Community-based learning enhances doctor retention.

Background: Rural doctor shortage is a problem in many countries. Factors associated with doctor retention were reported such as colleagues, workload, accommodations, transportation, proximity of family and friends, incentives and career path. Rural background recruitment, increasing the quantity of doctor production to supply in rural and remote areas, and regulation are claimed to alleviate doctor scarcity in rural communities. Many programs have been developed, but an imbalance in physician distribution persists. Community-based learning (CBL) is recommended by the WHO to promote doctor retention. The longer contact time of CBL is practical, but it is uncertain that this results in greater retention. The objective of this study is to determine the association between contact time of CBL and retention of doctor with rural background recruitment. Methods: A cohort study was performed. The study population was 10,018 doctors graduated during 2001-2010 and followed up at least to 2014. Of the 10,018 physicians, 2098 doctors (21%) were recruited from rural backgrounds by the Collaborative Project to Increase Production of Rural Doctor (CPIRD). Contact time of CBL was calculated to the proportion of total curricular credit hours. The primary outcome was retention rate in government health-care system over 4 years. Statistical analysis was performed using multiple logistic regression. Results: A total of 5774 doctors (57.6%) were retained in the government health-care system. Higher percentages of CPIRD doctors were retained than normal track (72.1% and 53.8%, P < 0.001), especially in rural hospitals (60.3% and 38.4%, P < 0.001). Based on univariate analysis, CBL was slightly higher in retention than resignation group with statistical significance (2.97% and 2.90%, P = 0.045). Multiple logistic regression results showed that CBL, graduate entry, and geographic location of workplace were significantly associated with retention. Discussion: CBL can enhance doctor retention. It should incorporate meaningful experience such as rural exposure together with classroom teaching to focus concepts and integrating service to the community. Graduate entry and geographic location of workplace also have an impact on decision-making regarding retention.

Effects of Stroke Unit Care in Acute Ischemic Stroke Patient Ineligible for Thrombolytic Treatment.

Background: Several trials have verified the benefits of stroke unit (SU) in acute stroke care worldwide. Objective: Compare clinical outcomes and costs of care in acute ischemic stroke patients who were ineligible for thrombolytic treatment (recombinant tissue plasminogen activator-rt PA) in a primary stroke center. Material and Method: A prospective study was conducted in acute ischemic stroke patients, aged 15 years old and above, presenting within 72 hours of onset. At discharge, neurological and medical complications, mortality rate, National Institutes of Health Stroke Scale (NIHSS), Barthel Activities of Daily Living (Barthel ADLs Index), and modified Rankin Scale (mRS) for disability were measured, as well as the length of stay, and cost of hospital care. Results: There were 1,110 acute ischemic stroke patients, 472 subjects (42.52%) in general medical ward (GMW), and 638 subjects (57.48%) in stroke unit (SU). The number of neurological (brain edema, hemorrhagic transformation, or recurrent stroke), and medical complications (gastrointestinal hemorrhage, pneumonia, or pressure sore) in GMW had highly statistical significance (p<0.001, p<0.001) more than those in SU, with adjusted OR (aOR) (95% CI) of 84.53 (31.14 to 229.46), 4.03 (1.99 to 8.17), respectively. Whereas, the death rate, NIHSS, and disability (Barthel Index of ADLs, and mRS) were statistically significant lower among SU cases (p = 0.05, p<0.001, p<0.001) respectively. The median length of stay was three days in both groups, while the median cost of in hospital care was 10,206 Thai Bahts in SU, which was 15.23% higher (p<0.001). Conclusion: The stroke unit increases the survival rate among stroke patient compared with the general medical ward and have less complication.