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1.
Public Health Res Pract ; 30(1)2020 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-32152613

RESUMEN

Recent reports highlight an inconsistent provision of palliative and end-of-life (palliative) care across Australia, particularly in regional, rural and remote areas. Palliative care improves quality of life and the experience of dying, and all people should have equitable access to quality needs-based care as they approach and reach the end of their lives. A palliative approach to care is crucial in rural and remote Australia where there is a reliance for such care on generalist providers amid the challenges of a limited workforce, poorer access, and vast geography. This article describes the development and implementation of the Far West NSW Palliative and End-of-Life Model of Care, a systematic solution that could drive improvement in the provision of a quality palliative approach to care and support from any clinician in a timely manner, for patients, their families and carers anywhere.


Asunto(s)
Cuidados Paliativos/normas , Servicios de Salud Rural/estadística & datos numéricos , Cuidado Terminal/normas , Australia , Necesidades y Demandas de Servicios de Salud , Humanos , Calidad de la Atención de Salud , Calidad de Vida , Población Rural
3.
BMC Health Serv Res ; 20(1): 16, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906938

RESUMEN

BACKGROUND: Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care. METHODS: Using an audit tool and interviews, respectively, facility readiness and health providers' knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Facility readiness to perform specific functions was assessed through descriptive analysis and comparisons by facility type (health post (HP), primary health care center (PHCC), private and District hospital). Knowledge was compared by facility type and by additional skilled birth attendant (SBA) training. RESULTS: Infection prevention items were lacking in more than one quarter of facilities, and widespread shortages of iron/folic acid tablets, injectable ampicillin/gentamicin, and magnesium sulfate were a major barrier to facility readiness. While parenteral oxytocin was commonly provided, only the District hospital was prepared to perform all seven basic emergency obstetric and newborn care signal functions. The required number of medical doctors, nurses and midwives were present in only 1 of 5 PHCCs. Private sector SBAs had significantly lower knowledge of active management of third stage of labor and correct diagnosis of severe pre-eclampsia. While half of the health workers had received the mandated additional two-month SBA training, comparison with the non-trained group showed no significant difference in knowledge indicators. CONCLUSIONS: Facility readiness to provide quality maternal and newborn care is low in this rural area of Nepal. Addressing the gaps by facility type through regular monitoring, improving staffing and supply chains, supervision and refresher trainings is important to improve quality.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Instituciones de Salud , Personal de Salud , Servicios de Salud Materna , Servicios de Salud Rural , Femenino , Investigación sobre Servicios de Salud , Humanos , Recién Nacido , Nepal , Atención Perinatal , Atención Posnatal , Embarazo , Atención Prenatal , Calidad de la Atención de Salud
4.
BMC Health Serv Res ; 20(1): 34, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931791

RESUMEN

BACKGROUND: The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. METHODS: Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience. RESULTS: The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic. CONCLUSIONS: This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.


Asunto(s)
Nativos de Alaska/psicología , Conducta Cooperativa , Depresión/etnología , Indios Norteamericanos/psicología , Atención Primaria de Salud/organización & administración , Servicios de Salud Rural/organización & administración , Población Rural , Adolescente , Adulto , Anciano , Nativos de Alaska/estadística & datos numéricos , Depresión/prevención & control , Femenino , Humanos , Indios Norteamericanos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Población Rural/estadística & datos numéricos , Resultado del Tratamiento , Adulto Joven
5.
BMC Public Health ; 20(1): 44, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931762

RESUMEN

BACKGROUND: The prevalence of non-communicable diseases, and associated morbidity and mortality, is increasing rapidly in low and middle-income countries where health systems often have limited access and lower quality of care. The intervention was to decentralise uncomplicated non-communicable disease (NCD) care from a hospital to nurse practitioners in health centres in a poor rural district in Eswatini, southern Africa. The objective of this study was to assess the feasibility and impact of decentralised care for NCDs within nurse-led clinics in order improve access and inform healthcare planning in Eswatini and similar settings. METHODS: In collaboration with the Eswatini Ministry of Health, we developed and implemented a package of interventions to support nurse-led delivery of care, including: clinical desk-guide for hypertension and diabetes, training modules, treatment cards and registries and patient leaflets. Ten community clinics in the Lubombo Region of Eswatini were randomly selected to be trained to deliver NCD care for a period of 18 months. Observational data on follow-up rates, blood pressure (BP), glucose etc. were recorded and evaluated. We compared blood pressure and blood glucose measurements between the first and fourth visits and fitted a linear mixed effects model. RESULTS: One thousand one hundred twenty-five patients were recruited to the study. Of these patients, 573 attended for at least 4 appointments. There was a significant reduction in mean BP among hypertensive patients after four visits of 9.9 mmHg systolic and 4.7 mmHg diastolic (p = 0.01), and a non-significant reduction in fasting blood glucose among diabetic patients of 1.2 mmol/l (p = 0.2). Key components of NCD care were completed consistently by nurses throughout the intervention period, including a trend towards patients progressing from monotherapy to dual therapy in accordance with prescribing guidelines. CONCLUSIONS: The findings suggest that management of diabetes and hypertension care in a rural district setting can be safely delivered by nurses in community clinics according to a shared care protocol. Improved access is likely to lead to improved patient compliance with treatment.


Asunto(s)
Hospitales Rurales , Enfermedades no Transmisibles/terapia , Pautas de la Práctica en Enfermería , Servicios de Salud Rural/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Planificación en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Adulto Joven
7.
N C Med J ; 81(1): 14-22, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908326

RESUMEN

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud/etnología , Hispanoamericanos/psicología , Enfermedad Relacionada con los Viajes , Infección por el Virus Zika/etnología , Estudios Transversales , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , North Carolina , Embarazo , Factores de Riesgo , Servicios de Salud Rural
8.
BMC Public Health ; 19(1): 1721, 2019 Dec 23.
Artículo en Inglés | MEDLINE | ID: mdl-31870334

RESUMEN

BACKGROUND: Community acquired pneumonia is responsible for 16% of under 5 mortality in India, probably due to delayed recognition and qualified care seeking. Therefore these deaths could possibly be averted by creating community awareness and promoting care seeking from qualified physicians in the government system. The objective of study was to assess the effectiveness of facility-based and village-based behavior change communication interventions delivered to community using validated information, education and communication materials, along with infrastructural strengthening of health facilities, for change in care seeking from government system for community acquired pneumonia in rural Lucknow, India. METHOD: Community based open labeled behavioral trial in 2 by 2 factorial design was conducted in eight rural blocks of Lucknow, northern India. Trained community health workers conducted Pneumonia Awareness Sessions once a month for the care givers of children using validated information, education and communication materials either at the villages or at government health facilities. Prior infrastructural strengthening of public health facilities was done to provide optimal care to cases. Pre packed pneumonia drug kits were provided which had amoxicillin, paracetamol and an instruction card on their use as well as pictorial representation of danger signs of pneumonia. RESULTS: Study lasted from October 2015 to September 2018. Adherence to conduct of facility-based intervention was 93.0% (279/300) and to village-based intervention was 73.4% (7638/10410). In village-based intervention there was 79.3% (p < 0.0001) increase from a baseline of 3.3% (14/420) and facility-based intervention 68.9% (p = 0.02) increase from a baseline of 5.35% (21/392) in cases of possible pneumonia treated at government health facilities. CONCLUSION: Conduct of structured pneumonia awareness session using validated information, education and communication material at village level with infrastructural strengthening resulted in improved qualified care seeking from government facilities for community acquired pneumonia. TRIAL REGISTRATION: AEARCTR-0003137, retrospectively registered on 10/July/2018.


Asunto(s)
Infecciones Comunitarias Adquiridas/prevención & control , Comunicación en Salud/métodos , Neumonía/prevención & control , Servicios de Salud Rural , Cuidadores/educación , Cuidadores/psicología , Preescolar , Agentes Comunitarios de Salud/psicología , Infecciones Comunitarias Adquiridas/mortalidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , India/epidemiología , Lactante , Masculino , Aceptación de la Atención de Salud , Neumonía/mortalidad , Evaluación de Programas y Proyectos de Salud
9.
BMC Health Serv Res ; 19(1): 998, 2019 Dec 26.
Artículo en Inglés | MEDLINE | ID: mdl-31878913

RESUMEN

BACKGROUND: Deficits in the rural medical workforce is an international issue. In Australia, The Rural Clinical School intervention is effective for initial recruitment of rural doctors. However, the extent of survival is not yet established. This paper summarises rural survival over a 10-year period. METHODS: Rural Clinical School graduates of Western Australia were surveyed annually, 2006-2015, and post Graduate Years (PGY) 3-12 included. Survival was described as "tours of service", where a tour was either a period of ≥1 year, or a period of ≥2 weeks, working rurally. A tour ended with a rural work gap of ≥52 weeks. Considering each exit from urban as an event, semi-parametric repeated measures survival models were fitted. RESULTS: Of 468 graduates, using the ≥2 weeks definition, 239 PGY3-12 graduates spent at least one tour rurally (average 61.1, CI 52.5-69.7 weeks), and a total length of 14,607 weeks. Based on the tour definition of ≥1 year, 120 graduates completed at least one tour (average 1.89, 1.69-2.10 years), and a total of 227 years' rural work. For both definitions, the number of tours increased from one to four by PGY10/11, giving 17,786 total weeks (342 years) across all PGYs for the ≥2 weeks tour definition, and 256 years total for ≥1 year. Significantly more graduates exited from urban work for the 2007-09 middle cohort compared with 2010-11 (HR 1.876, p = 0.022), but no significant difference between 2002 and 06 and 2010-11. Rural origin, age and gender were not statistically significant. CONCLUSIONS: PGY3-12 RCS graduates contributed substantially to the rural workforce: 51% did so by short rotations, while 26% contributed whole years of service. There was an apparent peak in entry and survival for the middle cohort and decline thereafter, likely attributable to lack of advanced/specialist vocational training. These data indicate a real commitment to rural practice by RCS graduates, and the need for rural vocational training as a key element of a successful rural survival strategy.


Asunto(s)
Fuerza Laboral en Salud/organización & administración , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/estadística & datos numéricos , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Australia Occidental , Adulto Joven
10.
BMC Health Serv Res ; 19(1): 1005, 2019 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-31881885

RESUMEN

BACKGROUND: An estimated 50 million people worldwide have Alzheimer's disease and related dementias (ADRD), and this number is projected to increase with the growth of the aging population, with the largest growth occurring in low and middle-income countries. Diagnostic coverage for dementia is estimated to be only 5-10% in low- and middle-income countries. Timely diagnosis of ADRD could prompt early access to information, medical treatments, and support for caregivers. The aim of this study was to assess how healthcare workers in rural southwestern Uganda assess for and diagnose ADRD. METHODS: We used in-depth interviews to investigate the medical knowledge and clinical practices surrounding ADRD diagnoses among 42 healthcare workers employed at mid-tier health facilities in southwestern Uganda. Qualitative content analysis was used to identify distinct categories and themes. RESULTS: Our findings show that healthcare workers without specific mental health training assessed and diagnosed dementia based on history and physical examination alone. On the other hand, healthcare workers with some specialized training in mental health were more likely to use neuropsychological tests, blood tests, urine tests, and brain imaging in the diagnosis of dementia. Collateral history from caregivers was noted to be very important in proper assessment and diagnosis of dementia among all categories of healthcare workers. The majority of healthcare workers regarded memory loss as part of the normal aging process and reported that it does not need any specific treatment. Other healthcare workers could recognize signs and symptoms of dementia, but focused on managing other medical problems at the expense of assessing cognitive decline and mental health. Diagnostic practices did not differ based on age, years of experience, or gender of the healthcare workers. CONCLUSION: These results indicate that specialized training in mental health among healthcare workers is crucial for the assessment and diagnosis of ADRD in rural southwestern Uganda.


Asunto(s)
Demencia/diagnóstico , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Personal de Salud/psicología , Práctica Profesional , Servicios de Salud Rural , Adulto , Anciano , Estudios Transversales , Femenino , Personal de Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Uganda
11.
Artículo en Inglés | MEDLINE | ID: mdl-31847468

RESUMEN

Elucidating the perceptions of residents regarding medical group practice (GP) among rural communities (GP-R) in Japan will be useful for establishing this system in such communities. A survey by questionnaire, as made by experts in rural health, was conducted in 2017. The self-administered questionnaire inquired about the perceptions of residents for accepting the GP-R into the community's healthcare using seven major elements of GP-R. The questionnaire was randomly distributed to 400 adult residents who lived in rural communities with a recently launched GP and had access to clinics within the communities. Among the 321 respondents, comparisons were made between younger (≤sixties) and older (≥seventies) residents, and a stepwise multiple regression analysis was performed to extract the factors influencing acceptance of the GP-R system. The results showed that older residents had a greater disapprove of being treated by different physicians daily or weekly in clinics (p < 0.001) and the use of telemedicine (p < 0.001) compared with younger residents. Younger residents showed a greater disapproval of clinics closing on weekdays than older residents (p = 0.007). Among all respondents, regardless of age groups, over half of residents approved of the involvement of nurse practitioners in the GP-R. Living with family and children was also extracted as an independent factor influencing a positive perception of the GP-R. These data suggest that the promotion of GP-R should consider generation gaps in the approach to medical practice as well as the family structures of residents. The involvement of nurse practitioners can also encourage the acceptance of GP-R in Japan.


Asunto(s)
Práctica de Grupo , Servicios de Salud Rural/organización & administración , Población Rural , Adulto , Anciano , Servicios de Salud Comunitaria/organización & administración , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Percepción , Salud Rural , Encuestas y Cuestionarios , Adulto Joven
12.
Artículo en Inglés | MEDLINE | ID: mdl-31847490

RESUMEN

This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.


Asunto(s)
Cuidados Posteriores , Enfermedades Cardiovasculares/terapia , Hospitales Rurales/organización & administración , Servicios de Salud Rural/organización & administración , Enfermedad Aguda , Humanos , Calidad de la Atención de Salud , Población Rural
13.
BMC Health Serv Res ; 19(1): 974, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31852493

RESUMEN

BACKGROUND: Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. METHODS: A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. RESULTS: Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence. CONCLUSIONS: While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud Rural , Servicios Urbanos de Salud , Humanos , Estados Unidos
14.
South Med J ; 112(11): 553-559, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31682734

RESUMEN

OBJECTIVES: This study assessed providers' present practices and perceived needs in Appalachian Kentucky to identify the standard of care and implementation of expert recommendations for managing pediatric obesity. METHODS: Questionnaire data were gathered from 28 providers at a pediatric obesity continuing medical education workshop in eastern Kentucky. We assessed current practices, perceived barriers to treatment, and needed resources for managing pediatric obesity. RESULTS: Respondents reported mixed adherence to expert recommendations, with providers less frequently addressing family-reported barriers to change and assessing a family's readiness to change behaviors related to pediatric obesity. Respondents also reported service barriers related to patient motivation, lack of time with patients, and a lack of referral options. Finally, providers reported needing multiple community resources to better address pediatric obesity, including improved physical education programs, access to community recreation centers, additional referral resources for multidisciplinary care, and additional training in motivational techniques. CONCLUSIONS: There remains a significant need for education and guidance regarding the implementation of expert recommendations for addressing pediatric obesity in Appalachian Kentucky. Providers reported needing multiple community resources, including improved physical education programs, access to community recreation centers, additional referral resources for multidisciplinary care, and additional training in motivational techniques. We discuss the implications for disseminating and implementing expert recommendations in rural eastern Kentucky, with an emphasis on the roles of behavioral health experts.


Asunto(s)
Obesidad Pediátrica/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud , Región de los Apalaches , Consejo , Femenino , Adhesión a Directriz , Conductas Relacionadas con la Salud , Humanos , Kentucky , Masculino , Evaluación de Necesidades , Guías de Práctica Clínica como Asunto , Servicios de Salud Rural , Población Rural , Encuestas y Cuestionarios
15.
Inquiry ; 56: 46958019886958, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31701787

RESUMEN

In large proportions of rural areas in many developing countries, health care delivery system is less developed and is less likely to be equipped to conduct sophisticated treatment for coronary heart disease (CHD) patients locally. This study aims at describing the status quo of and exploring factors associated with hospitalization costs of CHD in township hospitals where only drug therapy was available for CHD conditions. We collected data of inpatients with CHD from discharge records from 10 township hospitals in rural Liaoning from December 2013 to December 2014. We used multilevel linear regression to analyze the factors associated with CHD hospitalization costs. A total of 4635 inpatients were included in the analysis. We found that the average hospitalization costs were 6249.97 RMB (US$1012.47) with the average of 8.89 days of hospitalization in township hospitals in Liaoning. Age, gender, length of stay, the number of times of admissions, by which route was hospitalized, and type of CHD were all the factors significantly associated with hospitalization costs of CHD in township hospitals. The factors associated with hospitalization costs of CHD in township hospitals in rural China showed some different features from the existing studies. When the government designs the related policy, the policy makers need to consider the specific feature of hospitalization costs of CHD in township hospitals in rural areas.


Asunto(s)
Enfermedad Coronaria/economía , Costos de Hospital , Pacientes Internos/estadística & datos numéricos , Servicios de Salud Rural , Adulto , Anciano , Anciano de 80 o más Años , China , Enfermedad Coronaria/terapia , Femenino , Hospitalización/economía , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad
16.
Medicine (Baltimore) ; 98(45): e17709, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702622

RESUMEN

BACKGROUND: The rising maternal and child healthcare costs and the lack of training and educational resources for healthcare workers have reduced service quality in primary health centers of China. We sought to compare strategies promoting healthcare service utilization in rural western China. METHOD: A randomized community trial was carried out in Zhen'an country between 2007 and 2009. Two cross-sectional surveys were conducted to compare the outcomes of financial subsidy for pregnant women seeking antenatal care and clinical training provided to healthcare workers by difference-in-difference estimation. RESULTS: In all, 1113 women completed the questionnaires. The proportion of postnatal visits increased three times in the training group, reaching 35.7%. The number of women who received advice from their doctors regarding nutrition and warning signs necessitating immediate medical attention also improved significantly (5.8% and 8.2%, respectively). Furthermore, the percentage of women who underwent blood tests increased significantly to 19.5% in the training group. Compared to the financial group, the training group had more women who breastfed for longer than 4 months (15.8%) and provided timely complementary feeding (8.9%). CONCLUSION: The training intervention appeared to have improved prenatal care utilization. Essential obstetric training helped enhance knowledge and self-efficacy among healthcare workers.


Asunto(s)
Personal de Salud/educación , Servicios de Salud Materna/economía , Servicios de Salud Rural/economía , Estudios Transversales , Femenino , Humanos , Aceptación de la Atención de Salud , Embarazo , Autoeficacia , Encuestas y Cuestionarios
17.
Pediatrics ; 144(6)2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31690711

RESUMEN

We present the case of a 2-year-old boy with epidermolysis bullosa and supraglottic stenosis whose parents refuse an elective tracheostomy because of the significant care the tracheostomy would require. The patient's family lives in a rural area with few health care resources and his parents are already handling hours of daily skin care for his epidermolysis bullosa. In an attempt to convince the parents to pursue the intervention, the medical team recommends that the family move to an area with additional resources to assist in the child's care. The parents refuse to move, citing the many benefits their home environment provides for their son. The medical team calls an ethics consultation, questioning whether this decision constitutes medical neglect. This case raises important questions about medical decision-making in pediatrics. First, is a parent's refusal of a recommended medical intervention because it would require moving their family to a new environment a reasonable decision? Second, how broadly can parents define their child's best interest? Should only physical interests be included when making medical decisions? Is there a limit to what can be considered a relevant interest? Third, can parents only consider the interests of the individual child, or can they consider the interests of other members of the family? Finally, what is the threshold for overruling a parental decision? Is it whenever the parent's definition of a patient's best interest is different from the medical team's, or do other criteria have to be met?


Asunto(s)
Toma de Decisiones Clínicas/ética , Prestación de Atención de Salud/ética , Epidermólisis Ampollosa/terapia , Servicios de Salud Rural/ética , Supraglotitis/terapia , Preescolar , Prestación de Atención de Salud/métodos , Epidermólisis Ampollosa/diagnóstico , Humanos , Masculino , Padres/psicología , Población Rural , Supraglotitis/diagnóstico
18.
BMC Health Serv Res ; 19(1): 878, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752869

RESUMEN

BACKGROUND: Community Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of this study is to understand the work flow of CHWs in a rural Community Mental Health Project (CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in formulating a targeted policy approach, improving efficiency and supporting appropriate work allocation as the roles and responsibilities of the CHWs evolve. METHODS: A continuous observation Time Motion study was conducted on Community Health Workers selected through purposive sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5 days each, staggered during a period of 1 month. The 14 different activities performed by the CHWs were identified and the time duration was recorded. Activities were then classified as value added, non-value added but necessary and non-value-added to determine their time allocation. RESULTS: Home visits occupied the CHWs for the maximum number of hours followed by Documentation, and Traveling. Documentation, Administrative work and Review of work process are the non-value-added but necessary activities which consumed a significant proportion of their time. The CHWs spent approximately 40% of their time on value added, 58.5% of their time on non-value added but necessary and 1.5% of their time on non-value added activities. The CHWs worked for 0.7 h beyond the stipulated time daily. CONCLUSION: The CHW's are "dedicated" mental health workers as opposed to being "generalists" and their activities involve a significant investment of their time due to the specialized nature of the services offered such as counselling, screening and home visits. The CHWs are stretched beyond their standard work hours. Non-value added but necessary activities consumed a significant proportion of their time at the expense of value-added activities. Work flow redesign and implementation of Health Management Information Systems (HMIS) can mitigate inefficiencies.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Agentes Comunitarios de Salud , Servicios de Atención de Salud a Domicilio/organización & administración , Servicios de Salud Mental/organización & administración , Estudios de Tiempo y Movimiento , Visita Domiciliaria/estadística & datos numéricos , Humanos , India , Servicios de Salud Rural/organización & administración , Flujo de Trabajo
19.
BMC Health Serv Res ; 19(1): 852, 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747908

RESUMEN

BACKGROUND: Traditional "inverted triangle" healthcare resources allocation model in China has wasted a lot of health resources. The Chinese health reform began to strengthens the role of the primary health institutions in delivering primary health care especially in rural areas in the background of large development gap between urban-rural health and rapid growth in the incidence of chronic diseases in rural. We take hypertensive patients as an example, to verify the effect of policy implementation through distribution characteristics of rural primary health institutions preference of hypertensive patients and explore the influencing factor that promoting rationalized use of medical care for patients with chronic disease as well as rational allocation of health resources in rural areas. METHODS: A cross-sectional survey was conducted in Heilongjiang, a province in northeastern China by using a self-designed questionnaire. Stratified cluster sampling was used to choose 484 hypertensive patients from two villages in Heilongjiang province in 2010. RESULTS: About 88.4% of respondents reported preferred primary health institutions (83.5% preferred village clinics and 4.9% preferred township hospitals), 49.4% of respondents knew hypertension management administered by primary health institutions, 53.5% received hypertension education from primary care physicians, more than half of respondents reported that they didn't receive telephone interviews and family visits from primary care physicians over the past 6 months. Residence closer to the primary health institutions (OR = 10.360), trust in village doctors (OR = 7.323), elders (OR = 3.001), and asked for return visits by primary health physicians (OR = 2.073) promote preferences for primary health institutions. CONCLUSIONS: Accessibility to primary healthcare and doctor-patient trust stimulate patients to choose the primary health institutions. Primary health institutions should improve general approach to hypertension management and enhance the ability of providing basic public health services.


Asunto(s)
Hipertensión/terapia , Prioridad del Paciente , Atención Primaria de Salud/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Confianza , Adulto , Anciano , China , Enfermedad Crónica , Estudios Transversales , Utilización de Instalaciones y Servicios , Femenino , Asignación de Recursos para la Atención de Salud/estadística & datos numéricos , Reforma de la Atención de Salud , Recursos en Salud/estadística & datos numéricos , Humanos , Hipertensión/psicología , Masculino , Relaciones Médico-Paciente , Médicos de Atención Primaria , Estudios Retrospectivos , Salud Rural/estadística & datos numéricos , Encuestas y Cuestionarios
20.
BMC Health Serv Res ; 19(1): 848, 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747932

RESUMEN

BACKGROUND: Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision. METHODS: Mixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements. RESULTS: The results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts. CONCLUSION: Together with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.


Asunto(s)
Atención Primaria de Salud/normas , Mejoramiento de la Calidad/normas , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Niño , Preescolar , Femenino , Instituciones de Salud/normas , Personal de Salud/normas , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud/normas , Servicios de Salud Rural/normas , Tanzanía , Cobertura Universal del Seguro de Salud/organización & administración , Adulto Joven
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