scholarly journals Providing Specialty Telehealth Care to Older, Rural Patients: Voices From Field

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 118-119
Author(s):  
Eileen Dryden ◽  
Lauren Moo
Keyword(s):  
Rural Areas ◽  
Specialty Care ◽  
Older Patient ◽  
Viable Option ◽  
Urban Centers ◽  
Community Based ◽  
Hub And Spoke ◽  
Medical Centers ◽  
Facilitators And Barriers ◽  
Rural Patients

Abstract Older, rural adults have limited access to quality geriatric specialty care for several reasons including relatively few geriatric specialists in rural areas and lack of transportation options or patient ability to travel to more urban centers. GRECC Connect is a promising telehealth-hub and spoke model that provides rural patients access to teams of multidisciplinary geriatric specialists in more urban medical centers primarily by video connection with affiliated community-based outpatient clinics (CBOCs). This model provides a viable option for increasing access to geriatric specialty care for rural patients but is not used to the extent it could be. To date, much of our understanding of this model has come from the experts at the hub medical centers. To learn more about the experience of this model from the field we interviewed CBOC staff and providers as well as Veterans and their caregivers about geriatric specialty telehealth services. In this symposium we will discuss facilitators and barriers to implementing this model from the perspective of the field and then explore more deeply both the context of the CBOC environment and the older patient population served by rural CBOCs to further understand the challenges that are faced in attempting to connect older patients with telehealth services. Finally, we will share the perceived value of the service and alignment with local needs. This deeper understanding of the experience of the ‘spoke’ may help enhance access to much needed geriatric specialty care for rural veterans.

scholarly journals A Strategy Matching Tool for Boosting Implementation of Geriatric Telehealth Services in Rural CBOCs

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 120-120
Author(s):  
Laura Kernan ◽  
Eileen Dryden ◽  
Camilla Pimentel ◽  
Kathryn Nearing ◽  
Lauren Moo
Keyword(s):  
Change Implementation ◽  
Outpatient Clinics ◽  
Veterans Administration ◽  
Community Based ◽  
Hub And Spoke ◽  
Implementing Change ◽  
Medical Centers ◽  
Implementation Approach ◽  
Facilitators And Barriers ◽  
Expert Recommendations

Abstract Fifteen Veterans Administration Medical Centers (VAMCs) offer geriatric specialty care telehealth services through a hub and spoke model to patients at affiliated community-based outpatient clinics (CBOCs). These services are not used to the extent they could be. Through interviews with 50 staff and providers at rural CBOCs we identified several implementation facilitators and barriers. CBOC-level barriers included space constraints, low staffing, internet connection issues, and limited knowledge of services available and referral processes. Patient-level barriers included discomfort with technology, cognitive decline, and inability to travel to the CBOC. We found that champions within the CBOC and iterative, targeted outreach from the hub helped facilitate uptake of services. We entered the identified barriers into the CFIR-ERIC (Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool to help generate targeted strategies that will be used to refine each hub’s implementation approach.

scholarly journals GRECC Connect Increases Access to Geriatric Specialty Care for Rural, Older Veterans With Complex Care Needs

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 795-796
Author(s):  
Kathryn Nearing ◽  
Stuti Dang ◽  
Eileen Dryden ◽  
Laura Kernan ◽  
Lauren Moo ◽  
...  
Keyword(s):  
Rural Areas ◽  
Video On Demand ◽  
Specialty Care ◽  
Multiple Chronic Conditions ◽  
Care Needs ◽  
Community Based ◽  
Therapeutic Alliances ◽  
Caregiver Support ◽  
Complex Needs ◽  
Complex Care Needs

Abstract A higher percentage of Veterans in rural areas are older, have multiple chronic conditions and select the VA for healthcare. To address the needs of rural older Veterans with complex needs, GRECC Connect hubs use case finding approaches combined with regular outreach and education to VA community-based outpatient clinic (CBOC) providers serving rural Veterans and caregivers. Alignment of GRECC Connect services with needs of providers and patients promotes establishment of therapeutic alliances in caring for medically complex older Veterans. After identifying high risk, high need patients, hubs use the following strategies to increase access to geriatric specialty care through telehealth modalities: 1) Co-management of patients through e-consultation and telehuddles (GRECC Connect interprofessional geriatric specialty care teams extend support to CBOC providers); 2) Clinical video telehealth to CBOCs and Video on Demand to Veteran homes (to reduce travel burden); and, 3) Tele-group visits (especially for behavioral health and caregiver support).

scholarly journals Reconceptualising Rural Cancer Inequalities: Time for a New Research Agenda

2020 ◽  
Vol 17 (4) ◽  
pp. 1455 ◽  
Author(s):  
Christina Dobson ◽  
Greg Rubin ◽  
Peter Murchie ◽  
Sara Macdonald ◽  
Linda Sharp
Keyword(s):  
Rural Areas ◽  
Research Agenda ◽  
Community Based ◽  
Cancer Symptoms ◽  
Emergency Presentation ◽  
Rural Environments ◽  
New Research ◽  
Developed World ◽  
Rural Patients ◽  
Reductionist Approach

Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations.

Socio-Economic Characteristics of Immigrants in Western Greece Region: Urban – Rural Continuum or Divide?

2006 ◽  
Vol 3 (2) ◽  
pp. 91-105 ◽  
Author(s):  
Theodoros Iosifides ◽  
Thanasis Kizos ◽  
Elektra Petracou ◽  
Ekaterini Malliotaki ◽  
Konstantina Katsimantou ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Centers ◽  
Spatial Factors ◽  
Limited Role ◽  
Urban Rural ◽  
Of Greece ◽  
Western Greece

This paper aims at an investigation of factors of differentiation of basic social and economic characteristics of foreign immigrants in the Region of Western Greece. The paper explores whether the thesis of urban-rural divide is relevant for the differentiation of immigrants’ socio-economic characteristics in a typical Region of Greece, where there is a strong interplay between major urban centers and large rural areas. Findings show that spatial factors play a very limited role in the differentiation of socio-economic characteristics of immigrants and indicate that other factors are more important. Thus, and as regards socio-economic characteristics of immigrants, the overall picture is that of urban-rural continuum rather than divide. 

scholarly journals The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ramadhani Kigume ◽  
Stephen Maluka
Keyword(s):  
Health Insurance ◽  
Community Health ◽  
Rural Areas ◽  
Health Coverage ◽  
Access To Health Services ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Urban Districts ◽  
Health Fund ◽  
The Government

Abstract Background Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.

scholarly journals Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Aksheya Sridhar ◽  
Amy Drahota ◽  
Kiersten Walsworth
Keyword(s):  
Technology Acceptance ◽  
Technology Acceptance Model ◽  
Autism Spectrum ◽  
Ease Of Use ◽  
Science Literature ◽  
Community Based ◽  
Web Based ◽  
Community Based Organizations ◽  
Facilitators And Barriers ◽  
Acceptance Model

Abstract Background Evidence-based practices (EBPs) have been shown to improve behavioral and mental health outcomes for children diagnosed with autism spectrum disorder (ASD). Research suggests that the use of these practices in community-based organizations is varied; however, the utilization of implementation guides may bridge the gap between research and practice. The Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART) Implementation Toolkit is a web-based implementation toolkit developed to guide organization-based implementation teams through EBP identification, adoption, implementation, and sustainment in ASD community-based organizations. Methods This study examined the facilitators and barriers (collectively termed “determinants”) to the utilization of this toolkit, based on the perspectives of implementation teams at six ASD community-based organizations. Two independent coders utilized the adapted EPIS framework and the Technology Acceptance Model 3 to guide qualitative thematic analyses of semi-structured interviews with implementation teams. Results Salient facilitators (e.g., facilitation teams, facilitation meetings, phase-specific activities) and barriers (e.g., website issues, perceived lack of ease of use of the website, perceived lack of resources, inner context factors) were identified, highlighting key determinants to the utilization of this toolkit. Additionally, frequent determinants and determinants that differed across adapted EPIS phases of the toolkit were noted. Finally, analyses highlighted two themes: (a) Inner Context Determinants to use of the toolkit (e.g., funding) and (b) Innovation Determinants (e.g., all website-related factors), indicating an interaction between the two models utilized to guide study analyses. Conclusions Findings highlighted several factors that facilitated the utilization of this implementation guide. Additionally, findings identified key areas for improvement for future iterations of the ACT SMART Implementation Toolkit. Importantly, these results may inform the development, refinement, and utilization of implementation guides with the aim of increasing the uptake of EBPs in community-based organizations providing services to children with ASD and their families. Finally, these findings contribute to the implementation science literature by illustrating the joint use of the EPIS framework and Technology Acceptance Model 3 to evaluate the implementation of a web-based toolkit within community-based organizations.

Do the Heterogeneous Determinants of Repayment Affect Differently across Borrowers of Diverse Credit Sources in Rural Assam? A Double Hurdle Approach

2021 ◽  
pp. 245513332110316
Author(s):  
Tiken Das ◽  
Pradyut Guha ◽  
Diganta Das
Keyword(s):  
Rural Areas ◽  
Probit Model ◽  
Original Data ◽  
Community Based ◽  
Data Set ◽  
Brahmaputra Valley ◽  
Double Hurdle ◽  
Instrumental Variable Probit ◽  
Instrumental Variable Probit Model

This study made an attempt to answer the question: Do the heterogeneous determinants of repayment affect the borrowers of diverse credit sources differently? The study is based on data collected from 240 households from three districts in the lower Brahmaputra valley of Assam through a carefully designed primary survey. Besides, the study uses the double hurdle approach and the instrumental variable probit model to reduce possible selection bias. It observes better repayment performance among formal borrowers, followed by semiformal borrowers, while occupation wise it is prominent among organised employees. It has been found that in general, the household characteristics, loan characteristics and location-specific characteristics significantly affect repayment performance of borrowers. However, the nature of impact of the factors influencing repayment performance is remarkably different across credit sources. It ignores the role of traditional community-based organisations in rural Assam while analysing the determinants of repayment performance. The study also recommends for ensuring productive opportunities and efficient market linkages in rural areas of Assam. The study is based on an original data set that has specially been collected to examine question that—do the heterogeneous determinants of repayment affect the borrowers of diverse credit sources differently in the lower Brahmaputra valley of Assam—which has not been studied before.

scholarly journals Homeless on Main Street: Using Photovoice to Highlight Older Adults Among the Hidden Homeless

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 728-728
Author(s):  
H Shellae Versey
Keyword(s):  
Older Adults ◽  
Rural Areas ◽  
Meaning Making ◽  
Small Towns ◽  
Photo Elicitation ◽  
Service Agency ◽  
Structured Interviews ◽  
Community Based Interventions ◽  
Community Based ◽  
Formerly Homeless

Abstract Homelessness is a reality for a growing number of Americans living in small towns and rural areas. However, unlike in cities, housing instability may be less visible. Using a photo-elicitation method (i.e., Photovoice), this study explores the meaning of place and obscured visibility to currently and formerly homeless older adults living in a small town in central Connecticut. Participants (N = 27) were recruited from a local service agency, given cameras and asked to photograph areas around town that were meaningful to them. Photographs were developed and followed by in-person, semi-structured interviews with participants in which photos and experiences during the project were discussed. Primary themes included belonging, generativity, social isolation, and place-making as meaning-making. The study culminated in a community photography exhibition in which photographs from the project were displayed in public spaces around town. Implications for community-based interventions to reach homeless groups in rural areas are discussed. Part of a symposium sponsored by the Qualitative Research Interest Group.

scholarly journals Umbilical cord care through community-based distribution of chlorhexidine in rural Sindh, Pakistan

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Shah ◽  
Q Jamali ◽  
F Aisha
Keyword(s):  
Rural Communities ◽  
Data Collection ◽  
Umbilical Cord ◽  
Rural Areas ◽  
Health Workers ◽  
High Rate ◽  
Cord Care ◽  
Community Based ◽  
Sindh Province ◽  
At Home

Abstract Background Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality. Methods We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan. Results Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day. Conclusions Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan. Key messages Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.

scholarly journals Israeli Arabs develop diverticulitis at a younger age and are more likely to require surgery than Jews

2015 ◽  
Vol 28 (2) ◽  
pp. 102-104
Author(s):  
Itai GHERSIN ◽  
Nadav SLIJPER ◽  
Gideon SROKA ◽  
Ibrahim MATTER
Keyword(s):  
Surgical Treatment ◽  
Racial Differences ◽  
Rural Areas ◽  
Age Of Onset ◽  
Acute Diverticulitis ◽  
First Episode ◽  
Urban Centers ◽  
Younger Age ◽  
Israeli Arabs ◽  
The Impact

BACKGROUND: Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. AIM: To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. METHODS: Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. RESULTS: Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. CONCLUSIONS: Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis.

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