scholarly journals Workplace violence and its aftermath in China’s health sector: implications from a cross-sectional survey across three tiers of the health system

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031513 ◽  
Author(s):  
Sheng Zhi Yang ◽  
Dan Wu ◽  
Nan Wang ◽  
Therese Hesketh ◽  
Kai Sing Sun ◽  
...  
Keyword(s):  
Primary Care ◽  
Workplace Violence ◽  
Rural Areas ◽  
Health Workers ◽  
Physical Violence ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Facilities

ObjectivesTo determine the prevalence of physical violence and threats against health workers and the aftermath in tertiary, secondary and primary care facilities in China.DesignA cross-sectional questionnaire study.Setting5 tertiary hospitals, 8 secondary hospitals and 32 primary care facilities located in both urban and rural areas of Zhejiang Province, China, were chosen as the study sites.ParticipantsA total of 4862 health workers who have contact with patients completed a survey from July 2016 to July 2017.Outcome measuresThe prevalence of physical violence, threats and Yi Nao, specific forms of physical violence and their aftermath were measured by a self-designed and verified questionnaire. Multivariable logistic regression models were used to examine the association between perceived organisational encouragement of reporting workplace violence (WPV) and physical violence, threats and Yi Nao after controlling for age, sex, level of facility, professional ranking and type of health worker.ResultsAmong all respondents, 224 (4.6%) were physically attacked and 848 (17.4%) experienced threats in the past year. Respondents in secondary hospitals were more likely to experience physical violence (AOR=3.29, 95% CI 2.21 to 4.89), threats (AOR=1.61, 95% CI 1.32 to 1.98) and Yi Nao (AOR=2.47, 95% CI 2.10 to 2.91), compared with primary care providers. Lack of organisational policies to report WPV was associated with higher likelihood of physical violence (AOR=3.64, 95% CI 2.57 to 5.18) and threats (AOR=2.21, 95% CI 1.76 to 2.78). Among physical violence cases, only 29.1% reported the attack to police mainly because most felt it useless to do so (58.8%). Only 25.7% were investigated and 72.4% of attackers received no punishment. Of all those attacked or threatened, 59.4% wanted to quit current post and 76.0% were fearful of dealing with urgent or severe cases.ConclusionsProper management of the aftermath of violence against health workers is inadequate. Formal guidelines for reporting and managing WPV are urgently needed.

Integration between primary care providers and the cancer system: Gaps and opportunities

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6584-6584
Author(s):  
J. Sussman ◽  
W. Evans ◽  
T. Whelan ◽  
D. Bainbridge ◽  
S. Schiff ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Primary Care Providers ◽  
Cancer Case ◽  
Care Providers ◽  
Care Needs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Compensation Model ◽  
Cancer Program

6584 Background: A number of reports suggest that family physicians (FPs) are poorly integrated with the cancer care system. The specific gaps in care integration are poorly understood. In this study we examine specific processes of care associated with integration between FPs and regional cancer programs. Methods: Cross sectional survey of all identified primary care providers within a representative health region in Ontario, Canada. The survey instrument was created specifically for this study with items generated from published literature and expert input and pilot tested in a representative sample. A modified dilman method was used. Results: 500 physicians responded (response rate 60%). Overall 90% of respondants reported confidence in the workup of a new cancer case for the major disease sites but only half (54%) knew the process of referring to the regional cancer program. Only 57% felt investigations necessary could be done in a timely manner and 44% indicated that coordination of care needs to be improved. Most indicated preferance for an active navigation structure for newly diagnosed patients. Despite over 80% of respondents indicating use of the internet only 10% reported accessing cancer program web portals for information on the regional cancer program (such as waiting times). The majority of respondants (75%) indicated ongoing involvement in care during the active treatment phase, mostly for non cancer related medical issues but 20% indicated that they were not properly infomed of patients’ health status by the oncology program and only 57% indicated that they felt their role was valued by the cancer program during this phase in the care trajectory. In the follow up phase, 35% were unclear of their role specific to monitoring and surveillance. 60% felt their current compensation model was inadequate to support care of cancer patients. This did not vary by compensation model reported. Factors associated with better integration included attendance at educational sessions and years in practice. Conclusions: Cancer systems need to be more responsive to the needs of FPs to better integrate them and support optimal quality of care for cancer patients. Policies to clarify and support roles and responsibilites are necessary to ensure that FPs are integrated team members. No significant financial relationships to disclose.

scholarly journals Breast Cancer Screening Practices for High-Risk Women: A Cross-Sectional Survey of Primary Care Providers

2020 ◽  
Vol 29 (5) ◽  
pp. 686-692
Author(s):  
Anne Blaes ◽  
Rachel I. Vogel ◽  
Rebekah H. Nagler ◽  
Alicia Allen ◽  
Susan Mason ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
High Risk ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Screening Practices ◽  
High Risk Women

Primary Care Providers' Attitudes Towards Recommending Cancer Screening to Patients With Intellectual Disability: A Cross-Sectional Survey

Inclusion ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 185-193
Author(s):  
Genevieve Breau ◽  
Sally Thorne ◽  
Jennifer Baumbusch ◽  
T. Greg Hislop ◽  
Arminee Kazanjian
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Intellectual Disability ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Primary Care Providers ◽  
Survey Study ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Individuals with intellectual disability (ID) obtain breast, cervical, and colorectal cancer screening at lower rates, relative to the general population. This cross-sectional survey study explored how primary care providers and trainees recommend cancer screening to patients with ID, using a standardized attitudes questionnaire and vignettes of fictional patients. In total, 106 primary care providers and trainees participated. Analyses revealed that participants' attitudes towards community inclusion predicted whether participants anticipated recommending breast and colorectal cancer screening to fictional patients. Further research is needed to explore these factors in decisions to recommend screening, and how these factors contribute to cancer screening disparities.

Aging and Sexual Health: A Cross-Sectional Survey of Patients in a Canadian Urban Academic Family Health Team

2020 ◽  
Vol 39 (3) ◽  
pp. 365-372
Author(s):  
Erin Lurie ◽  
Meera Nathwani ◽  
Morgan Slater ◽  
Erica Pascoal ◽  
Sarah Chadwick ◽  
...  
Keyword(s):  
Primary Care ◽  
Sexual Health ◽  
Sexual Activity ◽  
Primary Care Physicians ◽  
Family Health ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health Concerns

ABSTRACTPrimary care physicians are in a position to recognize sexuality as a core component of health. Data examining the sexual behaviours of Canadians over the age of 50 and the role of primary care in this domain is lacking. A cross-sectional survey was administered to patients over the age of 50, which assessed the importance of sexual activity, problems, and preferences in discussing sexual health with their primary care providers. A total of 39 per cent of patients indicated ongoing sexual activity and 52% of male participants reported current sexual activity compared with 25 per cent of females (p < 0.01). More males reported sexual activity as important than did females (69% vs. 45%, p < 0.01). Participants identifying sexual health concerns discussed physical dysfunctions more than emotional, social, or global health concerns (p < 0.01). More male participants discussed sexual health concerns with their family physician than did females (p < 0.01). The results of our study indicate that many individuals over the age of 50 continue to be sexually active, and that physical and non-physical concerns directly impact participation in sexual activity.

scholarly journals Association between care coordination tasks with non-VA community care and VA PCP burnout: an analysis of a national, cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eric A. Apaydin ◽  
Danielle E. Rose ◽  
Michael R. McClean ◽  
Elizabeth M. Yano ◽  
Paul G. Shekelle ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Coordination ◽  
Community Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Two Measures ◽  
Administrative Tasks

Abstract Background The scope of care coordination in VA primary care increased with the launch of the Veterans Choice Act, which aimed to increase access through greater use of non-VA Community Care. These changes may have overburdened already busy providers with additional administrative tasks, contributing to provider burnout. Our objective was to understand the role of challenges with care coordination in burnout. We analyzed relationships between care coordination challenges with Community Care reported by VA primary care providers (PCPs) and VA PCP burnout. Methods Our cross-sectional survey contained five questions about challenges with care coordination. We assessed whether care coordination challenges were associated with two measures of provider burnout, adjusted for provider and facility characteristics. Models were also adjusted for survey nonresponse and clustered by facility. Trainee and executive respondents were excluded. 1,543 PCPs in 129 VA facilities nationwide responded to our survey (13 % response rate). Results 51 % of our sample reported some level of burnout overall, and 46 % reported feeling burned out at least once a week. PCPs were more likely to be burned out overall if they reported more than average challenges with care coordination (odds ratio [OR] 2.04, 95 % confidence interval [CI] 1.58 to 2.63). These challenges include managing patients with outside prescriptions or obtaining outside tests or records. Conclusions VA primary care providers who reported greater than average care coordination challenges were more likely to be burned out. Interventions to improve care coordination could help improve VA provider experience.

scholarly journals Risk assessment of workplace violence towards health workers in a Chinese hospital: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042800
Author(s):  
Yujie Liu ◽  
Min Zhang ◽  
Rui Li ◽  
Na Chen ◽  
Yiming Huang ◽  
...  
Keyword(s):  
Workplace Violence ◽  
Health Workers ◽  
Physical Violence ◽  
Health Sector ◽  
Physical Contact ◽  
Baseline Survey ◽  
Security Measures ◽  
Psychological Violence ◽  
Cross Sectional Survey ◽  
Cross Sectional

ObjectiveThis study aimed to assess the risk factors associated with workplace violence towards health workers (HWs) in a Chinese hospital.MethodsWe conducted a cross-sectional survey in a Chinese secondary hospital in 2019 using an international survey questionnaire, and collected valid data from 1028 HW respondents via mobile phone. Alongside analysing the potential association between exposure to violence and respondents’ characteristics, we compared the workplace violence between this survey and a baseline survey in the same hospital using the same questionnaire in 2018, and investigated the existing measures.ResultsA total of 5.45% of respondents had encountered physical violence while 41.63% had experienced psychological violence. Women (OR=3.45, 95% CI 1.87 to 6.38), those working in outpatient and emergency departments (OR=7.96, 95% CI 2.27 to 27.95), and those with extremely high concern about workplace violence (OR=7.94, 95% CI 1.04 to 60.85) were significantly more likely to suffer physical violence. Working in the outpatient and emergency department (OR=2.03, 95% CI 1.23 to 3.34), having direct physical contact/interaction with patients (OR=2.98, 95% CI 1.62 to 5.49), and extremely high worry about workplace violence (OR=6.47 95% CI 3.38 to 12.40) significantly increased the risk of psychological violence. When the results of the baseline survey were compared with those in this survey, it was shown that physical violence declined significantly from 8.79% in 2018 to 5.45% in 2019, while psychological violence declined significantly from 47.14% in 2018 to 41.63% in 2019. The most recognised measures were security measures (81.03%) while the least recognised measures were check-in procedures for staff (11.19%).ConclusionWorkplace violence towards HWs is a global problem with country-specific features. In our study, workplace violence in the hospital is of great concern. While demonstrating the effectiveness of measures in some degree, there is significant room for improvement. To achieve the vision of ‘zero violence’ in the health sector, aligned comprehensive measures should be systematically adopted.

scholarly journals Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045997
Author(s):  
Abhijit Pakhare ◽  
Ankur Joshi ◽  
Rasha Anwar ◽  
Khushbu Dubey ◽  
Sanjeev Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Multivariate Analysis ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Care Providers ◽  
Community Based ◽  
Public Health Facilities ◽  
Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

scholarly journals Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046638
Author(s):  
Sk Masum Billah ◽  
Abdullah Nurus Salam Khan ◽  
S M Rokonuzzaman ◽  
Nafisa Lira Huq ◽  
Marufa Aziz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Hypertensive Disorders ◽  
Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

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