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Allen LN, Azab H, Jonga R, Gordon I, Karanja S, Thaker N, Evans J, Ramke J, Bastawrous A. Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review. BJGP Open 2023; 7:BJGPO.2023.0047. [PMID: 37474255 DOI: 10.3399/bjgpo.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/15/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The advancement of universal health coverage (UHC) is largely based on identifying and addressing barriers to accessing community health services. Traditional qualitative research approaches provide excellent insights but have unfeasibly high resource requirements for most care providers. AIM To identify, categorise, and evaluate methods that have been used to identify barriers to and/or solutions for improving access to community-based health services, grounded in engagement with affected communities, excluding approaches that take >14 days. DESIGN & SETTING This was a scoping review. METHOD Following Joanna Briggs Institute (JBI) guidelines, a search was undertaken using the Cochrane Library, Ovid MEDLINE, Ovid Embase, Ovid Global Health, and Google Scholar. An information specialist designed the search, and dual independent review and data charting were used. RESULTS In total, 44 studies were included from 30 countries, reporting on 18 different clinical services. Thirty studies used self-described 'rapid' approaches; however, the majority of these did not justify what they meant by this term. Nearly half of the studies used mixed- or multi-methods and triangulation to verify early findings. All of the qualitative studies used interviews and/or focus groups, which were often supplemented with observations, document review, and mapping activities. The use of in situ snowball and convenience sampling; community members as data collectors and cultural guides; collaborative summarisation (review of findings with community members and end-users); and deductive framework analysis expedited the research processes. There were no data on costs. CONCLUSION There are a wide range of methods that can be used to deliver timely information about barriers to access. The methods employed in the articles reviewed tended to use traditional data collection approaches in innovative ways.
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Affiliation(s)
- Luke N Allen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Hagar Azab
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ronald Jonga
- Department of Audit and Clinical Effectiveness, Northampton Foundation trust, Northampton, UK
| | - Iris Gordon
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Karanja
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nam Thaker
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer Evans
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Simkin J, Khoo E, Darvishian M, Sam J, Bhatti P, Lam S, Woods RR. Addressing Inequity in Spatial Access to Lung Cancer Screening. Curr Oncol 2023; 30:8078-8091. [PMID: 37754501 PMCID: PMC10529474 DOI: 10.3390/curroncol30090586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The successful implementation of an equitable lung cancer screening program requires consideration of factors that influence accessibility to screening services. METHODS Using lung cancer cases in British Columbia (BC), Canada, as a proxy for a screen-eligible population, spatial access to 36 screening sites was examined using geospatial mapping and vehicle travel time from residential postal code at diagnosis to the nearest site. The impact of urbanization and Statistics Canada's Canadian Index of Multiple Deprivation were examined. RESULTS Median travel time to the nearest screening site was 11.7 min (interquartile range 6.2-23.2 min). Urbanization was significantly associated with shorter drive time (p < 0.001). Ninety-nine percent of patients with ≥60 min drive times lived in rural areas. Drive times were associated with sex, ethnocultural composition, situational vulnerability, economic dependency, and residential instability. For example, the percentage of cases with drive times ≥60 min among the least deprived situational vulnerability group was 4.7% versus 44.4% in the most deprived group. CONCLUSIONS Populations at risk in rural and remote regions may face more challenges accessing screening services due to increased travel times. Drive times increased with increasing sociodemographic and economic deprivations highlighting groups that may require support to ensure equitable access to lung cancer screening.
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Affiliation(s)
- Jonathan Simkin
- BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 4C2, Canada
| | - Edwin Khoo
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Maryam Darvishian
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Janette Sam
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1G1, Canada; (P.B.); (R.R.W.)
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen Lam
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Ryan R. Woods
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1G1, Canada; (P.B.); (R.R.W.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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Kassas P, Gogou E, Varsamas C, Vogiatzidis K, Psatha A, Pinaka M, Siachpazidou D, Sistou A, Papazoglou ED, Kalousi D, Vatzia K, Astara K, Tsiouvakas N, Zarogiannis SG, Gourgoulianis K. The Alonissos Study: Cross-Sectional Study of the Healthcare Access and User Satisfaction in the Community of a Non-Profit-Line Greek Island. Healthcare (Basel) 2023; 11:1931. [PMID: 37444765 DOI: 10.3390/healthcare11131931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Healthcare access and a high quality of the provided services to healthcare users are fundamental human rights according to the Alma Ata Declaration of 1978. Although 45 years have passed since then, health inequalities still exist, not only among countries but also within populations of the same country. For example, several small Greek islands have only a small Primary Healthcare Center in order to provide healthcare services to the insular population. In the current study, we investigated the level of self-reported overall, dental and mental health status and the level of satisfaction regarding the access to and the quality of the healthcare services provided by the Primary Healthcare center of Alonissos, along with registering the requirements for transportation to the mainland in order to receive such services. In this questionnaire-based cross-sectional study, 235 inhabitants of the remote Greek island of Alonissos that accounts for nearly 9% of the population participated (115 males and 120 females). The self-reported overall health status was reported to be moderate to very poor at a percentage of 31.49%, and the results were similar for dental and self-reported mental health status. Although nearly 60% of the participants reported very good/good quality of the healthcare provision, only 37.45% reported that the access to healthcare was very good/good, while around 94% had at least one visit to the mainland in order to receive proper healthcare services. Strategies for improving access to healthcare services need to be placed in remote Greek islands like Alonissos.
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Affiliation(s)
- Petros Kassas
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Eudoxia Gogou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Charalampos Varsamas
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Konstantinos Vogiatzidis
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Aggeliki Psatha
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Maria Pinaka
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Dimitra Siachpazidou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Alexandra Sistou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Eleftherios D Papazoglou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Despoina Kalousi
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Konstantina Vatzia
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Kyriaki Astara
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Nikolaos Tsiouvakas
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Sotirios G Zarogiannis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Konstantinos Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
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Bychkovska O, Strøm V, Tederko P, Engkasan JP, Juocevičius A, Battistella LR, Arora M, Egen C, Gemperli A. Health System's Role in Facilitating Health Service Access among Persons with Spinal Cord Injury across 22 Countries. Int J Environ Res Public Health 2023; 20:6056. [PMID: 37297660 PMCID: PMC10252714 DOI: 10.3390/ijerph20116056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/23/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
(1) Background: Despite efforts to improve access to health services, between- and within-country access inequalities remain, especially for individuals with complex disabling conditions like spinal cord injury (SCI). Persons with SCI require regular multidisciplinary follow-up care yet experience more access barriers than the general population. This study examines health system characteristics associated with access among persons with SCI across 22 countries. (2) Methods: Study data are from the International Spinal Cord Injury Survey with 12,588 participants with SCI across 22 countries. Cluster analysis was used to identify service access clusters based on reported access restrictions. The association between service access and health system characteristics (health workforce, infrastructure density, health expenditure) was determined by means of classification and regression trees. (3) Results: Unmet needs were reported by 17% of participants: lowest (10%) in Japan, Spain, and Switzerland (cluster 1) and highest (62%) in Morocco (cluster 8). The country of residence was the most important factor in facilitating access. Those reporting access restrictions were more likely to live in Morocco, to be in the lowest income decile, with multiple comorbidities (Secondary Conditions Scale (SCI-SCS) score > 29) and low functioning status (Spinal Cord Independence Measure score < 53). Those less likely to report access restriction tended to reside in all other countries except Brazil, China, Malaysia, Morocco, Poland, South Africa, and South Korea and have fewer comorbidities (SCI-SCS < 23). (4) Conclusions: The country of residence was the most important factor in facilitating health service access. Following the country of residence, higher income and better health were the most important facilitators of service access. Health service availability and affordability were reported as the most frequent health access barriers.
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Affiliation(s)
- Olena Bychkovska
- Swiss Paraplegic Research, Guido A. Zäch Institute, 6207 Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
| | - Vegard Strøm
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Nesoddtangen, Norway
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | | | | | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, St Leonards 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Christoph Egen
- Department of Rehabilitation Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Armin Gemperli
- Swiss Paraplegic Research, Guido A. Zäch Institute, 6207 Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
- Center for Primary and Community Care, University of Lucerne, 6002 Lucerne, Switzerland
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Ranabhat CL, Acharya SP, Adhikari C, Kim CB. Universal health coverage evolution, ongoing trend, and future challenge: A conceptual and historical policy review. Front Public Health 2023; 11:1041459. [PMID: 36815156 PMCID: PMC9940661 DOI: 10.3389/fpubh.2023.1041459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
The goal of universal health coverage (UHC) from the United Nations (UN) has metamorphized from its early phase of primary health care (PHC) to the recent sustainable development goal (SDG). In this context, we aimed to document theoretical and philosophical efforts, historical analysis, financial and political aspects in various eras, and an assessment of coverage during those eras in relation to UHC in a global scenario. Searching with broad keywords circumadjacent to UHC with scope and inter-disciplinary linkages in conceptual analysis, we further narrated the review with the historical development of UHC in different time periods. We proposed, chronologically, these frames as eras of PHC, the millennium development goal (MDG), and the ongoing sustainable development goal (SDG). Literature showed that modern healthcare access and coverage were in extension stages during the PHC era flagshipped with "health for all (HFA)", prolifically achieving vaccination, communicable disease control, and the use of modern contraceptive methods. Following the PHC era, the MDG era markedly reduced maternal, neonatal, and child mortalities mainly in developing countries. Importantly, UHC has shifted its philosophic stand of HFA to a strategic health insurance and its extension. After 2015, the concept of SDG has evolved. The strategy was further reframed as service and financial assurance. Strategies for further resource allocation, integration of health service with social health protection, human resources for health, strategic community participation, and the challenges of financial securities in some global public health concerns like the public health emergency and travelers' and migrants' health are further discussed. Some policy departures such as global partnership, research collaboration, and experience sharing are broadly discussed for recommendation.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Department of Health Promotion and Administration, College of Health Science, Eastern Kentucky University, Richmond, KY, United States,Global Center for Research and Development, Kathmandu, Nepal,*Correspondence: Chhabi Lal Ranabhat ✉ ; ✉
| | | | - Chiranjivi Adhikari
- School of Health and Allied Science, Pokhara University, Pokhara, Nepal,Indian Public Health-Gandhinagar, Gujarat, India
| | - Chun-Bae Kim
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
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Lakhani A, Dema S, Hose J, Erdem N, Wollersheim D, Grimbeek P, Charlifue S. What happens post-lockdown for people with disability? Autonomy, quality of life, service access and health changes for people with spinal cord injury in Victoria, Australia after COVID-19 social distancing restrictions. Health Soc Care Community 2022; 30:e5366-e5377. [PMID: 35924426 PMCID: PMC9538439 DOI: 10.1111/hsc.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/05/2022] [Accepted: 07/16/2022] [Indexed: 06/17/2023]
Abstract
Social distancing restrictions are undoubtedly important for controlling the spread of COVID-19 however, they are also adversely impacting population health and health service access. It is important that priority populations with a disability which may already have adverse health, access to health services, and autonomy and participation compared to those without disability, are able to receive preventative health and social care during periods of restriction. The impact of social distancing restrictions on people with disability is not uniform nor well-understood. Research has been cross-sectional and considered data gathered during social distancing restrictions, or longitudinal, considering data gathered during a pre-pandemic baseline. This longitudinal study investigated the impact of lifting social distancing restrictions on priority domains for people with disability including autonomy and participation, access to health services, health issues and quality of life. People with spinal cord injury in Victoria, Australia (n = 71) completed a survey towards the end of social-distancing restrictions (T1) and 6-months post social distancing restrictions (T2). Non-parametric tests for significant differences confirmed that 6-months post-lifting social distancing restrictions participants experienced a significant increase in health conditions, a significant decrease in the number of inaccessible health services, and a significantly lower level of limitations across participation and autonomy, outdoor autonomy and work and education domains. QOL improved 6-months post lifting restrictions, however not to a significant level. The adverse health experienced by people with spinal cord injury after lifting restrictions may in part result from limited health service access and reduced participation during the time of restrictions. Clear definitions of what constitutes as essential care may ensure that eligible and required care remains received during lockdown or instances when service provision is compromised. Health and social care providers should be equipped with the knowledge of priority populations so that their support can be targeted to those most in need.
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Affiliation(s)
- Ali Lakhani
- The School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
- The Hopkins Centre, Menzies Health Institute QueenslandGriffith UniversityMeadowbrookQueenslandAustralia
- Palliative Care DepartmentEastern HealthWantirnaVictoriaAustralia
| | - Salvatore Dema
- Austin Health ‐ Royal Talbot Rehabilitation CentreKewVictoriaAustralia
| | - Josh Hose
- AQA VictoriaHeidelbergVictoriaAustralia
| | | | - Dennis Wollersheim
- The School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
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Lamberti JS. Commentary: Reimagining Community Mental Health Care Services: Case Study of a Need Based Biopsychosocial Response Initiated During Pandemic. Front Psychiatry 2022; 13:859884. [PMID: 35711593 PMCID: PMC9196903 DOI: 10.3389/fpsyt.2022.859884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- J Steven Lamberti
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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Koehn SD, Donahue M, Feldman F, Drummond N. Fostering trust and sharing responsibility to increase access to dementia care for immigrant older adults. Ethn Health 2022; 27:83-99. [PMID: 31416342 DOI: 10.1080/13557858.2019.1655529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Abstract
Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health authority and local chapters of the Alzheimer Society) through their propensity to develop trusting relationships between staff and clients.Design: Our research is a qualitative case study of Punjabi and Korean speakers living in the Lower Mainland of BC, Canada. Data are drawn from interviews with 15 dyads of persons with dementia and their family caregivers (10 Punjabi, 5 Korean), six focus groups (one focus group with each of 8-10 older men, older women, and mixed gender working age adults in each community). We also interviewed 20 managerial and frontline staff of dementia service agencies, i.e. the health authority and the local Alzheimer Society (n = 11) and two immigrant-serving agencies (n = 9), each dedicated to either Punjabi or Korean-speaking clients. We adopted the Candidacy framework for understanding access to dementia services and supports and the concept of trust as guiding precepts in this study.Results: Families of persons with dementia are pivotal to identification of a problem requiring professional help, navigation to appropriate services and acceptance of services offered. However, trust in family members should not be taken for granted, since family dynamics are complex. Alternative sources of trusted support are therefore needed. Immigrant-serving agencies are more often instrumental in establishing trusted relationships between their staff and clients, but they often lack detailed knowledge about heath conditions, their treatment and management, and they lack power to implement statutory care.Conclusions: Partnerships between mainstream mental health/dementia services and the community sector have proven successful in increasing the accessibility of specialized resources, while maximizing their combined trustworthiness, accessibility and effectiveness. Such partnerships should become fundamental components of health service strategy and provision for vulnerable and underserved immigrant older adults.
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Affiliation(s)
| | | | - Fabio Feldman
- Clinical Quality & Patient Safety, Fraser Health, Surrey, Canada
| | - Neil Drummond
- Primary Care, Department of Family Medicine, University of Alberta, Edmonton, Canada
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McMaster E, Reid T, Farquhar E, McMaster D, Buckley D, Green E. Responding to rural allied health workforce challenges in the public health system: Evaluation of the Allied Health Rural Generalist Pathway pilot in western New South Wales. Aust J Rural Health 2021; 29:701-720. [PMID: 34672053 DOI: 10.1111/ajr.12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/05/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The Allied Health Rural Generalist Pathway pilot aimed to improve consistent access to physiotherapy services in rural communities using the "grow own" workforce strategy and existing resources. DESIGN A summative evaluation of the quality improvement project used to implement the Allied Health Rural Generalist Pathway was completed. A mixed method design was used and included focus groups and a framework analysis. PARTICIPANTS The temporary redesign of specific workforce resources created "development" positions. A shared same-discipline supervisor resource supported five early-career physiotherapists, the participants. SETTING The project was undertaken in rural New South Wales in the public health system. MAIN OUTCOME MEASURES The main outcome measures included a number of chronically vacant physiotherapy positions and stakeholder satisfaction. RESULTS Targeted vacancies were filled, services sustained with minimal service gaps and mean retention rate of 2.9 years. A statistically significant increase in service activity to patients in rural locations occurred as a result of the intervention (R-squared 29%, P < .05). Four out of five early career physiotherapists fulfilled terms of their contract and secured senior positions within the region. Whilst participants developed professionally, they did not complete the tertiary education component. CONCLUSIONS The Allied Health Rural Generalist multi-factorial approach supported recruitment, retention and capacity building within the targeted discipline of the allied health workforce. Patient need was met. The rural pipeline capacity was developed. The pathway was complementary of existing NSW Health systems. Systemic change is needed to overcome inefficiencies experienced during implementation and to ensure sustainability. Further research to develop discipline-specific clinical training guidance through the stages of a rural allied health professionals' career may be helpful.
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Affiliation(s)
- Ellen McMaster
- Griffith Base Hospital, Murrumbidgee Local Health District, Griffith, NSW, Australia
| | - Tegan Reid
- Murrumbidgee Local Health District Office, Wagga Wagga, NSW, Australia
| | - Emily Farquhar
- Wagga Wagga Base Hospital, Murrumbidgee Local Health District, Wagga Wagga, NSW, Australia
| | - Duncan McMaster
- Wagga Wagga Base Hospital, Murrumbidgee Local Health District, Wagga Wagga, NSW, Australia
| | - David Buckley
- Murrumbidgee Local Health District Office, Wagga Wagga, NSW, Australia
| | - Elyce Green
- Charles Sturt University, Three Rivers University Department of Rural Health, Wagga Wagga, NSW, Australia
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Stadskleiv K, van Walsem MR, Andersen GL, Bergqvist L, Bøttcher L, Christensen K, Heyerdahl D, Hollung SJ, Høye H, Jahnsen R, Klevberg GL, Lindquist B, Passmark H, Rike PO, Rodby-Bousquet E, Alriksson-Schmidt AI. Systematic Monitoring of Cognition for Adults With Cerebral Palsy-The Rationale Behind the Development of the CP Cog-Adult Follow-Up Protocol. Front Neurol 2021; 12:710440. [PMID: 34630285 PMCID: PMC8492925 DOI: 10.3389/fneur.2021.710440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebral palsy (CP) comprises a heterogeneous group of conditions recognized by disturbances of movement and posture and is caused by a non-progressive injury to the developing brain. Birth prevalence of CP is about 2-2.5 per 1,000 live births. Although the motor impairment is the hallmark of the diagnosis, individuals with CP often have other impairments, including cognitive ones. Cognitive impairments may affect communication, education, vocational opportunities, participation, and mental health. For many years, CP has been considered a "childhood disability," but the challenges continue through the life course, and health issues may worsen and new challenges may arise with age. This is particularly true for cognitive impairments, which may become more pronounced as the demands of life increase. For individuals with CP, there is no one-to-one correlation between cognition and functioning in other areas, and therefore, cognition must be individually assessed to determine what targeted interventions might be beneficial. To facilitate this for children with CP, a systematic follow-up protocol of cognition, the CPCog, has been implemented in Norway and Sweden. However, no such protocol currently exists for adults with CP. Such discontinuity in healthcare services that results from lack of follow-up of cognitive functioning and subsequent needs for adjustments and interventions makes transition from pediatric to adult healthcare services challenging. As a result, a protocol for the surveillance of cognition in adults with CP, the CPCog-Adult, has been developed. It includes assessment of verbal skills, non-verbal reasoning, visual-spatial perception, and executive functioning. It is recommended to perform these assessments at least once in young adulthood and once in the mid-fifties. This report describes the process of developing the CPCog-Adult, which has a three-fold purpose: (1) to provide equal access to healthcare services to enable the detection of cognitive impairments; (2) to provide interventions that increase educational and vocational participation, enhance quality of life, and prevent secondary impairments; and (3) to collect systematic data for research purposes. The consent-based registration of data in the well-established Swedish and Norwegian national CP registries will secure longitudinal data from childhood into adulthood.
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Affiliation(s)
- Kristine Stadskleiv
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Marleen R. van Walsem
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Guro L. Andersen
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway
| | - Lena Bergqvist
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Bøttcher
- Danish School of Education, Aarhus University, Copenhagen, Denmark
| | | | | | - Sandra Julsen Hollung
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Reidun Jahnsen
- Center for Habilitation and Rehabilitation Models and Services, Institute of Health and Society, University of Oslo, Oslo, Norway
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Gunvor L. Klevberg
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | | | - Henrik Passmark
- The Cerebral Palsy Surveillance Programme (CPUP), User board, Lund, Sweden
| | - Per-Ola Rike
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Elisabet Rodby-Bousquet
- Center for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
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11
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Weng SF, Malik A, Wongsin U, Lohmeyer FM, Lin LF, Atique S, Jian WS, Gusman Y, Iqbal U. Health Service Access among Indonesian Migrant Domestic Workers in Taiwan. Int J Environ Res Public Health 2021; 18:ijerph18073759. [PMID: 33916514 PMCID: PMC8038466 DOI: 10.3390/ijerph18073759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
The number of migrant workers in Taiwan increases annually. The majority is from Indonesia and most of them are female caregivers. This study aims to determine the access to health services and the associated factors among Indonesian female domestic workers in Taiwan. In this cross-sectional study, data were collected from February to May 2019, using a structured questionnaire. Subsequently, multiple logistic regression was used to examine the association between socio-demographic factors and health service access. Two hundred and eighty-four domestic migrant workers were interviewed. Eighty-five percent of the respondents declared sickness at work, but only 48.8% seek health care services. Factors associated with health service access were marital status, income, and the availability of an attendant to accompany the migrant workers to the healthcare facilities. Language barrier and time flexibility were the main obstacles. Further research and an effective health service policy are needed for the domestic migrant workers to better access health care services.
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Affiliation(s)
- Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 110, Taiwan;
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Azis Malik
- Master Program in Global Health & Development Department, College of Public Health, Taipei Medical University, Taipei City 110, Taiwan;
| | - Utoomporn Wongsin
- PhD Program in Global Health & Health Security Department, College of Public Health, Taipei Medical University, Taipei City 110, Taiwan;
| | | | - Li-Fong Lin
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan; (L.-F.L.); (W.-S.J.)
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei City 110, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Suleman Atique
- Department of Health Informatics, College of Public Health and Health Informatics, University of Ha’il, Ha’il City 55211, Saudi Arabia;
| | - Wen-Shan Jian
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan; (L.-F.L.); (W.-S.J.)
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei City 110, Taiwan
- School of Health Care Administration, Taipei Medical University, Taipei City 110, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei City 110, Taiwan
| | - Yuherina Gusman
- International Doctoral Program for Asia Pacific Studies, National Chengchi University, Taipei City 11605, Taiwan;
| | - Usman Iqbal
- Master Program in Global Health & Development Department, College of Public Health, Taipei Medical University, Taipei City 110, Taiwan;
- PhD Program in Global Health & Health Security Department, College of Public Health, Taipei Medical University, Taipei City 110, Taiwan;
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei City 110, Taiwan
- Correspondence: ; Tel.: +886-2-6638-2736 (ext. 1321)
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Sheppard-Law S, Cruickshank M, Debono D. Mapping diversity and demographic-based changes to a pediatric population attending a specialist tertiary hospital: a retrospective review. J Clin Nurs 2020; 30:466-474. [PMID: 33174268 DOI: 10.1111/jocn.15559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/04/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to describe the demographic characteristics and to measure annual changes in composition of the paediatric population attending a specialist tertiary hospital in Sydney, Australia, between 2015 and 2017. BACKGROUND Australia has experienced steady growth in the number of people born overseas in the last fifty years thereby building a culturally and linguistically rich country. Such dynamic population changes pose a challenge to the nursing workforce, in particular how the needs of migrant families from non-English-speaking countries are accommodated. DESIGN Retrospective review of medical records. METHODS De-identified paediatric inpatient data were imported from a hospital database into Statistical Package for the Social Sciences (version 21) database for cleaning and analysis. Strengthening the reporting of observational studies in epidemiology checklist was completed. RESULTS Paediatric inpatients born in a country other than Australia (8762, 5.7%) emigrated from 155 countries or were "born at Sea" (n = 13, 0.1%) and spoke an array of primary languages (n = 139), other than English. Whilst inpatient health service rates remained constant during the study period, an increased rate of service utilisation was reported for children born in Asia (IRR 1.3, p ≤ 0.001, 95% CI: 1.2-1.4) and in the Middle East (IRR 1.4, p ≤ 0.001, 95% CI: 1.2-1.6). Families who reported that they preferred to speak Chinese Languages, Middle Eastern languages (not Arabic) and languages of India reported increased rates. CONCLUSION Significant annual changes in composition of the paediatric population were reported. Regular analysis of local inpatient data will inform health care that is responsive to change and addresses the unique needs of diverse families. RELEVANCE TO CLINICAL PRACTICE Diversity poses a potential challenge to the nursing workforce on a daily basis and more broadly. To meet the changing needs of diverse inpatient populations, nurses will need to plan, implement and evaluate cultural competency, linguistic access, workforce diversity and the quality of care to diverse populations.
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Affiliation(s)
- Suzanne Sheppard-Law
- Nursing Research Unit, Sydney Children's Hospital Network, Sydney, NSW, Australia.,School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Marilyn Cruickshank
- Nursing Research Unit, Sydney Children's Hospital Network, Sydney, NSW, Australia.,School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Lakhani A. Which Melbourne Metropolitan Areas Are Vulnerable to COVID-19 Based on Age, Disability, and Access to Health Services? Using Spatial Analysis to Identify Service Gaps and Inform Delivery. J Pain Symptom Manage 2020; 60:e41-e44. [PMID: 32276097 PMCID: PMC7141477 DOI: 10.1016/j.jpainsymman.2020.03.041] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/23/2022]
Abstract
Aging adults (65+) with disability are especially vulnerable to coronavirus disease 2019 (COVID-19), and on contracting, they are a cohort most likely to require palliative care. Therefore, it is very important that health services-particularly health services providing palliative care-are proximately available. Treating the Melbourne metropolitan area as a case study, a spatial analysis was conducted to clarify priority areas with a significantly high percentage and number of aging adults (65+) with disability and high barriers to accessing primary health services. Afterward, travel times from priority areas to palliative medicine and hospital services were calculated. The geographic dispersion of areas with people vulnerable to COVID-19 with poor access to palliative care and health services is clarified. Unique methods of health service delivery are required to ensure that vulnerable populations in underserviced metropolitan areas receive prompt and adequate care. The spatial methodology used can be implemented in different contexts to support evidence-based COVID-19 and pandemic palliative care service decisions.
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Affiliation(s)
- Ali Lakhani
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia; The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
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14
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Lakhani A. Which Melbourne Metropolitan Areas Are Vulnerable to COVID-19 Based on Age, Disability, and Access to Health Services? Using Spatial Analysis to Identify Service Gaps and Inform Delivery. J Pain Symptom Manage 2020. [PMID: 32276097 DOI: 10.1016/j.jpainsymman.2020.03.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Aging adults (65+) with disability are especially vulnerable to coronavirus disease 2019 (COVID-19), and on contracting, they are a cohort most likely to require palliative care. Therefore, it is very important that health services-particularly health services providing palliative care-are proximately available. Treating the Melbourne metropolitan area as a case study, a spatial analysis was conducted to clarify priority areas with a significantly high percentage and number of aging adults (65+) with disability and high barriers to accessing primary health services. Afterward, travel times from priority areas to palliative medicine and hospital services were calculated. The geographic dispersion of areas with people vulnerable to COVID-19 with poor access to palliative care and health services is clarified. Unique methods of health service delivery are required to ensure that vulnerable populations in underserviced metropolitan areas receive prompt and adequate care. The spatial methodology used can be implemented in different contexts to support evidence-based COVID-19 and pandemic palliative care service decisions.
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Affiliation(s)
- Ali Lakhani
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia; The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
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15
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Bellotto E, Monasta L, Pellegrin MC, Bossini B, Tamaro G, Conte MS, Faleschini E, Barbi E, Tornese G. Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy. Front Pediatr 2020; 8:580588. [PMID: 33123505 PMCID: PMC7567164 DOI: 10.3389/fped.2020.580588] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: The knowledge of the pattern and the features of pediatric endocrinology referrals is crucial to optimize resources and guide public health interventions. We explored the numbers and the reasons for referral to a pediatric endocrinology outpatient clinic and investigated their features in terms of assignment of priority ranks, sex, age differences, the prevalence of pathological findings among referred cases, and the agreement among referrals, final diagnosis, treatment, and follow-up. Methods: Retrospective study with data collection for pediatric endocrinology first visits between November 2012 and February 2019 in a tertiary center. Results: A total of 1930 first visits were performed with an overall number of referrals of 2,165, and an increasing trend over the years. The most frequent referral reasons were slow growth, precocious puberty, and obesity; 14% of visits were classified as "urgent" (<7 days), 35% as "deferrable" (<30 days), and 51% as "planned" (<180 days). Sex and age differences among referrals were detected, with criticality in the appropriate timing for referral. Thirty-eight percent of patients had pathological findings. In 4% of the cases the final diagnosis was not concordant with the reason for referral. Treatment was prescribed in 35% of cases, and 67% returned at least for one follow-up visit. Conclusion: The study highlighted the need to target medical education of primary care on the definition of priority ranks, the need for more extended observation periods for subclinical or para-physiological conditions, the appropriate timing for referral, based on the definition of conditions or the best window of intervention.
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Affiliation(s)
| | - Lorenzo Monasta
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Maria Sole Conte
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Elena Faleschini
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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16
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MacLachlan JH, Cowie BC. Bridging the access gap: Medicare ineligibility in people living with chronic hepatitis B. Intern Med J 2019; 49:122-125. [PMID: 30680906 DOI: 10.1111/imj.14175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/16/2018] [Accepted: 06/07/2018] [Indexed: 12/01/2022]
Abstract
People living in Australia on temporary student or work visas are excluded from Medicare access and can face barriers to adequate healthcare, even if they are privately insured. This analysis aimed to quantify this issue in relation to people living with chronic hepatitis B, the majority of whom in Australia were born overseas. The data suggest that an estimated 25 000 people living with chronic hepatitis B in Australia are ineligible for Medicare, 10% of the total number affected, with considerable potential impact in access to effective healthcare and prevention of adverse outcomes.
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Affiliation(s)
- Jennifer H MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute, Melbourne, Victoria, Australia.,Department of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin C Cowie
- WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute, Melbourne, Victoria, Australia.,Department of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Abstract
BACKGROUND Low adoption of lung cancer screening is potentially caused by inadequate access to a comprehensive lung cancer screening registry (LCSR), currently a requirement for reimbursement by the Centers for Medicare and Medicaid Services. However, variations in LCSR facilities have not been extensively studied. METHODS We applied a hierarchical clustering method to a comprehensive database integrating state-level LCSR facility density, defined as the number of facilities per 100,000 at-risk persons, lung cancer outcomes including mortality and stage-specific incidence, and socioeconomic and behavioral factors. RESULTS We found three distinct clusters of LCSR facilities roughly corresponding to the northern (cluster 1), southeastern (cluster 2), and southwestern (cluster 3) states. The southeastern states had the lowest total number of facilities (67 ± 44 in cluster 2, 74 ± 69 in cluster 1, 80 ± 100 in cluster 3), the slowest increase in facilities (23 ± 20 in cluster 2, 26 ± 28 in cluster 1, 27 ± 32 in cluster 3) between 2016 and 2018, and the highest lung cancer burden and current smokers. They ranked second in terms of facility density (2.9 ± 1.0 in cluster 3, 3.8 ± 1.3 in cluster 2, 6.3 ± 2.8 in cluster 1) and increase in facility density (1.1 ± 0.3 in cluster 3, 1.3 ± 0.7 in cluster 2, 2.5 ± 2.5 in cluster 1). CONCLUSIONS We found substantial state-level variability in LCSR facilities tied to lung cancer burden, socioeconomic characteristics, and behavioral characteristics. Given the known risk factors of lung cancer, correcting a suboptimal distribution of screening programs will likely lead to improved lung cancer outcomes.
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Affiliation(s)
- Minal S Kale
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bian Liu
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
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18
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Besney JD, Angel C, Pyne D, Martell R, Keenan L, Ahmed R. Addressing Women's Unmet Health Care Needs in a Canadian Remand Center: Catalyst for Improved Health? J Correct Health Care 2018; 24:276-294. [PMID: 29925287 DOI: 10.1177/1078345818780731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Incarcerated women have a disproportionate burden of infectious and chronic disease, substance disorders, and mental illness. This study explored incarcerated women's health and whether a Women's Health Clinic improved care within this vulnerable population. Retrospective chart reviews and focus groups were conducted. Poor access to care in the community due to competing social needs was described. Barriers to care during incarceration included lack of comprehensive gender-specific services, mistrust of providers, and fragmentation. Of 109 women, high rates of mental illness, partner violence, substance use, sexually transmitted infection (STI), and irregular Pap testing were observed. Pap (15% to 54%, p < .001) and STI (17% to 89%, p < .001) testing rates increased. Fragmentation of care remained at transition points, and further work is needed to improve continuity within corrections and the community.
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Affiliation(s)
- Jonathan D Besney
- 1 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Cybele Angel
- 2 Corrections Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Diane Pyne
- 2 Corrections Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Rebecca Martell
- 3 Department of Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Louanne Keenan
- 4 Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rabia Ahmed
- 5 Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Adams R, Sheppard L, Jones A, Lefmann S. What factors influence physiotherapy service provision in rural communities? A pilot study. Aust J Rural Health 2016; 22:133-8. [PMID: 25039848 DOI: 10.1111/ajr.12110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To obtain stakeholder perspectives on factors influencing rural physiotherapy service provision and insights into decision making about service provision. DESIGN Purposive sampling, open-ended survey questions and semi-structured interviews were used in this exploratory, qualitative study. SETTING A rural centre and its regional referral centre formed the pilot sites. PARTICIPANTS Nine participant perspectives were obtained on rural physiotherapy services. MAIN OUTCOME MEASURES Stakeholder perspectives on factors influencing rural physiotherapy service provision and service level decision making. RESULTS Workforce capacity and capability, decision maker's knowledge of the role and scope of physiotherapy, consideration of physiotherapy within resource allocation decisions and proof of practice emerged as key issues. The latter three were particularly reflected in public sector participant comments. Business models and market size were identified factors in influencing private practice. CONCLUSION Influencing factors described by participants both align and extend our understanding of issues described in the rural physiotherapy literature. Participant insights add depth and meaning to quantitative data by revealing impacts on local service provision. Available funding and facility priorities were key determinants of public sector physiotherapy service provision, with market size and business model appearing more influential in private practice. The level of self direction or choice about which services to provide, emerged as a point of difference between public and private providers. Decisions by public sector physiotherapists about service provision appear constrained by existing capacity and workload. Further research into service level decision making might provide valuable insights into rural health service delivery.
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Affiliation(s)
- Robyn Adams
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
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20
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Tuttle CSL, Carrington MJ, Stewart S, Brown A. Overcoming the tyranny of distance: An analysis of outreach visits to optimise secondary prevention of cardiovascular disease in high-risk individuals living in Central Australia. Aust J Rural Health 2015; 24:99-105. [PMID: 27087389 DOI: 10.1111/ajr.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES We examined the logistical challenges of conducting an outreach, secondary prevention program for adults discharged from Alice Springs Hospital following an acute presentation of cardiovascular disease. DESIGN AND SETTING This represents a sub-study of the Central Australian Heart Protection Study (CAHPS). Clinical, logistic and demographic data were used to examine the characteristics of outreach visits in the intervention arm of the study. PARTICIPANTS Fifty subjects initially allocated to the intervention arm of the trial were studied. MAIN OUTCOME MEASURES Completion of scheduled, plus additional outreach visits according to the intervention protocol. RESULTS The majority of subjects presented with an acute coronary syndrome (44/50 (88%)) and 31 (62%) were of Indigenous ethnicity. However, Indigenous subjects being younger (53.1 ± 11.1 versus 58.0 ± 11.0 years non-Indigenous) had a more complex risk factor and co-morbid profile, with significantly more diabetes (77% versus 26% P < 0.001), hypertension (81% versus 53% P = 0.04) and renal failure (52% versus 21% P = 0.03). Community of origin of Indigenous subjects was 230 ± 208 km from the hospital versus 61 ± 150 km for non-Indigenous subjects (P = 0.004). Indigenous subjects missed a significantly higher number of scheduled visits at six months (1.39 ± 2.14 versus 0.16 ± 0.50 visits; P = 0.02). However, multivariate analyses suggested that distance did not influence successful completion of visits. CONCLUSIONS These early findings from CAHPS are invaluable to understanding and improving the feasibility of secondary prevention programs for Indigenous adults living with heart disease in remote communities.
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Affiliation(s)
- Camilla S L Tuttle
- Baker IDI Central Australia, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Melinda J Carrington
- Baker IDI Central Australia, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Simon Stewart
- Baker IDI Central Australia, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alex Brown
- Baker IDI Central Australia, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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21
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Davey M, Moore W, Walters J. Tasmanian Aborigines step up to health: evaluation of a cardiopulmonary rehabilitation and secondary prevention program. BMC Health Serv Res 2014; 14:349. [PMID: 25134693 PMCID: PMC4141095 DOI: 10.1186/1472-6963-14-349] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 08/14/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although the burden of cardiopulmonary diseases in the Aboriginal community is high, utilisation of rehabilitation services has been poor. We evaluated the uptake and effectiveness of a cardiovascular and pulmonary rehabilitation program specifically designed and provided for the Aboriginal community, by the Tasmanian Aboriginal Centre, for people with diagnosed chronic heart or respiratory disease and those at high risk of developing such conditions. METHODS Participants had established chronic obstructive pulmonary disease, ischaemic heart disease or chronic heart failure or were at high risk of developing such diseases because of multiple risk factors. Rehabilitation programs (n = 13) comprised two exercise and one education session per week over eight weeks. Data, collected at baseline and on completion, included health status, risk factors, attendance, anthropometric measurements, physical capacity and quality of life. Data from participants who attended at least one program session were analysed. Qualitative written feedback from participants and staff was analysed thematically. RESULTS Of 92 participants (39% with an established disease diagnosis), 72 provided follow-up data. Participants lost weight, and waist circumference decreased (mean -3.6 cm, 95% confidence interval (CI)-2.5 to -4.7). There were clinically significant improvements in six-minute walk distance (mean 55.7 m, 95% CI 37.8 to 73.7) and incremental shuttle walk (mean 106.2 m, 95% CI 79.1 to 133.2). There were clinically significant improvements in generic quality of life domains, dyspnoea and fatigue. Generally, the improvements in participants with established cardiac or respiratory diseases did not differ from that in people with risk factors. Analysis of qualitative data identified three factors that facilitated participation: support from peers and health workers, provision of transport and the program structure. Participants' awareness of improvements in their health contributed to ongoing participation and positive health outcomes, and participants would recommend the program to family and friends. CONCLUSION A cardiopulmonary program, which included exercise and education and met national guidelines, was designed and delivered specifically for the Aboriginal community. It increased participation in rehabilitation by Aborigines with, or at high risk of, established disease and led to positive changes in health behaviours, functional exercise capacity and health related quality of life.
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Affiliation(s)
- Maureen Davey
- />Tasmanian Aboriginal Centre, GPO Box 569, Hobart, 7001 Australia
- />School of Medicine, Medical Sciences Precinct, University of Tasmania, 17 Liverpool St, Hobart, 7000 Australia
| | - Wendy Moore
- />Tasmanian Aboriginal Centre, GPO Box 569, Hobart, 7001 Australia
| | - Julia Walters
- />Breathe Well: Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, Medical Sciences Precinct, University of Tasmania, 17 Liverpool St, Hobart, 7000 Australia
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22
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McGrath PJ, Sourander A, Lingley-Pottie P, Ristkari T, Cunningham C, Huttunen J, Filbert K, Aromaa M, Corkum P, Hinkka-Yli-Salomäki S, Kinnunen M, Lampi K, Penttinen A, Sinokki A, Unruh A, Vuorio J, Watters C. Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada). BMC Public Health 2013; 13:985. [PMID: 24139323 PMCID: PMC4015286 DOI: 10.1186/1471-2458-13-985] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/08/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. METHODS/DESIGN This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. DISCUSSION The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. TRIAL REGISTRATION ClinicalTrials.gov # NCT01750996.
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Affiliation(s)
- Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
- Center for Child and Adolescent Mental Health, North Norway (RBUP), University of Tromsø, 9037, Breivika, Norway
| | - Patricia Lingley-Pottie
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
- Strongest Families Institute, 7105 Chebucto Road, Suite 355, Halifax, Nova Scotia B3L 4W8, Canada
| | - Terja Ristkari
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Science, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Jukka Huttunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katharine Filbert
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Minna Aromaa
- Outpatient Clinic for Children and Adolescents, Itäinen Pitkäkatu 30, 20700, Turku, Finland
- Department of Public Health, University on Turku, FI-20014, Turun Yliopisto, Finland
| | - Penny Corkum
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katja Lampi
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anne Penttinen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anita Unruh
- Dalhousie University, Faculty of Health Professions, Burbidge Building, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Jenni Vuorio
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Carolyn Watters
- Dalhousie University, Faculty of Computer Science, 6050 University Avenue, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
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Cooper HLF, Bossak BH, Tempalski B, Friedman SR, Des Jarlais DC. Temporal trends in spatial access to pharmacies that sell over-the-counter syringes in New York City health districts: relationship to local racial/ethnic composition and need. J Urban Health 2009; 86:929-45. [PMID: 19911283 PMCID: PMC2791821 DOI: 10.1007/s11524-009-9399-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pharmacies that sell over-the-counter (OTC) syringes are a major source of sterile syringes for injection drug users in cities and states where such sales are legal. In these cities and states, however, black injectors are markedly less likely to acquire syringes from pharmacies than white injectors. The present analysis documents spatial and temporal trends in OTC pharmacy access in New York City health districts over time (2001-2006) and investigates whether these trends are related to district racial/ethnic composition and to local need for OTC pharmacies. For each year of the study period, we used kernel density estimation methods to characterize spatial access to OTC pharmacies within each health district. Higher values on this measure indicate better access to these pharmacies. "Need" was operationalized using two different measures: the number of newly diagnosed injection-related AIDS cases per 10,000 residents (averaged across 1999-2001), and the number of drug-related hospital discharges per 10,000 residents (averaged across 1999-2001). District sociodemographic characteristics were assessed using 2000 US decennial census data. We used hierarchical linear models (HLM) for descriptive and inferential analyses and investigated whether the relationship between need and temporal trajectories in the Expanded Syringe Access Demonstration Program access varied by district racial/ethnic composition, controlling for district poverty rates. HLM analyses indicate that the mean spatial access to OTC pharmacies across New York City health districts was 12.71 in 2001 and increased linearly by 1.32 units annually thereafter. Temporal trajectories in spatial access to OTC pharmacies depended on both need and racial/ethnic composition. Within high-need districts, OTC pharmacy access was twice as high in 2001 and increased three times faster annually, in districts with higher proportions of non-Hispanic white residents than in districts with low proportions of these residents. In low-need districts, "whiter" districts had substantially greater baseline access to OTC pharmacies than districts with low proportions of non-Hispanic white residents. Access remained stable thereafter in low-need districts, regardless of racial/ethnic composition. Conclusions were consistent across both measures of "need" and persisted after controlling for local poverty rates. In both high- and low-need districts, spatial access to OTC pharmacies was greater in "Whiter" districts in 2001; in high-need districts, access also increased more rapidly over time in "whiter" districts. Ensuring equitable spatial access to OTC pharmacies may reduce injection-related HIV transmission overall and reduce racial/ethnic disparities in HIV incidence among injectors.
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Affiliation(s)
- Hannah L F Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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