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Grierson L, Mercuri M, Elma A, Mahmud M, Bakker D, Johnston N, Aggarwal M, Agarwal G. Associations between education policies and the geographic disposition of family physicians: a retrospective observational study of McMaster University education data. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:641-657. [PMID: 37581856 DOI: 10.1007/s10459-023-10273-4] [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: 02/02/2023] [Accepted: 08/06/2023] [Indexed: 08/16/2023]
Abstract
The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities.
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Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada.
- McMaster Education Research, Innovation and Theory, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada.
| | - Mathew Mercuri
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Asiana Elma
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
| | - Meera Mahmud
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
| | - Dorothy Bakker
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada
| | - Neil Johnston
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gina Agarwal
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
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De Simone P, Germani G, Lai Q, Ducci J, Russo FP, Gitto S, Burra P. The impact of socioeconomic deprivation on liver transplantation. FRONTIERS IN TRANSPLANTATION 2024; 3:1352220. [PMID: 38993752 PMCID: PMC11235234 DOI: 10.3389/frtra.2024.1352220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/13/2024] [Indexed: 07/13/2024]
Abstract
Despite global expansion, social disparities impact all phases of liver transplantation, from patient referral to post-transplant care. In pediatric populations, socioeconomic deprivation is associated with delayed referral, higher waitlist mortality, and reduced access to living donor transplantation. Children from socially deprived communities are twice as much less adherent to immunosuppression and have up to a 32% increased incidence of graft failure. Similarly, adult patients from deprived areas and racial minorities have a higher risk of not initiating the transplant evaluation, lower rates of waitlisting, and a 6% higher risk of not being transplanted. Social deprivation is racially segregated, and Black recipients have an increased risk of post-transplant mortality by up to 21%. The mechanisms linking social deprivation to inferior outcomes are not entirely elucidated, and powered studies are still lacking. We offer a review of the most recent evidence linking social deprivation and post-liver transplant outcomes in pediatric and adult populations, as well as a literature-derived theoretical background model for future research on this topic.
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Affiliation(s)
- Paolo De Simone
- Liver Transplant Program, University of Pisa Medical School Hospital, Pisa, Italy
- Department of Surgical, Medical, Molecular Pathology and Intensive Care, University of Pisa, Pisa, Italy
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, La Sapienza University of Rome, Rome, Italy
| | - Juri Ducci
- Liver Transplant Program, University of Pisa Medical School Hospital, Pisa, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Gastroenterology, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Stefano Gitto
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, Florence, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
- Department of Surgery, Gastroenterology, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Flinterman LE, González-González AI, Seils L, Bes J, Ballester M, Bañeres J, Dan S, Domagala A, Dubas-Jakóbczyk K, Likic R, Kroezen M, Batenburg R. Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries. Int J Health Policy Manag 2023; 12:7454. [PMID: 38618823 PMCID: PMC10590222 DOI: 10.34172/ijhpm.2023.7454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies). METHODS We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes. RESULTS Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%). CONCLUSION Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.
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Affiliation(s)
- Linda E. Flinterman
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Laura Seils
- Avedis Donabedian Research Institute – UAB, Madrid, Spain
| | - Julia Bes
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | | | - Sorin Dan
- Innovation and Entrepreneurship InnoLab, University of Vaasa, Vaasa, Finland
| | - Alicja Domagala
- Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Robert Likic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marieke Kroezen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ronald Batenburg
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
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Shacham E, Scroggins SE, Ellis M. Implementing Geospatial Science and Technology to Get to Zero New HIV Infections. Curr HIV/AIDS Rep 2023; 20:139-147. [PMID: 37145264 DOI: 10.1007/s11904-023-00658-w] [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: 05/06/2023]
Abstract
PURPOSE OF REVIEW Tremendous advancements have been made in HIV treatment and prevention during the last 40 years that zero new HIV cases has become an attainable goal declared by international agencies. However, new cases of HIV infection persist. RECENT FINDINGS The emerging field of geospatial science is positioned to play key role in the reduction of continued HIV incidence through technology-driven interventions and innovative research that gives insights into at-risk populations. As these methods become more utilized, findings consistently show the important role of location and environment plays in HIV incidence and treatment adherence. This includes distance to HIV provider, locations of where HIV transmissions occurs compared to where people with HIV reside, and how geospatial technology has been leveraged to identify unique insights among varying groups of those at increased risk for HIV, among others. Given these insights, leveraging geospatial technology would play a prominent role in achieving zero new cases of HIV infections.
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Affiliation(s)
- Enbal Shacham
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA.
- Taylor Geospatial Institute, St. Louis, MO, USA.
| | | | - Matthew Ellis
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO, USA
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Belanger C, Carr K, Peixoto C, Bjerre LM. Distance, access and equity: a cross-sectional geospatial analysis of disparities in access to primary care for French-only speakers in Ottawa, Ontario. CMAJ Open 2023; 11:E434-E442. [PMID: 37192769 DOI: 10.9778/cmajo.20220061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Although language concordance between patients and primary care physicians results in better quality of care and health outcomes, little research has explored inequities in travel burden to access primary care people of linguistic minority groups in Canada. We sought to investigate the travel burden of language-concordant primary care among people who speak French but not English (French-only speakers) and the general public in Ottawa, Ontario, and any inequities in access across language groups and neighbourhood ruralities. METHODS Using a novel computational method, we estimated travel burden to language-concordant primary care for the general population and French-only speakers in Ottawa. We used language and population data from Statistics Canada's 2016 Census, neighbourhood demographics from the Ottawa Neighbourhood Study, and collected the main practice location and language of primary care physicians from the College of Physicians and Surgeons of Ontario. We measured travel burden using Valhalla, an open-source road-network analysis platform. RESULTS We included data from 869 primary care physicians and 916 855 patients. Overall, French-only speakers faced greater travel burdens than the general population to access language-concordant primary care. Median differences in travel burden were statistically significant but small (median difference in drive time 0.61 min, p < 0.001, interquartile range 0.26-1.17 min), but inequities in travel burden between groups were larger among people living in rural neighbourhoods. INTERPRETATION French-only speakers in Ottawa face modest - but statistically significant - overall inequities in travel burden when accessing primary care, compared with the general population, and higher inequities in specific neighbourhoods. Our results are of interest to policy-makers and health system planners, and our methods can be replicated and used as comparative benchmarks to quantify access disparities for other services and regions across Canada.
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Affiliation(s)
- Christopher Belanger
- Institut du Savoir Montfort (Belanger, Peixoto, Bjerre); Ottawa Neighbourhood Study (Belanger, Carr), and Department of Family Medicine (Bjerre), University of Ottawa, Ottawa, Ont
| | - Kady Carr
- Institut du Savoir Montfort (Belanger, Peixoto, Bjerre); Ottawa Neighbourhood Study (Belanger, Carr), and Department of Family Medicine (Bjerre), University of Ottawa, Ottawa, Ont
| | - Cayden Peixoto
- Institut du Savoir Montfort (Belanger, Peixoto, Bjerre); Ottawa Neighbourhood Study (Belanger, Carr), and Department of Family Medicine (Bjerre), University of Ottawa, Ottawa, Ont
| | - Lise M Bjerre
- Institut du Savoir Montfort (Belanger, Peixoto, Bjerre); Ottawa Neighbourhood Study (Belanger, Carr), and Department of Family Medicine (Bjerre), University of Ottawa, Ottawa, Ont.
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Sullivan E, Zahnd WE, Zhu JM, Kenzie E, Patzel M, Davis M. Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act. J Gen Intern Med 2022; 37:2941-2947. [PMID: 34981345 PMCID: PMC9485404 DOI: 10.1007/s11606-021-07229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans. OBJECTIVE Assess the extent to which the 2018 MISSION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon. DESIGN We identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas. PARTICIPANTS American Community Survey data representing Oregon adults. MAIN MEASURES Two measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand). KEY RESULTS Compared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30 min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas. CONCLUSIONS Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.
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Affiliation(s)
- Eliana Sullivan
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA.
| | - Whitney E Zahnd
- Arnold School of Public Health, Rural & Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Jane M Zhu
- Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Erin Kenzie
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Mary Patzel
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Melinda Davis
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Wilk P, Maltby A, Lau T, Gunz AC, Osornio-Vargas A, Yamamoto SS, Ali S, Lavigne É. Geographic inequalities in paediatric emergency department visits in Ontario and Alberta: a multilevel analysis of 2.5 million visits. BMC Pediatr 2022; 22:432. [PMID: 35858855 PMCID: PMC9297543 DOI: 10.1186/s12887-022-03485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Research on intra- and inter-regional variations in emergency department (ED) visits among children can provide a better understanding of the patterns of ED utilization and further insight into how contextual features of the urban environment may be associated with these health events. Our objectives were to assess intra-urban and inter-urban variation in paediatric emergency department (PED) visits in census metropolitan areas (CMAs) in Ontario and Alberta, Canada and explore if contextual factors related to material and social deprivation, proximity to healthcare facilities, and supply of family physicians explain this variation. Methods A retrospective, population-based analysis of data on PED visits recorded between April 1, 2015 and March 31, 2017 was conducted. Random intercept multilevel regression models were constructed to quantify the intra- (between forward sortation areas [FSAs]) and inter- (between CMAs) variations in the rates of PED visits. Results In total, 2,537,442 PED visits were included in the study. The overall crude FSA-level rate of PED visits was 415.4 per 1,000 children population. Across CMAs, the crude rate of PED visits was highest in Thunder Bay, Ontario (771.6) and lowest in Windsor, Ontario (237.2). There was evidence of substantial intra- and inter-urban variation in the rates of PED visits. More socially deprived FSAs, FSAs with decreased proximity to healthcare facilities, and CMAs with a higher rate of family physicians per 1,000 children population had higher rates of PED visits. Conclusions The variation in rates of PED visits across CMAs and FSAs cannot be fully accounted for by age and sex distributions, material and social deprivation, proximity to healthcare facilities, or supply of family physicians. There is a need to explore additional contextual factors to better understand why some metropolitan areas have higher rates of PED visits.
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Affiliation(s)
- Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. .,Department of Paediatrics, Western University, London, ON, Canada. .,Child Health Research Institute, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 3rd Floor, Western Centre for Public Health and Family Medicine, 1465 Richmond St, ON, N6G 2M1, London, Canada.
| | - Alana Maltby
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Tammy Lau
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Anna C Gunz
- Department of Paediatrics, Western University, London, ON, Canada.,Child Health Research Institute, London, ON, Canada.,Division of Paediatric Critical Care, Children's Hospital, London Health Sciences Center, London, ON, Canada
| | | | - Shelby S Yamamoto
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Éric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Cooper IR, Lindsay C, Fraser K, Hill TT, Siu A, Fletcher S, Klimas J, Hamilton MA, Frazer AD, Humphrys E, Koepke K, Hedden L, Price M, McCracken RK. Finding Primary Care—Repurposing Physician Registration Data to Generate a Regionally Accurate List of Primary Care Clinics: Development and Validation of an Open-Source Algorithm. JMIR Form Res 2022; 6:e34141. [PMID: 35731556 PMCID: PMC9496812 DOI: 10.2196/34141] [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: 10/21/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Some Canadians have limited access to longitudinal primary care, despite its known advantages for population health. Current initiatives to transform primary care aim to increase access to team-based primary care clinics. However, many regions lack a reliable method to enumerate clinics, limiting estimates of clinical capacity and ongoing access gaps. A region-based complete clinic list is needed to effectively describe clinic characteristics and to compare primary care outcomes at the clinic level. Objective The objective of this study is to show how publicly available data sources, including the provincial physician license registry, can be used to generate a verifiable, region-wide list of primary care clinics in British Columbia, Canada, using a process named the Clinic List Algorithm (CLA). Methods The CLA has 10 steps: (1) collect data sets, (2) develop clinic inclusion and exclusion criteria, (3) process data sets, (4) consolidate data sets, (5) transform from list of physicians to initial list of clinics, (6) add additional metadata, (7) create working lists, (8) verify working lists, (9) consolidate working lists, and (10) adjust processing steps based on learnings. Results The College of Physicians and Surgeons of British Columbia Registry contained 13,726 physicians, at 2915 unique addresses, 6942 (50.58%) of whom were family physicians (FPs) licensed to practice in British Columbia. The CLA identified 1239 addresses where primary care was delivered by 4262 (61.39%) FPs. Of the included addresses, 84.50% (n=1047) were in urban locations, and there was a median of 2 (IQR 2-4, range 1-23) FPs at each unique address. Conclusions The CLA provides a region-wide description of primary care clinics that improves on simple counts of primary care providers or self-report lists. It identifies the number and location of primary care clinics and excludes primary care providers who are likely not providing community-based primary care. Such information may be useful for estimates of capacity of primary care, as well as for policy planning and research in regions engaged in primary care evaluation or transformation.
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Affiliation(s)
- Ian R Cooper
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Cameron Lindsay
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Keaton Fraser
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Tiffany T Hill
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Siu
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Fletcher
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Jan Klimas
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Michee-Ana Hamilton
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Amanda D Frazer
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Elka Humphrys
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kira Koepke
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Academic Health Sciences Network, Vancouver, BC, Canada
| | - Morgan Price
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Rita K McCracken
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
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Christopher C, KC B, Shrestha S, Blebil AQ, Alex D, Mohamed Ibrahim MI, Ismail N. Medication use problems among older adults at a primary care: A narrative of literature review. Aging Med (Milton) 2022; 5:126-137. [PMID: 35783113 PMCID: PMC9245166 DOI: 10.1002/agm2.12203] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/09/2022] Open
Abstract
Appropriate medication use is one of the most significant challenges among the older population. Although medication use problems are well documented at the secondary and tertiary health care level, the evidence at the primary care level of OECD region is limited. A narrative review of existing literature was conducted through a nonsystematic search for original articles through electronic search databases, Ovid Medline, Google Scholar from 2001 to 2021, and a combination of citation references. Medication use problems are prevalent in older adults at the primary care level. The main issues of medication use identified were as follows; nonadherence, adverse drug events, accessibility, polypharmacy, inappropriate medications, belief about medications, lack of knowledge and awareness, and lack of deprescribing. In addition, the current review has identified the possibilities of the problems: many medications, forgetfulness, lack of deprescribing, lack of communication, poor understanding, and limited awareness of inappropriate medications. This review found that various medication use problems subclusters were identified to impact the health care need among older adults. Therefore, effective interventions targeting these issues need to be developed to reduce medication use problems among older adults at a primary care level.
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Affiliation(s)
| | - Bhuvan KC
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Sunil Shrestha
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Ali Qais Blebil
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Deepa Alex
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSubang JayaMalaysia
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Konstantelos N, Shakeri A, McCormack D, Campos-Meade A, Gomes T, Murti M, Pierre-Pierre V, Tadrous M. Regional differences in access to direct-acting antiviral treatments for hepatitis C across Ontario: A cross-sectional study. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:179-180. [PMID: 35480701 PMCID: PMC9018058 DOI: 10.14745/ccdr.v48i04a08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Direct-acting antivirals (DAAs) are curative treatments for hepatitis C virus (HCV) infection, a condition affecting over 100,000 Ontarians. Although DAAs are covered under the public drug programs in Ontario, receiving prescriptions depends on access to healthcare. The aim of this study is to understand the relationship between DAA treatment rates and distance to prescriber in Ontario, Canada. Methods We conducted a cross-sectional study and identified patients who filled a DAA prescription through the Ontario Drug Benefit (ODB) in 2019. We calculated crude (per 100,000 ODB recipients) and adjusted (by a regional HCV infection rate) DAA treatment rates by public health unit (PHU). We reported median distances to provider for all visit types, in-person visits, virtual visits, and proportions of visits that were virtual. Results In 2019, the crude DAA treatment rate for Ontario is 83.0 patients per 100,000 ODB recipients. The HCV-adjusted DAA treatment rate ranges from 28.2 (Northwestern Ontario) to 188.5 (Eastern Ontario) per 100,000. In our primary analysis, patients in rural PHUs, including Northwestern and Porcupine, were among the highest median distances to prescriber for all visit types (1,195 km and 556 km, respectively). These PHUs also had the highest proportions of virtual visits (greater than 60%). Urban PHUs, such as Toronto and Ottawa, had smaller median distances for all visit types, with smaller proportions of virtual visits (10.8% and 12.4%, respectively). Conclusion We observed heterogeneity in treatment rates, distance to DAA prescribers and use of virtual care in the management of HCV. Increasing use of telemedicine in regions with limited utilization of DAAs may improve access.
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Affiliation(s)
- Natalia Konstantelos
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
- Women’s College Research Institute, Toronto, ON
| | - Ahmad Shakeri
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
- Women’s College Research Institute, Toronto, ON
| | | | | | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
- ICES, Toronto, ON
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON
| | - Michelle Murti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
- Women’s College Research Institute, Toronto, ON
- ICES, Toronto, ON
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11
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Medeiros P. Mapping HIV-related services for women in Eastern Canada: A qualitative study. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221092264. [PMID: 35435076 PMCID: PMC9019332 DOI: 10.1177/17455057221092264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Geographic health disparities have been well described in parts of Canada; however, little is known about the experiences of women living with HIV in the Maritime Provinces. This article focuses on the complex health system women living with HIV navigate geographically to access care in New Brunswick and Nova Scotia, Canada. METHOD This study includes interviews with 10 women living with HIV and 39 community-based workers whose organizations provide services to this group of women in New Brunswick and Nova Scotia. Purposive sampling was used to recruit both women living with HIV and community workers. Interviews were recorded and transcribed into a Microsoft word document. Transcripts were imported into NVivo 11 for thematic analyses and used to map the services women with HIV were accessing in their communities in ArcGIS 10.2 for Windows. RESULTS The study found that there are a number of barriers women with HIV face in the Maritime Provinces, including the low number of specialist physicians, long travel distances to major urban centers for care, and the loss of HIV-specific supports and resources. In response to these difficulties, community-based organizations are leading efforts in their communities to increase outreach programs and the number of available peer workers to improve the health outcomes of women living with HIV. Furthermore, it showed that women living with HIV and community workers were interested in creating a women-centered HIV care system in the Maritime Provinces, but were uncertain how to move forward with this initiative. CONCLUSION There is a need for women-centered HIV services. This study proposes streamlining the healthcare pathway and decreasing obstacles to increase women's access to care in the Maritime Provinces.
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Affiliation(s)
- Priscilla Medeiros
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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12
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Haithcoat T, Liu D, Young T, Shyu CR. Investigating Health Context: Using Geospatial Big Data Ecosystem (Preprint). JMIR Med Inform 2021; 10:e35073. [PMID: 35311683 PMCID: PMC9021952 DOI: 10.2196/35073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/27/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Timothy Haithcoat
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
| | - Danlu Liu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
| | - Tiffany Young
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
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13
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Smith S, Walsh B, Wren MA, Barron S, Morgenroth E, Eighan J, Lyons S. Geographic inequalities in non-acute healthcare supply: evidence from Ireland. HRB Open Res 2021; 4:111. [PMID: 35356101 PMCID: PMC8927742 DOI: 10.12688/hrbopenres.13412.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Recent reforms in Ireland, as outlined in Sláintecare, the report of the cross-party parliamentary committee on health, are focused on shifting from a hospital-centric system to one where non-acute care plays a more central role. However, these reforms were embarked on in the absence of timely and accurate information about the capacity of non-acute care to take on a more central role in the system. To help address this gap, this paper outlines the most comprehensive analysis to date of geographic inequalities in non-acute care supply in Ireland. Methods: Data on the supply of 10 non-acute services including primary care, allied health, and care for older people, were collated. Per capita supply for each service is described for 28 counties in Ireland (Tipperary and Dublin divided into North and South), using 2014 supply and population data. To examine inequity in the geographic distribution of services, raw population in each county was adjusted for a range of needs indicators. Results: The findings show considerable geographic inequalities across counties in the supply of non-acute care. Some counties had low levels of supply of several types of non-acute care. The findings remain largely unchanged after adjusting for need, suggesting that the unequal patterns of supply are also inequitable. Conclusions: In the context of population changes and the influence of non-need factors, the persistence of historical budgeting in Ireland has led to considerable geographic inequities in non-acute supply, with important lessons for Ireland and for other countries. Such inequities come into sharp relief in the context of COVID-19, where non-acute supply plays a crucial role in ensuring that acute services are preserved for treating acutely ill patients.
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Affiliation(s)
- Samantha Smith
- Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland
| | - Brendan Walsh
- Economic and Social Research Institute, Sir John Rogerson's Quary, Whitaker Square, Dublin 2, Ireland
- Department of Economics, Trinity College Dublin, Dublin 2, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Sir John Rogerson's Quary, Whitaker Square, Dublin 2, Ireland
- Department of Economics, Trinity College Dublin, Dublin 2, Ireland
| | | | | | | | - Seán Lyons
- Economic and Social Research Institute, Sir John Rogerson's Quary, Whitaker Square, Dublin 2, Ireland
- Department of Economics, Trinity College Dublin, Dublin 2, Ireland
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14
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Kim K, Ghorbanzadeh M, Horner MW, Ozguven EE. Identifying areas of potential critical healthcare shortages: A case study of spatial accessibility to ICU beds during the COVID-19 pandemic in Florida. TRANSPORT POLICY 2021; 110:478-486. [PMID: 34257481 PMCID: PMC8263167 DOI: 10.1016/j.tranpol.2021.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/05/2021] [Indexed: 05/24/2023]
Abstract
Healthcare resource availability is potentially associated with COVID-19 mortality, and the potentially uneven geographical distribution of resources is a looming concern in the global pandemic. Given that access to healthcare resources is important to overall population health, assessing COVID-19 patients' access to healthcare resources is needed. This paper aims to examine the temporal variations in the spatial accessibility of the U.S. COVID-19 patients to medical facilities, identify areas that are likely to be overwhelmed by the COVID-19 pandemic, and explore associations of low access areas with their socioeconomic and demographic characteristics. We use a three-step floating catchment area method, spatial statistics, and logistic regression to achieve the goals. Findings of this research in the State of Florida revealed that North Florida, rural areas, and zip codes with more Latino or Hispanic populations are more likely to have lower access than other regions during the COVID-19 pandemic. Our approach can help policymakers identify potentially possible low access areas and establish appropriate policy intervention paying attention to those areas during a pandemic.
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Affiliation(s)
- Kyusik Kim
- Department of Geography, Florida State University, 600 W College Avenue, Tallahassee, FL, 32306, USA
| | - Mahyar Ghorbanzadeh
- Department of Civil and Environmental Engineering, Florida A&M University-Florida State University College of Engineering, Florida State University, 2525 Pottsdamer Street, Tallahassee, FL, 32310, USA
| | - Mark W Horner
- Department of Geography, Florida State University, 600 W College Avenue, Tallahassee, FL, 32306, USA
| | - Eren Erman Ozguven
- Department of Civil and Environmental Engineering, Florida A&M University-Florida State University College of Engineering, Florida State University, 2525 Pottsdamer Street, Tallahassee, FL, 32310, USA
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15
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The Flows of Nature to People, and of People to Nature: Applying Movement Concepts to Ecosystem Services. LAND 2021. [DOI: 10.3390/land10060576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To date, the provision of ecosystem services has largely been estimated based on spatial patterns of land cover alone, using benefit transfer analysis. Although it is increasingly being recognised that the distribution of the human population affects whether a potential service translates into a realised service, this misses key steps in the process and assumes that everyone accesses ecosystem services in the same way. Here we describe a conceptual approach to ecosystem services in terms of movement and flows. We highlight that ecosystem service flows can be broken down into ‘nature to people’ (the movement of nature towards beneficiaries) and ‘people to nature’ (the movement of beneficiaries towards nature). The former has been relatively well described. Here, we explore the latter by reviewing research on human migration, animal foraging and landscape connectivity. We assess if and how existing theories might be useful in describing how people seek out ecosystem services. We consider some of the ways in which flows of people to nature can be measured. Such measurements may reveal which movement theories best represent how people seek out and access ecosystem services. Overall, our review aims to improve the future modelling of ecosystem services by more explicitly considering how people access potential services and therefore realise them.
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Krzyśko M, Wołyńki W, Szymkowiak M, Wojtyła A. A Spatio-Temporal Analysis of the Health Situation in Poland Based on Functional Discriminant Coordinates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031109. [PMID: 33513775 PMCID: PMC7908150 DOI: 10.3390/ijerph18031109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate if the provinces of Poland are homogeneous in terms of the observed spatio-temporal data characterizing the health situation of their inhabitants. The health situation is understood as a set of selected factors influencing inhabitants' health and the healthcare system in their area of residence. So far, studies concerning the health situation of selected territorial units have been based on data relating to a specific year rather than longer periods. The task of assessing province homogeneity was carried out in two stages. In stage one, the original spatio-temporal data space (space of multivariate time series) was transformed into a functional discriminant coordinates space. The resulting functional discriminant coordinates are synthetic measures of the health situation of inhabitants of particular provinces. These measures contain complete information regarding 8 diagnostic variables examined over a period of 6 years. In the second stage, the Ward method, commonly used in cluster analysis, was applied in order to identify groups of homogeneous provinces in the space of functional discriminant coordinates. Sixteen provinces were divided into four clusters. The homogeneity of the clusters was confirmed by the multivariate functional coefficient of variation.
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Affiliation(s)
- Mirosław Krzyśko
- Interfaculty Institute of Mathematics and Statistics, Calisia University-Kalisz, 62-800 Kalisz, Poland;
| | - Waldemar Wołyńki
- Faculty of Mathematics and Computer Science, Adam Mickiewicz University, 61-614 Poznań, Poland
- Correspondence:
| | - Marcin Szymkowiak
- Institute of Informatics and Quantitative Economics, Poznań University of Economics and Business, 61-875 Poznań, Poland;
- Statistical Office in Poznań, 60-624 Poznań, Poland
| | - Andrzej Wojtyła
- Health Sciences Faculty, Calisia University-Kalisz, 62-800 Kalisz, Poland;
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17
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Bajgain BB, Bajgain KT, Badal S, Aghajafari F, Jackson J, Santana MJ. Patient-Reported Experiences in Accessing Primary Healthcare among Immigrant Population in Canada: A Rapid Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238724. [PMID: 33255379 PMCID: PMC7727859 DOI: 10.3390/ijerph17238724] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/21/2022]
Abstract
(1) Background: Immigrants represent around 21.9% of the total population in Canada and encounter multifaceted obstacles in accessing and receiving primary healthcare. This literature review explores patient experiences in primary care from the perspective of immigrants and identifies areas for further research and improvement. (2) Methods: A comprehensive search was performed on PubMed, MEDLINE, Embase, SCOPUS, and Google scholar to identify studies published from 2010 to July 2020. Relevant articles were peer-reviewed, in English language, and reported patient experiences in primary healthcare in Canada. (3) Results: Of the 1566 searched articles, 19 articles were included in this review. Overall, the finding from articles were summarized into four major themes: cultural and linguistic differences; socioeconomic challenges; health system factors; patient–provider relationship. (4) Conclusion: Understanding the gaps to accessing and receiving appropriate healthcare is important to shape policies, enhance the quality of services, and deliver more equitable healthcare services. It is therefore pertinent that primary healthcare providers play an active role in bridging these gaps with strong support from policymakers. Understanding and respecting diversity in culture, language, experiences, and systems is crucial in reducing health inequalities and improving access to quality care in a respectful and responsive manner.
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Affiliation(s)
- Bishnu Bahadur Bajgain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; (B.B.B.); (F.A.)
| | | | - Sujan Badal
- School of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA;
| | - Fariba Aghajafari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; (B.B.B.); (F.A.)
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Maria-Jose Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; (B.B.B.); (F.A.)
- Correspondence:
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18
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Wilk P, Ali S, Anderson KK, Clark AF, Cooke M, Frisbee SJ, Gilliland J, Haan M, Harris S, Kiarasi S, Maltby A, Norozi K, Petrella R, Sarma S, Singh SS, Stranges S, Thind A. Geographic variation in preventable hospitalisations across Canada: a cross-sectional study. BMJ Open 2020; 10:e037195. [PMID: 32414831 PMCID: PMC7232620 DOI: 10.1136/bmjopen-2020-037195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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
OBJECTIVE The objective of this study is to examine the magnitude and pattern of small-area geographic variation in rates of preventable hospitalisations for ambulatory care-sensitive conditions (ACSC) across Canada (excluding Québec). DESIGN AND SETTING A cross-sectional study conducted in Canada (excluding Québec) using data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) linked prospectively to hospitalisation records from the Discharge Abstract Database (DAD) for the three fiscal years: 2006-2007, 2007-2008 and 2008-2009. PRIMARY OUTCOME MEASURE Preventable hospitalisations (ACSC). PARTICIPANTS The 2006 CanCHEC represents a population of 22 562 120 individuals in Canada (excluding Québec). Of this number, 2 940 150 (13.03%) individuals were estimated to be hospitalised at least once during the 2006-2009 fiscal years. METHODS Age-standardised annualised ACSC hospitalisation rates per 100 000 population were computed for each of the 190 Census Divisions. To assess the magnitude of Census Division-level geographic variation in rates of preventable hospitalisations, the global Moran's I statistic was computed. 'Hot spot' analysis was used to identify the pattern of geographic variation. RESULTS Of all the hospitalisation events reported in Canada during the 2006-2009 fiscal years, 337 995 (7.10%) events were ACSC-related hospitalisations. The Moran's I statistic (Moran's I=0.355) suggests non-randomness in the spatial distribution of preventable hospitalisations. The findings from the 'hot spot' analysis indicate a cluster of Census Divisions located in predominantly rural and remote parts of Ontario, Manitoba and Saskatchewan and in eastern and northern parts of Nunavut with significantly higher than average rates of preventable hospitalisation. CONCLUSION The knowledge generated on the small-area geographic variation in preventable hospitalisations can inform regional, provincial and national decision makers on planning, allocation of resources and monitoring performance of health service providers.
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Affiliation(s)
- Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Andrew F Clark
- Department of Geography, Western University, London, Ontario, Canada
| | - Martin Cooke
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Stephanie J Frisbee
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Jason Gilliland
- Department of Geography, Western University, London, Ontario, Canada
| | - Michael Haan
- Department of Sociology, Western University, London, Ontario, Canada
| | - Stewart Harris
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Soushyant Kiarasi
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Alana Maltby
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Robert Petrella
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Sarah S Singh
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Comparison of patient perceptions of primary care quality across healthcare facilities in Korea: A cross-sectional study. PLoS One 2020; 15:e0230034. [PMID: 32155199 PMCID: PMC7064208 DOI: 10.1371/journal.pone.0230034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/19/2020] [Indexed: 11/19/2022] Open
Abstract
Primary care is not well established in Korea despite its importance in population health. To reinforce the primary care system, understanding the public view of primary care will be essential. We aimed to compare the public perception of primary care qualities across types of healthcare facilities. We conducted a cross-sectional, web-based survey at a university in Seoul, South Korea, from October 2018 to February 2019. Using the Korean Primary Care Assessment Tool (K-PCAT), participants assessed the qualities of primary care services provided by the university health service (a university-based, patient-centered primary care model), community clinics, and hospitals. We compared K-PCAT scores across facilities and evaluated the factors associated with the differences using general linear models. A total of 5,748 responses were analyzed. K-PCAT total scores were highest for the university health service (61.0 ± 15.9) and lowest for hospitals (48.1 ± 14.5), with significant differences between facilities (P < .001). The university health service received the highest scores for first contact, comprehensiveness, personalized care, and family/community orientation; community clinics for continuity of care; and hospitals for care coordination and trust/satisfaction. Primary care facilities were rated higher than hospitals by individuals in good health, with low income levels, using ambulatory care more frequently, and spending less on medical expenses. In conclusion, the user-perceived primary care quality was higher for community-based primary care facilities than hospitals. The highest score was for the university health service, suggesting that setting-based, patient-centered primary care would be an effective model for restructuring the primary care system in Korea.
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