Availability of health workforce in urban and rural areas in relation to Canadian seniors.

Geographic imbalances in health human resources exist in a health care system when the composition, level, or use of health care providers does not lead to the same optimal health-system goals in all regions. This can lead to inequitable distribution of health care services, particularly for rural and remote populations. This study aims to determine to what extent the distribution of regulated health professionals and seniors in urban and rural areas of the Canadian jurisdictions is different from one another and from the national average. Data used in this study are for the 2016 calendar year. Information about physicians was obtained from the Canadian Institute for Health Information (CIHI) Scott's Medical Database. The data for nurses (nurse practitioners, registered nurses, and licensed practical nurses) were also sourced from CIHI, Health Workforce Database. Geographic information is based on the postal code of physicians' preferred mailing address, and the residence in the case of nurses and the population. Using the Statistical Area Classification from Statistics Canada, each physician and nurse was assigned to either an urban metropolitan, urban non-metropolitan, or rural/remote area. Findings indicate that there were twice as many nurses per 1000 seniors in urban Canada than in rural Canada. However, this gap was threefold in the case of physicians. Provinces with the largest and lowest gap and international comparisons are also provided. Three broad strategies are offered for policymakers in order to mitigate this health workforce imbalance and reduce the regional shortage of nurses and physicians.

"If I had known, I would have applied": poor communication, job dissatisfaction, and attrition of rural health workers in Sierra Leone.

BACKGROUND: Sierra Leone's health outcomes rank among the worst in the world. A major challenge is the shortage of primary healthcare workers (HCWs) in rural areas due to especially high rates of attrition. This study was undertaken to determine the drivers of job dissatisfaction and poor retention among Sierra Leone's rural HCWs. METHODS: Interviews were conducted with 58 rural and 32 urban primary HCWs in Sierra Leone's public health sector, complemented by key informant discussions and review of national policy documents. HCW interviews included (1) semi-structured discussion, (2) questionnaire, (3) card sort about HCW priorities, and (4) free-listing of most pressing challenges and needs. Sampling for HCW interviews was stratified purposive, emphasizing rural HCWs. RESULTS: Among 90 HCWs interviewed, 67% were dissatisfied with their jobs (71% rural vs 52% urban) and 61% intended to leave their post (75% rural vs 38% urban). While working and living conditions and remuneration were significant factors, a major reason for rural HCW disenchantment was their inability to access worker rights, benefits, and advancement opportunities. This was caused by HCWs' lack of knowledge about human resource (HR) policies and procedures, as well as ambiguity in many policies and inequitable implementation. HCWs reported feeling neglected and marginalized and perceived a lack of transparency. These issues can be attributed to the absence of systems for regular two-way communication between the Ministry of Health and HCWs; lack of official national documents with up-to-date, clear HR policies and procedures for HCWs; pay statements that do not provide a breakdown of financial allowances and withholdings; and lack of HCW induction. CONCLUSIONS: HCWs in Sierra Leone lacked accurate information about entitlements, policies, and procedures, and this was a driver of rural HCW job dissatisfaction and attrition. System-oriented, low-cost initiatives can address these underlying structural causes in Sierra Leone. These issues likely apply to other countries facing HCW retention challenges and should be considered in development of global HCW retention strategies.

Rural-urban differences in unpaid caregivers of adults.

INTRODUCTION:   Rural–urban differences in the characteristics of unpaid caregivers of adults in the USA were explored. METHODS:   Using 'Caregiving in the U.S. 2015', a survey fielded by the National Alliance for Caregiving and AARP, a national examination of rural caregivers (n=1352) is presented. RESULTS:   Rural caregivers reported lower socioeconomic status than urban caregivers (measured by income, education, and employment), suggesting greater likelihood of caregiver strain. In multivariable analysis adjusting for age, race, educational attainment, and reported caregiver burden, residence was associated with self-reported health status of the caregiver but not with physical, financial or emotional distress. The odds of rural caregivers reporting poor to fair health were significantly lower than their urban counterparts (adjusted odds ratio 0.57; 95% confidence interval, 0.36­0.91). CONCLUSIONS:   These findings may indicate differing cultural values in rural and urban respondents, rather than better health among rural caregivers. Understanding the characteristics of rural caregivers may help policymakers target interventions. .

Inhabitants' and professionals' social representations of health determinants in a disadvantaged urban area in France: a qualitative analysis.

BACKGROUND AND OBJECTIVE: Access to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals' health. METHOD: In the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants' point of view. The textual responses were analyzed using the Alceste method. RESULTS: We observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. DISCUSSION: The results are discussed regarding the consequences of these different representations on the beneficiary - healthcare-provider relationship in terms of communication and trust.

'Rural' doesn't mean 'uniform': northern vs southern rural family physicians' workload and practice structures in Ontario.

INTRODUCTION: There is a tendency in health policy in Ontario, Canada, to conflate 'northern' with 'rural' and to equate northern rural settings with southern ones. Although previous research has identified some differences between rural and urban practitioners, these studies have not acknowledged the subtle nuances that make rural practice different in the north than in the south. This study looks more closely at practice patterns and compares number of hours worked per week, patient volume and practice type for rural northern, rural southern, urban northern and urban southern physicians. METHODS: This study utilized data from Ontario's medical regulatory authority's 2007 annual membership renewal survey. Descriptive statistics and χ(2) analyses were used to examine practice type (eg solo, clinical group), hours worked per week and number of patient visits per week for 10 968 primary care physicians in Ontario's rural north, rural south, urban north and urban south. RESULTS: Three key results emerged from the analyses: (1) physicians in rural northern Ontario worked more hours per week than their counterparts in other regions of the province, yet (2) they saw fewer patients per week, and (3) worked more frequently in clinical group-based practices. CONCLUSIONS: Rural northern physicians with different practice structures, different patient types, broader scope of services, and different encounter lengths indicate variations specific to locations and populations and communities. The interaction between the rural and northern context is unique and as such a blanket 'rural' or 'northern' approach to policy development is likely to be ineffective.

Does mandatory postgraduate clinical training worsen geographic distribution of dentists in Japan?

Postgraduate clinical training for dentists has been mandatory in Japan since 2006. Hirata et al. reported that the geographic distribution of postgraduate dental trainees by prefecture in 2006 was worse than that of practicing dentists. This suggests that the postgraduate clinical training system could intensify the problem of distribution of dentists. In this study, therefore, we reviewed the geographic distribution of postgraduate dental trainees and practicing dentists between 2006 and 2010 in detail by city, ward, town and village by using the Lorenz curve and Gini coefficient. The results showed that while there was no significant worsening of geographic distribution of postgraduate dental trainees, the distribution of practicing dentists continued to deteriorate. A number of reasons may explain these findings: the clinical training system is based on a one-year employment contract, and dentists subsequently relocate as driven by the market; and geographic distribution among cities, towns and villages has worsened as a result of the merger of municipalities. The geographic distribution of practicing dentists is expected to deteriorate further if the number of dentists takes a downward turn in the future. Therefore, it is necessary to continuously review the distribution of postgraduate dental trainees.

On the bubble? With healthcare job growth outstripping population in aging Rust Belt cities, some question the trend's durability.

Aging Rust Belt cities are some of the leaders in healthcare job growth despite stagnant or decreasing populations, even amid mounting pressure to cut healthcare costs. Areas seeing rapid population growth aren't as dependent on healthcare. "Cities that are growing quickly are most likely adding diversified industries," says Dr. Sheldon Retchin, of the Virginia Commonwealth University Health System.

Use of school nurse services among poor ethnic minority students in the urban Pacific Northwest.

OBJECTIVE: To determine whether patterns in student use of school nurse services existed according to poverty, race, and ethnicity. DESIGN AND SAMPLE: Cross-sectional descriptive study of 51,767 visits to school nurses made by 12,797 middle and high school students was conducted. Data were collected and analyzed by race, ethnicity, and poverty. MEASURES: Individual-level quantitative data on student visits to school nurses were collected via the School Nurse Entry Database. Numbers and types of student visits were measured, along with the demographic characteristics of student visitors. RESULTS: Poverty was the largest driver of visits to school nurses among all racial and ethnic groups. Poverty was a larger influence on White students' use of services, suggesting that factors related to race, ethnicity, or culture may have larger effects on promoting visits to school nurses by students of color. Subethnic Asian and Hispanic groups showed visit patterns that deviated from aggregated visit rates. CONCLUSIONS: Knowledge of visit patterns among poor, ethnic, and subethnic populations is important-and particularly urgent with the advent of national health reform-in informing and improving public health and school nursing policy and practice.

[Population density, age distribution and urbanisation as factors influencing the frequency of home visits--an analysis for Mecklenburg-West Pomerania]. / Bevölkerungsdichte, Altersverteilung und Urbanität als Einflussfaktoren der Hausbesuchshäufigkeit - eine Analyse für Mecklenburg-Vorpommern.

BACKGROUND: This study examines and compares the frequency of home visits by general practitioners in regions with a lower population density and regions with a higher population density. The discussion centres on the hypothesis whether the number of home visits in rural and remote areas with a low population density is, in fact, higher than in urbanised areas with a higher population density. The average age of the population has been considered in both cases. METHODOLOGY: The communities of Mecklenburg West-Pomerania were aggregated into postal code regions. The analysis is based on these postal code regions. The average frequency of home visits per 100 inhabitants/km2 has been calculated via a bivariate, linear regression model with the population density and the average age for the postal code region as independent variables. The results are based on billing data of the year 2006 as provided by the Association of Statutory Health Insurance Physicians of Mecklenburg-Western Pomerania. In a second step a variable which clustered the postal codes of urbanised areas was added to a multivariate model. RESULTS: The hypothesis of a negative correlation between the frequency of home visits and the population density of the areas examined cannot be confirmed for Mecklenburg-Western Pomerania. Following the dichotomisation of the postal code regions into sparsely and densely populated areas, only the very sparsely populated postal code regions (less than 100 inhabitants/km2) show a tendency towards a higher frequency of home visits. Overall, the frequency of home visits in sparsely populated postal code regions is 28.9% higher than in the densely populated postal code regions (more than 100 inhabitants/km2), although the number of general practitioners is approximately the same in both groups. In part this association seems to be confirmed by a positive correlation between the average age in the individual postal code regions and the number of home visits carried out in the area. As calculated on the basis of the data at hand, only the very sparsely populated areas with a still gradually decreasing population show a tendency towards a higher frequency of home visits. CONCLUSION: According to the data of 2006, the number of home visits remains high in sparsely populated areas. It may increase in the near future as the number of general practitioners in these areas will gradually decrease while the number of immobile and older inhabitants will increase.

Historical profile of gender in Turkish veterinary education.

Women in Turkey were first given the opportunity to attend schools of higher education in 1914. Following the establishment of the Turkish Republic in 1923, a number of social, judicial, and economic reforms took place that enabled women to participate actively in both the public and private sectors, and, as a consequence, the number of women students in higher education increased rapidly. The first woman graduated from the veterinary school in Ankara in 1935, becoming the first female veterinarian in the country. Since that time, the number of female veterinary graduates in Turkey has steadily increased.

The urban and rural distribution of dentists, 2000.

BACKGROUND: The authors examine urban and rural variation in the number of dentists in relation to the U.S. population. They focus on the number and distribution of dentists who practice in rural counties. METHODS: The authors divided U.S. counties into categories based on nine rural-urban continuum codes. They based county-level estimates of population on the 2000 census. They based county-level estimates of dentists on the Distribution of Dentists in the U.S. by Region and State, 2000--a report resulting from the annual census of dentists conducted by the American Dental Association. RESULTS: Although dentists were found to be more concentrated in urban areas, 84.7 percentage of the population living in the most rural counties lived in a county with one or more private practice dentists. CONCLUSIONS: Private practice dentists are distributed widely across rural areas and are available to a large proportion of the population living in these areas. PRACTICE IMPLICATIONS: A combination of population and per capita income largely determine the viability of a private dental practice located in a rural area. In areas in which this combination is insufficient, publicly funded or philanthropic programs will be necessary to ensure access to dental services.

Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review.

PURPOSE: The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States. METHOD: In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles. RESULTS: Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas. CONCLUSIONS: Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.

Regional disparities in the distribution of healthcare workers: evidence from Iran, Chaharmahal and Bakhtiari province.

A health care service is a prerequisite for sustainable development. This requires access to balanced health workers in different geographic areas. The first step is to identify inequality in access to health workers in different areas. This study is a descriptive study was carried out on the cities in Chaharmahal and Bakhtiari province. TOPSIS technique was used to rank the cities in terms of regional disparities in the distribution of health workers. The findings revealed that distinct disparities in the distribution of healthcare workers across Chaharmahal and Bakhtiari province. Shahrekord and Ardal cities were classified as 1st and 7th respectively. Policy makers should consider priority (regional planning, budget and resources allocation) according to the distribution of healthcare workers.

Urban-rural differences in Medicare physician expenditures.

Policymakers have long been concerned with urban-rural disparities in access to health care. These disparities may be particularly severe in the case of the elderly and others covered by Medicare. Descriptive tables show that the total volume of physician services provided to rural beneficiaries is more than 40% lower than the volume of physician services provided to urban beneficiaries. This result is fairly consistent across all types of care and sites of care. In our econometric analysis, we investigate the factors that may explain these differences in utilization. The results indicate that, with prices held constant, variations in demographic and economic characteristics are not the major reasons for the urban-rural gap. Differences in hospital and physician (particularly specialist) availability appear to be the main factors.

Geographic distribution of private dentists in Hong Kong in 1989 and 1998.

More than 80% of the dentists in Hong Kong are in private practice and third party payment schemes are uncommon. Thus, most dentists have to work according to the rules of a free market and have to respond to the demands of the population. Using official data, it was found that the geographic distribution of private dentists was highly uneven. In 1989, the dentist to population ratio in the commercial districts was below 1:2,500 while in the new towns the ratio was larger than 1:20,000. There has been an improvement in the availability of dentists in the under-served areas during the past 10 years although there are still a considerable number of dentists practising in the areas on both sides of the Victoria Harbour.

Survey of continuing dental education attendance in Western Australia.

A survey of attendance at continuing dental education courses convened by the University Postgraduate Dental Education Committee, University of Western Australia, and the Australian Dental Association. Western Australian Branch was collated for one calendar year. Attendances were compared relating to the number of dentists registered in the State, ADA membership, metropolitan versus rural dentists and the number of courses attended. The mandatory and voluntary options for continuing dental education are discussed in the light of the survey findings.

2012 rural Medicare Advantage quality ratings and bonus payments.

Key Data Findings. (1) The average rural Medicare Advantage (MA) plan enrollee in 2012 experienced a quality rating of 3.60 stars (of a potential 5.0), compared with a rating of 3.71 stars experienced by urban enrollees. (2) The measured rural-urban difference in the MA plan quality is a result of the difference in the composition of the enrollment and plan availability in MA markets, rather than differences between MA plans of the same type. (a) In general, rural Medicare beneficiaries often have limited MA plans available from which to choose, and typically have lower quality ratings than urban MA plans. (b) Rural MA beneficiaries are more likely to be enrolled in preferred provider organization (PPO) plans than in health maintenance organization (HMO) plans. (c) PPO plans have lower quality ratings on average than HMO plans. (d) HMO plans had the highest average quality rating at 3.83 and 3.78 stars, respectively, in rural and urban areas. PPO plans had lower quality ratings, at 3.52 and 3.50, respectively. (3) In rural areas, 32% of the MA population is enrolled in a plan with a star rating of 4.0 or higher, and 92% are enrolled in a plan with a star rating of at least 3.0, as contrasted to urban enrollment of 36% and 94% respectively, making these plans eligible for quality based bonus payments. (4) The quality rating of rural MA plans varies significantly across the country, with the highest quality ratings in rural areas in Minnesota, Iowa, Wisconsin, Oregon, Pennsylvania, and Maine.

Access to ophthalmologic care in Thailand: a regional analysis.

PURPOSE: The World Health Organization (WHO) recommends that Southeast Asian countries have ≥ 1 ophthalmologist per 100,000 persons, equally distributed in urban and rural areas. However, regional patterns of eye care have been poorly characterized. This study investigates the distribution of ophthalmologists in Thailand and provides regional estimates of access to ophthalmologists. METHODS: We geocoded the work address of ophthalmologists listed in the 2008 directory of the Royal College of Ophthalmologists of Thailand. We determined the number of ophthalmologists per 100,000 persons at the national, provincial, and district levels using data from the 2000 Thai Population Census, and assessed demographic factors associated with meeting the WHO recommendation of ≥ 1 ophthalmologist per 100,000 persons. RESULTS: In 2008, Thailand had 1.52 ophthalmologists per 100,000 persons; however, only 20 of 76 provinces (26%) and 134 of 926 districts (14%) met the WHO recommendation of ≥ 1 ophthalmologist per 100,000 persons. District factors associated with not meeting the WHO recommendation included a high proportion of children, a high proportion of elderly, and a high proportion of rural residents. CONCLUSION: Thailand meets the WHO's goal for access to ophthalmologic care, but the distribution of ophthalmologists is uneven, with less access to ophthalmologic care in rural areas.