scholarly journals Family Medicine Rural Training Track Residencies: Risks and Resilience

2019 ◽  
Vol 51 (8) ◽  
pp. 649-656 ◽  
Author(s):  
Davis G. Patterson ◽  
David Schmitz ◽  
Randall L. Longenecker
Keyword(s):  
Family Medicine ◽  
Health Care Providers ◽  
Local Population ◽  
Rural Practice ◽  
Local Health ◽  
Care Providers ◽  
Teaching Resources ◽  
Program Support ◽  
Multiple Challenges ◽  
Rural Training

Background and Objectives: Family medicine rural training track (RTT) residency programs produce a higher proportion of graduates who choose rural practice than other programs, yet RTTs face continuing threats to their existence. This study sought to understand threats to RTT sustainability and resilience factors that enable RTTs to thrive. Methods: In 2014 and 2015, the authors conducted semistructured interviews of 21 RTT leaders representing two closed programs and 22 functioning programs. Interview topics included program strengths providing resilience and sustainability, risk factors for closure or vulnerabilities threatening sustainability, and advice for other RTTs. The authors performed a content analysis, coding pertinent themes in all interview data. Results: From the top three assets, risks, and advice that respondents offered, the following nine themes emerged, in order from most to least mentioned: leadership, faculty and teaching resources, program support, finances, resident recruitment, program attributes, program mission, political and environmental context, and patient-related clinical experiences. Interviewees frequently reported multifactorial causes for RTT sustainability or closure. Conclusions: Numerous factors identified, such as distance, can operate as positive or negative influences for program resilience, depending on place and context. Resilience depends on multiple forms of social capital, including robust networks among individuals and various communities: the local population and patients, local health care providers, residency faculty, and RTTs in general. The small size and remoteness of RTTs make them vulnerable to multiple challenges in finances, regulations, and accreditation, requiring program adaptability and suggesting the need for flexibility in the policies that govern them.

scholarly journals Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Maria Jennings ◽  
Joanna Morrison ◽  
Kohenour Akter ◽  
Hassan Haghparast-Bidgoli ◽  
Carina King ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Care Providers ◽  
Low Income ◽  
Diabetes Management ◽  
Local Health ◽  
Care Seeking ◽  
Care Providers ◽  
Structured Interviews ◽  
Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

Creating Academic and Health Care Partnerships that Impact Public Health

2015 ◽  
Vol 4 (4) ◽  
pp. 378-384
Author(s):  
Peter W. Grandjean ◽  
Burritt W. Hess ◽  
Nicholas Schwedock ◽  
Jackson O. Griggs ◽  
Paul M. Gordon
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Professional Training ◽  
Local Health ◽  
Care Providers ◽  
Research Partnerships ◽  
Local Health Care ◽  
Training Community ◽  
The University

Kinesiology programs are well positioned to create and develop partnerships within the university, with local health care providers, and with the community to integrate and enhance the activities of professional training, community service, public health outreach, and collaborative research. Partnerships with medical and health care organizations may be structured to fulfill accreditation standards and the objectives of the “Exercise is Medicine®” initiative to improve public health through primary prevention. Barriers of scale, location, time, human resources, and funding can be overcome so all stakeholder benefits are much greater than the costs.

scholarly journals Generating Evidence From Contextual Clinical Research in Low- to Middle Income Countries: A Roadmap Based on Theory of Change

2021 ◽  
Vol 9 ◽  
Author(s):  
Babar S. Hasan ◽  
Muneera A. Rasheed ◽  
Asra Wahid ◽  
Raman Krishna Kumar ◽  
Liesl Zuhlke
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Theory Of Change ◽  
Health Priorities ◽  
Global Health Research ◽  
Local Health ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Ministries

Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low and Middle-Income Countries (LMICs). If diagnosed and managed in a timely manner, as in high-income countries (HICs), most children lead a healthy life and achieve adulthood. However, children with CHD in LMICs have limited care available with subsequent impact on survival. The large disparity in global health research focus on this complex disease makes it a solid paradigm to shape the debate. Despite many challenges, an essential aspect of improving research in LMICs is the realization and ownership of the problem around paucity of local evidence by patients, health care providers, academic centers, and governments in these countries. We have created a theory of change model to address these challenges at a micro- (individual patient or physician or institutions delivering health care) and a macro- (government and health ministries) level, presenting suggested solutions for these complex problems. All stakeholders in the society, from government bodies, health ministries, and systems, to frontline healthcare workers and patients, need to be invested in addressing the local health problems and significantly increase data to define and improve the gaps in care in LMICs. Moreover, interventions can be designed for a more collaborative and effective HIC-LMIC and LMIC-LMIC partnership to increase resources, capacity building, and representation for long-term productivity.

Implementing E-Health

2016 ◽  
Author(s):  
Bill Doolin
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Point Of Care ◽  
Health Care Organization ◽  
Technical Problem ◽  
Local Health ◽  
Care Organization ◽  
Care Providers ◽  
Health Care Information ◽  
Local Health Care

The application of information and communication technology to support health care organization, management, and delivery is high on the health policy agenda in many countries, and its implementation has become a significant issue. Despite optimistic expectations and increasing investment in e-health, the anticipated benefits are often elusive. This chapter reviews the factors driving the development of e-health before introducing a conceptualization of e-health focused on the management and use of health care information at the point of care, between health care providers and, ultimately, by health care consumers. The chapter then explores a range of issues that render e-health implementation problematic. In particular, implementing e-health is both a complex and emergent process that requires consideration of local health care contexts, and a socio-technical problem involving changes in work processes, interactions, and behaviors.

The determination of data collection tools that can measure and document the cooperation of local health care providers

2020 ◽  
Author(s):  
Beáta Erika Nagy ◽  
Róza Oláh ◽  
Erika Zombor ◽  
Péter Boris ◽  
Anna Szabina Szele
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Care Providers ◽  
Health Improvement ◽  
Local Health ◽  
Care Providers ◽  
Structured Interviews ◽  
Daily Work ◽  
Local Health Care ◽  
Institutional Relations

Abstract Background The overall objective of the study is to improve the mental health of the age group below 18 years through the investigation of the intra-and inter-sectoral cooperation between local suppliers and to make the intensity and quality of collaborations measurable. In this paper, based on Hungarian and international literature, we aim at describing the current and future optimal cooperation between the members of the mental health care system and examine the possibilities for documenting and measuring cooperation. Methods Semi-structured interviews were recorded with the leaders or representatives of 12 public educational institutions, six social and six health institutions involvement of the relevant experts (N = 24). Results The function of the institutions belonging to these systems, as well as the daily work of the professionals working there, have a significant impact on the mental health of children in either positive or negative directions. After exploring the current situation, the cooperation of local suppliers and inter-institutional relations can highly increase the mental health improvement of the youth. Conclusion According to the results, the developing progress can be more effective through organising the different forms of care, sectors and professionals together to achieve a common goal.

Supporting families managing parental mental illness: Challenges and resources

2018 ◽  
Vol 53 (5-6) ◽  
pp. 361-370 ◽  
Author(s):  
Michelle D Sherman ◽  
Stephanie A Hooker
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Family Medicine ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Family Members ◽  
The United States ◽  
Parental Mental Illness ◽  
Care Providers ◽  
Treatment Needs

Over five million children in the United States have a parent living with a serious mental illness. These offspring are at higher risk for developing mental health problems themselves due to a complex interplay of biological, psychological, and psychosocial factors. Life with a parent with psychiatric symptoms can be scary, confusing, overwhelming, and sad; children often blame themselves for their parent’s problems, find their parent’s behavior embarrassing, and struggle to explain the illness to their friends. Unfortunately, these children’s needs and experiences are often ignored by overwhelmed parents, worried family members and relatives, separate mental health systems of care for adults and children that often fail to coordinate care, and even well-intentioned health-care providers. Family medicine teams have an opportunity to detect and support these families in unique ways. We offer four recommendations for family medicine teams to help families managing parental mental illness including assessing functioning, treatment needs, and impacts on each family member; educating all family members about mental illness; instilling hope, noting the range of effective treatments for mental illness; and encouraging the use of supports and referral options. Providers can leverage family members’ strengths, work with community-based resources, and offer continuity to these families, as they struggle with an oftentimes chronic, relapsing disease that has ripple effects throughout the family system.

Cancer survival outcomes in Ontario, Canada: Significant unexplained variation.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 36-36
Author(s):  
Michael Donald Brundage ◽  
Patti Groome ◽  
Timothy Hanna ◽  
Christopher M. Booth ◽  
Weidong Kong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care Providers ◽  
Cancer Survival ◽  
Relative Survival ◽  
Survival Outcomes ◽  
Local Health ◽  
Care Providers ◽  
Cancer Specific Survival ◽  
Incident Cases ◽  
The Impact

36 Background: Cancer-specific outcomes are critical for assessing quality of care, and are key quality indicators for cancer control programs. Previous analyses of Ontario (Canada) data show that regional survival differences at the Local Health Integrated Network (LHIN) level exist for relative survival, overall survival, cancer-specific survival (CSS), and mortality rates.We sought to describe: 5-year cancer-specific survival (5Y-CSS) rates among Ontario LHINs; the impact of adjusting for known patient factors; and 5Y-CSS rates among patients diagnosed at Ontario's 50 largest cancer diagnosing hospitals. Methods: Newly diagnosed cases (colorectal, lung, breast, or prostate cancer) were identified in the Ontario Cancer Registry. Records were linked to data from CIHI and Statistics Canada, to identify date of diagnosis, cause-specific vital status, diagnosing hospital, and other reported variables. Cox regression models were used, and all models were adjusted for age and sex. Results: N = 498,382 incident cases (2007-2013) were included. 5Y-CSS varied across LHINs for all patients combined (range 62%-72%; p < 0.0001). Considering colorectal cancer cases as illustrative (N = 57,927), 5Y-CSS varied among LHINs from 58.4%-66.4% (p < 0.0001). Further adjusting for socioeconomic and urban-rural status minimally reduced that variation. Limiting the analysis cohort to patients diagnosed in one of Ontario's 50 largest hospitals (N = 43,245), 5Y-CSS ranged from 52% to 72% (p < 0.0001) among hospitals, and from 55% to 63% (p < 0.0001) among the hospitals affiliated with regional cancer centres. Comparable findings were seen for patients diagnosed with lung, breast, or prostate cancer. Collaborative staging data were available for a subset of patients; 5Y-CSS within all stage III patients (N = 5,360) ranged from 72% to 87%. Conclusions: Important, highly significant differences in cancer survival outcomes exist across Ontario. These are of great interest to patients, health-care providers, system administrators, and policy makers, and are not explained by adjusting for the variables included in these analyses.

scholarly journals From Passive Surveillance to Response: Suriname's Steady Efforts to Implement Maternal Death Surveillance and Response (MDSR)

2020 ◽  
Author(s):  
Lachmi R. Kodan ◽  
Kim J.C. Verschueren ◽  
Geertje E. Boerstra ◽  
Inder Gajadien ◽  
Robert S. Mohamed ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Maternal Death ◽  
Maternal Mortality Ratio ◽  
Lessons Learned ◽  
Local Health ◽  
Care Providers ◽  
Maternal Deaths ◽  
Surveillance And Response ◽  
Shame Culture ◽  
Maternal Death Review

Abstract Background Maternal death surveillance and response (MDSR) is essential in preventing avoidable maternal deaths. The cycle starts by accurately capturing maternal deaths with a surveillance system, followed by an audit to give insight into the underlying causes and "lessons learned." Subsequently, recommendations are formulated and targeted multisectoral responses such as quality of care improvement strategies, including clinical guidelines update, health promotion interventions, research to fulfill knowledge gaps, enabling policies and legislation and interventions addressing social determinants. Finally, continuous evaluation and monitoring close the MDSR cycle. We aim to describe the MDSR implementation process in Suriname to share valuable lessons with other countries.Methods We provide an overview of the evolvement from improved maternal death surveillance, toward review, response, and monitoring to fulfill the MDSR cycle in Suriname. Findings Middle-income country Suriname called for many years for improved surveillance and review, and in 2000 the first action was commenced by extension of maternal death case capturing from death certificates to active hospital surveillance. Consequently, the maternal mortality ratio increased in the following years. However, not the full MDSR cycle was completed in 2015, and local health care providers initiated the next step of the MDSR cycle with the installation of a national maternal death review committee (MaMS). Since then, the committee reviews each maternal death applying the "no blame, no shame" culture, formulates, and disseminates recommendations. Collaboration with the Ministry of Health (MOH), Bureau of Public Health (BOG), and the Pan American Health Organization (PAHO) should ensure progress to the sustainable implementation of MDSR. Committee MaMS demonstrates that maternal death review and recommended high impact interventions can only be effectively implemented and sustained, through strong professional and government commitment and practical, solution-oriented responses. Conclusions Crucial elements for a successful MDSR implementation are Commitment, "no blame, no shame" Culture, Coordination, Collaboration, and Communication (5 C's).We hope that describing this process toward successful nationwide MDSR implementation, with its facilitators and barriers, is helpful for other countries with similar ambitions.

scholarly journals Facilitators and Barriers to Self-Monitoring of Blood Glucose (SMBG) in Diabetic Patients

2020 ◽  
pp. 119-127
Author(s):  
Asif Hakim Brohi ◽  
Arsalan Hakim ◽  
Shafi Muhammad Wassan ◽  
Abdul Majeed Soomro ◽  
Wasim Sarwar Bhatti ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Family Medicine ◽  
Health Care Providers ◽  
Tertiary Care ◽  
University Hospital ◽  
Diabetic Patients ◽  
Care Providers ◽  
Hospital Data ◽  
Self Monitoring ◽  
Facilitators And Barriers

Objective: To determine factors that facilitate and are barriers to self-monitoring of blood glucose in type 2 diabetic patients visiting family medicine clinics at a tertiary care teaching hospital Karachi Pakistan. Methods: Approximately 255 patients were consecutively recruited from the clinics during April 2018 to May 2019 at Family Medicine outpatient clinics at the Aga Khan University Hospital. Data on socio-demographic status, facilitators and barriers to SMBG were extracted through a questionnaire, after obtaining an informed written consent. Data was entered and analyzed in SPSS version 19. Results: Among study participants 47.5% were above 50 years and 51.4% were males. About 30.2% of the participants were practicing SMBG at least once a month and 26% were practicing it daily. Fear of complications was the biggest facilitator (80.1%) and being expensive (51.4%) was barrier for SMBG. Over half of the SMBG practicing participants (59.7%) were diagnosed with diabetes for more than 05 years (p: 0.63). Conclusion: Assessment of blood glucose is a critical component of diabetes treatment and management. It can motivate patients to become active participants in their own care. Health care providers should communicate and educate the patients about the advantages of SMBG.

scholarly journals Perceptions of Febrile Illness among Local People Living in Malaria Endemic villages in Central Hill Region of Nepal

2012 ◽  
Vol 5 ◽  
pp. 121-142
Author(s):  
C B Budhathoki
Keyword(s):  
Health Care Providers ◽  
Febrile Illness ◽  
Traditional Healers ◽  
Local People ◽  
Physical Work ◽  
Local Health ◽  
Care Providers ◽  
Private Practitioners ◽  
Hill Region ◽  
Heavy Physical Work

Objective of this paper is to explore the perceptions of febrile illness among people living in malaria endemic areas of hill region. Qualitative data were collected from malaria endemic villages in Mahadevesthan VDC of Kavrepalanchok district through in-depth interviews and focus group discussions. Local people perceive febrile illnesses as common health problem. They classified febrile illnesses into sardi ko jwaro, dokh, lagu/laganiko jwaro and aulo jwaro. Fever occurring after engaging in heavy physical work is described as dagdi. Severe and complicated form of fever is interpreted as dokh in cultural meaning and typhoid as biomedical concept. Febrile illness which does not respond to biomedicine, but it is relieved by traditional ritual healing is labeled as lagani ko jwaro. Malaria fever is locally known as aul or aulo jwaro. People often avoid certain food such as sour curd, meat, egg, oily and spicy food during fever to prevent it from resulting in dokh (complicated fever). Herbal home remedy is rarely used in febrile illness. Now a day, local people interpret dokh as typhoid and aulo as malaria fever and seek medical treatment from local health institutions and private practitioners. Local perceptions of febrile illnesses such as dokh and aulo overlap with the biomedical concepts of typhoid and malaria fever due to interaction with both traditional healers and health care providers. DOI: http://dx.doi.org/10.3126/dsaj.v5i0.6359 Dhaulagiri Journal of Sociology and Anthropology Vol. 5, 2011: 121-42 

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