Delayed diagnosis of pemphigus vulgaris in rural Nepal due to healthcare inaccessibility and harmful traditional practices: A case report

Early intervention is imperative for potentially fatal dermatologic diseases such as pemphigus vulgaris. In rural Nepal, limited public awareness, home remedies, and delays in healthcare access lead to poor outcomes. Although biopsy confirms the diagnosis, experienced dermatologists can make an accurate clinical diagnosis when characteristic skin lesions are present.

The Impact of Telemedicine and Remote Patient Monitoring on Healthcare Delivery: A Comprehensive Evaluation

Background Telemedicine and remote patient monitoring have emerged as transformative solutions in contemporary healthcare. This study aimed to conduct a comprehensive evaluation of the impact of these technologies on healthcare delivery, focusing on patient outcomes, economic parameters, and overall satisfaction. Methods A prospective observational study was conducted in various healthcare facilities, involving 186 participants with chronic diseases. Inclusion criteria included patients actively using telemedicine services. Data collection methods included surveys, interviews, and review of medical records, focusing on patient demographics, clinical outcomes, and economic parameters. The intervention involved a seamless integration of telemedicine technologies into the existing health system. Results Primary outcomes revealed significant improvements in patient health, including a decrease in disease-specific markers (mean reduction of 12,000 to 11,000, p = 0.002), a substantial reduction in severity of symptoms (mean reduction from 3,500 to 2,500, p < 0.001), and a general improvement in health status (mean increase from 7,200 to 8,500, p < 0.001). The savings in healthcare costs were evident, with direct costs decreasing from 25,000 to 12,000 (p < 0.001) and indirect costs decreasing from <10,000 to <5,000 (p = 0.004). Secondary results demonstrated increased patient satisfaction with communication (increase from 80% to 95%, p < 0.001) and convenience of services (increase from 75% to 90%, p < 0.001). Patient satisfaction also increased significantly (from 80% to 95%, p < 0.001). Accessibility to healthcare services improved, with a reduction in geographic barriers (increase from 65% to 90%, p < 0.001) and a decrease in the frequency of healthcare utilization (decrease from 2.5 to 1.5, p < 0.001). Conclusion The study provides robust evidence of the positive impact of telemedicine and remote patient monitoring on healthcare delivery. Significant improvements in patient outcomes, coupled with substantial cost savings and increased satisfaction levels, underscore the transformative potential of these technologies.

A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility

Telemedicine has emerged as a transformative force in healthcare delivery, particularly in improving healthcare accessibility. This comprehensive review examines the impact of telemedicine on healthcare accessibility, exploring its ability to overcome geographical, financial, sociocultural, and infrastructural barriers to healthcare access. Through remote consultations, monitoring, and diagnosis facilitated by technology, telemedicine extends healthcare reach to remote and underserved areas while enhancing temporal accessibility with round-the-clock availability. By streamlining healthcare delivery systems, telemedicine reduces costs and promotes efficiency, ultimately fostering health equity and improving health outcomes. However, technological barriers, regulatory hurdles, and patient acceptance remain. To realize telemedicine's full potential, collaboration among stakeholders in the healthcare and technology sectors is imperative. Policymakers must enact supportive regulations, healthcare providers must integrate telemedicine into their practices, and technology companies must innovate to develop user-friendly platforms. Through concerted efforts, telemedicine can catalyze advancing healthcare accessibility and enhance the health and well-being of individuals worldwide.

The Digital Lifeline: Telemedicine and Artificial Intelligence Synergy as a Catalyst for Healthcare Equity in Pakistan

Telemedicine emerges as a critical innovation in Pakistan, aiming to overcome the nation's unique healthcare delivery challenges, including inadequate facilities, professional scarcity, and access disparities. Examining telemedicine's potential to bridge the healthcare gap, particularly in rural and underserved regions plagued by a digital divide and infrastructural deficits, is crucial. There is a critical need for robust digital infrastructure, regulatory frameworks, and digital literacy to facilitate telemedicine adoption. By highlighting the socio-economic and logistical obstacles alongside proposed strategic interventions, the analysis suggests that telemedicine can significantly enhance healthcare accessibility, efficiency, and equity across Pakistan, offering a pragmatic solution to its pressing healthcare needs while also opening room for artificial intelligence in the landscape.

Mapping Access to Children's Hospitals in Texas

Vehicle access, travel time, and distance to hospitals and emergency rooms with sufficient patient beds are critical healthcare accessibility measures, especially for children who require specific pediatric services. In a large state like Texas with vast rural areas and limited public transit infrastructure, 75% of the children live over an hour from the closest facility that provides pediatric emergency services or specialty care. In view of this challenge, this study first sought to map the prevailing geographical accessibility to children's hospitals and, second, to model the hospital beds per capita for each hospital's service area within the state of Texas. The results showed disparities in accessing emergency pediatric care, especially in rural areas. However, despite major metro areas recording better geographical accessibility to pediatric healthcare, residents in these areas may experience limited hospital bed availability. The findings indicate an urgent need for more pediatric healthcare services in rural Texas. Given the increasing population growth in metro areas and their surroundings, there is also a need for the expansion of healthcare infrastructure in these areas.

Supporting the Frontlines: A Scoping Review Addressing the Health Challenges of Military Personnel and Veterans

(1) Background: Military personnel and veterans meet unique health challenges that stem from the complex interplay of their service experiences, the nature of warfare, and their interactions with both military and civilian healthcare systems. This study aims to examine the myriad of injuries and medical conditions specific to this population, encompassing physical and psychological traumas. (2) Methods: A scoping review (systematic search and non-systematic review) was performed to evaluate the current landscape of military healthcare. (3) Results: A significant change in the injury profile over time is identified, linked to shifts in combat strategies and the integration of advanced technologies in warfare. Environmental exposures to diverse chemical or natural agents further complicate the health of service members. Additionally, the stressors they face, ranging from routine stress to traumatic experiences, lead to various mental health challenges. A major concern is the gap in healthcare accessibility and quality, worsened by challenges in the civilian healthcare system's capacity to address these unique needs and the military healthcare system's limitations. (4) Conclusions: This review underscores the need for holistic, integrated approaches to care, rigorous research, and targeted interventions to better serve the health needs of military personnel and veterans.

'We country women need advocacy': Birthing narratives from the Western Australian Wheatbelt region

INTRODUCTION

This study describes the experiences of eight mothers from the Wheatbelt region of Western Australia who shared their stories of travelling and/or temporarily relocating for birth.

OBJECTIVE

The aim of this study was to describe rural and remote Western Australian mothers' experiences of travelling long distances and/or relocating to give birth.

DESIGN

This study was based on Crotty's four elements of qualitative research. This study was underpinned by a constructivist epistemology, a feminist theoretical lens and a narrative approach using semistructured, story-based interviews. Participants narrated their stories of birthing away from home by telephone interview.

FINDINGS

Five major themes were identified utilising thematic analysis. These were (1) feeling forgotten in the system, (2) accessibility and choice, (3) compounded social isolation, (4) doing it hard: financial and logistical challenges and (5) building strength: advocating for myself and baby.

DISCUSSION

Mothers' stories were reflective of current and historical failures of rural maternal health policy, including widespread closures of rural birthing hospitals. Mothers described the logistical barriers they faced with little support and suggested multiple solutions that would improve their experiences.

CONCLUSION

Mothers faced significant obstacles which impeded their access to equitable maternal healthcare. This study highlights the complexities of birthing as a rural mother and the need to address maternal health inequities between rural and metropolitan women.

From Cultural Safety to Anti-Racism: Reflections on Addressing Inequities in Palliative Care

The purpose of palliative care is to ease the suffering of individuals with a serious and often life-limiting illness throughout the course of their disease by providing holistic care that considers the physical, spiritual, and psychosocial dimensions of health and well-being. Research shows that a palliative approach to care is cost-effective for the healthcare system and results in improved quality of life for patients and their loved ones. However, it is well-documented in the literature that structurally vulnerable populations have greater difficulty accessing equitable and culturally safe palliative care. Several domains are identified as contributing factors to the disparities seen in the literature, including systemic racism, cultural differences around death and suffering, and language barriers. Although Canada has had a national palliative care framework since 2018, ongoing issues of access and equity continue to disproportionately impact certain groups, including racially marginalized, immigrant, and low-income communities. In this commentary, successes and ongoing gaps in providing culturally safe and anti-racist palliative care are explored. In these proposed interventions, we advocate for a palliative approach to care that is grounded in equity, justice, and human rights.

Determinants of Patient-Perceived Primary Healthcare Quality in Lithuania

Patient-centered care is considered to be one of the essential pillars of a modern healthcare system. Thus, quality assessment based on patients' perceptions, views and experiences in their journey through the healthcare system is recognized as one of the key principles for quality improvement initiatives. Measuring patient satisfaction can be confounded by expectations and prior experiences, which can be at least partly overcome by evaluating patient-perceived healthcare quality (PPHQ). Understanding the principal constituents of PPHQ may aid healthcare professionals and decision makers in the healthcare management process and help in creating instruments to meaningfully measure patient feedback. Herein, we aimed to analyze the primary determinants of PPHQ and their interactions, with a focus on patient experiences and healthcare accessibility, using the example of Lithuanian primary healthcare. For this purpose, we conducted a cross-sectional representative telephone survey that included a total of 1033 respondents (48% male) who had encountered primary healthcare during last 3 years. Survey questions consisted of sociodemographic characteristics, patient perceptions of healthcare service provision, patient experiences, self-reported health status and overall PPHQ ranked with a 5-point Likert scale as the primary outcome. The classification-regression tree (CRT) technique was used to analyze the relationship between different explanatory variables and PPHQ, as well as their relative importance and interactions. The majority of respondents (89%) evaluated PPHQ as acceptable or good. CRT analysis identified staff behavior, organizational accessibility and financial accessibility as the most important factors affecting PPHQ. Importantly, the latter factors surpassed the effect of other known PPHQ determinants, such as sociodemographic characteristics or health status. Further analysis has revealed that the relative importance of staff behavior, including understanding, attention and empathy, increased when more problems with organizational accessibility were encountered. In conclusion, our study suggests that PPHQ in primary healthcare may primarily be determined by organizational and financial accessibility and staff behavior, which may also act as an important mediating factor.

Personas of pregnant and parenting women with substance use and their barriers and pathways to system engagement

BACKGROUND

Women with prenatal substance use have been identified as at-risk for the lack of engagement in perinatal services, such as medical care and home visitation programs. This issue is of particular concern in Florida (United States) where rates of fetal substance exposure have been steadily increasing.

METHODS

To identify pathways of and barriers to perinatal system and service engagement, journey mapping was used to compile various personas of perinatal women with substance use. A structured guide was developed to elicit maternal personas, system and service touchpoints, and system strengths and weaknesses from focus group participants with statewide stakeholders, including perinatal service administrators and community coalition members within three Florida communities. Workshop transcripts, debriefing, and member-checking sessions were transcribed verbatim and analyzed manually.

RESULTS

Six journey-mapping workshops and two member-checking meetings with mothers in-recovery were conducted with a total of 109 participants. Four personas were identified: women who (1) have substance use on a recreational basis, (2) have prescription drug use/misuse, (3) have chronic substance dependence, and (4) are in-recovery from substance dependence. Pathways that promote and barriers that prevent perinatal women with substance use from being identified, referred, or willing to accept and engage in medical care and social services were identified.

CONCLUSIONS

While these personas shed light on differential pathways experienced by women with OUD, they were not intended as fixed-member groups but rather fluid descriptions of circumstances in which individuals could shift over time. These personas are beneficial to understand differences in circumstances, as well as variations in pathways and barriers to service engagement. Additionally, personas may be used to identify approaches to optimize service engagement by perinatal women with substance use and to support system improvements and integrations.

Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources

African American/Black communities comprise 12.2% of the U.S. population, with a COVID-19 infection rate of more than 18% and marginal access to healthcare services. This scoping review synthesizes the emerging evidence on healthcare accessibility among older African American adult communities with dementia and COVID-19, as well as the resource requirements for this population during the pandemic. Searches of different databases for empirical studies and other sources on dementia and COVID-19 among older African American adults yielded 13 studies that met the following inclusion criteria: (a) focus on dementia and COVID-19, (b) sampled older African American adults, (c) investigated healthcare accessibility and resources, and (d) published between 2019 and 2022. Following the initial selection of the studies, eight were selected for relevance based on the Population, Concept, and Context (PCC) inclusion and exclusion criteria. Thematic analysis indicated that older African Americans with dementia and COVID-19 experienced longer delays in accessing timely healthcare, including transportation, intensive care units (ICUs), and mechanical ventilation. They also had reduced healthcare resources associated with a lack of health insurance, low financial resources, and an increased length of hospital stay, which further aggravated the negative effects of comorbid dementia and COVID-19 infections. Evidence showed that racial and age disparities affected older African American adults with dementia and COVID-19, resulting in lower healthcare access and marginal resources. This is consistent with historical and systemic inequities in meeting the healthcare needs of people of color in the United States, which was compounded for older African Americans during the COVID-19 pandemic.

Patient and Caregiver Perspectives on Telehealth Use in a Multidisciplinary Huntington's Disease Clinic: A Single-Institution Experience

BACKGROUND

The coronavirus pandemic saw technology evolve as outpatient clinics faced restriction of in-person visits. Reliance on telemedicine using two-way audio-video communication significantly increased. Telemedicine was observed to be convenient, cost-effective, reduced no-show rates, and fostered sustained engagement. Enhanced flexibility from short notice scheduling benefitted patients and their caregivers. Greater time value was perceived by patients, and reduced reliance on caregivers. Disadvantages included barriers of access to internet connectivity or equipment.

OBJECTIVE

We aimed to retrospectively survey patients with Huntington's disease (HD) seen via telehealth in our HDSA Center for Excellence Multidisciplinary clinic. We evaluated usability, learnability, interface quality, reliability, and future use.

METHODS

This qualitative survey used the 21-item Telehealth Usability Questionnaire. Close-ended responses ranged from strongly disagree to strongly agree scored on Likert scale (1 through 7). Averages were calculated to examine attitudes towards telemedicine. Spearman correlation test was performed to detect attitude biases between patients and caregivers.

RESULTS

Respondents were more likely than not to strongly agree with survey statements. Average attitude score of 5.92 (range 2.95-7.00) suggested favorability and improved convenience when telehealth was used in complement to in-person visits, without detriment to patient-provider communication. Spearman correlation coefficient between patient and family/caregiver groups was 0.023, which is below the cutoff of 0.344 for a = 0.05 at N = 24. This suggests there was no bias between patient and caregiver attitudes.

CONCLUSION

This study demonstrated telehealth is favored by caregivers and patients with HD. This population with specific physical, cognitive and psychiatric needs can benefit from adaptive systems that enhance compliance.

Impact of traffic congestion on spatial access to healthcare services in Nairobi

Background

Geographic accessibility is an important determinant of healthcare utilization and is critical for achievement of universal health coverage. Despite the high disease burden and severe traffic congestion in many African cities, few studies have assessed how traffic congestion impacts geographical access to healthcare facilities and to health professionals in these settings. In this study, we assessed the impact of traffic congestion on access to healthcare facilities, and to the healthcare professionals across the healthcare facilities.

Methods

Using data on health facilities obtained from the Ministry of Health in Kenya, we mapped 944 primary, 94 secondary and four tertiary healthcare facilities in Nairobi County. We then used traffic probe data to identify areas within a 15-, 30- and 45-min drive from each health facility during peak and off-peak hours and calculated the proportion of the population with access to healthcare in the County. We employed a 2-step floating catchment area model to calculate the ratio of healthcare and healthcare professionals to population during these times.

Results

During peak hours, <70% of Nairobi's 4.1 million population was within a 30-min drive from a health facility. This increased to >75% during off-peak hours. In 45 min, the majority of the population had an accessibility index of one health facility accessible to more than 100 people (<0.01) for primary health care facilities, one to 10,000 people for secondary facilities, and two health facilities per 100,000 people for tertiary health facilities. Of people with access to health facilities, a sub-optimal ratio of <4.45 healthcare professionals per 1,000 people was observed in facilities offering primary and secondary healthcare during peak and off-peak hours.

Conclusion

Our study shows access to healthcare being negatively impacted by traffic congestion, highlighting the need for multisectoral collaborations between urban planners, health sector and policymakers to optimize health access for the city residents. Additionally, growing availability of traffic probe data in African cities should enable similar analysis and understanding of healthcare access for city residents in other countries on the continent.

Factors associated with eHealth use among community dwelling older adults

BACKGROUND

With the proliferation of the internet and the development of internet-based healthcare interventions, eHealth is expected to be an effective complement to traditional healthcare services. However, without understanding the characteristics of the user population, eHealth itself can isolate older adults.

AIM

This study aims to identify the characteristics of internet use and the factors associated with eHealth use among older adults.

METHODS

A secondary data analysis was conducted from a cross-sectional descriptive study. A convenience sample of 186 community dwelling older adults was recruited at two senior welfare centres in Korea. The data collected included demographic characteristics, health related characteristics, internet use, eHealth use and eHealth literacy. Multiple linear regression was utilized to determine factors related to eHealth use.

RESULTS

Among 186 respondents, 98 reported that they used the internet. Internet usage was associated with educational attainment, marital status, cognitive function and possession of internet-enabled devices. The results of multiple regression analysis showed that greater eHealth usage was related to more positive perception of eHealth usability and better eHealth literacy among older adults.

CONCLUSION

Educational programmes for older adults should be developed to facilitate digital capability and eHealth literacy. Useful and effective online health resources that are easy to use should be also developed.

Facility or Transport Inequality? Decomposing Healthcare Accessibility Inequality in Shenzhen, China

Accessibility to healthcare services is crucial for residents’ wellbeing. Numerous studies have revealed significant spatial inequality in healthcare accessibility across various contexts. However, it still remains unclear whether the inequality is caused by the unbalanced spatial distribution of healthcare facilities or by unequal transport access to them. This study decomposes inequality in healthcare accessibility into facility- and transport-driven inequality by comparing scenarios of healthcare accessibility, which consider various combinations of multidimensional components of accessibility using different distance measures. Using a case study in Shenzhen, this study reveals that both facility distribution and transport access substantially contribute to spatial inequality in healthcare accessibility. Facility distribution accounts for 61.3% and 50.8% of the overall accessibility inequality for driving and transit modes, respectively. The remaining inequality is induced by imbalanced mobility provided by transport networks. Furthermore, the impact of transport component on healthcare accessibility is unevenly distributed. This study highlights that both facility- and transport-related countermeasures should be considered to improve the accessibility and equality of healthcare services. It provides transferable methods for quantitatively decomposing facility- and transport-driven inequality in accessibility to healthcare or other facilities.

Investigating eye examination-related anxiety in autistic adults

CLINICAL RELEVANCE

It is important to investigate whether anxiety is a barrier to accessing eye examinations for autistic adults, because existing research suggests this population are more likely to develop ophthalmic abnormalities.

BACKGROUND

Anxiety influences healthcare accessibility for autistic people without learning disabilities. Previous qualitative studies by the research team, with a small sample of autistic adults, have indicated several aspects of eyecare services which cause anxiety. Considering the limited existing research suggesting autistic individuals are more likely to develop ophthalmic abnormalities, this study explored whether this population more widely experiences anxiety when accessing eye examinations.

METHODS

A total of 322 UK-based autistic adults completed the Optometric Patient Anxiety Scale (OPAS) online, between July and December 2020. Rasch analysis was used to validate this questionnaire for an autistic adult population, and compare optometric anxiety levels to the general population.

RESULTS

Item infit (0.77 to 1.39) and outfit (0.78 to 1.33) values, the person separation index (2.64), and item (0.99) and person (0.97) reliability coefficients suggested that all 10 items in the OPAS are useful to assess optometric anxiety in an autistic adult population. Item probability curves confirmed the response scale to be appropriate. A comparison of optometric anxiety between the autistic population in the current study and a general population in previous work found no statistically significant difference.

CONCLUSION

The OPAS is a statistically valid tool for use in the autistic adult population. It appears to suggest no significant difference in optometric anxiety between the autistic adult and general population. However, it is possible that it underestimates the true optometric anxiety of autistic adults since the items do not include some of the anxiety provoking factors for this population which have been indicated in previous studies by the research team.

Comparing absolute and relative distance and time travel measures of geographic access to healthcare facilities in rural Haiti

INTRODUCTION

While travel distance and time are important proxies of physical access to health facilities, obtaining valid measures with an appropriate modelling method remains challenging in many settings. We compared five measures of geographic accessibility in Haiti, producing recommendations that consider available analytic resources and geospatial goals.

METHODS

Eight public hospitals within the ministry of public health and population were included. We estimated distance and time between hospitals and geographic centroids of Haiti's section communes and population-level accessibility. Geographic feature data were obtained from public administrative databases, academic research databases and government satellites. We used validated geographic information system methods to produce five geographic access measures: (1) Euclidean distance (ED), (2) network distance (ND), (3) network travel time (NTT), (4) AccessMod 5 (AM5) distance (AM5D) and (5) AM5 travel time (AM5TT). Relative ranking of section communes across the measures was assessed using Pearson correlation coefficients, while mean differences were assessed using analysis of variance (ANOVA) and pairwise t-tests.

RESULTS

All five geographic access measures were highly correlated (range: 0.78-0.99). Of the distance measures, ED values were consistently the shortest, followed by AM5D values, while ND values were the longest. ND values were as high as 2.3 times ED values. NTT models generally produced longer travel time estimates compared with AM5TT models. ED consistently overestimated population coverage within a given threshold compared with ND and AM5D. For example, population-level accessibility within 15 km of the nearest studied hospital in the Center department was estimated at 68% for ED, 50% for AM5D and 34% for ND.

CONCLUSION

While the access measures were highly correlated, there were significant differences in the absolute measures. Consideration of the benefits and limitations of each geospatial measure together with the intended purpose of the estimates, such as relative proximity of patients or service coverage, are key to guiding appropriate use.

Healthcare Safety Nets during the COVID-19 Pandemic Based on Double Diamond Model: A Concept Analysis

The purpose of this study was to analyze the concept of the "healthcare safety net" during the COVID-19 pandemic. Walker and Avant's process of concept analysis was used in this systematic literature review. The attributes of the concept of a healthcare safety net during the COVID-19 pandemic were found to be: (a) capacity, (b) accessibility, (c) health equality, and (d) education. In consideration of these defining criteria, antecedents to the concept were identified as: (a) the COVID-19 pandemic, (b) health inequalities (internal factors and external factors), and (c) healthcare systems (health insurance, screening, protective equipment, medicine, and medical services). Consequences of the concept were: (a) meeting healthcare needs, (b) quality of life, and (c) a decrease in morbidity and mortality. A healthcare safety net is an important concept during the COVID-19 pandemic. In situations like COVID-19, healthcare safety nets are designed to meet safety needs, improve quality of life, and reduce patient turnover and mortality. Based on the results of this study, the development of standardized tools for measuring a healthcare safety net as well as that of policies and systems for resolving a healthcare safety net in the COVID-19 situation is recommended.

Accessibility and site suitability for healthcare services using GIS-based hybrid decision-making approach: a study in Murshidabad, India

Healthcare accessibility and site suitability analysis is an elongated and complex task that requires evaluation of different decision factors. The main objective of the present study was to develop a hybrid decision-making approach with geographic information systems to integrate spatial and non-spatial data to form a weighted result. This study involved three-tier analyses for assessing accessibility and selecting suitable sites for healthcare facilities, and analysing shortest-path network. The first tier of analysis stressed the spatial distance, density and proximity from existing healthcare to find more deprived and inaccessible areas in term of healthcare facilities. The result revealed that spatial discrepancy exists in the study area in term of access to healthcare facilities and for achieving equal healthcare access, it is essential to propose new plans. Thus, require finding suitable sites for put forward new healthcare service, which was highlighted in the second tier of analysis based on land use land cover, distancing to road and rail, proximity to residential areas, and weighted overlay of accessibility as decision factors. Finally, in the third tier of analysis, the most suitable site among the proposed healthcare was identified using the technique for order of preference by similarity to ideal solution. The road network analysis was also performed in this study to determine the shortest and fastest route from these healthcare facilities to connect with district medical hospital. The present study found some suitable sites throughout the district on inaccessible zones where people are deprived from better healthcare facilities. This attempt will highly helpful for preparing a spatial decision support system which assists the health authorities regarding the healthcare services in inaccessible, underprivileged, and rural areas.

The Geography of Farmworker Health in Colorado: An Examination of Disease Clusters and Healthcare Accessibility

Background: Known by some as the "invisible" people because of their precarious work and low social status, migratory and seasonal farmworkers (MSFW) are a critical and underappreciated component to the agriculture industry in the United States. Despite advances in knowledge about the health needs of this population, identifying geographies of high-risk remains a challenging task for community health workers and farmworker advocacy organizations.Methods: Using patient encounter data (2011-2015) from regional Community and Migrant Health Centers (C/MHC), this study investigates the geography of farmworker chronic disease (diabetes, obesity, hypertension) and associated risk factors (anxiety, stress, depression, tobacco use) in Northeastern Colorado through the lens of Geographic Information Science (GIS).Results: Spatial scan statistics (SaTScan) identified disease cluster hot spots in 151 zip codes and chronic disease risk factor clusters in 44 zip codes. Additionally, 13487 farmworkers or 82% of the total population is found in zip codes designated as chronic disease hot spots, while 10,115 or 62% of the population reside in zip codes identified as risk factor hot spots. GIS-based Network Analysis determined that 1,269 farmworkers lived greater than 30 minutes from a C/MHC, or 7.7% of the total population in the study area (n = 16,419).Conclusions: The findings of this study confirm the need for geospatial analytics in farmworker population healthcare management. These methods, combined with multiple contextual and methodological perspectives, will inform appropriate outreach, research, and policy strategies, and further, serve to address the unique geographic challenges facing MSFW's in Northeastern Colorado.

Barriers and Mitigating Strategies to Healthcare Access in Indigenous Communities of Canada: A Narrative Review

The objective of this review is to document contemporary barriers to accessing healthcare faced by Indigenous people of Canada and approaches taken to mitigate these concerns. A narrative review of the literature was conducted. Barriers to healthcare access and mitigating strategies were aligned into three categories: proximal, intermediate, and distal barriers. Proximal barriers include geography, education attainment, and negative bias among healthcare professionals resulting in a lack of or inadequate immediate care in Indigenous communities. Intermediate barriers comprise of employment and income inequities and health education systems that are not accessible to Indigenous people. Distal barriers include colonialism, racism and social exclusion, resulting in limited involvement of Indigenous people in policy making and planning to address community healthcare needs. Several mitigation strategies initiated across Canada to address the inequitable health concerns include allocation of financial support for infrastructure development in Indigenous communities, increases in Indigenous education and employment, development of culturally sensitive education and medical systems and involvement of Indigenous communities and elders in the policy-making system. Indigenous people in Canada face systemic/policy barriers to equitable healthcare access. Addressing these barriers by strengthening services and building capacity within communities while integrating input from Indigenous communities is essential to improve accessibility.

Evidence of interventions for improving healthcare access for lesbian, gay, bisexual and transgender people in South Africa: A scoping review

Background

The lesbian, gay, bisexual and transgender (LGBT) populations have unique health risks including an increased risk of mental health problems, high usage of recreational drugs and alcohol, and high rates of infection with human immunodeficiency virus (HIV). Healthcare workers’ heteronormative attitudes compromise the quality of care to the LGBT population.

Aim

The objective of this study was to provide an overview of documented evidence on South Africa interventions aimed at improving healthcare access for LGBT individuals using a systematic scoping review.

Setting

This is a secondary literature review.

Methods

An electronic search was conducted using the following databases: EBSCOhost, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Abstract and full article data were screened using inclusion and exclusion criteria by two researchers. Data extracted from the eligible studies were analysed using thematic analysis. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool, version 2011.

Results

Seventeen articles of the initial 151 hits were selected for review and an additional five files were identified through bibliographical search. Most studies had small sample sizes and focused on sexual health, targeting gay men and men who have sex with men in urban areas. Lesbians and bisexual women were not prioritised.

Discussion

It emerged from the review that LGBT issues were not covered in the healthcare worker curriculum. Further it was noted that there is a paucity of data on the South African LGBT population, as sexual orientation does not form part of the routine data set. The findings of this review indicate gaps in the literature, practice guidelines and policies in LGBT healthcare in South Africa.

An Improved Healthcare Accessibility Measure Considering the Temporal Dimension and Population Demand of Different Ages

Healthcare accessibility has become an issue of social equity. An accurate estimation of existing healthcare accessibility is vital to plan and allocate health resources. Healthcare capacity, population demand, and geographic impedance are three essential factors to measure spatial accessibility. Additionally, geographic impedance is usually represented with a function of travel time. In this paper, the three-step floating catchment area (3SFCA) method is improved from the perspectives of the temporal dimension and population demand. Specifically, the travel time from the population location to the service site is precisely calculated by introducing real-time traffic conditions instead of utilizing empirical speed in previous studies. Additionally, with the utilization of real-time traffic, a dynamic result of healthcare accessibility is derived during different time periods. In addition, since the medical needs of the elderly are higher than that of the young, a demand weight index of demand is introduced to adjust the population demand. A case study of healthcare accessibility in Wuhan shows that the proposed method is effective to measure healthcare accessibility during different time periods. The spatial accessibility disparities of communities and crowdedness of hospitals are identified as an important reference for the balance between the supply and demand of medical resources.

Evaluating the Accessibility of Healthcare Facilities Using an Integrated Catchment Area Approach

Accessibility is a major method for evaluating the distribution of service facilities and identifying areas in shortage of service. Traditional accessibility methods, however, are largely model-based and do not consider the actual utilization of services, which may lead to results that are different from those obtained when people's actual behaviors are taken into account. Based on taxi GPS trajectory data, this paper proposed a novel integrated catchment area (ICA) that integrates actual human travel behavior to evaluate the accessibility to healthcare facilities in Shenzhen, China, using the enhanced two-step floating catchment area (E2SFCA) method. This method is called the E2SFCA-ICA method. First, access probability is proposed to depict the probability of visiting a healthcare facility. Then, integrated access probability (IAP), which integrates model-based access probability (MAP) and data-based access probability (DAP), is presented. Under the constraint of IAP, ICA is generated and divided into distinct subzones. Finally, the ICA and subzones are incorporated into the E2SFCA method to evaluate the accessibility of the top-tier hospitals in Shenzhen, China. The results show that the ICA not only reduces the differences between model-based catchment areas and data-based catchment areas, but also distinguishes the core catchment area, stable catchment area, uncertain catchment area and remote catchment area of healthcare facilities. The study also found that the accessibility of Shenzhen's top-tier hospitals obtained with traditional catchment areas tends to be overestimated and more unequally distributed in space when compared to the accessibility obtained with integrated catchment areas.

"You need to be an advocate for yourself": Factors associated with decision-making regarding influenza and pneumococcal vaccine use among US older adults from within a large metropolitan health system

In the United States, influenza and pneumonia account significantly to emergency room use and hospitalization of adults >65 y. The Centers for Disease Control and Prevention recommends use of the annual influenza vaccine and 2 pneumococcal vaccines for older adults to decrease risks of morbidity and mortality. However, actual vaccine up-take is estimated at 61.3% for pneumococcal vaccines and 65% for influenza vaccine in the 2013-2014 season. Vaccine up-take is affected by multiple socio-cultural and economic factors including general healthcare access and utilization, social networks and norms, communication with health providers and health information sources, as well as perceptions related to vaccines and targeted diseases. In this study, 8 focus group discussions (total N = 48) were conducted with adults 65+ years living in urban and suburban communities in the Detroit Metropolitan Area. The research objective was to increase understanding of barriers and facilitators to vaccine up-take in this age cohort within the context of general healthcare availability and accessibility, social networks, information sources, and personal perceptions of diseases and vaccines. The data suggest the need to integrate broader health care service experiences, concepts of knowledge of one's own well-being and vulnerabilities, and self-advocacy as factors associated with older adults' vaccine-use decisions. These data also support recognition of multiple levels of vaccine acceptance which can be disease specific. Implications include potential for increasing vaccine up-take through general improvement in health care delivery and services, as well as specific vaccine-focused patient and provider education programs.