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Iezadi S, Gholipour K, Sherbafi J, Behpaie S, Soltani N, Pasha M, Farahishahgoli J. Service quality: perspective of people with type 2 diabetes mellitus and hypertension in rural and urban public primary healthcare centers in Iran. BMC Health Serv Res 2024; 24:517. [PMID: 38658925 PMCID: PMC11044473 DOI: 10.1186/s12913-024-10854-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/12/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE This study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran. METHODS The Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17. RESULTS Among the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants' anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score (P = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p < 0.001) compared to the group without specific service providers. CONCLUSION Study reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas.
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Affiliation(s)
- Shabnam Iezadi
- Tabriz Health Services Management Research Center, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Tabriz Health Services Management Research Center, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Jabraeil Sherbafi
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sama Behpaie
- Student Research Committee, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazli Soltani
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Pasha
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Farahishahgoli
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
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Leeman L, Goldstein JT. Promoting Safety in Community-Based Birth Settings. Am Fam Physician 2021; 103:650-652. [PMID: 34060780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lawrence Leeman
- University of New Mexico School of Medicine, Albuquerque, NM, USA
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Mugambe RK, Yakubu H, Wafula ST, Ssekamatte T, Kasasa S, Isunju JB, Halage AA, Osuret J, Bwire C, Ssempebwa JC, Wang Y, McGriff JA, Moe CL. Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda. BMC Pregnancy Childbirth 2021; 21:329. [PMID: 33902472 PMCID: PMC8077901 DOI: 10.1186/s12884-021-03789-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/14/2020] [Accepted: 04/08/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. METHODS Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers' sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. RESULTS The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01-1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02-1.17)] favoured facility delivery while a higher parity of 3-4 [APR = 0.93, 95% CI (0.88-0.99)] was inversely associated with health facility delivery as compared to parity of 1-2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05-1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04-1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78-0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08-1.19)]. CONCLUSION Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.
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Affiliation(s)
- Richard K Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Habib Yakubu
- The Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Solomon T Wafula
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Simon Kasasa
- Department of Epidemiology and Biostatistics, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Abdullah Ali Halage
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Jimmy Osuret
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Constance Bwire
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - John C Ssempebwa
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Yuke Wang
- The Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Joanne A McGriff
- The Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Christine L Moe
- The Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
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Malik AT, Bonsu JM, Roser M, Khan SN, Phieffer LS, Ly TV, Harrison RK, Quatman CE. What Is the Quality of Surgical Care for Patients with Hip Fractures at Critical Access Hospitals? Clin Orthop Relat Res 2021; 479:9-16. [PMID: 32833925 PMCID: PMC7899572 DOI: 10.1097/corr.0000000000001458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/24/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Critical access hospitals (CAHs) play an important role in providing access to care for many patients in rural communities. Prior studies have shown that these facilities are able to provide timely and quality care for patients who undergo various elective and emergency general surgical procedures. However, little is known about the quality and reimbursement of surgical care for patients undergoing surgery for hip fractures at CAHs compared with non-CAH facilities. QUESTIONS/PURPOSES Are there any differences in 90-day complications, readmissions, mortality, and Medicare payments between patients undergoing surgery for hip fractures at CAHs and those undergoing surgery at non-CAHs? METHODS The 2005 to 2014 Medicare 100% Standard Analytical Files were queried using ICD-9 procedure codes to identify Medicare-eligible beneficiaries undergoing open reduction and internal fixation (79.15, 79.35, and 78.55), hemiarthroplasty (81.52), and THA (81.51) for isolated closed hip fractures. This database was selected because the claims capture inpatient diagnoses, procedures, charged amounts and paid claims, as well as hospital-level information of the care, of Medicare patients across the nation. Patients with concurrent fixation of an upper extremity, lower extremity, and/or polytrauma were excluded from the study to ensure an isolated cohort of hip fractures was captured. The study cohort was divided into two groups based on where the surgery took place: CAHs and non-CAHs. A 1:1 propensity score match, adjusting for baseline demographics (age, gender, Census Bureau-designated region, and Elixhauser comorbidity index), clinical characteristics (fixation type and time to surgery), and hospital characteristics (whether the hospital was located in a rural ZIP code, the average annual procedure volume of the operating facility, hospital bed size, hospital ownership and teaching status), was used to control for the presence of baseline differences in patients presenting at CAHs and those presenting at non-CAHs. A total of 1,467,482 patients with hip fractures were included, 29,058 of whom underwent surgery in a CAH. After propensity score matching, each cohort (CAH and non-CAH) contained 29,058 patients. Multivariate logistic regression analyses were used to assess for differences in 90-day complications, readmissions, and mortality between the two matched cohorts. As funding policies of CAHs are regulated by Medicare, an evaluation of costs-of-care (by using Medicare payments as a proxy) was conducted. Generalized linear regression modeling was used to assess the 90-day Medicare payments among patients undergoing surgery in a CAH, while controlling for differences in baseline demographics and clinical characteristics. RESULTS Patients undergoing surgery for hip fractures were less likely to experience many serious complications at a critical access hospital (CAH) than at a non-CAH. In particular, after controlling for patient demographics, hospital-level factors and procedural characteristics, patients treated at a CAH were less likely to experience: myocardial infarction (3% (916 of 29,058) versus 4% (1126 of 29,058); OR 0.80 [95% CI 0.74 to 0.88]; p < 0.001), sepsis (3% (765 of 29,058) versus 4% (1084 of 29,058); OR 0.69 [95% CI 0.63 to 0.78]; p < 0.001), acute renal failure (6% (1605 of 29,058) versus 8% (2353 of 29,058); OR 0.65 [95% CI 0.61 to 0.69]; p < 0.001), and Clostridium difficile infections (1% (367 of 29,058) versus 2% (473 of 29,058); OR 0.77 [95% CI 0.67 to 0.88]; p < 0.001) than undergoing surgery in a non-CAH. CAHs also had lower rates of all-cause 90-day readmissions (18% (5133 of 29,058) versus 20% (5931 of 29,058); OR 0.83 [95% CI 0.79 to 0.86]; p < 0.001) and 90-day mortality (4% (1273 of 29,058) versus 5% (1437 of 29,058); OR 0.88 [95% CI 0.82 to 0.95]; p = 0.001) than non-CAHs. Further, CAHs also had risk-adjusted lower 90-day Medicare payments than non-CAHs (USD 800, standard error 89; p < 0.001). CONCLUSION Patients who received hip fracture surgical care at CAHs had a lower risk of major medical and surgical complications than those who had surgery at non-CAHs, even though Medicare reimbursements were lower as well. Although there may be some degree of patient selection at CAHs, these facilities appear to provide high-value care to rural communities. These findings provide evidence for policymakers evaluating the impact of the CAH program and allocating funding resources, as well as for community members seeking emergent care at local CAH facilities. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Azeem Tariq Malik
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Janice M Bonsu
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Megan Roser
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Safdar N Khan
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura S Phieffer
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thuan V Ly
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ryan K Harrison
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carmen E Quatman
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
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Johnston K, Smith D, Preston R, Evans R, Carlisle K, Lengren J, Naess H, Phillips E, Shephard G, Lydiard L, Lattimore D, Larkins S. "From the technology came the idea": safe implementation and operation of a high quality teleradiology model increasing access to timely breast cancer assessment services for women in rural Australia. BMC Health Serv Res 2020; 20:1103. [PMID: 33256724 PMCID: PMC7708244 DOI: 10.1186/s12913-020-05922-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer in Australian women. Providing timely diagnostic assessment services for screen-detected abnormalities is a core quality indicator of the population-based screening program provided by BreastScreen Australia. However, a shortage of local and locum radiologists with availability and appropriate experience in breast work to attend onsite assessment clinics, limits capacity of services to offer assessment appointments to women in some regional centres. In response to identified need, local service staff developed the remote radiology assessment model for service delivery. This study investigated important factors for establishing the model, the challenges and enablers of successful implementation and operation of the model, and factors important in the provision of a model considered safe and acceptable by service providers. METHODS Semi-structured interviews were conducted with service providers at four assessment services, across three jurisdictions in Australia. Service providers involved in implementation and operation of the model at the service and jurisdictional level were invited to participate. A social constructivist approach informed the analysis. Deductive analysis was initially undertaken, using the interview questions as a classifying framework. Subsequently, inductive thematic analysis was employed by the research team. Together, the coding team aggregated the codes into overarching themes. RESULTS 55 service providers participated in interviews. Consistently reported enablers for the safe implementation and operation of a remote radiology assessment clinic included: clinical governance support; ability to adapt; strong teamwork, trust and communication; and, adequate technical support and equipment. Challenges mostly related to technology and internet (speed/bandwidth), and maintenance of relationships within the group. CONCLUSIONS Understanding the key factors for supporting innovation, and implementing new and safe models of service delivery that incorporate telemedicine, will become increasingly important as technology evolves and becomes more accessible. It is possible to take proposed telemedicine solutions initiated by frontline workers and operationalise them safely and successfully: (i) through strong collaborative relationships that are inclusive of key experts; (ii) with clear guidance from overarching bodies with some flexibility for adapting to local contexts; (iii) through establishment of robust teamwork, trust and communication; and, (iv) with appropriate equipment and technical support.
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Affiliation(s)
- Karen Johnston
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia.
| | - Deborah Smith
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Sciences, CQUniversity, QLD, Townsville, 4810, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Janet Lengren
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Helen Naess
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Elizabeth Phillips
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Greg Shephard
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | | | | | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
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Waxman AG, Haffner WHJ, Howe J, Wilder K, Ogburn T, Murphy N, Espey E, Tucker JM, Bruegl A, Locke E, Malloy Y. A 50-Year Commitment to American Indian and Alaska Native Women. Obstet Gynecol 2020; 136:739-744. [PMID: 32925622 DOI: 10.1097/aog.0000000000004040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.
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Affiliation(s)
- Alan G Waxman
- University of New Mexico, Albuquerque, New Mexico; the Uniformed Services University of the Health Sciences, Bethesda, Maryland; the Northern Navajo Medical Center, Shiprock, New Mexico; the Mid-Columbia Medical Center, The Dalles, Oregon; the University of Texas Rio Grande Valley, Edinburg, Texas; the Alaska Native Medical Center, Anchorage, Alaska; the University of Mississippi Medical Center, Jackson, Mississippi; the Oregon Health and Science University, Portland, Oregon; and the American College of Obstetricians and Gynecologists, Washington, DC
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Halverson AL. Rural Surgical Quality: Policy and Practice. Surg Clin North Am 2020; 100:901-908. [PMID: 32882172 DOI: 10.1016/j.suc.2020.07.001] [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] [Indexed: 11/18/2022]
Abstract
Several national studies have demonstrated that rural hospitals successfully deliver high-quality care. Data at the national, regional, institutional, and individual practitioner levels all contribute to understanding of surgical outcomes in the rural setting. Quality metrics should be interpreted within the context of the rural community and outcomes analyzed with relevant risk adjustment for patient factors.
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Affiliation(s)
- Amy L Halverson
- Northwestern University Feinberg School of Medicine, 676 North Street Clair, Suite 650, Chicago, IL 60611, USA.
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Kawamoto R, Ninomiya D, Akase T, Kikuchi A, Kumagi T. The effect of short-term exposure to rural interprofessional work on medical students. Int J Med Educ 2020; 11:136-137. [PMID: 32581144 PMCID: PMC7870448 DOI: 10.5116/ijme.5eb6.81cb] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/09/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Ryuichi Kawamoto
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Daisuke Ninomiya
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Taichi Akase
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Asuka Kikuchi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Teru Kumagi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
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Askelson NM, Ryan G, Seegmiller L, Pieper F, Kintigh B, Callaghan D. Implementation Challenges and Opportunities Related to HPV Vaccination Quality Improvement in Primary Care Clinics in a Rural State. J Community Health 2020; 44:790-795. [PMID: 31102115 DOI: 10.1007/s10900-019-00676-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Efforts to understand low human papillomavirus vaccine coverage led us to explore quality improvement (QI) decision-making programs and processes to increase vaccine uptake. These QI programs often include interventions recommended by the AFIX (Assessment Feedback Incentives eXchange) Program that supports Vaccines for Children (VFC) clinics. However, little is known about decision-making around intervention selection or extent of implementation. In collaboration with the state public health department in the rural Midwestern, investigators developed a survey to explore vaccine-related QI in VFC clinics. The survey was distributed via email to all VFC clinics (n = 605); results presented are from the primary care clinics (n = 115). Respondents (VFC liaisons) reported decisions about vaccine QI were made by multiple actors within their own clinics (45.1%), by a clinic manager in charge of multiple clinics (33.0%) and/or at a centralized administrative office (35.2%). Additionally, the majority of respondents considered external actors, like insurance companies (52.7%) or Medicaid/Medicare (50.5%), important to the decision-making process. Most commonly implemented interventions focused on provider knowledge and patient education. Least commonly implemented interventions required systematic changes, such as reminder/recall and follow-up after missed appointments. This preliminary research indicates there are multiple points of decision-making within clinics and health care systems, and therefore change agents at all points need to be involved. The most commonly implemented interventions focus on providers and patients, with an emphasis on education. Interventions requiring system-level changes and use of electronic health records are less common and more attention should be directed towards such interventions.
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Affiliation(s)
- Natoshia M Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, USA
- Public Policy Center, University of Iowa, 310 S Grand Ave, Iowa City, Iowa, USA
| | - Grace Ryan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, USA.
- Public Policy Center, University of Iowa, 310 S Grand Ave, Iowa City, Iowa, USA.
| | - Laura Seegmiller
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, USA
| | - Felicia Pieper
- Public Policy Center, University of Iowa, 310 S Grand Ave, Iowa City, Iowa, USA
| | - Bethany Kintigh
- Bureau of Immunization and Tuberculosis, Iowa Department of Public Health, Des Moines, Iowa, USA
| | - Donald Callaghan
- Bureau of Immunization and Tuberculosis, Iowa Department of Public Health, Des Moines, Iowa, USA
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Garcia B, Christon L, Gray S. In the south, if you give us lemons, we will make you lemonade. J Cyst Fibros 2020; 19:842-843. [PMID: 32546432 PMCID: PMC7269958 DOI: 10.1016/j.jcf.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Bryan Garcia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine. Medical University of South Carolina, Charleston SC, United States of America.
| | - Lillian Christon
- Department of Psychiatry and Behavioral Sciences, Division of Biobehavioral Medicine. Medical University of South Carolina, Charleston SC, United States of America
| | - Sue Gray
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine. Medical University of South Carolina, Charleston SC, United States of America
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Gajewski J, Monzer N, Pittalis C, Bijlmakers L, Cheelo M, Kachimba J, Brugha R. Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia. Hum Resour Health 2020; 18:25. [PMID: 32216789 PMCID: PMC7098155 DOI: 10.1186/s12960-020-00467-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/11/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. METHODS Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding. RESULTS Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision. CONCLUSION This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes.
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Affiliation(s)
- Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Nasser Monzer
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Chiara Pittalis
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Leon Bijlmakers
- Radboud University Medical Centre Netherlands, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, P.O. Box 50110, Lusaka, Zambia
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, P.O. Box 50110, Lusaka, Zambia
| | - Ruairi Brugha
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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Klein PW, Geiger T, Chavis NS, Cohen SM, Ofori AB, Umali KT, Hauck H. The Health Resources and Services Administration's Ryan White HIV/AIDS Program in rural areas of the United States: Geographic distribution, provider characteristics, and clinical outcomes. PLoS One 2020; 15:e0230121. [PMID: 32203556 PMCID: PMC7089565 DOI: 10.1371/journal.pone.0230121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background People living with HIV (PLWH) residing in rural areas experience substantial barriers to HIV care, which may contribute to poor HIV health outcomes, including retention in HIV care and viral suppression. The Health Resources and Services Administration’s Ryan White HIV/AIDS Program (HRSA RWHAP) is an important source of HIV medical care and support services in rural areas. The purpose of this analysis was to (1) assess the reach of the RWHAP in rural areas of the United States, (2) compare the characteristics and funded services of RWHAP provider organizations in rural and non-rural areas, and (3) compare the characteristics and clinical outcomes of RWHAP clients accessing medical care and support services in rural and non-rural areas. Methods and findings Data for this analysis were abstracted from the 2017 RWHAP Services Report (RSR), the primary source of annual, client-level RWHAP data. Organizations funded to deliver RWHAP any service (“RWHAP providers”) were categorized as rural or non-rural according to the HRSA FORHP’s definition of modified Rural-Urban Commuting Area (RUCA) codes. RWHAP clients were categorized based on their patterns of RWHAP service use as “visited only rural providers,” “visited only non-rural providers,” or “visited rural and non-rural providers.” In 2017, among the 2,113 providers funded by the RWHAP, 6.2% (n = 132) were located in HRSA-designated rural areas. Rural providers were funded to deliver a greater number of service categories per site than non-rural providers (44.7% funded for ≥5 services vs. 34.1% funded for ≥5 services, respectively). Providers in rural areas served fewer clients than providers in non-rural areas; 47.3% of RWHAP providers in rural areas served 1–99 clients, while 29.6% of non-rural providers served 1–99 clients. Retention in care and viral suppression outcomes did not differ on the basis of whether a client accessed services from rural or non-rural providers. Conclusions RWHAP providers are a crucial component of HIV care delivery in the rural United States despite evidence of significant barriers to engagement in care for rural PLWH, RWHAP clients who visited rural providers were just as likely to be retained in care and reach viral suppression as their counterparts who visited non-rural providers. The RWHAP, especially in partnership with Rural Health Clinics and federally funded Health Centers, has the infrastructure and expertise necessary to address the HIV epidemic in rural America.
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Affiliation(s)
- Pamela W. Klein
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
- * E-mail:
| | - Tanya Geiger
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Alexa B. Ofori
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Kathryn T. Umali
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Heather Hauck
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
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Irwin AJ. Improving patient satisfaction at a rural urgent care center. Nurs Manag (Harrow) 2020; 51:13-15. [PMID: 31990856 DOI: 10.1097/01.numa.0000576644.26417.bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Amber J Irwin
- Amber J. Irwin is an adjunct faculty member, community course lead, and clinical coordinator at the University of Cincinnati in Ohio
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Bajaria S, Abdul R. Preparedness of health facilities providing HIV services during COVID-19 pandemic and assessment of their compliance to COVID-19 prevention measures: findings from the Tanzania Service Provision Assessment (SPA) survey. Pan Afr Med J 2020. [PMID: 33343797 PMCID: PMC7733350 DOI: 10.11604/pamj.supp.2020.37.1.25443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction the increased demands of health facilities and workers due to coronavirus overwhelm the already burdened Tanzanian health systems. This study evaluates the current capacity of facilities and providers for HIV care and treatment services and their preparedness to adhere to the national and global precaution guidelines for HIV service providers and patients. Methods data for this study come from the latest available, Tanzania Service Provision Assessment survey 2014-15. Frequencies and percentages described the readiness and availability of HIV services and providers. Chi-square test compared the distribution of services by facility location and availability and readiness of precaution commodities and HIV services by managing authorities. Results availability of latex gloves was high (83% at OPD and 95.3% laboratory). Availability of medical masks, alcohol-based hand rub and disinfectants was low. Availability of medical mask at outpatient department (OPD) was 28.7% urban (23.5% public; 33.8% private, p=0.02) and 13.5% rural (10.1% public; 25.4% private, p=0.001) and lower at laboratories. Fewer facilities in rural area (68.4%) had running water in OPD than urban (86.3%). Higher proportions of providers at public than private facilities in urban (82.8% versus 73.1%) and rural (88.2% versus 81.6%) areas provided HIV test counseling and at least two other HIV services. Conclusion availability of commodities such as medical masks, alcohol-based hand rub, and disinfectant was low while the readiness of providers to multitask HIV related services was high. Urgent distribution and re-assessment of these supplies are necessary, to protect HIV patients, their caregivers, and health providers from COVID-19.
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Affiliation(s)
- Shraddha Bajaria
- Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania
- Corresponding author: Shraddha Bajaria, Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania.
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Babatunde OA, Olatunji MB, Omotajo OR, Ikwunne OI, Hamzat Z, Sola ST. A comparative assessment of cold chain management using the outbreak of circulating vaccine-derived polio virus type 2 as a surrogate marker in Oyo State, Nigeria-2019. Pan Afr Med J 2020; 37:313. [PMID: 33654532 PMCID: PMC7896533 DOI: 10.11604/pamj.2020.37.313.26152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction inspite of the demonstrable evidence of the preventive and protective ability of vaccines to reduce the outbreak of vaccine-preventable diseases, there are still some significant disease outbreaks recorded in our communities. In some settings, these outbreaks have been linked with poor vaccine management. Therefore, this study was conducted to compare the cold chain practices in Oyo State, Nigeria. Methods we conducted a cross-sectional survey among health workers in the local government areas of Oyo State between October and November 2019. Using purposive sampling, we recruited all the 84 routine immunization focal persons for the study. A self-administered questionnaire was used to collect data on cold chain management. Data were analyzed using SPSS version 24 and bivariate analysis was done using Chi-square. Statistical significance was set at p < 0.05. Results the mean age of the respondents was 46.4 ± 6.7 years. Most prevalent cadre in the rural facilities was health assistants (87.5%) while Community Extension Health Workers (54.8%) were prevalent in the urban (p = 0.002). The proportion of respondents with adequate cold chain equipment was significantly higher in the urban compared with the rural area. The cold boxes were the only adequate cold chain equipment found in the rural health facilities compared with the urban (p = 0.036). Conclusion there was a low proportion of qualified health workers and inadequate cold chain equipment in the rural area compared with the urban facilities. Engagement of skilled health workers and supply of the cold chain equipment are recommended.
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Affiliation(s)
- Olaniyan Akintunde Babatunde
- Oyo State Primary Health Care Board, State Secretariat, Agodi, Ibadan, Oyo State, Nigeria
- Oriire Local Government Health Authority, Ikoyi-Ile, Oyo State, Nigeria
- Corresponding author: Olaniyan Akintunde Babatunde, Oriire Local Government Health Authority, Ikoyi-Ile, Oyo State, Nigeria.
| | | | | | | | - Zainab Hamzat
- Oyo State Primary Health Care Board, State Secretariat, Agodi, Ibadan, Oyo State, Nigeria
| | - Sunday Thomas Sola
- Nigeria Field Epidemiology and Laboratory Programme, Asokoro, Abuja, Nigeria
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Ahmed S, Applegate JA, Mitra DK, Callaghan-Koru JA, Mousumi M, Khan AM, Joarder T, Harrison M, Ahmed S, Begum N, Quaiyum A, George J, Baqui AH. Implementation research to support Bangladesh Ministry of Health and Family Welfare to implement its national guidelines for management of infections in young infants in two rural districts. J Health Popul Nutr 2019; 38:41. [PMID: 31810496 PMCID: PMC6898944 DOI: 10.1186/s41043-019-0200-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/13/2018] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND World Health Organization revised the global guidelines for management of possible serious bacterial infection (PSBI) in young infants to recommend the use of simplified antibiotic therapy in settings where access to hospital care is not possible. The Bangladesh Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GOB) adopted these guidelines, allowing treatment at first-level facilities. During the first year of implementation, the Projahnmo Study Group and USAID/MaMoni Health Systems Strengthening (HSS) Project supported the MoHFW to operationalize the new guidelines and conducted an implementation research study in selected districts to assess challenges and identify solutions to facilitate scale-up across the country. IMPLEMENTATION SUPPORT Projahnmo and MaMoni HSS teams supported implementation in three areas: building capacity, strengthening service delivery, and mobilizing communities. Capacity building focused on training paramedics to conduct outpatient management of PSBI cases and developing monitoring and supervision systems. The teams also filled gaps in government supply of essential drugs, equipment, and logistics. Community mobilization strategies to promote care-seeking and referrals to facilities varied across districts; in one district community, health workers made home visits while in another district, the promotion was carried out through community volunteers, village doctors, and through existing community structures. METHODS We followed a plan-do-study-act (PDSA) cycle to identify and address implementation challenges. Three cycles-1 every 4 months-were conducted. We collected data utilizing quantitative and qualitative methods in both the community and facilities. The total sample size for this study was 13,590. DISCUSSION This article provides implementation research design details for program managers intending to implement new guidelines on management of young infant infections. Results of this research will be reported in the forthcoming papers. Preliminary findings indicate that the management of PSBI cases at the UH&FWCs is feasible. However, MoHFW, GOB needs to address the implementation challenges before scale-up of this policy to the national level.
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Affiliation(s)
| | - Jennifer A Applegate
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Dipak K Mitra
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229, Bangladesh
| | - Jennifer A Callaghan-Koru
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, MD, USA
| | | | | | - Taufique Joarder
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Meagan Harrison
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Sabbir Ahmed
- USAID's MaMoni Health Systems Strengthening Project, Save the Children, Washington, DC, USA
| | - Nazma Begum
- Johns Hopkins University-Bangladesh, Dhaka, 1213, Bangladesh
| | - Abdul Quaiyum
- Maternal and Child Health Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Joby George
- USAID's MaMoni Health Systems Strengthening Project, Save the Children, Washington, DC, USA
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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Ken-Opurum J, Lynch K, Vandergraff D, Miller DK, Savaiano DA. A mixed-methods evaluation using effectiveness perception surveys, social network analysis, and county-level health statistics: A pilot study of eight rural Indiana community health coalitions. Eval Program Plann 2019; 77:101709. [PMID: 31568893 DOI: 10.1016/j.evalprogplan.2019.101709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/18/2019] [Revised: 08/14/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
Community health coalitions (CHCs) are a promising approach for addressing disparities in rural health statistics. However, their effectiveness has been variable, and evaluation methods have been insufficient and inconsistent. Thus, we propose a mixed-methods evaluation framework and discuss pilot study findings. CHCs in our pilot study partnered with Purdue Extension. Extension links communities and land grant universities, providing programming and support for community-engaged research. We conducted social network analysis and effectiveness perception surveys in CHCs in 8 rural Indiana counties during summer 2017 and accessed county-level health statistics from 2015-16. We compared calculated variables (i.e., effectiveness survey k-means clusters, network measures, health status/outcomes) using Pearson's correlations. CHC members' positive perceptions of their leadership and functioning correlated with interconnectedness in their partnership networks, while more centralized partnership networks correlated with CHC members reporting problems in their coalitions. CHCs with highly rated leadership and functioning developed in counties with poor infant/maternal health and opioid outcomes. Likewise, CHCs reporting fewer problems for participation developed in counties with poor infant/maternal health, poor opioid outcomes, and more people without healthcare coverage. This pilot study provides a framework for iterative CHC evaluation. As the evidence grows, we will make recommendations for best practices that optimize CHC partnerships to improve local health in rural areas.
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Affiliation(s)
- Jennifer Ken-Opurum
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.
| | - Krystal Lynch
- Purdue Nutrition Education Program, West Lafayette, IN 47907, USA
| | | | | | - Dennis A Savaiano
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
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Bergloff A, Stratton E, Briggs Early K. A Cross-Sectional Pilot Survey of Rural Clinic Attitudes and Proficiency with Insulin Pumps and Continuous Glucose Monitoring Devices. Diabetes Technol Ther 2019; 21:665-670. [PMID: 31339738 DOI: 10.1089/dia.2019.0161] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: To examine the perceptions, proficiencies, and barriers of diabetes device use among rural clinic providers. Methods: A total of 210 surveys were sent through e-mail and/or U.S. Postal Service to rural clinics throughout Alaska, Idaho, Montana, Oregon, Washington, and Utah based on discussions with rural clinic network leadership in the states. Responses were included if the participant was 18 years of age and older, and worked at a rural clinic as a physician, physician assistant, nurse, nurse practitioner, allied health worker, or clinic manager. Results: Respondents included clinic management (13%), midlevel providers (physician assistants and nurse practitioners) and allied health workers (pharmacists, dietitians, and social workers, 30.8%), nurses (30.8%), and physicians (23.1%). We had a low response rate (20%; n = 41), but of those who said they work with patients who have diabetes, only 47.4% indicated that they use diabetes devices as part of their patients' treatment. The most common barrier reported among respondents suggested that additional medical team expertise is needed in their community or clinic to adopt insulin pumps and/or continuous glucose monitoring for qualified patients (75.9% and 80.8%, respectively). Conclusion: Lack of provider experience and having patients managed by out-of-area experts were the biggest reasons for providers not seeing or managing patients using these devices. Lack of provider access, patient satisfaction with current diabetes regimens, unsupportive health care team, patient literacy, and patient fear showed limited to negligible endorsements from survey respondents. A variety of potential solutions to this problem of limited provider experience and training are also offered.
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Affiliation(s)
- Andrew Bergloff
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences (PNWU), Yakima, Washington
| | - Emily Stratton
- Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York
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Ervin K, Reid C, Moran A, Opie C, Haines H. Implementation of an older person's nurse practitioner in rural aged care in Victoria, Australia: a qualitative study. Hum Resour Health 2019; 17:80. [PMID: 31675960 PMCID: PMC6824051 DOI: 10.1186/s12960-019-0415-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/16/2019] [Accepted: 09/10/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND There are staff shortages nation-wide in residential aged care, which is only predicted to grow as the population ages in Australia. The aged care staff shortage is compounded in rural and remote areas where the health service workforce overall experiences difficulties in recruitment and retention. There is evidence that nurse practitioners fill important service gaps in aged care and rural health care but also evidence that barriers exist in introducing this extended practice role. METHODS In 2018, 58 medical and direct care staff participated in interviews and focus groups about the implementation of an older person's nurse practitioner (OPNP) in aged care. All 58 interviewees had previously or currently worked in an aged care setting where the OPNP delivered services. The interviews were analysed using May's implementation theory framework to better understand staff perceptions of barriers and enablers when an OPNP was introduced to the workplace. RESULTS The major perceived barrier to capacity of implementing the OPNP was a lack of material resources, namely funding of the role given the OPNP's limited ability to self-fund through access to the Medicare Benefits Schedule (MBS). Staff perceived that benefits included timely access to care for residents, hospital avoidance and improved resident health outcomes. CONCLUSION Despite staff perceptions of more timely access to care for residents and improved outcomes, widespread implementation of the OPNP role may be hampered by a poor understanding of the role of an OPNP and the legislative requirement for a collaborative arrangement with a medical practitioner as well as limited access to the MBS. This study was not a registered trial.
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Affiliation(s)
- Kaye Ervin
- University of Melbourne, Melbourne, Australia
| | - Carol Reid
- University of Melbourne, Melbourne, Australia
| | - Anna Moran
- University of Melbourne, Melbourne, Australia
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Zhang H, van Doorslaer E, Xu L, Zhang Y, van de Klundert J. Can a results-based bottom-up reform improve health system performance? Evidence from the rural health project in China. Health Econ 2019; 28:1204-1219. [PMID: 31368190 DOI: 10.1002/hec.3935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/13/2018] [Revised: 06/26/2019] [Accepted: 07/06/2019] [Indexed: 05/12/2023]
Abstract
In 2008, the Rural Health Project (Health XI) was initiated in 40 Chinese counties to pilot interventions aimed at improving local health systems. Performance targets were pre-specified (results-based), and project counties were allowed to tailor their interventions (bottom-up) in recognition of the substantial regional variations. Using household data from the China National Health Services Survey in a difference-in-differences strategy combined with matching, we find that project counties have improved outcomes (both incentivized and not-directly-incentivized) in all three domains examined-medical care, public health services, and self-rated health-by 2013. In particular, the decrease in outpatient intravenous drip use and financial strain and the increase in all four components of public health services provision are robust to a variety of tests and alternative matching strategies. Results for not-directly-incentivized indicators suggest that results-based payment did not lead to multitasking problems but rather to positive spillovers. On the other hand, little improvement in inpatient-related indicators suggests that the Health XI interventions did not successfully redress the perverse incentives driving the bulk of providers' income. In general, however, our results indicate that interventions adopted in the results-based bottom-up approach generated substantial benefits given the investment.
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Affiliation(s)
- Hao Zhang
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Tinbergen Institute, Amsterdam, The Netherlands
| | - Eddy van Doorslaer
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Tinbergen Institute, Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ling Xu
- Health Human Resources Development Center, National Health Commission, Beijing, China
| | - Yaoguang Zhang
- Center for Health Statistics and Information, National Health Commission, Beijing, China
| | - Joris van de Klundert
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Thackrah RD, Thompson SC. Learning from follow-up of student placements in a remote community: a small qualitative study highlights personal and workforce benefits and opportunities. BMC Med Educ 2019; 19:331. [PMID: 31484513 PMCID: PMC6727324 DOI: 10.1186/s12909-019-1751-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/15/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The maldistribution of the Australian health workforce contributes to restricted accessibility and poorer health outcomes for rural and remote populations, especially Aboriginal and Torres Strait Islander Australians. Student exposure to rural and remote settings is a long-term strategy that aims to reduce workforce shortages by encouraging rural career uptake, with well-supervised, positive placement experiences associated with rural practice intentions. Furthermore, placements can build students' cultural capabilities and foster interest in working with disadvantaged and underserved Aboriginal communities. However, little is known about the translation of rural practice intentions to career paths, and the factors influencing employment decision-making and application of clinical and cultural content to professional practice. This in-depth study reports on the second stage of an investigation into the longer-term impact of remote placements. Stage One identified factors that contributed to students' learning experiences and highlighted challenges encountered; Stage Two explored the impact on professional practice and employment decision-making amongst a subset of the original cohort. METHODS Of 12 interviews with participants who completed a remote placement in 2013/4 (Stage One), eight graduates were located four years later and seven were re-interviewed. Telephone interviews used a semi-structured schedule; each interview was recorded, transcribed and analysed for recurring themes and meanings. RESULTS At the time of interview, all participants were employed as health professionals and worked in Australia. The follow-up highlighted the enduring legacy of the student placement in terms of participants' personal and professional growth. The majority were employed in rural settings; some were attracted by a rural lifestyle and employment opportunities while others were drawn by a desire to reduce rural health disparities. Regardless of setting, all actively applied clinical and cultural learnings acquired on placement to their professional practice. Rural job security, professional support and opportunities for professional development were all influences on continuing rural practice. CONCLUSIONS Despite the challenges of qualitative longitudinal follow-up, the findings of this study provide valuable information, which can inform scaled-up investigations into the role of placements in developing an expanded, more stable and culturally respectful rural workforce.
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Affiliation(s)
- Rosalie D. Thackrah
- Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009 Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009 Australia
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Zobair KM, Sanzogni L, Sandhu K. Expectations of telemedicine health service adoption in rural Bangladesh. Soc Sci Med 2019; 238:112485. [PMID: 31476664 DOI: 10.1016/j.socscimed.2019.112485] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/06/2018] [Revised: 05/27/2019] [Accepted: 08/05/2019] [Indexed: 11/18/2022]
Abstract
This study analyzes the antecedent factors that influence patients' expectations of telemedicine adoption in centres hosted by rural public hospitals in Bangladesh. It examines five antecedents of patients' expectations of telemedicine adoption-self-efficacy, telemedicine experience, knowledge, enjoyment, and prior satisfaction. A conceptual research model was formulated, encompassing a set of hypotheses that were developed and tested by employing partial least squares structural equation modelling. Using a structured survey questionnaire, a cross-sectional survey was conducted among 500 telemedicine users in different rural areas in Bangladesh. Except knowledge, four antecedents significantly contribute to patients' expectations of telemedicine health service adoption explaining 66% of the variance (R2) in expectations. These findings provide support for explaining antecedents to the formation of patients' expectations of telemedicine adoption and the institutionalisation of favourable policy guidelines as an early guidance for the development of successful healthcare industries in Bangladesh and other similar settings. Specific policy interventions and recommendations are provided, including current research limitations leading to opportunities for future research.
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Affiliation(s)
| | - Louis Sanzogni
- Business Strategy and Innovation, Griffith Business School, Griffith University, Australia
| | - Kuldeep Sandhu
- Business Strategy and Innovation, Griffith Business School, Griffith University, Australia
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Versace VL, Coffee NT, Franzon J, Turner D, Lange J, Taylor D, Clark R. Comparison of general and cardiac care-specific indices of spatial access in Australia. PLoS One 2019; 14:e0219959. [PMID: 31344082 PMCID: PMC6657861 DOI: 10.1371/journal.pone.0219959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/05/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA). Research design and methods Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations. Results Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer’s V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer’s V = 0.461, p<0.001). Conclusions Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA+ model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations–i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models.
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Affiliation(s)
- Vincent Lawrence Versace
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- * E-mail:
| | - Neil T. Coffee
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Centre for Research and Action in Public Health (CeRAPH), University of Canberra, Canberra, ACT, Australia
| | - Julie Franzon
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Dorothy Turner
- Spatial Sciences Group, School of Biological Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jarrod Lange
- Hugo Centre for Migration and Population Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Danielle Taylor
- Basil Hetzel Institute for Translational Health Research, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robyn Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Dockx K, Van Remoortel H, De Buck E, Schelstraete C, Vanderheyden A, Lievens T, Kinyagu JT, Mamuya S, Vandekerckhove P. Effect of Contextualized Versus Non-Contextualized Interventions for Improving Hand Washing, Sanitation, and Health in Rural Tanzania: Study Design of a Cluster Randomized Controlled Trial. Int J Environ Res Public Health 2019; 16:ijerph16142529. [PMID: 31311186 PMCID: PMC6678137 DOI: 10.3390/ijerph16142529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
Abstract
Nearly 90% of diarrhea-related mortalities are the result of unsafe drinking water, poor sanitation, and insufficient hygiene. Although “Water, Sanitation, and Hygiene” (WASH) interventions may significantly reduce the risk of diarrheal disease, it is currently unclear which interventions are the most effective. In this study, we aim to determine the importance of contextualizing a WASH intervention to the local context and the needs for increasing impact (Clinicaltrials.gov NCT03709368). A total of 1500 households in rural Tanzania will participate in this cluster randomized controlled trial. Households will be randomized into one of three cohorts: (1) a control group receiving a basic intervention and 1 placebo household visit, (2) an intervention group receiving a basic intervention + 9 additional household visits which are contextualized to the setting using the RANAS approach, and (3) an intervention group receiving a basic intervention + 9 additional household visits, which are not contextualized, i.e., a general intervention. Assessments will take place at a baseline, 1 and 2 years after the start of the intervention, and 1 year after the completion of the intervention. Measurements involve questionnaires and spot checks. The primary outcome is hand-washing behavior, secondary objectives include, the impact on latrine use, health, WASH infrastructure, quality of life, and cost-effectiveness.
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Affiliation(s)
- Kim Dockx
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium.
| | - Hans Van Remoortel
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium
- Faculty of Medicine, Department of Public Health and Primary Care, KU Leuven, Leuven 3000, Belgium
| | | | | | | | | | - Simon Mamuya
- Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Philippe Vandekerckhove
- Belgian Red Cross, Mechelen 2800, Belgium
- Faculty of Medicine, Department of Public Health and Primary Care, KU Leuven, Leuven 3000, Belgium
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Onnis LA, Hakendorf M, Diamond M, Tsey K. CQI approaches for evaluating management development programs: A case study with health service managers from geographically remote settings. Eval Program Plann 2019; 74:91-101. [PMID: 30965218 DOI: 10.1016/j.evalprogplan.2019.03.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/28/2019] [Accepted: 03/31/2019] [Indexed: 06/09/2023]
Abstract
Health systems are known for being complex. Yet, there is a paucity of evidence about programs that successfully develop competent frontline managers to navigate these complex systems. There is even less evidence about developing frontline managers in areas of contextual complexity such as geographically remote and isolated health services. This study used a customised management development program containing continuous quality improvement (CQI) approaches to determine whether additional levels of evaluation could provide evidence for program impact. Generalisability is limited by the small sample size; however, the findings suggest that continuous improvement approaches, such as action learning workplace-based CQI projects not only provide for real-world application of the manager's learning; they can potentially produce the type of data needed to conduct evaluations for organisational impact and cost-benefits. The case study contributes to the literature in an area where there is a scarcity of empirical research. Further, this study proposes a pragmatic method for using CQI approaches with existing management development programs to generate the type of data needed for multi-level evaluation.
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Affiliation(s)
- Leigh-Ann Onnis
- The College of Business, Law and Governance, The Cairns Institute, Australia; Indigenous Education & Research Centre, James Cook University, PO Box 6811, Cairns, Queensland, 4870, Australia.
| | | | - Mark Diamond
- Australasian College of Health Service Management (ACHSM), Australia
| | - Komla Tsey
- The Cairns Institute and the College of Arts Society and Education, James Cook University, Cairns, Australia
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Greenwood-Ericksen MB, Macy ML, Ham J, Nypaver MM, Zochowski M, Kocher KE. Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations? West J Emerg Med 2019; 20:477-484. [PMID: 31123549 PMCID: PMC6526889 DOI: 10.5811/westjem.2019.2.42057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/11/2019] [Accepted: 02/16/2019] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Attempts to reduce low-value hospital care often focus on emergency department (ED) hospitalizations. We compared rural and urban EDs in Michigan on resources designed to reduce avoidable admissions. METHODS A cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services. We performed chi-squared comparisons, regression modeling, and predictive margins. RESULTS Of 135 EDs, 64 (47%) responded with 33 in urban and 31 in rural counties. Clinical pathways were equally present in urban and rural EDs (67% vs 74%, p=0.5). Compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). Common barriers to connecting ED patients to outpatient services exist in both settings, including lack of social support (88% and 76%, p=0.20), and patient/family preference (68% and 68%, p=1.0). However, rural EDs were more likely to report time required for care coordination (88% vs 66%, p=0.05) and less likely to report limitations to home care (21% vs 48%, p=0.05) as barriers. In regression modeling, ED volume was predictive of the presence of clinical pathways rather than rurality. CONCLUSION While rural-urban differences in resources and barriers exist, ED size rather than rurality may be a more important indicator of ability to reduce avoidable hospitalizations.
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Affiliation(s)
| | - Michelle L. Macy
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jason Ham
- University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan
| | - Michele M. Nypaver
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
- University of Michigan, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Melissa Zochowski
- University of Michigan, College of Engineering, XTRM Labs, Ann Arbor, Michigan
| | - Keith E. Kocher
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
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Walker LE, Cross M, Barnett T. Students' experiences and perceptions of interprofessional education during rural placement: A mixed methods study. Nurse Educ Today 2019; 75:28-34. [PMID: 30677641 DOI: 10.1016/j.nedt.2018.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/24/2018] [Revised: 12/01/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Interprofessional collaboration is key to addressing the complexity of contemporary health care, therefore it is imperative that students from different disciplines have access to interprofessional education to equip them with the requisite skills and attributes. While interprofessional education promotes a person-centred approach and mutual recognition of one another's contributions to health outcomes, interprofessional education in Australian universities is fragmented and presents challenges that can be addressed through clinical placements. OBJECTIVES This article reports student perceptions and readiness for interprofessional education in the rural clinical learning environment in one region of Australia. DESIGN A mixed methods approach. SETTINGS Rural clinical learning environments in one geographic area in Victoria, Australia. PARTICIPANTS 60 undergraduate healthcare students from allied health, medicine, nursing and midwifery. METHODS A survey incorporating Readiness for Interprofessional Learning Scale, Interdisciplinary Education Perception Scale and focused interprofessional questions. Qualitative data were collected via survey comments, interviews and focus groups. RESULTS Students had numerous opportunities for interprofessional education, to observe role modelling in the workplace and considered that learning with other professions would help them become more effective members of the health care team. Students valued learning about collaborative practice, the roles of other professions and identified activities that enhanced interprofessional engagement. CONCLUSIONS This study provides important insights regarding students' perceptions and readiness for interprofessional education. These results demonstrate that there are numerous opportunities to embed interprofessional education within the rural clinical learning environment and offer new insights into students' experiences and preferences for potential activities. These findings may resonate with others implementing interprofessional education in the workplace and guide facilitators in planning activities for students. Factors influencing differences in attitudes towards interprofessional education and how students acquire an understanding of their professional or disciplinary role warrant further study.
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Affiliation(s)
- Lorraine E Walker
- Monash University, PO Box 527, Frankston, Victoria 3199, Australia; University of Tasmania, Australia.
| | - Merylin Cross
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tasmania 7250, Australia.
| | - Tony Barnett
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tasmania 7250, Australia.
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Benson AE, Benson MJ, Luke AH. Assessment of maternal referral systems used for a rural Zambian hospital: the development of setting specific protocols for the identification of complications. Afr Health Sci 2019; 19:1536-1543. [PMID: 31148981 PMCID: PMC6531953 DOI: 10.4314/ahs.v19i1.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/25/2022] Open
Abstract
Background In resource-limited countries, it is estimated that up to 75% of maternal deaths are preventable. Maternal referral systems are an effective measure to help prevent these deaths. Objective The objective of this study was to delineate criteria that health care workers use to identify obstetrical emergencies and make referrals, in order to evaluate the effectiveness of the established referral system and to implement improvements to this system. Methods Using a qualitative study design, the individuals with the highest level of formal obstetrics training at 10 health posts that refer to a rural Zambian hospital were surveyed using semi-structured interviews regarding their referral protocols. Data were analyzed through open-coding. At the conclusion of the interview, standardized referral protocols for obstetric emergencies derived from published guidelines and local practices were distributed. Results Identified complications resulting in referral most commonly included post-partum hemorrhage (70%), prolonged labor (70%), malpresentation (50%), antepartum hemorrhage (40%), and retained placenta (40%). While numerous reasons for referral were identified, there was little consensus on the referral protocol used for each complication. Obstacles to successful referral most commonly included cellular network disruptions (70%), distance (50%), and lack of transportation (30%). The referral protocols distributed to health posts covered only 11 of the 23 complications cited as the most common reason for referral. Conclusion The referral criteria and protocols were updated to include all of the reported complications. We propose this document for others working in resource-limited settings attempting to establish or evaluate a maternal referral systems.
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Affiliation(s)
- Ashley E Benson
- Loyola University Stritch School of Medicine, Center for Community and Global Health
| | - Michael J Benson
- Loyola University Stritch School of Medicine, Center for Community and Global Health
| | - Amy H Luke
- Loyola University Stritch School of Medicine, Center for Community and Global Health
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Kuupiel D, Tlou B, Bawontuo V, Drain PK, Mashamba-Thompson TP. Poor supply chain management and stock-outs of point-of-care diagnostic tests in Upper East Region's primary healthcare clinics, Ghana. PLoS One 2019; 14:e0211498. [PMID: 30811407 PMCID: PMC6392218 DOI: 10.1371/journal.pone.0211498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies. MATERIAL AND METHODS We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables. RESULTS Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region. DISCUSSION There is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics.
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Affiliation(s)
- Desmond Kuupiel
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Boikhutso Tlou
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Paul K. Drain
- International Clinical Research Centre, Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Tivani P. Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Sun X, Meng H, Ye Z, Conner KO, Duan Z, Liu D. Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China. PLoS One 2019; 14:e0211984. [PMID: 30730967 PMCID: PMC6366770 DOI: 10.1371/journal.pone.0211984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/23/2019] [Indexed: 01/04/2023] Open
Abstract
Objective To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. Methods A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents’ characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. Results The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09–0.26; urban: OR = 0.19, 95%CI = 0.10–0.36), had fair (rural: OR = 0.49, 95%CI = 0.26–0.92; urban: OR = 0.31, 95%CI = 0.15–0.64) or poor (rural: OR = 0.14, 95%CI = 0.07–0.30; urban: OR = 0.22, 95%CI = 0.11–0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08–0.59), being retired (OR = 0.90, 95%CI = 0.44–1.84) and earning a per capita annual income of household of 10,000–29,999 (OR = 0.24, 95%CI = 0.11–0.52) and 30,000–49,999 (OR = 0.26, 95%CI = 0.07–0.92) were associated with lower rates of seeking care at PCFs. Conclusion Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account.
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Affiliation(s)
- Xiaxia Sun
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Zhiqiu Ye
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Kyaien O. Conner
- Department of Mental Health Law & Policy, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Zhanqi Duan
- Health and Family Planning Information Centre of Sichuan Province, Chengdu, China
| | - Danping Liu
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
- * E-mail:
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Dethlefs HJ, Walker EA, Schechter CB, Dowd R, Filipi L, Garcia JF, Filipi C. Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic. Diabetes Res Clin Pract 2019; 148:212-221. [PMID: 30641164 PMCID: PMC6394404 DOI: 10.1016/j.diabres.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/28/2018] [Accepted: 01/04/2019] [Indexed: 12/22/2022]
Abstract
AIMS To describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. METHODS Dominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. RESULTS 1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4 years, BMI 27.4 kg/m2, HbA1c 8.8% (73 mmol/mol), BP 133/81 mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP and HbA1c assessments, and proportions reaching quality measures improved over time, especially after clinic goal setting. Modeling of BP, BMI and HbA1c values revealed important differences in outcomes by clinic over time. CONCLUSIONS Improvements in process and health outcomes are attainable in rural DR when medical teams have support and access to data. Scalability and sustainability are continuing goals.
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Affiliation(s)
- Henry J Dethlefs
- One World Community Health Centers, Inc, 4920 S 30th St. Suite 103, Omaha, NE 68107, USA
| | - Elizabeth A Walker
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Clyde B Schechter
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Rachel Dowd
- CHI Creighton University Medical Center, 7500 Mercy Rd., Omaha, NE 68124, USA
| | - Linda Filipi
- Chronic Care International, 12370 Rose Lane, Omaha, NE 68154, USA
| | | | - Charles Filipi
- Creighton University, School of Medicine, Education Building, Suite 105, 7710 Mercy Road, Omaha, NE 68124, USA
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Nagel M. Challenges in Providing Complex Paediatric Care in Rural Communities. Narrat Inq Bioeth 2019; 9:E1-E2. [PMID: 31447431 DOI: 10.1353/nib.2019.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Howe JL, Penrod JD, Gottesman E, Bean A, Kramer BJ. The rural interdisciplinary team training program: a workforce development workshop to increase geriatrics knowledge and skills for rural providers. Gerontol Geriatr Educ 2019; 40:3-15. [PMID: 29583103 DOI: 10.1080/02701960.2018.1454917] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Rural Interdisciplinary Team Training Program (RITT) is a team-based educational component of the Veterans Health Administration (VHA) Office of Rural Health Geriatric Scholars Program. It is a workforce development program to enhance the geriatrics knowledge and skills of VA primary care clinicians and staff caring for older veterans in rural communities. The RITT workshop, accredited for 6.5 hours, is interactive and multi-modal with didactic mini-lectures, interactive case discussions and role play demonstrations of assessments. Clinic teams also develop and implement a small quality improvement project based on common challenges faced by older persons. This report is an evaluation of the effect of the RITT Program on geriatrics knowledge and team development as well as success in developing and implementing the quality improvement projects in 80 VHA rural outpatient clinics in 38 states.
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Affiliation(s)
- Judith L Howe
- a Associate Director for Education and Evaluation, James J. Peters, VA Medical Center, Bronx , NY, USA; Professor, Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Joan D Penrod
- b Health Services Researcher, James J. Peters, VA Medical Center, Bronx, NY, USA; Associate Professor , Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Eve Gottesman
- c Education Specialist and RITT Coordinator , James J. Peters, VA Medical Center , Bronx , NY , USA
| | - Andrew Bean
- d Statistician , James J. Peters, VA Medical Center , Bronx , NY , USA
| | - B Josea Kramer
- e Associate Director for Education and Evaluation, Greater Los Angeles GRECC, Los Angeles, CA . USA; Professor, Division of Geriatric Medicine, David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
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Selby-Nelson EM, Bradley JM, Schiefer RA, Hoover-Thompson A. Primary care integration in rural areas: A community-focused approach. Fam Syst Health 2018; 36:528-534. [PMID: 30070545 DOI: 10.1037/fsh0000352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Current and developing models of integrated behavioral health service delivery have proven successful for the general population; however, these approaches may not sufficiently address the unique needs of individuals living in rural and remote areas. For all communities to benefit from the opportunities that the current trend toward integration has provided, it is imperative that cultural and contextual factors be considered determining features in care delivery. Rural integrated primary care practice requires specific training, expertise, and adjustments to service delivery and intervention to best meet the needs of rural and underserved communities. In this commentary, the authors present trends in integrated behavioral health service delivery in rural integrated primary care settings. Flexible and creative strategies are proposed to promote increased access to integrated behavioral health services, while simultaneously addressing patient care needs that arise as a result of the barriers to treatment that are prevalent in rural communities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Orchard JJ, Neubeck L, Freedman B, Webster R, Patel A, Gallagher R, Li J, Hespe CM, Ferguson C, Zwar N, Lowres N. Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: an implementation study protocol. BMJ Open 2018; 8:e023130. [PMID: 30385444 PMCID: PMC6252758 DOI: 10.1136/bmjopen-2018-023130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Screening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified.This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow to quickly and accurately identify AF, and will potentially inform a generalisable, scalable approach. METHODS AND ANALYSIS Screening with a smartphone ECG will be conducted by general practitioners and practice nurses in rural general practices in New South Wales, Australia for 3-4 months during 2018-2019. Up to 10 practices will be recruited, and we aim to screen 2000 patients aged ≥65 years. Practices will be given an electronic screening prompt and electronic decision support to guide evidence-based treatment for those with AF. De-identified data will be collected using a clinical audit tool and qualitative interviews will be conducted with selected practice staff. A process evaluation and cost-effectiveness analysis will also be undertaken. Outcomes include implementation success (proportion of eligible patients screened, fidelity to protocol), proportion of people screened identified with new AF and rates of treatment with anticoagulants and antiplatelets at baseline and completion. Results will be compared against an earlier metropolitan study and a 'control' dataset of practices. ETHICS AND DISSEMINATION Ethics approval was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/1017). Results will be disseminated through various forums, including peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12618000004268; Pre-results.
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Affiliation(s)
- Jessica J Orchard
- Sydney Medical School and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Ben Freedman
- Sydney Medical School and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Heart Research Institute, Sydney, New South Wales, Australia
| | - Ruth Webster
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Robyn Gallagher
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Jialin Li
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Charlotte Mary Hespe
- General Practice Research, School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Caleb Ferguson
- Western Sydney Nursing and Midwifery Centre, Western Sydney University and Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicholas Zwar
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicole Lowres
- Sydney Medical School and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Heart Research Institute, Sydney, New South Wales, Australia
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Saxena M, Srivastava A, Dwivedi P, Bhattacharyya S. Is quality of care during childbirth consistent from admission to discharge? A qualitative study of delivery care in Uttar Pradesh, India. PLoS One 2018; 13:e0204607. [PMID: 30261044 PMCID: PMC6160099 DOI: 10.1371/journal.pone.0204607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/11/2018] [Indexed: 11/26/2022] Open
Abstract
Background Improving quality of maternal healthcare services is key to reducing maternal mortality across developing nations, including India. Expanding access to institutionalized care alone has failed to address critical quality barriers to safe, effective, patient-centred, timely and equitable care. Multi-dimensional quality improvement focusing on Person Centred Care(PCC) has an important role in expanding utilization of maternal health services and reducing maternal mortality. Methods Nine public health facilities were selected in two rural districts of Uttar Pradesh(UP), India, to understand women’s experiences of childbirth and identify quality gaps in the process of maternity care. 23 direct, non-participant observations of uncomplicated vaginal deliveries were conducted using checklists with special reference to PCC, capturing quality of care provision at five stages—admission; pre-delivery; delivery; post-delivery and discharge. Data was thematically analysed using the framework approach. Case studies, good practices and gaps were noted at each stage of delivery care. Results Admission to maternity wards was generally prompt. All deliveries were conducted by skilled providers and at least one staff was available at all times. Study findings were discussed under two broad themes of care ‘structure’ and ‘process’. While infrastructure, supplies and human resource were available across most facilities, gaps were observed in the process of care, particularly during delivery and post-delivery stages. Key areas of concern included compromised patient safety like poor hand hygiene, usage of unsterilized instruments; inadequate clinical care like lack of routine monitoring of labour progression, inadequate postpartum care; partially compromised privacy in the labour room and postnatal ward; and few incidents of abuse and demand for informal payments. Conclusions The study findings reflect gaps in the quality of maternity care across public health facilities in the study area and support the argument for strengthening PCC as an important effort towards quality improvement across the continuum of delivery care.
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Affiliation(s)
- Malvika Saxena
- Research Department, Public Health Foundation of India, Gurugram, Haryana, India
| | - Aradhana Srivastava
- Research Department, Public Health Foundation of India, Gurugram, Haryana, India
| | - Pravesh Dwivedi
- Research Department, Public Health Foundation of India, Gurugram, Haryana, India
| | - Sanghita Bhattacharyya
- Research Department, Public Health Foundation of India, Gurugram, Haryana, India
- * E-mail:
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Wereta T, Betemariam W, Karim AM, Fesseha Zemichael N, Dagnew S, Wanboru A, Bhattacharya A. Effects of a participatory community quality improvement strategy on improving household and provider health care behaviors and practices: a propensity score analysis. BMC Pregnancy Childbirth 2018; 18:364. [PMID: 30255783 PMCID: PMC6157250 DOI: 10.1186/s12884-018-1977-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Maternal and newborn health care intervention coverage has increased in many low-income countries over the last decade, yet poor quality of care remains a challenge, limiting health gains. The World Health Organization envisions community engagement as a critical component of health care delivery systems to ensure quality services, responsive to community needs. Aligned with this, a Participatory Community Quality Improvement (PCQI) strategy was introduced in Ethiopia, in 14 of 91 rural woredas (districts) where the Last Ten Kilometers Project (L10 K) Platform activities were supporting national Basic Emergency Obstetric and Newborn Care (BEmONC) strengthening strategies. This paper examines the effects of the PCQI strategy in improving maternal and newborn care behaviors, and providers' and households' practices. METHODS PCQI engages communities in identifying barriers to access and quality of services, and developing, implementing and monitoring solutions. Thirty-four intervention kebeles (communities), which included the L10 K Platform, BEmONC, and PCQI, and 82 comparison kebeles, which included the L10 K Platform and BEmONC, were visited in December 2010-January 2011 and again 48 months later. Twelve women with children aged 0 to 11 months were interviewed in each kebele. Propensity score matching was used to estimate the program's average treatment effects (ATEs) on women's care seeking behavior, providers' service provision behavior and households' newborn care practices. RESULTS The ATEs of PCQI were statistically significant (p < 0.05) for two care seeking behaviors - four or more antenatal care (ANC) visits and institutional deliveries at 14% (95% CI: 6, 21) and 11% (95% CI: 4, 17), respectively - and one service provision behavior - complete ANC at 17% (95% CI: 11, 24). We found no evidence of an effect on remaining outcomes relating to household newborn care practices, and postnatal care performed by the provider. CONCLUSIONS National BEmONC strengthening and government initiatives to improve access and quality of maternal and newborn health services, together with L10 K Platform activities, appeared to work better for some care practices where communities were engaged in the PCQI strategy. Additional research with more robust measure of impact and cost-effectiveness analysis would be useful to establish effectiveness for a wider set of outcomes.
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Affiliation(s)
- Tewabech Wereta
- The Last Ten Kilometers Project (L10K) 2020, JSI Research and Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Wuleta Betemariam
- The Last Ten Kilometers Project (L10K) 2020, JSI Research and Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Ali Mehryar Karim
- The Last Ten Kilometers Project (L10K) 2020, JSI Research and Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers Project (L10K) 2020, JSI Research and Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Selamawit Dagnew
- The Last Ten Kilometers Project (L10K) 2020, JSI Research and Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Abera Wanboru
- The Last Ten Kilometers Project (L10K) 2020, JSI Research and Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Antoinette Bhattacharya
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Emaway Altaye D, Karim AM, Betemariam W, Fesseha Zemichael N, Shigute T, Scheelbeek P. Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis. BMC Pregnancy Childbirth 2018; 18:372. [PMID: 30255781 PMCID: PMC6157286 DOI: 10.1186/s12884-018-1978-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Maternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. The majority of deaths take place during childbirth or within the following 48 h. Therefore, ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia, covering about 17 million people. It aimed to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. More than 6000 Health Extension Workers were trained to initiate home-based Family Conversations with pregnant women and key household decision-makers. These conversations included discussions on birth preparedness, postpartum and newborn care needs to engage key household stakeholders in supporting women during their pregnancy, labor and postpartum periods. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices. METHODS We used cross-sectional data from a representative sample of 4684 women with children aged 0-11 months from 115 districts collected between December 2014 and January 2015. We compared intrapartum and newborn care practices related to the most recent childbirth, between those who reported having participated in a Family Conversation during pregnancy, and those who had not. Propensity score matched analysis was used to estimate average treatment effects of the Family Conversation strategy on intrapartum and newborn care practices, including institutional delivery, early postnatal and immediate breastfeeding. RESULTS About 17% of the respondents reported having had a Family Conversation during their last pregnancy. Average treatment effects of 7, 12, 9 and 16 percentage-points respectively were found for institutional deliveries, early postnatal care, clean cord care and thermal care of the newborn (p < 0.05). CONCLUSION We found evidence that Family Conversation, and specifically the involvement of household members who were major decision-makers, was associated with better intrapartum and newborn care practices. This study adds to the evidence base that involving husbands and mothers-in-law, as well as pregnant women, in behavior change communication interventions could be critical for improving maternal and newborn care and therewith lowering mortality rates.
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Affiliation(s)
- Dessalew Emaway Altaye
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc., Bole Sub-City, Kebele 03/05, Hs #, 2111 Addis Ababa, Ethiopia
| | - Ali Mehryar Karim
- JSI Research & Training Institute, Inc., 1616 N Fort Myer Dr, 16th Floor, Arlington, VA 22209 USA
| | - Wuleta Betemariam
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc., Bole Sub-City, Kebele 03/05, Hs #, 2111 Addis Ababa, Ethiopia
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc., Bole Sub-City, Kebele 03/05, Hs #, 2111 Addis Ababa, Ethiopia
| | - Tesfaye Shigute
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc., Bole Sub-City, Kebele 03/05, Hs #, 2111 Addis Ababa, Ethiopia
| | - Pauline Scheelbeek
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Chetty T, Yapa HMN, Herbst C, Geldsetzer P, Naidu KK, De Neve JW, Herbst K, Matthews P, Pillay D, Wyke S, Bärnighausen T. The MONARCH intervention to enhance the quality of antenatal and postnatal primary health services in rural South Africa: protocol for a stepped-wedge cluster-randomised controlled trial. BMC Health Serv Res 2018; 18:625. [PMID: 30089485 PMCID: PMC6083494 DOI: 10.1186/s12913-018-3404-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gaps in maternal and child health services can slow progress towards achieving the Sustainable Development Goals. The Management and Optimization of Nutrition, Antenatal, Reproductive, Child Health & HIV Care (MONARCH) study will evaluate a Continuous Quality Improvement (CQI) intervention targeted at improving antenatal and postnatal health service outcomes in rural South Africa where HIV prevalence among pregnant women is extremely high. Specifically, it will establish the effectiveness of CQI on viral load (VL) testing in pregnant women who are HIV-positive and repeat HIV testing in pregnant women who are HIV-negative. METHODS This is a stepped-wedge cluster-randomised controlled trial (RCT) of 7 nurse-led primary healthcare clinics to establish the effect of CQI on selected routine antenatal and postnatal services. Each clinic was a cluster, with the exception of the two smallest clinics, which jointly formed one cluster. The intervention was applied at the cluster level, where staff received training on CQI methodology and additional mentoring as required. In the control exposure state, the clusters received the South African Department of Health standard of care. After a baseline data collection period of 2 months, the first cluster crossed over from control to intervention exposure state; subsequently, one additional cluster crossed over every 2 months. The six clusters were divided into 3 groups by patient volume (low, medium and high). We randomised the six clusters to the sequences of crossing over, such that both the first three and the last three sequences included one cluster with low, one with medium, and one with high patient volume. The primary outcome measures were (i) viral load testing among pregnant women who were HIV-positive, and (ii) repeat HIV testing among pregnant women who were HIV-negative. Consenting women ≥18 years attending antenatal and postnatal care during the data collection period completed outcome measures at delivery, and postpartum at three to 6 days, and 6 weeks. Data collection started on 15 July 2015. The total study duration, including pre- and post-exposure phases, was 19 months. Data will be analyzed by intention-to-treat based on first booked clinic of study participants. DISCUSSION The results of the MONARCH trial will establish the effectiveness of CQI in improving antenatal and postnatal clinic processes in primary care in sub-Saharan Africa. More generally, the results will contribute to our knowledge on quality improvement interventions in resource-poor settings. TRIAL REGISTRATION This trial was registered on 10 December 2015: www.clinicaltrials.gov, identifier NCT02626351 .
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Affiliation(s)
- Terusha Chetty
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - H. Manisha N. Yapa
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - Carina Herbst
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Kevindra K. Naidu
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Maternal Adolescent and Child Health Systems (MatCH), School of Public Health, University of Witswatersrand, Braamfontein, South Africa
| | - Jan-Walter De Neve
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Kobus Herbst
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - Philippa Matthews
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - Deenan Pillay
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Division of Infection & Immunity, University College London, Gower Street, Bloomsbury, London, WC1E 6BT UK
| | - Sally Wyke
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Institute for Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ Scotland, UK
| | - Till Bärnighausen
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
- Department of Global Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT UK
| | - for the MONARCH study team
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Maternal Adolescent and Child Health Systems (MatCH), School of Public Health, University of Witswatersrand, Braamfontein, South Africa
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
- Division of Infection & Immunity, University College London, Gower Street, Bloomsbury, London, WC1E 6BT UK
- Institute for Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ Scotland, UK
- Department of Global Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT UK
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Beverly EA, Hamel-Lambert J, Jensen LL, Meeks S, Rubin A. A qualitative process evaluation of a diabetes navigation program embedded in an endocrine specialty center in rural Appalachian Ohio. BMC Endocr Disord 2018; 18:50. [PMID: 30053846 PMCID: PMC6064115 DOI: 10.1186/s12902-018-0278-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes in the United States has reached epidemic proportions and the people of Appalachia have been disproportionately affected by this disease. Strategies that complement standard diabetes care are critically important to mitigate the risk of complications, reduce health expenditures, and improve the quality of life of patients living in rural Appalachia. The purpose of this study was to conduct a qualitative process evaluation of a patient navigation program for diabetes after its first year of implementation. METHODS The process evaluation assessed how the Diabetes Navigation Program was delivered as well as how it was experienced by the navigators, providers, health administrators, and office staff at an endocrine specialty center in rural Appalachian Ohio. We employed total population sampling to conduct in-depth, face-to-face interviews with all providers, health administrators, staff, and navigators at a Diabetes Endocrine Center. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 11 software. RESULTS Seventeen individuals (providers n = 5, health administrators n = 4, office staff members n = 3, and navigators n = 5) participated in in-depth, face-to-face interviews (age = 44.7 ± 11.6 years, 82.4% female, 94.1% white, 13.3 ± 9.6 years work experience). Fidelity of implementation: The navigation team carried out most of the activities denoted in the Work Plan, therefore the program was implemented somewhat successfully. Qualitative analysis revealed three themes: 1) The navigator addresses sources of health disparities: All participants described the role of the diabetes navigator as someone who is knowledgeable about diabetes and able to identify and address health disparities. 2) The navigators are the eyes in the community and the patients' homes: Navigators offered providers and clinic staff a rare glimpse into the personal lives of patients, which led to the identification of unrecognized barriers. 3) Difficulties with cross-system integration of services: Differences in the organizational culture and vision of the specialty center and navigation office contributed to systemic barriers. CONCLUSIONS Overall, this process evaluation highlights the importance of coordinating providers, health administrators, medical office staff, and navigators to address barriers to diabetes care. Forthcoming research is needed to document the clinical effectiveness and sustainability of the Diabetes Navigation Program in rural Appalachia.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
- The Diabetes Institute, Ohio University, Athens, OH 45701 USA
| | - Jane Hamel-Lambert
- Department of Pediatric Psychology, Nationwide Children’s Hospital, Westerville, OH 43081 USA
- Department of Clinical Pediatrics, Ohio State University, Columbus, OH 43210 USA
| | - Laura L. Jensen
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
| | - Sue Meeks
- Community Service Programs, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
| | - Anne Rubin
- Southeastern Ohio Legal Services, Athens, OH USA
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Liao J, Chen Y, Cai Y, Zhan N, Sylvia S, Hanson K, Wang H, Wasserheit JN, Gong W, Zhou Z, Pan J, Wang X, Tang C, Zhou W, Xu D. Using smartphone-based virtual patients to assess the quality of primary healthcare in rural China: protocol for a prospective multicentre study. BMJ Open 2018; 8:e020943. [PMID: 29997138 PMCID: PMC6089284 DOI: 10.1136/bmjopen-2017-020943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Valid and low-cost quality assessment tools examining care quality are not readily available. The unannounced standardised patient (USP), the gold standard for assessing quality, is costly to implement while the validity of clinical vignettes, as a low-cost alternative, has been challenged. Computerised virtual patients (VPs) create high-fidelity and interactive simulations of doctor-patient encounters which can be easily implemented via smartphone at low marginal cost. Our study aims to develop and validate smartphone-based VP as a quality assessment tool for primary care, compared with USP. METHODS AND ANALYSIS The study will be implemented in primary health centres (PHCs) in rural areas of seven Chinese provinces, and physicians practicing at township health centres and village clinics will be our study population. The development of VPs involves three steps: (1) identifying 10 VP cases that can best represent rural PHCs' work, (2) designing each case by a case-specific development team and (3) developing corresponding quality scoring criteria. After being externally reviewed for content validity, these VP cases will be implemented on a smartphone-based platform and will be tested for feasibility and face validity. This smartphone-based VP tool will then be validated for its criterion validity against USP and its reliability (ie, internal consistency and stability), with 1260 VP/USP-clinician encounters across the seven study provinces for all 10 VP cases. ETHICS AND DISSEMINATION Sun Yat-sen University: No. 2017-007. Study findings will be published and tools developed will be freely available to low-income and middle-income countries for research purposes.
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Affiliation(s)
- Jing Liao
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yiyuan Cai
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Nan Zhan
- Department of Health Management, School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kara Hanson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hong Wang
- Health Economics, Financing & Systems, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Judith N Wasserheit
- Departments of Global Health, Medicine, and Epidemiology, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Jay Pan
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, China
| | - Wei Zhou
- Hospital Administration Institute, Xiangya Hospital, Central South University, Changsha, China
| | - Dong Xu
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University
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Abstract
The interrelationship between the public and private sectors, and formal and informal healthcare sectors effects market-level service quality, pricing behaviour and referral networks. However, health utilisation analysis of national survey data from many low and middle income countries is constrained by the lack of disaggregated health provider data. This study is concerned with the pattern of repeat outpatient consultations for a single episode of fever from public and private qualified providers and private unqualified providers. Cross-sectional survey data from 1173 adult respondents sampled from three districts within India's most populous state-Uttar Pradesh is analysed. Data was collected during the monsoon season-September to October-in 2012. Regression analysis focuses on the pattern of repeats visits for a single episode of mild-sever fever as the dependent variable. Results show that Women and Muslims in rural north India are more likely to not access healthcare, and if they do, consult with low quality unqualified outpatient healthcare providers. For fever durations of four or more days, men are more likely to access unqualified providers compared to women. Results of the current study supports the literature that women's utilisation of outpatient healthcare for communicable illnesses in LMICs is often less than men. A relative lack of access to household resources explains why fever duration parameter estimates for women and men differ.
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Affiliation(s)
- Richard A. Iles
- Washington State University, Pullman, Washington, United States of America
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Gutenstein M, Kiuru S. Development of an otitis media strategy in the Pacific: key informant perspectivesThe Matthew effect in New Zealand rural hospital trauma and emergency care: why rural simulation-based education matters. N Z Med J 2018; 131:81-84. [PMID: 29879729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We describe a phenomenon of self-reinforcing inequality between New Zealand rural hospitals and urban trauma centres. Rural doctors work in remote geographical locations, with rare exposure to managing critical injuries, and with little direct support when they do. Paradoxically, but for the same reasons, they also have little access to the intensive training resources and specialist oversight of their university hospital colleagues. In keeping with international experience, we propose that using simulation-based education for rural hospital trauma and emergency team training will mitigate this effect. Along with several different organisations in New Zealand, the University of Otago rural postgraduate programme is developing inter-professional simulation content to address this challenge and open new avenues for research.
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Affiliation(s)
- Marc Gutenstein
- Professional Practice Fellow, Rural Postgraduate Programme, Dean's Department Dunedin, University of Otago
| | - Sampsa Kiuru
- Clinical Senior Lecturer in Rural Health, Rural Health Academic Centre Ashburton, University of Otago
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Amalba A, Abantanga FA, Scherpbier AJJA, van Mook WNKA. Working among the rural communities in Ghana - why doctors choose to engage in rural practice. BMC Med Educ 2018; 18:133. [PMID: 29884172 PMCID: PMC5994092 DOI: 10.1186/s12909-018-1234-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND An unequal distribution of health personnel, leading to unfavourable differences in health status between urban and rural populations, is a serious cause for concern globally. Part of the solution to this problem lies in attracting medical doctors to rural, remote communities, which presents a real challenge. The present study therefore explored the factors that influence medical doctors' decision to practise in rural Ghana. METHODS We conducted a cross-sectional descriptive study based on questionnaires. Participants were doctors working in health facilities in the districts and rural areas of the Northern Region, Ghana. The qualitative data analysis consisted of an iterative process of open, axial and selective coding. RESULTS We administered the questionnaires to 40 doctors, 27 of whom completed and returned the form, signalling a response rate of 67.5%. The majority of the doctors were male (88.9%) and had been trained at the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS) (63%). Although they had chosen to work in the remote areas, they identified a number of factors that could prevent future doctors from accepting rural postings, such as: a lack of social amenities, financial and material resources; limited career progression opportunities; and too little emphasis on rural practice in medical school curricula. Moreover, respondents flagged specific stakeholders who, in their opinion, had a major role to play in the attraction of doctors and in convincing them to work in remote areas. CONCLUSIONS The medical doctors we surveyed had gravitated to the rural areas themselves for the opportunity to acquire clinical skills and gain experience and professional independence. Nevertheless, they felt that in order to attract such cadre of health professionals to rural areas and retain them there, specific challenges needed addressing. For instance, they called for an enforceable, national policy on rural postings, demanding strong political commitment and leadership. Another recommendation flowing from the study findings is to extend the introduction of Community-Based Education and Service (COBES) or similar curriculum components to other medical schools in order to prepare students for rural practice, increasing the likelihood of them accepting rural postings.
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Affiliation(s)
- Anthony Amalba
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences (SMHS), University for Development Studies (UDS), P. O. Box, 1883 Tamale, Ghana
| | - Francis A. Abantanga
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences (SMHS), University for Development Studies (UDS), P. O. Box, 1883 Tamale, Ghana
| | - Albert J. J. A. Scherpbier
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - W. N. K. A. van Mook
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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Sen Gupta T, Johnson P, Rasalam R, Hays R. Growth of the James Cook University Medical Program: Maintaining quality, continuing the vision, developing postgraduate pathways. Med Teach 2018; 40:495-500. [PMID: 29457929 DOI: 10.1080/0142159x.2018.1435859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND James Cook University (JCU) enrolled its first cohort of 64 in 2000 into a 6-year undergraduate medical program aimed at producing graduates capable of meeting the needs of North Queensland, Australia, with a focus on rural, remote, Indigenous and tropical health. The school's 1465 graduates over 13 cohorts who have a pattern of practice likely to meet the region's health needs. The JCU course was the first new Australian medical program for 25 years. The number of Australian medical schools has since doubled, while enrollments have almost tripled. METHODS JCU's course features innovations such as dispersed, community-based education, rurally-focused selection, extended rural placements, and an emphasis on community needs - which are all now mainstream. This paper traces developments at JCU over the past decade, illustrating parallels with the broader Australian scene. RESULTS Maintaining quality and educational integrity while numbers grow is challenging. The course has undergone modest curriculum redesign, but the fundamental elements are intact. The focus on meeting the region's needs remains, with some evolution of its mission to include social accountability and the needs of underserved populations. CONCLUSIONS Postgraduate pathways are an important priority. Regional training hubs are being developed to support local pipelines into specialty practice. Queensland's Rural Generalist Pathway provides an incentivised pathway to rural practice while Generalist Medical Training provides a local training pipeline into general practice and rural medicine. As these initiatives mature, communities should benefit as JCU and other Australian programs continue to address local workforce needs.
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Affiliation(s)
- Tarun Sen Gupta
- a College of Medicine and Dentistry , James Cook University , Townsville , QLD , Australia
| | - Peter Johnson
- a College of Medicine and Dentistry , James Cook University , Townsville , QLD , Australia
| | - Roy Rasalam
- a College of Medicine and Dentistry , James Cook University , Townsville , QLD , Australia
| | - Richard Hays
- b Mt Isa Centre for Rural & Remote Health , Mount Isa , QLD , Australia
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Abstract
In many low and middle-income countries patients often bypass the nearest government health center offering free or subsidized services and seek more expensive care elsewhere. This study examines the role of quality of care, in particular clinician competence and structural quality of the health center, on bypassing behavior. Data for this study comes from a survey of 136 primary health centers (PHCs) and 3517 individuals living in the PHC's immediate vicinity in rural Chhattisgarh, India. Overall, the majority (67%) of patients bypassed the local PHC when seeking treatment. Bypassing decreased as provider competence increased, up to a point, after which, improvements in competency did not reduce bypassing. The clinical competence of the health care provider had a greater effect on reducing bypassing compared to PHC structural quality such as the building condition and drug stock-outs. However, the regular presence of clinical providers in the PHC was associated with lower bypassing. Patients that visited the local PHC spent half as much out-of-pocket as those that were treated at private clinics. Poor patients were less likely to bypass the local PHC compared to non-poor patients. These findings suggest that improving structural quality is not sufficient to reduce bypassing of PHCs. While better provider competency can substantially reduce bypassing, beyond a threshold competency level there is little effect. Efforts to strengthen facility-based primary care services need to go beyond simply focusing on improving infrastructure or quality of clinical care. There is a need to rethink how PHCs can be made more relevant to the health care needs of the communities they serve.
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Affiliation(s)
- Krishna D Rao
- Johns Hopkins Bloomberg School of Public Health, USA
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Abstract
INTRODUCTION Access to quality healthcare services is considered a moral right. However, for people living in regional locations, timely access to the services that they need may not always be possible because of structural and attitudinal barriers. This suggests that people living in regional areas may have unmet healthcare needs. The aim of this research will be to examine the healthcare needs, expectations and experiences of regional South Australians. METHODS AND ANALYSIS The Regional South Australia Health (RESONATE) survey is a cross-sectional study of adult health consumers living in any private or non-private dwelling, in any regional, rural, remote or very remote area of South Australia and with an understanding of written English. Data will be collected using a 45-item, multidimensional, self-administered instrument, designed to measure healthcare need, barriers to healthcare access and health service utilisation, attitudes, experiences and satisfaction. The instrument has demonstrated acceptable psychometric properties, including good content validity and internal reliability, good test-retest reliability and a high level of acceptability. The survey will be administered online and in hard-copy, with at least 1832 survey participants to be recruited over a 12-month period, using a comprehensive, multimodal recruitment campaign. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of the University of South Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Esther May
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Hengel B, Bell S, Garton L, Ward J, Rumbold A, Taylor-Thomson D, Silver B, McGregor S, Dyda A, Knox J, Guy R, Maher L, Kaldor JM. Perspectives of primary health care staff on the implementation of a sexual health quality improvement program: a qualitative study in remote aboriginal communities in Australia. BMC Health Serv Res 2018; 18:230. [PMID: 29609656 PMCID: PMC5879735 DOI: 10.1186/s12913-018-3024-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young people living in remote Australian Aboriginal communities experience high rates of sexually transmissible infections (STIs). STRIVE (STIs in Remote communities, ImproVed and Enhanced primary care) was a cluster randomised control trial of a sexual health continuous quality improvement (CQI) program. As part of the trial, qualitative research was conducted to explore staff perceptions of the CQI components, their normalisation and integration into routine practice, and the factors which influenced these processes. METHODS In-depth semi-structured interviews were conducted with 41 clinical staff at 22 remote community clinics during 2011-2013. Normalisation process theory was used to frame the analysis of interview data and to provide insights into enablers and barriers to the integration and normalisation of the CQI program and its six specific components. RESULTS Of the CQI components, participants reported that the clinical data reports had the highest degree of integration and normalisation. Action plan setting, the Systems Assessment Tool, and the STRIVE coordinator role, were perceived as adding value to the program, but were less readily integrated or normalised. The remaining two components (dedicated funding for health promotion and service incentive payments) were seen as least relevant. Our analysis also highlighted factors which enabled greater integration of the CQI components. These included familiarity with CQI tools, increased accountability of health centre staff and the translation of the CQI program into guideline-driven care. The analysis also identified barriers, including high staff turnover, limited time involved in the program and competing clinical demands and programs. CONCLUSIONS Across all of the CQI components, the clinical data reports had the highest degree of integration and normalisation. The action plans, systems assessment tool and the STRIVE coordinator role all complemented the data reports and allowed these components to be translated directly into clinical activity. To ensure their uptake, CQI programs must acknowledge local clinical guidelines, be compatible with translation into clinical activity and have managerial support. Sexual health CQI needs to align with other CQI activities, engage staff and promote accountability through the provision of clinic specific data and regular face-to-face meetings. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12610000358044 . Registered 6/05/2010. Prospectively Registered.
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Affiliation(s)
- Belinda Hengel
- Apunipima Cape York Health Council, PO Box 12045, Earlville, Cairns, Qld 4870 Australia
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, NSW 2052 Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010 Australia
| | - Stephen Bell
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, NSW 2052 Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052 Australia
| | - Linda Garton
- NT Department of Health, Sexual Health and Blood Borne Virus Unit, Casuarina, NT 0811 Australia
| | - James Ward
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
- Flinders University, Adelaide, SA 5000 Australia
| | - Alice Rumbold
- Menzies School of Health Research, Darwin, NT 0810 Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5006 Australia
| | | | - Bronwyn Silver
- Central Australian Aboriginal Congress, Alice Springs, NT 0870 Australia
| | - Skye McGregor
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Amalie Dyda
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Janet Knox
- Lismore Sexual Health Service, NSW Health, Sydney, NSW 2480 Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - John Martin Kaldor
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, NSW 2052 Australia
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McCalmont JC, Jones KD, Bennett RM, Friend R. Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing? J Opioid Manag 2018; 14:103-116. [PMID: 29733096 DOI: 10.5055/jom.2018.0437] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES (1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations. METHODS A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training. RESULTS The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers' profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9). CONCLUSIONS Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.
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Affiliation(s)
| | - Kim D Jones
- Nursing, Oregon Health & Science University, Portland, Oregon
| | | | - Ronald Friend
- Psychology, Stony Brook University, Stony Brook, New York
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