Structural barriers to adherence to antiretroviral therapy in a resource-constrained setting: the perspectives of health care providers

AIDS Care ◽  
2011 ◽  
Vol 23 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Bronwyne Coetzee ◽  
Ashraf Kagee ◽  
Nadia Vermeulen
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Health Care Providers ◽  
Care Providers ◽  
Structural Barriers ◽  
Resource Constrained

scholarly journals Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline

2018 ◽  
pp. 1-24 ◽  
Author(s):  
Hibah Osman ◽  
Sudip Shrestha ◽  
Sarah Temin ◽  
Zipporah V. Ali ◽  
Rumalie A. Corvera ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Practice Guideline ◽  
Expert Panel ◽  
Psychosocial Support ◽  
Guideline Development ◽  
Indirect Evidence ◽  
Care Providers ◽  
Resource Constrained

Purpose The purpose of this new resource-stratified guideline is to provide expert guidance to clinicians and policymakers on implementing palliative care of patients with cancer and their caregivers in resource-constrained settings and is intended to complement the Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update of 2016. Methods ASCO convened a multidisciplinary, multinational panel of experts in medical oncology, family medicine, radiation oncology, hematology/oncology, palliative and/or hospice care, pain and/or symptom management, patient advocacy, public health, and health economics. Guideline development involved a systematic literature review, a modified ADAPTE process, and a formal consensus-based process with the Expert Panel and additional experts (consensus ratings group). Results The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including Expert Panel). Recommendations The recommendations help define the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings. Additional information is available at www.asco.org/resource-stratified-guidelines . It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

Identifying appropriate candidates for long-acting antiretroviral therapy: findings from a survey of health care providers in the ATLAS-2M trial

2020 ◽  
Vol 21 (4) ◽  
pp. 105-113
Author(s):  
Miranda Murray ◽  
Deanna Kerrigan ◽  
Krischan J. Hudson ◽  
Nicola Walters ◽  
Tahilin Sanchez Karver ◽  
...  
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Health Care Providers ◽  
Care Providers ◽  
Long Acting

scholarly journals Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study

10.2196/29755 ◽  
2021 ◽  
Vol 23 (10) ◽  
pp. e29755
Author(s):  
Amy Sarah Ginsburg ◽  
Mai-Lei Woo Kinshella ◽  
Violet Naanyu ◽  
Jessica Rigg ◽  
Dorothy Chomba ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Facility ◽  
University Hospital ◽  
Physiological Monitoring ◽  
Care Providers ◽  
Resource Constrained ◽  
Health Care Administrators ◽  
Training Requirements ◽  
Monitoring Technologies

Background Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization. Objective This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting. Methods We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software. Results Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies. Conclusions Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-035184

scholarly journals How clinicians experience a simulated antiretroviral therapy adherence exercise: A qualitative study

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Justin G. Engelbrecht ◽  
Fidele K. Mukinda ◽  
Beryl Green ◽  
Donald Skinner
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antiretroviral Therapy ◽  
Health Care Providers ◽  
Text Messaging ◽  
Health Care Facilities ◽  
Care Providers ◽  
Simulation Exercise ◽  
Primary Health ◽  
Adherence Counselling

Background: With the shift of paediatric antiretroviral therapy (ART) from tertiary to primary health care, there has been a need to train clinicians working in primary health care facilities to support adherence to treatment. An adherence simulation exercise was included in a course on paediatric human immunodeficiency virus (HIV) and tuberculosis (TB) to stimulate health care providers’ awareness and generate empathy of complex paediatric adherence practices.Aim: The aim of this study was to describe the experience of clinicians completing the simulation exercise and to assess whether enhancing their empathy with patients and treatment supporters would improve their perceived clinical and counselling skills.Setting: The study was conducted at the Faculty of Medicine and Health Sciences, Stellenbosch University, and a guesthouse in Cape Town.Methods: The adherence module used blended learning methodology consisting of face-to-face contact sessions and distance learning. A qualitative thematic approach was used to understand the participant experiences through focus-group discussions and semi-structured interviews.Results: Three thematic clusters emerged, namely, experiences of the simulated exercise, patient–provider relationships and adherence strategies. Their experiences were both positive and challenging, especially when a ‘caregiver and/or treatment supporter’ scenario encouraged participants to reflect on their own relationships with their patients. Clinicians had also considered how empathy fits into their scope of responsibilities. Text messaging and adherence counselling strategies were identified.Conclusion: Simulated learning activities have the potential to create awareness of relationships between clinicians and their patients and generate ideas and discussion that could lead to improvements in clinical practice, and adherence promotion strategies.

scholarly journals Nurses Perceptions regarding the antiretroviral therapy services at selected health facilities in Lesotho

2021 ◽  
Author(s):  
Isabel Nyangu ◽  
Zerish Zethu Nkosi
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Health Care Providers ◽  
Organizational Structures ◽  
Self Report ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Therapy Services ◽  
Strongly Agree

Background: In Lesotho, ART services are provided in primary health care (PHC) facilities which are mostly run by nurses. Purpose: The study aimed to describe perceptions of nurses regarding the antiretroviral therapy services at PHC facilities across six selected districts in Lesotho. Methods: A cross sectional survey was conducted in which convenience sampling was used to select 214 nurses working at PHC facilities across six districts. They completed a structured self-report questionnaire that collected information on their perceptions using a Likert scale with six options (strongly agree, agree, neutral, disagree, strongly disagree, and no answer). The response rate was 92% (n=197) and data were analyzed using SPSS (23). Results: Perceptions of nurses were positive and the same on whether ARVS and other medications were available; they were qualified and competent to provide ART services; they had adequate resources and equipment to provide ART services; they were satisfied with their jobs and the services they provided; and there was monitoring and evaluating system for the ART services. Their perceptions significantly differed and were mostly negative on whether they were adequately staffed to provide ART services; their organizational structures allowed for the provision of adequate and efficient services; ART services were accessible; and there was adequate and accurate documentation of the ART services they provided. Conclusions: As nurses are the main health care providers in Lesotho, their perceptions are important in improving service delivery. It is important to standardize ART services across the districts to ensure equitable accessibility in line with service demand.

scholarly journals Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study (Preprint)

2021 ◽  
Author(s):  
Amy Sarah Ginsburg ◽  
Mai-Lei Woo Kinshella ◽  
Violet Naanyu ◽  
Jessica Rigg ◽  
Dorothy Chomba ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Facility ◽  
University Hospital ◽  
Physiological Monitoring ◽  
Care Providers ◽  
Resource Constrained ◽  
Health Care Administrators ◽  
Training Requirements ◽  
Monitoring Technologies

BACKGROUND Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization. OBJECTIVE This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting. METHODS We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software. RESULTS Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies. CONCLUSIONS Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2019-035184

Combination antiretroviral therapy: Health care providers confront emerging dilemmas

AIDS Care ◽  
2000 ◽  
Vol 12 (4) ◽  
pp. 409-421 ◽  
Author(s):  
B. Gerbert ◽  
A. Bronstone ◽  
K. Clanon ◽  
P. Abercrombie ◽  
D. Bangsberg
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Health Care Providers ◽  
Combination Antiretroviral Therapy ◽  
Care Providers

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

Using Technology to Improve Access to Health Care for Culturally and Linguistically Diverse Populations

2012 ◽  
Vol 19 (3) ◽  
pp. 71-76 ◽  
Author(s):  
Pauline A. Mashima
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Access To Health Care ◽  
Underserved Populations ◽  
Linguistically Diverse ◽  
Care Providers ◽  
Department Of Health ◽  
Use Of Technology ◽  
Access To Health ◽  
Improve Access

Important initiatives in health care include (a) improving access to services for disadvantaged populations, (b) providing equal access for individuals with limited or non-English proficiency, and (c) ensuring cultural competence of health-care providers to facilitate effective services for individuals from diverse racial and ethnic backgrounds (U.S. Department of Health and Human Services, Office of Minority Health, 2001). This article provides a brief overview of the use of technology by speech-language pathologists and audiologists to extend their services to underserved populations who live in remote geographic areas, or when cultural and linguistic differences impact service delivery.

Interdisciplinary Therapy Assessments for the Older Adult

2012 ◽  
Vol 17 (1) ◽  
pp. 11-16
Author(s):  
Lynn Chatfield ◽  
Sandra Christos ◽  
Michael McGregor
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Standardized Testing ◽  
Health Care Providers ◽  
Outcome Measurement ◽  
Care Providers ◽  
Patient Centered ◽  
Screening Process ◽  
Evidenced Based ◽  
Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

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