Advancing an understanding of access as ‘human fit’: A qualitative participatory case study in general practice

Background: Good access to primary care is an important determinant of population health. Whilst the academic literature on access to care emphasises its complexity, policies aimed at improving access to general practice in the UK have tended to focus on measurable aspects, such as timeliness or number of appointments. Aim: To fill the gap between the complex understanding of primary care access in the literature and the narrow definition of access assumed in UK policies. Design and Setting: Qualitative, community-based participatory case study within the geographic footprint of a Clinical Commissioning Group in northwest England. Method: We applied Levesque et al.’s conceptual framework of patient-centred access and used multiple qualitative methods (interviews, focus groups, observation). Analysis was ongoing, iterative, inductive, and abductive with the theory. Results: The comprehensiveness of Levesque et al.’s access theory resonated with diverse participant experiences. However, while a strength of Levesque et al. was to highlight the importance of people’s abilities to access care, our data suggest equal importance of healthcare workforce abilities to make care accessible. Thus, we present a definition of access as the ‘human fit’ between the needs and abilities of people in the population and the abilities and capacity of people in the healthcare workforce, and provide a modified conceptual framework reflecting these insights. Conclusion: An understanding of access as ‘human fit’ has the potential to address longstanding problems of access within general practice, focusing attention on the need for staff training and support, and emphasising the importance of continuity of care.

The ‘haves’ and ‘have-nots’ of personal protective equipment during the COVID-19 pandemic: the ethics of emerging inequalities amongst healthcare workers

The COVID-19 pandemic has exacerbated inequalities, including among the healthcare workforce. Based on recent literature and drawing on our experiences of working in operating theatres and critical care in the UK’s National Health Service during the pandemic, we review the role of personal protective equipment and consider the ethical implications of its design, availability and provision at a time of unprecedented demand. Several important inequalities have emerged, driven by factors such as individuals purchasing their own personal protective equipment (either out of choice or to address a lack of provision), inconsistencies between guidelines issued by different agencies and organisations, and the standardised design and procurement of equipment required to protect a diverse healthcare workforce. These, we suggest, have resulted largely because of a lack of appropriate pandemic planning and coordination, as well as insufficient appreciation of the significance of equipment design for the healthcare setting. As with many aspects of the pandemic, personal protective equipment has created and revealed inequalities driven by economics, gender, ethnicity and professional influence, creating a division between the ‘haves’ and ‘have-nots’ of personal protective equipment. As the healthcare workforce continues to cope with ongoing waves of COVID-19, and with the prospect of more pandemics in the future, it is vital that these inequalities are urgently addressed, both through academic analysis and practical action.

Mobile technology and delegated work in specialist community services: the EnComPaSS Integration project

ObjectivesThe current UK healthcare workforce crisis is particularly severe in community services. A key limitation with traditional service-delivery models is the reliance on practitioners with levels of training and experience to enable them to operate independently. This paper describes a real-world evaluation of the implementation of digital health technology designed to provide remote, real-time support and task delegation in community palliative care services. It explores the ability of technology to support sustainable community workforce models and reports on key indicators of quality and efficiency.MethodsThe study was a mixed-methods, theory-driven evaluation, incorporating interviews, observations and analysis of routine data. The focus of this paper is the reporting of findings from pre–post implementation comparison and interrupted time series analysis. Data include community hospice service visits, hospital use by hospice patients and patient reported experiences.ResultsThe digital health intervention allowed the service to include a more junior workforce (p<0.001, Cramer’s V=0.241), requiring fewer joint visits (p<0.001, Cramer’s V=0.087). No negative changes in hospitalisation were observed and patient reported experiences improved (p=0.023). Changes in hospital non-emergency bed days were inconclusive. However, emergency department admissions reduced significantly (−76.9 /month at 17 months, p=0.001). The cost per hour for visits reduced from £16.71 to £16.23 and annual savings of £135 153 are estimated for reduced emergency admissions.ConclusionsThe evaluation demonstrates the value of digital innovation to support programmes of service redesign and begin to address the healthcare workforce crisis, while having a positive economic effect and indicating an improvement to patient experiences.

Telehealth for COVID-19 Pandemic

The COVID-19 epidemic has caused huge strain on health infrastructure. In this pandemic, burden on healthcare workforce is rising, as there was need to give treatment, observing, and subsequent follow-ups during the epidemic. Consequently, the Covid-19 pandemic has profoundly affected healthcare. Clinical focuses are presently reacting to CORONA VIRUS 19 through fast appropriation of advanced devices and advances, for example, Tele health and effective consideration which allude to the conveyance of medical care directing computerized or a ways off utilizing Information and Communications Technology (ICT) for therapy of One still living. Tele health was required to convey opportune consideration while limiting openness to secure clinical professionals and One still living. In like manner, a quick writing audit was led, and 35 examination contemplates distributed from 2019 to May 2020 were utilized to give hypothetical and functional proof on the hugeness of utilizing Tele health and effective consideration for far off treatment of One still living during the CORONA VIRUS 19epidemic. This article gives down to earth manage dependent on the best way to utilize Tele health and effective consideration during the CORONA VIRUS 19 epidemic. This investigation gives suggestion on the possibilities of combining effective consideration arrangements soon towards adding to incorporate advanced innovations into medical services. Materials and Methods: The material required for the review was taken from the databases of PubMed, Web of science,the from the website of World Health Organization and the patients data of SMHRC and DMMC Wanadongari Nagpur.

Public Health and Social Measures to Mitigate the Health and Economic Impact of the COVID-19 Pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland During 2020-2021: Situational Analysis

Background The COVID-19 pandemic had enormous impacts on human society. There were similarities and differences in the public health and social measures taken by countries, and comparative analysis facilitates cross-country learning of contextual practices and sharing lessons to mitigate the COVID-19 pandemic impact. We aim to conduct a situational analysis of the public health and social measures to mitigate the health and economic impact of the COVID-19 pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland during 2020-2021. Methods We conducted a situational analysis of the COVID-19 pandemic response in Turkey, Egypt, Ukraine, Kazakhstan, and Poland from the perspectives of the health system and health finance, national coordination, surveillance, testing capacity, health infrastructure, healthcare workforce, medical supply, physical distancing and non-pharmaceutical interventions, health communication, impact on non-COVID-19 health services, impact on the economy, education, gender and civil liberties, and COVID-19 vaccination. Results Since the onset of the COVID-19 pandemic, Turkey, Egypt, Ukraine, Kazakhstan, and Poland have expanded COVID-19 testing and treatment capacity over time. However, they faced a shortage of healthcare workforce and medical supplies. They took population-based quarantine measures rather than individual-based isolation measures, which significantly burdened their economies and disrupted education. The unemployment rate increased, and economic growth stagnated. Economic stimulus policy was accompanied by high inflation. Despite the effort to sustain essential health services, healthcare access declined. Schools were closed for 5-11 months. Gender inequality was aggravated in Turkey and Ukraine, and an issue was raised for balancing public health measures and civil liberties in Egypt and Poland. Digital technologies played an important role in maintaining routine healthcare, education, and public health communication. Conclusions The COVID-19 pandemic has exposed weaknesses in healthcare systems in emerging countries of Turkey, Egypt, Ukraine, Kazakhstan, and Poland, and highlighted the intricate link between health and economy. Individual-level testing, isolation, and contact tracing are effective public health interventions in mitigating the health and economic impact of the COVID-19 pandemic in comparison to population-level measures of lockdowns. Investment in health, including digital health and communication, is essential to minimize the impact of the pandemic and for more equitable and sustainable development beyond the pandemic.

Tackling Workplace Bullying for Minority Ethnic Doctors

Workplace bullying, undermining and microaggressions are a reality for many, and although the prevalence may vary, there is no environment that is free of such hostile interactions. The healthcare workforce is focussed on empathy, kindness and caring, yet the daily experiences of many are in stark contrast to this. Although awareness of these issues exist, incidents of bullying are still grossly under-reported. Bullying and undermining behaviours stem from a gradient of power and lack of appreciation of the societal advantages of diversity. In keeping with this, the experience of particular sub-populations are disproportionately worse, such as for women, minority ethnic groups, those with disability, LGBTQ+ and those from deprived backgrounds. There have been campaigns and initiatives to change workplace behaviours, with mixed successes. A less explored role is that of organisations whose declared mission is to stand up for equality, represent the voice of the minorities and the under-represented, akin to self-help groups and advocacy. This article explores workplace bullying from the perspective of the minority ethnic doctors and proposes the potential benefit of their representative organisations in helping to balance the inherent workplace disadvantages.

Healthcare workers’ perception of gender and work roles during the COVID-19 pandemic: a mixed-methods study

ObjectivesA high functioning healthcare workforce is a key priority during the COVID-19 pandemic. We sought to determine how work and mental health for healthcare workers changed during the COVID-19 pandemic in a universal healthcare system, stratified by gender factors.DesignA mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey (7 May–15 July 2020). Phase 2 was semistructured interviews offered to all respondents upon survey completion to describe how experiences may have differed by gender identity, roles and relations.SettingNational universal healthcare system (Canada).Participants2058 Canadian healthcare worker survey respondents (87% women, 11% men, 1% transgender or Two-Spirit), including 783 health professionals, 673 allied health professionals, 557 health support staff. Of the 63 unique healthcare worker types reported, registered nurses (11.5%), physicians (9.9%) and pharmacists (4.5%) were most common. Forty-six healthcare workers were interviewed.Main outcome measuresReported pandemic-induced changes to occupational leadership roles and responsibilities, household and caregiving responsibilities, and anxiety levels by gender identity.ResultsMen (19.8%) were more likely to hold pandemic leadership roles compared with women (13.4%). Women (57.5%) were more likely to report increased domestic responsibilities than men (45%). Women and those with dependents under the age of 10 years reported the greatest levels of anxiety during the pandemic. Interviews with healthcare workers further revealed a perceived imbalance in leadership opportunities based on gender identity, a lack of workplace supports disproportionately affecting women and an increase in domestic responsibilities influenced by gender roles.ConclusionsThe COVID-19 pandemic response has important gendered effects on the healthcare workforce. Healthcare workers are central to effective pandemic control, highlighting an urgent need for a gender-transformative pandemic response strategy.

Person-Centered Care for Family Caregivers: Co-Designing an Education Program for the Healthcare Workforce

Background Research recommends the healthcare workforce receive competency-based education to support family-caregivers [FCGs}. typically, education has been directed at FCG’s to increase their care skills rather that at healthcare providers to provide person-centered care to FCGs. Objectives: We present the co-design process used to create a competency-based education program for the healthcare workforce that ensures a person-centered focus on FCGs and introduce our Health Workforce Caregiver-Centered Care Education. Approach: Co-design is the act of creating with stakeholders to ensure useable results that meet stakeholder’s needs. We began by coining the concept “caregiver-centered care,” defined as a collaborative working relationship between families and healthcare providers aimed at supporting FCGs in their caregiving role, decisions about care management, and advocacy. From this definition we co-designed, then validated the Caregiver-Centered Care Competency Framework in a Delphi Process. Stakeholders (n= 101) including FCGs, providers, policy makers, community organizations, researchers, and educational designers then used effective practices for health workforce education to co-design the ‘foundational’ level of a Caregiver Centered Care education. Results Teaching and learning resources include six competency-aligned educational modules with videos and interactive exercises that encourage reflection. With the COVID-19 pandemic, we moved the education online (caregivercare.ca). In the first four months online, 815healthcare providers completed the education. We continue to use mixed methods to evaluate the Caregiver-Centered Care Education, for acceptability and effectiveness, in five care contexts (primary, acute, home, supportive living, long-term care). Conclusion We expect that our education will support caregiver-centered care in all healthcare settings.

Presidential Symposium: Disruption to Transformation of Communities of Care: Key Issues and Opportunities in Health Sciences

Consistent with the theme of the conference this year, this symposium explores the impact of the pandemic and our commitment to redress structural racism and health inequities on health of older adults, and our collective capacity to transform and innovate through our gerontological health sciences lens. Each presenter will focus on one sector of care: (1) the health system and healthcare workforce; (2) older persons; and (3) families and care partners. The first presenter provides a systems-level perspective on key disruptors in healthcare systems for care of older adults and the workforce, and emerging innovations to address increasingly transparent care inequities. Emerging research implications as a result of these disruptions will be highlighted. The second presenter highlights how the predominant features of the pandemic in older adults, loneliness and isolation, are co-occurring with significant resilience and innovation, and the resultant potential to create a paradigm shift in how we design and advance communities of care. The third presenter provides the perspective of family members and care partners of older adults during the time of the pandemic, focusing on disruptions that have informed changes going forward, innovations that have emerged, and implications for research to be addressed. Our discussant situates the presentations within the larger context of ‘the new normal’, with a particular focus on considering the global, inter-connected context of communities of care, a commitment to reducing inequities for older adults, and implications for health sciences education and policy.