scholarly journals Conceptualizing difference: an analysis of physicians’ views on delivering care to asylum seekers

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Jahn ◽  
L Biddle
Keyword(s):  
Medical Care ◽  
Patient Group ◽  
Health Care Professionals ◽  
Patient Population ◽  
Asylum Seekers ◽  
Care Provision ◽  
Structured Interviews ◽  
Appropriate Care ◽  
Adequate Care ◽  
Delivery Of Medical Care

Abstract Background International migration leads to an increasingly fluctuating and superdiverse migrant population in reception countries. In Germany, structural, legal, social and political barriers to adequate care complicate the ability of health care professionals to respond to the challenges associated with caring for such a dynamic patient population. In this analysis, we explore the views of physicians working with asylum seekers and refugees in Germany, and aim to identify the barriers and enablers they face in providing appropriate care. Methods We performed a secondary qualitative analysis of 16 semi-structured interviews conducted for two studies on the delivery of medical care to asylum seekers in Germany. To examine physicians' views towards their work with asylum seekers, we analysed evaluative judgements on interpersonal and workplace factors, the external environment, the physician's own self, and individual medical conduct. Analysis was conducted by identifying cross-cutting themes through thematic analysis and mapping these onto a framework matrix. Results We found that evaluative judgements made by physicians providing care to asylum seekers emphasized one of three conceptualisations of “difference”: regarding personal or cultural attributes of the patient group; the spaces of care provision; or the context of asylum seeking patients. Emphasis on differences of the patient population and the spaces of care provision to asylum seekers was found to impede appropriate care, while physicians emphasizing contextual factors reported more responsive medical practices. Discussion Our findings suggest that processes of “othering” asylum seekers as a patient group as well as the heterotopic spaces of care provision endanger the doctor-patient relationship and responsiveness of care. Appropriate training, physical and human resources and encouraging support between physicians working with asylum seeking patients could alleviate these processes. Key messages Physicians’ conceptualisations of “difference” in providing care to asylum seekers focus on the patient group, workplace, or structural context; and affect the way in which medical care is provided. Structural competency training, resource investments, and clear structures could reduce physicians’ experiences of “difference” of the patient group and workplace, and facilitate responsive care.

Care for delirium superimposed on dementia at an early stage

2020 ◽  
Keyword(s):  
Behavioral Problems ◽  
Healthcare Professionals ◽  
Early Stage ◽  
Good Care ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Appropriate Care ◽  
Adequate Care ◽  
Insight Into ◽  
Delirium Superimposed On Dementia

Delirium is a common serious complication in dementia that is associated with poor prognosis and a high burden on caregivers and healthcare professionals. Appropriate care is therefore important at an early stage for patients with delirium superimposed on dementia To gain insight into the care of six patients with delirium superimposed on dementia, 19 semi-structured interviews were conducted focused on the experiences of caregivers and professionals. The interviews revealed four themes that appeared to play a role: 1. experiences with and views on behavioral problems of these patients, 2. recognition and diagnosis of delirium in dementia, 3. views on good care and 4. organizational aspects. Knowledge gaps about delirium in dementia, as well as ethical considerations, play an important role in organizing timely and adequate care for patients with delirium superimposed on dementia.

Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle

2018 ◽  
Vol 76 (4) ◽  
pp. 359-385 ◽  
Author(s):  
L. Michele Issel
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Practice Guidelines ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Professional Expertise ◽  
Work Processes ◽  
Patient Centeredness ◽  
Medical Practitioners ◽  
Delivery Of Medical Care

The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. Method: Following Poole and van de Ven’s (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed. Results: A total of 10 paradoxes related to practice guidelines, professional expertise, and patient centeredness are revealed. The resolution of each paradox yields insights specific to structuring health care organizations in ways that support the delivery of medical care. Implications: The results renew an emphasis on the centrality of practitioners’ work processes to health care organizations; this has potential benefits for organizations, clinicians/employees, and patients.

scholarly journals To Do or Not to Do… Primary Health Care Professionals Experiences With Mothers With Children Born of Sexual Violence

2021 ◽  
Vol 12 ◽  
Author(s):  
Eline Meuleman ◽  
Elisa van Ee
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Sexual Violence ◽  
Health Care Professionals ◽  
Youth Services ◽  
Structured Interviews ◽  
Knowledge And Skills ◽  
Clinical Nurse Specialists ◽  
Adequate Care ◽  
Challenges And Opportunities

Mothers and their children born of sexual violence are at heightened risk for developing an insecure attachment relationship. These mothers and their children often enter care late or not at all, as they are not identified by health care professionals. In this qualitative study, semi structured interviews were conducted with sixteen professionals in primary care for pregnant women and/or young mothers with the aim to identify the status quo in knowledge and skills, challenges, and opportunities. Participants included among others professionals working at Youth Services, psychologists, and clinical nurse specialists. Through a thematic analysis, five themes were identified: the knowledge of the professional, discussing the sexual violence, suitable interventions, points of attention during care, and recommendations. Analysis revealed that three groups of professionals can be distinguished, based on their level of awareness of this target group and their available knowledge and skills. To improve primary care for mothers with children born of sexual violence an increase in awareness, knowledge, and skills is a necessary prerequisite. Scientifically based best practices are therefore necessary for health care professionals to provide adequate care for mothers with children born of sexual violence.

scholarly journals Healthcare access for asylum seekers and refugees in England: a mixed methods study exploring service users’ and health care professionals’ awareness

2019 ◽  
Vol 30 (3) ◽  
pp. 527-532 ◽  
Author(s):  
Louise J Tomkow ◽  
Cara Pippa Kang ◽  
Rebecca L Farrington ◽  
Ruth E Wiggans ◽  
Rebecca J Wilson ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Care Professionals ◽  
Asylum Seekers ◽  
Negative Impact ◽  
Healthcare Access ◽  
Political Climate ◽  
Structured Interviews ◽  
Language Difficulties ◽  
Asylum Seekers And Refugees

Abstract Background With the aim of decreasing immigration, the British government extended charging for healthcare in England for certain migrants in 2017. There is concern these policies amplify the barriers to healthcare already faced by asylum seekers and refugees (ASRs). Awareness has been shown to be fundamental to access. This article jointly explores (i) health care professionals’ (HCPs) awareness of migrants’ eligibility for healthcare, and (ii) ASRs’ awareness of health services. Methods Mixed methods were used. Quantitative survey data explored HCPs’ awareness of migrants’ eligibility to healthcare after the extension of charging regulations. Qualitative data from semi-structured interviews with ASRs were analyzed thematically using Saurman’s domains of awareness as a framework. Results In total 514 HCPs responded to the survey. Significant gaps in HCPs’ awareness of definitions, entitlements and charging regulations were identified. 80% of HCP respondents were not confident defining the immigration categories upon which eligibility for care rests. Only a small minority (6%) reported both awareness and understanding of the charging regulations. In parallel, the 18 ASRs interviewed had poor awareness of their eligibility for free National Health Service care and suitability for particular services. This was compounded by language difficulties, social isolation, frequent asylum dispersal accommodation moves, and poverty. Conclusion This study identifies significant confusion amongst both HCP and ASR concerning eligibility and healthcare access. The consequent negative impact on health is concerning given the contemporary political climate, where eligibility for healthcare depends on immigration status.

Maternal health care provision for refugee women

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Kasper
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Professionals ◽  
Maternal Health Care ◽  
Professional Practices ◽  
Health Care Provision ◽  
Care Provision ◽  
Structured Interviews ◽  
Childbearing Age ◽  
Refugee Women

Abstract Background In the recent past, the number of forcibly displaced people increased worldwide. About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women who are coming to Germany are currently of childbearing age. Refugee women are considered a highly vulnerable refugee subgroup, as they frequently experience physical strains and psychological burdens while fleeing their home countries and being pregnant at the same time. Moreover, pregnancy and the following period require specialized care and support in order to allow a transition to maternity without complications. The aim of this project is to analyze maternal health care services for refugee women on the level of interaction with maternal health care professionals in Germany. Methods Maternal health care professionals in outpatient and clinical settings with experiences of caring for refugee women were recruited. Semi-structured interviews were conducted. The interviews were analyzed following the standards of qualitative thematic analysis. Results Maternal health care professionals face challenges in implementing and providing maternal health care concerning their professional practices and interventions. Due to a lack of resources (e.g. translators, time) and other conditions, gynaecologists and midwives are forced to find new solutions that maintain (medical care), adapt (vaginal examination) or miss out on (informed consent) ordinary professional practices. Key messages Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers and problems in relationship building. The identification of challenges and opportunities for professionals in maternal health care provision may contribute to improve maternal health (care) for refugee women.

scholarly journals Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dieke Westerduin ◽  
Janneke Dujardin ◽  
Jaap Schuurmans ◽  
Yvonne Engels ◽  
Anne B. Wichmann
Keyword(s):  
General Practitioners ◽  
Thematic Analysis ◽  
Ethical Dilemmas ◽  
Self Determination ◽  
Duty Of Care ◽  
Care Provision ◽  
Structured Interviews ◽  
Inpatient Hospitalization ◽  
Adequate Care ◽  
Hospital Beds

Abstract Background General practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpatient or inpatient hospitalization) complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic. Methods Semi-structured interviews with Dutch general practitioners working in the Netherlands were conducted. Participants were recruited via purposive sampling. Thematic analysis was conducted using content coding. Results Fifteen interviews were conducted, identifying four themes: one overarching regarding (1) COVID-19 uncertainties, and three themes about experienced ethical dilemmas: (2) the patients’ self-determination vs. the general practitioners’ paternalism, (3) the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, (4) the general practitioners’ duty of care vs. adequate care provision. Conclusions Lack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account.

Toward a Duty to Report Clinical Trials Accurately: The Clinical Alert and beyond

1994 ◽  
Vol 22 (4) ◽  
pp. 327-338 ◽  
Author(s):  
Kathleen Cranley Glass
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
North America ◽  
Medical Care ◽  
Health Care Professionals ◽  
Appropriate Care ◽  
Legal Obligations ◽  
Trial Outcomes

Advances in medicine depend not only on the generation of information but also on its dissemination. Clinically relevant data must be transmitted to the practitioners who will use it. Health care professionals in North America are aware of their ethical and legal obligations to inform patients adequately concerning interventions and treatments so that they may make informed choices about medical care. This obligation has been well described and defined by the courts and in the literature of medicine, ethics, and law. But do investigators and others who are responsible for disseminating information have any obligation to divulge adequately the results of clinical trials to practitioners so that the latter might offer the choice of appropriate care to their patients? Can incomplete disclosure of trial outcomes result in harm to patients? If this is the case, what possible avenues are available to avoid such harm?

ANALYSIS OF THE MAIN INDICATORS CHARACTERIZING MEDICAL CARE FOR CHILDREN WITH CANCER IN SAINT-PETERSBURG AND IN THE LENINGRAD REGION IN 2013-2017

2019 ◽  
Vol 65 (1) ◽  
pp. 77-82
Author(s):  
Maksim Rykov ◽  
Ivan Turabov ◽  
Yuriy Punanov ◽  
Svetlana Safonova
Keyword(s):  
Mortality Rate ◽  
Medical Care ◽  
Statistical Data ◽  
Leningrad Region ◽  
Children With Cancer ◽  
Health Committee ◽  
The Government ◽  
Delivery Of Medical Care ◽  
One Year ◽  
The One

Background: St. Petersburg is a city of federal importance with a large number of primary patients, identified annually. Objective: analysis of the main indicators characterizing medical care for children with cancer in St. Petersburg and the Leningrad region. Methods: The operative reports for 2013-2017 of the Health Committee of the Government of St. Petersburg and the Health Committee of the Leningrad Region were analyzed. Results. In 2013-2017 in the Russian Federation, 18 090 primary patients were identified, 927 (5.1%) of them in the analyzed subjects: in St. Petersburg - 697 (75,2%), in the Leningrad Region - 230 (24,8%). For 5 years, the number of primary patients increased in St. Petersburg - by 36%, in the Leningrad Region - by 2,5%. The incidence increased in St. Petersburg by 18,1% (from 14,9 in 2013 to 17,6 in 2017 per 100 000 of children aged 0-17). The incidence in the Leningrad Region fell by 4.9% (from 14.4 in 2013 to 13.7 in 2017). Mortality in 2016-2017 in St. Petersburg increased by 50% (from 2 to 3), in the Leningrad Region - by 12,5% (from 2,4 to 2,7). The one-year mortality rate in St. Petersburg increased by 3,9% (from 2,5 to 6,4%). In the Leningrad Region, the one-year mortality rate decreased from 6,5% in 2016 to 0 in 2017. The number of pediatric oncological beds did not change in St. Petersburg (0,9 per 10,000 children aged 0-17 years) and the Leningrad Region (0). In St. Petersburg patients were not identified actively in 2016-2017; in the Leningrad Region their percentage decreased from 8,7 to 0. The number of oncologists increased in St. Petersburg from 0,09 to 0.12 (+33,3%), in the Leningrad Region - from 0 to 0,03. Conclusion: Morbidity in St. Petersburg and the Leningrad region is significantly different, which indicates obvious defects in statistical data. Patients were not identified during routine preventive examinations which indicate a low oncologic alertness of district pediatric physicians. Delivery of medical care for children with cancer and the statistical data accumulation procedures should be improved.

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