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1.
Pan Afr Med J ; 38: 35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33777303

RESUMO

Introduction: unsafe injection practices are commonplace in low-income countries, and place health care workers at risk of blood-borne infections. A safe injection strategy requires a synchronized approach to deal with change in behavior of users and service providers towards safer practice. There is general lack of data on injection safety practices in Cross River State. This was a baseline study to compare the knowledge and practice of safe injection practices among primary health care (PHC) workers in urban and rural health facilities in Cross River State, Nigeria. Methods: this was a cross-sectional comparative study among PHC workers in randomly selected rural and urban Local Government Areas (LGAs). Using multistage sampling technique, a total of 320 respondents: 160 from the urban LGAs and 160 from the rural LGAs were interviewed. Semi-structured interviewer administered questionnaires were used to obtain data. Data analysis was done using STATATM version 14.0. Associations were tested using Chi square, and multivariate logistic regression analysis. Results: in this study, there was no difference in the baseline knowledge (58.8% vs. 55.0%, P=0.499) and practice (33.1% vs. 34.4%, P=0.813) of injection safety between PHC workers in the urban and rural locations. In the multivariate logistic regression model, the senior health workers had a two-fold increased odds of practicing safe injection compared to their junior counterparts [OR=2.21 (95% CI: 1.28,3.84)]. Conclusion: in both the urban and rural locations, there was good knowledge but poor practice of injection safety among respondents in the LGAs; hence, the need to organize periodic injection safety training and retraining of PHC workers targeting junior workers to improve on the practices of injection safety.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Injeções/normas , Atenção Primária à Saúde/normas , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Serviços Urbanos de Saúde/normas , Adulto Jovem
2.
Pan Afr Med J ; 37(Suppl 1): 18, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343797

RESUMO

Introduction: the increased demands of health facilities and workers due to coronavirus overwhelm the already burdened Tanzanian health systems. This study evaluates the current capacity of facilities and providers for HIV care and treatment services and their preparedness to adhere to the national and global precaution guidelines for HIV service providers and patients. Methods: data for this study come from the latest available, Tanzania Service Provision Assessment survey 2014-15. Frequencies and percentages described the readiness and availability of HIV services and providers. Chi-square test compared the distribution of services by facility location and availability and readiness of precaution commodities and HIV services by managing authorities. Results: availability of latex gloves was high (83% at OPD and 95.3% laboratory). Availability of medical masks, alcohol-based hand rub and disinfectants was low. Availability of medical mask at outpatient department (OPD) was 28.7% urban (23.5% public; 33.8% private, p=0.02) and 13.5% rural (10.1% public; 25.4% private, p=0.001) and lower at laboratories. Fewer facilities in rural area (68.4%) had running water in OPD than urban (86.3%). Higher proportions of providers at public than private facilities in urban (82.8% versus 73.1%) and rural (88.2% versus 81.6%) areas provided HIV test counseling and at least two other HIV services. Conclusion: availability of commodities such as medical masks, alcohol-based hand rub, and disinfectant was low while the readiness of providers to multitask HIV related services was high. Urgent distribution and re-assessment of these supplies are necessary, to protect HIV patients, their caregivers, and health providers from COVID-19.


Assuntos
/prevenção & controle , Assistência à Saúde/estatística & dados numéricos , Infecções por HIV/terapia , Instalações de Saúde/estatística & dados numéricos , Assistência à Saúde/normas , Desinfetantes/provisão & distribução , Fidelidade a Diretrizes/estatística & dados numéricos , Higienizadores de Mão/provisão & distribução , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/normas , Humanos , Máscaras/provisão & distribução , Instalações Privadas/normas , Instalações Privadas/estatística & dados numéricos , Logradouros Públicos/normas , Logradouros Públicos/estatística & dados numéricos , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Tanzânia , Serviços Urbanos de Saúde/normas , Serviços Urbanos de Saúde/estatística & dados numéricos
3.
Obstet Gynecol ; 136(4): 739-744, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925622

RESUMO

Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.


Assuntos
Ginecologia , Acesso aos Serviços de Saúde , Obstetrícia , Melhoria de Qualidade/organização & administração , Serviços de Saúde da Mulher , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/etnologia , Humanos , Índios Norte-Americanos , Colaboração Intersetorial , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Estados Unidos/epidemiologia , Serviços Urbanos de Saúde/normas , Populações Vulneráveis/etnologia , Serviços de Saúde da Mulher/organização & administração , Serviços de Saúde da Mulher/normas , Serviços de Saúde da Mulher/tendências
4.
BMC Health Serv Res ; 20(1): 372, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366235

RESUMO

BACKGROUND: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. METHOD: We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. FINDINGS: Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). CONCLUSION: Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.


Assuntos
Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas , Idoso , China , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
5.
Surgery ; 167(1): 211-215, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31564486

RESUMO

BACKGROUND: Primary aldosteronism is a common cause of secondary hypertension. Treatment with adrenalectomy or mineralocorticoid receptor-blockers can prevent long-term adverse outcomes. This study aimed to determine primary aldosteronism screening rats in patients with hypertension in an underserved urban healthcare system. METHODS: We reviewed records of outpatient adults in an urban healthcare system from 2013 to 2017. Chart review along with International Statistical Classification of Diseases, 9th and 10th editions, diagnosis codes were used to identify patients meeting inclusion criteria for screening according to the 2016 Endocrine Society guidelines. The corresponding aldosterone, plasma renin activity, and 24-hour urine aldosterone values were identified. Multivariate logistic regression was performed to determine positive predictors of screening. RESULTS: Of 15,511 hypertensive patients seen, 6,809 (43.8%) met criteria for screening. Blacks were the most common racial group, and Medicare and Medicaid were the most frequent insurers. The aldosterone-to-renin ratio level was checked in 86 (1.3%) patients; 22 (25.6%) had an aldosterone-to-renin ratio >20. Of the 77 patients with hypertension and incidentaloma, 14 (18.2%) had an aldosterone-to-renin ratio checked. Additional positive predictors for being screened were hypertension and hypokalemia and sustained hypertension. CONCLUSION: Screening rates for primary aldosteronism in an underserved population are low. Proper identification of primary aldosteronism in those at risk could help ameliorate long-term effects of disease.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Hiperaldosteronismo/diagnóstico , Hipertensão/etiologia , Programas de Rastreamento/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Idoso , Aldosterona/sangue , Aldosterona/urina , Animais , Consenso , Feminino , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/complicações , Hiperaldosteronismo/urina , Hipertensão/sangue , Hipertensão/urina , Masculino , Programas de Rastreamento/normas , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , New York , Guias de Prática Clínica como Assunto , Ratos , Renina/sangue , Estudos Retrospectivos , Estados Unidos , Serviços Urbanos de Saúde/normas , Populações Vulneráveis/estatística & dados numéricos
6.
J Intensive Care Med ; 35(1): 82-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28931361

RESUMO

BACKGROUND: In the new era of decreasing hospital bed availability, there is an increasing rate of direct discharge to home (DDH) from intensive care units (ICUs), despite sparse literature informing this practice. OBJECTIVES: To evaluate patient, family, and ICU attending physician satisfaction with planning for DDH from the ICU and intensivists' current DDH practices and perceptions. METHODS: Prospective cohort study, using convenience sampling, of adult patients undergoing DDH from an ICU between February 2016 and February 2017 using a modified FS-ICU 24 satisfaction survey completed by patients, family members, and attending physicians at the time of patient discharge to home from the ICU. RESULTS: Seventy-two percent of patients, 37% of family members, and 100% of ICU physicians recruited completed the survey. A majority of patients (89%) and families (78%) were satisfied or very satisfied with DDH. Only 6% of patients and 8% of families were dissatisfied to very dissatisfied with DDH. Conversely, ICU physician satisfaction varied, with only 5% being very comfortable with DDH and the majority (50%) only somewhat comfortable. Twenty percent of staff consultants were uncomfortable to very uncomfortable with the practice of DDH. Thirty-one percent of staff physician respondents felt that patient and family discomfort would be barriers to DDH. Compared to physicians and other allied health professionals, nurses were identified as the most helpful members of the health-care team in preparation for DDH by 98% of patients and 92% of family members. The DDH rates have increased for the past 12 years in our ICUs but declined during the study period (February 2016 to February 2017). CONCLUSIONS: Patients and family members are satisfied with the practice of DDH from ICU, although ICU physician satisfaction is more variable. Physician comfort may be improved by data informing which patients may be safely DDH from the ICU.


Assuntos
Atitude do Pessoal de Saúde , Unidades de Terapia Intensiva/estatística & dados numéricos , Alta do Paciente/normas , Satisfação do Paciente , Adulto , Idoso , Canadá , Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Serviços Urbanos de Saúde/normas
7.
Pan Afr Med J ; 37: 313, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33654532

RESUMO

Introduction: inspite of the demonstrable evidence of the preventive and protective ability of vaccines to reduce the outbreak of vaccine-preventable diseases, there are still some significant disease outbreaks recorded in our communities. In some settings, these outbreaks have been linked with poor vaccine management. Therefore, this study was conducted to compare the cold chain practices in Oyo State, Nigeria. Methods: we conducted a cross-sectional survey among health workers in the local government areas of Oyo State between October and November 2019. Using purposive sampling, we recruited all the 84 routine immunization focal persons for the study. A self-administered questionnaire was used to collect data on cold chain management. Data were analyzed using SPSS version 24 and bivariate analysis was done using Chi-square. Statistical significance was set at p < 0.05. Results: the mean age of the respondents was 46.4 ± 6.7 years. Most prevalent cadre in the rural facilities was health assistants (87.5%) while Community Extension Health Workers (54.8%) were prevalent in the urban (p = 0.002). The proportion of respondents with adequate cold chain equipment was significantly higher in the urban compared with the rural area. The cold boxes were the only adequate cold chain equipment found in the rural health facilities compared with the urban (p = 0.036). Conclusion: there was a low proportion of qualified health workers and inadequate cold chain equipment in the rural area compared with the urban facilities. Engagement of skilled health workers and supply of the cold chain equipment are recommended.


Assuntos
Poliomielite/prevenção & controle , Vacinas contra Poliovirus/administração & dosagem , Poliovirus/imunologia , Refrigeração/normas , Adulto , Estudos Transversais , Surtos de Doenças , Armazenamento de Medicamentos/normas , Feminino , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Poliomielite/epidemiologia , Vacinas contra Poliovirus/imunologia , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Serviços Urbanos de Saúde/normas , Vacinação/normas
8.
Pan Afr Med J ; 33: 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303955

RESUMO

Epilepsy in Sudan accounts for 1.6 annual mortality rates and 238.7 disability adjusted life years per 100 000. These figures are higher among females; children and young adults. It is associated with notable stigma and social burdens. Patients of epilepsy are subjected to various forms of social discrimination that affect their quality of life. They are isolated, neglected and deprived of their education and employments rights and not able to achieve normal social and family life. Aiming at highlighting social implications of epilepsy among Sudanese patients, this study found that social encumbrances due to epilepsy in Sudan are more prevalent among highly vulnerable groups like women, children and poor populations living in remote areas. Lack of trained medical personnel in neurology and the medical equipment's required for proper diagnosis and treatment of epilepsy in Sudan are key reasons aggravating social and health burden of epilepsy both among patients and their caregivers.


Assuntos
Epilepsia/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Qualidade de Vida , Serviços Urbanos de Saúde/normas , Criança , Epilepsia/economia , Epilepsia/epidemiologia , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pobreza , Discriminação Social , Sudão/epidemiologia , Serviços Urbanos de Saúde/economia , População Urbana/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
9.
Public Health Rep ; 134(4): 395-403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31158319

RESUMO

OBJECTIVES: The objectives of our study were to (1) illustrate a public health workforce assessment process in a medium-sized city or county health department and (2) demonstrate the insights gained by moving from the use of aggregate department-level and competency domain-level training needs results to more granular division-level and skills-level results when creating a workforce development plan. METHODS: We used a 130-question needs assessment to guide the creation of a workforce development plan for the Lincoln Lancaster County Health Department (LLCHD) in Nebraska and its 7 divisions. Using SurveyMonkey, we administered the survey to 128 (of the 129) LLCHD public health staff members in June 2015. Using a Likert scale, respondents indicated (1) the importance of the skill to their work and (2) their capacity to carry out 57 skills in 8 domains of the core competencies for public health professionals. We identified training needs as those for which the percentage of respondents who perceived moderate-to-high importance was at least 15 percentage points higher than the percentage of respondents who perceived moderate-to-high capacity. RESULTS: LLCHD as a department had training needs in only 2 competency domains: financial planning and management (importance-capacity difference, 15 percentage points) and policy development and program planning (importance-capacity difference, 19 percentage points). The Health Promotion and Outreach division had training needs in all 8 domains (importance-capacity difference range, 15-45 percentage points). Of the 57 skills, 41 were identified by at least 1 of the LLCHD divisions as having training needs. In 24 instances, a division did not qualify as having training needs in the overall domain yet did have training needs for specific skills within a domain. CONCLUSIONS: When performing public health workforce assessments, medium-to-large public health departments can obtain detailed workforce training needs results that pertain to individual skills and that are tailored to each of their divisions. These results may help customize and improve workforce development plans, ensuring that the workforce has the necessary skills to do its job.


Assuntos
Diretrizes para o Planejamento em Saúde , Política de Saúde , Mão de Obra em Saúde/normas , Modelos Organizacionais , Administração em Saúde Pública/normas , Serviços Urbanos de Saúde/normas , Humanos , Nebraska , Planejamento Social , Estados Unidos
10.
West J Emerg Med ; 20(3): 477-484, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31123549

RESUMO

Introduction: Attempts to reduce low-value hospital care often focus on emergency department (ED) hospitalizations. We compared rural and urban EDs in Michigan on resources designed to reduce avoidable admissions. Methods: A cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services. We performed chi-squared comparisons, regression modeling, and predictive margins. Results: Of 135 EDs, 64 (47%) responded with 33 in urban and 31 in rural counties. Clinical pathways were equally present in urban and rural EDs (67% vs 74%, p=0.5). Compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). Common barriers to connecting ED patients to outpatient services exist in both settings, including lack of social support (88% and 76%, p=0.20), and patient/family preference (68% and 68%, p=1.0). However, rural EDs were more likely to report time required for care coordination (88% vs 66%, p=0.05) and less likely to report limitations to home care (21% vs 48%, p=0.05) as barriers. In regression modeling, ED volume was predictive of the presence of clinical pathways rather than rurality. Conclusion: While rural-urban differences in resources and barriers exist, ED size rather than rurality may be a more important indicator of ability to reduce avoidable hospitalizations.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Sobremedicalização/prevenção & controle , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Continuidade da Assistência ao Paciente/normas , Procedimentos Clínicos/normas , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Michigan , Garantia da Qualidade dos Cuidados de Saúde
11.
Lancet Glob Health ; 7(5): e633-e643, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30928341

RESUMO

BACKGROUND: In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice. METHODS: We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender. FINDINGS: Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1·05; 95% CI 0·76-1·45; p=0·77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification. INTERPRETATION: Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India. FUNDING: Grand Challenges Canada, Bill & Melinda Gates Foundation, World Bank Knowledge for Change Program.


Assuntos
Disparidades em Assistência à Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Tuberculose Pulmonar/terapia , Serviços Urbanos de Saúde/normas , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde/normas , Qualidade da Assistência à Saúde/normas , Fatores Sexuais , Tuberculose Pulmonar/diagnóstico , Adulto Jovem
12.
JAMA Netw Open ; 2(3): e190138, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30848804

RESUMO

Importance: Little is known about the distribution of life-saving trauma resources by racial/ethnic composition in US cities, and if racial/ethnic minority populations disproportionately live in US urban trauma deserts. Objective: To examine racial/ethnic differences in geographic access to trauma care in the 3 largest US cities, considering the role of residential segregation and neighborhood poverty. Design, Setting, and Participants: A cross-sectional, multiple-methods study evaluated census tract data from the 2015 American Community Survey in Chicago, Illinois; Los Angeles (LA), California; and New York City (NYC), New York (N = 3932). These data were paired to geographic coordinates of all adult level I and II trauma centers within an 8.0-km buffer of each city. Between February and September 2018, small-area analyses were conducted to assess trauma desert status as a function of neighborhood racial/ethnic composition, and geospatial analyses were conducted to examine statistically significant trauma desert hot spots. Main Outcomes and Measures: In small-area analyses, a trauma desert was defined as travel distance greater than 8.0 km to the nearest adult level I or level II trauma center. In geospatial analyses, relative trauma deserts were identified using travel distance as a continuous measure. Census tracts were classified into (1) racial/ethnic composition categories, based on patterns of residential segregation, including white majority, black majority, Hispanic/Latino majority, and other or integrated; and (2) poverty categories, including nonpoor and poor. Results: Chicago, LA, and NYC contained 798, 1006, and 2128 census tracts, respectively. A large proportion comprised a black majority population in Chicago (35.1%) and NYC (21.4%), compared with LA (2.7%). In primary analyses, black majority census tracts were more likely than white majority census tracts to be located in a trauma desert in Chicago (odds ratio [OR], 8.48; 95% CI, 5.71-12.59) and LA (OR, 5.11; 95% CI, 1.50-17.39). In NYC, racial/ethnic disparities were not significant in unadjusted models, but were significant in models adjusting for poverty and race-poverty interaction effects (adjusted OR, 1.87; 95% CI, 1.27-2.74). In comparison, Hispanic/Latino majority census tracts were less likely to be located in a trauma desert in NYC (OR, 0.03; 95% CI, 0.01-0.11) and LA (OR, 0.30; 95% CI, 0.22-0.40), but slightly more likely in Chicago (OR, 2.38; 95% CI, 1.56-3.64). Conclusions and Relevance: In this study, black majority census tracts were the only racial/ethnic group that appeared to be associated with disparities in geographic access to trauma centers.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Centros de Traumatologia , Serviços Urbanos de Saúde , Adulto , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Características de Residência , Fatores Socioeconômicos , Centros de Traumatologia/organização & administração , Centros de Traumatologia/normas , Estados Unidos/epidemiologia , Serviços Urbanos de Saúde/organização & administração , Serviços Urbanos de Saúde/normas
13.
PLoS One ; 14(2): e0211984, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730967

RESUMO

OBJECTIVE: To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. METHODS: A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents' characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. RESULTS: The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09-0.26; urban: OR = 0.19, 95%CI = 0.10-0.36), had fair (rural: OR = 0.49, 95%CI = 0.26-0.92; urban: OR = 0.31, 95%CI = 0.15-0.64) or poor (rural: OR = 0.14, 95%CI = 0.07-0.30; urban: OR = 0.22, 95%CI = 0.11-0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08-0.59), being retired (OR = 0.90, 95%CI = 0.44-1.84) and earning a per capita annual income of household of 10,000-29,999 (OR = 0.24, 95%CI = 0.11-0.52) and 30,000-49,999 (OR = 0.26, 95%CI = 0.07-0.92) were associated with lower rates of seeking care at PCFs. CONCLUSION: Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account.


Assuntos
Tomada de Decisões , Atenção Primária à Saúde/normas , Adulto , Idoso , Instituições de Assistência Ambulatorial , China , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Serviços Urbanos de Saúde/normas , Adulto Jovem
14.
Disaster Med Public Health Prep ; 13(3): 424-428, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30277179

RESUMO

OBJECTIVE: The intent of this study was to determine whether there are differences in disaster preparedness between urban and rural community hospitals across New York State. METHODS: Descriptive and analytical cross-sectional survey study of 207 community hospitals; thirty-five questions evaluated 6 disaster preparedness elements: disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. RESULTS: Completed surveys were received from 48 urban hospitals and 32 rural hospitals.There were differences in disaster preparedness between urban and rural hospitals with respect to disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. No difference was identified between these hospitals with respect to disaster preparedness funding levels. CONCLUSIONS: The results of this study provide an assessment of the current state of disaster preparedness in urban and rural community hospitals in New York. Differences in preparedness between the two settings may reflect differing priorities with respect to perceived threats, as well as opportunities for improvement that may require additional advocacy and legislation. (Disaster Med Public Health Preparedness. 2019;13:424-428).


Assuntos
Defesa Civil/normas , Hospitais/normas , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas , Distribuição de Qui-Quadrado , Defesa Civil/métodos , Defesa Civil/estatística & dados numéricos , Estudos Transversais , Hospitais/estatística & dados numéricos , Humanos , New York , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos
15.
J Rural Health ; 35(1): 58-67, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30561839

RESUMO

PURPOSE: Quality scores are strongly influenced by sociodemographic characteristics and health behaviors, many of which lie outside of the clinician's control. As a result, there is vigorous debate about whether, and how, to risk-adjust quality measures. Yet, rurality has been largely missing from this debate, even though population and environmental characteristics are demonstrably different by rurality. We addressed this gap by examining the influence of county-level population sociodemographic, environmental, and health characteristics on 3 Medicare quality measures. METHODS: We used a cross-sectional analysis of 2016 County Health Rankings data to estimate differences in 3 Medicare quality scores (preventable hospitalizations, HbA1c monitoring, and mammography screening) by rurality. We then adjusted for county-level sociodemographic and environmental characteristics in multivariable regression models in order to see whether the association between rurality and quality was impacted. FINDINGS: Both micropolitan and noncore counties exhibited lower quality scores than metropolitan counties for all 3 measures. After adjustment, noncore counties still had poorer quality on all 3 measures, while micropolitan counties improved on 2 measures. Several county-level sociodemographic and environmental characteristics were associated with quality, although the direction of association depended on the quality measure. CONCLUSIONS: Differences in Medicare quality scores by rurality cannot be entirely explained by differences in population or environmental characteristics. Still, to the extent that clinicians are evaluated-and paid-based on measures that are influenced by both population sociodemographic characteristics and geographic location without adequate risk adjustment, the challenges of delivering care in rural areas will only be exacerbated.


Assuntos
Medicare/normas , Qualidade da Assistência à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Estados Unidos , Serviços Urbanos de Saúde/normas , Serviços Urbanos de Saúde/estatística & dados numéricos
16.
J Rural Health ; 35(1): 97-107, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29664203

RESUMO

PURPOSE: Increased opioid analgesic prescribing (OAP) has been associated with increased risk of prescription opioid diversion, misuse, and abuse. We studied regional and rural-urban variations in OAP trends in Kentucky, from 2012 to 2015, and examined potential county-level risk and protective factors. METHODS: This study used prescription drug monitoring data. Marginal models employing generalized estimating equations were used to model repeated counts of residents with opioid analgesic prescriptions within county-quarter, 2012-2015, with offset for resident population, by rural-urban classification exposure, and adjusting for time-varying socioeconomic and relevant health status measures. FINDINGS: There were significant downward trends in rates of residents receiving dispensed opioid analgesic prescriptions, with no regional or rural/urban differences in the degree of decline over time. The adjusted models showed the Kentucky Appalachian region retained a significantly higher rate of residents with opioid analgesic prescriptions per 1,000 residents (30% higher than Central Kentucky and 19% higher than Kentucky Delta regions). Residents of nonmetropolitan not adjacent-to-metropolitan counties had significantly higher adjusted rates of OAP (33% higher than metropolitan counties and 17% higher compared to nonmetropolitan adjacent-to-metropolitan counties). The rate of OAP was significantly positively associated with emergency department visit injury rates and negatively associated with buprenorphine/naloxone prescribing rates. CONCLUSIONS: Information on OAP trends and patterns will be used by Kentucky stakeholders to inform targeted interventions. Further research is needed to evaluate the availability and accessibility of nonopioid pain treatment in rural counties and the role of geography and time/distance traveled as risk factors for increased OAP.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Mapeamento Geográfico , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas , Humanos , Kentucky , Estudos Longitudinais , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos
17.
J Rural Health ; 35(1): 49-57, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29949205

RESUMO

PURPOSE: This study examines rural-urban differences in employed caregivers' access to workplace supports, negative impacts of caregiving on work, and the association between work and caregiver strain, which can have negative impacts on health. METHODS: We used a cross-sectional analysis of employed caregivers (n = 635) from the 2015 Caregiving in the US survey, including bivariate comparisons of caregiver characteristics, access to workplace benefits, and workplace impacts by rural-urban location, as well as ordered logistic regression models to assess the relationship between workplace benefits and impacts and caregiver strain, stratified by rural-urban location. FINDINGS: Employed rural caregivers had significantly fewer workplace benefits available to them (1.3 out of 5 vs 1.9, P < .001), compared with urban caregivers. In particular, employed rural caregivers were less likely to have access to telecommuting, employee assistance programs, and paid leave. For the full sample, having more negative workplace impacts was associated with greater caregiver strain (adjusted odds ratio [AOR]: 1.65, P < .001); for employed rural caregivers, using paid help for caregiving was associated with more strain (AOR: 4.39, P < .05). CONCLUSIONS: More should be done to support all employed caregivers, especially those in rural locations who have more limited access to workplace supports and who may be more negatively impacted by the financial toll of caregiving and of missing work because of caregiving responsibilities. Interventions could range from employer-initiated programs to local, state, or national policies to improve supports provided to employed caregivers in urban and rural areas.


Assuntos
Pessoal de Saúde/psicologia , Sistemas de Apoio Psicossocial , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas , Local de Trabalho/normas , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde/economia , Pessoal de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Serviços de Saúde Rural/classificação , Serviços de Saúde Rural/estatística & dados numéricos , Salários e Benefícios/tendências , Inquéritos e Questionários , Estados Unidos , Serviços Urbanos de Saúde/classificação , Serviços Urbanos de Saúde/estatística & dados numéricos , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos
18.
Eur J Gen Pract ; 24(1): 223-228, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30257115

RESUMO

BACKGROUND: The incidence of anaphylaxis appears to be increasing worldwide with cases in the community outnumbering those in the hospital setting. General practice (GP) surgeries and pharmacies, based in the community, are often the first point of contact for many patients suffering from anaphylaxis. OBJECTIVES: To determine if studied GP surgeries and pharmacies have an anaphylaxis protocol on site and have access to an anaphylaxis kit; to explore GP's and pharmacists' personal experiences with management of anaphylaxis. METHODS: A cross-sectional, questionnaire-based study was performed examining anaphylaxis protocols in a sample of general practices and pharmacies from some counties in Ireland. This consisted of a sample from rural and urban settings. The study commenced in October 2014. RESULTS: Nineteen of 24 GPs (79%) and 9 (29%) pharmacies had an anaphylaxis protocol (P < 0.001). Twenty-four (100%) GP practices and 12 pharmacies (39%) surveyed had an anaphylaxis kit on site. Twelve GPs (50%) had treated a patient with anaphylaxis in the surgery while 8 (33%) had treated a patient in the community. One pharmacist (3%) had witnessed anaphylaxis in practice. Two pharmacies and one GP had been contacted by local businesses to alert them to a case of anaphylaxis. CONCLUSION: In contrast to national and international guidelines only 79% of GPs and 29% of pharmacies in this study from Ireland had an anaphylaxis protocol onsite.


Assuntos
Anafilaxia/tratamento farmacológico , Medicina Geral/normas , Farmácias/normas , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas , Clorfeniramina/provisão & distribução , Protocolos Clínicos , Estudos Transversais , Tratamento de Emergência , Epinefrina/provisão & distribução , Feminino , Medicina Geral/instrumentação , Humanos , Irlanda , Masculino , Guias de Prática Clínica como Assunto , Esteroides/provisão & distribução , Inquéritos e Questionários
19.
J Opioid Manag ; 14(2): 103-116, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29733096

RESUMO

OBJECTIVES: (1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations. METHODS: A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training. RESULTS: The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers' profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9). CONCLUSIONS: Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.


Assuntos
Analgésicos Opioides/uso terapêutico , Centers for Disease Control and Prevention, U.S./normas , Dor Crônica/tratamento farmacológico , Educação Médica Continuada/normas , Fidelidade a Diretrizes/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Avaliação de Processos em Cuidados de Saúde/normas , Adulto , Analgésicos Opioides/efeitos adversos , Atitude do Pessoal de Saúde , Dor Crônica/diagnóstico , Competência Clínica , Estudos Transversais , Prescrições de Medicamentos , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde Rural/normas , Estados Unidos , Serviços Urbanos de Saúde/normas
20.
Circ J ; 82(6): 1666-1674, 2018 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-29593169

RESUMO

BACKGROUND: There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.Methods and Results:In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001). CONCLUSIONS: AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in time delay to PPCI compared with those in metropolitan areas.


Assuntos
Serviços Médicos de Emergência/normas , Infarto do Miocárdio/terapia , Tempo para o Tratamento/normas , Idoso , Ambulâncias , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Sistema de Registros , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas
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