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1.
J Prim Care Community Health ; 11: 2150132720965080, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33084496

RESUMO

Hospitals and health systems suffer an over-reliance on elective surgeries to remain profitable. As a result, systems report record losses, while demand for emergency room, hospital, and intensive care beds have surged. Studies have admitted that many surgeries are unnecessary, and physician leaders admit that profit plays a role in driving such needless cost and risk. Most diseases are better managed with medications and lifestyle changes. But it pays more to replace a knee than to prevent that replacement. We must bring surgical and medical value closer in-line. Communities of color are suffering disproportionately from coronavirus. The social determinants of health that lead to higher concentrations of hypertension and diabetes can be mitigated by investment in primary care. Such investment has been proven to decrease cost and increase quality of life. However, the United States spends 50% less on primary care, than other developed countries. While showing promise, telehealth is not a panacea. It relies on continued reimbursement parity, and there remains a digital divide. Any meaningful fix will draw the ire from those who profit from such a profligate system. If we want to improve quality, access and equity, while avoiding unnecessary hospitalizations, risky surgeries, and runaway costs, we must invest in primary care.


Assuntos
Infecções por Coronavirus/etnologia , Pneumonia Viral/etnologia , Medicina Preventiva , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Procedimentos Cirúrgicos Eletivos/economia , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Área Carente de Assistência Médica , Pandemias , Determinantes Sociais da Saúde/etnologia , Estados Unidos/epidemiologia
3.
Ther Adv Cardiovasc Dis ; 14: 1753944720948651, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885724

RESUMO

BACKGROUND: We aimed to investigate the safety of endovascular procedures undertaken in a single outpatient center located in a rural, underserved area. Endovascular procedures for Peripheral Arterial Disease (PAD) have become increasingly common in outpatient settings; their safety is yet to be determined in a rural, underserved area with no stand-by vascular surgeon on site. METHODS: We undertook a retrospective case review of endovascular procedures for the investigation and management of lower extremity PAD between December 2012 and August 2015. Patients were classified by Rutherford score, degree of stenosis and length of lesions. Complications were major (requiring hospitalization) or minor, including perforation, distal embolization, hematoma, and allergic reactions, which could be treated immediately in the catheterization laboratory with no sequelae. Patients were monitored in the facility and followed up using clinical, biochemical and radiological parameters at 24 h and 1 month. RESULTS: A total of 692 patients underwent endovascular procedures for the investigation and/or treatment of PAD, of which 608 were interventional. Of these patients, 10.20% experienced procedural complications, of which 0.66% were classified as major, including wire retention and retroperitoneal hemorrhage. In total, 99.34% were discharged safely on the same day as the procedure. No adverse events were reported at follow up. CONCLUSION: Endovascular procedures for PAD can be performed safely in a rural outpatient setting with low complication rates. Most complications are minor and do not require hospitalization. Outpatient procedures for PAD are safe and may widen access to specialist procedures in areas of socio-economic deprivation.


Assuntos
Assistência Ambulatorial , Procedimentos Endovasculares , Tempo de Internação , Área Carente de Assistência Médica , Alta do Paciente , Doença Arterial Periférica/terapia , Serviços de Saúde Rural , Idoso , Idoso de 80 Anos ou mais , California , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Doença Arterial Periférica/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32943534

RESUMO

The National Institutes of Health's Environmental Influences on Child Health Outcomes (ECHO) program aims to study high-priority and high-impact pediatric conditions. This broad-based health initiative is unique in the National Institutes of Health research portfolio and involves 2 research components: (1) a large group of established centers with pediatric cohorts combining data to support longitudinal studies (ECHO cohorts) and (2) pediatric trials program for institutions within Institutional Development Awards states, known as the ECHO Institutional Development Awards States Pediatric Clinical Trials Network (ISPCTN). In the current presentation, we provide a broad overview of the ISPCTN and, particularly, its importance in enhancing clinical trials capabilities of pediatrician scientists through the support of research infrastructure, while at the same time implementing clinical trials that inform future health care for children. The ISPCTN research mission is aligned with the health priority conditions emphasized in the ECHO program, with a commitment to bringing state-of-the-science trials to children residing in underserved and rural communities. ISPCTN site infrastructure is critical to successful trial implementation and includes research training for pediatric faculty and coordinators. Network sites exist in settings that have historically had limited National Institutes of Health funding success and lacked pediatric research infrastructure, with the initial funding directed to considerable efforts in professional development, implementation of regulatory procedures, and engagement of communities and families. The Network has made considerable headway with these objectives, opening two large research studies during its initial 18 months as well as producing findings that serve as markers of success that will optimize sustainability.


Assuntos
Ensaios Clínicos como Assunto/organização & administração , Área Carente de Assistência Médica , Pediatria , Apoio à Pesquisa como Assunto/organização & administração , População Rural , Fortalecimento Institucional , Saúde da Criança , Ensaios Clínicos como Assunto/economia , Educação Continuada , Humanos , Apoio à Pesquisa como Assunto/economia , Estados Unidos
6.
Rev Panam Salud Publica ; 44, sept. 2020
Artigo em Espanhol | PAHO-IRIS | ID: phr-52651

RESUMO

Objetivo. Identificar y sistematizar la evidencia empírica disponible sobre factores e intervenciones que inciden en las condiciones y medio ambiente de trabajo para incrementar la atracción, captación y retención de recursos humanos en salud en el primer nivel de atención de áreas rurales, remotas o desatendidas. Métodos. Revisión rápida de revisiones, seleccionadas según criterios de pertinencia, elegibilidad e inclusión con búsquedas en bases de datos electrónicas, de literatura gris y manual. Se empleó el AMSTAR I para evaluar la calidad de revisiones sistemáticas y un análisis temático para síntesis de resultados. Resultados. Se incluyeron 16 revisiones, una de las cuales contenía a su vez 14 revisiones. Del total, 20 revisiones analizaron factores y 9 evaluaron efectividad de intervenciones. La evidencia sobre factores es abundante, pero de limitada calidad. Los factores individuales, familiares y la “exposición rural previa” se asociaron a mayor captación; factores organizacionales y del contexto externo fueron gravitantes en la retención. El trabajo en red y el apoyo profesional incidieron en la captación y retención. La evidencia sobre efectividad de intervenciones fue limitada, en cantidad y calidad. El tipo de intervención más frecuentemente empleada fueron los incentivos. Conclusiones. La evidencia sobre factores que se relacionan positivamente con la captación y retención de trabajadores en el primer nivel de atención de áreas rurales, remotas o desatendidas es suficiente y debería ser tenida en cuenta al diseñar intervenciones. La evidencia de calidad sobre la efectividad de intervenciones es escasa. Se requieren más estudios controlados con rigurosidad metodológica, particularmente en las Américas. Palabras clave Condiciones de trabajo


Objective. To identify and systematize available empirical evidence on factors and interventions that affect working conditions and environment in order to increase the attraction, recruitment and retention of human resources for health at the primary care level in rural, remote or underserved areas. Methods. Rapid review of reviews selected according to relevance, eligibility and inclusion criteria. The search was conducted on electronic and manual databases, including grey literature. AMSTAR I was used to assess the quality of systematic reviews and a thematic analysis for synthesis of the results. Results. Sixteen reviews were included, one of which contained 14 reviews. Of the total, 20 reviews analyzed factors and 9 evaluated the effectiveness of interventions. The evidence on factors is abundant, but of limited quality. Individual, family and “previous exposure to a rural setting” factors were associated with higher recruitment; organizational and external context factors were important for human resource retention. Networking and professional support influenced recruitment and retention. Evidence on the effectiveness of interventions was limited, both in quantity and quality. The most frequently used intervention was incentives. Conclusions. Evidence on factors that are positively related to recruitment and retention of workers at the first level of care in rural, remote or underserved areas is sufficient and should be taken into account when designing interventions. Quality evidence on the effectiveness of interventions is scarce. More controlled studies with methodological rigor are needed, particularly in the Americas.


Assuntos
Condições de Trabalho , Zona Rural , Zonas Remotas , Área Carente de Assistência Médica , Recursos Humanos , Atenção Primária à Saúde , Seleção de Pessoal , Condições de Trabalho , Zona Rural , Zonas Remotas , Seleção de Pessoal , Atenção Primária à Saúde
11.
Am J Public Health ; 110(9): 1304-1307, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32783737

RESUMO

The University of Iowa Mobile Clinic (UIMC) is an interdisciplinary student-run free medical clinic founded in 2002. UIMC provides free health screenings, education, and basic services to underserved populations in Iowa: immigrants, refugees, migrant farmworkers, individuals experiencing homelessness, low-income individuals, and people who live in rural communities. Forty-four percent of patients surveyed use UIMC as their only source of care. Ninety-seven percent of patients surveyed rate care as excellent or good. UIMC is a crucial safety net health care resource in Iowa to improve health equity.


Assuntos
Assistência à Saúde/métodos , Área Carente de Assistência Médica , Unidades Móveis de Saúde/organização & administração , Estudantes de Ciências da Saúde , Educação em Saúde , Pessoas em Situação de Rua , Humanos , Iowa , Pessoas sem Cobertura de Seguro de Saúde , Refugiados , População Rural , Migrantes
12.
Artigo em Inglês | MEDLINE | ID: mdl-32629963

RESUMO

Medical staff carry an inordinate risk of infection from patients, and many doctors, nurses, and other healthcare workers are affected by COVID-19 worldwide. The unreached communities with noncommunicable diseases (NCDs) such as chronic cardiovascular, respiratory, endocrine, digestive, or renal diseases became more vulnerable during this pandemic situation. In both cases, Remote Healthcare Systems (RHS) may help minimize the risk of SARS-CoV-2 transmission. This study used the WHO guidelines and Design Science Research (DSR) framework to redesign the Portable Health Clinic (PHC), an RHS, for the containment of the spread of COVID-19 as well as proposed corona logic (C-Logic) for the main symptoms of COVID-19. Using the distributed service platform of PHC, a trained healthcare worker with appropriate testing kits can screen high-risk individuals and can help optimize triage to medical services. PHC with its new triage algorithm (C-Logic) classifies the patients according to whether the patient needs to move to a clinic for a PCR test. Through modified PHC service, we can help people to boost their knowledge, attitude (feelings/beliefs), and self-efficacy to execute preventing measures. Our initial examination of the suitability of the PHC and its associated technologies as a key contributor to public health responses is designed to "flatten the curve", particularly among unreached high-risk NCD populations in developing countries. Theoretically, this study contributes to design science research by introducing a modified healthcare providing model.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Área Carente de Assistência Médica , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Telemedicina , Instituições de Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/transmissão , Humanos , Modelos Teóricos , Pneumonia Viral/transmissão , Saúde Pública , Triagem
13.
Prev Chronic Dis ; 17: E74, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32730199

RESUMO

Medically underserved patients in rural areas are more vulnerable to poor health outcomes, including the risks associated with coronavirus disease 2019 (COVID-19). Pharmacists, student pharmacists, and other health care professionals are working together to implement new, innovative ways to deliver the same standard of care during the COVID-19 pandemic to these vulnerable patients. These services include telehealth with virtual and telephone medication therapy management sessions led by ambulatory care pharmacists and student pharmacists. Pharmacists, student pharmacists, and other health care professionals should continue to adapt to these new technologies to improve health outcomes for their patients during the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Área Carente de Assistência Médica , Pandemias/prevenção & controle , Farmacêuticos/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , População Rural , Doença Crônica , Serviços Comunitários de Farmácia , Florida , Humanos , Conduta do Tratamento Medicamentoso/organização & administração , Papel Profissional , Telemedicina
14.
PLoS Negl Trop Dis ; 14(7): e0008474, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32716938

RESUMO

The estimated 50 million nomadic pastoralists in Africa are among the most "hard-to-reach" populations for health-service delivery. While data are limited, some studies have identified these communities as potential disease reservoirs relevant to neglected tropical disease programs, particularly those slated for elimination and eradication. Although previous literature has emphasized the role of these populations' mobility, the full range of factors influencing health service utilization has not been examined systematically. We systematically reviewed empirical literature on health services uptake among African nomadic pastoralists from seven online journal databases. Papers meeting inclusion criteria were reviewed using STROBE- and PRISMA-derived guidelines. Study characteristics were summarized quantitatively, and 10 key themes were identified through inductive qualitative coding. One-hundred two papers published between 1974-2019 presenting data from 16 African countries met our inclusion criteria. Among the indicators of study-reporting quality, limitations (37%) and data analysis were most frequently omitted (18%). We identified supply- and demand-side influences on health services uptake that related to geographic access (79%); service quality (90%); disease-specific knowledge and awareness of health services (59%); patient costs (35%); contextual tailoring of interventions (75%); social structure and gender (50%); subjects' beliefs, behaviors, and attitudes (43%); political will (14%); social, political, and armed conflict (30%); and community agency (10%). A range of context-specific factors beyond distance to facilities or population mobility affects health service uptake. Approaches tailored to the nomadic pastoralist lifeway, e.g., that integrated human and veterinary health service delivery (a.k.a., "One Health") and initiatives that engaged communities in program design to address social structures were especially promising. Better causal theorization, transdisciplinary and participatory research methods, clearer operational definitions and improved measurement of nomadic pastoralism, and key factors influencing uptake, will improve our understanding of how to increase accessibility, acceptability, quality and equity of health services to nomadic pastoralist populations.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Estilo de Vida , África , Serviços de Saúde , Humanos , Área Carente de Assistência Médica , População Rural , Migrantes
15.
Nurs Outlook ; 68(5): 601-610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32620272

RESUMO

BACKGROUND/PURPOSE: The patient-centered medical home (PCMH) is an enhanced model of primary care. This study examined to what extent nurse practitioner (NP)-led PCMHs differed from traditional physician-led PCMHs. METHODS: We tested for differences between 391 NP-led PCMHs and 11,479 physician-led PCMHs, as well as across two distinct clusters identified by the Two-Step cluster analysis procedure using a sample of 136 practices. FINDINGS: NP-led PCMHs were more likely to serve vulnerable populations in rural and underserved areas than physician-led PCMHs. NP-led PCMHs tended to be more responsive to population health needs in the areas during the recognition process, while physician-led PCMHs emphasized practice improvements through enhanced access to care and management of patient information data. DISCUSSION: The findings suggest possible differences in capabilities, priorities and needs of the population served across practices. This is an important guide as policymakers track the adoption of PCMHs.


Assuntos
Área Carente de Assistência Médica , Profissionais de Enfermagem/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Registros Eletrônicos de Saúde , Humanos , Profissionais de Enfermagem/provisão & distribução , Médicos/provisão & distribução , Serviços de Saúde Rural
16.
J Racial Ethn Health Disparities ; 7(5): 817-821, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32651882

RESUMO

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has ravaged many urban and high-density areas in the USA. However, rural areas (despite their low population density) may be especially vulnerable to poor outcomes from COVID-19, owing to limited healthcare infrastructure, long distances to advanced health care, and population characteristics (e.g., high tobacco use, hypertension, obesity, older age). A panel of experts who are actively engaged in treating and managing COVID-19 at a rural academic center was convened to address this topic. In this commentary, we provide readers with some specific issues faced by rural healthcare providers and offer guidance in overcoming these challenges. This guidance includes alternative ventilator strategies, personal protective equipment (PPE), and common therapeutic options.


Assuntos
Infecções por Coronavirus/terapia , Área Carente de Assistência Médica , Pandemias , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Serviços de Saúde Rural , Infecções por Coronavirus/epidemiologia , Humanos , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Respiração Artificial/métodos , Estados Unidos/epidemiologia
19.
Rev Assoc Med Bras (1992) ; 66(3): 321-327, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32520152

RESUMO

OBJECTIVE: To analyze the working process of the professionals of the More Doctors Program and its relationship with socioeconomic indicators. It is a quantitative study, in which secondary data from supervision reports of PMM were used. The dependent variable was the quality of work processes in Primary Care facilities, and the independent ones were the type of municipality, education, Gini index, Primary Health Care investments, and health facilities coverage. Data were analyzed with multiple modeling based on Poisson regression with robust variance. RESULTS: 16,000 doctors within 3816 municipalities were analyzed. Variables related to the working process the remained significant in the final model were the investments in Primary Health Care and the health facilities coverage. The results expressed the equity principle, as those municipalities with more vulnerable conditions and with higher coverage are prone to perform more activities in their working process. CONCLUSIONS: The implementation of the More Doctors Program and hence the provision of doctors in deprived regions promoted the consolidation of three main aspects, namely the health working process, primary health care and equity, making it possible to carry out a health working process focused on PHC. This implies performing a greater number of activities that are inherent to PHC, which were not carried out due to the absence of doctors. The More Doctors Program fulfills its role in the combat of inequalities, particularly regarding more vulnerable municipalities.


Assuntos
Médicos/provisão & distribução , Atenção Primária à Saúde/estatística & dados numéricos , Brasil , Programas Governamentais , Acesso aos Serviços de Saúde , Mão de Obra em Saúde , Humanos , Área Carente de Assistência Médica , Atenção Primária à Saúde/organização & administração , Fatores Socioeconômicos
20.
Heart Lung Circ ; 29(7): e88-e93, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487432

RESUMO

THE CHALLENGES: Rural and remote Australians and New Zealanders have a higher rate of adverse outcomes due to acute myocardial infarction, driven by many factors. The prevalence of cardiovascular disease (CVD) is also higher in regional and remote populations, and people with known CVD have increased morbidity and mortality from coronavirus disease 2019 (COVID-19). In addition, COVID-19 is associated with serious cardiac manifestations, potentially placing additional demand on limited regional services at a time of diminished visiting metropolitan support with restricted travel. Inter-hospital transfer is currently challenging as receiving centres enact pandemic protocols, creating potential delays, and cardiovascular resources are diverted to increasing intensive care unit (ICU) and emergency department (ED) capacity. Regional and rural centres have limited staff resources, placing cardiac services at risk in the event of staff infection or quarantine during the pandemic. MAIN RECOMMENDATIONS: Health districts, cardiologists and government agencies need to minimise impacts on the already vulnerable cardiovascular health of regional and remote Australians and New Zealanders throughout the COVID-19 pandemic. Changes in management should include.


Assuntos
Cardiologia , Doenças Cardiovasculares , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Pandemias , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral , Serviços de Saúde Rural , Telemedicina/métodos , Austrália/epidemiologia , Betacoronavirus , Cardiologia/métodos , Cardiologia/organização & administração , Cardiologia/tendências , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Área Carente de Assistência Médica , Nova Zelândia/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/tendências , Sociedades Médicas
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