Health System Factors Affecting Communication with Pediatricians: Gendered Work Culture in Primary Care

2011 ◽  
Vol 26 (7) ◽  
pp. 672-694 ◽  
Author(s):  
Sean Lynch
Keyword(s):  
Primary Care ◽  
Health System ◽  
Work Culture ◽  
Factors Affecting ◽  
System Factors ◽  
Gendered Work

scholarly journals Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross-sectional survey

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022904 ◽  
Author(s):  
Michael Harris ◽  
Peter Vedsted ◽  
Magdalena Esteva ◽  
Peter Murchie ◽  
Isabelle Aubin-Auger ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Factor Analysis ◽  
Health System ◽  
Health Systems ◽  
European Countries ◽  
Cancer Symptoms ◽  
Referral Decision ◽  
System Factors ◽  
Primary Care Practitioners

ObjectivesCancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners’ (PCPs’) referral decisions is lacking.This study analyses health system factors potentially influencing PCPs’ referral decision-making when consulting with patients who may have cancer, and how these vary between European countries.DesignBased on a content-validity consensus, a list of 45 items relating to a PCP’s decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs’ referral decision-making.SettingA primary care study; 25 participating centres in 20 European countries.Participants1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.Outcome measuresThe factors derived from items related to PCPs’ referral decision-making. Mean factor scores were produced for each country, allowing comparisons.ResultsFactor analysis identified five underlying factors: PCPs’ ability to refer; degree of direct patient access to secondary care; PCPs’ perceptions of being under pressure; expectations of PCPs’ role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses.ConclusionsFive healthcare system factors influencing PCPs’ referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.

scholarly journals Minimally Adequate Mental Health Treatment and Mortality in Primary Care Older Adults With Depression and Anxiety

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 864-865
Author(s):  
Helen-Maria Vasiliadis ◽  
Catherine Lamoureux-Lamarche ◽  
Sébastien Grenier ◽  
Pasquale Roberge
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Health System ◽  
Emergency Department Visits ◽  
Adequate Treatment ◽  
Risk Of Mortality ◽  
Follow Up Care ◽  
System Factors

Abstract Receipt of quality mental health (MH) care can influence mortality. Given the scarce literature on the topic, the aim was to assess the 3-year risk of mortality in older adults (OA) associated with receiving adequate MH treatment for depression/anxiety in an epidemiologic context. The study sample included 358 OA with depression/anxiety recruited in primary care practices and followed prospectively for 3 years. Mortality was assessed from vital statistics data. Adequate care was based on receipt of pharmacotherapy, follow-up care and psychotherapy. Propensity score analysis was carried out where the inverse probability (IPW) of receiving adequate treatment was calculated. Time to event analyses with IPW was used to assess the effect of receipt of adequate MH treatment on the risk of mortality controlling for individual and health system factors. The results showed that receipt of adequate MH treatment reduced the risk of mortality (HR0.44; 95% CI: 0.22 – 0.99). Individual factors that increased mortality were male sex, being single, reduced functional status and cognitive functioning, # physical disorders, current smoking; while exercise reduced risk. Health system factors such as past # of hospitalizations increased the risk; while # of emergency department visits and continuity of care reduced mortality. Finally, treating depression/anxiety with minimal follow-up care and pharmacotherapy or psychotherapy has a significant impact on reducing mortality in OA. Primary care physicians should recognize the important potential impact of years of lives saved when providing quality MH care to OA.

scholarly journals Assessing Health System Factors Affecting Access and Delivery of IPTp-SP and ITN to Pregnant Women Attending ANC Clinics in Ghana-A Quantitative Study

2021 ◽  
Author(s):  
Virtue Fiawokome De-Gaulle ◽  
Pascal Magnussen ◽  
Joseph Kamgno ◽  
Wilfred Mbacham ◽  
Verner Ndudiri Orish ◽  
...  
Keyword(s):  
Health System ◽  
Pregnant Women ◽  
Health Workers ◽  
Care Delivery ◽  
Health Planning ◽  
Intermittent Preventive Treatment ◽  
Health Staff ◽  
Factors Affecting ◽  
Delivery Practices ◽  
System Factors

Abstract Introduction: Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions.Methods: A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. Results: Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390). Despite the availability of SP, 15% (75) of all eligible women were not offered the medication and 37% (44) of inappropriate delivery was due to stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. Conclusions: IPTp-SP was appropriately delivered to 76% of clients as compared to 59% in the case of ITN. Despite stock availability, IPTp-SP and ITN were not delivered to some eligible women. This highlights health worker related factors influencing delivery.

scholarly journals Assessing health system factors affecting access and delivery of IPTp-SP and ITN to pregnant women attending ANC clinics in Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Virtue Fiawokome De-Gaulle ◽  
Pascal Magnussen ◽  
Joseph Kamgno ◽  
Wilfred Mbacham ◽  
Verner N. Orish ◽  
...  
Keyword(s):  
Health System ◽  
Pregnant Women ◽  
Health Workers ◽  
Care Delivery ◽  
Health Planning ◽  
Intermittent Preventive Treatment ◽  
Health Staff ◽  
Factors Affecting ◽  
Delivery Practices ◽  
System Factors

Abstract Introduction Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions. Methods A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. Results Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511/657) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390/511). Despite the availability of SP, 15% (75/511) of all eligible women were not offered the medication and 37% (44/119) of inappropriate delivery was recorded during periods of stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77/237) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. Conclusions IPTp-SP was appropriately delivered to most of the eligible pregnant women compared to ITN. While stock out of both intervention could account for inappropriate delivery, despite stock availability, IPTp-SP and ITN were not delivered to some eligible women.

Patient, tumor, and health system factors affecting groin node dissection rates in vulvar carcinoma: A population-based cohort study

2015 ◽  
Vol 139 (3) ◽  
pp. 465-470 ◽  
Author(s):  
Lilian T. Gien ◽  
Rinku Sutradhar ◽  
Gillian Thomas ◽  
Allan Covens ◽  
Laurie Elit ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health System ◽  
Population Based ◽  
Vulvar Carcinoma ◽  
Node Dissection ◽  
Factors Affecting ◽  
System Factors
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