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Clifford-Motopi A, Brown Nununccal R, White Palawa Iningai A, Harald Gangulu P, Butler D, Mathew S, Mackenzie J, Eaton M, Mills R. Aboriginal and Torres Strait Islander community members' experiences of care in an urban Aboriginal Community Controlled Health Service transforming to a Patient Centred Medical Home. Aust J Prim Health 2024; 30:PY23163. [PMID: 38739738 DOI: 10.1071/py23163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
Background Few studies have examined patient experiences of the Patient Centred Medical Home (PCMH). This qualitative study explores the experiences of patients of an urban Aboriginal Community Controlled Health Service during its transition to a model of a PCMH. Methods Twenty-eight community members who were registered as patients of an urban Aboriginal Community Controlled Health Service were purposively recruited to participate in yarning interviews. Yarns were conducted using a guide containing open-ended questions in the same domains as those used in patient satisfaction surveys at the participating clinic. Data from yarns were analysed by Aboriginal and non-Indigenous researchers using thematic analysis. The interpretations of Aboriginal and Torres Strait Islander researchers were privileged in the analysis. Results Key themes highlighted the importance of relationships, connectedness, and personal growth and empowerment to community members' health and wellbeing, which they described as a journey of healing and recovery. Delays in implementing a process to empanel patients in a care team meant that most community members were unaware a PCMH had been implemented. However, community members commonly reported a more welcoming environment, more contact with the same doctor and more involvement of Aboriginal Health Workers in their care. Conclusions Aboriginal and Torres Strait Islander community members' narratives of their experiences bear evidence of the acceptability of a PCMH model for delivery in Aboriginal Community Controlled Health Services to improve relational care between patients and health staff. A patient-directed empanelment process has been implemented to better connect patients to their care team in the clinic, and the role of the Aboriginal Health Worker reshaped to strengthen connections between patients and their care team in and outside the clinic.
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Affiliation(s)
- Anton Clifford-Motopi
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld 4066, Australia
| | - Renee Brown Nununccal
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | | | - Patrice Harald Gangulu
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Danielle Butler
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Saira Mathew
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld 4066, Australia
| | - Julie Mackenzie
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Martie Eaton
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Richard Mills
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
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Dableh S, Frazer K, Stokes D, Kroll T. Access of older people to primary health care in low and middle-income countries: A systematic scoping review. PLoS One 2024; 19:e0298973. [PMID: 38640096 PMCID: PMC11029620 DOI: 10.1371/journal.pone.0298973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/01/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Ensuring access for older people to Primary Health Care (PHC) is vital to achieve universal health coverage, improve health outcomes, and health-system performance. However, older people living in Low-and Middle-Income Countries (LMICs) face barriers constraining their timely access to appropriate care. This review aims to summarize the nature and breadth of literature examining older people's experiences with access to PHC in LMICs, and access barriers and enablers. METHODS Guided by Arksey and O'Malley's framework, four databases [CINAHL, Cochrane, PubMed, and Embase] were systematically searched for all types of peer-reviewed articles published between 2002 and 2023, in any language but with English or French abstract. Gray literature presenting empirical data was also included by searching the United Nations, World Health Organization, and HelpAge websites. Data were independently screened and extracted. RESULTS Of 1165 identified records, 30 are included. Data were generated mostly in Brazil (50%) and through studies adopting quantitative designs (80%). Older people's experiences varied across countries and were shaped by several access barriers and enablers classified according to the Patient-Centered Access to Healthcare framework, featuring the characteristics of the care delivery system at the supply side and older people's attributes from the demand side. The review identifies that most access barriers and enablers pertain to the availability and accommodation dimension, followed by the appropriateness, affordability, acceptability, and approachability of services. Socio-economic level and need perception were the most reported characteristics that affected older people's access to PHC. CONCLUSIONS Older people's experiences with PHC access varied according to local contexts, socioeconomic variables, and the provision of public or private health services. Results inform policymakers and PHC practitioners to generate policies and services that are evidence-based and responsive to older people's needs. Identified knowledge gaps highlight the need for research to further understand older people's access to PHC in different LMICs.
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Affiliation(s)
- Saydeh Dableh
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - Kate Frazer
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Thilo Kroll
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
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Rushlow DR, Thacher TD, Barry BA. Building Capacity for Pragmatic Trials of Digital Technology in Primary Care. Mayo Clin Proc 2024; 99:491-501. [PMID: 38432751 DOI: 10.1016/j.mayocp.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 03/05/2024]
Abstract
Frontline primary care teams face important challenges in seeking to transform the quality of care delivered to patients and to reduce clerical burden for clinicians. Digital technologies using artificial intelligence hold substantial promise to aid in this transformation. Both pragmatic clinical trials and implementation science are key tools to successfully introduce, evaluate, and sustain innovations in real-world primary care practices. Previous articles in this thematic series have provided an in-depth overview of pragmatic trials and implementation science. This paper demonstrates and provides a framework for how these concepts, together with digital transformation, can be used to solve many of the challenges facing primary care. This framework is conceived as the collaboration of frontline primary care teams with innovators in academic institutions and industry through pragmatic trials and implementation science.
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Affiliation(s)
| | | | - Barbara A Barry
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Chou YY, Lin CF, Lee YS, Weng SC, Kuo FH, Hsu CY, Lin SY. The associations of osteoporosis and possible sarcopenia with disability, nutrition, and cognition in community-dwelling older adults. BMC Geriatr 2023; 23:730. [PMID: 37950206 PMCID: PMC10638752 DOI: 10.1186/s12877-023-04431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Osteoporosis and sarcopenia, respectively, have detrimental impact on health, and combination of both conditions, termed osteosarcopenia, is becoming an increasingly important disorder in older adults as populations age. This study aimed to explore the relationship between osteoporosis and possible sarcopenia and their joint effect on physical performance, nutritional status, and cognition in community-dwelling older adults. METHODS This study was conducted at a medical center in Taiwan, which included the adjacent community care station. The participants were recruited through regular activities at the community care station between January 01, 2015 and February 28, 2022. During the study period, dual-energy X-ray absorptiometry and comprehensive geriatric assessment consisting of comorbidity burden, functional status, cognition, mood, and nutritional status were performed during the study period. Possible sarcopenia was identified utilizing the criteria set by the Asian Working Group on Sarcopenia in 2019 using the criteria of low muscle strength alone, and osteoporosis was defined by the World Health Organization criteria. Accordingly, the study subjects were divided into four groups: normal, only osteoporosis, only possible sarcopenia, and possible osteosarcopenia. RESULTS There were 337 participants (68.6% female) with a median age of 78.0 years (interquartile range: 71.0-85.0 y/o). According to the clinical definition of osteosarcopenia, 78 participants were normal, 69 participants showed possible sarcopenia, 61 participants had osteoporosis, and 129 had osteoporosis with possible sarcopenia. Among the four groups, the prevalence rates of chronic illness, functional capacity, physical performance, cognitive impairment, and malnutrition revealed statistically significant differences. Using logistic regression analysis after adjusting for the other covariates, osteoporosis with possible sarcopenia was associated with an increased odds ratio of cognitive impairment. CONCLUSIONS The findings suggest that compared to osteoporosis or possible sarcopenia alone, osteoporosis with possible sarcopenia was more likely to be associated with cognitive impairment. Early identification and targeted interventions for cognitive impairment in older adults with osteosarcopenia may be valuable in maintaining cognitive well-being and overall quality of life.
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Affiliation(s)
- Yin-Yi Chou
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Cheng-Fu Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
| | - Yu-Shan Lee
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Division of Neurology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Shuo-Chun Weng
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
| | - Fu-Hsuan Kuo
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
- Division of Neurology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan.
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
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Soriano MA, Warren JL, Clark CJ, Johnson NP, Siegel HG, Deziel NC, Saiers JE. Social Vulnerability and Groundwater Vulnerability to Contamination From Unconventional Hydrocarbon Extraction in the Appalachian Basin. GEOHEALTH 2023; 7:e2022GH000758. [PMID: 37064218 PMCID: PMC10100439 DOI: 10.1029/2022gh000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
Unconventional oil and gas (UOG) development, made possible by horizontal drilling and high-volume hydraulic fracturing, has been fraught with controversy since the industry's rapid expansion in the early 2000's. Concerns about environmental contamination and public health risks persist in many rural communities that depend on groundwater resources for drinking and other daily needs. Spatial disparities in UOG risks can pose distributive environmental injustice if such risks are disproportionately borne by marginalized communities. In this paper, we analyzed groundwater vulnerability to contamination from UOG as a physically based measure of risk in conjunction with census tract level sociodemographic characteristics describing social vulnerability in the northern Appalachian Basin. We found significant associations between elevated groundwater vulnerability and lower population density, consistent with UOG development occurring in less densely populated rural areas. We also found associations between elevated groundwater vulnerability and lower income, higher proportions of elderly populations, and higher proportion of mobile homes, suggesting a disproportionate risk burden on these socially vulnerable groups. We did not find a statistically significant association between elevated groundwater vulnerability and populations of racial/ethnic minorities in our study region. Household surveys provided empirical support for a relationship between sociodemographic characteristics and capacity to assess and mitigate exposures to potentially contaminated water. Further research is needed to probe if the observed disparities translate to differences in chemical exposure and adverse health outcomes.
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Affiliation(s)
- Mario A. Soriano
- School of the EnvironmentYale UniversityNew HavenCTUSA
- Integrated GroundWater Modeling CenterHigh Meadows Environmental InstitutePrinceton UniversityPrincetonNJUSA
| | - Joshua L. Warren
- Department of BiostatisticsSchool of Public HealthYale UniversityNew HavenCTUSA
| | - Cassandra J. Clark
- Department of Environmental Health SciencesSchool of Public HealthYale UniversityNew HavenCTUSA
| | - Nicholaus P. Johnson
- Department of Environmental Health SciencesSchool of Public HealthYale UniversityNew HavenCTUSA
| | | | - Nicole C. Deziel
- Department of Environmental Health SciencesSchool of Public HealthYale UniversityNew HavenCTUSA
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Sayani A, Ali MA, Dey P, Corrado AM, Ziegler C, Nicholson E, Lofters A. Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clin Res Rep 2023; 4:100469. [PMID: 36938372 PMCID: PMC10015251 DOI: 10.1016/j.jtocrr.2023.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Participation in lung cancer screening (LCS) is lower in populations with the highest burden of lung cancer risk (through the social patterning of smoking behavior) and lowest levels of health care utilization (through structurally inaccessible care) leading to a widening of health inequities. Methods We conducted a scoping review using the Arksey and O'Malley methodological framework to inform equitable access to LCS by illuminating knowledge and implementation gaps in interventions designed to increase the uptake of LCS. We comprehensively searched for LCS interventions (Ovid Medline, Excerpta Medica database, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus from 2000 to June 22, 2021) and included peer-reviewed articles and gray literature published in the English language that describe an intervention designed to increase the uptake of LCS, charted data using our previously published tool and conduced a health equity analysis to determine the intended-unintended and positive-negative outcomes of the interventions for populations experiencing the greatest inequities. Results Our search yielded 3572 peer-reviewed articles and 54,292 pieces of gray literature. Ultimately, we included 35 peer-reviewed articles and one gray literature. The interventions occurred in the United States, United Kingdom, Japan, and Italy, focusing on shared decision-making, the use of electronic health records as reminders, patient navigation, community-based campaigns, and mobile computed tomography scanners. We developed an equity-oriented LCS framework and mapped the dimensions and outcomes of the interventions on access to LCS on the basis of approachability, acceptability, availability, affordability, and appropriateness of the intervention. No intervention was mapped across all five dimensions. Most notably, knowledge and implementation gaps were identified in dimensions of acceptability, availability, and affordability. Conclusions Interventions that were most effective in improving access to LCS targeted priority populations, raised community-level awareness, tailored materials for sociocultural acceptability, did not depend on prior patient engagement/registration with the health care system, proactively considered costs related to participation, and enhanced utilization through informed decision-making.
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Affiliation(s)
- Ambreen Sayani
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Corresponding author. Address for correspondence: Ambreen Sayani, MD, PhD, Women’s College Research Institute, Women’s College Hospital, 76 Grenville St., Toronto, ON M5S 1B2, Canada.
| | - Muhanad Ahmed Ali
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Pooja Dey
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Ann Marie Corrado
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Millar L, Bhoyroo R, Molina YP, Watts J, Geagea A, Murphy J, Pollard CM. Intersection between health, health literacy and local government: a mixed methods approach to identifying ways to better connect people to place-based primary health care in western Australia. BMC Health Serv Res 2023; 23:63. [PMID: 36681825 PMCID: PMC9860229 DOI: 10.1186/s12913-022-08872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/22/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aim of this year-long mixed methods research was to examine the intersection between health, health literacy and local government to identify ways to better connect people to place-based primary health care (PHC). METHODS Four local government areas located within the Perth metropolitan geographic area provided the setting for the current research. Researchers were co-located into the four local governments over a 10-month period to engage with community stakeholders and services. Two methodologies were used to achieve the objective: eight group model building (GMB) workshops were conducted with N = 148 participants to create causal loop diagrams of the barriers and enablers to people being healthy and well in each of the LGAs and develop potential action ideas from these. Surveys were used to collect health service use and health literacy, as measured using a validated Health Literacy Questionnaire (HLQ), across the four LGAs (N = 409, approximately 100 respondents/area). RESULTS The causal loop diagram themes common across LGAs included: (1) mental health; (2) access to services; (3) health system capacity; (4) economics; and (5) physical wellbeing. Health literacy was relatively high for all nine domains of the HLQ. In the five domains rated from one to four the lowest score was 2.8 for 'appraisal of information' and the highest was 3.2 for 'feeling understood and supported by healthcare providers'. In the four domains rated from one to five; the lowest score was 3.7 for 'navigating the healthcare system' and the highest was 4.1 for 'understand health information well enough to know what to do'. Prioritised action ideas recommended increases in practitioners to meet local needs and training General Practitioners and other health staff in culturally sensitive and trauma informed health care. The survey findings and field notes from the GMB were used to construct personas embodied in vignettes highlighting general themes identified in the workshops including those relevant to local areas. CONCLUSIONS There are many possibilities for health care and local governments to work together to bring services to community members disengaged from the health system. Bringing together people from diverse backgrounds and organisations created synergies that resulted in novel and feasible potential strategies to improve community health.
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Affiliation(s)
- Lynne Millar
- grid.1032.00000 0004 0375 4078Population Health, Curtin University, GPO Box U1987, Kent Street, WA 6845 Perth, Australia
| | - Ranila Bhoyroo
- grid.1032.00000 0004 0375 4078Population Health, Curtin University, GPO Box U1987, Kent Street, WA 6845 Perth, Australia
| | - Yesid Pineda Molina
- grid.1032.00000 0004 0375 4078Population Health, Curtin University, GPO Box U1987, Kent Street, WA 6845 Perth, Australia
| | - Jessica Watts
- grid.1032.00000 0004 0375 4078Population Health, Curtin University, GPO Box U1987, Kent Street, WA 6845 Perth, Australia
| | - Antoinette Geagea
- grid.1032.00000 0004 0375 4078Population Health, Curtin University, GPO Box U1987, Kent Street, WA 6845 Perth, Australia
| | - Jennifer Murphy
- grid.1032.00000 0004 0375 4078Population Health, Curtin University, GPO Box U1987, Kent Street, WA 6845 Perth, Australia
| | - Christina M Pollard
- grid.1032.00000 0004 0375 4078Population Health, Curtin University, GPO Box U1987, Kent Street, WA 6845 Perth, Australia
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Lovejoy C, Fitzgerald L, Mutch A. Understanding access to healthcare for gender diverse young people: a critical review of the literature. CULTURE, HEALTH & SEXUALITY 2023; 25:18-32. [PMID: 35000558 DOI: 10.1080/13691058.2021.2017486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
Gender diverse young people face well-documented physical, mental and sexual health disparities compared to the general population. Differential access to healthcare is a key driver of these inequities and literature highlights high unmet healthcare need among members of this group. Healthcare access has been described through a model that defines five dimensions of health services: approachability; acceptability; availability and accommodation; affordability; and appropriateness; and five abilities of health service consumers that interact with these dimensions: the abilities to perceive, seek, reach, pay and engage. This comprehensive literature review examined barriers to and facilitators of healthcare access among gender diverse young people using the lens provided by this model as it relates to dimensions of access at the health service level and/or the abilities of health service users. We advocate expansion of this model to incorporate demand- and supply-side barriers and facilitators of access, and important structural factors including the gender binary health system framework, intersectionality and stigma. Findings highlight the need for improvements to healthcare provider education and the participatory redesign of health services with a focus on intersectionality, individually-tailored service provision and healthcare that is responsive to the unique needs of gender diverse young people.
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Affiliation(s)
- Charlotte Lovejoy
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Kim S, Jeon B. Decomposing Disability Inequality in Unmet Healthcare Needs and Preventable Hospitalizations: An Analysis of the Korea Health Panel. Int J Public Health 2023; 68:1605312. [PMID: 36926283 PMCID: PMC10011105 DOI: 10.3389/ijph.2023.1605312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/13/2023] [Indexed: 03/04/2023] Open
Abstract
Objectives: This study examines the inequality between people with and without disabilities regarding unmet healthcare needs and preventable hospitalization. Methods: We used the Korea Health Panel of 2016-2018; the final analytical observations were 43,512, including 6.95% of persons with disabilities. We examined the differences in contributors to the two dependent variables and decomposed the observed differences into explained and unexplained components using the Oaxaca-Blinder approach. Results: Unmet healthcare needs and preventable hospitalizations were 5.6% p (15.36% vs. 9.76%) and 0.68% p (1.82% vs. 0.61%), respectively, higher in people with disabilities than in those without, of which 48% and 35% were due to characteristics that the individual variables cannot explain. Decomposition of the distributional effect showed that sex, age, and chronic disease significantly increased disparities for unmet healthcare needs and preventable hospitalization. Socioeconomic factors such as income level and Medical aid significantly increased the disabled-non-disabled disparities for unmet healthcare needs. Conclusion: Socioeconomic conditions increased the disparities, but around 35%-48% of the disparities in unmet healthcare needs and preventable hospitalization were due to unexplained factors, such as environmental barriers.
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Affiliation(s)
- Sujin Kim
- Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Boyoung Jeon
- Department of Health and Medical Information, Myongji College, Seoul, Republic of Korea
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10
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Mangoyana C, March S, Lalloo R, Walsh LJ. Positive oral health outcomes: A partnership model improves care in a rural Indigenous community. Aust J Rural Health 2022. [PMID: 36583508 DOI: 10.1111/ajr.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore the benefits of a partnership between a university dental school and a Community Controlled Health Service, specifically in relation to improving the oral health of an underserved rural Indigenous community. We sought community opinions on health and social outcomes arising from the service provided by the dental student clinical outplacement. SETTING In Dalby, Queensland. PARTICIPANTS In total, 38 participants in five focus groups were representative of local Indigenous community Elders, community health support group members and management and staff. DESIGN A descriptive qualitative study employing semi-structured audio-recorded focus group discussions conducted with purposefully selected Indigenous community groups to explore participant views and experience of the partnership model. Qualitative data were analysed using thematic content analysis. RESULTS The Indigenous community representatives expressed positive benefit in both their general and oral health awareness, in improved access to dental care provided in their own safe space, while they were pleased to assist with students' learning. They viewed the partnership as mutually beneficial. Suggestions for enhancement of the oral health service were also offered. CONCLUSION This partnership between a university and a Community Controlled Health Service provides sustainable positive social and health benefits for the targeted Indigenous community and for the wider local population, while simultaneously providing enhanced educational benefits for students on clinical outplacement. Translation and uptake of this successful model of care would benefit both underserved communities and dental and other health care professional educators worldwide.
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Affiliation(s)
- Clare Mangoyana
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra March
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Ratilal Lalloo
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Laurence J Walsh
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
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Campillay-Campillay M, Calle-Carrasco A, Dubo P, Moraga-Rodríguez J, Coss-Mandiola J, Vanegas-López J, Rojas A, Carrasco R. Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12439. [PMID: 36231740 PMCID: PMC9564706 DOI: 10.3390/ijerph191912439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.
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Affiliation(s)
- Maggie Campillay-Campillay
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Ana Calle-Carrasco
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Pablo Dubo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Jorge Moraga-Rodríguez
- Programa de Magíster en Metodología de Investigación Cualitativa para la Salud, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Juan Coss-Mandiola
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Jairo Vanegas-López
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Alejandra Rojas
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Raúl Carrasco
- Facultad de Ingeniería y Negocios, Univerdidad de Las Américas, Santiago 3981000, Chile
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Butler D, Clifford-Motopi A, Mathew S, Nelson C, Brown R, Gardner K, Turner L, Coombe L, Roe Y, Gao Y, Ward J. Study protocol: primary healthcare transformation through patient-centred medical homes-improving access, relational care and outcomes in an urban Aboriginal and Torres Strait Islander population, a mixed methods prospective cohort study. BMJ Open 2022; 12:e061037. [PMID: 36175091 PMCID: PMC9528615 DOI: 10.1136/bmjopen-2022-061037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION For over 40 years, Aboriginal and Torres Strait Islander Community-Controlled Health Services (ACCHS) in Australia have led strategic responses to address the specific needs of Aboriginal and Torres Strait Islander populations. Globally, there has been rapid growth in urban Indigenous populations requiring an adaptive primary healthcare response. Patient-centred medical homes (PCMH) are an evidenced-based model of primary healthcare suited to this challenge, underpinned by principles aligned with the ACCHS sector-relational care responsive to patient identified healthcare priorities. Evidence is lacking on the implementation and effectiveness of the PCMH model of care governed by, and delivered for, Aboriginal and Torres Strait Islander populations in large urban settings. METHOD AND ANALYSIS Our multiphased mixed-methods prospective cohort study will compare standard care provided by a network of ACCHS to an adapted PCMH model of care. Phase 1 using qualitative interviews with staff and patients and quantitative analysis of routine primary care health record data will examine the implementation, feasibility and acceptability of the PCMH. Phase 2 using linked survey, primary care and hospitalisation data will examine the impact of our adapted PCMH on access to care, relational and quality of care, health and wellbeing outcomes and economic costs. Phase 3 will synthesise evidence on mechanisms for change and discuss their implications for sustainability and transferability of PCMHs to the broader primary healthcare system ETHICS AND DISSEMINATION: This study has received approval from the University of Queensland Human Research Ethics Committee (2021/HE00529). This research represents an Aboriginal led and governed partnership in response to identified community priorities. The findings will contribute new knowledge on how key mechanisms underpinning the success and implementation of the model can be introduced into policy and practice. Study findings will be disseminated to service providers, researchers, policymakers and, most importantly, the communities themselves.
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Affiliation(s)
- Danielle Butler
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Saira Mathew
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
| | - Renee Brown
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
- Nununccal
| | - Karen Gardner
- Business School, University of New South Wales Canberra at ADFA, Canberra, Australian Capital Territory, Australia
| | - Lyle Turner
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
| | - Leanne Coombe
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
| | - Yvette Roe
- Charles Darwin University, Casuarina, Australian Capital Territory, Australia
- Njikena Jawuru
| | - Yu Gao
- Charles Darwin University, Casuarina, Australian Capital Territory, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
- Pitjantjatjara and Nukunu
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13
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Kadel R, Allen J, Darlington O, Masters R, Collins B, Charles JM, Asaria M, Dyakova M, Bellis M, Cookson R. Cost of health inequality to the NHS in Wales. Front Public Health 2022; 10:959283. [PMID: 36187677 PMCID: PMC9523137 DOI: 10.3389/fpubh.2022.959283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background Forty years from the seminal work of Welsh GP Julian Tudor Hart on the Inverse Care Law, inequalities in health and healthcare remain deeply embedded in Wales. There is a wider gap (over 17 years) in healthy life expectancy between people living in the most and least deprived neighborhoods in Wales. This health inequality is reflected in additional healthcare use. In this study we estimate the cost of inequality associated with this additional healthcare use to the publicly funded National Health Service (NHS) in Wales. Methods We retrieved administrative data on all NHS inpatient admissions, outpatient and accident and emergency attendances in Wales between April 2018 and March 2019 from Digital Health and Care Wales (DHCW). Hospital service use data were translated to costs using Healthcare Resource Group (HRG) and health service specific unit cost data and linked with area level mid-year population and deprivation indices in order to calculate the healthcare costs associated with socioeconomics deprivation. Results Inequality in healthcare use between people from more and less deprived neighborhoods was associated with an additional cost of £322 million per year to the NHS in Wales, accounting for 8.7% of total NHS hospital expenditure in the country. Emergency inpatient admissions made up by far the largest component of this additional cost contributing £247.4 million, 77% of the total. There are also substantial costs of inequality for A&E attendances and outpatient visits, though not maternity services. Elective admissions overall have a negative cost of inequality, since among men aged 50-75 and women aged 60-70, elective utilization is actually negatively associated with deprivation. Conclusion There are wide inequalities in health and healthcare use between people living in more deprived neighborhoods and those living in less deprived neighborhoods in Wales. Tackling health inequality through a combination of health promotion and early intervention policies targeted toward deprived communities could yield substantial improvement in health and wellbeing, as well as savings for the Welsh NHS through reduced use of emergency hospital care.
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Affiliation(s)
- Rajendra Kadel
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom,*Correspondence: Rajendra Kadel
| | - James Allen
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Oliver Darlington
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Rebecca Masters
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Brendan Collins
- Health and Social Services Group, Finance Directorate, Welsh Government, Cardiff, United Kingdom
| | - Joanna M. Charles
- Health and Social Services Group, Finance Directorate, Welsh Government, Cardiff, United Kingdom
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Mariana Dyakova
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Mark Bellis
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Richard Cookson
- Centre for Health Economics, University of York, York, United Kingdom
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14
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Gomez del Pulgar M, Cuevas-Budhart MA, Hernández-Iglesias S, Kappes M, Riquelme Contreras VA, Rodriguez-Lopez E, De Almeida Souza AM, Gonzalez Jurado MA, Crespo Cañizares A. Best Nursing Intervention Practices to Prevent Non-Communicable Disease: A Systematic Review. Public Health Rev 2022; 43:1604429. [PMID: 36189187 PMCID: PMC9516617 DOI: 10.3389/phrs.2022.1604429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: To explore nursing health education interventions for non-communicable disease patients. Methods: The design was a systematic review of research work published between 2008 and 2018. The data sources included the Web of Science, PubMed, Scopus, COCHRANE, and LILACS. The studies that met the inclusion were assessed, and the analysis for methodological quality through the recommended tools CASPe, and JADAD. Results: Fifteen original studies from eight counties were included in the review; Findings revealed 13 studies with randomized samples and six used power analysis. Nurses’ interventions included house calls, home care, and individual and group health education. Conclusion: Nursing interventions showed 76.4% the effectiveness of results in patient outcomes to promote and improve healthier lifestyles and quality of life of non-communicable disease patients. This review discloses the significant impact of nursing health education interventions. Nursing leadership and political decision-makers should consider providing programs to enhance health education knowledge and abilities. All of this can favor the sustainability of the global economy by changing the life style of thousands of people worldwide. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42020208809.
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Affiliation(s)
- Mercedes Gomez del Pulgar
- Centro de Educación Superior Hygiea, Madrid, Spain
- Coordination of the Center for Advanced Clinical Simulation of the Nursing Degree, Universidad Francisco de Vitoria, Posuelo de Alarcon, Madrid, España
| | - Miguel Angel Cuevas-Budhart
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Instituto Mexicano del Seguro Social (IMSS), Mexico City, México
- *Correspondence: Miguel Angel Cuevas-Budhart, , ,
| | - Sonsoles Hernández-Iglesias
- Institutional Relations and Health Practices of Health Sciences, Faculty of the Nursing Degree, Universidad Francisco de Vitoria, Pozuelo de Alarcon, Madrid, España
| | - Maria Kappes
- College of Health Care Sciences, Nursing School, Universidad San Sebastián, Puerto Montt, Chile
| | | | | | | | | | - Almudena Crespo Cañizares
- Clinical Practices of the Degree in Nursing, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
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15
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Spinella S, McCune N, McCarthy R, El-Tahch M, George J, Dorritie M, Ford A, Posteraro K, DiNardo D. WVSUD-PACT: a Primary-Care-Based Substance Use Disorder Team for Women Veterans. J Gen Intern Med 2022; 37:837-841. [PMID: 36042085 PMCID: PMC9481786 DOI: 10.1007/s11606-022-07577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sara Spinella
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA. .,VA Pittsburgh Healthcare System, Pittsburgh, USA.
| | - Nicole McCune
- VA Pittsburgh Healthcare System, Pittsburgh, USA.,Waynesburg University, Waynesburg, USA
| | | | - Maria El-Tahch
- Primary Care Mental Health Integration, VA Pittsburgh Healthcare System, Pittsburgh, USA
| | | | | | - Alyssa Ford
- Primary Care Mental Health Integration, VA Pittsburgh Healthcare System, Pittsburgh, USA
| | | | - Deborah DiNardo
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.,VA Pittsburgh Healthcare System, Pittsburgh, USA
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16
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van der Meer L, Barsties LS, Daalderop LA, Waelput AJM, Steegers EAP, Bertens LCM. Social determinants of vulnerability in the population of reproductive age: a systematic review. BMC Public Health 2022; 22:1252. [PMID: 35751043 PMCID: PMC9233331 DOI: 10.1186/s12889-022-13651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age. Methods The databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021. Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner. Results We identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience. Conclusions This review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13651-6.
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Affiliation(s)
- Lindsey van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.
| | - Lisa S Barsties
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.,DRIFT - Dutch Research Institute for Transitions, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.,DRIFT - Dutch Research Institute for Transitions, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Adja J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
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D’Apice C, Ghirotto L, Bassi MC, Artioli G, Sarli L. A realist synthesis of staff-based primary health care interventions addressing universal health coverage. J Glob Health 2022; 12:04035. [PMID: 35569053 PMCID: PMC9107778 DOI: 10.7189/jogh.12.04035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Clelia D’Apice
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL – IRCCS, Reggio Emilia, Italy
| | - Maria C Bassi
- Medical Library, Azienda USL – IRCCS, Reggio Emilia, Italy
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
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Acquah-Hagan G, Boateng D, Appiah-Brempong E, Twum P, Amankwa Atta J, Agyei-Baffour P. Availability and Affordability of Primary Health Care Among Vulnerable Populations in Urban Kumasi Metropolis: Family Health Perspective. Health Equity 2022; 6:345-355. [PMID: 35651354 PMCID: PMC9148648 DOI: 10.1089/heq.2021.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Health-related expenditures pose a significant burden on vulnerable populations. This study assessed the availability and affordability of primary health care among disadvantaged populations in urban Kumasi Metropolis, Ghana. Methods This study was a descriptive cross-sectional study conducted among multi-level participants of vulnerable populations ≥18 years of age (n=710) constituting the older adults/aged, pregnant women, head porters, sex workers, and other vulnerable groups (people with disabilities and the homeless). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to assess the association between vulnerability and access to health care. Results There were significant differences in the availability and adequacy of health care among the vulnerable groups studied. Distance to the source of care was >5 km for majority of the vulnerable groups and the average expenditure on a visit to the health facility was GH¢ 27.04 (∼US$ 5.55 as at January 2019). Challenges to health care among the vulnerable groups included monetary (37.9%), stigmatization (18.6%), and staff attitude (25.9%). Head porters and other vulnerable groups were less likely to view health care as affordable compared with older adults. The difference in the perception of health care affordability was, however, explained by sociodemographic characteristic and health care-related factors. Conclusion Despite the introduction of a National Health Insurance Scheme in Ghana, this study highlights challenges in health care access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to adopt other innovative care strategies that may have broader applicability for all populations.
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Affiliation(s)
- Gertrude Acquah-Hagan
- Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Suntreso Government Hospital, Kumasi, Ghana
| | - Daniel Boateng
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Emmanuel Appiah-Brempong
- Department of Health Promotion and Disability Studies, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Peter Twum
- Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Peter Agyei-Baffour
- Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Sarikhani Y, Bastani P, Bayati M. A National Survey on the characteristics of Iranian General Practitioners and Their Preferred Specialty: A Need to Transition toward Preventive Medicine. Int J Prev Med 2021; 12:84. [PMID: 34584650 PMCID: PMC8428318 DOI: 10.4103/ijpvm.ijpvm_441_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022] Open
Abstract
Background: The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields. Methods: In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression. Results: The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties. Conclusions: This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.
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Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Ngo Bikoko Piemeu CS, Loignon C, Dionne É, Paré-Plante AA, Haggerty J, Breton M. Expectations and needs of socially vulnerable patients for navigational support of primary health care services. BMC Health Serv Res 2021; 21:999. [PMID: 34551747 PMCID: PMC8456577 DOI: 10.1186/s12913-021-06811-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary healthcare is the main entry to the health care system for most of the population. In 2008, it was estimated that about 26% of the population in Quebec (Canada) did not have a regular family physician. In early 2017, about 10 years after the introduction of a centralized waiting list for patients without a family physician, Québec had 25% of its population without a family physician and nearly 33% of these or 540,000, many of whom were socially vulnerable (SV), remained registered on the list. SV patients often have more health problems. They also face access inequities or may lack the skills needed to navigate a constantly evolving and complex healthcare system. Navigation interventions show promise for improving access to primary health care for SV patients. This study aimed to describe and understand the expectations and needs of SV patients. METHODS A descriptive qualitative study rooted in a participatory study on navigation interventions implemented in Montérégie (Quebec) addressed to SV patients. Semi-structured individual face-to-face and telephone interviews were conducted with patients recruited in three primary health care clinics, some of whom received the navigation intervention. A thematic analysis was performed using NVivo 11 software. RESULTS Sixteen patients living in socially deprived contexts agreed to participate in this qualitative study. Three main expectations and needs of patients for navigation interventions were identified: communication expectations (support to understand providers and to be understood by them, discuss about medical visit, and bridge the communication cap between patients and PHC providers); relational expectations regarding emotional or psychosocial support; and pragmatic expectations (information on available resources, information about the clinic, and physical support to navigate the health care system). CONCLUSIONS Our study contributes to the literature by identifying expectations and needs specified to SV patients accessing primary health care services, that relate to navigation interventions. This information can be used by decision makers for navigation interventions design and inform health care organizational policies.
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Affiliation(s)
- Carine Sandrine Ngo Bikoko Piemeu
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
| | - Christine Loignon
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Canada
| | - Émilie Dionne
- VITAM - Centre de Recherche en Santé Durable, Québec, Canada; Department of Sociology, Université Laval, Québec, Canada
| | - Andrée-Anne Paré-Plante
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Canada
- Charles-Lemoyne University Medicine Group, Saint-Lambert, Canada
| | - Jeannie Haggerty
- VITAM - Centre de Recherche en Santé Durable, Québec, Canada; Department of Sociology, Université Laval, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada.
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada.
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Wang JX, Somani S, Chen JH, Murray S, Sarkar U. Health Equity in Artificial Intelligence and Primary Care Research: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e27799. [PMID: 34533458 PMCID: PMC8486995 DOI: 10.2196/27799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Though artificial intelligence (AI) has the potential to augment the patient-physician relationship in primary care, bias in intelligent health care systems has the potential to differentially impact vulnerable patient populations. OBJECTIVE The purpose of this scoping review is to summarize the extent to which AI systems in primary care examine the inherent bias toward or against vulnerable populations and appraise how these systems have mitigated the impact of such biases during their development. METHODS We will conduct a search update from an existing scoping review to identify studies on AI and primary care in the following databases: Medline-OVID, Embase, CINAHL, Cochrane Library, Web of Science, Scopus, IEEE Xplore, ACM Digital Library, MathSciNet, AAAI, and arXiv. Two screeners will independently review all abstracts, titles, and full-text articles. The team will extract data using a structured data extraction form and synthesize the results in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. RESULTS This review will provide an assessment of the current state of health care equity within AI for primary care. Specifically, we will identify the degree to which vulnerable patients have been included, assess how bias is interpreted and documented, and understand the extent to which harmful biases are addressed. As of October 2020, the scoping review is in the title- and abstract-screening stage. The results are expected to be submitted for publication in fall 2021. CONCLUSIONS AI applications in primary care are becoming an increasingly common tool in health care delivery and in preventative care efforts for underserved populations. This scoping review would potentially show the extent to which studies on AI in primary care employ a health equity lens and take steps to mitigate bias. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/27799.
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Affiliation(s)
- Jonathan Xin Wang
- Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sulaiman Somani
- Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Jonathan H Chen
- Center for Biomedical Informatics Research, Division of Hospital Medicine, Stanford Department of Medicine, Stanford, CA, United States
| | - Sara Murray
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
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Karimi M, van der Zwaan L, Islam K, van Genabeek J, Mölken MRV. Evaluating Complex Health and Social Care Program Using Multi-Criteria Decision Analysis: A Case Study of "Better Together in Amsterdam North". VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:966-975. [PMID: 34243840 DOI: 10.1016/j.jval.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 01/04/2021] [Accepted: 02/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Multi-criteria decision analysis (MCDA) has been recommended to support policy making in healthcare. However, practical applications of MCDA are sparse. One potential use for MCDA is for the evaluation of programs for complex and vulnerable patients. These complex patients benefit from integrated care programs that span healthcare and social care and aim to improve more than just health outcomes. MCDA can evaluate programs that aim to improve broader outcomes because it allows the evaluation of multiple outcomes alongside each other. In this study, we evaluate an innovative integrated care program in the Netherlands using MCDA. METHODS We used an innovative MCDA framework with broad outcomes of health, well-being, and cost to evaluate the Better Together in Amsterdam North (BSiN) program using preferences of patients, partners, providers, payers, and policy makers in the Netherlands. BSiN provides case management support for a period of 6 months. Seven outcomes that previous research has deemed important to complex patients were measured, including physical functioning and social relationships and participation. RESULTS We find that the program improved the overall MCDA score marginally, and, thus, after 6 and after 12 months, BSiN was preferred to usual care by all stakeholders. BSiN was preferred to usual care, mostly owing to improvements in psychological well-being and social relationships and participation. CONCLUSIONS The integrated healthcare and social care program BSiN in the Netherlands was preferred to usual care according to an MCDA evaluation. MCDA seems a useful method to evaluate complex programs with benefits beyond health.
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Affiliation(s)
- Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands.
| | - Lennart van der Zwaan
- Netherlands Organization for Applied Scientific Research TNO, Unit Healthy Living, Leiden, The Netherlands
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway; NORCE Norwegian Research Centre, Bergen, Norway
| | - Joost van Genabeek
- Netherlands Organization for Applied Scientific Research TNO, Unit Healthy Living, Leiden, The Netherlands
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands; Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Dableh S, Frazer K, Kroll T. Access of older people to primary healthcare services in low- and middle-income countries: a systematic scoping review protocol. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13271.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: People across the world are living longer. This advantageous trend is escorted by an increased prevalence of chronic diseases, making healthcare needs more complex. Non-communicable diseases induce a sharply rising economic and societal cost, particularly in low- and middle-income countries (LMIC), where most older people reside. In this context, the access of older people to primary health care (PHC) is vital because it brings solutions to the aforementioned issues. Furthermore, evidence strongly suggests that this approach to health ensures universal health coverage and enables health systems to adapt to rapid economic, technologic, and demographic changes. PHC improves health outcomes, health system efficiency, and health equity. Given their distinctive needs, older people face financial, geographical, social, cultural, structural, and organisational barriers, affecting their equitable access to PHC services. Therefore, many interventions have been implemented to maximise their access to PHC. This paper outlines the protocol for a scoping review that addresses the central question: What is the scope and nature of available evidence on older peoples’ access to PHC in LMICs? This includes the experience of older people having access to PHC, enabling and hindering access, outcomes of the lack of access, interventions implemented to improve access, and related theoretical frameworks. Methods: This scoping review will follow the theoretical framework proposed by Arksey and O’Malley. The five databases that will be searched are CINAHL, PubMed, LILACS, Embase, and Cochrane Libraries. Studies will be selected according to a set of inclusion/exclusion criteria. Data will then be mapped, extracted, and presented graphically along with a narrative report. Conclusions: The scoping review is a first step to synthesise and disseminate the literature on older people’s access to PHC. This will provide information for researchers to reorient their studies, and intel for decision-makers, enabling them to enact policies that meet older people’s needs.
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Simning A, Caprio TV, Li Y, Conwell Y. Near Vision but not Hearing Loss is Associated with Lacking a Usual Source of Health Care. J Aging Health 2021; 33:786-797. [PMID: 33914652 DOI: 10.1177/08982643211014323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Sensory loss may be a barrier to accessing healthcare services, and this study seeks to examine the association of sensory loss with whether older adults report having a usual source of health care. Methods: Our study included 7548 older adults who participated in the National Health and Aging Trends Study in 2015. Having a self-reported usual source of health care was our outcome, and hearing and vision loss were our primary independent variables. Results: In multivariate analysis accounting for demographics, socioeconomic, health status, and environmental covariates, near vision loss but not distance vision or hearing loss was associated with decreased odds of having a usual source of health care. Discussion: That older adults with near vision loss were less likely to report having a usual source of health care is concerning. Examining barriers to care is needed to identify sensory loss-relevant processes to optimize and intervene upon.
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Affiliation(s)
- Adam Simning
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Department of Public Health Sciences, 6927University of Rochester, NY, USA
| | - Thomas V Caprio
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Department of Public Health Sciences, 6927University of Rochester, NY, USA.,Division of Geriatrics, Department of Medicine, 6927University of Rochester, NY, USA
| | - Yue Li
- Department of Public Health Sciences, 6927University of Rochester, NY, USA
| | - Yeates Conwell
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Office for Aging Research and Health Services, 6927University of Rochester, NY, USA
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25
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Stanimirovic A, Francis T, Cooper Reed A, Meerai S, Sutakovic O, Merritt R, Brent M, Rac V. Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study. JMIR Res Protoc 2021; 10:e23492. [PMID: 33666559 PMCID: PMC7980119 DOI: 10.2196/23492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/06/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background By 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender. Objective We aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019. Methods Using a convergent mixed methods design, we want to understand patients’, providers’, administrators’, and decision makers’ perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina. Results For the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021. Conclusions In Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care. International Registered Report Identifier (IRRID) PRR1-10.2196/23492
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Affiliation(s)
- Aleksandra Stanimirovic
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Diabetes Action Canada, CIHR SPOR Network, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Troy Francis
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Anna Cooper Reed
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sonia Meerai
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Gender, Feminist & Women Studies, Faculty of Graduate Studies, York University, Toronto, ON, Canada.,Lyle S Hallman Faculty of Social Work, Wilfrid Laurier University, Brantford, ON, Canada
| | - Olivera Sutakovic
- Diabetes Action Canada, CIHR SPOR Network, Toronto, ON, Canada.,Department of Ophthalmology, Toronto Western Hospital, Toronto, ON, Canada
| | - Rebecca Merritt
- South Riverdale Community Health Centre, Toronto, ON, Canada
| | - Michael Brent
- Diabetes Action Canada, CIHR SPOR Network, Toronto, ON, Canada.,Department of Ophthalmology, Toronto Western Hospital, Toronto, ON, Canada
| | - Valeria Rac
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Diabetes Action Canada, CIHR SPOR Network, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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Freeman T, Baum F, Javanparast S, Ziersch A, Mackean T, Windle A. Challenges facing primary health care in federated government systems: Implementation of Primary Health Networks in Australian states and territories. Health Policy 2021; 125:495-503. [PMID: 33602531 DOI: 10.1016/j.healthpol.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
In many federated countries, there is divided health system responsibility that can affect primary health care (PHC) policy and implementation, and complicate collaboration between PHC actors. We examined an Australian policy initiative, Primary Health Networks (PHNs), which are regional PHC organisations, to examine how they collaborated with state and territory PHC actors, and what factors enhanced or constrained collaboration. For PHNs we surveyed 66 staff, interviewed 82 staff, examined board membership, and analysed documents from all 31 PHNs. We also interviewed 11 state and 5 federal health bureaucrats. We mapped the PHC system in each state, and conducted team thematic analysis of the qualitative data collected. We found variation in how well PHNs collaborated with state and territory actors, ranging from poor relationships through to strong cooperation and co-commissioning. This was affected by factors to do with the state health department, geography, PHN funding and regulations, ambiguities in the federal/state divided responsibilities for PHC, and the extent of use of collaboration mechanisms and strategies. Resourcing and supporting such collaboration mechanisms, and increasing regional funding flexibility of funding would increase the potential for regional organisations to successfully navigate ambiguities in responsibility and foster a more integrated, cohesive PHC system.
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Affiliation(s)
- Toby Freeman
- Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia.
| | - Fran Baum
- Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia.
| | - Sara Javanparast
- Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia.
| | - Anna Ziersch
- Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia.
| | - Tamara Mackean
- Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia.
| | - Alice Windle
- Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia.
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Baghbanian A, Merlin T, Carter D, Wang S. Methods for the health technology assessment of complex interventions: a protocol for a scoping review. BMJ Open 2020; 10:e039263. [PMID: 33257482 PMCID: PMC7705549 DOI: 10.1136/bmjopen-2020-039263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In healthcare policy and economic literature, research on the health technology assessment (HTA) of complex interventions (CIs) is becoming increasingly important. In many developed countries, HTA guides decision-making to help achieve greater value for money when funding health care. However, research has yet to identify the forms of evidence and evaluation criteria that should be used in the HTA of CIs. Previous research has established that the HTA of CIs requires multiple factors to be evaluated but there is no agreement on which factors ought always to be considered. There is equally little agreement on which forms of evidence ought to be collected or synthesised and how. We plan to perform a systematic scoping review in order to identify the range of evaluation criteria and types of evidence currently used in the HTA of CIs. METHOD AND ANALYSIS This protocol was developed to guide the methodological framework for the conduct of a scoping review on health technology assessment (HTA) of complex interventions (CIs), using the Joanna Briggs Institute guidelines and the six-stage framework proposed by Arksey and O'Malley, in addition to more recent innovations in scoping review methodology. A grey literature search will supplement the primary searches of seven electronic databases for studies available in English between January 2000 and August 2020. Two reviewers will independently screen all search results for inclusion and data will be extracted using a customised data extraction or charting form. Any dispute will be resolved by consensus or through arbitration by a third author. The mnemonic Population, Concept and Context will be adopted to establish criteria for selecting relevant literature, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Review will be used for reporting the results. Several explanatory-descriptive methods will be used for analysing the extracted data including frequency and trend analyses as well as reflexive thematic coding and analysis.Mapping evidence on the HTA of CIs will allow us to gain a better understanding of both established and emerging practices, including the information types, requirements, values and parameters that are incorporated in the HTA of CIs. We also expect the findings of the scoping review to help identify research gaps that will guide future studies. As healthcare becomes more complex in its delivery, it is timely to determine how these complex interventions should be assessed so that policy decisions can be made about whether implementation and public funding is warranted. ETHICS AND DISSEMINATION This scoping review will involve secondary analysis of already collected data, and thus, does not require ethics approval. The research findings will be submitted to peer-reviewed journals for publication and will also be disseminated at conferences and seminars.
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Affiliation(s)
- Abdolvahab Baghbanian
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tracy Merlin
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Drew Carter
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shuhong Wang
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Smithman MA, Descôteaux S, Dionne É, Richard L, Breton M, Khanassov V, Haggerty JL. Typology of organizational innovation components: building blocks to improve access to primary healthcare for vulnerable populations. Int J Equity Health 2020; 19:174. [PMID: 33023575 PMCID: PMC7541234 DOI: 10.1186/s12939-020-01263-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving equity of access to primary healthcare requires organizations to implement innovations tailored to the specific needs and abilities of vulnerable populations. However, designing pro-vulnerable innovations is challenging without knowledge of the range of possible innovations tailored to vulnerable populations' needs. To better support decision-makers, we aimed to develop a typology of pro-vulnerable organizational innovation components - akin to "building blocks" that could be combined in different ways into new complex innovations or added to existing organizational processes to improve access to primary healthcare. METHODS To develop the typology, we used data from a previously conducted a) scoping review (2000-2014, searched Medline, Embase, CINAHL, citation tracking, n = 90 articles selected), and b) environmental scan (2014, online survey via social networks, n = 240 innovations). We conducted a typological analysis of the data. Our initial typology yielded 48 components, classified according to accessibility dimensions from the Patient-Centred Accessibility Framework. The initial typology was then field-tested for relevance and usability by health system stakeholders and refined from 2014 to 2018 (e.g., combined similar components, excluded non-organizational components). RESULTS The selected articles (n = 90 studies) and survey responses (n = 240 innovations) were mostly from the USA, Canada, Australia and the UK. Innovations targeted populations with various vulnerabilities (e.g., low income, chronic illness, Indigenous, homeless, migrants, refugees, ethnic minorities, uninsured, marginalized groups, mental illness, etc.). Our final typology had 18 components of organizational innovations, which principally addressed Availability & Accommodation (7/18), Approachability (6/18), and Acceptability (3/18). Components included navigation & information, community health worker, one-stop-shop, case management, group visits, defraying costs, primary healthcare brokerage, etc. CONCLUSIONS: This typology offers a comprehensive menu of potential components that can help inform the design of pro-vulnerable organizational innovations. Component classification according to the accessibility dimensions of the Patient-Centred Accessibility Framework is useful to help target access needs. Components can be combined into complex innovations or added to existing organizational processes to meet the access needs of vulnerable populations in specific contexts.
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Affiliation(s)
- Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Sarah Descôteaux
- St. Mary's Research Centre, McGill University, Montreal, Quebec, Canada
| | - Émilie Dionne
- St. Mary's Research Centre, McGill University, Montreal, Quebec, Canada
| | - Lauralie Richard
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Mylaine Breton
- Department of Community Health, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Vladimir Khanassov
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Jeannie L Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
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Noorihekmat S, Rahimi H, Mehrolhassani MH, Chashmyazdan M, Haghdoost AA, Ahmadi Tabatabaei SV, Dehnavieh R. Frameworks of Performance Measurement in Public Health and Primary Care System: A Scoping Review and Meta-Synthesis. Int J Prev Med 2020; 11:165. [PMID: 33312474 PMCID: PMC7716605 DOI: 10.4103/ijpvm.ijpvm_34_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 08/29/2019] [Indexed: 11/12/2022] Open
Abstract
Background: This study was conducted to synthesize the evidence on the dimensions of performance appraisal of the public health and primary care system through a scoping review and meta-synthesis. Methods: The review conducted systematically in 2018 with a scoping review approach. To identify pertinent studies, the following electronic databases were systematically searched until December 20, 2017: Cochrane, ISI Web of Science, PubMed, Scopus, Science Direct, and Embase. Reviewing the studies found on the search bases was carried out in three stages by two persons individually. According to refined studies, the data were extracted to meet the objectives and respond to the research questions. The thematic analysis was used to identify and categorize the dimensions of performance measurement. Results: Using this process, 20 studies were eligible for our research. The critical points in measuring the performance of the public health field were classified into eight main domains including leadership and stewardship, funding, resource generation, service delivery, quality, accessibility, efficiency/productivity, and community health status. The differences in measurement frameworks are inevitable. One reason for the differences in the health system performance measurement framework is the differences in the data or data collection, analysis, and reporting. Performance measurement in the field of health, especially primary care, was a multidimensional issue. Conclusions: Each of the main dimensions had several sub-criteria, indicating the broadness and complexity of the performance of first-level care providers. Single-dimensional performance measurement could underpin incorrect policies and decisions.
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Affiliation(s)
- Somayeh Noorihekmat
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamed Rahimi
- Students Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad H Mehrolhassani
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohamadreza Chashmyazdan
- Ph.D. Student in Medical Library and Information Science, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Vahid Ahmadi Tabatabaei
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Grandhi GR, Valero-Elizondo J, Mszar R, Brandt EJ, Annapureddy A, Khera R, Saxena A, Virani SS, Blankstein R, Desai NR, Blaha MJ, Cheema FH, Vahidy FS, Nasir K. Association of cardiovascular risk factor profile and financial hardship from medical bills among non-elderly adults in the United States. Am J Prev Cardiol 2020; 2:100034. [PMID: 34327457 PMCID: PMC8315456 DOI: 10.1016/j.ajpc.2020.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/14/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022] Open
Abstract
Background While optimal cardiovascular risk factor (CRF) profile is associated with lower mortality, morbidity, and healthcare expenditures among individuals with atherosclerotic cardiovascular disease (ASCVD), less is known regarding its impact on financial hardship from medical bills. Therefore, we assessed whether an optimal CRF profile is associated with a lower burden of financial hardship from medical bills and a reduction in cost-related barriers to health. Methods We used a nationally representative sample of adults between 18 and 64 years from the National Health Interview Survey between 2013 and 2017. We assessed ASCVD status and the number of risk factors to categorize the study population into 4 mutually exclusive categories: ASCVD (irrespective of CRF profile) and non-ASCVD with poor, average, and optimal CRF profile. Adjusted logistic regression model was used to determine the association of ASCVD/CRF profile with financial hardship from medical bills and cost-related barriers to health (cost-related medication non-adherence (CRN), foregone/delayed care, and high financial distress). Results We included 119,388 non-elderly adults, representing 189 million individuals annually across the United States. Non-ASCVD/optimal CRF profile individuals had a lower prevalence of financial hardship and an inability paying medical bills when compared with individuals with ASCVD (24% vs 45% and 6% vs 19%, respectively). Among individuals without ASCVD and an optimal CRF profile, the prevalence of each cost-related barrier to health was <50% compared with individuals with ASCVD. Poor/low income and uninsured individuals within non-ASCVD/average CRF profile strata had a lower prevalence of financial hardship and an inability paying medical bills when compared with middle/high income and insured individuals with ASCVD. Non-ASCVD individuals with optimal CRF profile had the lowest odds of all barriers to health. Conclusion Optimal CRF profile is associated with a lower prevalence of financial hardship from medical bills and cost-related barriers to health despite lower income and lack of insurance.
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Affiliation(s)
- Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.,Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA
| | - Eric J Brandt
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Amarnath Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Ron Blankstein
- Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA.,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Faisal H Cheema
- University of Houston College of Medicine, Houston, TX, USA.,HCA Research Institute, Nashville, TN, USA
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.,Center for Outcomes Research, Houston Methodist, Houston, TX, USA
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Cheraghi-Sohi S, Panagioti M, Daker-White G, Giles S, Riste L, Kirk S, Ong BN, Poppleton A, Campbell S, Sanders C. Patient safety in marginalised groups: a narrative scoping review. Int J Equity Health 2020; 19:26. [PMID: 32050976 PMCID: PMC7014732 DOI: 10.1186/s12939-019-1103-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/27/2019] [Indexed: 12/05/2022] Open
Abstract
Background Marginalised groups (‘populations outside of mainstream society’) experience severe health inequities, as well as increased risk of experiencing patient safety incidents. To date however no review exists to identify, map and analyse the literature in this area in order to understand 1) which marginalised groups have been studied in terms of patient safety research, 2) what the particular patient safety issues are for such groups and 3) what contributes to or is associated with these safety issues arising. Methods Scoping review. Systematic searches were performed across six electronic databases in September 2019. The time frame for searches of the respective databases was from the year 2000 until present day. Results The searches yielded 3346 articles, and 67 articles were included. Patient safety issues were identified for fourteen different marginalised patient groups across all studies, with 69% (n = 46) of the studies focused on four patient groups: ethnic minority groups, frail elderly populations, care home residents and low socio-economic status. Twelve separate patient safety issues were classified. Just over half of the studies focused on three issues represented in the patient safety literature, and in order of frequency were: medication safety, adverse outcomes and near misses. In total, 157 individual contributing or associated factors were identified and mapped to one of seven different factor types from the Framework of Contributory Factors Influencing Clinical Practice within the London Protocol. Patient safety issues were mostly multifactorial in origin including patient factors, health provider factors and health care system factors. Conclusions This review highlights that marginalised patient groups are vulnerable to experiencing a variety patient safety issues and points to a number of gaps. The findings indicate the need for further research to understand the intersectional nature of marginalisation and the multi-dimensional nature of patient safety issues, for groups that have been under-researched, including those with mental health problems, communication and cognitive impairments. Such understanding provides a basis for working collaboratively to co-design training, services and/or interventions designed to remove or at the very least minimise these increased risks. Trial registration Not applicable for a scoping review.
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Affiliation(s)
- Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England. .,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England.
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Gavin Daker-White
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Lisa Riste
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Sue Kirk
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Bie Nio Ong
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Keele University, Citylabs, Nelson St, Manchester, M13 9NQ, England
| | - Aaron Poppleton
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England.,NIHR School for Primary Care Research, Citylabs, Nelson St, Manchester, M13 9NQ, England.,Health Innvoation Manchester, Citylabs, Nelson St, Manchester, M13 9NQ, England
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Dantas BADS, de Miranda JMA, Cavalcante ACV, Toscano GADS, Torres LSS, Rossignolo SCDO, Nobre TTX, Maia EMC, de Miranda FAN, Torres GDV. Impact of multidimensional interventions on quality of life and depression among older adults in a primary care setting in Brazil: a quasi-experimental study. ACTA ACUST UNITED AC 2019; 42:201-208. [PMID: 31826082 PMCID: PMC7115439 DOI: 10.1590/1516-4446-2019-0577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/26/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the impact of multidimensional interventions on quality of life (QoL) and depressive symptoms in Brazilian older adults living in the community. METHODS Longitudinal, quasi-experimental study of older adults receiving conventional primary health care (PHC). The interventions were designed in response to a first round of data collection and validated through pilot testing in groups of older adults from another community. The validated interventions were then applied to an intervention group (IG). To measure their effect, we used the Medical Outcomes Short-Form Health Survey (SF-36) quality of life scale and the Geriatric Depression Scale (GDS-30). RESULTS The sample comprised 118 participants. IG participants exhibited significant improvement in several QoL domains (SF-36): mental health (p = 0.010), general health perceptions (p = 0.016), and physical functioning (p = 0.045). No such improvement occurred in controls (p > 0.050). The prevalence of depression (GDS-30) fell from 36.7 to 23.3% in the IG, despite no significant difference (p = 0.272). Controls also reported a reduction in depressive symptoms, but only from 44.8 to 41.4% (p = 0.112). CONCLUSIONS This multidimensional intervention was associated with significant improvement in mental health, general health perceptions, and physical functioning in a sample of Brazilian older adults. CLINICAL TRIAL REGISTRATION RBR-92dbtx.
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Affiliation(s)
- Bruno A da S Dantas
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Jessica M A de Miranda
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Anna C V Cavalcante
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Gislani A da S Toscano
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | | | | | - Thaiza T X Nobre
- Faculdade de Ciências da Saúde do Trairi, UFRN, Santa Cruz, RN, Brazil
| | - Eulália M C Maia
- Departamento de Psicologia, Centro de Ciências da Saúde, UFRN, Natal, RN, Brazil
| | | | - Gilson de V Torres
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
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Latif A, Waring J, Pollock K, Solomon J, Gulzar N, Choudhary S, Anderson C. Towards equity: a qualitative exploration of the implementation and impact of a digital educational intervention for pharmacy professionals in England. Int J Equity Health 2019; 18:151. [PMID: 31604434 PMCID: PMC6790050 DOI: 10.1186/s12939-019-1069-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients belonging to marginalised (medically under-served) groups experience problems with medicines (i.e. non-adherence, side effects) and poorer health outcomes largely due to inequitable access to healthcare (arising from poor governance, cultural exclusion etc.). In order to promote service equity and outcomes for patients, the focus of this paper is to explore the implementation and impact of a new co-produced digital educational intervention on one National Health Service (NHS) funded community pharmacy medicines management service. METHODS Semi-structured interviews with a total of 32 participants. This included a purposive sample of 22 community pharmacy professionals, (16 pharmacists and 6 pharmacy support staff) all who offered the medicine management service. In order to obtain a fuller picture of the barriers to learning, five professionals who were unable to complete the learning were also included. Ten patients (from a marginalised group) who had received the service (as a result of the digital educational intervention) were also interviewed. Drawing on an interpretative analysis, Normalisation Process Theory (NPT) was used as a theoretical framework. RESULTS Three themes are explored. The first is how the digital learning intervention was implemented and applied. Despite being well received, pharmacists found it challenging completing and cascading the learning due to organisational constraints (e.g. lack of time, workload). Using the four NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) the second theme exposes the impact of the learning and the organisational process of 'normalisation'. Professional reflective accounts revealed instances where inequitable access to health services were evident. Those completing the intervention felt more aware, capable and better equipped to engage with the needs of patients who were from a marginalised group. Operationally there was minimal structural change in service delivery constraining translation of learning to practice. The impact on patients, explored in our final theme, revealed that they experience significant disadvantage and problems with their medicines. The medication review was welcomed and the discussion with the pharmacist was helpful in addressing their medicine-related concerns. CONCLUSIONS The co-produced digital educational intervention increases pharmacy professionals' awareness and motivation to engage with marginalised groups. However structural barriers often hindered translation into practice. Patients reported significant health and medicine challenges that were going unnoticed. They welcomed the additional support the medication review offered. Policy makers and employers should better enable and facilitate ways for pharmacy professionals to better engage with marginalised groups. The impact of the educational intervention on patients' health and medicines management could be substantial if supported and promoted effectively.
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Affiliation(s)
- Asam Latif
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Justin Waring
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kristian Pollock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Josie Solomon
- School of Pharmacy, University of Lincoln, Lincoln, UK
| | - Nargis Gulzar
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Hawthorn Building, Leicester, LE1 9BH UK
| | - Shahida Choudhary
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- Claire Anderson, Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
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Russell G, Kunin M, Harris M, Levesque JF, Descôteaux S, Scott C, Lewis V, Dionne É, Advocat J, Dahrouge S, Stocks N, Spooner C, Haggerty J. Improving access to primary healthcare for vulnerable populations in Australia and Canada: protocol for a mixed-method evaluation of six complex interventions. BMJ Open 2019; 9:e027869. [PMID: 31352414 PMCID: PMC6661687 DOI: 10.1136/bmjopen-2018-027869] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/03/2019] [Accepted: 06/12/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Access to primary healthcare (PHC) has a fundamental influence on health outcomes, particularly for members of vulnerable populations. Innovative Models Promoting Access-to-Care Transformation (IMPACT) is a 5-year research programme built on community-academic partnerships. IMPACT aims to design, implement and evaluate organisational innovations to improve access to appropriate PHC for vulnerable populations. Six Local Innovation Partnerships (LIPs) in three Australian states (New South Wales, Victoria and South Australia) and three Canadian provinces (Ontario, Quebec and Alberta) used a common approach to implement six different interventions. This paper describes the protocol to evaluate the processes, outcomes and scalability of these organisational innovations. METHODS AND ANALYSIS The evaluation will use a convergent mixed-methods design involving longitudinal (pre and post) analysis of the six interventions. Study participants include vulnerable populations, PHC practices, their clinicians and administrative staff, service providers in other health or social service organisations, intervention staff and members of the LIP teams. Data were collected prior to and 3-6 months after the interventions and included interviews with members of the LIPs, organisational process data, document analysis and tools collecting the cost of components of the intervention. Assessment of impacts on individuals and organisations will rely on surveys and semistructured interviews (and, in some settings, direct observation) of participating patients, providers and PHC practices. ETHICS AND DISSEMINATION The IMPACT research programme received initial ethics approval from St Mary's Hospital (Montreal) SMHC #13-30. The interventions received a range of other ethics approvals across the six jurisdictions. Dissemination of the findings should generate a deeper understanding of the ways in which system-level organisational innovations can improve access to PHC for vulnerable populations and new knowledge concerning improvements in PHC delivery in health service utilisation.
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Affiliation(s)
- Grant Russell
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Marina Kunin
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jean-Frédéric Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Bureau of Health Information, Sydney, New South Wales, Australia
| | - Sarah Descôteaux
- St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada
| | - Catherine Scott
- PolicyWise for Children & Families, Calgary, Alberta, Canada
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia
| | - Émilie Dionne
- St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada
| | - Jenny Advocat
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Nigel Stocks
- Department of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Guedes BDAP, Vale FLBD, Souza RWD, Costa MKA, Batista SR. The Organization of Secondary Outpatient Care at SHS-DF. CIENCIA & SAUDE COLETIVA 2019; 24:2125-2134. [PMID: 31269171 DOI: 10.1590/1413-81232018246.08632019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/27/2019] [Indexed: 11/22/2022] Open
Abstract
Secondary Outpatient Care (SOC) is a subject seldom studied in the literature, but of great importance for the strengthening of Primary Health Care (PHC) and the structuring of the Health Care Network. After the increase of PHC coverage following the Family Health Strategy (FHS) model, through the "CONVERTE APS" project, the State Health Secretariat of the Federal District (SHS-DF) identified the need to organize this level of care throughout the Federal District. SHS-DF has, as its Health Care Planning basis, the knowledge experienced in one of its regions, in addition to the theoretical framework produced and systematized by the National Council of Health Secretariats (CONASS) in recent years, as well as successful experiences in other regions of Brazil and countries with public health systems. The strategies to be used include the following: diagnosis and organization of facility structures, creation of a regional managerial level for Secondary Care, personnel sizing, development of the legal framework for level of care regulation, creation of technical milestones, regulation of medical and non-medical consultations in health regions and matrix support as an education strategy, but also of connection between levels of care.
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Affiliation(s)
- Bruno de Almeida Pessanha Guedes
- Diretoria de Atenção Secundária e Integração de Serviços, Subsecretaria de Atenção Integral à Saúde, Secretaria de Estado da Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
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Sheridan SL, Donahue KE, Brenner AT. Beginning with high value care in mind: A scoping review and toolkit to support the content, delivery, measurement, and sustainment of high value care. PATIENT EDUCATION AND COUNSELING 2019; 102:238-252. [PMID: 30553576 DOI: 10.1016/j.pec.2018.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/01/2018] [Accepted: 05/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To create a shared vision for the content, delivery, measurement, and sustainment of patient-centered high value care. METHODS We performed a scoping review and translated findings into toolkit for system leaders. For our scoping review, we searched Medline, 2005-November 2015, for literature on patient-centered care (PCC) and its relationship to a high value care change model. We supplemented searches with key author, Google Scholar, and key website searches. One author reviewed all titles, abstracts, and articles for inclusion; another reviewed a random 20%. To develop our toolkit, we translated evidence into simple, actionable briefs on key topics and added resources. We then iteratively circulated briefs and the overall toolkit to potential users, making updates as needed. RESULTS In our scoping review, we found multiple interventions and measures to support the components of PCC and our change model. We found little on the overall effects of PCC or how PCC creates value. Potential users reported our toolkit was simple, understandable, thorough, timely, and likely to be globally useful. CONCLUSIONS Considerable evidence supports patient-centered high value care and a toolkit garnered enthusiasm. PRACTICE IMPLICATIONS The toolkit is ready for use, but needs comparison to other approaches.
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Affiliation(s)
| | - Katrina E Donahue
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family and Community Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison T Brenner
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ambagtsheer RC, Beilby JJ, Visvanathan R, Dent E, Yu S, Braunack-Mayer AJ. Should we screen for frailty in primary care settings? A fresh perspective on the frailty evidence base: A narrative review. Prev Med 2019; 119:63-69. [PMID: 30594533 DOI: 10.1016/j.ypmed.2018.12.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 11/27/2022]
Abstract
With older adults living longer, health service providers have increasingly turned their attention towards frailty and its significant consequences for health and well-being. Consequently, frailty screening has gained momentum as a possible health policy answer to the question of what can be done to prevent frailty's onset and progression. However, who should be screened for frailty, where and when remains a subject of extensive debate. The purpose of this narrative review is to explore the dimensions of this question with reference to Wilson and Jungner's time-tested and widely accepted principles for acceptable screening within community settings. Although the balance of the emerging evidence to support frailty screening is promising, significant gaps in the evidence base remain. Consequently, when assessed against Wilson and Jungner's principles, extensive population screening does not appear to be supported by the evidence. However, screening for the purpose of case-finding may prove useful among older adults.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Trans-disciplinary Research To Achieve Healthy Ageing, Adelaide, South Australia, Australia; Torrens University Australia, Adelaide, South Australia, Australia.
| | - Justin J Beilby
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Trans-disciplinary Research To Achieve Healthy Ageing, Adelaide, South Australia, Australia; Torrens University Australia, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Trans-disciplinary Research To Achieve Healthy Ageing, Adelaide, South Australia, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Solomon Yu
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Trans-disciplinary Research To Achieve Healthy Ageing, Adelaide, South Australia, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Annette J Braunack-Mayer
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; School of Health and Society, Faculty of Social Sciences, University of Wollongong, New South Wales, Australia
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Giguere AMC, Farmanova E, Holroyd-Leduc JM, Straus SE, Urquhart R, Carnovale V, Breton E, Guo S, Maharaj N, Durand PJ, Légaré F, Turgeon AF, Aubin M. Key stakeholders' views on the quality of care and services available to frail seniors in Canada. BMC Geriatr 2018; 18:290. [PMID: 30477438 PMCID: PMC6260583 DOI: 10.1186/s12877-018-0969-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 10/30/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Frail seniors often receive ineffective care, which does not meet their needs. It is still unclear how healthcare systems should be redesigned to be more sensitive to the needs and values of frail seniors and their caregivers. We thus aimed to describe key stakeholders' perspectives on the current healthcare and services available to frail seniors. METHODS In this qualitative descriptive study, we conducted semi-structured interviews with a convenience sample of 42 frail seniors, caregivers, clinicians, or healthcare administrators/decision makers involved in frail senior care from five Canadian provinces. We explored participants' perspectives on the quality of care and services for frail seniors. We used an inductive/deductive thematic data analysis approach based on the Square-of-Care model, including emerging themes using the constant comparison method. RESULTS We grouped participants' perspectives into strengths, weaknesses and opportunities for improvement, and then into nine themes: care processes, continuity of care, social frailty, access to healthcare and services, models of healthcare delivery, cost of care, healthcare staff management and professional development of healthcare providers, material resources and environmental design of healthcare facilities, and coordination of care. Our findings suggest redesigning assessment, communication with frail seniors and their caregivers, targeting care and services to the needs, and integrating care better across settings and in time. CONCLUSIONS A systematic identification of frail older people is the first step to adapt healthcare systems to this population's needs. Participation of frail older people and their caregivers to decision making would also allow choosing care plans meeting their care goals. The integration of care and services across settings, over time, and with various providers, is also needed to meet frail senior needs.
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Affiliation(s)
- Anik M. C. Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- Quebec Centre for Excellence in Aging, St. Sacrement Hospital, Quebec, QC Canada
- Laval University Research Centre on Primary healthcare and services, Quebec, QC Canada
- Laval University Research Centre of the CHU de Quebec, Population Health and Optimal Health Practices Unit, Quebec, QC Canada
| | - Elina Farmanova
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- Quebec Centre for Excellence in Aging, St. Sacrement Hospital, Quebec, QC Canada
- Laval University Research Centre on Primary healthcare and services, Quebec, QC Canada
| | - Jayna M. Holroyd-Leduc
- Section of Geriatric Medicine, Departments of Medicine and CHS, University of Calgary, Calgary, AB Canada
| | - Sharon E. Straus
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - Valerie Carnovale
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Erik Breton
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Selynne Guo
- Section of Geriatric Medicine, Departments of Medicine and CHS, University of Calgary, Calgary, AB Canada
| | - Nandini Maharaj
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - Pierre J. Durand
- Quebec Centre for Excellence in Aging, St. Sacrement Hospital, Quebec, QC Canada
- Laval University Research Centre on Primary healthcare and services, Quebec, QC Canada
- Department of Social and Preventive Medicine, Laval University, Quebec, QC Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- Laval University Research Centre on Primary healthcare and services, Quebec, QC Canada
- Laval University Research Centre of the CHU de Quebec, Population Health and Optimal Health Practices Unit, Quebec, QC Canada
| | - Alexis F. Turgeon
- Laval University Research Centre of the CHU de Quebec, Population Health and Optimal Health Practices Unit, Quebec, QC Canada
- Department of Social and Preventive Medicine, Laval University, Quebec, QC Canada
- Department of Anesthesiology and Intensive Care, Division of Critical Care Medicine Laval University, Quebec, QC Canada
| | - Michèle Aubin
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- Quebec Centre for Excellence in Aging, St. Sacrement Hospital, Quebec, QC Canada
- Laval University Research Centre on Primary healthcare and services, Quebec, QC Canada
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Javanparast S, Windle A, Freeman T, Baum F. Community Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries? Int J Health Policy Manag 2018; 7:943-954. [PMID: 30316247 PMCID: PMC6186464 DOI: 10.15171/ijhpm.2018.53] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 06/02/2018] [Indexed: 11/28/2022] Open
Abstract
Background: Community Health Workers (CHWs) are proven to be highly effective in low- and middle-income countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing disadvantage. This study is the first that examines the scope and potential value of CHW programs in Australia and the challenges involved in integrating CHWs into the health system. The potential for CHWs to improve health equity is explored.
Methods: Academic and grey literature was searched to examine existing CHW roles in the Australian primary healthcare system. Semi-structured telephone interviews were conducted with a purposive sample of 11 people including policymakers, program managers and practitioners, to develop an understanding of policy and practice.
Results: Literature on CHWs in Australia is sparse, yet combined with interview data indicates CHWs conduct a broad range of roles, including education, advocacy and basic clinical services, and work with a variety of communities experiencing disadvantage. Many, and to some extent inconsistent, terms are used for CHWs, reflecting the various strategies employed by CHWs, the characteristics of the communities they serve, and the health issues they address. The role of aboriginal health workers (AHWs) is comparatively well recognised, understood and documented in Australia with evidence on their contribution to overcoming cultural barriers and improving access to health services. Ethnic health workers assist with language barriers and increase the cultural appropriateness of services. CHWs are widely seen to be well accepted and valuable, facilitating access to health services as a trusted ‘bridge’ to communities. They work best where ‘health’ is conceived to include action on social determinants and service models are less hierarchical. Short term funding models and the lack of professional qualifications and recognition are challenges CHWs encounter.
Conclusion: CHWs serve a range of functions in various contexts in Australian primary healthcare (PHC) with a common, valued purpose of facilitating access to services and information for marginalised communities. CHWs offer a promising opportunity to enhance equity of access to PHC for communities facing disadvantage, especially in the face of rising chronic disease.
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Affiliation(s)
- Sara Javanparast
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Alice Windle
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Toby Freeman
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Fran Baum
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
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Ward B, Lane R, McDonald J, Powell-Davies G, Fuller J, Dennis S, Kearns R, Russell G. Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care. Int J Equity Health 2018; 17:78. [PMID: 29903017 PMCID: PMC6003144 DOI: 10.1186/s12939-018-0788-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/29/2018] [Indexed: 01/01/2023] Open
Abstract
Background Equitable access to primary health care (PHC) is an important component of integrated chronic disease management. Whilst context is known to influence access to PHC, it is poorly researched. The aim of this study was to determine the contextual influences associated with access arrangements in four Australian models of integrated PHC. Methods A multi-method comparative case study design. Purposive sampling identified four models of PHC across six sites in two Australian states. Complexity theory informed the choice of contextual factors that influenced access arrangements, which were analysed across five dimensions: availability and accommodation, affordability, acceptability, appropriateness and approachability. Semi-structured interviews, document/website analysis and non-participant observation were used to collect data from clinicians, administrative staff and other key stakeholders. Within and cross-case thematic analysis identified interactions between context and access across sites. Results Overall, financial viability, objectives of the PHC model and relationships with the local hospital network (LHN) underpinned access arrangements. Local supply of general practitioners and financial viability were strong influences on availability of after-hours services. Influences on affordability were difficult to determine because all models had nil/low out-of-pocket costs for general practitioner services. The biggest influence on acceptability was the goal/objectives of the PHC model. Appropriateness and to a lesser degree affordability arrangements were influenced by the relationship with the LHN. The provision of regular outreach services was strongly influenced by perceived population need, referral networks and model objectives. Conclusions These findings provide valuable insights for policy makers charged with improving access arrangements in PHC services. A financially sustainable service underpins attempts to improve access that meets the needs of the service population. Smaller services may lack infrastructure and capacity, suggesting there may be a minimum size for enhancing access. Access arrangements may be facilitated by aligning the objectives between PHC, LHN and other stakeholder models. While some access arrangements are relatively easy to modify, improving resource intensive (e.g. acceptability) access arrangements for vulnerable and/or chronic disease populations will require federal and state policy levers with input from primary health networks and LHNs.
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Affiliation(s)
- Bernadette Ward
- School of Rural Health, Monash University, PO Box 666, Bendigo, VIC, Australia.
| | - Riki Lane
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Clayton, Australia
| | - Julie McDonald
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Gawaine Powell-Davies
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Jeff Fuller
- College of Nursing & Health Sciences, Flinders University, South, Bedford Park, South Australia
| | - Sarah Dennis
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.,South Western Sydney Local Health District, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Rachael Kearns
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Grant Russell
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Clayton, Australia
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Fowler Davis S, Piercy H, Pearson S, Thomas B, Kelly S. Factors affecting decisions to extend access to primary care: results of a qualitative evaluation of general practitioners' views. BMJ Open 2018; 8:e019084. [PMID: 29502089 PMCID: PMC5855197 DOI: 10.1136/bmjopen-2017-019084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To report general practitioners' (GPs') views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the Prime Minister's Challenge Fund (second wave) for England which aimed to extend patient access to primary care. SETTING Primary care in Sheffield, England. PARTICIPANTS Semi-structured interviews with a purposive sample of GPs working in 24 practices across the city. RESULTS Four core themes were derived: GPs' receptivity to the aims of the EPCP, their capacity to support integrated care teams, their capacity to manage urgent care and the value of some new community-based schemes to enhance locality-based primary care. GPs were aware of the policy initiatives associated with out-of-hours access that aimed to reduce emergency department and hospital admissions. Due to limited capacity to respond to the programme, they selected elements that directly related to local patient demand and did not increase their own workload. CONCLUSIONS The variation in practice engagement and capacity to manage changes in primary care services warrants a subtle and specialist approach to programme planning. The study makes the case for enhanced planning and organisational development with GPs as stakeholders within individual practices and groups. This would ensure that policy implementation is effective and sustained at local level. A failure to localise implementation may be associated with increased workloading in primary care without the sustained benefits to patients and the public. To enable GPs to become involved in systems transformation, further research is needed to identify the best methods to engage GPs in programme planning and evaluation.
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Affiliation(s)
- Sally Fowler Davis
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Hilary Piercy
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Sarah Pearson
- Centre for Regional, Economic and Social Research, Sheffield Hallam University, Sheffield, UK
| | - Ben Thomas
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Shona Kelly
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Lazar M, Davenport L. Barriers to Health Care Access for Low Income Families: A Review of Literature. J Community Health Nurs 2018; 35:28-37. [DOI: 10.1080/07370016.2018.1404832] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Malerie Lazar
- College of Nursing, The University of Tennessee, Knoxville, Tennessee
| | - Lisa Davenport
- College of Nursing, The University of Tennessee, Knoxville, Tennessee
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Roche M, Duffield C, Smith J, Kelly D, Cook R, Bichel-Findlay J, Saunders C, Carter D. Nurse-led primary health care for homeless men: a multimethods descriptive study. Int Nurs Rev 2017; 65:392-399. [DOI: 10.1111/inr.12419] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M.A. Roche
- Mental Health Drug and Alcohol Nursing; Northern Sydney Local Health District & Australian Catholic University; Sydney NSW Australia
- Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - C. Duffield
- Nursing & Health Services Management; University of Technology Sydney; Sydney NSW Australia
- Nursing & Health Services Management; Edith Cowan University; Western Australia
| | - J. Smith
- Primary Health Clinic; Matthew Talbot Hostel; St Vincent de Paul Society New South Wales; Woolloomooloo NSW Australia
| | - D. Kelly
- Support Services; St Vincent de Paul Society New South Wales; Australia
| | - R. Cook
- Centre for Health Services Management; University of Technology Sydney; Sydney NSW Australia
| | - J. Bichel-Findlay
- Digital Health and Innovation; Centre for Health Services Management; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - C. Saunders
- Centre for Health Services Management; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - D.J. Carter
- Faculty of Law; University of Technology Sydney; Sydney NSW Australia
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