse
Affiliation(s)
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | | | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | | |
Collapse
|
7
|
Miller KJ, Couchie C, Ehman W, Graves L, Grzybowski S, Medves J. N o 282-Soins de maternité en région rurale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e566-e575. [PMID: 29197494 DOI: 10.1016/j.jogc.2017.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
8
|
Miller KJ, Couchie C, Ehman W, Graves L, Grzybowski S, Medves J. No. 282-Rural Maternity Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e558-e565. [DOI: 10.1016/j.jogc.2017.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Miller KJ, Couchie C, Ehman W, Graves L, Grzybowski S, Medves J. Rural maternity care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 34:984-991. [PMID: 23067955 DOI: 10.1016/s1701-2163(16)35414-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an overview of current information on issues in maternity care relevant to rural populations. EVIDENCE Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. OUTCOMES This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in rural settings. Remuneration models should facilitate interprofessional collaboration. 9. Practitioners skilled in neonatal resuscitation and newborn care are essential to rural maternity care. 10. Training of rural maternity health care providers should include collaborative practice as well as the necessary clinical skills and competencies. Sites must be developed and supported to train midwives, nurses, and physicians and provide them with the skills necessary for rural maternity care. Training in rural and northern settings must be supported. 11. Generalist skills in maternity care, surgery, and anaesthesia are valued and should be supported in training programs in family medicine, surgery, and anaesthesia as well as nursing and midwifery. 12. All physicians and nurses should be exposed to maternity care in their training, and basic competencies should be met. 13. Quality improvement and outcome monitoring should be integral to all maternity care systems. 14. Support must be provided for ongoing, collaborative, interprofessional, and locally provided continuing education and patient safety programs.
Collapse
|
10
|
Soins de maternité en région rurale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012. [DOI: 10.1016/s1701-2163(16)35415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Mhyre JM. What's New in Obstetric Anesthesia in 2009? An Update on Maternal Patient Safety. Anesth Analg 2010; 111:1480-7. [DOI: 10.1213/ane.0b013e3181f8e4e9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
12
|
Douglas J, Preston R. Provision of obstetric anesthesia: throwing down the gauntlet! Can J Anaesth 2009; 56:631-5. [PMID: 19548050 DOI: 10.1007/s12630-009-9134-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022] Open
|