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Sample records for seeking specialty care

  1. Care coordination and unmet specialty care among children with special health care needs.

    Science.gov (United States)

    Boudreau, Alexy Arauz; Perrin, James M; Goodman, Elizabeth; Kurowski, Daniel; Cooley, W Carl; Kuhlthau, Karen

    2014-06-01

    Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families. Secondary data analysis of participants in the 2009–2010 National Survey of CSHCN who reported unmet specialty care needs and for whom care coordination and medical home status could be determined (n = 18 905). Logistic regression models explored the association of unmet need with care coordination and medical home status adjusting for household income. Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds of unmet specialty care need (without a medical home, odds ratio: 0.63, 95% confidence interval: 0.47–0.86; within a medical home, odds ratio: 0.22, 95% confidence interval: 0.16–0.29) with a greater reduction among those receiving care coordination within a medical home versus those receiving care coordination without a medical home. We did not find differences in the impact of care coordination by percentage of the federal poverty level. Care coordination is associated with family report of decreased unmet specialty care needs among CSHCN independent of household income. The effect of care coordination is greater when care is received in a medical home.

  2. Identifying Telemedicine Services to Improve Access to Specialty Care for the Underserved in the San Francisco Safety Net

    Directory of Open Access Journals (Sweden)

    Ken Russell Coelho

    2011-01-01

    Full Text Available Safety-net settings across the country have grappled with providing adequate access to specialty care services. San Francisco General Hospital and Trauma Center, serving as the city's primary safety-net hospital, has also had to struggle with the same issue. With Healthy San Francisco, the City and County of San Francisco's Universal Healthcare mandate, the increased demand for specialty care services has placed a further strain on the system. With the recent passage of California Proposition 1D, infrastructural funds are now set aside to assist in connecting major hospitals with primary care clinics in remote areas all over the state of California, using telemedicine. Based on a selected sample of key informant interviews with local staff physicians, this study provides further insight into the current process of e-referral which uses electronic communication for making referrals to specialty care. It also identifies key services for telemedicine in primary and specialty care settings within the San Francisco public health system. This study concludes with proposals for a framework that seek to increase collaboration between the referring primary care physician and specialist, to prioritize institution of these key services for telemedicine.

  3. Gender bias in specialty preferences among Danish medical students

    DEFF Research Database (Denmark)

    Pedersen, Laura Erna Toftegaard; Skytte, Nanna Hasle Bak; Dissing, Agnete Skovlund

    2011-01-01

    Female medical students tend to prefer person-oriented specialties characterized by close doctor-patient contact and aspects of care. Conversely, male medical students tend to seek towards specialties with elements of autonomy, technology and "action" . Furthermore, female doctors will outnumber ...

  4. Challenges in referral communication between VHA primary care and specialty care.

    Science.gov (United States)

    Zuchowski, Jessica L; Rose, Danielle E; Hamilton, Alison B; Stockdale, Susan E; Meredith, Lisa S; Yano, Elizabeth M; Rubenstein, Lisa V; Cordasco, Kristina M

    2015-03-01

    Poor communication between primary care providers (PCPs) and specialists is a significant problem and a detriment to effective care coordination. Inconsistency in the quality of primary-specialty communication persists even in environments with integrated delivery systems and electronic medical records (EMRs), such as the Veterans Health Administration (VHA). The purpose of this study was to measure ease of communication and to characterize communication challenges perceived by PCPs and primary care personnel in the VHA, with a particular focus on challenges associated with referral communication. The study utilized a convergent mixed-methods design: online cross-sectional survey measuring PCP-reported ease of communication with specialists, and semi-structured interviews characterizing primary-specialty communication challenges. 191 VHA PCPs from one regional network were surveyed (54% response rate), and 41 VHA PCPs and primary care staff were interviewed. PCP-reported ease of communication mean score (survey) and recurring themes in participant descriptions of primary-specialty referral communication (interviews) were analyzed. Among PCPs, ease-of-communication ratings were highest for women's health and mental health (mean score of 2.3 on a scale of 1-3 in both), and lowest for cardiothoracic surgery and neurology (mean scores of 1.3 and 1.6, respectively). Primary care personnel experienced challenges communicating with specialists via the EMR system, including difficulty in communicating special requests for appointments within a certain time frame and frequent rejection of referral requests due to rigid informational requirements. When faced with these challenges, PCPs reported using strategies such as telephone and e-mail contact with specialists with whom they had established relationships, as well as the use of an EMR-based referral innovation called "eConsults" as an alternative to a traditional referral. Primary-specialty communication is a continuing

  5. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

    Science.gov (United States)

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  6. Care-seeking behavior of Japanese gynecological cancer survivors suffering from adverse effects

    Directory of Open Access Journals (Sweden)

    Oshima Sumiko

    2013-01-01

    Full Text Available Abstract Background Post-treatment follow-up visits for gynecological cancer survivors should provide opportunities for management of adverse physical/psychological effects of therapy and early recurrence detection. However, the adequacy of such visits in Japan is poorly documented. We qualitatively explored care-seeking experiences of Japanese gynecological cancer survivors and deduced factors influencing care-seeking behaviors and treatment access. Methods We conducted 4 semi-structured focus groups comprising altogether 28 Japanese gynecological cancer survivors to collect a variety of participants’ post-treatment care-seeking behaviors through active interaction with participants. Factors influencing access to treatment for adverse effects were analyzed qualitatively. Results Survivors sought care through specialty clinic visits when regular post-treatment gynecological follow-ups were inadequate or when symptoms seemed to be non-treatment related. Information provided by hospital staff during initial treatment influenced patients’ understanding and response to adverse effects. Lack of knowledge and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms. Gynecologists’ attitudes during follow-ups frequently led survivors to cope with symptoms on their own. Information from mass media, Internet, and support groups helped patients understand symptoms and facilitated care seeking. Conclusions Post-treatment adverse effects are often untreated during follow-up visits. Awareness of possible post-treatment adverse effects is important for gynecological cancer survivors in order to obtain appropriate care if the need arises. Consultation during the follow-up visit is essential for continuity in care.

  7. Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences.

    Science.gov (United States)

    Greer, Joseph A; Park, Elyse R; Green, Alexander R; Betancourt, Joseph R; Weissman, Joel S

    2007-08-01

    Previous research has shown that resident physicians report differences in training across primary care specialties, although limited data exist on education in delivering cross-cultural care. The goals of this study were to identify factors that relate to primary care residents' perceived preparedness to provide cross-cultural care and to explore the extent to which these perceptions vary across primary care specialties. Cross-sectional, national mail survey of resident physicians in their last year of training. Eleven hundred fifty primary care residents specializing in family medicine (27%), internal medicine (23%), pediatrics (26%), and obstetrics/gynecology (OB/GYN) (24%). Male residents as well as those who reported having graduated from U.S. medical schools, access to role models, and a greater cross-cultural case mix during residency felt more prepared to deliver cross-cultural care. Adjusting for these demographic and clinical factors, family practice residents were significantly more likely to feel prepared to deliver cross-cultural care compared to internal medicine, pediatric, and OB/GYN residents. Yet, when the quantity of instruction residents reported receiving to deliver cross-cultural care was added as a predictor, specialty differences became nonsignificant, suggesting that training opportunities better account for the variability in perceived preparedness than specialty. Across primary care specialties, residents reported different perceptions of preparedness to deliver cross-cultural care. However, this variation was more strongly related to training factors, such as the amount of instruction physicians received to deliver such care, rather than specialty affiliation. These findings underscore the importance of formal education to enhance residents' preparedness to provide cross-cultural care.

  8. Primary Care Resident Perceived Preparedness to Deliver Cross-cultural Care: An Examination of Training and Specialty Differences

    Science.gov (United States)

    Park, Elyse R.; Green, Alexander R.; Betancourt, Joseph R.; Weissman, Joel S.

    2007-01-01

    Objective Previous research has shown that resident physicians report differences in training across primary care specialties, although limited data exist on education in delivering cross-cultural care. The goals of this study were to identify factors that relate to primary care residents’ perceived preparedness to provide cross-cultural care and to explore the extent to which these perceptions vary across primary care specialties. Design Cross-sectional, national mail survey of resident physicians in their last year of training. Participants Eleven hundred fifty primary care residents specializing in family medicine (27%), internal medicine (23%), pediatrics (26%), and obstetrics/gynecology (OB/GYN) (24%). Results Male residents as well as those who reported having graduated from U.S. medical schools, access to role models, and a greater cross-cultural case mix during residency felt more prepared to deliver cross-cultural care. Adjusting for these demographic and clinical factors, family practice residents were significantly more likely to feel prepared to deliver cross-cultural care compared to internal medicine, pediatric, and OB/GYN residents. Yet, when the quantity of instruction residents reported receiving to deliver cross-cultural care was added as a predictor, specialty differences became nonsignificant, suggesting that training opportunities better account for the variability in perceived preparedness than specialty. Conclusions Across primary care specialties, residents reported different perceptions of preparedness to deliver cross-cultural care. However, this variation was more strongly related to training factors, such as the amount of instruction physicians received to deliver such care, rather than specialty affiliation. These findings underscore the importance of formal education to enhance residents’ preparedness to provide cross-cultural care. PMID:17516107

  9. Contingent Valuation Analysis of an Otolaryngology and Ophthalmology Emergency Department: The Value of Acute Specialty Care.

    Science.gov (United States)

    Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H G; Gray, Stacey T; Shrime, Mark G

    2017-03-01

    Specialty emergency departments (EDs) provide a unique mechanism of health care delivery, but the value that they add to the medical system is not known. Evaluation of patient preferences to determine value can have a direct impact on resource allocation and direct-to-specialist care. To assess the feasibility of contingent valuation (CV) methodology using a willingness-to-pay (WTP) survey to evaluate specialty emergency services, in the context of an ophthalmology- and otolaryngology-specific ED. Contingent valuation analysis of a standalone otolaryngology and ophthalmology ED. Participants were English-speaking adults presenting to a dedicated otolaryngology and ophthalmology ED. The WTP questions were assessed using a payment card format, with reference to an alternative modality of treatment (ie, general ED), and were analyzed with multivariate regression. Validated WTP survey administered from October 14, 2014, through October 1, 2015. Sociodemographic data, level of distress, referral data, income, and WTP. A total of 327 of 423 (77.3%) ED patients responded to the WTP survey, with 116 ophthalmology and 211 otolaryngology patients included (52.3% female; mean [range] age, 46 [18-90] years). The most common reason for seeking care at this facility was a reputation for specialty care for both ear, nose, and throat (80 [37.9%]) and ophthalmology (43 [37.1%]). Mean WTP for specialty-specific ED services was $377 for ophthalmology patients, and $321 for otolaryngology patients ($340 overall; 95% CI, $294 to $386), without significant difference between groups (absolute difference, $56; 95% CI, $-156 to $43). Self-reported level of distress was higher among ear, nose, and throat vs ophthalmology patients (absolute difference, 0.47 on a Likert scale of 1-7; 95% CI, 0.10 to 0.84). Neither level of distress, income, nor demographic characteristics influenced WTP, but patients with higher estimates of total visit cost were more likely to have higher WTP (β coefficient

  10. Strategies for Introducing Outpatient Specialty Palliative Care in Gynecologic Oncology.

    Science.gov (United States)

    Hay, Casey M; Lefkowits, Carolyn; Crowley-Matoka, Megan; Bakitas, Marie A; Clark, Leslie H; Duska, Linda R; Urban, Renata R; Creasy, Stephanie L; Schenker, Yael

    2017-09-01

    Concern that patients will react negatively to the idea of palliative care is cited as a barrier to timely referral. Strategies to successfully introduce specialty palliative care to patients have not been well described. We sought to understand how gynecologic oncologists introduce outpatient specialty palliative care. We conducted a national qualitative interview study at six geographically diverse academic cancer centers with well-established palliative care clinics between September 2015 and March 2016. Thirty-four gynecologic oncologists participated in semistructured telephone interviews focusing on attitudes, experiences, and practices related to outpatient palliative care. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine a coding framework. This analysis focuses on practices for introducing palliative care. Mean participant age was 47 years (standard deviation, 10 years). Mean interview length was 25 minutes (standard deviation, 7 minutes). Gynecologic oncologists described the following three main strategies for introducing outpatient specialty palliative care: focus initial palliative care referral on symptom management to dissociate palliative care from end-of-life care and facilitate early relationship building with palliative care clinicians; use a strong physician-patient relationship and patient trust to increase acceptance of referral; and explain and normalize palliative care referral to address negative associations and decrease patient fear of abandonment. These strategies aim to decrease negative patient associations and encourage acceptance of early referral to palliative care specialists. Gynecologic oncologists have developed strategies for introducing palliative care services to alleviate patient concerns. These strategies provide groundwork for developing system-wide best practice approaches to the presentation of palliative care referral.

  11. Care seeking for orofacial pain

    NARCIS (Netherlands)

    Rollman, A.; Visscher, C.M.; Gorter, R.C.; Naeije, M.

    2012-01-01

    AIMS: To determine the contribution of a wide range of factors to care-seeking behavior in orofacial pain patients, expressed as (A) decision to seek care and (B) number of health care practitioners visited. METHODS: Subjects with orofacial pain complaints were recruited in seven TMD clinics and

  12. Patient-Centered Specialty Practice: Defining the Role of Specialists in Value-Based Health Care.

    Science.gov (United States)

    Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani

    2017-04-01

    Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.

  13. Access to specialty care in autism spectrum disorders-a pilot study of referral source

    Directory of Open Access Journals (Sweden)

    West Therese

    2011-05-01

    Full Text Available Abstract Background In the United States, a medical home model has been shown to improve the outcomes for children with special health care needs. As part of this model, primary care physicians provide comprehensive medical care that includes identification of delayed and/or atypical development in children and coordination of care with specialists. However, it is not clear if families of children with Autism Spectrum Disorder (ASD rely on the medical home model for care of their child to the same extent as families of children with other special health care needs. This study aims to add to the understanding of medical care for children with ASD by examining the referral source for specialty care. Methods This retrospective study was accomplished by evaluating parent completed intake data for children with ASD compared to those with other neurological disorders in a single physician Pediatric Neurology Practice at a major urban medical center in Northern New Jersey. To account for referral bias, a similar comparison study was conducted using a multispecialty ASD practice at the same medical center. Parent reported "source of referral" and "reason for the referral" of 189 ASD children and 108 non-ASD neurological disordered children were analyzed. Results The specialty evaluations of ASD were predominantly parent initiated. There were significantly less referrals received from primary care physicians for children with ASD compared to children with other neurodevelopmental disorders. Requirement of an insurance referral was not associated with a primary care physician prompted specialty visit.We identified different patterns of referral to our specialty clinics for children with ASD vs. children with other neurolodevelopmental disorders. Conclusion The majority of the families of children with ASD evaluated at our autism center did not indicate that a primary care physician initiated the specialty referral. This study suggests that families of

  14. Ideal versus real conditions for type 2 diabetes care : diabetes specialty nurses’ perspectives

    OpenAIRE

    Jutterström, Lena; Hällgren Graneheim, Ulla; Isaksson, Ulf; Hörnsten, Åsa

    2012-01-01

    Background: Since diabetes specialty nurses are the professionals who spend the most time with patients living with diabetes, they probably have the greatest influence on the quality of diabetes care. Therefore, their personal perceptions about what constitutes “good care” in type 2 diabetes care are important to explore. Aim: The aim of this study was to describe conditions for “good care” in type 2-diabetes as perceived by diabetes specialty nurses. Method: Twenty-one experienced diabetes s...

  15. Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project.

    Science.gov (United States)

    Jennings, Fiona L; Mitchell, Marion

    2017-06-01

    Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan War veterans seeking postdeployment VA health care.

    Science.gov (United States)

    Jakupcak, Matthew; Luterek, Jane; Hunt, Stephen; Conybeare, Daniel; McFall, Miles

    2008-05-01

    The relationship between posttraumatic stress and physical health functioning was examined in a sample of Iraq and Afghanistan War veterans seeking postdeployment VA care. Iraq and Afghanistan War veterans (N = 108) who presented for treatment to a specialty postdeployment care clinic completed self-report questionnaires that assessed symptoms of posttraumatic stress disorder (PTSD), chemical exposure, combat exposure, and physical health functioning. As predicted, PTSD symptom severity was significantly associated with poorer health functioning, even after accounting for demographic factors, combat and chemical exposure, and health risk behaviors. These results highlight the unique influence of PTSD on the physical health in treatment seeking Iraq and Afghanistan War veterans.

  17. Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling.

    Science.gov (United States)

    Mallidou, Anastasia A; Cummings, Greta G; Estabrooks, Carole A; Giovannetti, Phyllis B

    2011-01-01

    Hospital organizational culture is widely held to matter to the delivery of services, their effectiveness, and system performance in general. However, little empirical evidence exists to support that culture affects provider and patient outcomes; even less evidence exists to support how this occurs. To explore causal relationships and mechanisms between nursing specialty subcultures and selected patient outcomes (i.e., quality of care, adverse patient events). Martin's differentiation perspective of culture (nested subcultures within organizations) was used as a theoretical framework to develop and test a model. Hospital nurse subcultures were identified as being reflected in formal practices (i.e., satisfactory salary, continuing education, quality assurance program, preceptorship), informal practices (i.e., autonomy, control over practice, nurse-physician relationships), and content themes (i.e., emotional exhaustion). A series of structural equation models were assessed using LISREL on a large nurse survey database representing four specialties (i.e., medical, surgical, intensive care, emergency) in acute care hospitals in Alberta, Canada. Nursing specialty subcultures differentially influenced patient outcomes. Specifically, quality of care (a) was affected by nurses' control over practice, (b) was better in intensive care than in medical specialty, and (c) was related to lower adverse patient events; nurses in intensive care and emergency specialties reported fewer adverse events than did their counterparts in medical specialties. Understanding the meaning of subcultures in clinical settings would influence nurses and administrators efforts to implement clinical change and affect outcomes. More research is needed on nested subcultures within healthcare organizations for better understanding differentiated subspecialty effects on complexity of care and outcomes in hospitals. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. Classification Model That Predicts Medical Students' Choices of Primary Care or Non-Primary Care Specialties.

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    Fincher, Ruth-Marie E.; And Others

    1992-01-01

    This study identified factors in graduating medical students' choice of primary versus nonprimary care specialty. Subjects were 509 students at the Medical College of Georgia in 1988-90. Students could be classified by such factors as desire for longitudinal patient care opportunities, monetary rewards, perception of lifestyle, and perception of…

  19. Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

    Science.gov (United States)

    Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

    2010-01-01

    Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

  20. Does a single specialty intensive care unit make better business sense than a multi-specialty intensive care unit? A costing study in a trauma center in India.

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, Vishwanathan; Gupta, Shakti Kumar

    2015-01-01

    Though intensive care units (ICUs) only account for 10% of hospital beds, they consume nearly 22% of hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. To evaluate and compare the cost of intensive care delivery between multi-specialty and neurosurgery ICU in an apex trauma care facility in India. The study was conducted in a polytrauma and neurosurgery ICU at a 203 bedded level IV trauma care facility in New Delhi, India from May, 2012 to June 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Fisher's two-tailed t-test. Total cost/bed/day for the multi-specialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU was Rs. 14,306.7/-, manpower constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Quantification of expenditure in running an ICU in a trauma center would assist healthcare decision makers in better allocation of resources. Although multi-specialty ICUs are more expensive, other factors will also play a role in defining the kind of ICU that need to be designed.

  1. medical students' preference for choice of clinical specialties

    African Journals Online (AJOL)

    Zamzar

    This study seeks to determine the medical student preference for the clinical specialty and the factors that they consider in making ... undergraduates in selecting these specialties is important. .... effect of National Health Insurance on changes.

  2. Does a single specialty intensive care unit make better business sense than a multi-specialty intensive care unit? A costing study in a trauma center in India

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, Vishwanathan; Gupta, Shakti Kumar

    2015-01-01

    Context: Though intensive care units (ICUs) only account for 10% of hospital beds, they consume nearly 22% of hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: To evaluate and compare the cost of intensive care delivery between multi-specialty and neurosurgery ICU in an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203 bedded level IV trauma care facility in New Delhi, India from May, 2012 to June 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Fisher's two-tailed t-test. Results: Total cost/bed/day for the multi-specialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU was Rs. 14,306.7/-, manpower constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist healthcare decision makers in better allocation of resources. Although multi-specialty ICUs are more expensive, other factors will also play a role in defining the kind of ICU that need to be designed. PMID:25829909

  3. Does a single specialty intensive care unit make better business sense than a multi-specialty intensive care unit? A costing study in a trauma center in India

    Directory of Open Access Journals (Sweden)

    Parmeshwar Kumar

    2015-01-01

    Full Text Available Context: Though intensive care units (ICUs only account for 10% of hospital beds, they consume nearly 22% of hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: To evaluate and compare the cost of intensive care delivery between multi-specialty and neurosurgery ICU in an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203 bedded level IV trauma care facility in New Delhi, India from May, 2012 to June 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Fisher′s two-tailed t-test. Results: Total cost/bed/day for the multi-specialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU was Rs. 14,306.7/-, manpower constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist healthcare decision makers in better allocation of resources. Although multi-specialty ICUs are more expensive, other factors will also play a role in defining the kind of ICU that need to be designed.

  4. Lifetime earnings for physicians across specialties.

    Science.gov (United States)

    Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Romano, Patrick S; Kravitz, Richard L

    2012-12-01

    Earlier studies estimated annual income differences across specialties, but lifetime income may be more relevant given physicians' long-term commitments to specialties. Annual income and work hours data were collected from 6381 physicians in the nationally representative 2004-2005 Community Tracking Study. Data regarding years of residency were collected from AMA FREIDA. Present value models were constructed assuming 3% discount rates. Estimates were adjusted for demographic and market covariates. Sensitivity analyses included 4 alternative models involving work hours, retirement, exogenous variables, and 1% discount rate. Estimates were generated for 4 broad specialty categories (Primary Care, Surgery, Internal Medicine and Pediatric Subspecialties, and Other), and for 41 specific specialties. The estimates of lifetime earnings for the broad categories of Surgery, Internal Medicine and Pediatric Subspecialties, and Other specialties were $1,587,722, $1,099,655, and $761,402 more than for Primary Care. For the 41 specific specialties, the top 3 (with family medicine as reference) were neurological surgery ($2,880,601), medical oncology ($2,772,665), and radiation oncology ($2,659,657). The estimates from models with varying rates of retirement and including only exogenous variables were similar to those in the preferred model. The 1% discount model generated estimates that were roughly 150% larger than the 3% model. There was considerable variation in the lifetime earnings across physician specialties. After accounting for varying residency years and discounting future earnings, primary care specialties earned roughly $1-3 million less than other specialties. Earnings' differences across specialties may undermine health reform efforts to control costs and ensure adequate numbers of primary care physicians.

  5. The educational impact of the Specialty Care Access Network-Extension of Community Healthcare Outcomes program.

    Science.gov (United States)

    Salgia, Reena J; Mullan, Patricia B; McCurdy, Heather; Sales, Anne; Moseley, Richard H; Su, Grace L

    2014-11-01

    With the aging hepatitis C cohort and increasing prevalence of fatty liver disease, the burden on primary care providers (PCPs) to care for patients with liver disease is growing. In response, the Veterans Administration implemented initiatives for primary care-specialty referral to increase PCP competency in complex disease management. The Specialty Care Access Network-Extension of Community Healthcare Outcomes (SCAN-ECHO) program initiative was designed to transfer subspecialty knowledge to PCPs through case-based distance learning combined with real-time consultation. There is limited information regarding the initiative's ability to engage PCPs to learn and influence their practice. We surveyed PCPs to determine the factors that led to their participation in this program and the educational impact of participation. Of 51 potential participants, 24 responded to an anonymous survey. More than 75% of respondents participated more than one time in a SCAN-ECHO clinic. Providers were motivated to participate by a desire to learn more about liver disease, to apply the knowledge gained to future patients, and to save their patients time traveling to another center for specialty consultation. Seventy-one percent responded that the didactic component and case-based discussion were equally important. It is important that participation changed clinical practice: 75% of providers indicated they had personally discussed the information they learned from the case presentations with their colleague(s), and 42% indicated they helped a colleague care for their patient with the knowledge learned during discussions of other participants' cases. This study shows that the SCAN-ECHO videoconferencing program between PCPs and specialists can educate providers in the delivery of specialty care from a distance and potentially improve healthcare delivery.

  6. Physician wages across specialties: informing the physician reimbursement debate.

    Science.gov (United States)

    Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Kravitz, Richard L

    2010-10-25

    Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (-$24.36), internal medicine (-$24.27), family medicine (-$23.70), and other pediatric subspecialties (-$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.

  7. Organizational readiness in specialty mental health care.

    Science.gov (United States)

    Hamilton, Alison B; Cohen, Amy N; Young, Alexander S

    2010-01-01

    Implementing quality improvement efforts in clinics is challenging. Assessment of organizational "readiness" for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort. This paper discusses organizational assessment in specialty mental health, in preparation for improving care for individuals with schizophrenia. To assess organizational readiness for change in specialty mental health in order to facilitate locally tailored implementation strategies. EQUIP-2 is a site-level controlled trial at nine VA medical centers (four intervention, five control). Providers at all sites completed an organizational readiness for change (ORC) measure, and key stakeholders at the intervention sites completed a semi-structured interview at baseline. At the four intervention sites, 16 administrators and 43 clinical staff completed the ORC, and 38 key stakeholders were interviewed. The readiness domains of training needs, communication, and change were the domains with lower mean scores (i.e., potential deficiencies) ranging from a low of 23.8 to a high of 36.2 on a scale of 10-50, while staff attributes of growth and adaptability had higher mean scores (i.e., potential strengths) ranging from a low of 35.4 to a high of 41.1. Semi-structured interviews revealed that staff perceptions and experiences of change and decision-making are affected by larger structural factors such as change mandates from VA headquarters. Motivation for change, organizational climate, staff perceptions and beliefs, and prior experience with change efforts contribute to readiness for change in specialty mental health. Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention. We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the

  8. The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients.

    Science.gov (United States)

    Matsushima, Kazuhide; Goldwasser, Eleanor R; Schaefer, Eric W; Armen, Scott B; Indeck, Matthew C

    2013-09-01

    The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists' base specialty of training on the disparity of care process and patient outcome. We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists' base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79-2.80; P = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73-1.67; P = 0.63). Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists' base specialty of training. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States.

    Science.gov (United States)

    Takaki, Hiroko; Onozuka, Daisuke; Hagihara, Akihito

    2018-03-01

    Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14-0.57, p  < 0.001) and triptans for menstrual migraine (OR 0.50, 95% CI 0.28-0.91, p  = 0.025) were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

  10. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States

    Directory of Open Access Journals (Sweden)

    Hiroko Takaki

    2018-03-01

    Full Text Available Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14–0.57, p < 0.001 and triptans for menstrual migraine (OR 0.50, 95% CI 0.28–0.91, p = 0.025 were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

  11. Providing Specialty Care for the Poor and Underserved at Student-Run Free Clinics in the San Francisco Bay Area.

    Science.gov (United States)

    Liu, Max Bolun; Xiong, Grace; Boggiano, Victoria Lynn; Ye, Patrick Peiyong; Lin, Steven

    2017-01-01

    This report describes the model of specialty clinics implemented at Stanford University's two student-run free clinics, Arbor Free Clinic and Pacific Free Clinic, in the San Francisco Bay Area. We describe our patient demographic characteristics and the specialty services provided. We discuss challenges in implementing specialty care at student-run free clinics.

  12. Medical costs, Cesarean delivery rates, and length of stay in specialty hospitals vs. non-specialty hospitals in South Korea.

    Directory of Open Access Journals (Sweden)

    Seung Ju Kim

    Full Text Available Since 2011, specialty hospitals in South Korea have been known for providing high- quality care in specific clinical areas. Much research related to specialty hospitals and their performance in many such areas has been performed, but investigations about their performance in obstetrics and gynecology are lacking. Thus, we aimed to compare specialty vs. non-specialty hospitals with respect to mode of obstetric delivery, especially the costs and length of stay related to Cesarean section (CS procedures, and to provide evidence to policy-makers for evaluating the success of hospitals that specialize in obstetric and gynecological (OBGYN care.We obtained National Health Insurance claim data from 2012 to 2014, which included information from 418,141 OBGYN cases at 214 hospitals. We used a generalized estimating equation model to identify a potential association between the likelihood of CS at specialty hospitals compared with other hospitals. We also evaluated medical costs and length of stay in specialty hospitals according to type of delivery.We found that 150,256 (35.9% total deliveries were performed by CS. The odds ratio of CS was significantly lower in specialty hospitals (OR: 0.95, 95% CI: 0.93-0.96compared to other hospitals Medical costs (0.74% and length of stay (1% in CS cases increased in specialty hospitals, although length of stay following vaginal delivery was lower (0.57% in specialty hospitals compared with other hospitals.We determined that specialty hospitals are significantly associated with a lower likelihood of CS delivery and shorter length of stay after vaginal delivery. Although they are also associated with higher costs for delivery, the increased cost could be due to the high level of intensive care provided, which leads to improve quality of care. Policy-makers should consider incentive programs to maintain performance of specialty hospitals and promote efficiency that could reduce medical costs accrued by patients.

  13. The role of emergency medicine physicians in trauma care in North America: evolution of a specialty

    Directory of Open Access Journals (Sweden)

    Grossman Michael D

    2009-08-01

    Full Text Available Abstract The role of Emergency Medicine Physicians (EMP in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded role for EMPs in trauma care. Two training models currently in the early stages of development have been proposed to address needs for increased manpower in trauma and the critical care of trauma patients. The available information regarding these models will be reviewed along with the implications for improving the care of trauma patients in both Europe and North America.

  14. Holes in the safety net: a case study of access to prescription drugs and specialty care.

    Science.gov (United States)

    Stanley, Ava; Cantor, Joel C; Guarnaccia, Peter

    2008-07-01

    The health care safety net in the United States is intended to fill gaps in health care services for uninsured and other vulnerable populations. This paper presents a case study of New Brunswick, NJ, a small city rich in safety net resources, to examine the adequacy of the American model of safety net care. We find substantial gaps in access to care despite the presence of a medical school, an abundance of primary care and specialty physicians, two major teaching hospitals, a large federally qualified health center and other safety net resources in this community of about 50,000 residents. Using a blend of random-digit-dial and area probability sampling, a survey of 595 households was conducted in 2001 generating detailed information about the health, access to care, demographic and other characteristics of 1,572 individuals. Confirming the great depth of the New Brunswick health care safety net, the survey showed that more than one quarter of local residents reported a hospital or community clinic as their usual source of care. Still, barriers to prescription drugs were reported for 11.0% of the area population and more than two in five (42.8%) local residents who perceived a need for specialty care reported difficulty getting those services. Bivariate analyses show significantly elevated risk of access problems among Hispanic and black residents, those in poor health, those relying on hospital and community clinics or with no usual source of care, and those living at or below poverty. In multivariate analysis, lack of health insurance was the greatest risk factor associated with both prescription drug and specialty access problems. Few local areas can claim the depth of safety net resources as New Brunswick, NJ, raising serious concerns about the adequacy of the American safety net model, especially for people with complex and chronic health care needs.

  15. Orthopedic specialty hospitals: centers of excellence or greed machines?

    Science.gov (United States)

    Badlani, Neil; Boden, Scott; Phillips, Frank

    2012-03-07

    Orthopedic specialty hospitals have recently been the subject of debate. They are patient-centered, physician-friendly health care alternatives that take advantage of the economic efficiencies of specialization. Medically, they provide a higher quality of care and increase patient and physician satisfaction. Economically, they are more efficient and profitable than general hospitals. They also positively affect society through the taxes they pay and the beneficial aspects of the competition they provide to general hospitals. Their ability to provide a disruptive innovation to the existing hospital industry will lead to lower costs and greater access to health care. However, critics say that physician ownership presents potential conflicts of interest and leads to overuse of medical care. Some general hospitals are suffering as a result of unfair specialty hospital practices, and a few drastic medical complications have occurred at specialty hospitals. Specialty hospitals have been scrutinized for increasing the inequality of health care and continue to be a target of government regulations. In this article, the pros and cons are examined, and the Emory Orthopaedics and Spine Hospital is analyzed as an example. Orthopedic specialty hospitals provide excellent care and are great assets to society. Competition between specialty and general hospitals has provided added value to patients and taxpayers. However, physicians must take more responsibility in their appropriate and ethical leadership. It is critical to recognize financial conflicts of interest, disclose ownership, and act ethically. Patient care cannot be compromised. With thoughtful and efficient leadership, specialty hospitals can be an integral part of improving health care in the long term. Copyright 2012, SLACK Incorporated.

  16. Seeking high reliability in primary care: Leadership, tools, and organization.

    Science.gov (United States)

    Weaver, Robert R

    2015-01-01

    Leaders in health care increasingly recognize that improving health care quality and safety requires developing an organizational culture that fosters high reliability and continuous process improvement. For various reasons, a reliability-seeking culture is lacking in most health care settings. Developing a reliability-seeking culture requires leaders' sustained commitment to reliability principles using key mechanisms to embed those principles widely in the organization. The aim of this study was to examine how key mechanisms used by a primary care practice (PCP) might foster a reliability-seeking, system-oriented organizational culture. A case study approach was used to investigate the PCP's reliability culture. The study examined four cultural artifacts used to embed reliability-seeking principles across the organization: leadership statements, decision support tools, and two organizational processes. To decipher their effects on reliability, the study relied on observations of work patterns and the tools' use, interactions during morning huddles and process improvement meetings, interviews with clinical and office staff, and a "collective mindfulness" questionnaire. The five reliability principles framed the data analysis. Leadership statements articulated principles that oriented the PCP toward a reliability-seeking culture of care. Reliability principles became embedded in the everyday discourse and actions through the use of "problem knowledge coupler" decision support tools and daily "huddles." Practitioners and staff were encouraged to report unexpected events or close calls that arose and which often initiated a formal "process change" used to adjust routines and prevent adverse events from recurring. Activities that foster reliable patient care became part of the taken-for-granted routine at the PCP. The analysis illustrates the role leadership, tools, and organizational processes play in developing and embedding a reliable-seeking culture across an

  17. Specialty Choice Among Sexual and Gender Minorities in Medicine: The Role of Specialty Prestige, Perceived Inclusion, and Medical School Climate

    Science.gov (United States)

    Pachankis, John E.

    2016-01-01

    Abstract Purpose: Sexual and gender minorities (SGMs) in medicine experience unique stressors in training. However, little is known about SGM specialty choice. This study examined predictors of SGM specialty choice, associations between specialty prestige and perceived SGM inclusion, and self-reported influences on specialty choice. Methods: Medical trainees and practitioners (358 SGM, 1528 non-SGM) were surveyed online. We operationalized specialty choice at the individual level as respondents' specialty of practice; at the specialty level, as a percentage of SGM respondents in each specialty. We examined specialty prestige, perceived SGM inclusivity, and medical school climate as predictors of SGM specialty choice, and we compared additional influences on specialty choice between SGM and non-SGM. Results: The percentage of SGM in each specialty was inversely related to specialty prestige (P = 0.001) and positively related to perceived SGM inclusivity (P = 0.01). Prestigious specialties were perceived as less SGM inclusive (P gender identity strongly influenced specialty choice (P work–life balance as strong influences on specialty choice. Exposure as a medical student to SGM faculty did not predict specialty prestige among SGM. Conclusion: Specialty prestige and perceived inclusivity predict SGM specialty choice. SGM diversity initiatives in prestigious specialties may be particularly effective by addressing SGM inclusion directly. Further research is needed to inform effective mentorship for SGM medical students. Exposure to SGM in medical training reduces anti-SGM bias among medical professionals, and SGM in medicine often assume leadership roles in clinical care, education, and research regarding SGM health. Supporting and promoting SGM diversity across the spectrum of medical specialties, therefore, represents a critical avenue to improve the care delivered to SGM populations and addresses the role of providers in the health disparities

  18. Specialty Choice Among Sexual and Gender Minorities in Medicine: The Role of Specialty Prestige, Perceived Inclusion, and Medical School Climate.

    Science.gov (United States)

    Sitkin, Nicole A; Pachankis, John E

    2016-12-01

    Sexual and gender minorities (SGMs) in medicine experience unique stressors in training. However, little is known about SGM specialty choice. This study examined predictors of SGM specialty choice, associations between specialty prestige and perceived SGM inclusion, and self-reported influences on specialty choice. Medical trainees and practitioners (358 SGM, 1528 non-SGM) were surveyed online. We operationalized specialty choice at the individual level as respondents' specialty of practice; at the specialty level, as a percentage of SGM respondents in each specialty. We examined specialty prestige, perceived SGM inclusivity, and medical school climate as predictors of SGM specialty choice, and we compared additional influences on specialty choice between SGM and non-SGM. The percentage of SGM in each specialty was inversely related to specialty prestige (P = 0.001) and positively related to perceived SGM inclusivity (P = 0.01). Prestigious specialties were perceived as less SGM inclusive (P gender identity strongly influenced specialty choice (P role models, and work-life balance as strong influences on specialty choice. Exposure as a medical student to SGM faculty did not predict specialty prestige among SGM. Specialty prestige and perceived inclusivity predict SGM specialty choice. SGM diversity initiatives in prestigious specialties may be particularly effective by addressing SGM inclusion directly. Further research is needed to inform effective mentorship for SGM medical students. Exposure to SGM in medical training reduces anti-SGM bias among medical professionals, and SGM in medicine often assume leadership roles in clinical care, education, and research regarding SGM health. Supporting and promoting SGM diversity across the spectrum of medical specialties, therefore, represents a critical avenue to improve the care delivered to SGM populations and addresses the role of providers in the health disparities experienced by SGM.

  19. Association of medical student burnout with residency specialty choice.

    Science.gov (United States)

    Enoch, Lindsey; Chibnall, John T; Schindler, Debra L; Slavin, Stuart J

    2013-02-01

    Given the trend among medical students away from primary care medicine and toward specialties that allow for more controllable lifestyles, the identification of factors associated with specialty choice is important. Burnout is one such factor. The purpose of this study was to examine the associations between burnout and residency specialty choice in terms of provision for a less versus more controllable lifestyle (e.g. internal medicine versus dermatology) and a lower versus higher income (e.g. paediatrics versus anaesthesiology). A survey was sent to 165 Year 4 medical students who had entered the residency matching system. Students answered questions about specialty choice, motivating factors (lifestyle, patient care and prestige) and perceptions of medicine as a profession. They completed the Maslach Burnout Inventory-Human Services (MBI), which defines burnout in relation to emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Burnout and other variables were tested for associations with specialty lifestyle controllability and income. A response rate of 88% (n = 145) was achieved. Experiences of MBI-EE, MBI-DP and MBI-PA burnout were reported by 42 (29%), 26 (18%) and 30 (21%) students, respectively. Specialties with less controllable lifestyles were chosen by 87 (60%) students and lower-income specialties by 81 (56%). Adjusted odds ratios (ORs) indicated that the choice of a specialty with a more controllable lifestyle was associated with higher MBI-EE burnout (OR = 1.77, 95% confidence interval [CI] 1.06-2.96), as well as stronger lifestyle- and prestige-related motivation, and weaker patient care-related motivation. The choice of a higher-income specialty was associated with lower MBI-PA burnout (OR = 0.56, 95% CI 0.32-0.98), weaker lifestyle- and patient care-related motivation, and stronger prestige-related motivation. Specialty choices regarding lifestyle controllability and income were associated with the amount and type of

  20. Seeking health care through international medical tourism.

    Science.gov (United States)

    Eissler, Lee Ann; Casken, John

    2013-06-01

    The purpose of this study was the exploration of international travel experiences for the purpose of medical or dental care from the perspective of patients from Alaska and to develop insight and understanding of the essence of the phenomenon of medical tourism. The study is conceptually oriented within a model of health-seeking behavior. Using a qualitative design, 15 Alaska medical tourists were individually interviewed. The data were analyzed using a hermeneutic process of inquiry to uncover the meaning of the experience. Six themes reflecting the experiences of Alaska medical tourists emerged: "my motivation," "I did the research," "the medical care I need," "follow-up care," "the advice I give," and "in the future." Subthemes further categorized data for increased understanding of the phenomenon. The thematic analysis provides insight into the experience and reflects a modern approach to health-seeking behavior through international medical tourism. The results of this study provide increased understanding of the experience of obtaining health care internationally from the patient perspective. Improved understanding of medical tourism provides additional information about a contemporary approach to health-seeking behavior. Results of this study will aid nursing professionals in counseling regarding medical tourism options and providing follow-up health care after medical tourism. Nurses will be able to actively participate in global health policy discussions regarding medical tourism trends. © 2013 Sigma Theta Tau International.

  1. Impact of physician specialty on quality care for patients hospitalized with decompensated cirrhosis.

    Directory of Open Access Journals (Sweden)

    Nicholas Lim

    Full Text Available Decompensated cirrhosis is a common precipitant for hospitalization, and there is limited information concerning factors that influence the delivery of quality care in cirrhotic inpatients. We sought to determine the relation between physician specialty and inpatient quality care for decompensated cirrhosis.We reviewed 247 hospital admissions for decompensated cirrhosis, managed by hospitalists or intensivists, between 2009 and 2013. The primary outcome was quality care delivery, defined as adherence to all evidence-based specialty society practice guidelines pertaining to each specific complication of cirrhosis. Secondary outcomes included new complications, length-of-stay, and in-hospital death.Overall, 147 admissions (59.5% received quality care. Quality care was given more commonly by intensivists, compared with hospitalists (71.7% vs. 53.1%, P = .006, and specifically for gastrointestinal bleeding (72% vs. 45.8%, P = .03 and hepatic encephalopathy (100% vs. 63%, P = .005. Involvement of gastroenterology consultation was also more common in admissions in which quality care was administered (68.7% vs. 54.0%, P = .023. Timely diagnostic paracentesis was associated with reduced new complications in admissions for refractory ascites (9.5% vs. 46.6%, P = .02, and reduced length-of-stay in admissions for spontaneous bacterial peritonitis (5 days vs. 13 days, P = .02.Adherence to quality indicators for decompensated cirrhosis is suboptimal among hospitalized patients. Although quality care adherence appears to be higher among cirrhotic patients managed by intensivists than by hospitalists, opportunities for improvement exist in both groups. Rational and cost-effective strategies should be sought to achieve this end.

  2. Performer's attitudes toward seeking health care for voice issues: understanding the barriers.

    Science.gov (United States)

    Gilman, Marina; Merati, Albert L; Klein, Adam M; Hapner, Edie R; Johns, Michael M

    2009-03-01

    Contemporary commercial music (CCM) performers rely heavily on their voice, yet may not be aware of the importance of proactive voice care. This investigation intends to identify perceptions and barriers to seeking voice care among CCM artists. This cross-sectional observational study used a 10-item Likert-based response questionnaire to assess current perceptions regarding voice care in a population of randomly selected participants of professional CCM conference. Subjects (n=78) were queried regarding their likelihood to seek medical care for minor medical problems and specifically problems with their voice. Additional questions investigated anxiety about seeking voice care from a physician specialist, speech language pathologist, or voice coach; apprehension regarding findings of laryngeal examination, laryngeal imaging procedures; and the effect of medical insurance on the likelihood of seeking medical care. Eighty-two percent of subjects reported that their voice was a critical part of their profession; 41% stated that they were not likely to seek medical care for problems with their voice; and only 19% were reluctant to seek care for general medical problems (Peducation about the importance of voice care is needed in this population of vocal performers.

  3. Dental students' perceptions of dental specialties and factors influencing specialty and career choices.

    Science.gov (United States)

    Dhima, Matilda; Petropoulos, Vicki C; Han, Rita K; Kinnunen, Taru; Wright, Robert F

    2012-05-01

    The goals of this study were to 1) evaluate dental students' perceptions of dental specialties, 2) identify factors that play an important role in students' decision to pursue specialty training or career choices, and 3) establish a baseline of students' perceptions of the dental fields with the best future in terms of salary, personal and patient quality of life, and overall impact on the dental profession. Surveys were distributed to 494 students at the University of Pennsylvania School of Dental Medicine. Data were collected from 380 traditional four-year students and thirty advanced standing students. Chi-square tests, multivariate analysis, and logistic regressions were used to determine associations and independent contributions of student demographics to their perceptions of dental specialties and factors influencing specialty training or career choices. Debt was a statistically significant factor (p<0.001) in choosing specialty training or career independent of gender, age, or class year. Enjoyment of providing care in a specialty or field was identified as the single most important factor in choosing a specialty career. Half of the respondents had decided not to specialize. Pursuing postdoctoral general dentistry training and private practice in general dentistry were the most commonly reported plans after completion of dental school. Suggestions are made for ways to inform students about specialty training.

  4. Primary care specialty career choice among Canadian medical students: Understanding the factors that influence their decisions.

    Science.gov (United States)

    Osborn, Heather Ann; Glicksman, Jordan T; Brandt, Michael G; Doyle, Philip C; Fung, Kevin

    2017-02-01

    To identify which factors influence medical students' decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non-front-line specialties. Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Ontario medical school. An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). The main factors that influenced participants' decision to choose a career in primary care or pediatrics, and the main factors that influenced participants' decision to choose a career in a non-front-line specialty. A total of 323 participants were included in this study. Factors that significantly influenced participants' career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [ P = .005], acceptable on-call demands [ P = .012], and lifestyle flexibility [ P = .006]); a robust physician-patient relationship (ability to promote individual health promotion [ P = .014] and the opportunity to form long-term relationships [ P  < .001], provide comprehensive care [ P = .001], and treat patients and their families [ P = .006]); and duration of residency program ( P = .001). The career-related factors that significantly influenced participants' decision to choose a non-front-line specialty were as follows: becoming an expert ( P  < .001), maintaining a focused scope of practice ( P  < .001), having a procedure-focused practice ( P = .001), seeing immediate results from one's actions ( P  < .001), potentially earning a high income ( P  < .001), and having a perceived status among colleagues ( P  < .001). In this study, 8 factors were found to positively influence medical students' career choice in family medicine and pediatrics, and 6 factors influenced the decision to choose a career in a non-front-line specialty. Medical students can be

  5. Care-seeking behaviour of adolescents with knee pain

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Skuldbøl, Sune Kjems; Rasch, Mads Nyhuus

    2013-01-01

    Knee pain is common during adolescence. Adolescents and their parents may think that knee pain is benign and self-limiting and therefore avoid seeking medical care. However, long-term prognosis of knee pain is not favourable and treatment seems to offer greater reductions in pain compared...... to a "wait-and-see" approach. The purpose of this study was to describe the determinants of care-seeking behaviour among adolescents with current knee pain and investigate what types of treatment are initiated....

  6. Physician career satisfaction within specialties

    Directory of Open Access Journals (Sweden)

    Kravitz Richard L

    2009-09-01

    Full Text Available Abstract Background Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options. Methods We analyzed cross-sectional data from 6,590 physicians (response rate, 53% in Round 4 (2004-2005 of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions Results After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349; geriatric medicine (0.323; other pediatric subspecialties (0.270; neonatal/prenatal medicine (0.266; internal medicine and pediatrics (combined practice (0.250; pediatrics (0.250; dermatology (0.249;and child and adolescent psychiatry (0.203. The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707; pulmonary critical care medicine (-0.273; nephrology (-0.206; and obstetrics and gynecology (-0.188. We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites. Conclusion Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they

  7. Veterans Affairs general surgery service: the last bastion of integrated specialty care.

    Science.gov (United States)

    Poteet, Stephen; Tarpley, Margaret; Tarpley, John L; Pearson, A Scott

    2011-11-01

    In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients. Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to 2009 at the Nashville VA. Over a 5-year span general surgery residents spent an average of 5 months on the VA general surgery service, which includes a postgraduate year (PGY)-5, PGY-3, and 2 PGY-1 residents. Surgeries involved the following specialties: surgical oncology, endocrine, colorectal, hepatobiliary, transplant, gastrointestinal laparoscopy, and elective and emergency general surgery. The surgeries were categorized according to ACGME index requirements. A total of 2,956 surgeries were performed during the 5-year period from 2005 through 2009. Residents participated in an average of 246 surgeries during their experience at the VA; approximately 50 cases are completed during the chief year. On the VA surgery service alone, 100% of the ACGME requirement was met for the following categories: endocrine (8 cases); skin, soft tissue, and breast (33 cases); alimentary tract (78 cases); and abdominal (88 cases). Approximately 50% of the ACGME requirement was met for liver, pancreas, and basic laparoscopic categories. The VA hospital provides an authentic, broad-based, general surgery training experience that integrates complex surgical patients simultaneously. Opportunities for this level of comprehensive care are decreasing or absent in many general surgery training

  8. Physician office vs retail clinic: patient preferences in care seeking for minor illnesses.

    Science.gov (United States)

    Ahmed, Arif; Fincham, Jack E

    2010-01-01

    Retail clinics are a relatively new phenomenon in the United States, offering cheaper and convenient alternatives to physician offices for minor illness and wellness care. The objective of this study was to investigate the effects of cost of care and appointment wait time on care-seeking decisions at retail clinics or physician offices. As part of a statewide random-digit-dial survey of households, adult residents of Georgia were interviewed to conduct a discrete choice experiment with 2 levels each of 4 attributes: price ($59; $75), appointment wait time (same day; 1 day or longer), care setting-clinician combination (nurse practitioner in retail clinic; physician in private office), and acute illness (urinary tract infection [UTI]; influenza). The respondents indicated whether they would seek care under each of the 16 resulting choice scenarios. A cooperation rate of 33.1% yielded 493 completed telephone interviews. The respondents preferred to seek care for both conditions; were less likely to seek care for UTI (beta = -0.149; P = .008); preferred to seek care from a physician (beta = 1.067; P clinic and $82.12 to wait 1 day or more. Time and cost savings offered by retail clinics are attractive to patients, and they are likely to seek care there given sufficient cost savings. Appointment wait time is the most important factor in care-seeking decisions and should be considered carefully in setting appointment policies in primary care practices.

  9. Optimizing the pre-referral workup for gastroenterology and hepatology specialty care: consensus using the Delphi method.

    Science.gov (United States)

    Ho, Chanda K; Boscardin, Christy K; Gleason, Nathaniel; Collado, Don; Terdiman, Jonathan; Terrault, Norah A; Gonzales, Ralph

    2016-02-01

    Specialty care referrals have doubled in the last decade. Optimization of the pre-referral workup by a primary care doctor can lead to a more efficient first specialty visit with the patient. Guidance regarding pre-referral laboratory testing is a first step towards improving the specialty referral process. Our aim was to establish consensus regarding appropriate pre-referral workup for common gastrointestinal and liver conditions. The Delphi method was used to establish local consensus for recommending certain laboratory tests prior to specialty referral for 13 clinical conditions. Seven conditions from The University of Michigan outpatient referral guidelines were used as a baseline. An expert panel of three PCPs and nine gastroenterologists from three academic hospitals participated in three iterative rounds of electronic surveys. Each panellist ranked each test using a 5-point Likert scale (strongly disagree to strongly agree). Local panellists could recommend additional tests for the initial diagnoses, and also recommended additional diagnoses needing guidelines: iron deficiency anaemia, abdominal pain, irritable bowel syndrome, fatty liver disease, liver mass and cirrhosis. Consensus was defined as ≥70% of experts scoring ≥4 (agree or strongly agree). Applying Delphi methodology to extrapolate externally developed referral guidelines for local implementation resulted in considerable modifications. For some conditions, many tests from the external group were eliminated by the local group (abdominal bloating; iron deficiency anaemia; irritable bowel syndrome). In contrast, for chronic diarrhoea, abnormal liver enzymes and viral hepatitis, all/most original tests were retained with additional tests added. For liver mass, fatty liver disease and cirrhosis, there was high concordance among the panel with few tests added or eliminated. Consideration of externally developed referral guidelines using a consensus-building process leads to significant local

  10. Gender variations in specialties among medical doctors working in ...

    African Journals Online (AJOL)

    Background: Gender variations exist in the choice of specialties among ... as it affects the distribution of doctors in public health institutions and patient care. ... For female doctors,pediatrics was the topmost specialty (25%) followed by ... Keywords: Gender variation,Specialties,Doctors,Public healthcare,Health workforce ...

  11. Exodus of male physicians from primary care drives shift to specialty practice.

    Science.gov (United States)

    Tu, Ha T; O'Malley, Ann S

    2007-06-01

    An exodus of male physicians from primary care is driving a marked shift in the U.S. physician workforce toward medical-specialty practice, according to a national study by the Center for Studying Health System Change (HSC). Two factors have helped mask the severity of the shift--a growing proportion of female physicians, who disproportionately choose primary care, and continued reliance on international medical graduates (IMGs), who now account for nearly a quarter of all U.S. primary care physicians. Since 1996-97, a 40 percent increase in the female primary care physician supply has helped to offset a 16 percent decline in the male primary care physician supply relative to the U.S. population. At the same time, primary care physicians' incomes have lost ground to both inflation and medical and surgical specialists' incomes. And women in primary care face a 22 percent income gap relative to men, even after accounting for differing characteristics. If real incomes for primary care physicians continue to decline, there is a risk that the migration of male physicians will intensify and that female physicians may begin avoiding primary care--trends that could aggravate a predicted shortage of primary care physicians.

  12. Influence of inpatient service specialty on care processes and outcomes for patients with non ST-segment elevation acute coronary syndromes.

    Science.gov (United States)

    Roe, Matthew T; Chen, Anita Y; Mehta, Rajendra H; Li, Yun; Brindis, Ralph G; Smith, Sidney C; Rumsfeld, John S; Gibler, W Brian; Ohman, E Magnus; Peterson, Eric D

    2007-09-04

    Since the broad dissemination of practice guidelines, the association of specialty care with the treatment of patients with acute coronary syndromes has not been studied. We evaluated 55 994 patients with non-ST-segment elevation acute coronary syndromes (ischemic ST-segment changes and/or positive cardiac markers) included in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Quality Improvement Initiative from January 2001 through September 2003 at 301 tertiary US hospitals with full revascularization capabilities. We compared baseline characteristics, the use of American College of Cardiology/American Heart Association guidelines class I recommendations, and in-hospital outcomes by the specialty of the primary in-patient service (cardiology versus noncardiology). A total of 35 374 patients (63.2%) were primarily cared for by a cardiology service, and these patients had lower-risk clinical characteristics, but they more commonly received acute (processes were improved when care was provided by a cardiology service regardless of the propensity to receive cardiology care. The adjusted risk of in-hospital mortality was lower with care provided by a cardiology service (adjusted odds ratio 0.80, 95% confidence interval 0.73 to 0.88), and adjustment for differences in the use of acute medications and invasive procedures partially attenuated this mortality difference (adjusted odds ratio 0.92, 95% confidence interval 0.83 to 1.02). Non-ST-segment elevation acute coronary syndrome patients primarily cared for by a cardiology inpatient service more commonly received evidence-based treatments and had a lower risk of mortality, but these patients had lower-risk clinical characteristics. Results from the present analysis highlight the difficulties with accurately determining how specialty care is associated with treatment patterns and clinical outcomes for patients with acute

  13. Doing More for More: Unintended Consequences of Financial Incentives for Oncology Specialty Care.

    Science.gov (United States)

    O'Neil, Brock; Graves, Amy J; Barocas, Daniel A; Chang, Sam S; Penson, David F; Resnick, Matthew J

    2016-02-01

    Specialty care remains a significant contributor to health care spending but largely unaddressed in novel payment models aimed at promoting value-based delivery. Bladder cancer, chiefly managed by subspecialists, is among the most costly. In 2005, Centers for Medicare and Medicaid Services (CMS) dramatically increased physician payment for office-based interventions for bladder cancer to shift care from higher cost facilities, but the impact is unknown. This study evaluated the effect of financial incentives on patterns of fee-for-service (FFS) bladder cancer care. Data from a 5% sample of Medicare beneficiaries from 2001-2013 were evaluated using interrupted time-series analysis with segmented regression. Primary outcomes were the effects of CMS fee modifications on utilization and site of service for procedures associated with the diagnosis and treatment of bladder cancer. Rates of related bladder cancer procedures that were not affected by the fee change were concurrent controls. Finally, the effect of payment changes on both diagnostic yield and need for redundant procedures were studied. All statistical tests were two-sided. Utilization of clinic-based procedures increased by 644% (95% confidence interval [CI] = 584% to 704%) after the fee change, but without reciprocal decline in facility-based procedures. Procedures unaffected by the fee incentive remained unchanged throughout the study period. Diagnostic yield decreased by 17.0% (95% CI = 12.7% to 21.3%), and use of redundant office-based procedures increased by 76.0% (95% CI = 59% to 93%). Financial incentives in bladder cancer care have unintended and costly consequences in the current FFS environment. The observed price sensitivity is likely to remain a major issue in novel payment models failing to incorporate procedure-based specialty physicians. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  14. Health care seeking behaviour and utilisation in a multiple health insurance system

    DEFF Research Database (Denmark)

    Chomi, Eunice Nahyuha; Mujinja, Phares G M; Enemark, Ulrika

    2014-01-01

    : Reducing fragmentation is necessary to provide opportunities for redistribution and to promote equity in utilisation of health services. Improvement in the delivery of services is crucial for achievement of improved access and financial protection and for increased enrolment into the CHF, which...... characteristics on the probability of seeking care and choice of provider. RESULTS: Generally, health insurance is found to increase the probability of seeking care and reduce delays. However, the probability, timing of seeking care and choice of provider varies across the CHF and NHIF members. CONCLUSIONS...

  15. Seeking maternal care at times of conflict: the case of Lebanon.

    Science.gov (United States)

    Kabakian-Khasholian, Tamar; Shayboub, Rawan; El-Kak, Faysal

    2013-01-01

    Providing quality maternity care within the emergency care packages for internally displaced populations in war-affected areas is somewhat challenging, although very essential. In this retrospective study, we describe the experiences and health care seeking behaviors of 1,015 pregnant and postpartum women during the 2006 war in Lebanon. Women reported interruptions in regular maternity care and experienced more complications during this period. Availability of health services and experiences of complications were the most important determinants of health care seeking behaviors. Maternal health services should be a part of any comprehensive emergency responsiveness plan, catering to women's needs in war-affected areas.

  16. Health plan utilization and costs of specialty drugs within 4 chronic conditions.

    Science.gov (United States)

    Gleason, Patrick P; Alexander, G Caleb; Starner, Catherine I; Ritter, Stephen T; Van Houten, Holly K; Gunderson, Brent W; Shah, Nilay D

    2013-09-01

    Drugs are most typically defined as specialty because they are expensive; however, other criteria used to define a drug as specialty include biologic drugs, the need to inject or infuse the drug, the requirement for special handling, or drug availability only via a limited distribution network. Specialty drugs play an increasingly important role in the treatment of chronic conditions such as multiple sclerosis (MS), rheumatoid arthritis (RA), psoriasis, and inflammatory bowel disease (IBD), yet little is known regarding the comprehensive medical and pharmacy benefit utilization and cost trends for these conditions. To describe MS, RA, psoriasis, and IBD trends for condition prevalence, treatment with specialty drugs, specialty costs, nonspecialty costs, and total direct costs of care within the medical and pharmacy benefits. This was a descriptive analysis of a commercially insured population made up of 1 million members, using integrated medical and pharmacy administrative claims data from 2008 to 2010. Analyses were limited to continuously enrolled commercially insured individuals less than 65 years of age. Condition-specific cohorts for MS, RA, psoriasis, and IBD were defined using standardized criteria. Trends in condition prevalence, specialty drug use for the conditions, and direct total cost of care were analyzed. The direct costs were subcategorized into the following: medical benefit specialty drug costs, medical benefit all other costs, pharmacy benefit specialty drug costs, and pharmacy benefit all other costs. Trends and compound annual growth rates were calculated for the total cost of care and subcategory costs from 2008 through 2010. Condition prevalence ranged from a low of 1,720 per million members for MS to a high of 4,489 per million members for RA. Psoriasis and MS condition prevalence rates were unchanged over the 3 years; however, IBD prevalence increased 7.0%, and RA prevalence increased 9.7%. The rate of specialty drug use was lowest for IBD

  17. Factors Affecting Initial Intimate Partner Violence-Specific Health Care Seeking in the Tokyo Metropolitan Area, Japan.

    Science.gov (United States)

    Kamimura, Akiko; Bybee, Deborah; Yoshihama, Mieko

    2014-09-01

    This study examined the factors affecting a women's initial intimate partner violence (IPV)-specific health care seeking event which refers to the first health care seeking as a result of IPV in a lifetime. Data were collected using the Life History Calendar method in the Tokyo metropolitan area from 101 women who had experienced IPV. Discrete-time survival analysis was used to assess the time to initial IPV-specific health care seeking. IPV-related injury was the most significant factor associated with increased likelihood of seeking IPV-specific health care seeking for the first time. In the presence of a strong effect of formal help seeking, physical and sexual IPV were no longer significantly related to initial IPV-specific health care seeking. The results suggest some victims of IPV may not seek health care unless they get injured. The timing of receiving health care would be important to ensure the health and safety of victims. © The Author(s) 2014.

  18. Health care help seeking behaviour among prisoners in Norway

    Directory of Open Access Journals (Sweden)

    Nesset Merete

    2011-11-01

    Full Text Available Abstract Background Prisoners are associated with high health care needs compared with the general population. This study aims to investigate prisoners' use of health service. Methods A cross-sectional study of 29 prisons in central and southern parts of Norway. A questionnaire was distributed to 1, 454 prisoners (90% response rate. Multilevel analyses were employed to analyse help seeking behaviour among the prisoners. Results Help seeking was substantially associated with sleep problems and drug problems. There was also a tendency for closed prisons as well as high staffing levels of healthcare professionals to be associated with elevated health care use. Conclusions This study suggests that sleep problems and drug use are most frequently associated with health service use. The differences in health care use between prisons suggest that the implementation of prison health care standards should be addressed.

  19. Integrated specialty service readiness in health reform: connections in haemophilia comprehensive care.

    Science.gov (United States)

    Pritchard, A M; Page, D

    2008-05-01

    The World Health Organization (WHO) has identified primary healthcare reform as a global priority whereby innovative practice changes are directed at improving health. This transformation to health reform in haemophilia service requires clarification of comprehensive care to reflect the WHO definition of health and key elements of primary healthcare reform. While comprehensive care supports effective healthcare delivery, comprehensive care must also be regarded beyond immediate patient management to reflect the broader system purpose in the care continuum with institutions, community agencies and government. Furthermore, health reform may be facilitated through integrated service delivery (ISD). ISD in specialty haemophilia care has the potential to reduce repetition of assessments, enhance care plan communication between providers and families, provide 24-h access to care, improve information availability regarding care quality and outcomes, consolidate access for multiple healthcare encounters and facilitate family self-efficacy and autonomy [1]. Three core aspects of ISD have been distinguished: clinical integration, information management and technology and vertical integration in local communities [2]. Selected examples taken from Canadian haemophilia comprehensive care illustrate how practice innovations are bridged with a broader system level approach and may support initiatives in other contexts. These innovations are thought to indicate readiness regarding ISD. Reflecting on the existing capacity of haemophilia comprehensive care teams will assist providers to connect and direct their existing strengths towards ISD and health reform.

  20. Effect of community mobilization on appropriate care seeking for pneumonia in Haripur, Pakistan

    Directory of Open Access Journals (Sweden)

    Salim Sadruddin

    2015-07-01

    Full Text Available Background: Appropriate and timely care seeking reduces mortality for childhood illnesses including pneumonia. Despite over 90 000 Lady Health Workers (LHWs deployed in Pakistan, whose tasks included management of pneumonia, only 16% of care takers sought care from them for respiratory infections. As part of a community case management trial for childhood pneumonia, community mobilization interventions were implemented to improve care seeking from LHWs in Haripur district, Pakistan. The objective of the study was to increase the number of children receiving treatment for pneumonia and severe pneumonia by Lady Health Workers (LHWs through community mobilization approaches for prompt recognition and care seeking in 2 to 59 month–old children. Methods: To assess pneumonia care seeking practices, pre and post– intervention household surveys were conducted in 28 target Union Councils. Formative research to improve existing LHW training materials, job aids and other materials was carried out. Advocacy events were organized, LHWs and male health promoters were trained in community mobilization, non–functional women and male health committees were revitalized and LHWs and male health promoters conducted community awareness sessions. Results: The community mobilization interventions were implemented from April 2008 – December 2009. Project and LHW program staff organized 113 sensitization meetings for opinion leaders, which were attended by 2262 males and 3288 females. The 511 trained LHWs organized 6132 community awareness sessions attended by 50 056 women and 511 male promoters conducted 523 sessions attended by 7845 males. In one year period, the number of LHWs treating pneumonia increased from 11 in April 2008 to 505 in March 2009. The care seeking from LHWs for suspected pneumonia increased from 0.7% in pre–intervention survey to 49.2% in post–intervention survey. Conclusion: The increase in care seeking from LHWs benefited the community

  1. Mental health self-care in medical students: a comprehensive look at help-seeking.

    Science.gov (United States)

    Gold, Jessica A; Johnson, Benjamin; Leydon, Gary; Rohrbaugh, Robert M; Wilkins, Kirsten M

    2015-02-01

    The authors characterize medical student help-seeking behaviors and examine the relationship with stress, burnout, stigma, depression, and personal health behaviors. In 2013, the authors administered an electronic survey of all enrolled students at Yale School of Medicine (183 responders, response rate=35 %), inquiring about students' primary medical and mental health care, personal health behaviors, support systems, and help-seeking behaviors. Students completed the Attitudes to Mental Health Questionnaire, the Patient Health Questionnaire-2, and a modified Maslach Burnout Inventory. The authors analyzed the results with logistic regression, the Wilcoxon rank-sum test, the Kruskal-Wallis test, or a test for significance of Kendall rank correlation. Most students reported having a primary care provider (PCP), yet few reported seeking care when sick (33 %). Nineteen percent of students reported having a mental health provider, fewer than reported having a PCP (pstudents reported increased mental health needs since beginning medical school, and these students were more likely to agree that their needs were untreated. The majority of students endorsed stress, which correlated with increased and unmet mental health needs (pstudents and correlated with stress and increased and untreated needs. Most students reported comfort with asking for academic help; those uncomfortable were more likely to have mental health needs for which they did not seek treatment (p=0.004). Mental health stigma was low. Medical students had a significant unmet need for health care, influenced by barriers to accessing care, stress, burnout, and depression. Academic help seeking and supportive faculty relationships appear related to mental health treatment seeking. Targeted interventions for stress and burnout reduction, as well as incorporation of reflective practice, may have an impact on overall care seeking among medical students. Future studies should expand to other medical and professional

  2. Access to specialty mental health services among women in California.

    Science.gov (United States)

    Kimerling, Rachel; Baumrind, Nikki

    2005-06-01

    The Anderson behavioral model was used to investigate racial and ethnic disparities in access to specialty mental health services among women in California as well as factors that might account for such disparities. The study was a cross-sectional examination of a probability sample of 3,750 California women. The main indicators of access to services were perceived need, service seeking, and service use. Multivariate models were constructed that accounted for need and enabling and demographic variables. Significant racial and ethnic variations in access to specialty mental health services were observed. African-American, Hispanic, and Asian women were significantly less likely to use specialty mental health services than white women. Multivariate analyses showed that Hispanic and Asian women were less likely than white women to report perceived need, even after frequent mental distress had been taken into account. Among women with perceived need, African-American and Asian women were less likely than white women to seek mental health services after differences in insurance status had been taken into account. Among women who sought services, Hispanic women were less likely than white women to obtain services after adjustment for the effects of poverty. Need and enabling factors did not entirely account for the observed disparities in access to services. Additional research is needed to identify gender- and culture-specific models for access to mental health services in order to decrease disparities in access. Factors such as perceived need and decisions to seek services are important factors that should be emphasized in future studies.

  3. Specialty-service lines: salvos in the new medical arms race.

    Science.gov (United States)

    Berenson, Robert A; Bodenheimer, Thomas; Pham, Hoangmai H

    2006-01-01

    Hospitals and physicians are developing and marketing discrete and profitable specialty-service lines. Although closely affiliated specialist physicians are central to hospitals' service-line products, other physicians compete directly with hospitals via physician-owned specialty facilities. Specialty-service lines may be provided in a variety of settings, both inside and outside traditional hospital walls. Thus far, the escalating battle between hospitals and physicians for control over specialty services has not affected hospital profitability. However, as the scope of care that can be safely performed in the outpatient arena expands, physician competition for control over specialty services may threaten hospitals' financial health.

  4. A Participatory Model of the Paradox of Primary Care

    Science.gov (United States)

    Homa, Laura; Rose, Johnie; Hovmand, Peter S.; Cherng, Sarah T.; Riolo, Rick L.; Kraus, Alison; Biswas, Anindita; Burgess, Kelly; Aungst, Heide; Stange, Kurt C.; Brown, Kalanthe; Brooks-Terry, Margaret; Dec, Ellen; Jackson, Brigid; Gilliam, Jules; Kikano, George E.; Reichsman, Ann; Schaadt, Debbie; Hilfer, Jamie; Ticknor, Christine; Tyler, Carl V.; Van der Meulen, Anna; Ways, Heather; Weinberger, Richard F.; Williams, Christine

    2015-01-01

    PURPOSE The paradox of primary care is the observation that primary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources, and have less health inequality. The purpose of this article is to explore, from a complex systems perspective, mechanisms that might account for the effects of primary care beyond disease-specific care. METHODS In an 8-session, participatory group model-building process, patient, caregiver, and primary care clinician community stakeholders worked with academic investigators to develop and refine an agent-based computer simulation model to test hypotheses about mechanisms by which features of primary care could affect health and health equity. RESULTS In the resulting model, patients are at risk for acute illness, acute life-changing illness, chronic illness, and mental illness. Patients have changeable health behaviors and care-seeking tendencies that relate to their living in advantaged or disadvantaged neighborhoods. There are 2 types of care available to patients: primary and specialty. Primary care in the model is less effective than specialty care in treating single diseases, but it has the ability to treat multiple diseases at once. Primary care also can provide disease prevention visits, help patients improve their health behaviors, refer to specialty care, and develop relationships with patients that cause them to lower their threshold for seeking care. In a model run with primary care features turned off, primary care patients have poorer health. In a model run with all primary care features turned on, their conjoint effect leads to better population health for patients who seek primary care, with the primary care effect being particularly pronounced for patients who are disadvantaged and patients with multiple chronic conditions. Primary care leads to more total health care visits that are due to more disease

  5. [Infectious diseases - a specialty of internal medicine].

    Science.gov (United States)

    Fätkenheuer, G; Jung, N; Kern, W V; Fölsch, U R; Salzberger, B

    2018-04-01

    Infectious diseases have recently gained wide public interest. Emerging infections and rising rates of antibiotic resistance are determining this trend. Both challenges will need to be addressed in international and local collaborations between different specialties in medicine and basic science. Infectious diseases as a clinical specialty in this scenario is directly responsible for the care of patients with infectious diseases. Its involvement in the care of patients with complicated infections has proved to be highly effective. Antibiotic stewardship programmes are effective measures in slowing the development of antibiotic resistance and have been widely implemented. But antibiotic stewardship specialists should not be confused with or taken as an alternative to infectious disease experts. Infectious diseases requires appropriate and specific training. It mainly uses the instrumentarium of internal medicine. With the current challenges in modern medicine, infectious diseases in Germany should thus be upgraded from a subspecialty to a clinical specialty, ideally within Internal Medicine.

  6. Care Seeking Determinants among Adolescents in Lagos, Nigeria ...

    African Journals Online (AJOL)

    Adolescents often lack basic reproductive health information, knowledge, and access to affordable confidential health services for reproductive health. This cross-sectional descriptive study aimed to examine the care seeking determinants of adolescents accessing the adolescent friendly services at the Action Health ...

  7. [The scientometric analysis of dissertation studies in the field of specialty public health and health care concerning children population].

    Science.gov (United States)

    Albitskiy, V S; Ustinova, N V; Antonova, Ye V

    2014-01-01

    The article considers trends and priority directions of research studies of the field of public health and health care of children population. The interpretative content analysis was applied to study dissertations in the field of public health and health care in 1991-2012. The sampling included 4194 units of information. The first stage of study established that problems of children population are considered in 14.8% dissertations defended on the mentioned specialty. The next stage the categories of content-analysis were examined. They were divided on the following axes: axis I "Main problem of study", axis II "Localization of study", axis III "Examined age groups", axis IV "Distribution of studies on gender of examined contingent", axis V "Examined contingent", axis VI "Additional medical specialty". It is established that in dissertations on public health and health care of children population on axis I prevails organizational subject matter (27.2%). The health condition of various contingents of children population (16.8%), preventive aspects of pediatrics (12.2%), examination of particular conditions/diseases/classes of diseases (10.8%) are fixed as priority directions. In the most dissertations the regional character of studies is presented (98.2%). The prevailing age group in studies is the adolescent group (19.9%). The inter-disciplinary relationships of dissertations on problems of public health and health care of children population are revealed with such specialties as "Pediatrics" (16.2%), "Obstetrics and gynecology" (3.8%) and "Hygiene" (3.4%). With consideration for recognition of health promotion and optimization of health care of children population as priority directions of public health policy amount of research studies in this field is to be admitted as inadequate. With purpose of optimization of scientific knowledge and development of system of medical social care to children population it is needed to promote research studies of problems of

  8. Collaboration between paediatric surgery and other medical specialties in Nigeria

    Directory of Open Access Journals (Sweden)

    Philemon E Okoro

    2012-01-01

    Full Text Available Background: The quality of service and success of patient care and research in most fields of medicine depend on effective collaboration between different specialties. Paediatric surgery is a relatively young specialty in Nigeria and such collaborations are desirable. This survey assesses the nature and extent of collaboration between paediatric surgery and other specialties in Nigeria. Materials and Methods: This is a questionnaire survey carried out in November 2008 among paediatric surgeons and their trainees practising in Nigeria. Questionnaires were distributed and retrieved either by hand or e-mailing. The responses were then collated and analysed using the SPSS 17.0. Results: Forty-seven respondents were included in the survey. Forty-five (95.7% respondents thought that there was inadequate collaboration and that there was a need for an increased collaboration between paediatric surgery and other specialties. Anaesthesia, paediatrics and radiology are among the specialties where collaborations were most required but not adequately received. Collaboration had been required from these specialties in areas of patient care, training and research. Reasons for inadequate collaboration included the paucity of avenues for inter-specialty communication and exchange of ideas 33 (70.3%, lack of awareness of the need for collaboration 32 (68.1%, tendency to apportion blames for bad outcome 13 (27.7%, and mutual suspicion 8 (17%. Conclusion: There is presently inadequate collaboration between paediatric surgery and other specialties in Nigeria. There is a need for more inter-specialty support, communication, and exchange of ideas in order to achieve desirable outcomes.

  9. Help and Care Seeking for Sexually Transmitted Infections Among Youth in Low- and Middle-Income Countries.

    Science.gov (United States)

    Newton-Levinson, Anna; Leichliter, Jami S; Chandra-Mouli, Venkatraman

    2017-06-01

    The ability to seek help or medical care for sexually transmitted infections (STIs) is vital for sexually active youth; yet, their needs are often unmet. We conducted a qualitative systematic review of studies to assess youth and provider views about the behaviors of young people in help seeking and care seeking for STI services in low- and middle-income countries. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (age, 10-24 years) and/or health service providers. Eighteen studies were identified for inclusion from 18 countries. Thematic analyses identified key themes across the studies. The majority of studies included discussion of youth not seeking treatment, resorting to self-treatment, or waiting to access care, suggesting that many youth still do not seek timely care for STIs. Youth desired more information on sexual health and cited barriers related to fear or taboos in obtaining help or information, especially from providers or parents. Many did not recognize symptoms or waited until symptoms worsened. However, many youth were able to identify a number of sources for STI related care including public and private clinics, pharmacies, alternative healers, and nongovernmental organizations. Youth's help seeking and care seeking preferences were frequently influenced by desires for confidentiality, friendliness, and cost. Youth in low- and middle-income countries experience significant barriers in help seeking for STIs and often do not seek or postpone medical care. Improving uptake may require efforts to address clinic systems, provider attitudes, confidentiality, and cultural norms related to youth sexuality.

  10. Delays and care seeking behavior among tuberculosis patients in ...

    African Journals Online (AJOL)

    Delays and care seeking behavior among tuberculosis patients in Tigray of Northern Ethiopia. Mengiste M Mesfin, Tesfay W Tasew, Israel G Tareke, Yohannes T Kifle, Witten H Karen, Madeley J Richard ...

  11. Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan.

    Science.gov (United States)

    Doocy, Shannon; Lyles, Emily; Roberton, Timothy; Akhu-Zaheya, Laila; Oweis, Arwa; Burnham, Gilbert

    2015-10-31

    There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model. Among adults, hypertension prevalence was the highest (9.7%, CI: 8.8-10.6), followed by arthritis (6.8%, CI: 5.9-7.6), diabetes (5.3%, CI: 4.6-6.0), chronic respiratory diseases (3.1%, CI: 2.4-3.8), and cardiovascular disease (3.7%, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7% (CI: 81.6-87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65%, (CI:0-88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89% (CI: 22-98) and 88% (CI: 13-98) lower odds of seeking care

  12. Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care.

    Science.gov (United States)

    Ellbrant, Julia A; Åkeson, S Jonas; Karlsland Åkeson, Pia M

    2018-06-01

    Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments - with overall reference to socioeconomic status - of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours ( p=0.014) and were scored as less urgent ( p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status ( p=0.027). Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.

  13. Emotions delay care-seeking in patients with an acute myocardial infarction.

    Science.gov (United States)

    Nymark, Carolin; Mattiasson, Anne-Cathrine; Henriksson, Peter; Kiessling, Anna

    2014-02-01

    In acute myocardial infarction the risk of death and loss of myocardial tissue is at its highest during the first few hours. However, the process from symptom onset to the decision to seek medical care can take time. To comprehend patients' pre-hospital delay, attention must be focused on the circumstances preceding the decision to seek medical care. To add a deeper understanding of patients' thoughts, feelings and actions that preceded the decision to seek medical care when afflicted by an acute myocardial infarction. Fourteen men and women with a first or second acute myocardial infarction were interviewed individually in semi-structured interviews. Data were analysed by qualitative content analysis. Four themes were conceptualized: 'being incapacitated by fear, anguish and powerlessness', 'being ashamed of oneself', 'fear of losing a healthy identity' and 'striving to avoid fear by not interacting with others'. Patients were torn between feelings such as anguish, fear, shame and powerlessness. They made an effort to uphold their self-image as being a healthy person thus affected by an unrecognized discomfort. This combined with a struggle to protect others from involvement, strengthened the barriers to seeking care. The present study indicates that emotional reactions are important and influence patients' pre-hospital behaviour. Being ashamed of oneself stood out as a novel finding. Emotions might be an important explanation of undesired and persisting patient delays. However, our findings have to and should be evaluated quantitatively. Such a study is in progress.

  14. Specialty and full-service hospitals: a comparative cost analysis.

    Science.gov (United States)

    Carey, Kathleen; Burgess, James F; Young, Gary J

    2008-10-01

    To compare the costs of physician-owned cardiac, orthopedic, and surgical single specialty hospitals with those of full-service hospital competitors. The primary data sources are the Medicare Cost Reports for 1998-2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database. We identified all physician-owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full-service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t-tests of significance compared the inefficiency measures of specialty hospitals with those of full-service hospitals to make general comparisons between these classes of hospitals. Results do not provide evidence that specialty hospitals are more efficient than the full-service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect. Policymakers should not embrace the assumption that physician-owned specialty hospitals produce patient care more efficiently than their full-service hospital competitors.

  15. Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda.

    Science.gov (United States)

    Kagabo, Daniel M; Kirk, Catherine M; Bakundukize, Benjamin; Hedt-Gauthier, Bethany L; Gupta, Neil; Hirschhorn, Lisa R; Ingabire, Willy C; Rouleau, Dominique; Nkikabahizi, Fulgence; Mugeni, Catherine; Sayinzoga, Felix; Amoroso, Cheryl L

    2018-01-01

    Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children's lives. This study describes the context surrounding children's deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the child's death, and identifies factors associated with care-seeking for these children in rural Rwanda. Secondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the child's birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisher's exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level. Among the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking. Interventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further

  16. Health insurance and care-seeking behaviours of female migrants in Accra, Ghana.

    Science.gov (United States)

    Lattof, Samantha R

    2018-05-01

    People working in Ghana's informal sector have low rates of enrolment in the publicly funded National Health Insurance Scheme. Informal sector workers, including migrant girls and women from northern Ghana working as head porters (kayayei), report challenges obtaining insurance and seeking formal health care. This article analyses how health insurance status affects kayayei migrants' care-seeking behaviours. This mixed-methods study involved surveying 625 migrants using respondent-driven sampling and conducting in-depth interviews with a sub-sample of 48 migrants. Analyses explore health status and health seeking behaviours for recent illness/injury. Binary logistic regression modelled the effects of selected independent variables on whether or not a recently ill/injured participant (n = 239) sought health care. Although recently ill/injured participants (38.4%) desired health care, less than half (43.5%) sought care. Financial barriers overwhelmingly limit kayayei migrants from seeking health care, preventing them from registering with the National Health Insurance Scheme, renewing their expired health insurance policies, or taking time away from work. Both insured and uninsured migrants did not seek formal health services due to the unpredictable nature of out-of-pocket expenses. Catastrophic and impoverishing medical expenses also drove participants' migration in search of work to repay loans and hospital bills. Health insurance can help minimize these expenditures, but only 17.4% of currently insured participants (58.2%) reported holding a valid health insurance card in Accra. The others lost their cards or forgot them when migrating. Access to formal health care in Accra remains largely inaccessible to kayayei migrants who suffer from greater illness/injury than the general female population in Accra and who are hindered in their ability to receive insurance exemptions. With internal migration on the rise in many settings, health systems must recognize the

  17. Report of the ASHP Task Force on Caring for Patients Served by Specialty Suppliers.

    Science.gov (United States)

    Caselnova, Dominick; Donley, Kathy; Ehlers, Diane; Hyduk, Amy E; Koontz, Susannah E; Nowobilski-Vasilios, Anna; Pawlicki, Kathleen S; Poikonen, John C; Poremba, Art C; Sasser, Cathy L; Schell, Kenneth H; Schwab, Jay L; Swinarski, Dave; Chen, David; Kirschenbaum, Bonnie; Armitstead, John

    2010-10-01

    Task Force recommendations are discussed in more detail in eAppendix A (available at www.ajhp.org). What follows is a brief summary of those recommendations. In very abbreviated terms, the Task Force suggested that ASHP: 1. Consider creating and maintaining a Web resource center on ASHP's website to provide information about restricted drug distributions systems (RDDSs), risk evaluation and mitigation strategies (REMSs), risk assessment and minimization plans (RiskMAPs), and specialty suppliers and products. 2. Provide comprehensive education to members, other health professionals, regulators, third-party payers, patients, and other stakeholders about RDDSs, REMSs, RiskMAPs, and specialty suppliers and products. 3. Develop policies to advocate that a. Pharmacists serve as the institutional leaders in compliance and utilization challenges of safely managing externally supplied medications and related drug administration devices, b. Agencies, organizations, and associations that influence the distribution, sale, and dispensing of medications under these alternative distribution models address issues these models create in continuity of care, reimbursement, and patient safety, c. The Centers for Medicare and Medicaid Services and the Joint Commission develop standards and interpretations that accommodate hospital use of these products and devices when currently available technology (e.g., cold-chain storage, e-pedigree) is used to ensure patient safety, d. Group purchasing organizations negotiate contractual arrangements for specialty pharmaceuticals for both acquisition costs and distribution arrangements, and e. Information technology (IT) be used to resolve issues created by alternative distribution models and that ASHP work with IT vendors to ensure that programs are designed to meet the needs of these evolving models. 4. Quantify through research, perhaps in cooperation with entities such as the Agency for Healthcare Research and Quality, the Institute of

  18. Health care information seeking and seniors: determinants of Internet use.

    Science.gov (United States)

    Sheng, Xiaojing; Simpson, Penny M

    2015-01-01

    While seniors are the most likely population segment to have chronic diseases, they are the least likely to seek information about health and diseases on the Internet. An understanding of factors that impact seniors' usage of the Internet for health care information may provide them with tools needed to improve health. This research examined some of these factors as identified in the comprehensive model of information seeking to find that demographics, trust in health information websites, perceived usefulness of the Internet, and internal locus of control each significantly impact seniors' use of the Internet to seek health information.

  19. Do financial incentives linked to ownership of specialty hospitals affect physicians' practice patterns?

    Science.gov (United States)

    Mitchell, Jean M

    2008-07-01

    Although physician-owned specialty hospitals have become increasingly prevalent in recent years, little research has examined whether the financial incentives linked to ownership influence physicians' referral rates for services performed at the specialty hospital. We compared the practice patterns of physician owners of specialty hospitals in Oklahoma, before and after ownership, to the practice patterns of physician nonowners who treated similar cases over the same time period in Oklahoma markets without physician-owned specialty hospitals. We constructed episodes of care for injured workers with a primary diagnosis of back/spine disorders. We used pre-post comparisons and difference-in-differences analysis to evaluate changes in practice patterns for physician owners and nonowners over the time period spanned by the entry of the specialty hospital. Findings suggest the introduction of financial incentives linked to ownership coincided with a significant change in the practice patterns of physician owners, whereas such changes were not evident among physician nonowners. After physicians established ownership interests in a specialty hospital, the frequency of use of surgery, diagnostic, and ancillary services used in the treatment of injured workers with back/spine disorders increased significantly. Physician ownership of specialty hospitals altered the frequency of use for an array of procedures rendered to patients treated at these hospitals. Given the growth in physician-owned specialty hospitals, these findings suggest that health care expenditures will be substantially greater for patients treated at these institutions relative to persons who obtain care from nonself-referral providers.

  20. Exploring Attitudes of Indian Classical Singers Toward Seeking Vocal Health Care.

    Science.gov (United States)

    Gunjawate, Dhanshree R; Aithal, Venkataraja U; Guddattu, Vasudeva; Kishore, Amrutha; Bellur, Rajashekhar

    2016-11-01

    The attitude of Indian classical singers toward seeking vocal health care is a dimension yet to be explored. The current study was aimed to determine the attitudes of these singers toward seeking vocal health care and further understand the influence of age and gender. Cross-sectional. A 10-item self-report questionnaire adapted from a study on contemporary commercial music singers was used. An additional question was added to ask if the singer was aware about the profession and role of speech-language pathologists (SLPs). The questionnaire was administered on 55 randomly selected self-identified trained Indian classical singers who rated the items using a five-point Likert scale. Demographic variables were summarized using descriptive statistics and t test was used to compare the mean scores between genders and age groups. Of the singers, 78.2% were likely to see a doctor for heath-related problems, whereas 81.8% were unlikely to seek medical care for voice-related problems; the difference was statistically significant (P attitudes toward findings from medical examination by a specialist revealed a statistically significant difference (P = 0.02) between the genders. Age did not have a significant influence on the responses. Only 23.6% of the respondents were aware about the profession and the role of SLPs. The findings are in tune with western literature reporting hesitation of singers toward seeking vocal health care and draws attention of SLPs to promote their role in vocal health awareness and management. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  1. Maternal knowledge and care.seeking behaviors for newborn ...

    African Journals Online (AJOL)

    Background: Delay in the presentation of infants with jaundice at the hospital is a reason for the persistence of the severe forms of jaundice. Objective: The aim was to determine the influence of maternal knowledge on newborn jaundice on their care-seeking practices. Methods: In a cross-sectional survey, mothers whose ...

  2. Pediatric Dentistry Specialty as Part of a Longer Continuum of Care: A Commentary.

    Science.gov (United States)

    Waldman, H Barry; Rader, Rick; Sulkes, Stephen; Perlman, Steven P

    The transition of teenagers with special needs to young adulthood is a complex period for the children and their families. This transition is especially difficult when it comes to securing needed oral health care. The teenager is forced to transfer from the services of an age defined pediatric dental specialist with training to provide care for individuals with special needs, to 1) general practitioners with limited formal training and often unwillingness to provide care and 2) at a period when most states provide limited or lack of adult dental Medicaid programs. These issues and the need to expand pediatric dental specialist involvement in the general transitional period are reviewed. "Pediatric dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs."(1) "Our system of preparing and maintaining our abilities to provide oral health services for an increasing diverse population must be brought up to date to meet the challenges posed by the treatment of young adults with disabilities."(2) "Most responding dentists (to a national study of pediatric dentists) helped adolescents with and without SHCNs (Special Health Care Needs) make the transition into adult care, but the major barrier was the availability of general dentists and specialists."(3).

  3. Impact of a national specialty e-consultation implementation project on access.

    Science.gov (United States)

    Kirsh, Susan; Carey, Evan; Aron, Dacid C; Cardenas, Omar; Graham, Glenn; Jain, Rajiv; Au, David H; Tseng, Chin-Lin; Franklin, Heather; Ho, P Michael

    2015-12-01

    To assess the early impact of implementation of the electronic consults (e-consults) initiative by the Veterans Health Administration (VHA), designed to improve specialty care access. Observational cohort study exploiting a natural experiment begun in May 2011 at 12 VHA medical centers and expanded to 122 medical centers by December 2013. The following were assessed: 1) growth of e-consults by VHA regional networks, medical centers, and specialty; 2) location of patient's primary care provider (medical center vs community-based outpatient clinic [CBOC]); 3) potential patient miles needed to travel for a specialty care face-to-face consult in place of the observed e-consults using estimated geodesic distance; 4) use of specialty care subsequent to the e-consult. Of 11,270,638 consults completed in 13 clinics of interest, 217,014 were e-consults (adjusted rate, 1.93 e-consults per 100 consults). The e-consult rate was highest in endocrinology (5.0 per 100), hematology (3.0 per 100), and gastroenterology (3.0 per 100). The percentage of e-consult patients with CBOC-based primary care grew from 28.5% to 44.4% in the first year of implementation and to 45.6% at year 3. Of those e-consult patients from community clinics, the average potential miles needed to travel was 72.1 miles per patient (SD = 72.6; median = 54.6; interquartile range = 17.1-108), translating to a potential savings of 6,875,631 total miles and travel reimbursement costs of $2,853,387. E-consult volume increased significantly since inception within many medical and surgical specialties. For patients receiving primary care at one of more than 800 CBOCs, e-consults may decrease travel burden and direct travel costs for patients.

  4. Factors affecting eye care-seeking behavior of parents for their children.

    Science.gov (United States)

    Balasubramaniam, Sudharsanam M; Kumar, Divya Senthil; Kumaran, Sheela Evangeline; Ramani, Krishna Kumar

    2013-10-01

    Most of the causes of childhood blindness are either treatable or preventable. Eye care-seeking behavior (ESB) of parents for their children plays a pivotal role in reducing this problem. This study was done because there was a sparsity of literature in this context and with a view to help eye care professionals plan better programs and to identify factors facilitating and/or hindering ESB of parents for their school-going children in an urban area. This study adopted a qualitative snapshot narrative study design. In-depth interviews and focus group discussions were conducted in areas of Chennai with parents and eye care professionals selected through stratified purposive sampling. Parents were based on those who sought care and did not seek care after a school eye screening program and on their socioeconomic status. Data were transcribed to English, familiarized, and inductive coded, and themes were formed. Redundancy was considered as end point of data collection. Two focus group discussions and 11 in-depth interviews were conducted. Squint, redness or watering of eyes, eye irritation, headache, family history of ocular diseases, severity, and repetitiveness of symptoms facilitate parents seeking eye care for their wards/children. Economic status was an important barrier reported to affect the ESB. Logistic factors like taking appointment with doctor, taking leave from work, transport, and traveling distance were noted. This study shows the facilitating factors and barriers for ESB of the Chennai urban parents for their wards. The results suggest that efforts needed to be put to overcome the barriers through planned awareness programs.

  5. Children referred for specialty care: Parental perspectives and preferences on referral, follow-up and primary care.

    Science.gov (United States)

    Freed, Gary L; Turbitt, Erin; Kunin, Marina; Gafforini, Sarah; Sanci, Lena; Spike, Neil

    2017-01-01

    Over the last decade, there has been a dramatic increase in the number of referrals for paediatric subspecialty care and in overall appointments (new and review) to these doctors. We sought to determine the perspective of parents regarding their role in the initiation of referrals, their preferences for follow-up and the role of general practitioners (GPs) in care co-ordination. Self-completed survey in outpatient paediatric clinics (general paediatrics and four subspecialties) at two children's hospitals in Victoria. Recruitment targets were 100 parents in each of the general paediatrics clinics and 50 parents in each subspecialty clinic, equally divided between new and review visits (total n = 600). A total of 606 parents provided responses, with a decline rate of 9%. Many (52%) new patients were referred by a GP with the remainder from a variety of other sources. With specific regard to providing general care to their child, only 45% were completely confident in a GP. Most (76%) agreed with the statement that a GP would give their child a referral to see a paediatrician whenever they ask. Approximately, a third of parents reported that a GP rarely or never co-ordinates the care of their child with other doctors. Parents play an important role in both the initiation of paediatric specialty referrals and the patterns of follow-up care provided. Parent perspectives, preferences and motivations on both the referral process and the patterns for ongoing care are essential to develop policies that provide the best and most efficient care for children. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  6. The importance of job characteristics in determining medical care-seeking in the Dutch working population, a longitudinal survey study.

    Science.gov (United States)

    Steenbeek, Romy

    2012-08-31

    The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking. Data were collected in a longitudinal two-wave study (n = 2305 workers). The outcome measures were visits (yes/no and frequency) to a general practitioner (GP), a physical therapist, a medical specialist and/or a mental health professional. Multivariate regression analyses were carried out separately for men and women for workers with health complaints. In the Dutch working population, personal, health, and work characteristics, but not sickness absence, were associated with later care-seeking. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. Women experience more health complaints and seek health care more often than men. For women, experiencing a work handicap (health complaints that impede work performance) was the only work characteristic associated with more care-seeking (GP). For men, work characteristics that led to less care-seeking were social support by colleagues (GP frequency), high levels of decision latitude (GP frequency) and high levels of social support by the supervisor (medical specialist). Other work characteristics led to more care-seeking: high levels of engagement (GP), full time work (GP frequency) and experiencing a work handicap (physical therapist). We can conclude that personal and health characteristics are most important when explaining medical care-seeking in the Dutch working population. Work characteristics independently attributed to medical care-seeking but only for men and only for the

  7. Patterns and determinants of care seeking for obstetric complications in rural northwest Bangladesh: analysis from a prospective cohort study.

    Science.gov (United States)

    Sikder, Shegufta S; Labrique, Alain B; Craig, Ian M; Wakil, Mohammad Abdul; Shamim, Abu Ahmed; Ali, Hasmot; Mehra, Sucheta; Wu, Lee; Shaikh, Saijuddin; West, Keith P; Christian, Parul

    2015-04-18

    In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions. Utilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor). Out of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p s literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women's employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers. While the majority of women reporting obstetric complications sought care, less than a third visited health facilities. Improvements in socioeconomic factors such as maternal literacy, coupled with improved geographic access and

  8. The tremendous cost of seeking hospital obstetric care in Bangladesh.

    Science.gov (United States)

    Afsana, Kaosar

    2004-11-01

    In Bangladesh, maternal mortality is estimated to be 320 per 100,000 live births, among the highest in the world, and most deliveries in rural areas occur at home. Women with obstetric complications fear to seek hospital care for various reasons; one of which is the tremendous cost. This paper shows how cost impedes rural, poor women's access to emergency obstetric care. The data are from a larger ethnographic study of childbirth practices in 2000--01 in Apurbabari village, the adjacent sub-district health complex and more distant tertiary hospitals at district level. Families had to spend what for them added up to a fortune for a caesarean section and other surgery, medicines, laboratory investigations, blood transfusion, food, travel and other expenses. Corruption in the form of demands for under-the-table payments to obtain these aspects of essential care is rife. Adequate resources should be allocated to the different health facilities, including for emergency obstetric treatment. Thana health complexes (sub-district hospitals) should be upgraded to provide comprehensive obstetric care. The system for prescribing drugs should be reformed and the causes of corruption investigated and addressed. Hospital care should not be allowed to further impoverish the poor. Addressing these issues will help to encourage rural, poor women to seek skilled delivery and post-partum care, particularly in emergency situations.

  9. Awareness of treatment history in family and friends, and mental health care seeking propensity.

    Science.gov (United States)

    Thériault, François L; Colman, Ian

    2017-04-01

    Many adults suffering from mental disorders never receive the care they need. The role of family and friends in overcoming mental health treatment barriers is poorly understood. We investigated the association between awareness of lifetime mental health treatment history in one's family or friends, and likelihood of having recently received mental health care for oneself. Using Canadian Community Health Survey 2012-Mental Health data, we defined care seekers as individuals who talked about mental health issues to at least one health professional in the past 12 months. Seekers were matched to non-seekers based on estimated care seeking propensity, and 1933 matched pairs were created. Reported awareness of lifetime treatment history in family and friends was compared between seekers and non-seekers. There were no differences in the distribution of any confounder of interest between seekers and non-seekers. 73% of seekers were aware of treatment history in family or friends, compared to only 56% of non-seekers (RR 1.3; 95% CI 1.2, 1.3). Awareness of treatment history in family members had nearly identical associations with care seeking as awareness of treatment history in friends. We have found a social clustering of mental health care seeking behavior; individuals who were aware of lifetime treatment history in family or friends were more likely to have recently sought care for themselves. These novel results are consistent with a social learning model of care seeking behavior, and could inform efforts to bridge the current mental health treatment gap.

  10. Accustomed to enduring: experiences of African-American women seeking care for cardiac symptoms.

    Science.gov (United States)

    Banks, Angela D; Malone, Ruth E

    2005-01-01

    Understand the meaning of delayed treatment seeking in African-American women with unstable angina and myocardial infarction. Phenomenologic analysis of in-depth interview data and field notes on 12 African-American women hospitalized with unstable angina or myocardial infarction. Women's interpretation of and response to symptoms were informed by experiences of marginalization and their self-understanding as people who were strong and who had endured life's hardships. When hospitalized, some women experienced trivialization of their complaints by clinicians and a focus on technological procedures over respectfully attending to their concerns, which provided further disincentives to seeking care. Three major themes emerged: misrecognition and discounting of symptoms, enduring, and influence of faith. Experiences of marginalization shape responses to symptoms, care-seeking behavior, and interpretation of subsequent care experiences for African-American women with cardiac disease, who may experience different symptoms as well as interpret them differently than members of other groups.

  11. Do work-related factors affect care-seeking in general practice for back pain or upper extremity pain?

    Science.gov (United States)

    Jensen, Jens Christian; Haahr, Jens Peder; Frost, Poul; Andersen, Johan Hviid

    2013-10-01

    Musculoskeletal pain conditions remain a major cause of care-seeking in general practice. Not all patients with musculoskeletal pain (MP) seek care at their general practitioner (GP), but for those who do, the GP's knowledge of what work-related factors might have influenced the patient's decision to seek care could be important in order to give more well-founded advice to our patients. The objective of this study was to elucidate the effects of workloads on care-seeking for back pain or upper extremity pain during an eighteen-month follow-up period. This is a prospective study with a baseline questionnaire and eighteen-month follow-up. Among the registered patients of 8 GPs, we identified 8,517 persons between 17 and 65 years of age, who all received the questionnaire. A total of 5,068 (59.5 %) persons answered. During the eighteen months of follow-up, we used the International Classification for Primary Care (ICPC) to identify all care-seekers with either back pain or upper extremity pain. Of these, all currently employed persons were included in our analysis, in all 4,325 persons. For analysis, we used Cox proportional hazards regression analysis. Analyses were stratified by gender. High levels of heavy lifting, defined as the upper tertile on a categorical scale, were associated with care-seeking for back pain (HR 1.90 [95 % CI: 1.14-3.15]) and upper extremity pain (HR 2.09 [95 % CI: 1.30-3.38]) among males, but not in a statistically significant way among females. Repetitive work and psychosocial factors did not have any statistically significant impact on care-seeking for neither back pain nor upper extremity pain. Work-related factors such as heavy lifting do, to some extent, contribute to care-seeking with MP. We suggest that asking the patient about physical workloads should be routinely included in consultations dealing with MP.

  12. Healthcare-seeking behavior of patients with epileptic seizure disorders attending a tertiary care hospital, Kolkata

    Directory of Open Access Journals (Sweden)

    Abhik Sinha

    2012-01-01

    Full Text Available Introduction : Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique. Aims and Objectives: The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants. Materials and Methods: Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma. Results and Conclusion: More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.

  13. Temporomandibular disorders and chronic daily headaches in the community and in specialty care.

    Science.gov (United States)

    da Silva Junior, Ariovaldo Alberto; Krymchantowski, Abouch Valenty; Gomes, João Bosco Lima; Leite, Frederico Mota Gonçalves; Alves, Betânia Mara Franco; Lara, Rodrigo Pinto; Gómez, Rodrigo Santiago; Teixeira, Antônio Lúcio

    2013-09-01

    Chronic daily headaches (CDHs) are often associated with temporomandibular disorders (TMDs). However, large studies assessing the relationship were conducted in general, and not clinical, populations. Thus, clinical exams were not completed. Clinic-based studies with expert diagnosis are, in turn, often small and may not be representative. To contrast the demographic and clinical symptoms of CDH and TMD in participants within the general population relative to patients seen in a headache clinic. All inhabitants 10 years and older of a small city in Brazil were interviewed. Those with more than 15 days of headache per month were examined by a team consisting of a neurologist, a dentist, and a physical therapist. Headaches were classified as per the Second Edition of the International Classification of Headache Disorders and TMD as per the Research Diagnostic Criteria. The procedure was repeated (by the same team) with CDH sufferers consecutively seen in a headache center. Of 1605 inhabitants interviewed, 57 (3.6%) had CDH, and 43 completed all physical assessments. For specialty care group, of 289 patients, 92 had CDH, and 85 completed all assessments. No significant differences were seen for gender and age, but education level was significantly higher among those recruited at specialty care. Muscular TMD happened in 30.2% of CDH patients from the community vs 55.3% in the headache center (difference of -25.1%, 95% confidence interval of difference=-40.8% to -9.4%). No TMD happened in 41.9% of those recruited from the population relative to 20% of those in the headache center (21.9%, 95% confidence interval=6.7-37.1%). Individuals with CDH recruited from the general population are significantly less likely to have CDH relative to those selected from the headache center. Issues of generalizability are of concern when conducting clinic-based studies on the topic. © 2013 American Headache Society.

  14. The impact of endovascular repair on specialties performing abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Ultee, Klaas H J; Hurks, Rob; Buck, Dominique B.; Dasilva, George S.; Soden, Peter A.; Van Herwaarden, Joost A.; Verhagen, Hence J M; Schermerhorn, Marc L.

    2015-01-01

    Background Abdominal aortic aneurysm (AAA) repair has been performed by various surgical specialties for many years. Endovascular aneurysm repair (EVAR) may be a disruptive technology, having an impact on which specialties care for patients with AAA. Therefore, we examined the proportion of AAA

  15. The impact of endovascular repair on specialties performing abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    K.H.J. Ultee (Klaas); R. Hurks (Rob); D.B. Buck (Dominique B.); G.S. Dasilva (George S.); P.A. Soden (Peter A.); J.A. van Herwaarden (Joost); H.J.M. Verhagen (Hence); M.L. Schermerhorn (Marc)

    2015-01-01

    textabstractBackground Abdominal aortic aneurysm (AAA) repair has been performed by various surgical specialties for many years. Endovascular aneurysm repair (EVAR) may be a disruptive technology, having an impact on which specialties care for patients with AAA. Therefore, we examined the proportion

  16. Health care utilization and barriers experienced by individuals with spinal cord injury.

    Science.gov (United States)

    Stillman, Michael D; Frost, Karen L; Smalley, Craig; Bertocci, Gina; Williams, Steve

    2014-06-01

    To identify from whom individuals with spinal cord injury (SCI) seek health care, the percentage who receive preventative care screenings, and the frequency and types of barriers they encounter when accessing primary and specialty care services; and to examine how sociodemographic factors affect access to care and receipt of preventative screenings. Cross-sectional, observational study using an Internet-based survey. Internet based. Adults (N=108) with SCI who use a wheelchair as their primary means of mobility in the community. Not applicable. Health care utilization during the past year, barriers encountered when accessing health care facilities, and receipt of routine care and preventative screenings. All but 1 participant had visited a primary care provider within the past 12 months, and 85% had had ≥ 1 visit to specialty care providers. Accessibility barriers were encountered during both primary care (91.1%) and specialty care (80.2%) visits; most barriers were clustered in the examination room. The most prevalent barriers were inaccessible examination tables (primary care=76.9%; specialty care=51.4%) and lack of transfer aids (primary care=69.4%; specialty care=60.8%). Most participants had not been weighed during their visit (89%) and had remained seated in their wheelchair during their examinations (85.2%). Over one third of individuals aged ≥ 50 years had not received a screening colonoscopy, 60% of women aged ≥ 50 years had not had a mammogram within the past year, 39.58% of women had not received a Papanicolaou smear within the previous 3 years, and only 45.37% of respondents had ever received bone density testing. Individuals with SCI face remediable obstacles to care and receive fewer preventative care screenings than their nondisabled counterparts. We recommend that clinics conduct Americans with Disabilities Act self-assessments, ensure that their clinical staff are properly trained in assisting individuals with mobility disabilities, and take

  17. Newborn care seeking practices in Central and Southern Ethiopia ...

    African Journals Online (AJOL)

    admin

    Objective: To investigate local perspectives and practices related to newborn care-seeking and the factors affecting them. .... In Arbe Gonna, they rub the newborn with a herb called hamessa, or take the baby to a health facility like many mothers in the other communities. Sore skin is .... Levels & Trends in Child Mortality.

  18. Gender differences in health care-seeking behavior for sexually transmitted diseases: a population-based study in Nairobi, Kenya.

    Science.gov (United States)

    Voeten, Hélène A C M; O'hara, Hilda B; Kusimba, Judith; Otido, Julius M; Ndinya-Achola, Jeckoniah O; Bwayo, Job J; Varkevisser, Corlien M; Habbema, J Dik F

    2004-05-01

    Health care-seeking behavior for sexually transmitted diseases (STDs) is important in STD/HIV control. The goal of this study was to describe the proportion seeking care, patient delay, and choice of provider among men and women with STD-related complaints in Nairobi, Kenya. A population-based questionnaire was administered in 7 randomly selected clusters (small geographic areas covering approximately 150 households each). Of the 291 respondents reporting complaints, 20% of men versus 35% of women did not seek care, mainly because symptoms were not considered severe, symptoms had disappeared, or as a result of lack of money. Of those who sought care, women waited longer than men (41 vs. 16 days). Most men and women went to the private sector (72% and 57%, respectively), whereas the informal sector was rarely visited (13% and 16%, respectively). Relatively more women visited the government sector (28% vs. 15%). Because women were mostly monogamous, they did not relate their complaints to sexual intercourse, which hampered prompt care-seeking. Women should be convinced to seek care promptly, eg, through health education in communities.

  19. Health care-seeking behaviour for child illnesses among rural ...

    African Journals Online (AJOL)

    The aim of this study was to examine the health care-seeking behaviour of mothers when their children under five years suffer from common childhood illnesses such as diarrhoea, fever, cough and worms. The study was conducted in a rural community in the Limpopo Province of South Africa. The sample consisted of 100 ...

  20. Brief Report: Need for Autonomy and Other Perceived Barriers Relating to Adolescents' Intentions to Seek Professional Mental Health Care

    Science.gov (United States)

    Wilson, Coralie J.; Deane, Frank P.

    2012-01-01

    The current study examined the relationship between belief-based barriers to seeking professional mental health care and help-seeking intentions in a sample of 1037 adolescents. From early adolescence to adulthood, for males and females, the need for autonomy was a strong barrier to seeking professional mental health care. Help-seeking fears were…

  1. Health Problems and Health Care Seeking Behaviour of Rohingya Refugees

    OpenAIRE

    Masud, Abdullah Al; Ahmed, Md. Shahoriar; Sultana, Mst. Rebeka; Alam, S. M. Iftekhar; Kabir, Russell; Arafat, S. M. Yasir; Papadopoulos, Konstantinos

    2017-01-01

    Abstract Background: Rohingya refugees are one of the most vulnerable group due to lack of health care system, personal hygiene, shelter, sanitation and violence. Aim: The present study aims to find out the health problems and health care seeking behavior of rohingya refugee peoples, to identify the socio-demographic information for such exposure group in relation to age, sex, occupation, living areas, to explore the patient's physical, emotional, perceptions, attitudes and environmen...

  2. Specialties differ in which aspects of doctor communication predict overall physician ratings.

    Science.gov (United States)

    Quigley, Denise D; Elliott, Marc N; Farley, Donna O; Burkhart, Q; Skootsky, Samuel A; Hays, Ron D

    2014-03-01

    Effective doctor communication is critical to positive doctor-patient relationships and predicts better health outcomes. Doctor communication is the strongest predictor of patient ratings of doctors, but the most important aspects of communication may vary by specialty. To determine the importance of five aspects of doctor communication to overall physician ratings by specialty. For each of 28 specialties, we calculated partial correlations of five communication items with a 0-10 overall physician rating, controlling for patient demographics. Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS®) 12-month Survey data collected 2005-2009 from 58,251 adults at a 534-physician medical group. CG-CAHPS includes a 0 ("Worst physician possible") to 10 ("Best physician possible") overall physician rating. Five doctor communication items assess how often the physician: explains things; listens carefully; gives easy-to-understand instructions; shows respect; and spends enough time. Physician showing respect was the most important aspect of communication for 23/28 specialties, with a mean partial correlation (0.27, ranging from 0.07 to 0.44 across specialties) that accounted for more than four times as much variance in the overall physician rating as any other communication item. Three of five communication items varied significantly across specialties in their associations with the overall rating (p importance of other aspects of communication varied significantly by specialty. Quality improvement efforts by all specialties should emphasize physicians showing respect to patients, and each specialty should also target other aspects of communication that matter most to their patients. The results have implications for improving provider quality improvement and incentive programs and the reporting of CAHPS data to patients. Specialists make important contributions to coordinated patient care, and thus customized approaches to measurement

  3. Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents.

    Science.gov (United States)

    Dodd, Virginia J; Logan, Henrietta; Brown, Cameron D; Calderon, Angela; Catalanotto, Frank

    2014-12-01

    An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents. Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male. Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care. Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed. © 2014, American School Health Association.

  4. Help and Care Seeking for Sexually Transmitted Infections Among Youth in Low- and Middle-Income Countries

    OpenAIRE

    Newton-Levinson, Anna; Leichliter, Jami S.; Chandra-Mouli, Venkatraman

    2017-01-01

    Background The ability to seek help or medical care for sexually transmitted infections (STIs) is vital for sexually active youth; yet, their needs are often unmet. Methods We conducted a qualitative systematic review of studies to assess youth and provider views about the behaviors of young people in help seeking and care seeking for STI services in low- and middle-income countries. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of yo...

  5. The Effect of Medical Student Volunteering in a Student-Run Clinic on Specialty Choice for Residency.

    Science.gov (United States)

    Brown, Ashley; Ismail, Rahim; Gookin, Glenn; Hernandez, Caridad; Logan, Grace; Pasarica, Magdalena

    2017-01-09

     Student-run free clinics (SRFCs) are a recent popular addition to medical school education, and a subset of studies has looked at the influence of SRFC volunteering on the medical student's career development. The majority of the research done in this area has focused on understanding if these SRFCs produce physicians who are more likely to practice medicine in underserved communities, caring for the uninsured. The remainder of the research has investigated if volunteering in an SRFC influences the specialty choice of medical school students. The results of these specialty choice studies give no definitive answer as to whether medical students chose primary or specialty care residencies as a result of their SRFC experience. Keeping Neighbors in Good Health through Service (KNIGHTS) is the SRFC of the University of Central Florida College of Medicine (UCF COM). Both primary and specialty care is offered at the clinic. It is the goal of this study to determine if volunteering in the KNIGHTS SRFC influences UCF COM medical students to choose primary care, thereby helping to meet the rising need for primary care physicians in the United States.  A survey was distributed to first, second, and third-year medical students at the UCF COM to collect data on demographics, prior volunteering experience, and specialty choice for residency. Responses were then combined with records of volunteer hours from the KNIGHTS Clinic and analyzed for correlations. We analyzed the frequency and Pearson's chi-squared values. A p value of less than 0.05 was considered statistically significant.  Our survey had a total response rate of 39.8%. We found that neither the act of becoming a KNIGHTS Clinic volunteer nor the hours volunteered at the KNIGHTS Clinic influenced the UCF COM student's choice to enter a primary care specialty (p = NS). Additionally, prior volunteering/clinical experience or the gender of the medical school student did not influence a student's choice to volunteer at

  6. A cross-sectional survey of parental care-seeking behavior for ...

    African Journals Online (AJOL)

    Background: Infections are a common cause of childhood morbidity and mortality in developing countries. Proper management of these conditions in appropriate health facilities provides the best opportunity for survival and reducing disability. Aims: To evaluate the care-seeking behavior by parents of under-five children ...

  7. Characteristics of Adults Seeking Health Care Provider Support Facilitated by Mobile Technology: Secondary Data Analysis.

    Science.gov (United States)

    Bosak, Kelly; Park, Shin Hye

    2017-12-21

    Mobile health technology is rapidly evolving with the potential to transform health care. Self-management of health facilitated by mobile technology can maximize long-term health trajectories of adults. Little is known about the characteristics of adults seeking Web-based support from health care providers facilitated by mobile technology. This study aimed to examine the following: (1) the characteristics of adults who seek human support from health care providers for health concerns using mobile technology rather than from family members and friends or others with similar health conditions and (2) the use of mobile health technology among adults with chronic health conditions. Findings of this study were interpreted in the context of the Efficiency Model of Support. We first described characteristics of adults seeking Web-based support from health care providers. Using chi-square tests for categorical variables and t test for the continuous variable of age, we compared adults seeking Web-based and conventional support by demographics. The primary aim was analyzed using multivariate logistic regression to examine whether chronic health conditions and demographic factors (eg, sex, income, employment status, race, ethnicity, education, and age) were associated with seeking Web-based support from health care providers. The sample included adults (N=1453), the majority of whom were female 57.60% (837/1453), white 75.02% (1090/1453), and non-Hispanic 89.13% (1295/1453). The age of the participants ranged from 18 to 92 years (mean 48.6, standard deviation [SD] 16.8). The majority 76.05% (1105/1453) of participants reported college or higher level of education. A disparity was found in access to health care providers via mobile technology based on socioeconomic status. Adults with annual income of US $30,000 to US $100,000 were 1.72 times more likely to use Web-based methods to contact a health care provider, and adults with an annual income above US $100,000 were 2.41 to

  8. Behaviour of medical students in seeking mental and physical health care: exploration and comparison with psychology students.

    Science.gov (United States)

    Brimstone, Renee; Thistlethwaite, Jill E; Quirk, Frances

    2007-01-01

    Doctors are often reluctant to seek health care through the usual channels and tend to self-diagnose and prescribe. Medical students learn attitudes and values from clinician role models and may also adopt behaviour patterns that lead them to seek help for physical and mental health problems from informal sources. This study aimed to explore the behaviour of students in seeking health care for physical and mental health problems, comparing medical with psychology students, and to understand what barriers to conventional routes of seeking health care may affect this. We administered a questionnaire asking for demographic details and responses to 2 vignettes in which a student from the respondent's discipline was experiencing firstly symptoms of a mental health problem and secondly symptoms of a physical health problem. Data were analysed with spss and univariate anovas to examine differences between respondents. A total of 172 students at the psychology and medical schools at James Cook University in Australia participated. We identified a number of barriers affecting student behaviour in seeking help, which included worries about knowing the doctor they could consult at the university health centre or having future dealings with him or her, and cost of treatment. There were differences between the 2 groups of students. There are several barriers for both psychology and medical students to accessing appropriate professional mental health care. Medical students also experience barriers to attaining appropriate physical health care when needed. Psychology and medical students were more likely to seek advice informally from friends and/or family with regard to mental health care.

  9. Care seeking for maternal health: challenges remain for poor women

    African Journals Online (AJOL)

    Data were analysed using Nudist software. Important findings: The location of childbirth involves retaining control of the process and outcome, and securing a safe delivery. The pregnant woman is influenced by her attendants; families only seek care for complications if local or herbal, remedies and prayer are defeated.

  10. Acute HIV-1 infection is as common as malaria in young febrile adults seeking care in coastal Kenya.

    Science.gov (United States)

    Sanders, Eduard J; Mugo, Peter; Prins, Henrieke A B; Wahome, Elizabeth; Thiong'o, Alexander N; Mwashigadi, Grace; van der Elst, Elisabeth M; Omar, Anisa; Smith, Adrian D; Graham, Susan M

    2014-06-01

    Febrile adults are usually not tested for acute HIV-1 infection (AHI) in Africa. We assessed a strategy to diagnose AHI among young adult patients seeking care. Young adults (defined as a positive p24 antigen test, and subsequent seroconversion or RNA detection. Febrile patients evaluated for AHI were also screened for malaria using a rapid test, with PCR confirmation of positives. In 3602 adults seeking care, overall HIV-1 prevalence was 3.9%: 7.6% (68/897) among patients meeting AHI criteria vs. 2.6% (71/2705) among those who did not (P young febrile adults seeking care. An AHI detection strategy targeting young febrile adults seeking care at pharmacies and health facilities is feasible and should be considered as an HIV-prevention strategy in high-transmission settings.

  11. Using marketing research concepts to investigate specialty selection by medical students.

    Science.gov (United States)

    Weissman, Charles; Schroeder, Josh; Elchalal, Uriel; Weiss, Yoram; Tandeter, Howard; Zisk-Rony, Rachel Y

    2012-10-01

    This study was intended to examine whether a marketing research approach improves understanding of medical specialty selection by medical students. This approach likens students to consumers who are deciding whether or not to purchase a product (specialty). This approach proposes that when consumers' criteria match their perceptions of a product's features, the likelihood that they will purchase it (select the specialty) increases. This study examines whether exploring students' selection criteria and perceptions of various specialties provides additional insights into the selection process. Using a consumer behaviour model as a framework, a questionnaire was designed and administered to Year 6 (final-year) students in 2008 and 2009 to elicit information on their knowledge about and interests in various specialties, the criteria they used in specialty selection, and their perceptions of six specialties. A total of 132 (67%) questionnaires were returned. In many instances, consistency between selection criteria and perceptions of a specialty was accompanied by interest in pursuing the specialty. Exceptions were noted and pointed to areas requiring additional research. For example, although > 70% of female students replied that the affordance of a controllable lifestyle was an important selection criterion, many were interested in obstetrics and gynaecology despite the fact that it was not perceived as providing a controllable lifestyle. Minimal overlap among students reporting interest in primary specialties that possess similar characteristics (e.g. paediatrics and family medicine) demonstrated the need to target marketing (recruitment) efforts for each specialty individually. Using marketing research concepts to examine medical specialty selection may precipitate a conceptual shift among health care leaders which acknowledges that, to attract students, specialties must meet students' selection criteria. Moreover, if consumers (students) deem a product (specialty

  12. How older persons structure information in the decision to seek medical care

    Directory of Open Access Journals (Sweden)

    Peter J. Veazie

    2014-10-01

    Full Text Available Typical models of the decision to seek care consider information as a single conceptual object. This paper presents an alternative that allows multiple objects. For older persons seeking care, results support this alternative. Older decision-makers that segregate information into multiple conceptual objects assessed separately are characterized by socio-demographic (younger age, racial category, non-Hispanic, higher education, higher income, and not married, health status (better general health for men and worse general health for women, fewer known illnesses, and neuropsychological (less memory loss for men, trouble concentrating and trouble making decisions for men factors. Results of this study support the conclusion that older persons are more likely to integrate information, and individuals with identifiable characteristics are more likely to do so than others. The theory tested in this study implies a potential explanation for misutilization of care (either over or under-utilization.

  13. Postpartum haemorrhage and eclampsia: differences in knowledge and care-seeking behaviour in two districts of Bangladesh.

    Science.gov (United States)

    Kalim, Nahid; Anwar, Iqbal; Khan, Jasmin; Blum, Lauren S; Moran, Allisyn C; Botlero, Roslin; Koblinsky, Marge

    2009-04-01

    In high- and low-performing districts of Bangladesh, the study explored the demand-side of maternal healthcare by looking at differences in perceived knowledge and care-seeking behaviours of women in relation to postpartum haemorrhage or eclampsia. Haemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. The study was conducted during July 2006-December 2007. Both postpartum bleeding and eclampsia were recognized by women of different age-groups as severe and life-threatening obstetric complications. However, a gap existed between perception and actual care-seeking behaviours which could contribute to the high rate of maternal deaths associated with these conditions. There were differences in care-seeking practices among women in the two different areas of Bangladesh, which may reflect sociocultural differences, disparities in economic and educational opportunities, and a discrimination in the availability of care.

  14. In-gap discounts in Medicare Part D and specialty drug use.

    Science.gov (United States)

    Jung, Jeah; Xu, Wendy Yi; Cheong, Chelim

    2017-09-01

    Specialty drugs can bring significant benefits to patients, but they can be expensive. Medicare Part D plans charge relatively high cost-sharing costs for specialty drugs. A provision in the Affordable Care Act reduced cost sharing in the Part D coverage gap phase in an attempt to mitigate the financial burden of beneficiaries with high drug spending. We examined the early impact of the Part D in-gap discount on specialty cancer drug use and patients' out-of-pocket (OOP) spending. Natural experimental design. We compared changes in outcomes before and after the in-gap discount among beneficiaries with and without low-income subsidies (LIS). Beneficiaries with LIS, who were not affected by the in-gap discount, made up the control group. We studied a random sample of elderly standalone prescription drug plan enrollees with relatively uncommon cancers (eg, leukemia, skin, pancreas, kidney, sarcomas, and non-Hodgkin lymphoma) between 2009 and 2013. We constructed 4 outcome variables annually: 1) use of any specialty cancer drug, 2) the number of specialty cancer drug fills, 3) total specialty drug spending, and 4) OOP spending for specialty cancer drugs. The in-gap discount did not influence specialty cancer drug use, but reduced annual OOP spending for specialty cancer drugs among users without LIS by $1108. In-gap discounts in Part D decreased patients' financial burden to some extent, but resulted in no change in specialty drug use. As demand for specialty drugs increases, it will be important to ensure patients' access to needed drugs, while simultaneously reducing their financial burden.

  15. Household costs of seeking outpatient care in Egyptian children with ...

    African Journals Online (AJOL)

    Introduction: Addressing difficulties of seeking and getting health care would lower the burden of diarrhea among ill children from developing countries as Egypt. The purpose of the study is to evaluate the economic burden of diarrhea associated with outpatient visits of children in Egypt by identifying the different types of ...

  16. Care seeking for maternal health: challenges remain for poor women

    African Journals Online (AJOL)

    Bernt Lindtjorn

    Timely care seeking is reliant on the knowledge, understanding and financial ... on the relative heterogeneity and security situation of that region. ... adolescent girls and boys, newly delivered mothers, older ... such as the mother in-law or older sister in-laws. The main overriding factors that contribute to the decisions and ...

  17. A community based approach to improve health care seeking for newborn danger signs in rural Wardha, India.

    Science.gov (United States)

    Dongre, Amol R; Deshmukh, Pradeep R; Garg, Bishan S

    2009-01-01

    To find out the effect of community mobilization and health education effort on health care seeking behavior of families with sick newborns, and to explore the rationale behind the changed health care seeking behaviors of mothers in a rural Indian community. In the present community based participatory intervention, a triangulated research design of quantitative (survey) and qualitative (Focus group discussions, FGDs) method was undertaken for needs assessment in year 2004. In community mobilization, women's self help groups; Kishori Panchayat (KP, forum of adolescent girls), Kisan Vikas Manch (Farmers' club) and Village Coordination Committees (VCC) were formed in the study area. The trained social worker facilitated VCCs to develop village health plans to act upon their priority maternal and child health issues. The pregnant women and group members were given health education. The Lot Quality Assurance Sampling (LQAS) technique was used to monitor awareness regarding newborn danger signs among pregnant women. In year 2007, a triangulation of quantitative survey and a qualitative study (free list and pile sort exercise) was undertaken to find out changes in health care seeking behaviors of mothers. There was significant improvement in mothers' knowledge regarding newborn danger signs. About half of the mothers got information from CLICS doot (female community health worker). The monitoring over three years period showed encouraging trend in level of awareness among pregnant women. After three years, the proportion of mothers giving no treatment/home remedy for newborn danger signs declined significantly. However, there was significant improvement in mothers' health care seeking from private health care providers for sick newborns. The present approach improved mothers' knowledge regarding newborn danger signs and improved their health care seeking behavior for newborn danger signs at community level. Due to lack of faith in government health services, women

  18. Birth rights and rituals in rural south India: care seeking in the intrapartum period.

    Science.gov (United States)

    Matthews, Zoë; Ramakrishna, Jayashree; Mahendra, Shanti; Kilaru, Asha; Ganapathy, Saraswathy

    2005-07-01

    Maternal morbidity and mortality are high in the Indian context, but the majority of maternal deaths could be avoided by prompt and effective access to intrapartum care (WHO, 1999). Understanding the care seeking responses to intrapartum morbidities is crucial if maternal health is to be effectively improved, and maternal mortality reduced. This paper presents the results of a prospective study of 388 women followed through delivery and traditional postpartum in rural Karnataka in southern India. In this setting, few women use the existing health facilities and most deliveries occur at home. The analysis uses quantitative data, collected via questionnaires administered to women both during pregnancy and immediately after delivery. By virtue of its prospective design, the study gives a unique insight into intentions for intrapartum care during pregnancy as well as events following morbidities during labour. Routine care in the intrapartum period, both within institutions and at home, and impediments to appropriate care are also examined. The study was designed to collect information about health seeking decisions made by women and their families as pregnancies unfolded, rather than trying to capture women's experience from a retrospective instrument. The data set is therefore a rich source of quantitative information, which incorporates details of event sequences and health service utilization not previously collected in a Safe Motherhood study. Additional qualitative information was also available from concurrent in-depth interviews with pregnant women, their families, health care providers and other key informants in the area. The level of unplanned institutional care seeking during the intrapartum period within the study area was very high, increasing from 11% planning deliveries at a facility to an eventual 35% actually delivering in hospitals. In addition there was a significant move away from planned deliveries with the auxiliary nurse midwive (ANM), to births

  19. What Teens Want: Barriers to Seeking Care for Depression

    Science.gov (United States)

    Wisdom, Jennifer P.; Clarke, Gregory N.; Green, Carla A.

    2013-01-01

    This study examined the experiences of teenagers seeking and receiving care for depression from primary care providers. We investigated teens’ perceived barriers in obtaining care to determine how primary care can effectively address depressed teens’ stated needs. In-depth individual (n = 15) and focus group (n = 7) interviews with adolescents were conducted and analyzed using grounded theory and prominent themes were identified. Teenagers reported faring best when providers actively considered and reflected upon the teenagers’ developmentally appropriate desires to be normal, to feel connected, and to be autous. These goals are achieved by providers establishing rapport, exchanging information about depression etiology and treatment, and helping teens make decisions about their treatment. To the extent that providers improve efforts to help teens feel normal, autonomous, and connected, the teens report they are more likely to accept treatment for depression and report success in treatment. PMID:16489480

  20. Demographics and care-seeking behaviors of sexual violence survivors in South Kivu province, Democratic Republic of Congo.

    Science.gov (United States)

    Bartels, Susan A; Scott, Jennifer A; Leaning, Jennifer; Kelly, Jocelyn T; Joyce, Nina R; Mukwege, Denis; Vanrooyen, Michael J

    2012-12-01

    One of the most striking features of the ongoing conflict in the Democratic Republic of Congo (DRC) is the use of sexual violence. In spite of the brutality of these crimes, the experiences of women affected by sexual violence in Eastern DRC remain poorly characterized. This analysis aimed to (1) provide detailed demographics of sexual violence survivors presenting to Panzi Hospital; (2) examine how demographic factors might impact patterns of sexual violence; and (3) describe care-seeking behavior among sexual violence survivors. The demographics and care-seeking behavior of sexual violence survivors in South Kivu Province were described from a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital (2004-2008). A total of 4311 records were reviewed. The mean age of survivors was 35 years. Most women (53%) were married, self-identified with the Bashi tribe (65%), and reported agriculture as their livelihood (74%). The mean time delay between sexual assault and seeking care was 10.4 months. Five reasons were identified to help explain the lengthy delays to seeking care: waiting for physical symptoms to develop or worsen before seeking medical attention, lack of means to access medical care, concerns that family would find out about the sexual assault, stigma surrounding sexual violence, and being abducted into sexual slavery for prolonged periods of time. Many sexual assault survivors have very delayed presentations to medical attention. Promoting timely access of medical care may best be facilitated by reducing stigma and by educating women about the benefits of early medical care, even in the absence of injuries or symptoms.

  1. Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study.

    Science.gov (United States)

    Bracke, Piet F; Colman, Elien; Symoens, Sara A A; Van Praag, Lore

    2010-04-29

    Little is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced or separated compared to the married or cohabiting. The aim of this study is to determine whether, in a sample of the European general population, the divorced or separated seek more professional mental health care than the married or cohabiting, regardless of self-reported mental health problems. Furthermore, we examine whether two country-level features--the supply of mental health professionals and the country-level divorce rates--contribute to marital status differences in professional care-seeking behavior. We use data from the Eurobarometer 248 on mental well-being that was collected via telephone interviews. The unweighted sample includes 27,146 respondents (11,728 men and 15,418 women). Poisson hierarchical regression models were estimated to examine whether the divorced or separated have higher professional health care use for emotional or psychological problems, after controlling for mental and somatic health, sociodemographic characteristics, support from family and friends, and degree of urbanization. We also considered country-level divorce rates and indicators of the supply of mental health professionals, and applied design and population weights. We find that professional care seeking is strongly need based. Moreover, the divorced or separated consult health professionals for mental health problems more often than people who are married or who cohabit do. In addition, we find that the gap between the divorced or separated and the married or cohabiting is highest in countries with low divorce rates. The higher rates of professional care seeking for mental health problems among the divorced or separated only partially correlates with their more severe mental health problems. In countries where marital dissolution is more common, the marital status gap in professional care seeking is

  2. Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study

    Directory of Open Access Journals (Sweden)

    Symoens Sara AA

    2010-04-01

    Full Text Available Abstract Background Little is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced or separated compared to the married or cohabiting. The aim of this study is to determine whether, in a sample of the European general population, the divorced or separated seek more professional mental health care than the married or cohabiting, regardless of self-reported mental health problems. Furthermore, we examine whether two country-level features--the supply of mental health professionals and the country-level divorce rates--contribute to marital status differences in professional care-seeking behavior. Methods We use data from the Eurobarometer 248 on mental well-being that was collected via telephone interviews. The unweighted sample includes 27,146 respondents (11,728 men and 15,418 women. Poisson hierarchical regression models were estimated to examine whether the divorced or separated have higher professional health care use for emotional or psychological problems, after controlling for mental and somatic health, sociodemographic characteristics, support from family and friends, and degree of urbanization. We also considered country-level divorce rates and indicators of the supply of mental health professionals, and applied design and population weights. Results We find that professional care seeking is strongly need based. Moreover, the divorced or separated consult health professionals for mental health problems more often than people who are married or who cohabit do. In addition, we find that the gap between the divorced or separated and the married or cohabiting is highest in countries with low divorce rates. Conclusions The higher rates of professional care seeking for mental health problems among the divorced or separated only partially correlates with their more severe mental health problems. In countries where marital dissolution is more

  3. Perceived stereotyping and seeking care for chronic vulvar pain.

    Science.gov (United States)

    Nguyen, Ruby H N; Turner, Rachael M; Rydell, Sarah A; Maclehose, Richard F; Harlow, Bernard L

    2013-10-01

    We examined stereotyping of chronic pain sufferers among women aged 18-40 years and determined whether perceived stereotyping affects seeking care for women with chronic vulvar pain. Cross-sectional study using a community-based survey of vulvodynia asking if "Doctors think that people with chronic pain exaggerate their pain," and if "People believe that vulvar pain is used as an excuse to avoid having sex". Twelve thousand eight hundred thirty-four women aged 18-40 years in metropolitan Minneapolis/St. Paul, Minnesota. Women were considered to have a history of chronic vulvar pain if they reported vulvar burning lasting more than 3 months or vulvar pain on contact. Four thousand nine hundred eighty-seven (38.9%) women reported a chronic pain condition; 1,651 had chronic vulvar pain. Women experiencing chronic pain were more likely than those without to perceive stereotyping from both doctors and others; a dose-response with the number of pain conditions existed. Women with chronic vulvar pain were more likely to believe that people think vulvar pain is an excuse to avoid intercourse. Half of the women with chronic vulvar pain did not seek medical care for it; of these, 40.4% perceived stereotyping from doctors. However, it was women who actually sought care (45.1%) who were more likely to feel stigmatized by doctors (adjusted relative risk = 1.11, 95% confidence interval: 1.01-1.23). Perceived negative stereotyping among chronic pain sufferers is common, particularly negative perceptions about physicians. In fact, chronic vulvar pain sufferers who felt stigmatized were more likely to have sought care than those who did not feel stigmatized. Wiley Periodicals, Inc.

  4. Specialty pharmacy: an emerging area of interest for medical management.

    Science.gov (United States)

    Dong, Xiaoli; Fetterolf, Donald

    2005-04-01

    Specialty pharmaceuticals are expensive injectable and infusion therapies used to treat patients with chronic or life-threatening diseases. The high cost of these agents and their frequent usage in chronic diseases represent not only challenges, but also opportunities for medical management programs to improve the quality of care and moderate the rapid cost escalation seen in the industry. The number and variety of these agents have been increasing significantly, with hundreds of drug candidates in the development pipeline. The specialty pharmacy industry also is going through a consolidation stage, both horizontally and vertically. Industry approaches to medical management include the acquisition of specialty pharmacy companies, restrictive contracting to achieve concentrated buying power, and the development of utilization management strategies.

  5. A cross-sectional survey of parental care-seeking behavior for febrile illness among under-five children in Nigeria

    Directory of Open Access Journals (Sweden)

    Mohammed Baba Abdulkadir

    2017-03-01

    Conclusion: There is poor care-seeking for fever in under-five children by parents in Nigeria. Improved literacy, women empowerment and health education are strategies that may improve care-seeking behavior. Highlighted regional differences are additional considerations for such interventions.

  6. Referral of children seeking care at private health facilities in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K.; Buregyeya, Esther; Rutebemberwa, Elizeus

    2017-01-01

    Background In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health...... facilities in order to explore ways of improving treatment and referral of sick children in this sector. Methods A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant...... interviews with private providers and community members. Results A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick...

  7. Urban-Rural Differences in Health-Care-Seeking Pattern of Residents of Abia State, Nigeria, and the Implication in the Control of NCDs.

    Science.gov (United States)

    Onyeonoro, Ugochukwu U; Ogah, Okechukwu S; Ukegbu, Andrew U; Chukwuonye, Innocent I; Madukwe, Okechukwu O; Moses, Akhimiem O

    2016-01-01

    Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization's STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas. In both urban and rural areas, patent medicine vendors (73.0%) were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index. Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system.

  8. Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study.

    Science.gov (United States)

    Khanam, Rasheda; Creanga, Andreea A; Koffi, Alain K; Mitra, Dipak K; Mahmud, Arif; Begum, Nazma; Moin, Syed Mamun Ibne; Ram, Malathi; Quaiyum, Md Abdul; Ahmed, Saifuddin; Saha, Samir K; Baqui, Abdullah H

    2016-01-01

    The burden of maternal complications during antepartum and intrapartum periods is high and care seeking from a trained provider is low, particularly in low middle income countries of sub-Saharan Africa and South Asia. Identification of barriers to access to trained care and development of strategies to address them will contribute to improvements in maternal health. Using data from a community-based cohort of pregnant women, this study identified the prevalence of antepartum and intrapartum complications and determinants of care-seeking for these complications in rural Bangladesh. The study was conducted in 24,274 pregnant women between June 2011 and December 2013 in rural Sylhet district of Bangladesh. Women were interviewed during pregnancy to collect data on demographic and socioeconomic characteristics; prior miscarriages, stillbirths, live births, and neonatal deaths; as well as data on their ability to make decision to go to health center alone. They were interviewed within the first 7 days of child birth to collect data on self-reported antepartum and intrapartum complications and care seeking for those complications. Bivariate analysis was conducted to explore association between predisposing (socio-demographic), enabling (economic), perceived need, and service related factors with care-seeking for self-reported antepartum and intrapartum complications. Multivariable multinomial logistic regression was performed to examine the association of selected factors with care-seeking for self-reported antepartum and intrapartum complications adjusting for co-variates. Self-reported antepartum and intrapartum complications among women were 14.8% and 20.9% respectively. Among women with any antepartum complication, 58.9% sought care and of these 46.5% received care from a trained provider. Of the women with intrapartum complications, 61.4% sought care and of them 46.5% did so from a trained provider. Care-seeking for both antepartum and intrapartum complications from

  9. Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal.

    Science.gov (United States)

    Lama, Tsering P; Khatry, Subarna K; Katz, Joanne; LeClerq, Steven C; Mullany, Luke C

    2017-12-21

    Identification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking behavior among families and communities who experienced a maternal complication, death, neonatal illness, or death in a rural setting of Nepal. Thirty-two event narratives (six maternal/newborn deaths each and 10 maternal/newborn illnesses each) were collected using in-depth interviews and small group interviews. We purposively sampled across specific illness and complication definitions, using data collected prospectively from a cohort of women and newborns followed from pregnancy through the first 28 days postpartum. The event narratives were coded and analyzed for common themes corresponding to three main domains of illness recognition, decision-making, and care-seeking; detailed event timelines were created for each. While signs were typically recognized early, delays in perceiving the severity of illness compromised prompt care-seeking in both maternal and newborn cases. Further, care was often sought initially from informal health providers such as traditional birth attendants, traditional healers, and village doctors. Key decision-makers were usually female family members; husbands played limited roles in decisions related to care-seeking, with broader family involvement in decision-making for newborns. Barriers to seeking care at any type of health facility included transport problems, lack of money, night-time illness events, low perceived severity, and distance to facility. Facility care was often sought only after referral or following treatment failure from an informal provider and private facilities were sought for newborn care. Respondents characterized government facility-based care as low quality and reported staff rudeness and drug type and/or supply stock shortages. Delaying

  10. Do work-related factors affect care-seeking in general practice for back pain or upper extremity pain?

    DEFF Research Database (Denmark)

    Jensen, Jens Christian; Haahr, Jens Peder; Frost, Poul

    2013-01-01

    's decision to seek care could be important in order to give more well-founded advice to our patients. The objective of this study was to elucidate the effects of workloads on care-seeking for back pain or upper extremity pain during an eighteen-month follow-up period. METHODS: This is a prospective study...

  11. Patient navigation pathway and barriers to treatment seeking in cancer in India: a qualitative inquiry.

    Science.gov (United States)

    Pati, Sanghamitra; Hussain, Mohammad Akhtar; Chauhan, Abhimanyu Singh; Mallick, Diptimayee; Nayak, Sukdev

    2013-12-01

    Cancer is a leading cause of mortality worldwide. Early diagnosis and treatment of cancer may curb the growing burden of the disease. Understanding cancer patients' navigation pathways for seeking treatment is important in order to facilitate early diagnosis and treatment. With this background we conducted a hospital-based cross-sectional study comprising 68 randomly selected cancer inpatients in a tertiary cancer specialty hospital in Odisha, India, to explore the treatment-seeking pathways of the cancer patients and the barriers and enablers in seeking treatment. Financial constraint is one of the major reasons for the delay in accessing treatment, even when patients are suspected of or diagnosed with cancer. Low awareness of the presenting signs and symptoms of cancer and limited knowledge of the availability of cancer diagnosis and treatment facilities are major factors contributing to delay. Family and friends' support is found to be the major enabling factor toward seeking treatment. Generation of awareness of cancer among the general population and primary-care practitioners - including those in alternative systems of medicine - is important. Information on diagnostic and treatment services appears to be a felt need. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Health Care Seeking Behavior of Persons with Acute Chagas Disease in Rural Argentina: A Qualitative View

    Directory of Open Access Journals (Sweden)

    Ignacio Llovet

    2016-01-01

    Full Text Available Chagas disease (CD is a tropical parasitic disease largely underdiagnosed and mostly asymptomatic affecting marginalized rural populations. Argentina regularly reports acute cases of CD, mostly young individuals under 14 years old. There is a void of knowledge of health care seeking behavior in subjects experiencing a CD acute condition. Early treatment of the acute case is crucial to limit subsequent development of disease. The article explores how the health outcome of persons with acute CD may be conditioned by their health care seeking behavior. The study, with a qualitative approach, was carried out in rural areas of Santiago del Estero Province, a high risk endemic region for vector transmission of CD. Narratives of 25 in-depth interviews carried out in 2005 and 2006 are analyzed identifying patterns of health care seeking behavior followed by acute cases. Through the retrospective recall of paths for diagnoses, weaknesses of disease information, knowledge at the household level, and underperformance at the provincial health care system level are detected. The misdiagnoses were a major factor in delaying a health care response. The study results expose lost opportunities for the health care system to effectively record CD acute cases.

  13. 29 CFR 825.310 - Certification for leave taken to care for a covered servicemember (military caregiver leave).

    Science.gov (United States)

    2010-07-01

    ...) of the health care provider, the type of medical practice, the medical specialty, and whether the... illness for which the current need for leave exists. An employer may seek authentication and/or... authentication and clarification of the ITO or ITA under § 825.307. An employer may not utilize the second or...

  14. Urban–Rural Differences in Health-Care-Seeking Pattern of Residents of Abia State, Nigeria, and the Implication in the Control of NCDs

    Directory of Open Access Journals (Sweden)

    Ugochukwu U. Onyeonoro

    2016-01-01

    Full Text Available Background Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. Methods This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization's STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas. Results In both urban and rural areas, patent medicine vendors (73.0% were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index. Conclusions Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system.

  15. Urban–Rural Differences in Health-Care-Seeking Pattern of Residents of Abia State, Nigeria, and the Implication in the Control of NCDs

    Science.gov (United States)

    Onyeonoro, Ugochukwu U.; Ogah, Okechukwu S.; Ukegbu, Andrew U.; Chukwuonye, Innocent I.; Madukwe, Okechukwu O.; Moses, Akhimiem O.

    2016-01-01

    BACKGROUND Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. METHODS This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization’s STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas. RESULTS In both urban and rural areas, patent medicine vendors (73.0%) were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index. CONCLUSIONS Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system. PMID:27721654

  16. Physician work intensity among medical specialties: emerging evidence on its magnitude and composition.

    Science.gov (United States)

    Horner, Ronnie D; Szaflarski, Jerzy P; Ying, Jun; Meganathan, Karthikeyan; Matthews, Gerald; Schroer, Brian; Weber, Debra; Raphaelson, Marc

    2011-11-01

    Similarities and differences in physician work intensity among specialties are poorly understood but have implications for quality of care, patient safety, practice organization and management, and payment. To determine the magnitude and important dimensions of physician work intensity for 4 specialties. Cross-sectional assessment of work intensity associated with actual patient care in the examination room or operating room. A convenience sample of 45 family physicians, 20 general internists, 22 neurologists, and 21 surgeons, located in Kansas, Kentucky, Maryland, Ohio, and Virginia. Work intensity measures included the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), Subjective Work Assessment Technique (SWAT), and Multiple Resource Questionnaire. Stress was measured by the Dundee Stress State Questionnaire. Physicians reported similar magnitude of work intensity on the NASA-TLX and Multiple Resource Questionnaire. On the SWAT, general internists reported work intensity similar to surgeons but significantly lower than family physicians and neurologists (P=0.035). Surgeons reported significantly higher levels of task engagement on the stress measure than the other specialties (P=0.019), significantly higher intensity on physical demand (P NASA-TLX than the other specialties (P=0.003). Surgeons reported the lowest intensity for temporal demand of all specialties, being significantly lower than either family physicians or neurologists (P=0.014). Family physicians reported the highest intensity on the time dimension of the SWAT, being significantly higher than either general internists or surgeons (P=0.008). Level of physician work intensity seems to be similar among specialties.

  17. Benign Prostatic Hyperplasia: Health Seeking Behaviour of patients at a tertiary care hospital.

    Directory of Open Access Journals (Sweden)

    Aman Deep

    2010-03-01

    Full Text Available BackgroundBenign Prostatic Hyperplasia is a widely prevalent conditionaffecting elderly men throughout the world. With increasinglife expectancy, there has been a rise in the percentage ofelderly men and so for this disease across the globe. There islack of information about health seeking behaviour of patientswith Benign Prostatic Hyperplasia. Therefore the study wasdesigned with the objectives of assessing health-seekingbehaviour and the effect of literacy on it among adult andolder subjects suffering from Benign Prostatic Hyperplasiaattending a tertiary care hospital.MethodA series of 81 patients suffering from Benign ProstaticHyperplasia above the age of 50 years, attending surgical OutPatient Department of a tertiary care hospital in Delhi, wereassessed for their health seeking behaviour using a pre-testedand a modified questionnaire designed for assessing healthseeking behaviour.ResultsPositive health seeking behaviour of patients was observed in44%, who reported to a doctor within a month of noticingtheir problem. A greater proportion of the literates was awareabout the symptoms suggestive of enlarged prostate andconsulted a qualified health care practitioner as their firstaction. More literates approached the higher level of healthcare facility on being referred and had maximum faith inallopathic system of medicine. Also, lesser number of literateshad performed pooja (Hindi word for worship or othertraditional rituals for relief of their problems.ConclusionWe concluded that majority of subjects suffering fromBenign Prostatic Hypertrophy were not aware of theirdisease and their health-seeking behaviour was poor andcould be related to literacy. Our data highlights the needfor public awareness program targeting the younger malepopulation so that early detection and treatment can beoffered.

  18. Algorithmic Approach With Clinical Pathology Consultation Improves Access to Specialty Care for Patients With Systemic Lupus Erythematosus.

    Science.gov (United States)

    Chen, Lei; Welsh, Kerry J; Chang, Brian; Kidd, Laura; Kott, Marylee; Zare, Mohammad; Carroll, Kelley; Nguyen, Andy; Wahed, Amer; Tholpady, Ashok; Pung, Norin; McKee, Donna; Risin, Semyon A; Hunter, Robert L

    2016-09-01

    Harris Health System (HHS) is a safety net system providing health care to the underserved of Harris County, Texas. There was a 6-month waiting period for a rheumatologist consult for patients with suspected systemic lupus erythematosus (SLE). The objective of the intervention was to improve access to specialty care. An algorithmic approach to testing for SLE was implemented initially through the HHS referral center. The algorithm was further offered as a "one-click" order for physicians, with automated reflex testing, interpretation, and case triaging by clinical pathology. Data review revealed that prior to the intervention, 80% of patients did not have complete laboratory workups available at the first rheumatology visit. Implementation of algorithmic testing and triaging of referrals by pathologists resulted in decreasing the waiting time for a rheumatologist by 50%. Clinical pathology intervention and case triaging can improve access to care in a county health care system. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma.

    Directory of Open Access Journals (Sweden)

    Artur Tenenbaum

    Full Text Available The aim was to study gender differences in care-seeking behavior and treatment provided immediately after whiplash trauma.Participants were residents from a defined geographical area, Skaraborg County in the southwestern part of Sweden. A cohort of 3,368 persons exposed to whiplash trauma and attending a healthcare facility immediately after the trauma between 1999 and 2008 were identified in a database. Information about gender, age, time elapsed prior to seeking care, type of healthcare contact, initial treatment provided and eventual hospitalization time was retrieved.Women sought care later than men (p = 0.00074. Women consulted primary healthcare first more often than men, who more often first sought hospital care (p = 0.0060. There were no gender differences regarding the type of treatment after trauma. Women had longer hospital admission than men (p = 0.022, indicating their injuries were at least similar to or worse than men's.Women sought healthcare later than men after whiplash trauma. Although not directly investigated in this study, it raises the question if this may reduce their probability of getting financial compensation compared to men.

  20. Impact of health insurance for tertiary care on postoperative outcomes and seeking care for symptoms: quasi-experimental evidence from Karnataka, India.

    Science.gov (United States)

    Sood, Neeraj; Wagner, Zachary

    2016-01-06

    To evaluate the effects of a government insurance programme covering tertiary care for the poor in Karnataka, India--Vajpayee Arogyashree Scheme (VAS)--on treatment seeking and postoperative outcomes. Geographic regression discontinuity. 572 villages in Karnataka, India. 3478 households in 300 villages where VAS was implemented and 3486 households in 272 neighbouring matched villages ineligible for VAS. A government insurance programme that provided free tertiary care to households below the poverty line in half of villages in Karnataka from February 2010 to August 2012. Seeking treatment for symptoms, posthospitalisation well-being, occurrence of infections during hospitalisation and need for rehospitalisation. The prevalence of symptoms was nearly identical for households in VAS-eligible villages compared with households in VAS-ineligible villages. However, households eligible for VAS were 4.96 percentage points (95% CI 1 to 8.9; p=0.014) more likely to seek treatment for their symptoms. The increase in treatment seeking was more pronounced for symptoms of cardiac conditions, the condition most frequently covered by VAS. Respondents from VAS-eligible villages reported greater improvements in well-being after a hospitalisation in all categories assessed and they were statistically significant in 3 of the 6 categories (walking ability, pain and anxiety). Respondents eligible for VAS were 9.4 percentage points less likely to report any infection after their hospitalisation (95% CI -20.2 to 1.4; p=0.087) and 16.5 percentage points less likely to have to be rehospitalised after the initial hospitalisation (95% CI -28.7 to -4.3; p<0.01). Insurance for tertiary care increased treatment seeking among eligible households. Moreover, insured patients experienced better posthospitalisation outcomes, suggesting better quality of care received. These results suggest that there are several pathways through which tertiary care insurance could improve health, aside from

  1. Social support and delays seeking care after HIV diagnosis, North Carolina, 2000-2006.

    Science.gov (United States)

    McCoy, Sandra I; Strauss, Ronald P; MacDonald, Pia D M; Leone, Peter A; Eron, Joseph J; Miller, William C

    2009-09-01

    Many adults in the USA enter primary care late in the course of HIV infection, countering the clinical benefits of timely HIV services and missing opportunities for risk reduction. Our objective was to determine if perceived social support was associated with delay entering care after an HIV diagnosis. Two hundred and sixteen patients receiving primary care at a large, university-based HIV outpatient clinic in North Carolina were included in the study. Dimensions of functional social support (emotional/informational, tangible, affectionate, and positive social interaction) were quantified with a modified Medical Outcomes Study Social Support Scale and included in proportional hazards models to determine their effect on delays seeking care. The median delay between diagnosis and entry to primary care was 5.9 months. Levels of social support were high but only positive social interaction was moderately associated with delayed presentation in adjusted models. The effect of low perceived positive social interaction on the time to initiation of primary care differed by history of alcoholism (no history of alcoholism, hazard ratio (HR): 1.43, 95% confidence interval (CI): 0.88, 2.34; history of alcoholism, HR: 0.71, 95% CI: 0.40, 1.28). Ensuring timely access to HIV care remains a challenge in the southeastern USA. Affectionate, tangible, and emotional/informational social support were not associated with the time from diagnosis to care. The presence of positive social interaction may be an important factor influencing care-seeking behavior after diagnosis.

  2. The importance of job characteristics in determining medical care-seeking in the Dutch working population, a longitudinal survey study

    NARCIS (Netherlands)

    Steenbeek, R.

    2012-01-01

    The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will

  3. Health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya.

    Science.gov (United States)

    Mukiira, Carol; Ibisomi, Latifat

    2015-06-01

    In Kenya, as in other developing countries, diarrhea is among the leading causes of child mortality. Despite being easy to prevent and treat, care seeking for major child illnesses including diarrhea remains poor in the country. Mortality due to diarrhea is even worse in informal settlements that are characterized by poor sanitary conditions and largely unregulated health care system among other issues. The study aims to examine the health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya. The article used data from a maternal and child health (MCH) prospective study conducted between 2006 and 2010. Results show that more than half (55%) of the caregivers sought inappropriate health care in the treatment of diarrhea of their child. Of the 55%, about 35% sought no care at all. Use of oral rehydration solution and zinc supplements, which are widely recommended for management of diarrhea, was very low. The critical predictors of health care seeking identified in the study are duration of illness, informal settlement of residence, and the child's age. The study showed that appropriate health care seeking practices for childhood diarrhea remain a great challenge among the urban poor in Kenya. © The Author(s) 2013.

  4. THE SPECIALTY OF EMERGENCY MEDICINE IN CHILE: 20 YEARS OF HISTORY

    Directory of Open Access Journals (Sweden)

    WK Mallon

    2017-03-01

    Full Text Available Chile is uniquely situated to be a leader in South American development of the specialty of Emergency Medicine. Chilean emergency medicine has successfully transitioned from a novelty training idea to a nationally and internationally recognized entity with serious public health goals. There are more residency training programs in Chile than in any other South American or Latin American country, and the specialty is formally recognized by the Ministry of Health. Chilean emergency medicine thought leaders have networked internationally with multiple groups, intelligently used outside resources, and created durable academic relationships. While focusing on locally important issues and patient care they have successfully advanced their agenda. Despite this, the specialty faces many new challenges and remains fragile but sustainable. Policy makers and the Chilean MOH need to be acutely aware of this fragility to preserve the progress achieved so far, and support ongoing maturation of the specialty of Emergency Medicine.

  5. Pain medicine: The case for an independent medical specialty and training programs.

    Science.gov (United States)

    Dubois, Michel Y; Follett, Kenneth A

    2014-06-01

    Over the last 30 years, pain has become one of the most dynamic areas of medicine and a public health issue. According to a recent Institute of Medicine report, pain affects approximately 100 million Americans at an estimated annual economic cost of $560 to $635 billion and is poorly treated overall. The American Board of Medical Specialties (ABMS) recognizes a pain subspecialty, but pain care delivery has struggled with increasing demand and developed in an inconsistent and uncoordinated fashion. Pain education is insufficient and highly variable. Multiple pain professional organizations have led to fragmentation of the field and lack of interdisciplinary agreement, resulting in confusion regarding who speaks for pain medicine. In this Perspective, the authors argue that ABMS recognition of pain medicine as an independent medical specialty would provide much needed structure and oversight for the field and would generate credibility for the specialty and its providers among medical peers, payers, regulatory and legislative agencies, and the public at large. The existing system, managed by three ABMS boards, largely excludes other specialties that contribute to pain care, fails to provide leadership from a single professional organization, provides suboptimal training exposure to pain medicine, and lengthens training, which results in inefficient use of time and educational resources. The creation of a primary ABMS conjoint board in pain medicine with its own residency programs and departments would provide better coordinated training, ensure the highest degree of competence of pain medicine specialists, and improve the quality of pain care and patient safety.

  6. Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma

    Science.gov (United States)

    Tenenbaum, Artur; Nordeman, Lena; Sunnerhagen, Katharina S.; Gunnarsson, Ronny

    2017-01-01

    Objective The aim was to study gender differences in care-seeking behavior and treatment provided immediately after whiplash trauma. Methods Participants were residents from a defined geographical area, Skaraborg County in the southwestern part of Sweden. A cohort of 3,368 persons exposed to whiplash trauma and attending a healthcare facility immediately after the trauma between 1999 and 2008 were identified in a database. Information about gender, age, time elapsed prior to seeking care, type of healthcare contact, initial treatment provided and eventual hospitalization time was retrieved. Results Women sought care later than men (p = 0.00074). Women consulted primary healthcare first more often than men, who more often first sought hospital care (p = 0.0060). There were no gender differences regarding the type of treatment after trauma. Women had longer hospital admission than men (p = 0.022), indicating their injuries were at least similar to or worse than men’s. Conclusion Women sought healthcare later than men after whiplash trauma. Although not directly investigated in this study, it raises the question if this may reduce their probability of getting financial compensation compared to men. PMID:28441465

  7. Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors.

    Directory of Open Access Journals (Sweden)

    Ligia Correia Lima de Souza

    Full Text Available Choosing a medical specialty is an important, complex, and not fully understood process. The present study investigated the factors that are related to choosing and rejecting medical specialties in a group of students and recent medical doctors.A cross-sectional survey of 1,223 medical students and doctors was performed in Brazil in 2012. A standardized literature-based questionnaire was applied that gathered preferable or rejected specialties, and asked questions about extracurricular experiences and the influence of 14 factors on a Likert-type scale from 0 to 4. Specialties were grouped according to lifestyle categories: controllable and uncontrollable, which were subdivided into primary care, internal medicine, and surgical specialties. Notably, the time period of rejection was usually earlier than the time period of intended choice (p < 0.0001, χ(2 = 107.2. The choice mainly occurred during the internship period in medical school (n = 466; 38.7%. An overall large frequency of participation in extracurricular activities was observed (n = 1,184; 95.8%, which were highly associated with the respective medical area. Orthopedic surgery had the highest correlation with participation in specialty-specific organized groups (OR = 59.9, 95% CI = 21.6-166.3 and psychiatry was correlated with participation in research groups (OR = 18.0, 95% CI = 9.0-36.2. With regard to influential factors in controllable lifestyle specialties, "financial reason" (mean score ± standard deviation: 2.8 ± 1.0; median = 3 and "personal time" (3.1 ± 1.3; median = 4 were important factors. In primary care, these factors were less important (1.7 ± 1.3 and 1.7 ± 1.5, respectively; median = 2 for both, and higher scores were observed for "curricular internship" (3.2 ± 1.1, median = 4 and "social commitment" (2.6 ± 1.3, median = 3.The present findings provide important insights into developing strategies to stimulate interest in specialties based on the needs of the

  8. Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia

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    Liljestrand Jerker

    2009-07-01

    Full Text Available Abstract Background Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia. Methods Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours. Results The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system. Conclusion The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.

  9. Associations between health care seeking and socioeconomic and demographic determinants among people reporting alarm symptoms of cancer

    DEFF Research Database (Denmark)

    Svendsen, Rikke P; Jarbol, Dorte E; Larsen, Pia V

    2013-01-01

    Late diagnosis of cancer may partly be explained by the fact that some patients do not seek health care promptly when experiencing an alarm symptom. Socioeconomic and demographic differences exist concerning knowledge and awareness of cancer alarm symptoms in the general population...... and socioeconomic differences are found in cancer incidence and survival. We therefore hypothesise that socioeconomic and demographic differences in health care-seeking behaviour are present among people with alarm symptoms....

  10. Association of Online Health Information-Seeking Behavior and Self-Care Activities Among Type 2 Diabetic Patients in Saudi Arabia.

    Science.gov (United States)

    Jamal, Amr; Khan, Samina A; AlHumud, Ahmed; Al-Duhyyim, Abdulaziz; Alrashed, Mohammed; Bin Shabr, Faisal; Alteraif, Alwalid; Almuziri, Abdullah; Househ, Mowafa; Qureshi, Riaz

    2015-08-12

    Health information obtained from the Internet has an impact on patient health care outcomes. There is a growing concern over the quality of online health information sources used by diabetic patients because little is known about their health information-seeking behavior and the impact this behavior has on their diabetes-related self-care, in particular in the Middle East setting. The aim of this study was to determine the online health-related information-seeking behavior among adult type 2 diabetic patients in the Middle East and the impact of their online health-related information-seeking behavior on their self-care activities. A cross-sectional survey was conducted on 344 patients with type 2 diabetes attending inpatient and outpatient primary health care clinics at 2 teaching hospitals in Riyadh, Saudi Arabia. The main outcome measures included the ability of patients to access the Internet, their ability to use the Internet to search for health-related information, and their responses to Internet searches in relation to their self-care activities. Further analysis of differences based on age, gender, sociodemographic, and diabetes-related self-care activities among online health-related information seekers and nononline health-related information seekers was conducted. Among the 344 patients, 74.1% (255/344) were male with a mean age of 53.5 (SD 13.8) years. Only 39.0% (134/344) were Internet users; 71.6% (96/134) of them used the Internet for seeking health-related information. Most participants reported that their primary source of health-related information was their physician (216/344, 62.8%) followed by television (155/344, 45.1%), family (113/344, 32.8%), newspapers (100/344, 29.1%), and the Internet (96/344, 27.9%). Primary topics participants searched for were therapeutic diet for diabetes (55/96, 57%) and symptoms of diabetes (52/96, 54%) followed by diabetes treatment (50/96, 52%). Long history of diabetes, familial history of the disease

  11. MEDICO-SOCIAL CHARACTERISTICS OF POPULATION GROUPS SEEKING FOR DENTAL CARE IN POLYCLINICS SMOLENSK

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    Светлана Николаевна Дехнич

    2013-09-01

    Full Text Available The research’s aim is to give health-social characteristic of contingents of the urban population, seeking for outpatient dental care, including a comparative estimation of stomatological index of life quality (SILQ by doctors and patients.Novelty: Was installed the difference in the estimation of work sets SILQ by doctors and patients.Methodology of the research work. It was used an advantage «Card of studying the dental health» for holding the research, including the objective and subjective expert estimations of the dental patient’s status by doctors. This information was comparing with the subjective estimation of SILQ by patients. The sample volume was about 400 people out of number of people, seeking for outpatient dental care in state budget dental clinics during 2011-2012 years.Results. Was installed mostly very high level of prevalence of caries, the destruction of fabrics of parodont reaches 100 % with the age. The stomatological index of life quality among the patients, seeking for outpatient care is low. One of the reasons- a low population’s sanitary culture. A big part of patients seek in case of acute pain(40%. Out of three components of SILQ the criteria of social welfare got rather high estimation. The lowest estimation was given to moral psychological well-being criteria. In this case the moral psychological well-being criteria was given a higher estimation by doctors then by patients (in 1,8. The criteria of the physical and social well-being is lower compared with the patient’s (in 1,8 and 1,2 times respectively.Practical implication: Indicators SILQ may be the basis for planning activities of stomatological polyclinics, including the preventive dentists’ work.DOI: http://dx.doi.org/10.12731/2218-7405-2013-6-46

  12. Integration of outpatient infectious diseases clinic pharmacy services and specialty pharmacy services for patients with HIV infection.

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    Gilbert, Elise M; Gerzenshtein, Lana

    2016-06-01

    The integration of specialty pharmacy services and existing outpatient clinical pharmacy services within an infectious diseases (ID) clinic to optimize the care of patients with human immunodeficiency virus (HIV) infection is described. The management of HIV-infected patients is a highly specialized area of practice, often requiring use of complex medication regimens for reduction of HIV-associated morbidity and mortality prophylaxis and treatment of opportunistic infections, and prevention of HIV transmission. To maximize the effectiveness and safety of treatment with antiretroviral agents and associated pharmacotherapies, an interdisciplinary team is often involved in patient care. At Chicago-based Northwestern Medicine (NM), the outpatient ID clinic has long worked with an interdisciplinary care team including physicians, clinical pharmacists, nurses, and social workers to care for patients with HIV infection. In April 2014, specialty pharmacy services for patients with HIV infection were added to the NM ID clinic's care model to help maintain continuity of care and enhance patient follow-up. The care model includes well-defined roles for clinical pharmacists, pharmacy residents and students on rotation, and licensed pharmacy technicians. Specialty pharmacy services, including medication education, prescription fulfillment, assistance with medication access (e.g., navigation of financial assistance programs, completion of prior-authorization requests), and treatment monitoring, allow for closed-loop medication management of the HIV-infected patient population. Integration of specialty pharmacy services with the interdisciplinary care provided in the outpatient NM ID clinic has enhanced continuity of care for patients with HIV infection in terms of prescription filling, medication counseling, and adherence monitoring. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  13. Reproductive health care for asylum-seeking women - a challenge for health professionals

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    Zemp Elisabeth

    2010-11-01

    Full Text Available Abstract Background Dealing with pregnancy, childbirth and the care of newborn babies is a challenge for female asylum seekers and their health care providers. The aim of our study was to identify reproductive health issues in a population of women seeking asylum in Switzerland, and to examine the care they received. The women were insured through a special Health Maintenance Organisation (HMO and were attending the Women's Clinic of the University Hospital in Basel. We also investigated how the health professionals involved perceived the experience of providing health care for these patients. Methods A mixed methods approach combined the analysis of quantitative descriptive data and qualitative data obtained from semi-structured interviews with health care providers and from patients' files. We analysed the records of 80 asylum-seeking patients attending the Women's Clinic insured through an HMO. We conducted semi-structured interviews with 10 care providers from different professional groups. Quantitative data were analysed descriptively. Qualitative data analysis was guided by Grounded Theory. Results The principal health problems among the asylum seekers were a high rate of induced abortions (2.5 times higher than in the local population, due to inadequate contraception, and psychosocial stress due to the experience of forced migration and their current difficult life situation. The language barriers were identified as a major difficulty for health professionals in providing care. Health care providers also faced major emotional challenges when taking care of asylum seekers. Additional problems for physicians were that they were often required to act in an official capacity on behalf of the authorities in charge of the asylum process, and they also had to make decisions about controlling expenditure to fulfil the requirements of the HMO. They felt that these decisions sometimes conflicted with their duty towards the patient. Conclusion

  14. Referral of children seeking care at private health facilities in Uganda.

    Science.gov (United States)

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus; Clarke, Siân E; Lal, Sham; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip

    2017-02-14

    In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health facilities in order to explore ways of improving treatment and referral of sick children in this sector. A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant interviews with private providers and community members. A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral facilities, inadequate finances at household level; while the perception that referral leads to loss of prestige and profit was a major constraint to private providers. In conclusion, the results show that referral of sick children at private health facilities faces many challenges at provider, caretaker, household and community levels. Thus, interventions to address constraints to referral of sick children are urgently needed.

  15. The individual determinants of care-seeking among middle-aged women reporting urinary incontinence: analysis of a 2273-woman cohort.

    Science.gov (United States)

    Fritel, Xavier; Panjo, Henri; Varnoux, Noëlle; Ringa, Virginie

    2014-09-01

    Our main objective was to analyze individual determinants that lead middle-aged women to seek medical care for urinary incontinence (UI). Observational longitudinal study among GAZEL cohort participants: 2,640 women aged 50-62 completed a self-administered questionnaire at baseline. Eight years later (2008) 2,273 (86%) responded to a follow-up questionnaire. Seeking care for UI was defined as any consultation for UI during the 8-year follow-up period. Individual determinants considered in the regression analysis were social and demographic characteristics, social relations, UI type and severity, and other health factors. Among 1,192 women reporting incontinence at baseline, 24.4% had visited a physician at least once for UI during the follow-up period (56.0% of those reporting severe UI). The care-seeking rate increased with age at baseline. Multivariate analysis showed that women who reported severe UI (OR = 4.1; 95% CI 2.6-6.5), mixed UI (2.0; 1.3-3.0), or neurologic disease (1.6; 1.1-2.6), had weak social support (1.4; 1.0-2.0), or talked about their UI with close friends or family (1.5; 1.0-2.1) were more likely to seek care for UI. A model including these factors had a 78% probability of correctly differentiating women with incontinence who chose to seek care from those who did not. Our analysis could not take factors related to the organization of health services into account. Women do not always seek care for UI, even when it is severe. Besides UI severity and type, consultation is associated with aging, weak social support, conversation about it with close friends and family, and neurologic disorders. © 2013 Wiley Periodicals, Inc.

  16. Medical returns: seeking health care in Mexico.

    Science.gov (United States)

    Horton, Sarah; Cole, Stephanie

    2011-06-01

    Despite the growing prevalence of transnational medical travel among immigrant groups in industrialized nations, relatively little scholarship has explored the diverse reasons immigrants return home for care. To date, most research suggests that cost, lack of insurance and convenience propel US Latinos to seek health care along the Mexican border. Yet medical returns are common even among Latinos who do have health insurance and even among those not residing close to the border. This suggests that the distinct culture of medicine as practiced in the border clinics Latinos visit may be as important a factor in influencing medical returns as convenience and cost. Drawing upon qualitative interviews, this article presents an emic account of Latinos' perceptions of the features of medical practice in Mexico that make medical returns attractive. Between November 15, 2009 and January 15, 2010, we conducted qualitative interviews with 15 Mexican immigrants and nine Mexican Americans who sought care at Border Hospital, a private clinic in Tijuana. Sixteen were uninsured and eight had insurance. Yet of the 16 uninsured, six had purposefully dropped their insurance to make this clinic their permanent "medical home." Moreover, those who substituted receiving care at Border Hospital for their US health insurance plan did so not only because of cost, but also because of what they perceived as the distinctive style of medical practice at Border Hospital. Interviewees mentioned the rapidity of services, personal attention, effective medications, and emphasis on clinical discretion as features distinguishing "Mexican medical practice," opposing these features to the frequent referrals and tests, impersonal doctor-patient relationships, uniform treatment protocols and reliance on surgeries they experienced in the US health care system. While interviewees portrayed these features as characterizing a uniform "Mexican medical culture," we suggest that they are best described as

  17. Effect of residence on mothers' health care seeking behavior for common childhood illness in Northwest Ethiopia: a community based comparative cross--sectional study.

    Science.gov (United States)

    Gelaw, Yalemzewod Assefa; Biks, Gashaw Andargie; Alene, Kefyalew Addis

    2014-10-08

    Children are at higher risk of acquiring infections and developing severe disease. This study assessed the health care seeking behavior and associated factors of urban and rural mothers for common childhood illness in Northwest Ethiopia. A comparative community based cross-sectional study was conducted among urban and rural mothers living in the district. A multistage sampling technique was used to select the study participants. A pre-tested and structured questioner via interview was used to collect the data. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of the associations. A total of 827 (274 urban and 553 rural) mothers were interviewed. Among these, 79.3% (95% CI: (76.5%, 82.06%)) of the mothers were sought health care in the district. Health care seeking behavior was higher among urban mothers (84.6%) than rural mothers (76.7%). Marital status, completion health extension package, and sex of child were significantly associated with health care seeking behavior of urban mothers. Whereas age of child, age and occupation of mothers, educational level of fathers, wealth quintile, and type of reported illness were significantly associated with rural mothers. Perceived severity of illness was significantly associated with both urban and rural mothers for health care seeking behavior. The overall health seeking behaviors of mothers for common childhood illness was high. However, urban mothers seek health care more than rural. Socio Economic position and types of reported illness has an effect for health seeking behavior of rural mothers. Whereas child sex preference and graduation status for health extension package has an effect for health care seeking behavior of urban mothers. Work on strengthen accessibility of health care services in the rural mothers and increase awareness of mothers about the disadvantage of sex preferences will improve the health care seek behavior of

  18. Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement.

    Science.gov (United States)

    Gabrysch, Sabine; McMahon, Shannon A; Siling, Katja; Kenward, Michael G; Campbell, Oona M R

    2016-03-02

    It is widely held that decisions whether or when to attend health facilities for childbirth are not only influenced by risk awareness and household wealth, but also by factors such as autonomy or a woman's ability to act upon her own preferences. How autonomy should be constructed and measured - namely, as an individual or cluster-level variable - has been less examined. We drew on household survey data from Zambia to study the effect of several autonomy dimensions (financial, relationship, freedom of movement, health care seeking and violence) on place of delivery for 3200 births across 203 rural clusters (villages). In multilevel logistic regression, two autonomy dimensions (relationship and health care seeking) were strongly associated with facility delivery when measured at the cluster level (OR 1.27 and 1.57, respectively), though not at the individual level. This suggests that power relations and gender norms at the community level may override an individual woman's autonomy, and cluster-level measurement may prove critical to understanding the interplay between autonomy and care seeking in this and similar contexts.

  19. Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement

    Science.gov (United States)

    Gabrysch, Sabine; McMahon, Shannon A.; Siling, Katja; Kenward, Michael G.; Campbell, Oona M. R.

    2016-01-01

    It is widely held that decisions whether or when to attend health facilities for childbirth are not only influenced by risk awareness and household wealth, but also by factors such as autonomy or a woman’s ability to act upon her own preferences. How autonomy should be constructed and measured – namely, as an individual or cluster-level variable – has been less examined. We drew on household survey data from Zambia to study the effect of several autonomy dimensions (financial, relationship, freedom of movement, health care seeking and violence) on place of delivery for 3200 births across 203 rural clusters (villages). In multilevel logistic regression, two autonomy dimensions (relationship and health care seeking) were strongly associated with facility delivery when measured at the cluster level (OR 1.27 and 1.57, respectively), though not at the individual level. This suggests that power relations and gender norms at the community level may override an individual woman’s autonomy, and cluster-level measurement may prove critical to understanding the interplay between autonomy and care seeking in this and similar contexts. PMID:26931301

  20. Utilization of Total Joint Arthroplasty in Physician-Owned Specialty Hospitals vs Acute Care Facilities.

    Science.gov (United States)

    Chen, Antonia F; Pflug, Emily; O'Brien, Daniel; Maltenfort, Mitchell G; Parvizi, Javad

    2017-07-01

    The recent emergence of physician-owned specialty hospitals has sparked controversy about overutilization. Thus, the purpose of this study was to compare utilization patterns of total joint arthroplasty (TJA) between physician-specialty hospitals (PSHs) and acute care hospitals (ACHs). A retrospective study was conducted from January 2010 to August 2014 comparing primary TJA patients between a PSH and an ACH; 103 PSH patients were matched to 103 ACH patients by age, gender, BMI, and ASA classification with similar case distribution between facilities. All surgeons in the study operated at both hospitals and were shareholders of the PSH. Information on nonoperative treatments, and timing to the initial appointment, consent, and surgery were analyzed using univariate analysis. Nonoperative treatments before surgery were similar between hospitals (P = 1.00). The time from the initial appointment to consent was longer for PSH (P = .0001). However, the time from consent to the date of surgery (P = .04) and the timing from symptoms to initial appointment (P = .006) was shorter for PSH. The time from initial appointment to the day of surgery was similar between groups (P = .20). Patients were more likely to be consented for surgery on their first clinic visit when undergoing surgery at ACH (87 of 103, 84.4%) compared to PSH (61 of 103; 59.2%; P total knee arthroplasty (P = .001) and total hip arthroplasty patients (P = .001) at PSH. Facility ownership in PSH resulted in similar conservative treatment before TJA. The time to surgical consent after the initial appointment was longer PSH, whereas the time from consent to the date of surgery was shorter at the PSH. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. A network of Pediatric Environmental Health Specialty Units (PEHSUs: Filling a critical gap in the health care system

    Directory of Open Access Journals (Sweden)

    Christine M. Zachek

    2012-09-01

    Full Text Available A network of pediatric environmental health specialty units (PEHSUs in the United States was formed in 1998 out of a recognized need for clinical expertise in children’s environmental health. Documented trends in a rise of pediatric diseases caused or exacerbated by environmental conditions, coupled with the failure of medical schools and residency programs to cover these issues in a significant way, leaves health care providers, parents, communities, and governments at a loss for this specialized knowledge. The PEHSUs fill this gap by providing: 1 medical education, 2 general outreach and communications, and 3 consultative services to communities and health care professionals. This paper presents examples of key situations where PEHSU involvement was instrumental in improved patient outcomes or advancing clinical expertise in children’s environmental health. Challenges and opportunities for future directions for the program are also discussed.

  2. Level of modern health care seeking behaviors among mothers having under five children in Dangila town, north West Ethiopia, 2016: a cross sectional study.

    Science.gov (United States)

    Dagnew, Amare Belachew; Tewabe, Tilahun; Murugan, Rajalakshmi

    2018-05-29

    Health seeking behavior is an action taken by an individual who perceive to have a health problem. In most developing countries including Ethiopia the health of the children is strongly dependant on maternal health care behavior. Most childhood morbidities and mortalities are associated with low level of mothers health care seeking behavior. Therefore, the objective of this study was to assess level of modern health care seeking behavior among mothers having under five children in Dangila town, North West Ethiopia. Community based quantitative cross-sectional study was conducted from April 15 to May 15, 2016. Systematic random sampling technique was used to select study participants. A total of273 mothers with children less than five years were included in this study. The data was collected from all five Kebeles using interviewer administered questionnaire. Descriptive and inferential statistics were used to present the data. Both bivariate and multivariate logistic regression analyses were used to identify factors associated with level of modern health care seeking behavior. Prevalence of modern health care seeking behavior was 82.1%. Age of mothers (AOR = 2.4(1.1, 5.3), age of the child (AOR = 6.7(2.8, 22.2), severity of illness (AOR = 5.2(1.2, 22.6) and family number (AOR = 6.4(2.1, 20.2) were predictors of modern health care seeking behavior among mothers. Majority of the mothers preferred to take their children to modern health care when they got illness. Age of children, age of mother, number of family and severity of illness were the determinant factors for modern health care seeking behavior. Therefore, health care services should be strengthened at community level through community integrated management of childhood illness, information, education communication / behavioral change communication strategies to improve mothers health care seeking behaviors.

  3. Parental use of the Internet to seek health information and primary care utilisation for their child: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Migeot Virginie

    2008-08-01

    Full Text Available Abstract Background Using the Internet to seek health information is becoming more common. Its consequences on health care utilisation are hardly known in the general population, in particular among children whose parents seek health information on the Internet. Our objective was to investigate the relationship between parental use of the Internet to seek health information and primary care utilisation for their child. Methods This cross-sectional survey has been carried out in a population of parents of pre-school children in France. The main outcome measure was the self-reported number of primary care consultations for the child, according to parental use of the Internet to seek health information, adjusted for the characteristics of the parents and their child respectively, and parental use of other health information sources. Results A total of 1 068 out of 2 197 questionnaires were returned (response rate of 49%. No association was found between parental use of the Internet to seek health information and the number of consultations within the last 12 months for their child. Variables related to the number of primary care consultations were characteristics of the child (age, medical conditions, homeopathic treatment, parental characteristics (occupation, income, stress level and consultation of other health information sources (advice from pharmacist, relatives. Conclusion We did not find any relationship between parental use of the Internet to seek health information and primary care utilisation for children. The Internet seems to be used as a supplement to health services rather than as a replacement.

  4. Emergency medicine as a specialty in Asia.

    Science.gov (United States)

    Pek, Jen Heng; Lim, Swee Han; Ho, Hiu Fai; Ramakrishnan, T V; Jamaluddin, Sabariah Faizah; Mesa-Gaerlan, Faith Joan C; Tiru, Mohan; Hwang, Sung Oh; Choi, Wai-Mau; Kanchanasut, Somchai; Khruekarnchana, Pairoj; Avsarogullari, Levent; Shimazu, Takeshi; Hori, Shingo

    2016-04-01

    We aim to examine the similarities and differences in areas of EM development, workload, workforce, and capabilities and support in the Asia region. Emerging challenges faced by our EM community are also discussed. The National Societies for Emergency Medicine of Hong Kong, India, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand and Turkey participated in the joint Japanese Association of Acute Medicine (JAAM) and Asian Conference of Emergency Medicine (ACEM) Special Symposium held in October 2013 at Tokyo, Japan. The findings are reviewed in this paper. Emergency medicine (EM) has over the years evolved into a distinct and recognized medical discipline requiring a unique set of cognitive, administrative and technical skills for managing all types of patients with acute illness or injury. EM has contributed to healthcare by providing effective, safe, efficient and cost-effective patient care. Integrated systems have developed to allow continuity of emergency care from the community into emergency departments. Structured training curriculum for undergraduates, and specialty training programs for postgraduates are in place to equip trainees with the knowledge and skills required for the unique practice of EM. The practice of EM still varies among the Asian countries. However, as a region, we strive to continue in our efforts to develop the specialty and improve the delivery of EM.

  5. Differences in health care seeking behaviour between rural and urban communities in South Africa

    Science.gov (United States)

    2012-01-01

    Objective The aim of this study was to explore possible differences in health care seeking behaviour among a rural and urban African population. Design A cross sectional design was followed using the infrastructure of the PURE-SA study. Four rural and urban Setswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to) health care was collected. Results The results clearly illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. In general, inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. The difference in employment rate between urban and rural communities in this study indicated that participants of urban communities were more likely to be employed. Consequently, participants from rural communities had a significantly lower available weekly budget, not only for health care itself, but also for transport to the health care facility. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice (OR:5.29, 95% CI 2.83-988). Conclusion Recommendations are formulated for infrastructure investments in rural communities, quality of health care and its perception, improvement of household socio-economical status and further research on the consequences of delay in health care seeking behaviour. PMID:22691443

  6. Treatment Seeking and Ebola Community Care Centers in Sierra Leone: A Qualitative Study.

    Science.gov (United States)

    Carter, Simone E; O'Reilly, Marion; Frith-Powell, Jack; Umar Kargbo, Alpha; Byrne, Daniel; Niederberger, Eva

    2017-01-01

    Ebola Treatment Units were able to provide only 60% of necessary treatment beds in Sierra Leone. As a result, the Government of Sierra Leone decided to construct Community Care Centers. These were intended to increase treatment-seeking behavior and reduce the community-level spread of Ebola by facilitating access to care closer to communities. Through qualitative data collection in 3 districts, this study seeks to understand the perceived impact that proximity to such Centers had on treatment-seeking behavior. Feedback from community members and Community Health Volunteers indicates that proximity to treatment reduced fears, especially those arising from the use of ambulances, lack of familiarity with medical Centers, and loss of contact with family members taken for treatment. Participants report that having a Center close to their home enables them to walk to treatment and witness survivors being discharged. Living close to Centers also enables communities to be involved in their design and daily operation, helping to build trust in them as acceptable treatment facilities. Further research is required to understand the appropriate design, operation, and epidemiological impact of Centers. Further investigation should incorporate the effect of an outbreak's severity and the stage (duration) of the outbreak on potential acceptance of Centers.

  7. Specialty, political affiliation, and perceived social responsibility are associated with U.S. physician reactions to health care reform legislation.

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    Antiel, Ryan M; James, Katherine M; Egginton, Jason S; Sheeler, Robert D; Liebow, Mark; Goold, Susan Dorr; Tilburt, Jon C

    2014-02-01

    Little is known about how U.S. physicians’ political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation. To assess U.S. physicians’ impressions about the direction of U.S. health care under the Affordable Care Act (ACA), whether that legislation will make reimbursement more or less fair, and examine how those judgments relate to political affiliation and perceived social responsibility. A cross-sectional, mailed, self-reported survey. Simple random sample of 3,897 U.S.physicians. Views on the ACA in general, reimbursement under the ACA in particular, and perceived social responsibility. Among 2,556 physicians who responded (RR2: 65 %), approximately two out of five (41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA (OR 33.0 [95 % CI, 23.6–46.2]; OR 5.0 [95 % CI, 3.7–6.8], respectively), as were physicians reporting a salary (OR 1.7 [95 % CI, 1.2–2.5])or salary plus bonus (OR 1.4 [95 % CI, 1.1–1.9)compensation type. In the same multivariate models, those who agreed that addressing societal health policy issues are within the scope of their professional obligations (OR 1.5 [95 % CI, 1.0–2.0]), who believe physicians are professionally obligated to care for the uninsured / under-insured (OR 1.7 [95 % CI,1.3–2.4]), and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage (OR 2.3 [95 % CI, 1.8

  8. Family culture in mental health help-seeking and utilization in a nationally representative sample of Latinos in the United States: The NLAAS.

    Science.gov (United States)

    Villatoro, Alice P; Morales, Eduardo S; Mays, Vickie M

    2014-07-01

    Considering the central role of familismo in Latino culture, it is important to assess the extent to which familismo affects mental health help-seeking. This study examined the role of behavioral familismo, the level of perceived family support, in the use of mental health services of Latinos in the United States. Data come from the National Latino and Asian American Study (NLAAS), a representative household survey examining the prevalence of mental disorders and services utilization among Latinos and Asian Americans. Analyses were limited to Latino adults with a clinical need for mental health services, indexed by meeting DSM-IV diagnostic criteria for any mood, anxiety, or substance use disorder during the past 12 months (N = 527). One-third of Latinos with a clinical need used any type of service in the past year, including specialty mental health, general medical, and informal or religious services. High behavioral familismo was significantly associated with increased odds of using informal or religious services, but not specialty or medical services. Self-perceived need and social perceptions of need for care within close networks (i.e., told by family/friends to seek professional help) also were significant predictors of service use. These results carry important implications toward expansions of the mental health workforce in the informal and religious services settings.

  9. Oral health in Brazil - Part II: Dental Specialty Centers (CEOs

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    Vinícius Pedrazzi

    2008-08-01

    Full Text Available The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers, which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System. Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.

  10. Care-seeking patterns for fatal non-communicable diseases among women of reproductive age in rural northwest Bangladesh.

    Science.gov (United States)

    Sikder, Shegufta S; Labrique, Alain B; Ullah, Barkat; Mehra, Sucheta; Rashid, Mahbubur; Ali, Hasmot; Jahan, Nusrat; Shamim, Abu A; West, Keith P; Christian, Parul

    2012-08-15

    Though non-communicable diseases contribute to an increasing share of the disease burden in South Asia, health systems in most rural communities are ill-equipped to deal with chronic illness. This analysis seeks to describe care-seeking behavior among women of reproductive age who died from fatal non-communicable diseases as recorded in northwest rural Bangladesh between 2001 and 2007. This analysis utilized data from a large population-based cohort trial in northwest rural Bangladesh. To conduct verbal autopsies of women who died while under study surveillance, physicians interviewed family members to elicit the biomedical symptoms that the women experienced as well as a narrative of the events leading to deaths. We performed qualitative textual analysis of verbal autopsy narratives for 250 women of reproductive age who died from non-communicable diseases between 2001 and 2007. The majority of women (94%) sought at least one provider for their illnesses. Approximately 71% of women first visited non-certified providers such as village doctors and traditional healers, while 23% first sought care from medically certified providers. After the first point of care, women appeared to switch to medically certified practitioners when treatment from non-certified providers failed to resolve their illness. This study suggests that treatment seeking patterns for non-communicable diseases are affected by many of the sociocultural factors that influence care seeking for pregnancy-related illnesses. Families in northwest rural Bangladesh typically delayed seeking treatment from medically certified providers for NCDs due to the cost of services, distance to facilities, established relationships with non-certified providers, and lack of recognition of the severity of illnesses. Most women did not realize initially that they were suffering from a chronic illness. Since women typically reached medically certified providers in advanced stages of disease, they were usually told that

  11. Care-seeking patterns for fatal non-communicable diseases among women of reproductive age in rural northwest Bangladesh

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    Sikder Shegufta S

    2012-08-01

    Full Text Available Abstract Background Though non-communicable diseases contribute to an increasing share of the disease burden in South Asia, health systems in most rural communities are ill-equipped to deal with chronic illness. This analysis seeks to describe care-seeking behavior among women of reproductive age who died from fatal non-communicable diseases as recorded in northwest rural Bangladesh between 2001 and 2007. Methods This analysis utilized data from a large population-based cohort trial in northwest rural Bangladesh. To conduct verbal autopsies of women who died while under study surveillance, physicians interviewed family members to elicit the biomedical symptoms that the women experienced as well as a narrative of the events leading to deaths. We performed qualitative textual analysis of verbal autopsy narratives for 250 women of reproductive age who died from non-communicable diseases between 2001 and 2007. Results The majority of women (94% sought at least one provider for their illnesses. Approximately 71% of women first visited non-certified providers such as village doctors and traditional healers, while 23% first sought care from medically certified providers. After the first point of care, women appeared to switch to medically certified practitioners when treatment from non-certified providers failed to resolve their illness. Conclusions This study suggests that treatment seeking patterns for non-communicable diseases are affected by many of the sociocultural factors that influence care seeking for pregnancy-related illnesses. Families in northwest rural Bangladesh typically delayed seeking treatment from medically certified providers for NCDs due to the cost of services, distance to facilities, established relationships with non-certified providers, and lack of recognition of the severity of illnesses. Most women did not realize initially that they were suffering from a chronic illness. Since women typically reached medically certified

  12. Health care-seeking behavior among patients with chronic kidney disease: A cross-sectional study of patients presenting at a single teaching hospital in Lagos

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    Babawale Taslim Bello

    2015-01-01

    Full Text Available Introduction: Health care-seeking behavior of individuals determines how early they present for appropriate care. In patients with chronic kidney disease (CKD, late presentation to the nephrologist is associated with poor outcomes. This study aims to describe the health care-seeking behavior of patients with CKD attending the nephrology outpatient clinic of a teaching hospital located in Lagos, Nigeria. Materials and Methods: This was a cross-sectional survey conducted on 104 consecutive adult patients with CKD, presenting for the first time at the nephrology outpatient clinic of a teaching hospital located in Lagos, South West Nigeria. Information was retrieved from the study participants using a structured interviewer-administered questionnaire, entered into an Excel spreadsheet, and analyzed using Epi Info® statistical software version 7.0. Results: Overall, 74 (71.2% patients sought help, first from a trained health care provider, and their health care-seeking behavior was adjudged to be appropriate. Compared to patients with appropriate health care-seeking behavior, those with inappropriate health care-seeking behavior had a lower mean age (40.4 ± 13.7 years vs 47.3 ± 15.6 years;P = 0.03, were less likely to see their illness as a medical problem (46.7% vs 67.6%;P = 0.04, more likely to have a monthly income less than N25,000 ($150 (80.0% vs 59.5%;P = 0.04, and have received below tertiary level education (20.0% vs 48.6%; P < 0.01. They were also more likely to have consulted more than one health care provider before being referred to our clinic. The factors predicting inappropriate health care-seeking behavior were education below the tertiary level and age less than 45 years. Conclusion: Though health care-seeking behavior was appropriate in majority of our patients with CKD, there remains a need for improved public health awareness.

  13. A review of literature on delays in seeking care for tuberculosis in different Indian states

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    Janmejaya Samal

    2017-01-01

    Full Text Available The passive case-finding approach of Revised National Tuberculosis (TB Control Programme in India strongly affects the health-seeking behavior of TB patients, the timing of help seeking as well as the subsequent delays associated with the same. Studies carried out in different parts of India reveal a host of several factors for delay in seeking help and the reasons for not seeking help at all. Important reasons for delayed health-seeking behavior include financial constraint, symptoms are not severe (as perceived by the patients, work pressure, lack of awareness, first consulted nonpublic sector, inaccessibility to health facility, home remedy, social stigma, self-medication, transport problem, and dissatisfaction with health facility. Similarly, the median patient delay ranged from 7 to 56 days as reported by various studies. Health-seeking behavior and related delays are of utmost importance in TB care from two important perspectives; first, TB requires timely treatment, and second, it requires protracted treatment. Required level of knowledge and a positive health behavior helps the patients in taking timely help from an appropriate health facility. Moreover, timely help-seeking prevents further spread of the disease and helps in establishing a TB-free society.

  14. Much ado about nothing? The financial impact of physician-owned specialty hospitals.

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    Chakravarty, Sujoy

    2016-06-01

    The U.S. hospital industry has recently witnessed a number of policy changes aimed at aligning hospital payments to costs and these can be traced to significant concerns regarding selection of profitable patients and procedures by physician-owned specialty hospitals. The policy responses to specialty hospitals have alternated between payment system reforms and outright moratoriums on hospital operations including one in the recently enacted Affordable Care Act. A key issue is whether physician-owned specialty hospitals pose financial strain on the larger group of general hospitals through cream-skimming of profitable patients, yet there is no study that conducts a systematic analysis relating such selection behavior by physician-owners to financial impacts within hospital markets. The current paper takes into account heterogeneity in specialty hospital behavior and finds some evidence of their adverse impact on profit margins of competitor hospitals, especially for-profit hospitals. There is also some evidence of hospital consolidation in response to competitive pressures by specialty hospitals. Overall, these findings underline the importance of the payment reforms aimed at correcting distortions in the reimbursement system that generate incentives for risk-selection among providers groups. The identification techniques will also inform empirical analysis on future data testing the efficacy of these payment reforms.

  15. One-year incidence and predictors of homelessness among 300,000 U.S. Veterans seen in specialty mental health care.

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    Tsai, Jack; Hoff, Rani A; Harpaz-Rotem, Ilan

    2017-05-01

    The Department of Veterans Affairs (VA) is committed to preventing and ending homelessness among U.S. veterans, but there have been few estimates of the incidence of veteran homelessness and prospective studies to identify predictors of homelessness. This study examines the 1-year incidence of homelessness among veterans seen in VA specialty mental health clinics and identified sociodemographic and clinical predictors of homelessness. Using a retrospective cohort study design, data were extracted from the VA medical records of 306,351 veterans referred to anxiety and posttraumatic stress disorder clinics across 130 VA facilities from 2008-2012 and followed for 1 year after referral. Homeless incidence was defined as new use of any VA homeless services or a documented International Classification of Diseases (9th rev.) V60.0 (lack of housing) code during the year. Of the total sample, 5.6% (7.8% for women and 5.4% for men) experienced homelessness within 1 year after referral to VA specialty mental health care. Veterans who were unmarried or diagnosed with a drug use disorder were more than twice as likely to become homeless; those who were Black or had annual incomes less than $25,000 were more than one and a half times as likely to become homeless. Together, these findings suggest a notable and important percentage of veterans seen in VA specialty mental health clinics newly experience homelessness annually. Monitoring early signs of housing vulnerability and preventing homelessness in this vulnerable but treatment-engaged population may be important in the VA's efforts to end veteran homelessness. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  16. A qualitative exploration of care-seeking pathways for sick children in the rural Oromia region of Ethiopia.

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    Shaw, Bryan; Amouzou, Agbessi; Miller, Nathan P; Bryce, Jennifer; Surkan, Pamela J

    2017-03-09

    Ethiopia has experienced rapid improvements in its healthcare infrastructure, such as through the recent scale up of integrated community case management (iCCM) delivered by community-based health extension workers (HEWs) targeting children under the age of five. Despite notable improvements in child outcomes, the use of HEWs delivering iCCM remains very low. The aim of our study was to explain this phenomenon by examining care-seeking practices and treatment for sick children in two rural districts in the Oromia Region of Ethiopia. Using qualitative methods, we explored perceptions of child illness, influences on decision-making processes occurring over the course of a child's illness and caregiver perceptions of available community-based sources of child illness care. Sixteen focus group discussions (FGDs) and 40 in-depth interviews (IDIs) were held with mothers of children under age five. For additional perspective, 16 IDIs were conducted fathers and 22 IDIs with health extension workers and community health volunteers. Caregivers often described the act of care-seeking for a sick child as a time of considerable uncertainty. In particular, mothers of sick children described the cultural, social and community-based resources available to minimize this uncertainty as well as constraints and strategies for accessing these resources in order to receive treatment for a sick child. The level of trust and familiarity were the most common dynamics noted as influencing care-seeking strategies; trust in biomedical and government providers was often low. Overall, our research highlights the multiple and dynamic influences on care-seeking for sick children in rural Ethiopia. An understanding of these influences is critical for the success of existing and future health interventions and continued improvement of child health in Ethiopia.

  17. Reasons for Seeking Clinical Care for Lower Urinary Tract Symptoms: A Mixed Methods Study.

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    Griffith, James W; Messersmith, Emily E; Gillespie, Brenda W; Wiseman, Jonathan B; Flynn, Kathryn E; Kirkali, Ziya; Kusek, John W; Bavendam, Tamara; Cella, David; Kreder, Karl J; Nero, Jasmine J; Corona, Maria E; Bradley, Catherine S; Kenton, Kimberly S; Helfand, Brian T; Merion, Robert M; Weinfurt, Kevin P

    2018-02-01

    The primary objective of this study was to evaluate reasons for seeking care among men and women with lower urinary tract symptoms. Participants were recruited from urology and urogynecology clinics, and the community. The sample was enriched with persons expected to have abnormal or diminished bladder sensations (eg participants with lower back surgery and participants 65 years old or older). Interviews were performed in person beginning with an open-ended assessment of urinary symptoms and associated bother followed by more directed questions, including reasons for seeking or not seeking treatment. We also examined the relationship between symptom frequency and bother using the LUTS (Lower Urinary Tract Symptoms) Tool. A total of 88 participants, including 38 men and 50 women, with a mean ± SD age of 52.2 ± 14.3 years provided information about urinary symptoms, including a range of quality of life consequences and coping behaviors. They sought treatment mostly because of new, continuing or bothersome symptoms. Factors associated with not seeking treatment included low symptom severity and concerns about the costs vs the benefits of treatment (eg side effects of medication). Symptom frequency and bother were associated with each other across symptoms assessed by the LUTS Tool. In this large qualitative study we obtained useful insights into the impact of lower urinary tract symptoms from the perspective of the person with the symptoms. Removing barriers and misconceptions about the treatment of lower urinary tract symptoms may increase the number of people who seek clinical care and improve the clinical course of men and women who experience lower urinary tract symptoms. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  18. Maternal complications and women's behavior in seeking care from skilled providers in North Gondar, Ethiopia.

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    Abebaw Gebeyehu Worku

    Full Text Available BACKGROUND: Maternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women's experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study. METHODS: This study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders. RESULTS: Out of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7% reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6% sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider. CONCLUSION: Nearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved

  19. Ruptured tubal pregnancy: predictors of delays in seeking and obtaining care in a Nigerian population

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    Awoleke JO

    2015-01-01

    Full Text Available Jacob O Awoleke,1 Abiodun I Adanikin,1 Adeola O Awoleke2 1Department of Obstetrics and Gynaecology, Ekiti State University, 2School of Nursing, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria Purpose: Morbidity and mortality from ruptured tubal pregnancies (RTPs have been linked with delays in seeking and receiving care. Evaluation of the reasons for these delays and their contributions to maternal deaths is rarely done for women with RTPs in resource-constrained settings.Patients and methods: This was a 3-year retrospective review of the case records of women with tubal pregnancies managed at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Clinical and sociodemographic parameters were obtained, including information on onset of symptoms and intervals between the symptoms and when help was sought and obtained at the hospital.Results: There were 92 cases of tubal pregnancies, giving an incidence of 18 per 1,000 births. Most of the patients were married (74.7%, parous (64.9%, and urban dwellers (76.9%, and 11% were severely anemic on arrival. The case-fatality rate was 1.1% and 74.7% had delay in seeking care, while 82.4% of the women spent more than 2 hours after admission before surgical intervention. Rural dwellers (adjusted odds ratio 2.96, 95% confidence interval 1.08–8.36 and those without formal education (adjusted odds ratio 6.39, 95% confidence interval 1.06–67.30 had delays in seeking help, while problems with funds (χ2=7.354, P=0.005 and initial misdiagnosis (χ2=5.824, P=0.018 predicted delay in obtaining help at the hospital.Conclusion: RTPs are common gynecological emergencies in our environment that are often associated with delayed decisions to seek help and obtain care. Efforts should be geared toward women’s education and financial independence, improved hospital accessibility, and better diagnostic skills. Keywords: delay, ruptured tubal pregnancies, predictors, health care, Nigeria

  20. Care seeking behaviour and various delays in tuberculosis patients registered under RNTCP in Pune city

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    Jayashree Sachin Gothankar

    2016-03-01

    Full Text Available Introduction: Case finding in tuberculosis is known to be influenced by factors such as patient motivation, care seeking, the degree of diagnostic suspicion by health care provider which could result in a delayed diagnosis.Objective: To determine care seeking behaviour and delay in diagnosis and treatment of new sputum positive tuberculosis patients registered under RNTCP.Material and Methods: Descriptive cross sectional study. 283 new sputum positive tuberculosis patients (≥15 years of age registered during a period of six months at two randomly selected tuberculosis unit of Pune city. Questionnaire by WHO was modified and used. Interviews were conducted in DOT centres. Statistical analysis: Frequency, mean and standard deviation, chi square test.Results: Mean age of patients was 35 (±15 years18% of patients were unemployed and 77% resided in urban slums. The commonest co morbidity in 7.4% and 3.5 % patients was HIV/ AIDS followed by diabetics respectively. Majority of the patients, for the first and second time visited a general practitioner. Median patient, health care system and total delay were 18, 22 and 47 days with mean of 24±21, 32±30 and 56±33 days respectively. Health care system delay was less (p<0.05 in patients who first visited the public health care facility than patients who first visited a private health care provider.Conclusions: General practitioners are preferred first choice of health care provider for tuberculosis patients. Mean health care system delay is more than patient delay.

  1. Medical student debt and major life choices other than specialty

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    James Rohlfing

    2014-11-01

    Full Text Available Background: Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Methods: Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students. No incentives were offered for survey completion. Results: Responses were recorded from 102 US Allopathic medical schools (n=3,032, with 22 institutions (11 public, 11 private meeting inclusion criteria of 10% student body response proportion (n=1,846. Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Conclusions: Medical student debt and particularly debt

  2. Medical student debt and major life choices other than specialty.

    Science.gov (United States)

    Rohlfing, James; Navarro, Ryan; Maniya, Omar Z; Hughes, Byron D; Rogalsky, Derek K

    2014-01-01

    Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students). No incentives were offered for survey completion. Responses were recorded from 102 US Allopathic medical schools (n=3,032), with 22 institutions (11 public, 11 private) meeting inclusion criteria of 10% student body response proportion (n=1,846). Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Medical student debt and particularly debt relative to peers at the same institution appears to

  3. History of Medical Specialty Interest Assessment

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    Burns, Stephanie T.

    2016-01-01

    Medical specialties require decidedly different abilities, skills, and talents; which results in divergent experiences, lifestyles, skill sets, and income levels. To help medical students select their preferred medical specialty and alleviate shortages in medical specialty staffing, US medical schools and associations invest time and money in…

  4. Routine Prenatal Care Visits by Provider Specialty in the United States, 2009-2010

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    ... and are not in the specialties of anesthesiology, pathology, or radiology. The NAMCS physician response rate was ... last reviewed: November 6, 2015 Page last updated: March 13, 2014 Content source: Email Recommend Tweet YouTube ...

  5. Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?

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    Fenny, Ama Pokuaa; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S

    2015-04-12

    Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy. Using a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study. Out of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities. Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.

  6. Dentistry's oldest specialty: orthodontics and dentofacial orthopedics.

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    George, Raymond

    2009-01-01

    The American Association of Orthodontists (AAO) has 15,500 members worldwide and is the oldest and largest of the recognized dental specialties. A strategic planning process has identified six key challenges, and this article describes the progress that is being made in the areas of (a) consumer education, (b) volunteer leadership development, (c) recruitment and retention of orthodontic educators, (d) relationships with ADA and other healthcare organizations, (e) the AAO's role in international orthodontics, and (f) advocacy. The AAO is working for freedom of choice in dental healthcare providers; fee-for-service dental care; orthodontic insurance coverage as a benefit of employment, with direct reimbursement as the preferred plan; self-referred access to specialists; private and public funding that promote quality orthodontic care; and the retention of tax deductibility of dental healthcare benefits, including orthodontic care.

  7. A cross-sectional analysis of barriers to health-care seeking among medical students across training period

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    Vikas Menon

    2017-01-01

    Full Text Available Background and Aims: Very little information is available on how needs and perceptions to service utilization may change with duration of medical training. Our objective was to compare the self-reported barriers to health-care seeking for mental and physical health services separately between 1st year and final year medical students. Methods: In this cross-sectional study, we invited all medical students of the concerned cohorts to complete a prevalidated checklist and 28-item self-reported questionnaire about perceived barriers to health-care seeking. The questionnaire had separate items pertaining to usage of mental and physical health-care services. Results: The response rate of the 1st year and final year cohorts were 83.8% and 86.6%, respectively. Lack of time, unawareness about where to seek help, cost issues, and fear of future academic jeopardy were more common concerns among 1st year students to the usage of mental health services (odds ratio [OR] 0.27, 0.45,0.09, and 0.49, respectively whereas issues of stigma were more commonly reported by final year students for using mental health services (OR = 2.87. In contrast, the barriers in using physical health services were broadly comparable between the two cohorts. Conclusion: Differences exist between medical students in various years of training particularly with regard to self-reported barriers and perceptions particularly about using mental health-care services. This may have key implications for designing and delivery of service provisions in this group.

  8. Current and future funding sources for specialty mental health and substance abuse treatment providers.

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    Levit, Katharine R; Stranges, Elizabeth; Coffey, Rosanna M; Kassed, Cheryl; Mark, Tami L; Buck, Jeffrey A; Vandivort-Warren, Rita

    2013-06-01

    Goals were to describe funding for specialty behavioral health providers in 1986 and 2005 and examine how the recession, parity law, and Affordable Care Act (ACA) may affect future funding. Numerous public data sets and actuarial methods were used to estimate spending for services from specialty behavioral health providers (general hospital specialty units; specialty hospitals; psychiatrists; other behavioral health professionals; and specialty mental health and substance abuse treatment centers). Between 1986 and 2005, hospitals-which had received the largest share of behavioral health spending-declined in importance, and spending shares trended away from specialty hospitals that were largely funded by state and local governments. Hospitals' share of funding from private insurance decreased from 25% in 1986 to 12% in 2005, and the Medicaid share increased from 11% to 23%. Office-based specialty providers continued to be largely dependent on private insurance and out-of-pocket payments, with psychiatrists receiving increased Medicaid funding. Specialty centers received increased funding shares from Medicaid (from 11% to 29%), and shares from other state and local government sources fell (from 64% to 46%). With ACA's full implementation, spending on behavioral health will likely increase under private insurance and Medicaid. Parity in private plans will also push a larger share of payments for office-based professionals from out-of-pocket payments to private insurance. As ACA provides insurance for formerly uninsured individuals, funding by state behavioral health authorities of center-based treatment will likely refocus on recovery and support services. Federal Medicaid rules will increase in importance as more people needing behavioral health treatment become covered.

  9. Irish midwives' experiences of providing maternity care to non-Irish women seeking asylum

    Directory of Open Access Journals (Sweden)

    Tobin CL

    2014-01-01

    Full Text Available Carolyn L Tobin,1 Jo Murphy-Lawless2 1Department of Nursing, College of Health and Human Services, University of New Hampshire, Durham, NH, USA; 2School of Nursing and Midwifery, Trinity College, Dublin, Ireland Background: Immigration and asylum seeking has been an important social and political phenomenon in Ireland since the mid 1990s. Inward migration to Ireland was seen in unprecedented numbers from 1995 onward, peaking in 2002 with 11,634 applications for refugee status. Asylum and immigration is an issue of national and international relevance as the numbers of displaced people worldwide continues to grow, reaching the highest level in 20 years at 45.2 million in 2012. Midwives provide the majority of care to childbearing women around the world, whether working as autonomous practitioners or under the direction of an obstetrician. Limited data currently exist on the perspectives of midwives who provide care to childbearing women while they are in the process of seeking asylum. Such data are important to midwifery leaders, educators, and policy-makers. The aims of this study were to explore midwives' perceptions and experiences of providing care to women in the asylum process and to gain insight into how midwives can be equipped and supported to provide more effective care to this group in the future.Methods: Data were collected via indepth unstructured interviews with a purposive sample of ten midwives from two sites, one a large urban inner city hospital, and the second, a smaller more rural maternity hospital. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using content analysis. Results: Five themes emerged from the data, barriers to communication, understanding cultural difference, challenges of caring for women who were unbooked, the emotional cost of caring, and structural barriers to effective care. Conclusion: Findings highlight a need to focus on support and education for midwives, improved

  10. Gender inflexion in the construction of a new medical specialty

    Directory of Open Access Journals (Sweden)

    Rachel Aisengart Menezes

    2008-01-01

    Full Text Available This article presents the constitution of a new medical specialty, Palliative Care, directed to patients "out of therapeutic possibilities". The concept emerged around 1960 in England and was implemented in Brazil a couple of years before 1990. It is characterized by an active attendance of the dying process. It postulates a "spiritual assistance" to the patient and his/her family members, including the emotional universe. Ethnographical observation and interviews with Brazilian professionals showed a majority of women among the health teams involved in this proposal. This article discusses and analyses the connection between the construction of the specialty and gender representation among these professionals that reflects popular social images about death, beliefs, emotions and the roles played by women and men in these subjects.

  11. Apprehensive parents: a qualitative study on parents seeking immediate primary care for their children

    NARCIS (Netherlands)

    Hugenholtz, M.; Bröer, C.; van Daalen, R.

    2009-01-01

    Background: Children are more frequent users of out-of-hours primary care than other age groups, although their medical problems are less urgent. Aim: To gain insight into the health-seeking behaviour of parents who ask for immediate medical attention for their children. Design of study: Qualitative

  12. Surgical resident perceptions of trauma surgery as a specialty.

    Science.gov (United States)

    Hadzikadic, Lejla; Burke, Peter A; Esposito, Thomas J; Agarwal, Suresh

    2010-05-01

    Presenting the opinions of surgical residents about the appeal of trauma surgery as a specialty may influence current reform. Survey study. Academic research. General surgery residents (postgraduate years 1-5 and recent graduates) registered with the American College of Surgeons. A 22-item survey. Career plans and perceptions about trauma surgery as a specialty. Of 6006 mailed surveys, we had a 20.1% response rate. Midlevel residents comprised most of the respondents, and most were undecided about their career choice or planned to enter general surgical private practice. The typical residency programs represented were academic (81.7%), urban (90.6%), and level I trauma centers (78.7%), and included more than 6 months of trauma experience (77.6%). Most respondents (70.6%) thought that trauma surgery was unappealing. The most important deterrents to entering the field were lifestyle, poor reimbursement, and limited operating room exposure, while increased surgical critical care was not seen as a restriction. When questioned about the future of trauma surgery, they believed that trauma surgeons should perform elective (86.8%) and nontrauma emergency (91.5%) cases and would benefit from active association with an outpatient clinic (76.0%). Intellectual challenge and exciting nature of the field were listed as the most appealing aspects, and ideal practice characteristics included guaranteed salary and time away from work. As demand for trauma surgeons increases, resident interest has dwindled. As a specialty, trauma surgery must undergo changes that reflect the needs of the incoming generation. We present a sampling of current surgical resident opinion and offer these data to assist the changing discipline and the evolving field of acute care surgery.

  13. Lesbian, gay, bisexual, and transgender parents seeking health care for their children: a systematic review of the literature.

    Science.gov (United States)

    Shields, Linda; Zappia, Tess; Blackwood, Diana; Watkins, Rochelle; Wardrop, Joan; Chapman, Rose

    2012-12-01

    Few studies have examined the issues faced by lesbian, gay, bisexual, and transgender (LGBT)-parented families in relation to their access to and satisfaction with healthcare services for their children. It is thought that LGBT individuals have experienced negative interactions with the healthcare environment. To systematically review the literature investigating the experience of LGBT parents seeking health care for their children. A search of the following databases: Cochrane Library, CINAHL, Embase, Google Scholar, Medline, PsychInfo, Science Direct, Sociological Abstracts, Proquest, Scopus, and Web of Science was conducted. Using the PRISMA flow chart and processes of the United Kingdom Centre for Reviews and Dissemination, we selected and analysed relevant studies. Four studies that met the inclusion criteria were identified. Studies showed that while the experience of LGBT parents seeking health care was largely positive, strategies need to be implemented to improve the quality of healthcare services for LGBT families and ensure that their needs are met. Although many LGBT parents have positive experiences of health care, some still experience discrimination and prejudice. Specific educational interventions are needed to support LGBT parents seeking health care for their children. Further research is required to explore LGBT-parented families' experiences of healthcare services, and this should include children's experiences. © 2012 Sigma Theta Tau International.

  14. Modeling stigma, help-seeking attitudes, and intentions to seek behavioral healthcare in a clinical military sample.

    Science.gov (United States)

    Wade, Nathaniel G; Vogel, David L; Armistead-Jehle, Patrick; Meit, Scott S; Heath, Patrick J; Strass, Haley A

    2015-06-01

    This study examined the relationship between public and self-stigma of seeking behavioral health services, and help-seeking attitudes and intent in a sample of active duty military personnel currently being assessed for traumatic brain injuries in a military health center. Although it has been suggested that many military personnel in need of care do not seek services due to concerns with stigma it is not fully clear what role different types of stigma play in the process. Using previously collected data from a clinical sample of 97 military personnel, we conducted path analyses to test the mediation effects of self-stigma on the relationship between public stigma and attitudes toward and intentions to seek behavioral health care. In contrast to a model of military stigma but in line with research with civilian samples, results from this study indicate that self-stigma fully mediates the relationship between public stigma and help-seeking attitudes and intentions. These results indicate that programming aimed at increasing mental health care use in the military might best focus on reducing self-stigma associated with seeking mental health services. (c) 2015 APA, all rights reserved).

  15. Influence of Watchful Waiting on Satisfaction and Anxiety Among Patients Seeking Care for Unexplained Complaints

    NARCIS (Netherlands)

    van Bokhoven, Marloes A.; Koch, Hèlen; van der Weijden, Trudy; Grol, Richard P. T. M.; Kester, Arnold D.; Rinkens, Paula E. L. M.; Bindels, Patrick J. E.; Dinant, Geert-Jan

    2009-01-01

    PURPOSE We undertook a study to determine whether test-ordering strategy and other consultation-related factors influence satisfaction with and anxiety after a consultation among patients seeking care for unexplained complaints. METHODS A cluster-randomized clinical trial was conducted in family

  16. Meta-Analysis of Surgeon Burnout Syndrome and Specialty Differences.

    Science.gov (United States)

    Bartholomew, Alex J; Houk, Anna K; Pulcrano, Marisa; Shara, Nawar M; Kwagyan, John; Jackson, Patrick G; Sosin, Michael

    2018-02-27

    Surgeon burnout compromises the quality of life of physicians and the delivery of care to patients. Burnout rates and interpretation of the Maslach Burnout Inventory (MBI) complicates the interpretation of surgeon burnout. The purpose of this study is to apply a standardized interpretation of severe surgeon burnout termed, "burnout syndrome" to analyze inherent variation within surgical specialties. A systematic literature search was performed using MEDLINE, PsycINFO, and EMBASE to identify studies reporting MBI data by surgical specialty. Data extraction was performed to isolate surgeon specific data. A meta-analysis was performed. A total of 16 cross-sectional studies were included in this meta-analysis, totaling 3581 subjects. A random effects model approximated burnout syndrome at 3.0% (95% CI: 2.0%-5.0%; I 2 = 78.1%). Subscale analysis of emotional exhaustion, depersonalization, and personal accomplishment indicated subscale burnout in 30.0% (CI: 25.0%-36.0%; I 2 = 93.2%), 34.0% (CI: 25.0%-43.0%; I 2 = 96.9%), and 25.0% (CI: 18.0%-32.0%; I 2 = 96.5%) of surgeons, respectively. Significant differences (p burnout termed "burnout syndrome," although surgeon burnout may occur in up to 34% of surgeons, characterized by high burnout in 1 of 3 subscales. Surgical specialties have significantly different rates of burnout subscales. Future burnout studies should target the specialty-specific level to understand inherent differences in an effort to better understand methods of improving surgeon burnout. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  17. Personality traits and career choices among physicians in Finland: employment sector, clinical patient contact, specialty and change of specialty.

    Science.gov (United States)

    Mullola, Sari; Hakulinen, Christian; Presseau, Justin; Gimeno Ruiz de Porras, David; Jokela, Markus; Hintsa, Taina; Elovainio, Marko

    2018-03-27

    Personality influences an individual's adaptation to a specific job or organization. Little is known about personality trait differences between medical career and specialty choices after graduating from medical school when actually practicing different medical specialties. Moreover, whether personality traits contribute to important career choices such as choosing to work in the private or public sector or with clinical patient contact, as well as change of specialty, have remained largely unexplored. In a nationally representative sample of Finnish physicians (N = 2837) we examined how personality traits are associated with medical career choices after graduating from medical school, in terms of employment sector, patient contact, medical specialty and change of specialty. Personality was assessed using the shortened version of the Big Five Inventory (S-BFI). An analysis of covariance with posthoc tests for pairwise comparisons was conducted, adjusted for gender and age with confounders (employment sector, clinical patient contact and medical specialty). Higher openness was associated with working in the private sector, specializing in psychiatry, changing specialty and not practicing with patients. Lower openness was associated with a high amount of patient contact and specializing in general practice as well as ophthalmology and otorhinolaryngology. Higher conscientiousness was associated with a high amount of patient contact and specializing in surgery and other internal medicine specialties. Lower conscientiousness was associated with specializing in psychiatry and hospital service specialties. Higher agreeableness was associated with working in the private sector and specializing in general practice and occupational health. Lower agreeableness and neuroticism were associated with specializing in surgery. Higher extraversion was associated with specializing in pediatrics and change of specialty. Lower extraversion was associated with not practicing with

  18. Gender Inequality Prevents Abused Women from Seeking Care Despite Protection Given in Gender-Based Violence Legislation: A Qualitative Study from Rwanda.

    Science.gov (United States)

    Umubyeyi, Aline; Persson, Margareta; Mogren, Ingrid; Krantz, Gunilla

    2016-01-01

    Despite its burden on a person's life, Intimate Partner Violence (IPV) is known to be poorly recognised and managed in most countries and communities. This study aimed to explore health care professionals' experiences of the health care seeking processes of women exposed to intimate partner violence in Rwanda. Six focus group discussions were conducted in three district hospitals and three mental health units in Rwanda. A sample of 43 health care professionals with various professions and length of work experience, who regularly took care of patients subjected to IPV, was selected for focus group discussions. The analysis was performed using qualitative content analysis. The theme "Gendered norms and values defeat the violence legislation in women's health care seeking when women are abused" expressed the health care professionals' experiences of the double-faced situation which women exposed to IPV met in their help seeking process. Positive initiatives to protect women were identified, but the potential for abused women to seek help and support was reduced because of poverty, gender inequality with prevailing strong norms of male superiority, and the tendency to keep abuse as a private family matter. Legislative measures have been instituted to protect women from abuse. Still many Rwandan women do not benefit from these efforts. The role of the health care services needs to be reinforced as an important and available resource for help and support for abused women but further legislative changes are also needed. Initiatives to further improve gender equality, and institutionalised collaboration between different sectors in society would contribute to protecting women from IPV.

  19. Gender Inequality Prevents Abused Women from Seeking Care Despite Protection Given in Gender-Based Violence Legislation: A Qualitative Study from Rwanda.

    Directory of Open Access Journals (Sweden)

    Aline Umubyeyi

    Full Text Available Despite its burden on a person's life, Intimate Partner Violence (IPV is known to be poorly recognised and managed in most countries and communities. This study aimed to explore health care professionals' experiences of the health care seeking processes of women exposed to intimate partner violence in Rwanda.Six focus group discussions were conducted in three district hospitals and three mental health units in Rwanda. A sample of 43 health care professionals with various professions and length of work experience, who regularly took care of patients subjected to IPV, was selected for focus group discussions. The analysis was performed using qualitative content analysis.The theme "Gendered norms and values defeat the violence legislation in women's health care seeking when women are abused" expressed the health care professionals' experiences of the double-faced situation which women exposed to IPV met in their help seeking process. Positive initiatives to protect women were identified, but the potential for abused women to seek help and support was reduced because of poverty, gender inequality with prevailing strong norms of male superiority, and the tendency to keep abuse as a private family matter.Legislative measures have been instituted to protect women from abuse. Still many Rwandan women do not benefit from these efforts. The role of the health care services needs to be reinforced as an important and available resource for help and support for abused women but further legislative changes are also needed. Initiatives to further improve gender equality, and institutionalised collaboration between different sectors in society would contribute to protecting women from IPV.

  20. Dating Violence among Male and Female Youth seeking Emergency Department Care

    Science.gov (United States)

    Singh, Vijay; Walton, Maureen A; Whiteside, Lauren K; Stoddard, Sarah; Epstein-Ngo, Quyen; Chermack, Stephen T; Cunningham, Rebecca M

    2014-01-01

    Objective To determine prevalence and correlates of dating violence, dating victimization, and dating aggression among males and females age 14–20 seeking emergency department (ED) care. Methods Systematic sampling of subjects age 14–20 seeking care at a single large academic ED between 9/2010- 3/2013. Participants completed a computerized, self-administered, cross-sectional survey of demographics, dating violence from physical abuse measures of the Conflict in Adolescent Dating Relationships Inventory, associated behaviors, and ED health service use. Separate analyses were conducted for males and females. Results 4389 youth (86.1% participation rate) were screened, and 4089 (mean age 17.5 years, 58% female) were eligible for analysis. Almost 1 in 5 females (n= 215, 18.4%) and 1 in 8 males (n= 212, 12.5%) reported past year dating violence. Of females, 10.6% reported dating victimization, and 14.6% dating aggression, while of males, 11.7% reported dating victimization, and 4.9% reported dating aggression. Multivariate analyses showed variables associated with any male dating violence were African American race (AOR 2.26, CI 1.54–3.32), alcohol misuse (AOR 1.03, CI 1.00–1.06), illicit drug misuse (AOR 2.38, CI 1.68–3.38), and depression (AOR 2.13, CI 1.46–3.10); any female dating violence was associated with African-American race (AOR 1.68, CI 1.25–2.25), public assistance (AOR 1.64, CI 1.28–2.09), grades D and below (AOR 1.62, CI 1.07–2.43), alcohol misuse (AOR 1.04, CI 1.02–1.07), illicit drug misuse (AOR 2.85, CI 2.22–3.66), depression (AOR 1.86, CI 1.42–2.44), and any past year ED visit for intentional injury (AOR 2.64, CI 1.30–5.40). Conclusions Nearly 1 of 6 male and female adolescents seeking ED care report recent dating violence, and health disparities remain among this population. Dating violence was strongly associated with alcohol, illicit drug misuse, and depression, and correlated with prior ED service utilization among female

  1. Gender Inflexion in the Construction of a New Medical Specialty

    Directory of Open Access Journals (Sweden)

    Rachel Aisengart Menezes

    2007-09-01

    Full Text Available This article presents the constitution of a new medical specialty, Palliative Care, directed to patients “out of therapeutic possibilities”. The concept emerged around 1960 in England and was implemented in Brazil a couple of years before 1990. It is characterized by an active attendance of the dying process. It postulates a “spiritual assistance” to the patient and his/her family members, including the emotional universe. Ethnographical observation and interviews with Brazilian professionals showed a majority of women among the health teams involved in this proposal. This article discusses and analyses the connection between the construction of the specialty and gender representation among these professionals that reflects popular social images about death, beliefs, emotions and the roles played by women and men in these subjects.

  2. Gender difference in preference of specialty as a career choice among Japanese medical students

    OpenAIRE

    Kawamoto, Ryuichi; Ninomiya, Daisuke; Kasai, Yoshihisa; Kusunoki, Tomo; Ohtsuka, Nobuyuki; Kumagi, Teru; Abe, Masanori

    2016-01-01

    Abstract Background In Japan, the absolute deficiency of doctors and maldistribution of doctors by specialty is a significant problem in the Japanese health care system. The purpose of this study was to investigate the factors contributing to specialty preference in career choice among Japanese medical students. Methods A total of 368 medical students completed the survey giving an 88.2 % response rate. The subjects comprised 141 women aged 21 ± 3 (range, 18–34) years and 227 men aged 22 ± 4 ...

  3. Residents' views about family medicine specialty education in Turkey

    Directory of Open Access Journals (Sweden)

    Uzuner Arzu

    2010-04-01

    Full Text Available Abstract Background Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. Methods This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27 and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11 by e-mail and by personal contact. Results A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%. Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e

  4. Health Seeking Behavior on Child Care Among Fishermen Community of Kovalam Village, Tamil Nadu, India

    Directory of Open Access Journals (Sweden)

    Annadurai K

    2015-10-01

    Full Text Available While progress has been made to reduce under-five mortality in India from 52 to 39 per thousand live births by 2015 to meet Millennium Development Goal, it is unequally distributed between regions and remains insufficient to reach by 2015. Further, fishermen community possesses unique characteristics features, and remains homogeneous in socioeconomic and cultural matters. Objectives: 1 To assess the health seeking behaviour of parents for child care in children under five years of age among the fisherman community of Kovalam. 2 To assess the factors associated with health seeking behaviour among the above mentioned population. Material and methods: This was a descriptive cross sectional study conducted among 260 parents of children under five years of age in fishermen community with six months recall period in Kovalam, India during May to October, 2014 using pretested semi-structured questionnaire. Results: Prevalence of common childhood illness in the previous six months was 93.46% for ARI, 77.69% for ADD, and 69.23% for fever. Majority of them took their sick children (90.82% immediately to health care facility especially. Conclusion: Health seeking behaviour among parents of children of this specific population was fairly adequate but the prevalence of childhood illnesses was quite high which needs further evaluation.

  5. Pre-emergency-department care-seeking patterns are associated with the severity of presenting condition for emergency department visit and subsequent adverse events: a timeframe episode analysis.

    Science.gov (United States)

    Chan, Chien-Lung; Lin, Wender; Yang, Nan-Ping; Lai, K Robert; Huang, Hsin-Tsung

    2015-01-01

    Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits. We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS) and subsequent events. This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events. The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13), and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively. The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.

  6. Agile Model Driven Development of Electronic Health Record-Based Specialty Population Registries

    Science.gov (United States)

    Kannan, Vaishnavi; Fish, Jason C.; Willett, DuWayne L.

    2018-01-01

    The transformation of the American healthcare payment system from fee-for-service to value-based care increasingly makes it valuable to develop patient registries for specialized populations, to better assess healthcare quality and costs. Recent widespread adoption of Electronic Health Records (EHRs) in the U.S. now makes possible construction of EHR-based specialty registry data collection tools and reports, previously unfeasible using manual chart abstraction. But the complexities of specialty registry EHR tools and measures, along with the variety of stakeholders involved, can result in misunderstood requirements and frequent product change requests, as users first experience the tools in their actual clinical workflows. Such requirements churn could easily stall progress in specialty registry rollout. Modeling a system’s requirements and solution design can be a powerful way to remove ambiguities, facilitate shared understanding, and help evolve a design to meet newly-discovered needs. “Agile Modeling” retains these values while avoiding excessive unused up-front modeling in favor of iterative incremental modeling. Using Agile Modeling principles and practices, in calendar year 2015 one institution developed 58 EHR-based specialty registries, with 111 new data collection tools, supporting 134 clinical process and outcome measures, and enrolling over 16,000 patients. The subset of UML and non-UML models found most consistently useful in designing, building, and iteratively evolving EHR-based specialty registries included User Stories, Domain Models, Use Case Diagrams, Decision Trees, Graphical User Interface Storyboards, Use Case text descriptions, and Solution Class Diagrams. PMID:29750222

  7. 76 FR 2290 - TRICARE; Reimbursement for Travel for Specialty Care Under Exceptional Circumstances

    Science.gov (United States)

    2011-01-13

    ... or TRICARE Prime Remote. The Director, TRICARE Management Activity, shall issue procedures and... from members of the public is to make these submissions available for viewing on the Internet at http... live in certain more remote areas where there are insufficient numbers or types of specialty or...

  8. Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties.

    Science.gov (United States)

    Hooper, Crystal; Craig, Janet; Janvrin, David R; Wetsel, Margaret A; Reimels, Elaine

    2010-09-01

    Today the proportion of acute patients entering the health care system through emergency departments continues to grow, the number of uninsured patients relying primarily on treatment in the emergency department is increasing, and patients' average acuities are rising. At the same time, support resources are constrained, while reimbursement and reputation depends increasingly on publicly available measures of patient satisfaction. It is important to understand the potential effect of these pressures on direct care staff. This study explores the prevalence of compassion satisfaction, burnout, and compassion fatigue among emergency nurses and nurses in other selected inpatient specialties. Emergency nurses and nurses from 3 other specialty units self-selected participation in a cross-sectional survey. Participants completed a sociodemographic profile and the Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV. Scale scores were summed for compassion satisfaction, burnout, and compassion fatigue for emergency nurses and compared with those of nurses in other specialties. Approximately 82% of emergency nurses had moderate to high levels of burnout, and nearly 86% had moderate to high levels of compassion fatigue. Differences between emergency nurses and those working in 3 other specialty areas, that is, oncology, nephrology, and intensive care, on the subscales for compassion satisfaction, burnout, or compassion fatigue did not reach the level of statistical significance. However, the scores of emergency nurses evidenced a risk for less compassion satisfaction, while intensive care nurses demonstrated a higher risk for burnout and oncology nurses reflected a risk for higher compassion fatigue. ED nurse managers, along with other nurse leaders, are faced with the competing demands of managing the satisfaction of patients, recruitment and retention of experienced nurses, and provision of quality and safe care customized to patients' needs

  9. Antenatal Care Seeking Behaviour among Slum Mothers: A Study of Rajshahi City Corporation, Bangladesh.

    Science.gov (United States)

    Rahman, Mahfuzar; Islam, Rafiqul; Rahman, Mosfequr

    2010-04-01

    The study aimed to identify the important effects of some selected variables in antenatal care (ANC) seeking behaviour among slum mothers. The data for the study were collected in 2006 from 700 mothers in the slum areas of Rajshahi City Corporation (RCC), Bangladesh. The results indicate that tetanus toxoid (TT) is relatively widespread in slum areas of RCC. Serious health implications were observed for the mothers and their children who lived in the study areas because more than half of the respondents (56.1%) were not assisted at their last childbirth by any health professional. The respondents were too poor to buy iron tablets/syrup and vitamin tablets/syrup during their last pregnancy. The application of a logistic regression model suggested that demographic and socio-economic factors were associated with ANC seeking behaviour among slum mothers. Respondents' education, place of treatment, husband's occupation, family's income, and exposure to mass media had highly significant effects on mothers seeking medical checkups during their last pregnancy.

  10. Health care seeking among men with genital ulcer disease in South Africa: correlates and relationship to human immunodeficiency virus-1 and herpes simplex virus type 2 detection and shedding.

    Science.gov (United States)

    Leichliter, Jami S; Lewis, David A; Sternberg, Maya; Habel, Melissa A; Paz-Bailey, Gabriela

    2011-09-01

    Episodic acyclovir therapy has been added to genital ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes. Men with GUD (n = 615) were recruited from primary health care clinics in Gauteng province, South Africa for a randomized controlled trial of episodic acyclovir therapy. We used baseline survey and sexually transmitted infection/HIV-testing data to examine delay in health care seeking (defined as time from ulcer recognition to baseline study visit). Median delay in health care seeking for GUD was 5 days, and one-quarter of men had previously sought care for the current ulcer. Previous care seekers were older, had more episodes of ulceration in the past year, and were more likely to test seropositive for HIV-1 and HSV-2. Delay in health care seeking was significantly associated with age, education level, and sex during the ulceration episode. Delays in care seeking were related to poorer HIV-1 outcomes; these findings were valid after controlling for advanced HIV. Interventions to help shorten the duration between ulcer recognition and health care seeking for men with GUD are needed.

  11. Specialty pharmacies and other restricted drug distribution systems: financial and safety considerations for patients and health-system pharmacists.

    Science.gov (United States)

    Kirschenbaum, Bonnie E

    2009-12-15

    To discuss the role of restricted drug distribution systems in the implementation of risk evaluation and mitigation strategies (REMS), health-system pharmacists' concerns associated with the use of specialty pharmacies and other restricted drug distribution systems, reimbursement policies for high-cost specialty drugs, supply chain models for traditional and specialty drugs, and emerging trends in the management of and reimbursement for specialty pharmaceuticals. Restricted drug distribution systems established by pharmaceutical manufacturers, specialty pharmacies, or other specialty suppliers may be a component of REMS, which are required by the Food and Drug Administration for the management of known or potential serious risks from certain drugs. Concerns of health-system pharmacists using specialty suppliers include access to pharmaceuticals, operational challenges, product integrity, financial implications, continuity of care, and patient safety. An ambulatory care patient taking a specialty drug product from home to a hospital outpatient clinic or inpatient setting for administration, a practice known as "brown bagging," raises concerns about product integrity and institutional liability. An institution's finances, tolerance for liability, and ability to skillfully manage the processes involved often determine its choice between an approach that prohibits brown bagging but is costly and one that permits the practice under certain conditions and is less costly. The recent shift from a traditional supply chain model to a specialty pharmacy supply chain model for high-cost pharmaceuticals has the potential to increase pharmaceutical costs for health systems. A dialogue is needed between health-system pharmacists and group purchasing organizations to address the latter's role in mitigating the financial implications of this change and to help clarify the safety issues. Some health plans have shifted part of the cost of expensive drugs to patients by establishing a

  12. Does Embarrassment Contribute to Delay in Seeking Medical Care for Breast Cancer? A Review

    Directory of Open Access Journals (Sweden)

    Mohamadreza Neishaboury

    2015-08-01

    Full Text Available Background: Embarrassment and shame of visiting a doctor for a breast disease are among psychosocial factors that potentially contribute to delay in seeking medical advice. The purpose of this study is to review the published literature to determine if embarrassment regarding breast examination, diagnosis and treatment is associated with patient delay.Methods: We searched PubMed with the following key terms: patient acceptance of health care (MeSH, breast neoplasms/psychology (MeSH, shame (MeSH, embarrassment, delayed diagnosis, to find relevant literature published before August 2015.Results: The studies that explicitly assessed the association between embarrassment and delay for seeking medical advice for breast cancer were very limited. Among these studies, only 2 were quantitative studies, 4 were based on qualitative research and 4 were reviews. Other studies assessed attitudes in population-based surveys or included patients (females and males suffering from different types of cancer.Conclusions: Women should be educated that diseases of the breast need to be cared for as health issues in other parts of the body. They should be informed that embarrassment in this regard is not related to grace and integrity but can be potentially life-threatening. Further research is necessary to quantify the association of embarrassment or shame with delay in seeking diagnosis and treatment of breast cancer. More research can elucidate the ways that the negative impact of shame/embarrassment can be minimized in different ethnic groups.

  13. Perceptions of Child Body Size and Health Care Seeking for Undernourished Children in Southern Malawi.

    Science.gov (United States)

    Flax, Valerie L; Thakwalakwa, Chrissie; Ashorn, Ulla

    2016-12-01

    Child undernutrition affects millions of children globally, but little is known about the ability of adults to detect different types of child undernutrition in low-income countries. We used focused ethnographic methods to understand how Malawian parents and grandparents describe the characteristics they use to identify good and poor child growth, their actual or preferred patterns of health seeking for undernourished children, and the perceived importance of child undernutrition symptoms in relation to other childhood illnesses. Malawians value adiposity rather than stature in assessing child growth. Symptoms of malnutrition, including wasting and edema, were considered the least severe childhood illness symptoms. Parents delayed health care seeking when a child was ill. When they sought care, it was for symptoms such as diarrhea or fever, and they did not recognize malnutrition as the underlying cause. These findings can be used to tailor strategies for preventing and treating growth faltering in Malawian children. © The Author(s) 2015.

  14. E-mental health care among young adults and help-seeking behaviors: a transversal study in a community sample.

    Science.gov (United States)

    Younes, Nadia; Chollet, Aude; Menard, Estelle; Melchior, Maria

    2015-05-15

    The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete. In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care. Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen's behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents' income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not. Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186

  15. U.S. Air Force Operational Medicine: Using the Enterprise Estimating Supplies Program to Develop Materiel Solutions for the Operational Requirements of the EMEDS Specialty Care Augmentation Team

    Science.gov (United States)

    2011-06-28

    0.20 $10.74 0.26 0.20 $10.74 A 6515013146694 STETHOSCOPE LITTMAN CLASSIC II 28IN EA 2 2 1.72 0.50 $98.82 1.72 0.50 $98.82 A 6520012650108 STOOL DENTAL ...NEC 1 533.9 PEPTIC ULCER NOS 2 5 STAPH FOOD POISONING 4 592.9 URINARY CALCULUS NOS 3 PATIENT TOTAL 320 EMEDS Specialty Care

  16. Widespread pain - do pain intensity and care-seeking influence sickness absence? - A population-based cohort study

    DEFF Research Database (Denmark)

    Mose, Søren; Christiansen, David Høyrup; Jensen, Jens Christian

    2016-01-01

    BACKGROUND: Both musculoskeletal pain-intensity in relation to a specific location (e.g. lower back or shoulder) and pain in multiple body regions have been shown to be associated with impaired function and sickness absence, but the impact of pain intensity on the association between widespread...... between number of musculoskeletal pain sites and sickness absence, and to analyze the impact on absenteeism from care-seeking in general practice due to musculoskeletal disorders.METHODS: 3745 Danish adults registered with eight General Practitioners (GPs) in one primary medical center reported location...... pain and sickness absence has not been studied. Additionally it is unknown whether care-seeking in general practice due to musculoskeletal disorders has a positive or negative impact on future absenteeism. The purpose of this study was to examine the influence of pain intensity on the association...

  17. 'Clinics aren't meant for men': sexual health care access and seeking behaviours among men in Gauteng province, South Africa.

    Science.gov (United States)

    Leichliter, Jami S; Paz-Bailey, Gabriela; Friedman, Allison L; Habel, Melissa A; Vezi, Alex; Sello, Martha; Farirai, Thato; Lewis, David A

    2011-01-01

    Men may be key players in the transmission of sexually transmitted infections (STI), and it is important that STI/HIV health services reach men. The objective of this study was to explore sexual health care access and seeking behaviours in men. This study used focus groups to examine sexual health care access and seeking behaviours in men 5 years after implementation of free antiretroviral therapy (ART) in the South African public sector. Six focus groups (N=58) were conducted with men ≫18 years in an urban area of Gauteng province. Men were recruited from various locations throughout the community. Men reported several barriers and facilitators to the use of public and private clinics for sexual health services including HIV testing, and many men reported seeking care from traditional healers. Men often viewed public clinics as a place for women and reported experiences with some female nurses who were rude or judgmental of the men. Additionally, some men reported that they sought sexual health care services at public clinics; however, they were not given physical examinations by health care providers to diagnose their STI syndrome. Most men lacked knowledge about ART and avoided HIV testing because of fear of death or being abandoned by their families or friends. Study findings suggest that men still require better access to high-quality, non-judgmental sexual health care services. Future research is needed to determine the most effective method to increase men's access to sexual health care services.

  18. Pre-emergency-department care-seeking patterns are associated with the severity of presenting condition for emergency department visit and subsequent adverse events: a timeframe episode analysis.

    Directory of Open Access Journals (Sweden)

    Chien-Lung Chan

    Full Text Available Many patients treated in Emergency Department (ED visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits.We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS and subsequent events.This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events.The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13, and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively.The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.

  19. Health Care Resource Utilization for Outpatient Cardiovascular Disease and Diabetes Care Delivery Among Advanced Practice Providers and Physician Providers in Primary Care.

    Science.gov (United States)

    Virani, Salim S; Akeroyd, Julia M; Ramsey, David J; Deswal, Anita; Nasir, Khurram; Rajan, Suja S; Ballantyne, Christie M; Petersen, Laura A

    2017-10-10

    Although effectiveness of diabetes or cardiovascular disease (CVD) care delivery between physicians and advanced practice providers (APPs) has been shown to be comparable, health care resource utilization between these 2 provider types in primary care is unknown. This study compared health care resource utilization between patients with diabetes or CVD receiving care from APPs or physicians. Diabetes (n = 1,022,588) or CVD (n = 1,187,035) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities were identified. Using hierarchical regression adjusting for covariates including patient illness burden, the authors compared number of primary or specialty care visits and number of lipid panels and hemoglobinA1c (HbA1c) tests among diabetes patients, and number of primary or specialty care visits and number of lipid panels and cardiac stress tests among CVD patients receiving care from physicians and APPs. Physicians had significantly larger patient panels compared with APPs. In adjusted analyses, diabetes patients receiving care from APPs received fewer primary and specialty care visits and a greater number of lipid panels and HbA1c tests compared with patients receiving care from physicians. CVD patients receiving care from APPs received more frequent lipid testing and fewer primary and specialty care visits compared with those receiving care from physicians, with no differences in the number of stress tests. Most of these differences, although statistically significant, were numerically small. Health care resource utilization among diabetes or CVD patients receiving care from APPs or physicians appears comparable, although physicians work with larger patient panels.

  20. Theoretical Model of Professional Competence Development in Dual-Specialty Students (On the Example of the "History, Religious Studies" Specialty)

    Science.gov (United States)

    Karimova, A. E.; Amanova, A. S.; Sadykova, A. M.; Kuzembaev, N. E.; Makisheva, A. T.; Kurmangazina, G. Zh.; Sakenov, Janat

    2016-01-01

    The article explores the significant problem of developing a theoretical model of professional competence development in dual-specialty students (on the example of the "History, Religious studies" specialty). In order to validate the specifics of the professional competence development in dual-specialty students (on the example of the…

  1. Maternal health-care seeking behavior in North India

    Directory of Open Access Journals (Sweden)

    Anjali Jain

    2017-01-01

    Full Text Available Introduction: Pregnancy and labour, if not kept under constant vigil, can end in serious complications or even death at any moment. The aim of the study was done to know the practices of community regarding maternity care during pregnancy, delivery and postnatal period. Methods: A cross-sectional, community based study was conducted on 120 rural, 120 urban elite and 120 urban slum areas mothers, who delivered within last three months. Results: One-fourth mothers in rural area faced one or the other problem during antenatal period while in urban slum and urban elite only 15% and 9.2% mothers had some problems, this percentage being 19.4 at district level. 14.5% respondents faced some kind of complication during delivery and more problems were faced by rural (17.5% while least common by urban elite (7.5% but the area wise difference was not significant. The most common source of treatment was ANM/ LHV/ Nurse (47.1% in rural, 40% in urban elite and 60% in urban slum. 12.8%, mothers took treatment from doctor (Government- 7.2%; Private- 5.6%. More than 10% did not take any treatment (11.8% in rural, 20% in urban elite. Conclusion: Still the large numbers of mothers are not seeking care of their ailments, during prenatal, natal or postnatal especially rural mothers

  2. Gender difference in preference of specialty as a career choice among Japanese medical students.

    Science.gov (United States)

    Kawamoto, Ryuichi; Ninomiya, Daisuke; Kasai, Yoshihisa; Kusunoki, Tomo; Ohtsuka, Nobuyuki; Kumagi, Teru; Abe, Masanori

    2016-11-10

    In Japan, the absolute deficiency of doctors and maldistribution of doctors by specialty is a significant problem in the Japanese health care system. The purpose of this study was to investigate the factors contributing to specialty preference in career choice among Japanese medical students. A total of 368 medical students completed the survey giving an 88.2 % response rate. The subjects comprised 141 women aged 21 ± 3 (range, 18-34) years and 227 men aged 22 ± 4 (range, 18-44) years. Binary Logistic regression analysis was performed using specialty preferences as the criterion variable and the factors in brackets as six motivational variables (e.g., Factor 1: educational experience; Factor 2: job security; Factor 3: advice from others; Factor 4: work-life balance; Factor 5: technical and research specialty; and Factor 6: personal reasons). Women significantly preferred pediatrics, obstetrics & gynecology, and psychology than the men. Men significantly preferred surgery and orthopedics than the women. For both genders, a high odds ratio (OR) of "technical & research specialty" and a low OR for "personal reasons" were associated with preference for surgery. "Technical & research specialty" was positively associated with preference for special internal medicine and negatively for pediatrics. "Work-life balance" was positively associated with preference for psychology and negatively for emergency medicine. Among the women only, "technical & research specialty" was negatively associated with preference for general medicine/family medicine and obstetrics & gynecology, and "job security" was positively associated for general medicine/family medicine and negatively for psychology. Among men only, "educational experience" and "personal reasons" were positively, and "job security" was negatively associated with preference for pediatrics. For both genders, "work-life balance" was positively associated with preference for controllable lifestyle specialties. We

  3. Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice.

    Science.gov (United States)

    MacKichan, Fiona; Brangan, Emer; Wye, Lesley; Checkland, Kath; Lasserson, Daniel; Huntley, Alyson; Morris, Richard; Tammes, Peter; Salisbury, Chris; Purdy, Sarah

    2017-05-04

    To describe how processes of primary care access influence decisions to seek help at the emergency department (ED). Ethnographic case study combining non-participant observation, informal and formal interviewing. Six general practitioner (GP) practices located in three commissioning organisations in England. Reception areas at each practice were observed over the course of a working week (73 hours in total). Practice documents were collected and clinical and non-clinical staff were interviewed (n=19). Patients with recent ED use, or a carer if aged 16 and under, were interviewed (n=29). Past experience of accessing GP care recursively informed patient decisions about where to seek urgent care, and difficulties with access were implicit in patient accounts of ED use. GP practices had complicated, changeable systems for appointments. This made navigating appointment booking difficult for patients and reception staff, and engendered a mistrust of the system. Increasingly, the telephone was the instrument of demand management, but there were unintended consequences for access. Some patient groups, such as those with English as an additional language, were particularly disadvantaged, and the varying patient and staff semantic of words like 'urgent' and 'emergency' was exacerbated during telephone interactions. Poor integration between in-hours and out-of-hours care and patient perceptions of the quality of care accessible at their GP practice also informed ED use. This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around 'inappropriate' patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups. © Article author(s) (or

  4. Predictors of Delayed Healthcare Seeking Among American Muslim Women.

    Science.gov (United States)

    Vu, Milkie; Azmat, Alia; Radejko, Tala; Padela, Aasim I

    2016-06-01

    Delayed care seeking is associated with adverse health outcomes. For Muslim women, delayed care seeking might include religion-related motivations, such as a preference for female clinicians, concerns about preserving modesty, and fatalistic beliefs. Our study assesses associations between religion-related factors and delayed care seeking due to a perceived lack of female clinicians. Surveys were distributed to Muslim women attending mosque and community events in Chicago. Survey items included measures of religiosity, religious fatalism, discrimination, modesty, and alternative medicine utilization and worship practices. The outcome measure asked for levels of agreement to the statement "I have delayed seeking medical care when no woman doctor is available to see me." Two hundred fifty-four women completed the survey with nearly equal numbers of African Americans (26%), Arab Americans (33%), and South Asians (33%). Fifty-three percent reported delays in care seeking due to a perceived lack of female clinicians. In multivariate analysis adjusting for sociodemographic factors, higher religiosity (odds ratio [OR] = 5.2, p 20 years (OR = 0.22, p American Muslim women reported delays in care seeking due to a perceived lack of female clinicians. Women with higher levels of modesty and self-rated religiosity had higher odds of delaying care. Women who had lived in the United States for longer durations had lower odds of delaying care. Our research highlights the need for gender-concordant providers and culturally sensitive care for American Muslims.

  5. The importance of examining movements within the US health care system: sequential logit modeling

    Directory of Open Access Journals (Sweden)

    Lee Chioun

    2010-09-01

    Full Text Available Abstract Background Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. Methods The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage, having a perceived need for specialty care (i.e., second stage, and utilization of specialty care (i.e., third stage. In the sequential logit model, all stages are nested within the previous stage. Results Gender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62 or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20 were significant barriers to utilization of specialty care. Conclusions Use of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities

  6. A prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit.

    Science.gov (United States)

    Talento, Alida Fe; Dunne, Katie; Joyce, Eimear Ann; Palmer, Michael; Johnson, Elizabeth; White, P Lewis; Springer, Jan; Loeffler, Juergen; Ryan, Thomas; Collins, Daniel; Rogers, Thomas R

    2017-08-01

    The diagnosis of invasive fungal diseases (IFD) in critical care patients (CrCP) is difficult. The study investigated the performance of a set of biomarkers for diagnosis of IFD in a mixed specialty critical care unit (CrCU). A prospective observational study in patients receiving critical care for ≥7days was performed. Serum samples were tested for the presence of: (1-3) - β-d-glucan (BDG), galactomannan (GM), and Aspergillus fumigatus DNA. GM antigen detection was also performed on bronchoalveolar lavage (BAL) samples. The patients were classified using published definitions for IFD and a diagnostic algorithm for invasive pulmonary aspergillosis. Performance parameters of the assays were determined. In patients with proven and probable IFD, the sensitivity, specificity, PPV and NPV of a single positive BDG were 63%, 83%, 65% and 83% respectively. Specificity increased to 86% with 2 consecutive positive results. The mean BDG value of patients with proven and probable IFD was significantly higher compared to those with fungal colonization and no IFD (p value<0.0001). New diagnostic criteria which incorporate these biomarkers, in particular BDG, and host factors unique to critical care patients should enhance diagnosis of IFD and positively impact antifungal stewardship programs. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Exploratory study into awareness of heart disease and health care seeking behavior among Emirati women (UAE) - Cross sectional descriptive study.

    Science.gov (United States)

    Khan, Sarah; Ali, Syed Adnan

    2017-09-26

    Cardiovascular disease was the leading cause of death among women in the United Arab Emirates (UAE) in 2010. Heart attacks usually happen in older women thus symptoms of heart disease may be masked by symptoms of chronic diseases, which could explain the delay in seeking health care and higher mortality following an ischaemic episode among women. This study seeks to a) highlight the awareness of heart diseases among Emirati women and b) to understand Emirati women's health care seeking behaviour in UAE. A cross sectional, descriptive study was conducted using a survey instrument adapted from the American Heart Association National survey. A convenience sample of 676 Emirati women between the ages of 18-55 years completed the questionnaire. The study showed low levels of awareness of heart disease and associated risk factors in Emirati women; only 19.4% participants were found to be aware of heart diseases. Awareness levels were highest in Dubai (OR 2.18, p < 0.05) among all the other emirates and in the 18-45 years age group (OR 2.74, p < 0.05). Despite low awareness levels, women paradoxically perceived themselves to be self-efficacious in seeking health care. Interestingly, just 49.1% Emirati women believed that good quality and affordable health care was available in the UAE. Only 28.8% of the participants believed there were sufficient female doctors to respond to health needs of women in UAE. Furthermore, only 36.7% Emirati women chose to be treated in the UAE over treatment in other countries. Emirati women clearly lack the knowledge on severity and vulnerability to heart disease in the region that is essential to improve cardiovascular related health outcomes. This study has identified the need for wider outreach that focuses on gender and age specific awareness on heart disease risks and symptoms. The study has also highlighted potential modifiable barriers in seeking health care that should be overcome to reduce morbidity and mortality due to heart

  8. Barriers of Chinese primary care attenders to seeking help for psychological distress in Hong Kong.

    Science.gov (United States)

    Sun, Kai Sing; Lam, Tai Pong; Lam, Kwok Fai; Lo, Tak Lam; Chao, David Vai Kiong; Lam, Edmund Wing Wo

    2016-05-15

    Most of the previous studies on help seeking for psychological distress were derived from Western countries. This study investigated the barriers to help-seeking for psychological distress among Chinese primary care attenders in Hong Kong. Nine focus groups and 6 individual interviews were conducted among Chinese primary care attenders with/without known distress, patients' significant others and the general public. The identified barriers were investigated in a questionnaire survey with data from 1626 primary care attenders recruited from 13 private clinics and 6 public clinics. Worries about side effects of drugs (79.9%, 95% CI:(77.9%, 81.8%)) and drug dependency (74.7%, 95% CI:(72.5%, 76.8%)) were rated as the top barriers in the survey. Qualitative interviews found both worries and actual experience of the side effects of drugs, which weakened patients' trust in the treatment. Factor analysis on all barrier items suggested three factors: 1) worries of treatment, 2) uncertainties on primary care physicians' capacity, 3) public's limited knowledge on distress and sources of help. Distress level, education level and age were associated with factor 1, whereas distress level and healthcare setting were associated with the other two factors. Qualitative interviews revealed that not having a regular primary care physician in the public setting discouraged disclosure of psychological problems. The findings were based on self-reported data from the respondents. Hong Kong is influenced by a mixed Chinese and Western culture. Relevant public education in a Chinese context should target at reducing patients' worries of drug treatment and strengthening the image of primary care physicians as a feasible source of help. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Dating violence among male and female youth seeking emergency department care.

    Science.gov (United States)

    Singh, Vijay; Walton, Maureen A; Whiteside, Lauren K; Stoddard, Sarah; Epstein-Ngo, Quyen; Chermack, Stephen T; Cunningham, Rebecca M

    2014-10-01

    We determine prevalence and correlates of dating violence, dating victimization, and dating aggression among male and female patients aged 14 to 20 years seeking emergency department (ED) care. This was a systematic sampling of subjects aged 14 to 20 years seeking care at a single large academic ED between September 2010 and March 2013. Participants completed a computerized, self-administered, cross-sectional survey of demographics, dating violence from physical abuse measures of the Conflict in Adolescent Dating Relationships Inventory, associated behaviors, and ED health service use. Separate analyses were conducted for male and female patients. Four thousand three hundred eighty-nine youths (86.1% participation rate) were screened, and 4,089 (mean age 17.5 years; 58% female patients) were eligible for analysis. Almost 1 in 5 female patients (n=215; 18.4%) and 1 in 8 male patients (n=212; 12.5%) reported past-year dating violence. Of female patients, 10.6% reported dating victimization and 14.6% dating aggression, whereas of male patients, 11.7% reported dating victimization and 4.9% reported dating aggression. Multivariate analyses showed that variables associated with any male dating violence were black race (adjusted odds ratio [AOR] 2.26; 95% CI 1.54 to 3.32), alcohol misuse (AOR 1.03; 95% CI 1.00 to 1.06), illicit drug use (AOR 2.38; 95% CI 1.68 to 3.38), and depression (AOR 2.13; 95% CI 1.46 to 3.10); any female dating violence was associated with black race (AOR 1.68; 95% CI 1.25 to 2.25), public assistance (AOR 1.64; 95% CI 1.28 to 2.09), grades D and below (AOR 1.62; 95% CI 1.07 to 2.43), alcohol misuse (AOR 1.04; 95% CI 1.02 to 1.07), illicit drug use (AOR 2.85; 95% CI 2.22 to 3.66), depression (AOR 1.86; 95% CI 1.42 to 2.44), and any past year ED visit for intentional injury (AOR 2.64; 95% CI 1.30 to 5.40). Nearly 1 of 6 male and female patients aged 14 to 20 years and seeking ED care report recent dating violence, and health disparities remain among

  10. Health-care seeking behaviour among persons with diabetes in Uganda: an interview study

    Directory of Open Access Journals (Sweden)

    Atwine Fortunate

    2011-09-01

    Full Text Available Abstract Background Healthcare-seeking behaviour in patients with diabetes mellitus (DM has been investigated to a limited extent, and not in developing countries. Switches between different health sectors may interrupt glycaemic control, affecting health. The aim of the study was to explore healthcare-seeking behaviour, including use of complementary alternative medicine (CAM and traditional healers, in Ugandans diagnosed with DM. Further, to study whether gender influenced healthcare-seeking behaviour. Methods This is a descriptive study with a snowball sample from a community in Uganda. Semi-structured interviews were held with 16 women and 8 men, aged 25-70. Data were analysed by qualitative content analysis. Results Healthcare was mainly sought among doctors and nurses in the professional sector because of severe symptoms related to DM and/or glycaemic control. Females more often focused on follow-up of DM and chronic pain in joints, while males described fewer problems. Among those who felt that healthcare had failed, most had turned to traditional healers in the folk sector for prescription of herbs or food supplements, more so in women than men. Males more often turned to private for-profit clinics while females more often used free governmental institutions. Conclusions Healthcare was mainly sought from nurses and physicians in the professional sector and females used more free-of-charge governmental institutions. Perceived failure in health care to manage DM or related complications led many, particularly women, to seek alternative treatment from CAM practitioners in the folk sector. Living conditions, including healthcare organisation and gender, seemed to influence healthcare seeking, but further studies are needed.

  11. A qualitative study on physicians' perceptions of specialty characteristics.

    Science.gov (United States)

    Park, Kwi Hwa; Jun, Soo-Koung; Park, Ie Byung

    2016-09-01

    There has been limited research on physicians' perceptions of the specialty characteristics that are needed to sustain a successful career in medical specialties in Korea. Medical Specialty Preference Inventory in the United States or SCI59 (specialty choice inventory) in the United Kingdom are implemented to help medical students plan their careers. The purpose of this study was to explore the characteristics of the major specialties in Korea. Twelve physicians from different specialties participated in an exploratory study consisting of qualitative interviews about the personal ability and emotional characteristics and job attributes of each specialty. The collected data were analysed with content analysis methods. Twelve codes were extracted for ability & skill attributes, 23 codes for emotion & attitude attributes, and 12 codes for job attributes. Each specialty shows a different profile in terms of its characteristic attributes. The findings have implications for the design of career planning programs for medical students.

  12. The Value of Specialty Oncology Drugs

    Science.gov (United States)

    Goldman, Dana P; Jena, Anupam B; Lakdawalla, Darius N; Malin, Jennifer L; Malkin, Jesse D; Sun, Eric

    2010-01-01

    Objective To estimate patients' elasticity of demand, willingness to pay, and consumer surplus for five high-cost specialty medications treating metastatic disease or hematologic malignancies. Data Source/Study Setting Claims data from 71 private health plans from 1997 to 2005. Study Design This is a revealed preference analysis of the demand for specialty drugs among cancer patients. We exploit differences in plan generosity to examine how utilization of specialty oncology drugs varies with patient out-of-pocket costs. Data Collection/Extraction Methods We extracted key variables from administrative health insurance claims records. Principal Findings A 25 percent reduction in out-of-pocket costs leads to a 5 percent increase in the probability that a patient initiates specialty cancer drug therapy. Among patients who initiate, a 25 percent reduction in out-of-pocket costs reduces the number of treatments (claims) by 1–3 percent, depending on the drug. On average, the value of these drugs to patients who use them is about four times the total cost paid by the patient and his or her insurer, although this ratio may be lower for oral specialty therapies. Conclusions The decision to initiate therapy with specialty oncology drugs is responsive to price, but not highly so. Among patients who initiate therapy, the amount of treatment is equally responsive. The drugs we examine are highly valued by patients in excess of their total costs, although oral agents warrant further scrutiny as copayments increase. PMID:19878344

  13. Integration of specialties: An institutional and organizational view.

    Science.gov (United States)

    Gerson, Elihu M

    2013-12-01

    By what mechanisms of organizational and institutional change do different specialties succeed in accommodating and working with one another? How do these mechanisms function over time to support and retard the emergence and stability of new knowledge? This paper considers two such mechanisms, metawork (work that determines the organization of work) and common knowledge (knowledge that participants know is known by all participants). These mechanisms integrate specialties by making the activities of multiple specialties dependent upon one another, and by segmenting the common effort from the parent specialties. Integration of specialties can lead to the development of new specialties. Integration is facilitated and impeded by the anchoring of specialties in the system of institutions that participate in research. Host organizations, degree programs, sponsors, associations, regulators, and other organizations provide resources and impose demands that shape research. Some of these impacts are obvious and direct; others are indirect and more subtle. The research specialties form a network (not a hierarchy) in which connections constantly form and reform, and in which the influence of different anchoring institutions are constantly waxing and waning. The complexity of connections and their pattern of change are especially obvious in the life sciences, which are an especially good place to study problems of integration. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Are new medical students' specialty preferences gendered? Related motivational factors at a Dutch medical school.

    Science.gov (United States)

    van Tongeren-Alers, Margret; van Esch, Maartje; Verdonk, Petra; Johansson, Eva; Hamberg, Katarina; Lagro-Janssen, Toine

    2011-01-01

    Female students currently outnumber male students in most medical schools. Some medical specialties are highly gender segregated. Therefore, it is interesting to know whether medical students have early specialization preferences based on their gender. Consequently, we like to know importance stipulated to motivational factors. Our study investigates new medical students' early specialization preferences and motivational factors. New students at a Dutch medical school (n = 657) filled in a questionnaire about specialty preferences (response rate = 94%; 69.5% female, 30.5% male). The students chose out of internal medicine, psychiatry, neurology, pediatrics, surgery, gynecology and family medicine, "other" or "I don't know." Finally, they valued ten motivational factors. Forty percent of the medical students reported no specialty preference yet. Taken together, female medical students preferred pediatrics and wished to combine work and care, whereas male students opted for surgery and valued career opportunities. Gender-driven professional preferences in new medical students should be noticed in order to use competencies. Changes in specialty preferences and motivational factors in pre- and post graduates should further assess the role of medical education.

  15. 78 FR 10608 - David Grant United States Air Force Medical Center Specialty Care Travel Reimbursement...

    Science.gov (United States)

    2013-02-14

    ... principle of the TRICARE program and the Military Health System (MHS) business design is that MTFs have... identified specialties. There will also be quarterly tracking of marketing initiatives to measure their...

  16. Lessons Learned in Pilot Testing Specialty Consultations to Benefit Individuals with Lower Limb Loss

    Directory of Open Access Journals (Sweden)

    Christine Elnitsky

    2012-12-01

    Full Text Available Telerehabilitation technologies enable the delivery of rehabilitation services from providers to people with disabilities as well as specialty care consultations. This article discusses the barriers experienced when planning and pilot testing a telerehabilitation multi-site specialty consultation for specialists in their medical centers, and the lessons learned. The barriers included integration and participation, coordination across organizational units, and privacy and information security. Lessons learned included the need for collaboration across multiple departments, telerehabilitation equipment back-ups, and anonymous and private communication protocols. Despite delays resulting from coordination at multiple levels of a national organization, we developed a program plan and successfully implemented a pilot test of the southeast region program.  Specialty consultation using telerehabilitation delivery methods requires identifying provider preferences for technological features. Lessons learned could inform development of outpatient telerehabilitation for patients with amputations and studies of patients and providers involved in telerehabilitation.

  17. Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh.

    Science.gov (United States)

    Chowdhury, Fahmida; Sturm-Ramirez, Katharine; Mamun, Abdullah Al; Iuliano, A Danielle; Bhuiyan, Mejbah Uddin; Chisti, Mohammod Jobayer; Ahmed, Makhdum; Haider, Sabbir; Rahman, Mahmudur; Azziz-Baumgartner, Eduardo

    2017-01-01

    Pharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI) identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome. A cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients' relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome. We interviewed 302 customers patronizing 76 pharmacies; 186 (62%) sought care for themselves and 116 (38%) sought care for a sick relative. Most customers (215; 71%) were males. The majority (90%) of customers sought care from the study pharmacy as their first point of care, while 18 (6%) had previously sought care from another pharmacy and 11 (4%) from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%), lower cost (46%), availability of medicine (33%), knowing the drug seller (20%), and convenient hours of operation (19%). The most commonly recommended drugs were acetaminophen dispensed in 76% (228) of visits, antihistamine in 69% (208), and antibiotics in 42% (126). On follow-up, most (86%) of the customers had recovered and 12% had sought further treatment. People with ARI preferred to seek care at pharmacies rather than clinics because these pharmacies were more accessible and provided prompt treatment and medicine with no service charge. We recommend raising awareness among drug sellers on proper dispensing practices and enforcement of laws and regulations for drug sales.

  18. A qualitative study on physicians' perceptions of specialty characteristics

    Directory of Open Access Journals (Sweden)

    Kwi Hwa Park

    2016-09-01

    Full Text Available Purpose: There has been limited research on physicians’ perceptions of the specialty characteristics that are needed to sustain a successful career in medical specialties in Korea. Medical Specialty Preference Inventory in the United States or SCI59 (specialty choice inventory in the United Kingdom are implemented to help medical students plan their careers. The purpose of this study was to explore the characteristics of the major specialties in Korea. Methods: Twelve physicians from different specialties participated in an exploratory study consisting of qualitative interviews about the personal ability and emotional characteristics and job attributes of each specialty. The collected data were analysed with content analysis methods. Results: Twelve codes were extracted for ability & skill attributes, 23 codes for emotion & attitude attributes, and 12 codes for job attributes. Each specialty shows a different profile in terms of its characteristic attributes. Conclusion: The findings have implications for the design of career planning programs for medical students.

  19. Nursing specialty and burnout.

    Science.gov (United States)

    Browning, Laura; Ryan, Carey S; Thomas, Scott; Greenberg, Martin; Rolniak, Susan

    2007-03-01

    We examined the relationship between perceived control and burnout among three nursing specialties: nurse practitioners, nurse managers, and emergency nurses. Survey data were collected from 228 nurses from 30 states. Findings indicated that emergency nurses had the least control and the highest burnout, whereas nurse practitioners had the most control and the least burnout. Mediational analyses showed that expected control, hostility, and stressor frequency explained differences between specialties in burnout. The implications of these findings for interventions that reduce burnout and promote nursing retention are discussed.

  20. Alcohol use disorder severity and reported reasons not to seek treatment: a cross-sectional study in European primary care practices.

    Science.gov (United States)

    Probst, Charlotte; Manthey, Jakob; Martinez, Alicia; Rehm, Jürgen

    2015-08-12

    Alcohol use disorders are among the mental disorders with the lowest treatment rates. Increasing the treatment rates requires insight on the reasons why patients do not seek treatment. This study examined self-reported reasons for not seeking treatment and their association with alcohol use disorder severity among primary health care patients diagnosed with an alcohol use disorder. Alcohol use disorders, health service utilization, and reasons for not seeking treatment were assessed via interviews on regionally representative samples of primary care patients from 6 European countries (Italy, Germany, Hungary, Latvia, Poland and Spain, total N = 9,098). Additionally, general practitioners had to fill in a questionnaire assessing their patients' alcohol use and alcohol use disorders. A multinomial logistic regression was performed to investigate the association between reasons for not seeking treatment and alcohol use disorder severity. Of 1,008 patients diagnosed with an alcohol use disorder (via general practitioner or patient interview) in the past 12 months, the majority (N = 810) did not receive treatment and 251 of those gave a reason for not seeking treatment. The most frequent reason was 'lack of problem awareness' (55.3% of those who responded), the second most common response was 'stigma or shame' (28.6%), followed by 'encounter barriers' (22.8%) and 'cope alone' (20.9%). The results indicated lower probabilities of reporting 'denial' and higher probabilities to report 'encounter barriers' as alcohol use disorders severity increases. However, both trends were discontinued for patients with severe alcohol use disorders. Particularly at lower levels of alcohol use disorder severity, a lack of problem awareness prevents patients from seeking treatment. Routinely alcohol consumption monitoring in primary care practices could help primary and secondary prevention of alcohol use disorders and increase treatment coverage.

  1. When and Why Parents Seek Dental Care for Children under 36 Months.

    Science.gov (United States)

    Volpato, Luiz Evaristo Ricci; Palti, Dafna Geller; Lima, Jose Eduardo de Oliveira; Machado, Maria Aparecida de Andrade Moreira; Aranha, Andreza Maria Fabio; Bandeca, Matheus Coelho; Pedro, Fabio Luis Miranda; Borges, Alvaro Henrique

    2013-08-01

    The aim was to analyze an infant preventive program determining at what age parents take their children for their first dental visit and the reasons why they do it. A total of 844 children aged from 0 to 36 months, enrolled in the program of oral health maintenance of the Baby Clinic, participated in this study. During the first dental visit, the parents were inquired about the reasons that led them to enroll their children in the program. One trained investigator identified this reasons on the records and classified them according to the following scores: orientation/prevention, caries treatment, malpositioned teeth, dental trauma, tooth color alterations and others. Orientation/prevention was the most prevalent reason from 0-6 months to 25-30 months of age, and at the age 30-36 months, the reason caries/treatment overcame orientation/prevention, becoming the most prevalent reason in that age group. The third place was occupied by dental trauma. The mean age parents seek for dental care to their children was 14, 92 months. This study showed a preferentially preventive/educational profile for the children. However, lots of parents still take children to the dentist preferentially for curative instead of preventive treatment. How to cite this article: Volpato LE, Palti DG, Lima JE, Machado MA, Aranha AM, Bandeca MC, Pedro FL, Borges AH. When and Why Parents Seek Dental Care for Children under 36 Months. J Int Oral Health 2013; 5(4):21-25.

  2. Seeking harmony in the provision of care to the stroke-impaired: views of Chinese family caregivers.

    Science.gov (United States)

    Lee, Regina L T; Mok, Esther S B

    2011-05-01

    To explore the coping strategies of Chinese family caregivers of stroke-impaired older relatives. Many stroke-impaired patients rely heavily on support from their families, and the daily lives of such family caregivers are severely impacted. However, services and support for family caregivers of stroke-impaired relatives in the home setting have received little attention. Appropriate and relevant information and support to family caregivers are important in facilitating the care-giving task. It is, therefore, necessary to understand the nature and demands of care-giving before planning specific educational and support programmes. Grounded theory. Fifteen Chinese family caregivers of stroke-impaired older relatives were recruited and interviewed in 2003 and 2004. Theoretical sampling and constant comparative analysis were used to recruit the sample and perform data analysis. Seeking harmony to provide care for the stroke-impaired was the core category for describing and guiding the family care-giving process, with five main stages: (1) living with ambiguity, (2) monitoring the recovery progress, (3) accepting the downfalls, (4) meeting family obligations and (5) reconciling with harmony. These issues were seldom discussed openly with health professionals. The findings indicated that Chinese family caregivers determine their own needs by seeking harmony to continue to provide care without thinking about getting help from others or their own health problems. These findings help to define some of the complex dynamics that have an impact on the development of partnership care and might challenge nurses practising in the community. Community nurses should assess and understand the coping strategies of family caregivers and assist them to engage in stress-reducing practices. This is an important partnership to be formed in stroke care for family caregivers in the community. The study findings will guide further development of family care-giving aspects in nursing practice

  3. Mental health help-seeking patterns and perceived barriers for care among nulliparous pregnant women.

    Science.gov (United States)

    Da Costa, Deborah; Zelkowitz, Phyllis; Nguyen, Tuong-Vi; Deville-Stoetzel, Jean-Benoit

    2018-05-30

    This study examined the patterns of consultation with health providers for emotional symptoms and barriers preventing mental health help-seeking among pregnant women. A total of 652 nulliparous women in their third trimester completed an online questionnaire assessing depressed mood, adjustment in their couple relationship, demographics, help-seeking behaviors for emotional problems and barriers to help-seeking in the past year. The prevalence of having consulted with at least one health provider over the past year for emotional symptoms was 20.1% for the entire sample and 32.7% for the subgroup of women reporting elevated depressive symptoms in the third trimester. Women in the 30-39 age range were more likely to discuss their emotional symptoms with a health provider in the past year compared to younger women (OR = 1.6, CI = 1.0, 2.6, p = 0.041). Among women depressed in the third trimester, being White was independently associated with a greater likelihood of having consulted with a health provider about their emotional symptoms (OR = 2.9, CI = 1.4, 6.1, p = 0.005). Barriers to mental help-seeking included not having gotten around to it (46.1%), being too busy (26.1%), deciding not to seek care (24.3%), cost (22.6%) and not knowing where to go (19.1%). Women with more depressive symptoms in the third trimester endorsed more barriers to mental health service use (β = 0.25, 95% CI = 0.02, 0.12, p = 0.015). Innovative, evidence-based approaches are needed to more effectively promote mental health during the perinatal period and help women overcome the practical barriers identified to help-seeking.

  4. How the relationship of attitudes toward mental health treatment and service use differs by age, gender, ethnicity/race and education.

    Science.gov (United States)

    Gonzalez, Jodi M; Alegría, Margarita; Prihoda, Thomas J; Copeland, Laurel A; Zeber, John E

    2011-01-01

    Promoting help-seeking for mental health problems can result in improved treatment rates. For the most impact, social marketing interventions need to be tailored to targeted demographic subgroups. We investigated the influence of interactions between attitudes toward treatment and age, gender, ethnicity/race and education for both general medical and specialty care. Cross-sectional data from the 2001-2003 National Comorbidity Survey Replication (NCS-R) were analyzed using multivariate models adjusted for the sampling design and controlled for relevant clinical and sociodemographic factors. Greater comfort talking to a professional was associated with greater past-year specialty care across all demographic groups, while strongest for non-Latino whites and not evident for those 50-64 years old. For all demographic groups, reported willingness to seek professional help was associated with general medical care. However, for specialty care the association was much stronger for men compared to women. For African Americans, but not non-Latino whites, the perceived efficacy of mental health treatment improved the likelihood of past-year specialty use. Our analyses suggest both the importance of understanding demographic differences in relevant attitudes and potential directions for marketing campaigns.

  5. Implementation of the cross-border healthcare directive in Poland: How not to encourage patients to seek care abroad?

    Science.gov (United States)

    Kowalska-Bobko, Iwona; Mokrzycka, Anna; Sagan, Anna; Włodarczyk, W Cezary; Zabdyr-Jamróz, Michał

    2016-11-01

    In October 2014, after over 12 months of delay, Poland finally implemented directive 2011/24/EU on the application of patients' rights in cross-border healthcare. The implementing legislation in the area of cost reimbursement and prior authorization is very restrictive. The goal is to either defer the public payer's expenses into the future or to discourage patients from seeking care abroad or from seeking care altogether. The Polish government and the Ministry of Health, the key stakeholders in the implementation process, seemed to overlook the potential monetary benefits that the implementation of the directive could bring, for example, by promoting Poland as a destination for health tourism. Other stakeholders, such as patients and healthcare providers, had no real influence on the policy process. So far, the number of applications for planned treatment abroad has been very low and the majority of them were actually turned down as they did not meet the formal requirements. This number is likely to remain low in the future as accessing such care is cumbersome and not affordable for many patients. Overall, while the directive does not aim to encourage patients to seek cross-border healthcare, the current national regulations in Poland do not seem to facilitate access to cross-border healthcare, which is the main goal of the directive. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  6. Health seeking behavior of the mothers for the special care new-born unit discharged children: A comparative study

    OpenAIRE

    Gursimer Jeet; Atul Sharma; Tulika Goswami Mohanta; Ajay Trakroo

    2013-01-01

    Establishment of special care new-born units (SCNU) in hospitals not only serves to provide the intensive care to sick neonates, but presents with opportunities to enhance knowledge and modify attitude and practices of their parents through behavior change communication (BCC). A cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011 to assess differences in health-care seeking behavior of these mothers from mothers of newborns who were born at home and mot...

  7. Effect of specialty care on the low-level laser therapy for the patients with temporomandibular joint pain%低强度激光治疗颞下颌关节疼痛的临床专科护理∗

    Institute of Scientific and Technical Information of China (English)

    叶莺; 张燕平; 刘然; 张静露

    2015-01-01

    目的:探讨颞下颌关节专科护理用于低强度激光治疗颞下颌关节疼痛治疗的效果。方法将144例颞下颌关节疼痛患者随机分为激光治疗专科护理组、单纯激光治疗组、单纯专科护理组和对照组。激光治疗专科护理组在治疗过程中采用低强度镓铝砷半导体激光治疗辅以颞下颌关节专科护理,单纯激光治疗组仅使用低强度镓铝砷半导体激光进行治疗,单纯专科护理组采用模拟激光照射并进行个性化专科护理,对照组仅采用模拟激光进行安慰照射。治疗周期为10 d。结果激光治疗专科护理组治疗前后开口度(t=8.770,P<0.001)和前伸运动度(t=6.306,P<0.001)明显增大,开口偏斜减小(t=4.233,P<0.001),疼痛减轻(t=12.084,P<0.001);单纯激光治疗组颞下颌关节疼痛减轻,差异有统计学意义(t=4.702,P<0.001),但下颌前伸运动改善不明显(t=1.784,P=0.083);单纯护理组颞下颌关节疼痛减轻(t=6.136,P<0.001)。结论颞下颌关节专科护理能够提高镓铝砷半导体激光对颞下颌关节病治疗的效果。%Objective To evaluate the clinical effect of temporomandibular joint ( TMJ) specialty care on the low-level Ga-Al-As laser therapy for the patients with TMJ pain in a random and double-blind research design. Methods A total of 144 patients were randomly divided into four groups. Patients in Group 1 received laser therapy combined with specialty care. Group 2 accepted simple laser therapy only. Group 3 had specialty care and sham laser as placebo and controlled group received sham laser as without specialty care. All the patients treated for 10 days. Results Compared with the other three groups, Laser treatment combined with specialty care group showed significant better improvement on mandib-ular function ( P<0. 001) and pain intensity ( P<0. 001) after treatment. Simple laser treatment can also relief pain in-tensity ( P<0. 001) and increase the vertical movement ( P<0. 001

  8. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Peter Waiswa

    2015-03-01

    Full Text Available Background: Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective: To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design: The Uganda Newborn Study (UNEST was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care. Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results: The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively. Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively. Half (49.6% of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in

  9. Specialty choice among dental students in Ibadan, Nigeria ...

    African Journals Online (AJOL)

    The majority of dental students at the University of Ibadan preferred the oral and maxillofacial surgery (OMS) specialty above all other dental specialties, while prosthetic dentistry was least preferred. Of all the factors to take into consideration when choosing a dental specialty, personal interest was the only factor considered ...

  10. Stigma as a barrier to seeking health care among military personnel with mental health problems.

    Science.gov (United States)

    Sharp, Marie-Louise; Fear, Nicola T; Rona, Roberto J; Wessely, Simon; Greenberg, Neil; Jones, Norman; Goodwin, Laura

    2015-01-01

    Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon: a mixed-methods study on caregivers' perceptions.

    Science.gov (United States)

    Pajuelo, Mónica J; Anticona Huaynate, Cynthia; Correa, Malena; Mayta Malpartida, Holger; Ramal Asayag, Cesar; Seminario, Juan R; Gilman, Robert H; Murphy, Laura; Oberhelman, Richard A; Paz-Soldan, Valerie A

    2018-03-01

    Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents' limited education and their difficulties in recognizing the severity of the illness. The "three delays" was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers' perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework. There were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children's caregivers. Half of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians. According to caregivers, the main delays to get health care services for pneumonia among young children were

  12. Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery

    OpenAIRE

    Trosman, Julia R.; Carlos, Ruth C.; Simon, Melissa A.; Madden, Debra L.; Gradishar, William J.; Benson, Al B.; Rapkin, Bruce D.; Weiss, Elisa S.; Gareen, Ilana F.; Wagner, Lynne I.; Khan, Seema A.; Bunce, Mikele M.; Small, Art; Weldon, Christine B.

    2016-01-01

    Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. W...

  13. Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh

    Directory of Open Access Journals (Sweden)

    Chowdhury F

    2017-03-01

    Full Text Available Fahmida Chowdhury,1 Katharine Sturm-Ramirez,1,2 Abdullah Al Mamun,1 A Danielle Iuliano,2 Mejbah Uddin Bhuiyan,1 Mohammod Jobayer Chisti,1 Makhdum Ahmed,1 Sabbir Haider,3 Mahmudur Rahman,3 Eduardo Azziz-Baumgartner2 1Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; 2Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; 3Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh Background: Pharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome.Methods: A cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients’ relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome.Results: We interviewed 302 customers patronizing 76 pharmacies; 186 (62% sought care for themselves and 116 (38% sought care for a sick relative. Most customers (215; 71% were males. The majority (90% of customers sought care from the study pharmacy as their first point of care, while 18 (6% had previously sought care from another pharmacy and 11 (4% from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%, lower cost (46%, availability of medicine (33%, knowing the drug seller (20%, and convenient hours of operation (19%. The most commonly recommended drugs were

  14. Intention to Seek Care for Symptoms Associated With Gynecologic Cancers, HealthStyles Survey, 2008

    OpenAIRE

    Trivers, Katrina F.; Rodriguez, Juan L.; Hawkins, Nikki A.; Polonec, Lindsey; Gelb, Cynthia A.; Purvis Cooper, Crystale

    2011-01-01

    Introduction Women with ovarian cancer typically experience symptoms before diagnosis; such symptoms for other gynecologic cancers have not been systematically studied. We investigated which symptoms of gynecologic cancers prompt intention to seek care among women and whether demographic differences in intention exist. This study was undertaken, in part, to inform development of the Centers for Disease Control and Prevention's campaign, Inside Knowledge: Get the Facts About Gynecologic Cancer...

  15. Delay in seeking care for tuberculosis symptoms among adults newly diagnosed with HIV in rural Malawi.

    Science.gov (United States)

    Ngwira, L G; Dowdy, D W; Khundi, M; Barnes, G L; Nkhoma, A; Choko, A T; Murowa, M; Chaisson, R E; Corbett, E L; Fielding, K

    2018-03-01

    Ten primary health clinics in rural Thyolo District, Malawi. Tuberculosis (TB) is a common initial presentation of human immunodeficiency virus (HIV) infection. We investigated the time from TB symptom onset to HIV diagnosis to describe TB health-seeking behaviour in adults newly diagnosed with HIV. We asked adults (18 years) about the presence and duration of TB symptoms at the time of receiving a new HIV diagnosis. Associations with delayed health seeking (defined as >30 and >90 days from the onset of TB symptoms) were evaluated using multivariable logistic regression. TB symptoms were reported by 416 of 1265 participants (33%), of whom 36% (150/416) had been symptomatic for >30 days before HIV testing. Most participants (260/416, 63%) were below the poverty line (US$0.41 per household member per day). Patients who first sought care from informal providers had an increased odds of delay of >30 days (adjusted odds ratio [aOR] 1.6, 95%CI 0.9-2.8) or 90 days (aOR 2.0, 95%CI 1.1-3.8). Delayed health seeking for TB-related symptoms was common. Poverty was ubiquitous, but had no clear relationship to diagnostic delay. HIV-positive individuals who first sought care from informal providers were more likely to experience diagnostic delays for TB symptoms.

  16. A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use

    Science.gov (United States)

    Pope, Charlene A.; Davis, Boyd H.; Wine, Leticia; Nemeth, Lynne S.; Axon, Robert N.

    2018-01-01

    Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving. PMID:29482411

  17. Pre-Emergency-Department Care-Seeking Patterns Are Associated with the Severity of Presenting Condition for Emergency Department Visit and Subsequent Adverse Events: A Timeframe Episode Analysis

    OpenAIRE

    Chan, Chien-Lung; Lin, Wender; Yang, Nan-Ping; Lai, K. Robert; Huang, Hsin-Tsung

    2015-01-01

    Background Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits. Objectives We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity ...

  18. Prevalence and Correlates of Herbal Medicine Use among Women Seeking Care for Infertility in Freetown, Sierra Leone.

    Science.gov (United States)

    James, Peter Bai; Taidy-Leigh, Lexina; Bah, Abdulai Jawo; Kanu, Joseph Sam; Kangbai, Jia Bainga; Sevalie, Stephen

    2018-01-01

    In resource-poor countries where access to infertility care is limited, women may turn to traditional medicine to achieve motherhood. It is unknown whether Sierra Leonean women with such condition use herbal medicine. This study investigates the prevalence and factors associated with herbal medicine use among women seeking care for infertility. This was a questionnaire-based cross-sectional study conducted among women seeking care for infertility at various clinics within Freetown, Sierra Leone. Data analysis included Chi-square tests and logistic regression. Out of the 167 women that participated, 36.5% used herbal medicine for infertility treatment. Women with no formal (AOR 4.03, CL: 1.38-11.76, p = 0.011), primary education (AOR: 6.23, CL: 2.02-19.23, p = 0.001) and those that visited a traditional medicine practitioner (AOR: 20.05, CL: 2.10-192.28, p = 0.009) as well as women suffering from other reproductive health problems (AOR: 2.57, CL: 1.13-5.83, p = 0.024) were more likely to use herbal medicines. Friends and family ( n = 57, 96.7%) were the main influencers of herbal medicine use. Only ( n = 12) 19.7% of users disclosed their status to their healthcare provider. Over half ( n = 32, 52.5%) could not remember the name of the herb they used . Luffa acutangula ( n = 29, 100%) was the herbal medicinal plant users could recall. Herbal medicine use among women seeking care for infertility in Freetown is common. Healthcare providers should be aware of the potential dyadic use of herbal and allopathic medicines by their patients and be knowledgeable about commonly used herbal remedies as well as being proactive in communicating the potential risks and benefits associated with their use.

  19. Prevalence and Correlates of Herbal Medicine Use among Women Seeking Care for Infertility in Freetown, Sierra Leone

    Science.gov (United States)

    Taidy-Leigh, Lexina; Bah, Abdulai Jawo; Kanu, Joseph Sam; Kangbai, Jia Bainga; Sevalie, Stephen

    2018-01-01

    In resource-poor countries where access to infertility care is limited, women may turn to traditional medicine to achieve motherhood. It is unknown whether Sierra Leonean women with such condition use herbal medicine. This study investigates the prevalence and factors associated with herbal medicine use among women seeking care for infertility. This was a questionnaire-based cross-sectional study conducted among women seeking care for infertility at various clinics within Freetown, Sierra Leone. Data analysis included Chi-square tests and logistic regression. Out of the 167 women that participated, 36.5% used herbal medicine for infertility treatment. Women with no formal (AOR 4.03, CL: 1.38–11.76, p = 0.011), primary education (AOR: 6.23, CL: 2.02–19.23, p = 0.001) and those that visited a traditional medicine practitioner (AOR: 20.05, CL: 2.10–192.28, p = 0.009) as well as women suffering from other reproductive health problems (AOR: 2.57, CL: 1.13–5.83, p = 0.024) were more likely to use herbal medicines. Friends and family (n = 57, 96.7%) were the main influencers of herbal medicine use. Only (n = 12) 19.7% of users disclosed their status to their healthcare provider. Over half (n = 32, 52.5%) could not remember the name of the herb they used. Luffa acutangula (n = 29, 100%) was the herbal medicinal plant users could recall. Herbal medicine use among women seeking care for infertility in Freetown is common. Healthcare providers should be aware of the potential dyadic use of herbal and allopathic medicines by their patients and be knowledgeable about commonly used herbal remedies as well as being proactive in communicating the potential risks and benefits associated with their use. PMID:29849738

  20. Prevalence and Correlates of Herbal Medicine Use among Women Seeking Care for Infertility in Freetown, Sierra Leone

    Directory of Open Access Journals (Sweden)

    Peter Bai James

    2018-01-01

    Full Text Available In resource-poor countries where access to infertility care is limited, women may turn to traditional medicine to achieve motherhood. It is unknown whether Sierra Leonean women with such condition use herbal medicine. This study investigates the prevalence and factors associated with herbal medicine use among women seeking care for infertility. This was a questionnaire-based cross-sectional study conducted among women seeking care for infertility at various clinics within Freetown, Sierra Leone. Data analysis included Chi-square tests and logistic regression. Out of the 167 women that participated, 36.5% used herbal medicine for infertility treatment. Women with no formal (AOR 4.03, CL: 1.38–11.76, p=0.011, primary education (AOR: 6.23, CL: 2.02–19.23, p=0.001 and those that visited a traditional medicine practitioner (AOR: 20.05, CL: 2.10–192.28, p=0.009 as well as women suffering from other reproductive health problems (AOR: 2.57, CL: 1.13–5.83, p=0.024 were more likely to use herbal medicines. Friends and family (n=57, 96.7% were the main influencers of herbal medicine use. Only (n=12 19.7% of users disclosed their status to their healthcare provider. Over half (n=32, 52.5% could not remember the name of the herb they used. Luffa acutangula (n=29, 100% was the herbal medicinal plant users could recall. Herbal medicine use among women seeking care for infertility in Freetown is common. Healthcare providers should be aware of the potential dyadic use of herbal and allopathic medicines by their patients and be knowledgeable about commonly used herbal remedies as well as being proactive in communicating the potential risks and benefits associated with their use.

  1. Seeking a balance between employment and the care of an ageing parent.

    Science.gov (United States)

    Eldh, Ann Catrine; Carlsson, Eva

    2011-06-01

    A growing number of middle-aged people are engaged in informal care of their parents while employed. To provide support as employers, co-workers or staff, health care professionals need insight into the experiences of people managing these responsibilities. To elucidate the experience of providing informal care to an ageing parent while managing the responsibilities of a working life. Narrative interviews were performed with 11 persons with experience of the phenomenon. Transcribed interviews were analysed with phenomenological hermeneutics. Informed consent was given prior to the interviews. The study was approved by a research ethics committee. Providing informal care to an ageing parent while also pursuing a working life implies seeking balance: a balance between providing support to the parent's needs and one's responsibilities at work. Being employed supports this balance as it provides both fulfilment and refuge. Being capable of managing both roles grants a sense of satisfaction, supporting one's sense of balance in life. The balance can be supported by sharing the responsibility of caring for the ageing parent with others. Despite perceived saturation and an effort to provide for the possibility to consider internal consistency, the findings should be considered as a contribution to the understanding of the phenomenon, as experienced by individuals in their life world. It is essential to recognise the impact that providing care for an ageing parent may have on the lives of a growing number of people, particularly if they have employment responsibilities. Acknowledgement by others supports one's ability to attain balance; as co-workers and managers, we can acknowledge the efforts of an informal caregiver and as health care staff recognise the valuable contribution made by people in mid-life who provide informal care for their ageing parents. © 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

  2. Developing Federal Clinical Care Recommendations for Women.

    Science.gov (United States)

    Godfrey, Emily M; Tepper, Naomi K; Curtis, Kathryn M; Moskosky, Susan B; Gavin, Loretta E

    2015-08-01

    The provision of family planning services has important health benefits for the U.S. Approximately 25 million women in the U.S. receive contraceptive services annually and 44 million make at least one family planning-related clinical visit each year. These services are provided by private clinicians, as well as publicly funded clinics, including specialty family planning clinics, health departments, Planned Parenthoods, community health centers, and primary care clinics. Recommendations for providing quality family planning services have been published by CDC and the Office of Population Affairs of the DHHS. This paper describes the process used to develop the women's clinical services portion of the new recommendations and the rationale underpinning them. The recommendations define family planning services as contraceptive care, pregnancy testing and counseling, achieving pregnancy, basic infertility care, sexually transmitted disease services, and preconception health. Because many women who seek family planning services have no other source of care, the recommendations also include additional screening services related to women's health, such as cervical cancer screening. These clinical guidelines are aimed at providing the highest-quality care and are designed to establish a national standard for family planning in the U.S. Published by Elsevier Inc.

  3. Insomnia patients' help-seeking experiences.

    Science.gov (United States)

    Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Glozier, Nicholas; Saini, Bandana

    2014-03-04

    Timely access to appropriate treatment is important for optimizing insomnia management. To date, little is known about insomnia patients' treatment experiences or how they access and engage with the available health care resources. This study sought to capture the help-seeking experiences and behavioral patterns of patients with insomnia who are seeking or receiving specialist care. A purposive sample of 26 insomnia patients from specialist sleep and mental health clinics located in metropolitan New South Wales, Australia was recruited. Participants completed a brief questionnaire, followed by an in-depth, semi-structured interview. Interviews were digitally recorded, transcribed verbatim, and analyzed using framework analysis. Three key themes emerged from the data: patients' sleep beliefs, treatment beliefs, and accessing specialized care. The findings show that daytime symptoms arising from insomnia serve as important illness cues for patients to seek medical help. In addition, participants' treatment pathways highlight factors that prevent the widespread use of cognitive behavioral therapy for insomnia (CBT-I), including limited awareness about CBT-I, tentative referral mechanisms, limited service providers, and the high cost of CBT-I.

  4. The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective.

    Science.gov (United States)

    Banaszak-Holl, J; Zinn, J S; Mor, V

    1996-04-01

    Using resource dependency theory as a conceptual framework, this study investigates both the organizational and environmental factors associated with an emerging health care service delivery innovation, the provision of specialty care in designated units in nursing care facilities. We consider two types of specialty units, Alzheimer's Disease and subacute care. The Medicare/Medicaid Automated Certification Survey (MMACS) data file was merged with local market area data obtained from the 1992 Area Resource File and with state level regulatory data. The likelihood of providing Alzheimer's Disease or subacute care in dedicated units was estimated by separate logistic regressions. Results indicate that facilities with fewer Medicare patients are more likely to operate a dedicated Alzheimer's care unit, while facilities located in markets with a large HMO population and greater hospital supply are more likely to operate a subacute care unit. While competition among nursing homes, for the most part, is an incentive to innovate, greater regulatory stringency appears to constrain the development of specialty care units of both types. Finally, organizational characteristics (e.g., size and proprietary status) appear to be important enabling factors influencing the propensity to provide specialty care in dedicated units. Nursing care facilities are moving toward providing specialty care units partly as a response to a growing demand by resource providers and to maintain a competitive edge in tighter markets. Loosening regulation directed at cost containment would further encourage the development of specialty care but should be preceded by some evaluation of population needs for specialty care and the effectiveness of specialty care units.

  5. Chronic morbidity and health care seeking behaviour amongst elderly population in rural areas of Uttarakhand

    Directory of Open Access Journals (Sweden)

    Surekha Kishore

    2015-06-01

    Full Text Available Background: Ageing is a natural process, always associated with physiological and biological decline. Global population is ageing; the proportion of older persons has been rising steadily, from 7% in 1950 to 11% in 2007, with an expected rise to reach 22 % in 2050. With improving knowledge and awareness the health care seeking behavior has shown an increasingly positive trend. With increasing age, morbidity,   especially those arising from chronic diseases also increases. On the contrary, health care delivered at household level has definitely   gone down due to financial constraints and increasing cost of living, thus posing a problem for the elderly.  Aims & Objective: To find out the prevalence of chronic morbidity and health care seeking behaviour amongst the elderly in rural areas of Uttarakhand. Material and Methods: A cross-sectional study was carried out in rural areas of Uttarakhand to assess the chronic morbidity amongst elderly population. All the persons above the age group of 60 years of the eight villages were interviewed using a pre-defined, pre-tested, semi-structured and indigenously developed questionnaire. Results: The study group suffered from various chronic morbidities like hypertension, diabetes, cardiovascular diseases. Men were greater in number (158, 62.2%. Participants belonging mostly to nuclear families (156, 61.9%. Below the poverty line were (98, 38.9%. Half of the study population had one or the other chronic morbid condition. Majority of the elderly men contacted the health care facility whereas majority of the elderly women chose to use remedies. Conclusion: There is definitely a need of   provision of health care services for poor geriatric population. In addition to this government should take up some program for social security of this population along with creating an awareness about the same.

  6. Depression, Help-Seeking and Self-Recognition of Depression among Dominican, Ecuadorian and Colombian Immigrant Primary Care Patients in the Northeastern United States

    Directory of Open Access Journals (Sweden)

    Susan Caplan

    2015-08-01

    Full Text Available Latinos, the largest minority group in the United States, experience mental health disparities, which include decreased access to care, lower quality of care and diminished treatment engagement. The purpose of this cross-sectional study of 177 Latino immigrants in primary care is to identify demographic factors, attitudes and beliefs, such as stigma, perceived stress, and ethnic identity that are associated with depression, help-seeking and self-recognition of depression. Results indicated that 45 participants (25% had depression by Patient Health Questionnaire (PHQ-9 criteria. Factors most likely to be associated with depression were: poverty; difficulty in functioning; greater somatic symptoms, perceived stress and stigma; number of chronic illnesses; and poor or fair self-rated mental health. Fifty-four people endorsed help-seeking. Factors associated with help-seeking were: female gender, difficulty in functioning, greater somatic symptoms, severity of depression, having someone else tell you that you have an emotional problem, and poor or fair self-rated mental health. Factors most likely to be associated with self-recognition were the same, but also included greater perceived stress. This manuscript contributes to the literature by examining attitudinal factors that may be associated with depression, help-seeking and self-recognition among subethnic groups of Latinos that are underrepresented in research studies.

  7. Health-Seeking Behavior and Barriers to Care in Patients With Rectal Bleeding in Nigeria

    Directory of Open Access Journals (Sweden)

    Olusegun I. Alatise

    2017-12-01

    Full Text Available Purpose: Colorectal cancer (CRC incidence rates are steadily increasing in Nigeria. Organized screening is still largely unused because of financial and logistical barriers; most CRCs are detected by symptoms. One symptom of CRC is rectal bleeding. This study sought to determine health-seeking behavior and barriers to care in patients with rectal bleeding in Nigeria. This study also surveyed physicians to determine major breakdowns in access to care. Methods: The recruitment process for this study involved patients referred for colonoscopy because of rectal bleeding as well as response to a media advertisement for a free colonoscopy. Physicians were recruited at the African Research Group for Oncology meeting. Patient responses were scored on the basis of knowledge of rectal bleeding. The physician questionnaire was supporting information and mainly descriptive in nature. Results: A total of 82 patients and 45 physicians participated in this study. Less than 40% of patients knew that rectal bleeding could be caused by cancer. Major barriers to care were resolution of the symptom (42%, no consideration of the bleeding as problematic (40%, and financial constraint (22%. Education was strongly correlated with knowledge of rectal bleeding and health-seeking behavior. Although physicians regularly saw patients with rectal bleeding, most of them provided a differential diagnosis of hemorrhoids and few referred patients for colonoscopy. Conclusion: General awareness about the signs of colorectal cancer is lacking. This demonstrates the strong need for patient education programs about this issue. Physicians should also receive additional training on differentiation of a potential cancer diagnosis from something more benign, such as hemorrhoids.

  8. Health-Seeking Behavior and Barriers to Care in Patients With Rectal Bleeding in Nigeria.

    Science.gov (United States)

    Alatise, Olusegun I; Fischer, Sara E; Ayandipo, Omobolaji O; Omisore, Akinlolu G; Olatoke, Samuel A; Kingham, T Peter

    2017-12-01

    Purpose Colorectal cancer (CRC) incidence rates are steadily increasing in Nigeria. Organized screening is still largely unused because of financial and logistical barriers; most CRCs are detected by symptoms. One symptom of CRC is rectal bleeding. This study sought to determine health-seeking behavior and barriers to care in patients with rectal bleeding in Nigeria. This study also surveyed physicians to determine major breakdowns in access to care. Methods The recruitment process for this study involved patients referred for colonoscopy because of rectal bleeding as well as response to a media advertisement for a free colonoscopy. Physicians were recruited at the African Research Group for Oncology meeting. Patient responses were scored on the basis of knowledge of rectal bleeding. The physician questionnaire was supporting information and mainly descriptive in nature. Results A total of 82 patients and 45 physicians participated in this study. Less than 40% of patients knew that rectal bleeding could be caused by cancer. Major barriers to care were resolution of the symptom (42%), no consideration of the bleeding as problematic (40%), and financial constraint (22%). Education was strongly correlated with knowledge of rectal bleeding and health-seeking behavior. Although physicians regularly saw patients with rectal bleeding, most of them provided a differential diagnosis of hemorrhoids and few referred patients for colonoscopy. Conclusion General awareness about the signs of colorectal cancer is lacking. This demonstrates the strong need for patient education programs about this issue. Physicians should also receive additional training on differentiation of a potential cancer diagnosis from something more benign, such as hemorrhoids.

  9. Commercial production of specialty chemicals and pharmaceuticals from biomass

    Energy Technology Data Exchange (ETDEWEB)

    McChesney, J.D. [Univ. of Mississippi, University, MS (United States)

    1993-12-31

    The chemical substances utilized in consumer products, and for pharmaceutical and agricultural uses are generally referred to as specialty chemicals. These may be flavor or fragrance substances, intermediates for synthesis of drugs or agrochemicals or the drugs or agrochemicals themselves, insecticides or insect pheromones or antifeedants, plant growth regulators, etc. These are in contrast to chemicals which are utilized in large quantities for fuels or preparation of plastics, lubricants, etc., which are usually referred to as industrial chemicals. The specific utilization of specialty chemicals is associated with a specific important physiochemical or biological property. They may possess unique properties as lubricants or waxes or have a very desirable biological activity such as a drug, agrochemical or perfume ingredient. These unique properties convey significant economic value to the specific specialty chemical. The economic commercial production of specialty chemicals commonly requires the isolation of a precursor or the specialty chemical itself from a natural source. The discovery, development and commercialization of specialty chemicals is presented and reviewed. The economic and sustainable production of specialty chemicals is discussed.

  10. Variables associated with the performance of Centers for Dental Specialties in Brazil.

    Science.gov (United States)

    Cortellazzi, Karine Laura; Balbino, Edna Cesar; Guerra, Luciane Miranda; Vazquez, Fabiana de Lima; Bulgareli, Jaqueline Vilela; Ambrosano, Glaucia Maria Bovi; Pereira, Antonio Carlos; Mialhe, Fábio Luiz

    2014-12-01

    The aim of this study was to evaluate the performance of the Centers for Dental Specialties (CDS) in the country and associations with sociodemographic indicators of the municipalities, structural variables of services and primary health care organization in the years 2004-2009. The study used secondary data from procedures performed in the CDS to the specialties of periodontics, endodontics, surgery and primary care. Bivariate analysis by χ2 test was used to test the association between the dependent variable (performance of the CDS) with the independents. Then, Poisson regression analysis was performed. With regard to the overall achievement of targets, it was observed that the majority of CDS (69.25%) performance was considered poor/regular. The independent factors associated with poor/regular performance of CDS were: municipalities belonging to the Northeast, South and Southeast regions, with lower Human Development Index (HDI), lower population density, and reduced time to deployment. HDI and population density are important for the performance of the CDS in Brazil. Similarly, the peculiarities related to less populated areas as well as regional location and time of service implementation CDS should be taken into account in the planning of these services.

  11. Health seeking and access to care for children with suspected dengue in Cambodia: An ethnographic study

    Directory of Open Access Journals (Sweden)

    Manderson Lenore

    2007-09-01

    Full Text Available Abstract Background The continuing contribution of dengue fever to the hospitalization and deaths in hospital of infants and small children in Cambodia is associated with delays in presentation for medical attention, diagnosis and appropriate care. It is important to identify the reasons that influence these delays, in order to develop appropriate interventions to redress the impact of dengue. Methods Data on health seeking were collected during an ethnographic study conducted in two villages in the eastern province of Kampong Cham, Cambodia in 2004. Interviews were conducted with mothers whose children had been infected with suspected dengue fever, or who had been sick for other reasons, in 2003 and 2004. Results Women selected a therapeutic option based on perceptions of the severity of the child's condition, confidence in the particular modality, service or practitioner, and affordability of the therapy. While they knew what type of health care was required, poverty in combination with limited availability and perceptions of the poor quality of care at village health centers and public referral hospitals deterred them from doing so. Women initially used home remedies, then sought advice from public and private providers, shifting from one sector to another in a pragmatic response to the child's illness. Conclusion The lack of availability of financial resources for poor people and their continuing lack of confidence in the care provided by government centres combine to delay help seeking and inappropriate treatment of children sick with dengue.

  12. Health seeking and access to care for children with suspected dengue in Cambodia: an ethnographic study.

    Science.gov (United States)

    Khun, Sokrin; Manderson, Lenore

    2007-09-24

    The continuing contribution of dengue fever to the hospitalization and deaths in hospital of infants and small children in Cambodia is associated with delays in presentation for medical attention, diagnosis and appropriate care. It is important to identify the reasons that influence these delays, in order to develop appropriate interventions to redress the impact of dengue. Data on health seeking were collected during an ethnographic study conducted in two villages in the eastern province of Kampong Cham, Cambodia in 2004. Interviews were conducted with mothers whose children had been infected with suspected dengue fever, or who had been sick for other reasons, in 2003 and 2004. Women selected a therapeutic option based on perceptions of the severity of the child's condition, confidence in the particular modality, service or practitioner, and affordability of the therapy. While they knew what type of health care was required, poverty in combination with limited availability and perceptions of the poor quality of care at village health centers and public referral hospitals deterred them from doing so. Women initially used home remedies, then sought advice from public and private providers, shifting from one sector to another in a pragmatic response to the child's illness. The lack of availability of financial resources for poor people and their continuing lack of confidence in the care provided by government centres combine to delay help seeking and inappropriate treatment of children sick with dengue.

  13. Factors affecting future specialty choice among medical students in Kuwait.

    Science.gov (United States)

    Al-Fouzan, Rawan; Al-Ajlan, Sarah; Marwan, Yousef; Al-Saleh, Mervat

    2012-01-01

    Choosing a medical specialty can be either a daunting and confusing experience for some medical students and junior doctors or a foregone conclusion to others. The aim of this study is to evaluate factors affecting future specialty choice among medical students in Kuwait University. A self-administered questionnaire was used to collect data from medical students registered in Kuwait University during the academic year 2011/2012. Chi-square test and logistic regression were used to test the association between deciding a future specialty and students' sociodemographic and academic factors. Of the 422 students approached, 387 (91.7%) decided to participate. A total of 144 (37.2%) students made a decision regarding their choice of future medical specialty. Pediatrics, general surgery, and cardiology were the most desired specialties - 18 (12.5%), 17 (11.8%), and 16 (11.1%) students requested these specialties, respectively. Only 61 (42.4%) of those who selected a future specialty received advice regarding their choice. Looking for a good treatment outcome for patients (66; 45.8%) and a challenging specialty (58; 40.3%) were the most influencing incentives when selecting a future specialty. Students in the clinical phase of their study were 3.014 (95% CI: 1.498-6.065) more likely to report on their decision regarding a future specialty compared to students in the basic medical sciences phase (p=0.002). A variety of factors appeared to inspire medical students in Kuwait to choose a future medical specialty. When identified, these factors can be used by mentors of medical students and directors of residency training programs to motivate students to choose specialties that are limited in Kuwait.

  14. Optimizing the quality of breast cancer care at certified german breast centers: a benchmarking analysis for 2003-2009 with a particular focus on the interdisciplinary specialty of radiation oncology.

    Science.gov (United States)

    Brucker, Sara Y; Wallwiener, Markus; Kreienberg, Rolf; Jonat, Walter; Beckmann, Matthias W; Bamberg, Michael; Wallwiener, Diethelm; Souchon, Rainer

    2011-02-01

    A voluntary, external, science-based benchmarking program was established in Germany in 2003 to analyze and improve the quality of breast cancer (BC) care. Based on recent data from 2009, we aim to show that such analyses can also be performed for individual interdisciplinary specialties, such as radiation oncology (RO). Breast centers were invited to participate in the benchmarking program. Nine guideline-based quality indicators (QIs) were initially defined, reviewed annually, and modified, expanded, or abandoned accordingly. QI changes over time were analyzed descriptively, with particular emphasis on relevance to radiation oncology. During the 2003-2009 study period, there were marked increases in breast center participation and postoperatively confirmed primary BCs. Starting from 9 process QIs, 15 QIs were developed by 2009 as surrogate indicators of long-term outcome. During 2003-2009, 2/7 RO-relevant QIs (radiotherapy after breast-conserving surgery or after mastectomy) showed considerable increases (from 20 to 85% and 8 to 70%, respectively). Another three, initially high QIs practically reached the required levels. The current data confirm proof-of-concept for the established benchmarking program, which allows participating institutions to be compared and changes in quality of BC care to be tracked over time. Overall, marked QI increases suggest that BC care in Germany improved from 2003-2009. Moreover, it has become possible for the first time to demonstrate improvements in the quality of BC care longitudinally for individual breast centers. In addition, subgroups of relevant QIs can be used to demonstrate the progress achieved, but also the need for further improvement, in specific interdisciplinary specialties.

  15. Opioid Prescriptions by Specialty in Ohio, 2010-2014.

    Science.gov (United States)

    Weiner, Scott G; Baker, Olesya; Rodgers, Ann F; Garner, Chad; Nelson, Lewis S; Kreiner, Peter W; Schuur, Jeremiah D

    2018-05-01

    The current US opioid epidemic is attributed to the large volume of prescribed opioids. This study analyzed the contribution of different medical specialties to overall opioids by evaluating the pill counts and morphine milligram equivalents (MMEs) of opioid prescriptions, stratified by provider specialty, and determined temporal trends. This was an analysis of the Ohio prescription drug monitoring program database, which captures scheduled medication prescriptions filled in the state as well as prescriber specialty. We extracted prescriptions for pill versions of opioids written in the calendar years 2010 to 2014. The main outcomes were the number of filled prescriptions, pill counts, MMEs, and extended-released opioids written by physicians in each specialty, and annual prescribing trends. There were 56,873,719 prescriptions for the studied opioids dispensed, for which 41,959,581 (73.8%) had prescriber specialty type available. Mean number of pills per prescription and MMEs were highest for physical medicine/rehabilitation (PM&R; 91.2 pills, 1,532 mg, N = 1,680,579), anesthesiology/pain (89.3 pills, 1,484 mg, N = 3,261,449), hematology/oncology (88.2 pills, 1,534 mg, N = 516,596), and neurology (84.4 pills, 1,230 mg, N = 573,389). Family medicine (21.8%) and internal medicine (17.6%) wrote the most opioid prescriptions overall. Time trends in the average number of pills and MMEs per prescription also varied depending on specialty. The numbers of pills and MMEs per opioid prescription vary markedly by prescriber specialty, as do trends in prescribing characteristics. Pill count and MME values define each specialty's contribution to overall opioid prescribing more accurately than the number of prescriptions alone.

  16. Gender differences in specialty preference and mismatch with real needs in Japanese medical students

    Directory of Open Access Journals (Sweden)

    Harada Tadanari

    2010-02-01

    Full Text Available Abstract Background The shortage of doctors and maldistribution among specialties are of great concern in the Japanese health care system. This study investigated specialty preference in medical students of one university, and examined gender differences and compared their preference with real needs. Methods We conducted a self-administered questionnaire including specialty preference in all students of one medical university. Preference was assessed by the five-level probability of their future choice: 1 = very low, 2 = low, 3 = moderate, 4 = high, and 5 = very high. The proportion of 4 or 5 was calculated as the preference rate. The real needs (magnitude of doctor shortage in the prefecture were drawn from two different surveys. The relationship between the sex-specific preference rate by specialty and real needs was assessed by Spearman's correlation coefficient. Results Internal medicine showed the highest preference rate, followed by general surgery, pediatrics, and emergency medicine. There was no significant correlation between the preference rates of men and women (r = 0.27, p = 0.34. The preference rates for general surgery, orthopedics, neurosurgery, and emergency medicine were significantly higher in men than in women, while those of obstetrics & gynecology, pediatrics, and dermatology were significantly higher in women. The magnitude of doctor shortage by specialty from two surveys were significantly correlated with the total preference rate and men's preference rate (r = 0.54 to 0.74, but not with women's preference rate (r = 0.06 and 0.32. Conclusions This study elucidated not only gender differences in specialty preference but also the relationship to real needs. Critical gender differences and mismatch with real needs were found in women. In addition to traditional gender roles and insufficient support for women's participation in Japan, gender differences and mismatch influence the current and future maldistribution of

  17. The management of gout in different clinical specialties in Turkey: a patient-based survey.

    Science.gov (United States)

    Öztürk, Mehmet Akif; Mercan, Rıdvan; Gök, Kevser; Onat, Ahmet Mesut; Kısacık, Bünyamin; Kimyon, Gezmiş; Balkarlı, Ayşe; Kaya, Arif; Çobankara, Veli; Balcı, Mehmet Ali; Pamuk, ÖmerNuri; Yıldırım Çetin, Gözde; Sayarlıoğlu, Mehmet; Şenel, Soner; Tezcan, Mehmet Engin; Küçük, Adem; Üreten, Kemal; Şahin, Şafak; Tufan, Abdurrahman

    2016-12-01

    Although gout is potentially curable, the management of this disease is often suboptimal. In this study, we investigated the treatment of gout in Turkey and also compared the management approaches to gout in different clinical specialties. Three hundred and nineteen consecutive patients (mean age 58.60 ± 12.8 years; 44 females, 275 males) were included in this multicenter study. A standardized form was generated to collect data about the patient's first admission to health care, the specialty of the doctor first diagnosed the gout, the treatment options for gout including attack management, patient referral, chronic treatment including medical treatment, and life style modifications. Forty patients were referred to another center without any treatment (12.8 %), and referral rate is most common among the primary care physicians (28.8 %). Colchicine was more commonly used for attack prophylaxis than allopurinol. Ninety-two patients had never been treated with allopurinol (28.8 %). Allopurinol prescription was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. Recommendation of diet and life style modifications was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. The rates of life style modification recommendation and long-term allopurinol prescription were 83.7 and 77.6 %, respectively, among the rheumatologists. Both acute and chronic management of gout is suboptimal in Turkey especially among the primary care physicians and orthopedists. Moreover, chronic treatment is even suboptimal among rheumatologists.

  18. Exploring determinants of care-seeking behaviour of oral cancer patients in India: A qualitative content analysis.

    Science.gov (United States)

    Rath, Hemamalini; Shah, Swikant; Sharma, Gaurav; Mishra, Ekagrata

    2018-04-01

    A major public health concern in India is the high morbidity and mortality rates of oral cancer because of late diagnosis. Among the several determinants of this late diagnosis, the most important is the healthcare-seeking behaviour of the oral cancer patients. The aim of this study was to explore the care-seeking behaviour and its determinants among oral cancer patients. A face-to-face in-depth interview was conducted among 70 oral cancer patients using a semi-structured questionnaire, and qualitative content analysis of the results was performed. All the patients had squamous-cell carcinoma and none had attended any screening programme. The most common site affected was the buccal mucosa with a non-healing wound. Most of the patients contacted a doctor available nearby; only 7% of patients consulted a dentist. Only one patient approached a traditional healer. The median patient delay was 30 (4-365) days and the professional delay was 40 (4-650) days. Enablers included determinants such as increasing symptoms (80%), influence of the society (74%), fear (10%), and social media (3%). The main barriers were lack of awareness (97%), hope that the lesion will heal spontaneously (90%), lack of perception of seriousness (64%), financial constraints (55%), provider switching (47%), and missed diagnosis (44%). The care-seeking path among oral cancer patients is complex, customised, and influenced by multiple patient-related and system-related factors. Copyright © 2018. Published by Elsevier Ltd.

  19. Why don't men seek help? Family physicians' perspectives on help-seeking behavior in men.

    Science.gov (United States)

    Tudiver, F; Talbot, Y

    1999-01-01

    Men tend to underuse primary care health services despite their susceptibility to particular types of illness. The purpose of this study was to report the family physician's perspective on why men do not access the health care system for medical problems. We used focus group interviews to identify major themes. The participants were family physicians in active practice randomly selected from a list of 500 full- and part-time teachers. Four focus groups were formed from 18 participants (12 men, 6 women), in practice an average of 17 years. Eleven of the physicians were in community practice. Three key themes were identified: (1) Support: Men appear to get most of their support for health concerns from their female partners, little from their male friends. Their pattern of seeking support tends to be indirect rather than straightforward. (2) Help Seeking: Perceived vulnerability, fear, and denial are important influences on whether men seek help. They look for help for specific problems rather than for more general health concerns. (3) Barriers: Personal barriers involved factors related to a man's traditional social role characteristics: a sense of immunity and immortality; difficulty relinquishing control; a belief that seeking help is unacceptable; and believing men are not interested in prevention. Systematic barriers had to do with time and access; having to state the reason for a visit; and the lack of a male care provider. Many of these findings are supported by psychological theories. Future research should apply these theories in more transferable populations and settings. However, an in-depth understanding of the patterns of men's use of primary care services is needed before we can determine if a regular source of primary care would have a positive impact on their health.

  20. Factors affecting future specialty choice among medical students in Kuwait

    Directory of Open Access Journals (Sweden)

    Rawan Al-Fouzan

    2012-12-01

    Full Text Available Background: Choosing a medical specialty can be either a daunting and confusing experience for some medical students and junior doctors or a foregone conclusion to others. The aim of this study is to evaluate factors affecting future specialty choice among medical students in Kuwait University. Methods: A self-administered questionnaire was used to collect data from medical students registered in Kuwait University during the academic year 2011/2012. Chi-square test and logistic regression were used to test the association between deciding a future specialty and students’ sociodemographic and academic factors. Results: Of the 422 students approached, 387 (91.7% decided to participate. A total of 144 (37.2% students made a decision regarding their choice of future medical specialty. Pediatrics, general surgery, and cardiology were the most desired specialties – 18 (12.5%, 17 (11.8%, and 16 (11.1% students requested these specialties, respectively. Only 61 (42.4% of those who selected a future specialty received advice regarding their choice. Looking for a good treatment outcome for patients (66; 45.8% and a challenging specialty (58; 40.3% were the most influencing incentives when selecting a future specialty. Students in the clinical phase of their study were 3.014 (95% CI: 1.498–6.065 more likely to report on their decision regarding a future specialty compared to students in the basic medical sciences phase (p=0.002. Conclusion : A variety of factors appeared to inspire medical students in Kuwait to choose a future medical specialty. When identified, these factors can be used by mentors of medical students and directors of residency training programs to motivate students to choose specialties that are limited in Kuwait.

  1. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.

  2. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Directory of Open Access Journals (Sweden)

    Joke Bilcke

    Full Text Available This is one of the first studies to (1 describe the out-of-hospital burden of influenza-like-illness (ILI and clinically diagnosed flu, also for patients not seeking professional medical care, (2 assess influential background characteristics, and (3 formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever, a longer duration of illness, more use of medication (especially antibiotics and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.

  3. Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India.

    Directory of Open Access Journals (Sweden)

    Nerges Mistry

    Full Text Available Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai.A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values.The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days and retreatment patients (25 days. Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation.Achieving positive behavioural changes in providers (especially non-allopaths and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics

  4. Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India.

    Science.gov (United States)

    Mistry, Nerges; Rangan, Sheela; Dholakia, Yatin; Lobo, Eunice; Shah, Shimoni; Patil, Akshaya

    2016-01-01

    Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai. A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values. The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation. Achieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be

  5. Understanding the nature of information seeking behavior in critical care: implications for the design of health information technology.

    Science.gov (United States)

    Kannampallil, Thomas G; Franklin, Amy; Mishra, Rashmi; Almoosa, Khalid F; Cohen, Trevor; Patel, Vimla L

    2013-01-01

    Information in critical care environments is distributed across multiple sources, such as paper charts, electronic records, and support personnel. For decision-making tasks, physicians have to seek, gather, filter and organize information from various sources in a timely manner. The objective of this research is to characterize the nature of physicians' information seeking process, and the content and structure of clinical information retrieved during this process. Eight medical intensive care unit physicians provided a verbal think-aloud as they performed a clinical diagnosis task. Verbal descriptions of physicians' activities, sources of information they used, time spent on each information source, and interactions with other clinicians were captured for analysis. The data were analyzed using qualitative and quantitative approaches. We found that the information seeking process was exploratory and iterative and driven by the contextual organization of information. While there was no significant differences between the overall time spent paper or electronic records, there was marginally greater relative information gain (i.e., more unique information retrieved per unit time) from electronic records (t(6)=1.89, p=0.1). Additionally, information retrieved from electronic records was at a higher level (i.e., observations and findings) in the knowledge structure than paper records, reflecting differences in the nature of knowledge utilization across resources. A process of local optimization drove the information seeking process: physicians utilized information that maximized their information gain even though it required significantly more cognitive effort. Implications for the design of health information technology solutions that seamlessly integrate information seeking activities within the workflow, such as enriching the clinical information space and supporting efficient clinical reasoning and decision-making, are discussed. Copyright © 2012 Elsevier B.V. All

  6. Animal health care seeking behavior of pets or livestock owners and knowledge and awareness on zoonoses in a university community.

    Science.gov (United States)

    Awosanya, Emmanuel J; Akande, H O

    2015-07-01

    We investigated the attitude of pets or livestock owning households in a university community to animal health care services and assessed the knowledge and awareness level of the residents on zoonoses. Structured questionnaire was used to obtain information on demography, pet or livestock ownership, animal health care seeking behavior, awareness and knowledge of zoonoses from 246 households. We did descriptive statistics and bivariate analysis to determine the level of association in discrete variables between owners and non-owners of pets or livestock at a significant level of panimal health care seeking behavior of the 80 pets or livestock owners in terms of treatment and vaccination was 70%. Of the 56 (70%) who provided health care services for their animals, about 48 (85.7%) engaged the services of a veterinarian. Dog owning households (42) had the highest frequency of treating their pets against endoparasites (97.6%); ectoparasites (81%) and vaccination against diseases (73.8%). Of the 246 respondents, only 47 (19.1%) have heard of the term zoonoses. Of the considered zoonoses; their awareness of rabies (79.3%) was the highest, followed by Lassa fever (66.3%), the least was pasteurellosis with 18.7%. Having pets or livestock was significantly associated (p=0.04) with rabies awareness. However, there is no significant difference in the level of awareness of zoonoses; knowledge of zoonoses, knowledge of prevention of zoonoses and knowledge of risk of zoonoses between owners and non-owners of pets or livestock. The animal health care seeking behavior of households with pets or livestock is good and should be encouraged. Public education should be created for other zoonoses aside from rabies, Lassa fever, and avian influenza.

  7. CARE SEEKING BEHAVIOUR OF MOTHERS DURING ILLNESS OF NEWBORN IN URBAN SLUMS OF LUCKNOW CITY.

    Directory of Open Access Journals (Sweden)

    P Gupta

    2012-10-01

    Full Text Available Objectives: To study the knowledge of mothers about recognition of danger signs and care seeking behaviour during illness of newborn child in urban slums of Lucknow city, UP. Methods : A cross- sectional study in Urban slums of Lucknow city, UP included 524 women who had a live birth during last one year preceding data collection. The data was tabulated on Microsoft Excel sheet and analyzed using the software SPSS 10.0 for Windows. Results : Study findings showed that Majority (76.9% of the mothers said that if the baby was very cold to touch or running temperature is a danger sign during newborn period followed by absence of sucking (68.9% in previously sucking newborn as danger sign. Majority (71.9% of the mothers consulted local doctor for any problem during neonatal period. Only 12 percent of the mothers approached Govt. doctor for the treatment . It was observed that Hing was given by 86.2 percent mothers in case of stomachache. 82.8 percent mothers had given salt and sugar solutions in the case of diarrhoea\t. Conclusion: In majority of cases correct knowledge and care seeking behaviour during illness of newborn were lacking among mothers and this should be promoted through improved coverage with existing health services.

  8. CARE SEEKING BEHAVIOUR OF MOTHERS DURING ILLNESS OF NEWBORN IN URBAN SLUMS OF LUCKNOW CITY

    Directory of Open Access Journals (Sweden)

    P Gupta

    2012-09-01

    Full Text Available Objectives: To study the knowledge of mothers about recognition of danger signs and care seeking behaviour during illness of newborn child in urban slums of Lucknow city, UP. Methods : A cross- sectional study in Urban slums of Lucknow city, UP included 524 women who had a live birth during last one year preceding data collection. The data was tabulated on Microsoft Excel sheet and analyzed using the software SPSS 10.0 for Windows. Results : Study findings showed that Majority (76.9% of the mothers said that if the baby was very cold to touch or running temperature is a danger sign during newborn period followed by absence of sucking (68.9% in previously sucking newborn as danger sign. Majority (71.9% of the mothers consulted local doctor for any problem during neonatal period. Only 12 percent of the mothers approached Govt. doctor for the treatment . It was observed that Hing was given by 86.2 percent mothers in case of stomachache. 82.8 percent mothers had given salt and sugar solutions in the case of diarrhoea . Conclusion: In majority of cases correct knowledge and care seeking behaviour during illness of newborn were lacking among mothers and this should be promoted through improved coverage with existing health services.

  9. Quantifying the demand for hospital care services: a time and motion study

    NARCIS (Netherlands)

    van Oostveen, Catharina J.; Gouma, Dirk J.; Bakker, Piet J.; Ubbink, Dirk T.

    2015-01-01

    The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch

  10. Optimizing the quality of breast cancer care at certified German breast centers. A benchmarking analysis for 2003-2009 with a particular focus on the interdisciplinary specialty of radiation oncology

    International Nuclear Information System (INIS)

    Brucker, Sara Y.; Wallwiener, Diethelm; Wallwiener, Markus; Kreienberg, Rolf; Jonat, Walter; Beckmann, Matthias W.; Bamberg, Michael; Souchon, Rainer

    2011-01-01

    Purpose: A voluntary, external, science-based benchmarking program was established in Germany in 2003 to analyze and improve the quality of breast cancer (BC) care. Based on recent data from 2009, we aim to show that such analyses can also be performed for individual interdisciplinary specialties, such as radiation oncology (RO). Methods: Breast centers were invited to participate in the benchmarking program. Nine guideline-based quality indicators (QIs) were initially defined, reviewed annually, and modified, expanded, or abandoned accordingly. QI changes over time were analyzed descriptively, with particular emphasis on relevance to radiation oncology. Results: During the 2003-2009 study period, there were marked increases in breast center participation and postoperatively confirmed primary BCs. Starting from 9 process QIs, 15 QIs were developed by 2009 as surrogate indicators of long-term outcome. During 2003-2009, 2/7 RO-relevant QIs (radiotherapy after breast-conserving surgery or after mastectomy) showed considerable increases (from 20 to 85% and 8 to 70%, respectively). Another three, initially high QIs practically reached the required levels. Conclusion: The current data confirm proof-of-concept for the established benchmarking program, which allows participating institutions to be compared and changes in quality of BC care to be tracked over time. Overall, marked QI increases suggest that BC care in Germany improved from 2003-2009. Moreover, it has become possible for the first time to demonstrate improvements in the quality of BC care longitudinally for individual breast centers. In addition, subgroups of relevant QIs can be used to demonstrate the progress achieved, but also the need for further improvement, in specific interdisciplinary specialties. (orig.)

  11. Health needs and care seeking behaviours of Yazidis and other minority groups displaced by ISIS into the Kurdistan Region of Iraq.

    Science.gov (United States)

    Cetorelli, Valeria; Burnham, Gilbert; Shabila, Nazar

    2017-01-01

    During the summer of 2014, ISIS overran Nineveh governorate in Northern Iraq. Yazidis and other religious minorities were subjected to brutal attacks and forced to seek refuge into the neighbouring Kurdistan Region, where they remain living in local communities or in camps. This survey provides a population-based assessment of the health needs and care seeking behaviours of Yazidis and other groups currently residing in camps. The survey covered 13 camps managed by the Kurdish Board of Relief and Humanitarian Affairs. A systematic random sample of 1,300 households with a total of 8,360 members were interviewed between November and December 2015. Participants were asked if any household members had needed care for a health condition in the two weeks preceding the survey, and whether care was obtained from the camp primary health care centre, an outside public hospital or a private clinic. If care was received, the out-of-pocket payment was recorded; otherwise, the reason for not seeking care was queried. In 33.9% (CI: 31.0-37.0) of households one or more members had needed care for a health condition in the two weeks preceding the survey. The most likely to have needed care were older persons (18.5%; CI: 13.6-24.6) and infants (18.0%; CI: 11.6-26.8). The reported health conditions revealed a complex picture of communicable and non-communicable diseases as well as mental health problems and physical injuries. Care was primarily sought from private clinics (41.8%; CI: 36.4-47.4) or public hospitals (27.3%; CI: 22.6-32.7) rather than from the camp primary health care clinics (23.6%; CI: 19.5-28.2). The mean out-of-pocket payment for care received was nearly 3 times higher in public hospitals than in the camp primary health care clinics and nearly 11 times higher in private clinics. Cost was the main perceived barrier to obtaining health services. Demand for health services was high among Yazidis and other minorities living in camps. Private services were preferred in

  12. Racial Disparities in Asthma Morbidity Among Pediatric Patients Seeking Asthma Specialist Care.

    Science.gov (United States)

    Mitchell, Stephanie J; Bilderback, Andrew L; Okelo, Sande O

    2016-01-01

    To elucidate whether there may be a higher morbidity threshold for African American versus white children to be referred to or seek asthma specialist care. Secondary analysis of registry data captured from children presenting for an initial routine outpatient asthma consultation. Parents completed standard survey instruments, and spirometry was conducted when deemed appropriate by the provider. Wilcoxon rank sum tests revealed that African American patients had been hospitalized twice as often and admitted to the intensive care unit or intubated significantly more than 1½ times more frequently than their white patient counterparts. t tests indicated African American patients' forced expiratory volume in 1 second (FEV1) percentage predicted was significantly worse than that of whites, but there was no significant difference for FEV1/forced vital capacity ratio. t tests suggested that African American patients had statistically worse asthma control than did white patients at the time of initial presentation to the pulmonologist, but there was no difference in the distribution of asthma severity categories. Multivariate regression models indicated that racial differences in parent education did not explain the disparities in asthma morbidity. African American patients had significantly worse asthma morbidity than their white counterparts, including higher rates of hospitalization and intensive care unit admission and poorer lung functioning. Given that receipt of asthma specialist care can improve those outcomes that are disparately experienced by African American children, methods of increasing their access to and use of asthma specialist care need to be developed. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  13. Health Care-Seeking Behavior During Childhood Diarrheal Illness: Results of Health Care Utilization and Attitudes Surveys of Caretakers in Western Kenya, 2007–2010

    Science.gov (United States)

    Omore, Richard; O'Reilly, Ciara E.; Williamson, John; Moke, Fenny; Were, Vincent; Farag, Tamer H.; van Eijk, Anna Maria; Kotloff, Karen L.; Levine, Myron M.; Obor, David; Odhiambo, Frank; Vulule, John; Laserson, Kayla F.; Mintz, Eric D.; Breiman, Robert F.

    2013-01-01

    We interviewed caretakers of 1,043 children 20,000 children on five separate subsequent occasions (May of 2009 to December 31, 2010) to assess healthcare seeking patterns for diarrhea. Diarrhea prevalence during the preceding 2 weeks ranged from 26% at baseline to 4–11% during 2009–2010. Caretakers were less likely to seek healthcare outside the home for infants (versus older children) with diarrhea (adjusted odds ratio [aOR] = 0.33, confidence interval [CI] = 0.12–0.87). Caretakers of children with reduced food intake (aOR = 3.42, CI = 1.37–8.53) and sunken eyes during their diarrheal episode were more likely to seek care outside home (aOR = 4.76, CI = 1.13–8.89). Caretakers with formal education were more likely to provide oral rehydration solution (aOR = 3.01, CI = 1.41–6.42) and visit a healthcare facility (aOR = 3.32, CI = 1.56–7.07). Studies calculating diarrheal incidence and healthcare seeking should account for seasonal trends. Improving caretakers' knowledge of home management could prevent severe diarrhea. PMID:23629929

  14. Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel.

    Science.gov (United States)

    Shmueli, Liora; Davidovitch, Nadav; Pliskin, Joseph S; Balicer, Ran D; Hekselman, Igal; Greenfield, Geva

    2017-12-08

    Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO. A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, for the same medical concern. We describe the characteristics of respondents who obtained SOs, their reasons for doing so and their perceived outcomes: (1) Satisfaction with the SO; (2) Experiencing health improvement after receiving a SO; (3) A difference in the diagnosis or treatment suggested in the first opinions and the second opinions; (4) Preference of the SO over the first one. Most of the respondents who sought a SO (n = 344) were above 60 years old, secular, living with a partner, perceived their income to be above average and their health status to be not so good. For the patients who utilized SOs, orthopedic surgeons were sought out more than any other medical professional.Reasons for seeking a SO included doubts about diagnosis or treatment (38%), search for a sub-specialty expert (19%) and dissatisfaction with communication (19%). SO seekers most frequently chose a specific specialist based on a recommendation from a friend or a relative (33%). About half of the SO seekers also searched for information on the internet. Most of the respondents who sought a SO mentioned that they were satisfied with it (84%), felt health improvement (77%), mentioned that there was a difference between the diagnosis or treatment between the first opinion and the SO (56%) and preferred the SO over the first one (91%). Clinical uncertainty or dissatisfaction with patient-physician communication

  15. Factors affecting membership in specialty nursing organizations.

    Science.gov (United States)

    White, Mary Joe; Olson, Rhonda S

    2004-01-01

    A discouraging trend in many specialty nursing organizations is the stagnant or declining membership. The research committee of the Southeast Texas Chapter of the Association of Rehabilitation Nurses (ARN) collected data and studied this trend to determine what changes would be necessary to increase membership. Using Herzberg's motivational theory as a framework, a review of the literature was initiated. There were few current studies on this issue, but relevant information was found about nursing's emerging workforce, as well as implications of the growth of magnet hospitals, which affect whether nurses join specialty nursing organizations. A multifaceted data-collection approach using convenience samples was designed. First, relevant literature was reviewed. Second, a survey was sent by e-mail to other ARN chapters. Third, a telephone survey on other specialty organizations in the geographic region was completed. Finally, members of the local ARN chapter and four other specialty organizations, as well staff nurses in the geographic area, were given questionnaires to complete. Descriptive statistics and cross tabulations were used to determine why nurses do and do not join specialty organizations (N = 81). The most frequent reasons for joining an organization were to increase knowledge, benefit professionally, network, and earn continuing education units. Reasons for choosing not to participate were family responsibilities, lack of information about these organizations, and lack of time. Ways to reverse the decline in membership are discussed.

  16. Competing in value-based health care: keys to winning the foot race.

    Science.gov (United States)

    Hamid, Kamran S; Nwachukwu, Benedict U; Ellis, Scott J

    2014-05-01

    The US health care system is transitioning to a value-based model of health care in which providers will be rewarded for delivering services that achieve excellent clinical outcomes with efficient cost utilization. The concept of "value" in health care (defined as health outcomes achieved per dollar spent) is rapidly spreading as physicians and health systems brace for the paradigm shift from "fee-for-volume" to "fee-for-value" reimbursement. What constitutes good value versus poor value in health care remains nebulous at this time. Various specialties across medicine and within orthopaedics are seeking to better demonstrate value delivered to patients, payers, and policy makers. The objective of this article is to develop a framework for defining and measuring value in foot and ankle surgery. In this new era of health care, we believe that a working knowledge of value and its determinants will be imperative for foot and ankle surgeons to unify research and quality improvement efforts so as to demonstrate the value of services rendered within the subspecialty. Level V, expert opinion.

  17. Implementation of a Cross-specialty Training Program in Basic Laparoscopy

    DEFF Research Database (Denmark)

    Bjerrum, Flemming; Sorensen, Jette Led; Thinggaard, Jette

    2015-01-01

    BACKGROUND AND OBJECTIVES: Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the ...... laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up....

  18. Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools.

    Science.gov (United States)

    Abdulrahman, Mahera; Makki, Maryam; Shaaban, Sami; Al Shamsi, Maryam; Venkatramana, Manda; Sulaiman, Nabil; Sami, Manal M; Abdelmannan, Dima K; Salih, AbdulJabbar M A; AlShaer, Laila

    2016-01-01

    Workforce planning is critical for being able to deliver appropriate health service and thus is relevant to medical education. It is, therefore, important to understand medical students' future specialty choices and the factors that influence them. This study was conducted to identify, explore, and analyze the factors influencing specialty preferences among medical students of the United Arab Emirates (UAE). A multiyear, multicenter survey of medical student career choice was conducted with all five UAE medical schools. The questionnaire consisted of five sections. Chi-squared tests, regression analysis, and stepwise logistic regression were performed. The overall response rate was 46% (956/2079). Factors that students reported to be extremely important when considering their future career preferences were intellectual satisfaction (87%), work-life balance (71%), having the required talent (70%), and having a stable and secure future (69%). The majority of students (60%) preferred internal medicine, surgery, emergency medicine, or family Medicine. The most common reason given for choosing a particular specialty was personal interest (21%), followed by flexibility of working hours (17%). The data show that a variety of factors inspires medical students in the UAE in their choice of a future medical specialty. These factors can be used by health policymakers, university mentors, and directors of residency training programs to motivate students to choose specialties that are scarce in the UAE and therefore better serve the health-care system and the national community.

  19. Financial and Temporal Advantages of Virtual Consultation in Veterans Requiring Specialty Care.

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    Abbott, Daniel E; Macke, Ryan A; Kurtz, Jodi; Safdar, Nasia; Greenberg, Caprice C; Weber, Sharon M; Voils, Corrine I; Fisher, Deborah A; Maloney, James D

    2018-01-01

    Access to specialty health care in the Veterans Affairs (VA) system continues to be problematic. Given the potential temporal and fiscal benefits of telehealth, the Madison VA developed a virtual consultation (VC) mechanism to expedite diagnostic and therapeutic interventions for Veterans with incidentally discovered pulmonary nodules. Materials and. VC, a remote encounter between referring provider and thoracic surgeon for incidentally discovered pulmonary nodules, was implemented at the Madison VA between 2009 and 2011. Time from request to completion of consultation, hospital cost, and travel costs were determined for 157 veterans. These endpoints were then compared with in-person consultations over a concurrent 6-mo period. For the entire study cohort, the mean time to completion of VC was 3.2 d (SD ± 4.4 d). For the 6-mo period of first VC availability, the mean time to VC completion versus in-person consultation was 2.8 d (SD ± 2.8 d) and 20.5 d (SD ± 15.6 d), respectively (p < 0.05). Following initial VC, 84 (53%) veterans were scheduled for virtual follow-up alone; no veteran required an additional office visit before further diagnostic or therapeutic intervention. VA hospital cost was $228 per in-person consultation versus $120 per episode for VC - a 47.4% decrease. The average distance form veteran home to center was 86 miles, with an average travel reimbursement of $112 per in-person consultation, versus no travel cost associated with VC. VC for incidentally discovered pulmonary nodules significantly decreases time to consultation completion, hospital cost, and veteran travel cost. These data suggest that a significant opportunity exists for expansion of telehealth into additional practice settings within the VA system. © Association of Military Surgeons of the United States 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  20. Social Dominance Theory and Medical Specialty Choice

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    Lepièce, Brice; Reynaert, Christine; van Meerbeeck, Philippe; Dory, Valérie

    2016-01-01

    Understanding how medical students select their specialty is a fundamental issue for public health and educational policy makers. One of the factors that students take into account is a specialty's prestige which hinges partly on its focus on technique rather than whole person. We examine the potential of a psychological framework, social…

  1. Health seeking behavior in karnataka: does micro-health insurance matter?

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    Savitha, S; Kiran, Kb

    2013-10-01

    Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage. This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India. The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals. Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed. Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective.

  2. Detecting clinically relevant new information in clinical notes across specialties and settings.

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    Zhang, Rui; Pakhomov, Serguei V S; Arsoniadis, Elliot G; Lee, Janet T; Wang, Yan; Melton, Genevieve B

    2017-07-05

    Automated methods for identifying clinically relevant new versus redundant information in electronic health record (EHR) clinical notes is useful for clinicians and researchers involved in patient care and clinical research, respectively. We evaluated methods to automatically identify clinically relevant new information in clinical notes, and compared the quantity of redundant information across specialties and clinical settings. Statistical language models augmented with semantic similarity measures were evaluated as a means to detect and quantify clinically relevant new and redundant information over longitudinal clinical notes for a given patient. A corpus of 591 progress notes over 40 inpatient admissions was annotated for new information longitudinally by physicians to generate a reference standard. Note redundancy between various specialties was evaluated on 71,021 outpatient notes and 64,695 inpatient notes from 500 solid organ transplant patients (April 2015 through August 2015). Our best method achieved at best performance of 0.87 recall, 0.62 precision, and 0.72 F-measure. Addition of semantic similarity metrics compared to baseline improved recall but otherwise resulted in similar performance. While outpatient and inpatient notes had relatively similar levels of high redundancy (61% and 68%, respectively), redundancy differed by author specialty with mean redundancy of 75%, 66%, 57%, and 55% observed in pediatric, internal medicine, psychiatry and surgical notes, respectively. Automated techniques with statistical language models for detecting redundant versus clinically relevant new information in clinical notes do not improve with the addition of semantic similarity measures. While levels of redundancy seem relatively similar in the inpatient and ambulatory settings in the Fairview Health Services, clinical note redundancy appears to vary significantly with different medical specialties.

  3. Factors Influencing Medical Students' Choice of Specialty

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    Pei-Yeh Chang

    2006-01-01

    Conclusion: This study found that personal intelligence/ability preference and career opportunities were more important factors to the current generation of students in choosing a specialty. Knowledge of these students' attitudes could form the basis for the development of strategies to enhance the attractiveness of specialties facing the problem of a shortage of manpower.

  4. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries.

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    Davé, Dattesh R; Nagarjan, Neeraja; Canner, Joseph K; Kushner, Adam L; Stewart, Barclay T

    2018-02-20

    Low-and middle-income (LMIC) countries account for 90% of all reported burns, nevertheless there is a paucity of providers to treat burns. Current studies on burns in LMICs have not evaluated the gap between care seeking and receiving. This study explores this gap across socioeconomically similar populations in a multi-country population based assessment to inform burn care strategies. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument is a cross sectional national, cluster random sampling survey administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. The survey identifies burn etiology, demographics, timing, disability, and barriers to receiving care. Among 13,763 individuals surveyed, 896 burns were identified. Rwanda had the highest proportion of individuals seeking and receiving care (91.6% vs 88.5%) while Sierra Leone reported the fewest (79.3% vs 70.3%). Rwanda reported the largest disability while Nepal reported the highest proportion with no disability (47.5% vs 76.2%). Lack of money, healthcare providers, and rural living reduce the odds of receiving care by 68% and 85% respectively. Despite similar country socioeconomic characteristics there was significant variability in burn demographics, timing, and disability. Nevertheless, being geographically and economically disadvantaged predict lack of access to burn care. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

  5. Factors influencing medical students' choice of emergency medicine as a career specialty-a descriptive study of Saudi medical students.

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    Alkhaneen, Hadeel; Alhusain, Faisal; Alshahri, Khalid; Al Jerian, Nawfal

    2018-03-07

    Choosing a medical specialty is a poorly understood process. Although studies conducted around the world have attempted to identify the factors that affect medical students' choice of specialty, data is scarce on the factors that influence the choice of specialty of Saudi Arabian medical students, in particular those planning a career in emergency medicine (EM). In this study, we investigated whether Saudi medical students choosing EM are influenced by different factors to those choosing other specialties. A cross-sectional survey was conducted at King Saud bin Abdulaziz University for Health Sciences (KSAUHS), Riyadh, Saudi Arabia. The questionnaire distributed among all undergraduate and postgraduate medical students of both sexes in the second and third phases (57% were males and 43% were females). A total of 436 students answered the questionnaire, a response rate of 53.4%. EM group was most influenced by hospital orientation and lifestyle and least influenced by social orientation and prestige provided by their specialty. Unlike controllable lifestyle (CL) group and primary care (PC) group, EM reported lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical subspecialties (SS), EM group were less likely to report prestige as an important influence. Moreover, students interested in SS reported a leaser influence of medical lifestyle in comparison to EM group. When compared with CL group, EM group reported more interest in medical lifestyle. We found that students primarily interested in EM had different values and career expectations to other specialty groups. The trends in specialty choice should be appraised to meet future needs.

  6. Gender difference in preference of specialty as a career choice among Japanese medical students

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    Ryuichi Kawamoto

    2016-11-01

    Full Text Available Abstract Background In Japan, the absolute deficiency of doctors and maldistribution of doctors by specialty is a significant problem in the Japanese health care system. The purpose of this study was to investigate the factors contributing to specialty preference in career choice among Japanese medical students. Methods A total of 368 medical students completed the survey giving an 88.2 % response rate. The subjects comprised 141 women aged 21 ± 3 (range, 18–34 years and 227 men aged 22 ± 4 (range, 18–44 years. Binary Logistic regression analysis was performed using specialty preferences as the criterion variable and the factors in brackets as six motivational variables (e.g., Factor 1: educational experience; Factor 2: job security; Factor 3: advice from others; Factor 4: work-life balance; Factor 5: technical and research specialty; and Factor 6: personal reasons. Results Women significantly preferred pediatrics, obstetrics & gynecology, and psychology than the men. Men significantly preferred surgery and orthopedics than the women. For both genders, a high odds ratio (OR of “technical & research specialty” and a low OR for “personal reasons” were associated with preference for surgery. “Technical & research specialty” was positively associated with preference for special internal medicine and negatively for pediatrics. “Work-life balance” was positively associated with preference for psychology and negatively for emergency medicine. Among the women only, “technical & research specialty” was negatively associated with preference for general medicine/family medicine and obstetrics & gynecology, and “job security” was positively associated for general medicine/family medicine and negatively for psychology. Among men only, “educational experience” and “personal reasons” were positively, and “job security” was negatively associated with preference for pediatrics. For both genders,

  7. Health-seeking behaviors and self-care practices of people with filarial lymphoedema in Nepal: a qualitative study.

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    Adhikari, Ram Kumar; Sherchand, Jeevan Bahadur; Mishra, Shiva Raj; Ranabhat, Kamal; Pokharel, Amrit; Devkota, Pramila; Mishra, Durga; Ghimire, Yadu Chandra; Gelal, Khageshwor; Paudel, Rajan; Wagle, Rajendra Raj

    2015-01-01

    Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices.

  8. Time, Cost, Information Seeking Skills and Format of Resources Present Barriers to Information Seeking by Primary Care Practitioners in a Research Environment. A review of: Andrews James E., Kevin A. Pearce, Carol Ireson, and Margaret M. Love. “Information‐Seeking Behaviors of Practitioners in a Primary Care Practice‐Based Research Network (PBRN.” Journal of the Medical Library Association 93.2 (Apr. 2005: 206‐12.

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    Martha Ingrid Preddie

    2007-09-01

    Full Text Available Objective – To determine the information seeking behaviors of primary care practitioners in order to inform future efforts towards the design of information services that would support quality inprimary care.Design – A cross‐sectional survey.Setting – A primary care practice based research network (PBRN of caregivers who serve a broad population while simultaneously studying and disseminating innovations aimed at improvements in quality, efficiency and/or safety of primaryhealth care in the United States.Subjects – All primary care practitioners in the PBRN including family practitioners, general practitioners, nurse practitioners and physician assistants.Methods – A questionnaire comprising twenty‐six questions was distributed to 116 practitioners. Practitioners attached to academic centres (who were also members of the PBRN were excluded in order “to achieve a sample of practices more representative of the primary care practising population” (208. Descriptive data were collected and analyzed. SPSS v11.5 was used for statistical analyses.Main results – There was a response rate of 51% (59 of 116. Fifty‐eight percent of the respondents stated that they sought information (excluding drug dosing or drug interactions information to support patient care several times a week. Sixty‐eight per cent sought this information while the patient waited. Almost half of therespondents had access to a small medical library (48% or a hospital library (46%, while 21% used a university medical library.Approximately 14% had no immediate access to a medical library. Almost 60% of practitioners stated that they had an e‐mail account. Thirty‐four percent agreed that the use of e‐mail to communicate with patients enhanced medical practice, while 24% disagreed. There was frequent prescribing of Internet‐based consumer health information to patients by only 16% of the practitioners, while Internet support groups were frequently recommended

  9. Paramedic specialization: a strategy for better out-of-hospital care.

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    Caffrey, Sean M; Clark, John R; Bourn, Scott; Cole, Jim; Cole, John S; Mandt, Maria; Murray, Jimm; Sibold, Harry; Stuhlmiller, David; Swanson, Eric R

    2014-01-01

    Demographic, economic, and political forces are driving significant change in the US health care system. Paramedics are a health profession currently providing advanced emergency care and medical transportation throughout the United States. As the health care system demands more team-based care in nonacute, community, interfacility, and tactical response settings, specialized paramedic practitioners could be a valuable and well-positioned resource to meet these needs. Currently, there is limited support for specialty certifications that demand appropriate education, training, or experience standards before specialized practice by paramedics. A fragmented approach to specialty paramedic practice currently exists across our country in which states, regulators, nonprofit organizations, and other health care professions influence and regulate the practice of paramedicine. Multiple other medical professions, however, have already developed effective systems over the last century that can be easily adapted to the practice of paramedicine. Paramedicine practitioners need to organize a profession-based specialty board to organize and standardize a specialty certification system that can be used on a national level. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  10. Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

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    Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

    2014-01-01

    ABSTRACT Background: The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. Methods: The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. Results: While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. Conclusions: The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of i

  11. Seashell specialties and food handling in Slovene Istria restaurants

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    Tamara POKLAR VATOVEC

    2015-11-01

    Full Text Available The purpose of the research was to evaluate the offer of seashell specialties in Slovene Istria restaurants, and to assess food safety knowledge (gained through formal and informal education as well as to assess the behaviour of food handlers in preparing shell dishes. A self-administered questionnaire was designed that included four sections: a demographic section, a general section, a restaurant menu offer, and a food safety section related to preparation of seashell specialties. Seashell specialties were offered in 41 restaurants, of which the employed food handlers 24 attended formal education and 17 informal education. Seashells specialties and seashell menus are commonly part of the culinary and gastronomic specialties along the Slovene coast, with the most frequently offered main dish being “Blue Mussels alla Busara”. Results the questionnaire indicated poor food safety knowledge and poor behaviour regardless of the (informal education of those who prepared the dishes. We propose that formal education for catering workers preparing shell dishes should be much more emphasized.

  12. Knowledge silos: assessing knowledge sharing between specialties through the vestibular schwannoma literature.

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    Schnurman, Zane; Golfinos, John G; Roland, J Thomas; Kondziolka, Douglas

    2017-12-01

    OBJECTIVE It is common for a medical disorder to be managed or researched by individuals who work within different specialties. It is known that both neurosurgeons and neurotologists manage vestibular schwannoma (VS) patients. While overlap in specialty focus has the potential to stimulate multidisciplinary collaboration and innovative thinking, there is a risk of specialties forming closed-communication loops, called knowledge silos, which may inhibit knowledge diffusion. This study quantitatively assessed knowledge sharing between neurosurgery and otolaryngology on the subject of VS. METHODS A broad Web of Science search was used to download details for 4439 articles related to VS through 2016. The publishing journal's specialty and the authors' specialties (based on author department) were determined for available articles. All 114,647 of the article references were categorized by journal specialty. The prevalence of several VS topics was assessed using keyword searches of titles. RESULTS For articles written by neurosurgeons, 44.0% of citations were from neurosurgery journal articles and 23.4% were from otolaryngology journals. The citations of otolaryngology authors included 11.6% neurosurgery journals and 56.5% otolaryngology journals. Both author specialty and journal specialty led to more citations of the same specialty, though author specialty had the largest effect. Comparing the specialties' literature, several VS topics had significantly different levels of coverage, including radiosurgery and hearing topics. Despite the availability of the Internet, there has been no change in the proportions of references for either specialty since 1997 (the year PubMed became publicly available). CONCLUSIONS Partial knowledge silos are observed between neurosurgery and otolaryngology on the topic of VS, based on the peer-reviewed literature. The increase in access provided by the Internet and searchable online databases has not decreased specialty reference bias

  13. The acceptance of dental operating microscope among advance education specialty programs in endodontics in the middle east

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    Mansour Alrejaie

    2012-01-01

    Full Text Available Aim: To present the current situation of dental operating microscopy (DOM training in the available Advance Specialty Education Programs in Endodontics in Arab Middle-Eastern countries. Materials and Methods: A web-based survey was sent to the electronic mail address of Advance Specialty Education programs of 15 Arab and middle east countries. The questions were limited to those who have an advanced specialty education program in Endodontics at their University if they are using an operating microscope? Results: Out of 15 countries, only 4 countries have microscopic technology in their Advance Education Programs in Endodontics. Conclusion: Few Arab Middle-Eastern countries have DOM in their advance education programs in endodontics. The highest authority in advancing endodontic education in the Arab Middle-East should consider in the near future the importance of this technology as standard care in teaching advance endodontics. An advance workshops should be organized regularly to provide enough knowledge about this standard educational technology.

  14. "I never had the money for blood testing" – Caretakers' experiences of care-seeking for fatal childhood fevers in rural Uganda – a mixed methods study

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    Kaija Judith

    2008-12-01

    Full Text Available Abstract Background The main killer diseases of children all manifest as acute febrile illness, yet are curable with timely and adequate management. To avoid a fatal outcome, three essential steps must be completed: caretakers must recognize illness, decide to seek care and reach an appropriate source of care, and then receive appropriate treatment. In a fatal outcome some or all of these steps have failed and it remains to be elucidated to what extent these fatal outcomes are caused by local disease perceptions, inappropriate care-seeking or inadequate resources in the family or health system. This study explores caretakers' experiences of care-seeking for childhood febrile illness with fatal outcome in rural Uganda to elucidate the most influential barriers to adequate care. Methods A mixed methods approach using structured Verbal/Social autopsy interviews and in-depth interviews was employed with 26 caretakers living in Iganga/Mayuge Demographic Surveillance Site who had lost a child 1–59 months old due to acute febrile illness between March and June 2006. In-depth interviews were analysed using content analysis with deductive category application. Results Final categories of barriers to care were: 1 "Illness interpretation barriers" involving children who received delayed or inappropriate care due to caretakers' labelling of the illness, 2 "Barriers to seeking care" with gender roles and household financial constraints hindering adequate care and 3 "Barriers to receiving adequate treatment" revealing discontents with providers and possible deficiencies in quality of care. Resource constraints were identified as the underlying theme for adequate management, both at individual and at health system levels. Conclusion The management of severely ill children in this rural setting has several shortcomings. However, the majority of children were seen by an allopathic health care provider during the final illness. Improvements of basic health care

  15. Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis.

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    Kabiru, Caroline W; Ushie, Boniface A; Mutua, Michael M; Izugbara, Chimaraoke O

    2016-05-14

    Unsafe abortion is a leading cause of death among young women aged 10-24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12-24 years seeking abortion-related care in Kenya. We used data on 1,378 young women aged 12-24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form. Nine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting no previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (not wanted at all or mistimed) compared with women reporting no previous induced abortion (64 %). Our study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post

  16. Help-seeking in transit workers exposed to acute psychological trauma: a qualitative analysis.

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    Bance, Sheena; Links, Paul S; Strike, Carol; Bender, Ash; Eynan, Rahel; Bergmans, Yvonne; Hall, Peter; O'Grady, John; Antony, Jesmin

    2014-01-01

    Traumatic events often occur in workplace settings and can lead to stress reactions such as Post-Traumatic Stress Disorder (PTSD). One such workplace is the transportation industry, where employees are often exposed to trauma. However, extant research shows that a considerable proportion of people with PTSD do not seek specialty mental health treatment. In this qualitative study, we sought to better understand the experience of a traumatic event at work and the barriers and motivating factors for seeking mental health treatment. Twenty-nine Toronto Transit Commission (TTC) employees participated in a one-on-one interview, 18 soon after the traumatic event and 11 after entering a specialized treatment program. Semi-structured, one-on-one interviews were conducting using qualitative description and analyzed using content analysis. Participants described emotional responses after the trauma such as guilt, anger, disbelief as particularly difficult, and explained that barriers to seeking help included the overwhelming amount and timing of paperwork related to the incident as well as negative interactions with management. Motivating factors included family and peer support, as well as financial and emotional issues which persuaded some to seek help. Seeking treatment is a multifactorial process. Implications and recommendations for the organization are discussed.

  17. Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey

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    Djibo Ali

    2011-05-01

    Full Text Available Abstract Background Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases. Methods A cluster survey was done on 35 clusters of 21 children under 5 years of age in each of four districts of the Maradi Region, Niger. Caretakers were asked about diarrhea of the child during the recall period and their health seeking behavior in case of diarrhea. A weighted cluster analysis was conducted to determine the prevalence of diarrhea, as well as the proportion of consultations and types of health structures consulted. Results In total, the period prevalence of diarrhea and severe diarrhea between April 24th and May 21st 2009 were 36.8% (95% CI: 33.7 - 40.0 and 3.4% (95% CI: 2.2-4.6, respectively. Of those reporting an episode of diarrhea during the recall period, 70.4% (95% CI: 66.6-74.1 reported seeking care at a health structure. The main health structures visited were health centers, followed by health posts both for simple or severe diarrhea. Less than 10% of the children were brought to the hospital. The proportion of consultations was not associated with the level of education of the caretaker, but increased with the number of children in the household. Conclusions The proportion of consultations for diarrhea cases in children under 5 years old was higher than those reported in previous surveys in Niger and elsewhere. Free health care for under 5 years old might have participated in this improvement. In this type of decentralized health systems, the WHO recommended hospital-based surveillance of

  18. Opportunities for Prevention: Assessing Where Low-Income Patients Seek Care for Preventable Coronary Artery Disease.

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    Klaiman, Tamar A; Valdmanis, Vivian G; Bernet, Patrick; Moises, James

    2015-10-01

    The Affordable Care Act has many aspects that are aimed at improving health care for all Americans, including mandated insurance coverage for individuals, as well as required community health needs assessments (CHNAs), and reporting of investments in community benefit by nonprofit hospitals in order to maintain tax exemptions. Although millions of Americans have gained access to health insurance, many--often the most vulnerable--remain uninsured, and will continue to depend on hospital community benefits for care. Understanding where patients go for care can assist hospitals and communities to develop their CHNA and implementation plans in order to focus resources where the need for prevention is greatest. This study evaluated patient care-seeking behavior among patients with coronary artery disease (CAD) in Florida in 2008--analyzed in 2013--to assess whether low-income patients accessed specific safety net hospitals for treatment or received care from hospitals that were geographically closer to their residence. This study found evidence that low-income patients went to hospitals that treated more low-income patients, regardless of where they lived. The findings demonstrate that hospitals-especially public safety net hospitals with a tradition of treating low-income patients suffering from CAD-should focus prevention activities where low-income patients reside.

  19. The long overdue medical specialty: bioethiatrics.

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    Kevorkian, J

    1986-11-01

    Traditional bioethical codes have been unable to cope with the results of modern technology and the drastic changes in life patterns. The medical profession can reestablish bioethical order and reassert leadership through a new and urgently needed medical specialty, which the author tentatively calls bioethiatrics or bioethiatry. Bioethiatrics embodies a unique combination of ethical action and moral judgment.Training for the specialty would start with a residency program, consisting of thorough training in philosophy and religion coupled with continued experience in clinical medicine and indoctrination in contemporary research. Requirements would include the practice of general medicine for at least two years after internship, the passing of oral and written examinations after four years of residency, board certification, and subsequent periodic evaluations.Bioethiatricians would assume all the usual privileges, obligations, and risks associated with the practice of any medical specialty, thereby averting unnecessary ethical crises and ensuring a more rational response to present and future moral challenges.

  20. Preferences for Depression Help-Seeking Among Vietnamese American Adults.

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    Kim-Mozeleski, Jin E; Tsoh, Janice Y; Gildengorin, Ginny; Cao, Lien H; Ho, Tiffany; Kohli, Sarita; Lam, Hy; Wong, Ching; Stewart, Susan; McPhee, Stephen J; Nguyen, Tung T

    2017-11-11

    Culture impacts help-seeking preferences. We examined Vietnamese Americans' help-seeking preferences for depressive symptoms, through a telephone survey (N = 1666). A vignette describing an age- and gender-matched individual with depression was presented, and respondents chose from a list of options and provided open-ended responses about their help-seeking preferences. Results showed that 78.3% would seek professional help, either from a family doctor, a mental health provider, or both; 54.4% preferred to seek help from a family doctor but not from a mental health provider. Most (82.1%) would prefer to talk to family or friends, 62.2% would prefer to look up information, and 50.1% would prefer to get spiritual help. Logistic regression analysis revealed that preferences for non-professional help-seeking options (such as talking to friends or family, looking up information, and getting spiritual help), health care access, and perceived poor health, were associated with increased odds of preferring professional help-seeking. This population-based study of Vietnamese Americans highlight promising channels to deliver education about depression and effective help-seeking resources, particularly the importance of family doctors and social networks. Furthermore, addressing barriers in access to care remains a critical component of promoting professional help-seeking.

  1. Pakistani medical students' specialty preference and the influencing factors.

    Science.gov (United States)

    Rehman, Anis; Rehman, Tariq; Shaikh, Muhammad Ateeb; Yasmin, Haleema; Asif, Ammara; Kafil, Hina

    2011-07-01

    To elucidate the specialty preferences of Pakistani medical students and the factors which influence medical students to make the decision regarding which specialty to pursue. Both basic sciences and clinical students from four medical colleges of Pakistan, i.e., Dow Medical College, Sindh Medical College, Liaquat National Medical College and Muhammad Medical College, were included in the cross-sectional survey during the period of July 2008 to Jan' 2009. After ethical acceptance, data was collected using convenient sampling technique. The questionnaire covered the following demographic details: 13 common specialties and 15 influencing factors. Questionnaires included in the analysis were 771. Most students gave preference to surgery and its associated sub-specialties (50.3%) followed by internal medicine (26.8%), paediatrics (23.2%), dermatology (16.7%), gynaecology and obstetrics (16.7%), psychiatry (13.1%), radiology (10.8%), ENT (8.8%), anaesthesiology (8.7%), administrative medicine (8.6%), orthopaedics (8.2%), ophthalmology (7.5%), and laboratory medicine (6.1%). The highly considered factors (regarding specialties) chosen by 70% of the medical students were: applicable to respective personalities of the individuals, prestige and respect, international opportunities, and time commitment. Surgical-skills, job availability, financial rating, academic performance, and a role model were moderately influencing factors. Hospital environment, parents, general practice, peer-pressure and personal health were the least influential. This trend suggests competition in surgery and its sub-specialties along with internal medicine, paediatrics, dermatology, gynaecology and obstetrics. Specialty suited to personality, time commitment, prestige/respect and international opportunity, influenced more than 70% of the students.

  2. Participation of the family in hospital-based palliative cancer care: perspective of nurses

    Directory of Open Access Journals (Sweden)

    Marcelle Miranda da Silva

    Full Text Available The objective was to understand the perspective of nurses about the participation of the family in palliative cancer care and to analyze the nursing care strategies to meet their needs. Descriptive and qualitative research, conducted at the National Cancer Institute between January and March 2013, with 17 nurses. Elements of the Roy Adaptation Model were used for the interpretation of the data. Two categoriesemergedfrom the thematic analysis: perspective of nurses about the presence and valuation of family in the hospital; and appointing strategies to encourage family participation in care and meet their needs. This participation is essentialand represents a training opportunity for the purpose of homecare. Nurses create strategies to encourage it and seek to meet the needs. The results contribute to promote the family adaptation and integrity, in order to balance the dependent and independent behaviors, aimingfor quality of life and comfort. Further studies are neededdue to the challenges of the specialty.

  3. Health seeking behavior in Karnataka: Does micro-health insurance matter?

    Directory of Open Access Journals (Sweden)

    S Savitha

    2013-01-01

    Full Text Available Background: Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage. Objectives: This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India. Materials and Methods: The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals. Results: Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed. Conclusion : Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective.

  4. Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA infection control policies differs by ward specialty.

    Directory of Open Access Journals (Sweden)

    Rosemarie Sadsad

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.

  5. Population aging and its impacts: strategies of the health-care system in Taipei.

    Science.gov (United States)

    Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung

    2010-11-01

    Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.

  6. Recent trends in specialty pharma business model

    Directory of Open Access Journals (Sweden)

    Mannching Sherry Ku

    2015-12-01

    Full Text Available The recent rise of specialty pharma is attributed to its flexible, versatile, and open business model while the traditional big pharma is facing a challenging time with patent cliff, generic threat, and low research and development (R&D productivity. These multinational pharmaceutical companies, facing a difficult time, have been systematically externalizing R&D and some even establish their own corporate venture capital so as to diversify with more shots on goal, with the hope of achieving a higher success rate in their compound pipeline. Biologics and clinical Phase II proof-of-concept (POC compounds are the preferred licensing and collaboration targets. Biologics enjoys a high success rate with a low generic biosimilar threat, while the need is high for clinical Phase II POC compounds, due to its high attrition/low success rate. Repurposing of big pharma leftover compounds is a popular strategy but with limitations. Most old compounds come with baggage either in lackluster clinical performance or short in patent life. Orphan drugs is another area which has gained popularity in recent years. The shorter and less costly regulatory pathway provides incentives, especially for smaller specialty pharma. However, clinical studies on orphan drugs require a large network of clinical operations in many countries in order to recruit enough patients. Big pharma is also working on orphan drugs starting with a small indication, with the hope of expanding the indication into a blockbuster status. Specialty medicine, including orphan drugs, has become the growth engine in the pharmaceutical industry worldwide. Big pharma is also keen on in-licensing technology or projects from specialty pharma to extend product life cycles, in order to protect their blockbuster drug franchises. Ample opportunities exist for smaller players, even in the emerging countries, to collaborate with multinational pharmaceutical companies provided that the technology platforms or

  7. Recent trends in specialty pharma business model.

    Science.gov (United States)

    Ku, Mannching Sherry

    2015-12-01

    The recent rise of specialty pharma is attributed to its flexible, versatile, and open business model while the traditional big pharma is facing a challenging time with patent cliff, generic threat, and low research and development (R&D) productivity. These multinational pharmaceutical companies, facing a difficult time, have been systematically externalizing R&D and some even establish their own corporate venture capital so as to diversify with more shots on goal, with the hope of achieving a higher success rate in their compound pipeline. Biologics and clinical Phase II proof-of-concept (POC) compounds are the preferred licensing and collaboration targets. Biologics enjoys a high success rate with a low generic biosimilar threat, while the need is high for clinical Phase II POC compounds, due to its high attrition/low success rate. Repurposing of big pharma leftover compounds is a popular strategy but with limitations. Most old compounds come with baggage either in lackluster clinical performance or short in patent life. Orphan drugs is another area which has gained popularity in recent years. The shorter and less costly regulatory pathway provides incentives, especially for smaller specialty pharma. However, clinical studies on orphan drugs require a large network of clinical operations in many countries in order to recruit enough patients. Big pharma is also working on orphan drugs starting with a small indication, with the hope of expanding the indication into a blockbuster status. Specialty medicine, including orphan drugs, has become the growth engine in the pharmaceutical industry worldwide. Big pharma is also keen on in-licensing technology or projects from specialty pharma to extend product life cycles, in order to protect their blockbuster drug franchises. Ample opportunities exist for smaller players, even in the emerging countries, to collaborate with multinational pharmaceutical companies provided that the technology platforms or specialty medicinal

  8. Health-Seeking Behaviors and Self-Care Practices of People with Filarial Lymphoedema in Nepal: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Ram Kumar Adhikari

    2015-01-01

    Full Text Available Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices.

  9. Vision Screening of Ophthalmic Nursing Staff in a Tertiary Eye Care Hospital; Outcomes and ocular healthcare-seeking behaviours

    Directory of Open Access Journals (Sweden)

    Ruhi A. Khan

    2017-03-01

    Full Text Available Objectives: This study aimed to evaluate ocular healthcare-seeking behaviours and vision screening outcomes of nursing staff at a tertiary eye care hospital. Methods: This study was conducted between April and September 2016 among all 500 nurses employed at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Data were collected on age, gender, use of visual aids, the presence of diabetes, a history of refractive surgery and date of last ocular health check-up. Participants were tested using a handheld Spot™ Vision Screener (Welch Allyn Inc., Skaneateles Falls, New York, USA. Results: A total of 150 nurses participated in the study (response rate: 30.0%. The mean age was 41.2 ± 8.9 years old. Distance spectacles, reading spectacles and both types of spectacles were used by 37 (24.7%, 32 (21.3% and 10 (6.7% nurses, respectively. A total of 58 nurses (38.7% failed the vision screening test. Visual defects were detected for the first time in 13 nurses (8.7%. With regards to regular eye checkups, 77 participants (51.3% reported acceptable ocular healthcare-seeking behaviours; this factor was significantly associated with age and the use of visual aids (P <0.01 each. Conclusion: A high proportion of participants failed the vision screening tests and only half displayed good ocular healthcare-seeking behaviours. This is concerning as ophthalmic nurses are likely to face fewer barriers to eye care services than the general population.

  10. Paediatric stoma care nursing in the UK and Ireland.

    Science.gov (United States)

    Waller, Marie

    Improving quality of care and developing and maintaining high standards of care are issues that are high on the NHS, nursing, and paediatric care agendas. Stoma formation will have an impact on the wellbeing and lifestyle of the person and their family, whatever the person's age. The specialty of stoma care nursing in the UK and Ireland is well established. However, the sub-specialty of paediatric stoma care nursing is much smaller in its 'membership' and its client group. There are differences in the needs of, and the associated care of, paediatric stoma patients even within this overall patient group. Paediatric stoma care nurses are in an ideal position to increase awareness about the specialty and improve standards of nursing care for neonates, children, adolescents and their families. However, until the establishment of the Paediatric Stoma Nurse Group (PSNG) in 2005, this 'position' had not being utilized. This article discusses the ongoing work of the PSNG to devise standards of paediatric stoma care nursing, best practice guidelines, relevant patient/parental information and establish itself as a valuable, proactive and independent forum for all healthcare professionals involved in the care of children with stomas.

  11. Maternal health care seeking behavior: the case of Haor (wetland in Bangladesh

    Directory of Open Access Journals (Sweden)

    Md. Aminul Haque

    2016-07-01

    Full Text Available Abstract Background The state of maternal healthcare (MHC in Bangladesh is a grave concern especially in the remote haor areas. In this study, we aimed to determine the factors affecting the utilization of MHC services in the haor areas, to discover mothers’ knowledge of MHC, and explore their attitudes toward MHC as well as practices in seeking MHC services. Method In this cross-sectional survey (n = 400, we randomly selected mothers (aged 15–49 years from haor areas of the Habiganj district of Bangladesh. The study participants’ socio demographic information as well as the extent of their knowledge about MHC, their attitudes, and practices in seeking MHC services were ascertained. The degree of association between the respondents’ socio-demographic characteristics and their health-seeking behavior (before, during, and after childbirth was assessed by the odds ratio (OR with 95 % confidence intervals (CI estimated from the bivariate and multivariable logistic regression analyses. Results The mean age of the study participants was 27.26 years. Respondents had an average of 2.64 children, and 88.6 % had at best a primary education or less. Among the study participants, 61 % of mothers had no knowledge about the availability of MHC in the study area, and only 36 % received any antenatal care (ANC. Also, 47 % sought ANC from government healthcare institutions. Irrespective of complications and potential danger signs, 95 % of births were delivered at home with the assistance of untrained birth attendants. Only 19.75 % of mothers and 12.3 % of infants received postnatal care (PNC. Moreover, mothers who had a secondary or tertiary education level had a higher likelihood of receiving ANC (OR: 3.48, 95 % C.I: 1.49–7.63 compared to mothers with no education. Also, mothers aged 25 years or older were less likely (OR: 0.24, 95 % C.I: 0.06–0.095 to give birth in a health facility than mothers who were younger than 25. The low

  12. Medical specialty considerations by medical students early in their clinical experience

    Directory of Open Access Journals (Sweden)

    Weissman Charles

    2012-03-01

    Full Text Available Abstract Background Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined. Methods Questionnaires distributed to fifth-year medical students at two Israeli medical schools. Results 229 of 275 (83% questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in

  13. Embracing a competency-based specialty curriculum for community-based nursing roles.

    Science.gov (United States)

    Levin, Pamela F; Swider, Susan M; Breakwell, Susan; Cowell, Julia M; Reising, Virginia

    2013-01-01

    The Quad Council competencies for public health nursing (PHN) provide guidance in developing curricula at both the generalist and specialist level. However, these competencies are based on nursing roles in traditional public health agencies and community/public health is defined more broadly than official agency practice. The question arises as to whether community-based specialties require largely the same knowledge and skill set as PHN. The purpose of the competency cross-mapping project reported here was to (a) assess the intersection of the Quad Council competencies with four community-based specialties and (b) ensure the appropriateness of a Quad Council-based curriculum to prepare graduates across these four specialties (home health, occupational health, environmental health, and school nursing). This article details the multistep cross-mapping process, including validation with practice leaders. Results indicate strong alignment of community-based specialty competencies with Quad Council competencies. Community-based specialty-specific content that did not align well is identified, along with examples of didactic and clinical strategies to address gaps. This work indicates that a Quad Council-based curriculum is appropriate to prepare graduates in community-based specialties when attention to the specialty-specific competencies in the clinical setting is included. This work guides the development of a doctorate of nursing practice curriculum in PHN, encompassing the four additional community-based specialties. © 2013 Wiley Periodicals, Inc.

  14. Variation of fee-for-service specialist direct care work effort with patient overall illness burden.

    Science.gov (United States)

    Goodman, Robert

    2011-08-01

    To explore whether a common industry measure of overall patient illness burden, used to assess the total costs of members in a health plan, would be suitable to describe variation in a summary metric of utilization that assesses specialist physician direct patient care services not grouped into clinical episodes, but with exclusion criteria applied to reduce any bias in the data. Data sources/study setting Calendar year 2006 administrative data on 153,557 commercial members enrolled in a non-profit single-state statewide Health Maintenance Organization (HMO) and treated by 4356 specialists in 11 specialties. The health plan's global referral process and specialist fee-for-service reimbursement likely makes these results applicable to the non-managed care setting, as once a global referral was authorized there was no required intervention by the HMO or referring primary care provider for the majority of any subsequent specialist direct clinical care. Study design Specialty-specific correlations and ordinary least-squares regression models to assess variations in specialist direct patient care work effort with patient overall illness burden, after the application of exclusion criteria to reduce potential bias in the data. Principle findings Statistically significant positive correlations exist between specialist direct patient care work effort and patient overall illness burden for all studied specialties. Regression models revealed a generally monotonic increasing relationship between illness burden categories and aggregate specialist direct patient care work effort. Almost all regression model differences from the reference category across specialties are statistically significant (P ≤ 0.012). Assessment of additional results demonstrates the relationship has more substantive significance in some specialties and less in others. The most substantive relationships in this study were found in the specialties of orthopaedic surgery, general surgery and interventional

  15. Factors considered by undergraduate medical students when selecting specialty of their future careers.

    Science.gov (United States)

    Alawad, Awad Ali Mohamed Ahmed; Khan, Waleed Shabeer; Abdelrazig, Yousif Mohammed; Elzain, Yamin Ibrahim; Khalil, Hassan Osman; Ahmed, Omer Bakri Elsayed; Adam, Omeralfaroug Ahmed Ibrahim

    2015-01-01

    Medical students are the source of a country's physicians. Determining how medical students select their areas of specialization is the key to achieve a balanced distribution of doctors among all specialties. The objective is to identify the number of medical students who have decided their postgraduate specialty career, their career specialties preference, and factors that may influence their decision to select a particular specialty. A facility based cross-sectional study was conducted in September 2013 at Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan. A self-administered semi-structured questionnaire comprising demographic data and questions about future specialties preferences and factors influencing those preferences was distributed to 887 male and female students, (from first to fifth academic years) recruited in the study. Response rate was 73% with 647 questionnaires collected, out of 887 eligible medical students. Of the returned questionnaires, 604 were valid. The majority of students (541, 89.6%) have chosen a specialty. Surgery, medicine, paediatrics and obstetrics and gynecology were the most selected specialties. The least selected specialty was anaesthesiology. A significant association was found between gender and specialty choice using Chi-square test (p = 0.00). There was no association between undergraduate level and specialty choice (p = 0.633). The most common reason for choosing a specific specialty was "Personal Interest" (215, 39.7%) followed by being "Helpful to the community" (144, 26.6%). Surgery, medicine, paediatrics and obstetrics and gynecology were the most selected specialties.

  16. PTSD Care Among Veterans With and Without Co-Occurring Substance Use Disorders.

    Science.gov (United States)

    Mansfield, Alyssa J; Greenbaum, Mark A; Schaper, Kim M; Banducci, Anne N; Rosen, Craig S

    2017-06-01

    This study examined whether a co-occurring substance use disorder contributed to disparities in receipt of Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) specialty care or psychotherapy. Logistic regression, controlling for sociodemographic characteristics, was used to examine predictors of PTSD care among 424,211 veterans with confirmed PTSD (two or more PTSD diagnosis encounters) who accessed care in a VHA facility between fiscal years 2009 and 2010. Overall, 16% of veterans had PTSD and a co-occurring substance use disorder diagnosis. In adjusted analyses, veterans with a co-occurring substance use disorder were more likely than veterans with PTSD alone to receive any outpatient PTSD specialty care and complete eight or more sessions of outpatient psychotherapy within 14 weeks, but they were less likely to be treated in inpatient PTSD specialty units. Co-occurring substance use disorders did not appear to hinder receipt of outpatient specialty PTSD treatment or of sufficient psychotherapy among VHA-enrolled veterans.

  17. Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.

    Science.gov (United States)

    Abimbola, Seye; Ukwaja, Kingsley N; Onyedum, Cajetan C; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra L C

    2015-10-01

    Health care costs incurred prior to the appropriate patient-provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

  18. Expanding rural access to mental health care through online postgraduate nurse practitioner education.

    Science.gov (United States)

    Kverno, Karan; Kozeniewski, Kate

    2016-12-01

    Workforce shortages in mental health care are especially relevant to rural communities. People often turn to their primary care providers for mental healthcare services, yet primary care providers indicate that more education is needed to fill this role. Rural primary care nurse practitioners (NPs) are ideal candidates for educational enhancement. Online programs allow NPs to continue living and working in their communities while developing the competencies to provide comprehensive and integrated mental healthcare services. This article presents a review of current online postgraduate psychiatric mental health NP (PMHNP) options. Website descriptions of online PMHNP programs were located using keywords: PMHNP or psychiatric nurse practitioner, postgraduate or post-master's, and distance or online. Across the United States, 15 online postgraduate certificate programs were located that are designed for primary care NPs seeking additional PMHNP specialization. For rural primary care NPs who are ready, willing, and able, a postgraduate PMHNP specialty certificate can be obtained online in as few as three to four semesters. The expected outcome is a cadre of dually credentialed NPs capable of functioning in an integrated role and of increasing rural access to comprehensive mental healthcare services. ©2016 American Association of Nurse Practitioners.

  19. Determinants of patient delay in seeking treatment among ...

    African Journals Online (AJOL)

    Patients delay in seeking care increases the transmission of pulmonary tuberculosis and hence the burden of the disease. This study investigates the pattern and determinants of patients delay in seeking treatment among pulmonary tuberculosis cases attending a Government Chest Clinic in Ibadan, Nigeria. A descriptive ...

  20. Depression and Help-Seeking Among Native Hawaiian Women.

    Science.gov (United States)

    Ta Park, Van M; Kaholokula, Joseph Keawe'aimoku; Chao, Puihan Joyce; Antonio, Mapuana

    2018-07-01

    The purpose of this mixed-methods study was to gain insight about Native Hawaiian (NH) women's experiences with, and viewpoints of, depression and help-seeking behaviors (N = 30: 10 from the university and 20 from the community). More women reported depression in the interviews than through their Center for Epidemiologic Studies Depression Scale (CES-D) responses. Quantitative data revealed 57% of the women had ever received mental health help (80% of university vs. 45% of community sample). There was a range of satisfaction reported for various types of mental health care, with satisfaction being the highest for spiritual/religious advisor/folk healer. During the interviews, one woman reported that she is currently receiving professional care and five women are seeking help from their family/social network. Future research should explore reasons for the differences in the quantitative and qualitative findings regarding depression and associated help-seeking as well as in the satisfaction levels by type of help-seeking.

  1. Increasing specialty care access through use of an innovative home telehealth-based spinal cord injury disease management protocol (SCI DMP).

    Science.gov (United States)

    Woo, Christine; Seton, Jacinta M; Washington, Monique; Tomlinson, Suk C; Phrasavath, Douangmala; Farrell, Karen R; Goldstein, Barry

    2016-01-01

    A spinal cord injury disease management protocol (SCI DMP) was developed to address the unique medical, physical, functional, and psychosocial needs of those living with spinal cord injuries and disorders (SCI/D). The SCI DMP was piloted to evaluate DMP clinical content and to identify issues for broader implementation across the Veterans Affairs (VA) SCI System of Care. Thirty-three patients with SCI/D from four VA SCI centers participated in a 6-month pilot. Patients received customized SCI DMP questions through a data messaging device (DMD). Nurse home telehealth care coordinators (HTCC) monitored responses and addressed clinical alerts daily. One site administered the Duke Severity of Illness (DUSOI) Checklist and Short Form-8 (SF-8™) to evaluate the changes in comorbidity severity and health-related quality of life while on the SCI DMP. Patients remained enrolled an average of 116 days, with a mean response rate of 56%. The average distance between patient's home and their VA SCI center was 59 miles. Feedback on SCI DMP content and the DMD included requests for additional clinical topics, changes in administration frequency, and adapting the DMD for functional impairments. Improvement in clinical outcomes was seen in a subset of patients enrolled on the SCI DMP. SCI HTCCs and patients reported that the program was most beneficial for newly injured patients recently discharged from acute rehabilitation that live far from specialty SCI care facilities. SCI DMP content changes and broader implementation strategies are currently being evaluated based on lessons learned from the pilot.

  2. Sampling and farm stories prompt consumers to buy specialty cheeses

    OpenAIRE

    Reed, Barbara A.; Bruhn, Christine M.

    2003-01-01

    California specialty cheese makers need information on what drives product sales so they can effectively market their products. Focus group and telephone research revealed that specialty cheese consumers have a strong preference for sampling cheese before making a purchase. Consumers also rely heavily on staff recommendations to select cheese. They appreciate unlimited sampling in an unhurried, low-pressure environment. Specialty cheese consumers consider themselves “food experimenters”; they...

  3. Abstracts of the Canadian Society for Civil Engineering annual conference including the general conference, the 1. international structural specialty conference, the 1. international construction specialty conference, and the 1. specialty conference on disaster mitigation : towards a sustainable future

    International Nuclear Information System (INIS)

    El-Badry, M.; Loov, R.E.; Ruwanpura, J.; El-Hacha, R.; Kroman, J.; Rankin, J.

    2006-01-01

    This conference provided a forum for national and international practicing engineers, researchers and technical experts to discuss sustainable solutions to infrastructure development. Discussions focused on recent developments in new technologies for building more economic and sustainable infrastructure, while improving the safety of buildings, bridges, roads, water supply and sewage treatment systems. The conference was held in conjunction with associated specialty conferences, including a first international structures specialty conference, a first international construction specialty conference, and a first specialty conference on disaster mitigation. This book of abstracts highlights all the specialty conferences and accompanies a CD-ROM that has the full text of all the papers. Manuscripts of the full papers submitted to the specialty conferences were peer-reviewed by international scientific committees. The general conference provided a forum to learn about new technologies and future directions in various areas of civil engineering. It included a special theme session on sustainable development and a special session on innovation and information technology. Other technical sessions focused on topics such as civil engineering history and education; infrastructure management and renewal; asset management; risk assessment and management; engineering materials and mechanics; environmental engineering and science; hydrotechnical engineering; cold region engineering; and, transportation engineering. The general conference featured 88 presentations, of which 15 have been catalogued separately for inclusion in this database

  4. Care-Seeking Patterns and Direct Economic Burden of Injuries in Bangladesh.

    Science.gov (United States)

    Alfonso, Natalia Y; Alonge, Olakunle; Hoque, Dewan Md Emdadul; Baset, Kamran Ul; Hyder, Adnan A; Bishai, David

    2017-04-29

    This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims' perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8-$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $$355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment.

  5. The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study.

    Science.gov (United States)

    Hsieh, Ronan Wenhan; Chen, Likwang; Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Chen, Yen-Yuan; Tsai, Chin-Chung

    2016-12-07

    Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (PInternet may be associated with patients' increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits. ©Ronan Wenhan Hsieh, Likwang Chen, Tsung-Fu Chen, Jyh-Chong Liang, Tzu-Bin Lin, Yen-Yuan Chen, Chin-Chung Tsai. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.12.2016.

  6. Factors Influencing Medical Students' Choice of Specialty

    OpenAIRE

    Chang, Pei-Yeh; Hung, Chih-Young; Wang, Kuei-lng; Huang, Yuan-Huei; Chang, King-Jen

    2006-01-01

    Medical school graduates are the source of a country's physicians. Determining how the graduates of these schools select their areas of specialization is the key to achieving a balanced distribution of doctors among all specialties. The purposes of this study were to determine the factors that influence medical students' choice of medical specialty, and to derive the relative weight of each factor. Methods: We constructed a two-tiered analytic hierarchy process (AHP) model which was repres...

  7. Cost consideration in the clinical guidance documents of physician specialty societies in the United States.

    Science.gov (United States)

    Schwartz, Jennifer A T; Pearson, Steven D

    2013-06-24

    Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis. To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies. Qualitative document review. Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations. Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost. Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.

  8. Professional burnout syndrome in doctors of surgical specialties in Ukraine: causes, consequences, labor optimization ways.

    Science.gov (United States)

    Skurupii, Dmytro A; Kholod, Dmytro A; Sonnik, Evgen G

    The professional burnout syndrome (PBS) affects quality of medical care provision for people, which is acquires the special actuality in terms of reforming the health care system. To study ways to improve the efficiency of doctors of surgical specialties based on analyzes of PBS and its consequences. A survey of psychological tests and 62 surgical doctors was carried out. It was found out that the PBS reaches a peak after 11 to 15 years of working experience. Anesthesiologists have high levels of PBS, emotional exhaustion, cynicism, low desire for career growth, frequent misunderstanding with the administration, they prefer 8-hour working day, and relieve stress by sleeping and consuming alcohol. Obstetrician-gynecologists show moderate level of PBS and emotional exhaustion, high degree of cynicism, strong desire for career growth, frequent misunderstandings with patients and their relatives, prefer 8-hour working day, relieve stress by smoking and socializing with family and friends. Traumatic surgeons have moderate level of PBS, emotional exhaustion, high degree of cynicism, strong desire for career growth, frequent misunderstandings with their colleagues of related specialties, prefer the 24-hour working day, and reli eve their stress with alcohol and sports. Surgeons have moderate level of PBS, emotional exhaustion, low degree of cynicism, moderate desire for career growth, frequent misunderstandings with their colleagues of related specialties, prefer the 8-hour working day, and relieve stress by smoking and sleeping. PBS is most expressed in doctors having working experience of 11 to 15 years and in anesthesiologists. They get professional deformations. These features should be considered in course of organization of working process of medical teams.

  9. Specialty Training's Organizational Readiness for curriculum Change (STORC): development of a questionnaire in a Delphi study.

    Science.gov (United States)

    Bank, Lindsay; Jippes, Mariëlle; van Luijk, Scheltus; den Rooyen, Corry; Scherpbier, Albert; Scheele, Fedde

    2015-08-05

    In postgraduate medical education (PGME), programs have been restructured according to competency-based frameworks. The scale and implications of these adjustments justify a comprehensive implementation plan. Organizational Readiness for Change (ORC) is seen as a critical precursor for a successful implementation of change initiatives. Though, ORC in health care settings is mostly assessed in small scale settings and in relation to new policies and practices rather than educational change. Therefore our aim with this work was to develop an instrument to asses Specialty Training's Organizational Readiness for curriculum Change (STORC). A Delphi procedure was conducted to examine the applicability of a preliminary questionnaire in PGME, which was based on existing instruments designed for business and health care organizations. The 41 panellists (19 trainees and 22 supervisors from 6 specialties) from four different countries who were confronted with an apparent curriculum change, or would be in the near future, were asked to rate the relevance of a 89-item web-based questionnaire with regard to changes in specialty training on a 5-point Likert scale. Furthermore, they were invited to make qualitative comments on the items. In two rounds the 89-item preliminary questionnaire was reduced to 44 items. Items were either removed, kept, adapted or added based on individual item scores and qualitative comments. In the absence of a gold standard, this Delphi procedure was considered complete when the overall questionnaire rating exceeded 4.0 (scale 0-5). The overall item score reached 4.1 in the second round, meeting our criteria for completion of this Delphi procedure. This Delphi study describes the initial validating step in the development of an instrument to asses Specialty Training's Organisational Readiness for curriculum Change (STORC). Since ORC is measured on various subscales and presented as such, its strength lies in analysing these subscales. The latter makes

  10. Intention to seek information on cancer genetics

    Directory of Open Access Journals (Sweden)

    J.E. Andrews

    2005-01-01

    Full Text Available Objective. The public has a high interest in seeking personal genetic information, which holds implications for health information seeking research and health care policy. Rapid advances in cancer genetics research promise early detection, prevention and treatment, yet consumers may have greater difficulty finding and using the information they may need to make informed decisions regarding their personal health and the future of their families. Design. A statewide telephone survey was conducted of non-institutionalized Kentucky residents 18 years of age or older to investigate factors associated with the intention to seek cancer genetics information, including the need for such information seeking help. Results. The results show that intention to seek cancer genetics information, if testing were readily available, is moderately high (62.5% of those responding; n=835, and that status as a racial minority, the perception that cancer runs in one's family, and frequent worrying about cancer risk are statistically significant predictors of intent to seek genetics information. Conclusion. . We argue that an already complex health information environment will be even more difficult for individuals to navigate as genetic research becomes more ubiquitous in health care. An increase in demand for genetics information in various forms, as suggested by these results and those of other studies, implies that enduring intervention strategies are needed to help individuals acquire necessary health information literacy skills, with special attention given to racial minorities.

  11. Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions

    DEFF Research Database (Denmark)

    Lord, E; Stockdale, A J; Malek, R

    2017-01-01

    OBJECTIVES: European guidelines recommend HIV testing for individuals presenting with indicator conditions (ICs) including AIDS-defining conditions (ADCs). The extent to which non-HIV specialty guidelines recommend HIV testing in ICs and ADCs is unknown. Our aim was to pilot a methodology in the UK...... are piloting methods to engage with guideline development groups to ensure that patients diagnosed with ICs/ADCs are tested for HIV. We then plan to apply our methodology in other European settings as part of the Optimising Testing and Linkage to Care for HIV across Europe (OptTEST) project....... to review specialty guidelines and ascertain if HIV was discussed and testing recommended. METHODS: UK and European HIV testing guidelines were reviewed to produce a list of 25 ADCs and 49 ICs. UK guidelines for these conditions were identified from searches of the websites of specialist societies...

  12. Institutional sponsorship, student debt, and specialty choice in physician assistant education.

    Science.gov (United States)

    Cawley, James F; Jones, P Eugene

    2013-01-01

    Physician assistant (PA) educational programs emerged in the mid 1960s in response to health workforce shortages and decreasing access to care and, specifically, the decline of generalist physicians. There is wide diversity in the institutional sponsorship of PA programs, and sponsorship has trended of late to private institutions. We analyzed trends in sponsorship of PA educational programs and found that, in the past 15 years, there were 25 publicly sponsored and 96 privately sponsored programs that gained accreditation, a 3.84:1 private-to-public ratio. Of the 96 privately sponsored programs, only seven (7.3%) were located within institutions reporting membership in the Association of Academic Health Centers, compared to eight of the 25 publicly sponsored programs (32%). In 1978, a large majority (estimated 43 of the 48 then-existing PA programs) received their start-up or continuing funding through the US Public Health Service, Section 747 Title VII program, whereas in 2012 there were far fewer (39 of 173). The finding of a preponderance of private institutions may correlate with the trend of PAs selecting specialty practice (65%) over primary care. Specialty choice of graduating PA students may or may not be related to the disproportionate debt burden associated with attending privately sponsored programs, where the public-to-private tuition difference is significant. Moreover, the waning number of programs participating in the Title VII grant process may also have contributed to the overall rise in tuition rates among PA educational programs due to the loss of supplemental funding.

  13. Managed Care for Children: Effect on Access to Care and Utilization of Health Services.

    Science.gov (United States)

    Szilagyi, Peter G.

    1998-01-01

    Reviews what is known about the effect of managed care on access to health services, as well as utilization of hospital care, emergency department visits, primary care services, and specialty pediatric services. The effect of managed care appears dependent on several factors and, thus, is likely to vary according to the population served. (SLD)

  14. Two interesting cases highlighting an oblivious specialty of psychoneuroendocrinology.

    Science.gov (United States)

    Hari Kumar, K V S; Dhull, Pawan; Somasekharan, Manoj; Seshadri, K

    2012-01-01

    Psychoneuroendocrinology deals with the overlap disorders pertaining to three different specialties. Awareness about the somatic manifestations of psychiatric diseases and vice versa is a must for all the clinicians. The knowledge of this interlinked specialty is essential because of the obscure presentation of certain disorders. Our first case was treated as depressive disorder, whereas the diagnosis was hypogonadism with empty sella. Our second patient was managed as schizophrenia and the evaluation revealed bilateral basal ganglia calcification and a diagnosis of Fahr's disease. We report these cases for their unusual presentation and to highlight the importance of this emerging specialty.

  15. Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional's Help?

    Science.gov (United States)

    BinDhim, Nasser F; Alanazi, Eman M; Aljadhey, Hisham; Basyouni, Mada H; Kowalski, Stefan R; Pont, Lisa G; Shaman, Ahmed M; Trevena, Lyndal; Alhawassi, Tariq M

    2016-06-27

    The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question. This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple's App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app's download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month. A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29). A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use

  16. Physician Burnout and the Calling to Care for the Dying: A National Survey.

    Science.gov (United States)

    Yoon, John D; Hunt, Natalie B; Ravella, Krishna C; Jun, Christine S; Curlin, Farr A

    2017-12-01

    Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout. In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue"). Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious. Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.

  17. Medical specialty preferences in early medical school training in Canada.

    Science.gov (United States)

    Vo, Anthony; McLean, Laurie; McInnes, Matthew D F

    2017-11-14

    To understand what medical students consider when choosing their specialty, prior to significant clinical exposure to develop strategies to provide adequate career counseling. A cross-sectional study was performed by distributing optional questionnaires to 165 first-year medical students at the University of Ottawa in their first month of training with a sample yield of 54.5% (n=90).  Descriptive statistics, analysis of variance, Spearman's rank correlation, Cronbach's alpha coefficient, Kaiser-Meyer-Olkin Measure, and exploratory factor analyses were used to analyze the anonymized results. "Job satisfaction", "lifestyle following training" and, "impact on the patient" were the three highest rated considerations when choosing a specialty.  Fifty-two and seventeen percent (n=24) and 57.89% (n=22) of males and females ranked non-surgical specialties as their top choice. Student confidence in their specialty preferences was moderate, meaning their preference could likely change (mean=2.40/5.00, SD=1.23). ANOVA showed no significant differences between confidence and population size (F(2,86)=0.290, p=0.75) or marital status (F(2,85)=0.354, p=0.70) in both genders combined. Five underlying factors that explained 44.32% of the total variance were identified. Five themes were identified to enhance career counseling. Medical students in their first month of training have already considered their specialty preferences, despite limited exposure. However, students are not fixed in their specialty preference. Our findings further support previous results but expand what students consider when choosing their specialty early in their training. Medical educators and administrators who recognize and understand the importance of these considerations may further enhance career counseling and medical education curricula.

  18. Healthcare-seeking preferences of patients with sexually transmitted infection attending a tertiary care center in South Kerala.

    Science.gov (United States)

    Jayapalan, Sabeena

    2016-01-01

    Sexually transmitted infections (STIs) are a major public health problem in developing countries. These diseases are associated with increased risk of transmission of human immunodeficiency virus as well as adverse outcomes on pregnancy and reproductive health. Sexual behavior and healthcare-seeking behavior are identified as the true risk factors of STIs. Hospital-based cross-sectional study design was adopted. Eighty-five STI patients were studied regarding the inappropriate treatment-seeking behavior, the nature of the first point of contact with the health care, the appropriateness of treatment and the concerns of the patient regarding the services rendered by government health-care facilities. Among the 85 patients studied, 55.3% were males and 44.7% were females. Inappropriate treatment-seeking behavior was seen in 29.8% of males and 36.8% of females. About 59.6% of males and 81.6% of females sought appropriate treatment from modern medicine practitioners before attending our institution. Only 7.1% of males and 3.2% of females received appropriate treatment. The government sector was the choice of treatment for 46.4% males and 93.5% females and this difference was statistically significant ( P = 0.00081). Lack of free medicines, issues of confidentiality, and privacy were the major service-related issues in the public sector. Appropriate treatment at the first point of contact with the health system is an important measure to prevent further transmission and development of complications. Health providers from both private and public sector should be given frequent periodic training regarding syndromic management of STIs and the training should stress on the need for risk reduction and condom promotion messages along with medical management. Program planners should take necessary steps to ensure adequate and continuous supply of free drugs and tackle issues of confidentiality and privacy.

  19. Stigma and demographic correlates of help-seeking intentions in returning service members.

    Science.gov (United States)

    Blais, Rebecca K; Renshaw, Keith D

    2013-02-01

    Many U.S. Iraq/Afghanistan-era veterans return from deployment with posttraumatic stress (PTS) symptoms, but few veterans seek psychological help. Research on barriers to care is growing, but the link between stigma and help-seeking is understudied. The present study examined anticipated enacted stigma from military and nonmilitary sources, self-stigma, PTS, perceived likelihood of deploying again, marital status, and history of mental health care engagement as correlates of help-seeking intentions from a mental health professional or medical doctor/advance practice registered nurse (MD/APRN) in a sample of 165 combat veterans. Using structural equation modeling, results demonstrated that self-stigma was negatively associated with help-seeking intentions from a mental health professional and MD/APRN with small-to-medium effect sizes. Being married was positively associated with help-seeking intentions from a mental health professional and MD/APRN with small effect sizes. History of previous mental health care engagement was positively associated with help-seeking intentions from a mental health professional with a medium effect size, but unrelated to help-seeking intentions from a MD/APRN. Anticipated enacted stigma from any source, PTS, and greater perceived likelihood of deploying again were unrelated to help-seeking intentions from a mental health professional and MD/APRN. Implications for interventions aimed at decreasing self-stigma and increasing intention to seek help are discussed. Copyright © 2013 International Society for Traumatic Stress Studies.

  20. Gender Distribution Among American Board of Medical Specialties Boards of Directors.

    Science.gov (United States)

    Walker, Laura E; Sadosty, Annie T; Colletti, James E; Goyal, Deepi G; Sunga, Kharmene L; Hayes, Sharonne N

    2016-11-01

    Since 1995, women have comprised more than 40% of all medical school graduates. However, representation at leadership levels in medicine remains considerably lower. Gender representation among the American Board of Medical Specialties (ABMS) boards of directors (BODs) has not previously been evaluated. Our objective was to determine the relative representation of women on ABMS BODs and compare it with the in-training and in-practice gender composition of the respective specialties. The composition of the ABMS BODs was obtained from websites in March 2016 for all Member Boards. Association of American Medical Colleges and American Medical Association data were utilized to identify current and future trends in gender composition. Although represented by a common board, neurology and psychiatry were evaluated separately because of their very different practices and gender demographic characteristics. A total of 25 specialties were evaluated. Of the 25 specialties analyzed, 12 BODs have proportional gender representation compared with their constituency. Seven specialties have a larger proportion of women serving on their boards compared with physicians in practice, and 6 specialties have a greater proportion of men populating their BODs. Based on the most recent trainee data (2013), women have increasing workforce representation in almost all specialties. Although women in both training and practice are approaching equal representation, there is variability in gender ratios across specialties. Directorship within ABMS BODs has a more equitable gender distribution than other areas of leadership in medicine. Further investigation is needed to determine the reasons behind this difference and to identify opportunities to engage women in leadership in medicine. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  1. Estimated cost savings associated with the transfer of office-administered specialty pharmaceuticals to a specialty pharmacy provider in a Medical Injectable Drug program.

    Science.gov (United States)

    Baldini, Christopher G; Culley, Eric J

    2011-01-01

    A large managed care organization (MCO) in western Pennsylvania initiated a Medical Injectable Drug (MID) program in 2002 that transferred a specific subset of specialty drugs from physician reimbursement under the traditional "buy-and-bill" model in the medical benefit to MCO purchase from a specialty pharmacy provider (SPP) that supplied physician offices with the MIDs. The MID program was initiated with 4 drugs in 2002 (palivizumab and 3 hyaluronate products/derivatives) growing to more than 50 drugs by 2007-2008. To (a) describe the MID program as a method to manage the cost and delivery of this subset of specialty drugs, and (b) estimate the MID program cost savings in 2007 and 2008 in an MCO with approximately 4.6 million members. Cost savings generated by the MID program were calculated by comparing the total actual expenditure (plan cost plus member cost) on medications included in the MID program for calendar years 2007 and 2008 with the total estimated expenditure that would have been paid to physicians during the same time period for the same medication if reimbursement had been made using HCPCS (J code) billing under the physician "buy-and-bill" reimbursement rates. For the approximately 50 drugs in the MID program in 2007 and 2008, the drug cost savings in 2007 were estimated to be $15.5 million (18.2%) or $290 per claim ($0.28 per member per month [PMPM]) and about $13 million (12.7%) or $201 per claim ($0.23 PMPM) in 2008. Although 28% of MID claims continued to be billed by physicians using J codes in 2007 and 22% in 2008, all claims for MIDs were limited to the SPP reimbursement rates. This MID program was associated with health plan cost savings of approximately $28.5 million over 2 years, achieved by the transfer of about 50 physician-administered injectable pharmaceuticals from reimbursement to physicians to reimbursement to a single SPP and payment of physician claims for MIDs at the SPP reimbursement rates.

  2. The association between ethnicity and delay in seeking medical care for chest pain: a systematic review.

    Science.gov (United States)

    Wechkunanukul, Kannikar; Grantham, Hugh; Damarell, Raechel; Clark, Robyn A

    2016-07-01

    Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates.People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies. Delay in seeking medical care for chest pain in the general population has been well documented; however, limited studies have focused on delay times within ethnic groups. There is little research to date as to whether ethnicity is associated with the time taken to seek medical care for chest pain. Consequently, addressing this gap in knowledge will play a crucial role in improving the health outcomes of culturally and linguistically diverse (CALD) patients suffering from chest pain and for developing appropriate clinical practice and public awareness for these populations. The current review aimed to determine if there is an association between ethnicity and delay in seeking medical care for chest pain among CALD populations. Patients from different ethnic minority groups presenting to emergency departments (EDs) with chest pain. The current review will examine studies that evaluate the association between ethnicity and delay in seeking medical care for chest pain among CALD populations. The current review will consider quantitative studies including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. The current review will consider studies that measure delay time as the main outcome. The time will be measured as the interval between the time of symptom onset and time to reach an

  3. Sex differences in biopsychosocial correlates of binge eating disorder: a study of treatment-seeking obese adults in primary care setting.

    Science.gov (United States)

    Udo, Tomoko; McKee, Sherry A; White, Marney A; Masheb, Robin M; Barnes, Rachel D; Grilo, Carlos M

    2013-01-01

    Although community-based studies suggest equivalent levels of physical and psychological impairment by binge eating disorder (BED) in men and women, men with BED are still underrepresented in clinical studies. This study aimed to provide a comprehensive analysis of sex differences in biopsychosocial correlates of treatment-seeking obese patients with BED in primary care. One hundred-ninety obese adults (26% men) were recruited in primary care settings for a treatment study for obesity and BED. Very few significant sex differences were found in the developmental history and in current levels of eating disorder features, as well as psychosocial factors. Women reported significantly earlier age at onset of overweight and dieting and greater frequency of dieting. Men reported more frequent strenuous exercise. Men were more likely than women to meet criteria for metabolic syndrome; men were more likely to show clinically elevated levels of triglycerides, blood pressure, and fasting glucose levels. Despite few sex differences in behavioral and psychosocial factors, metabolic problems associated with obesity were more common among treatment-seeking obese men with BED than women. The findings highlight the importance of including men in clinical studies of BED and active screening of BED in obese men at primary care settings. © 2013.

  4. Experiences of Traumatic Events and Associations with PTSD and Depression Development in Urban Health Care-seeking Women

    OpenAIRE

    Gill, Jessica M.; Page, Gayle G.; Sharps, Phyllis; Campbell, Jacquelyn C.

    2008-01-01

    Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used ...

  5. [Role of an educational-and-methodological complex in the optimization of teaching at the stage of additional professional education of physicians in the specialty "anesthesiology and reanimatology"].

    Science.gov (United States)

    Buniatian, A A; Sizova, Zh M; Vyzhigina, M A; Shikh, E V

    2010-01-01

    An educational-and-methodological complex (EMC) in the specialty 'Anesthesiology and Reanimatology", which promotes manageability, flexibility, and dynamism of an educational process, is of great importance in solving the problem in the systematization of knowledge and its best learning by physicians at a stage of additional professional education (APE). EMC is a set of educational-and-methodological materials required to organize and hold an educational process for the advanced training of anesthesiologists and resuscitation specialists at the stage of APE. EMC includes a syllabus for training in the area "Anesthesiology and Reanimatology" by the appropriate training pattern (certification cycles, topical advanced training cycles); a work program for training in the specialty "Anesthesiology and Reanimatology"; a work curriculums for training in allied specialties (surgery, traumatology and orthopedics, obstetrics and gynecology, and pediatrics); work programs on basic disciplines (pharmacology, normal and pathological physiology, normal anatomy, chemistry and biology); working programs on the area "Public health care and health care service", guidelines for the teacher; educational-and-methodological materials for the student; and quiz programs. The main point of EMC in the specialty "Anesthesiology and Reanimatology" is a work program. Thus, educational-and-methodological and teaching materials included into the EMC in the specialty 'Anesthesiology and Reanimatology" should envisage the logically successive exposition of a teaching material, the use of currently available methods and educational facilities, which facilitates the optimization of training of anesthesiologists and resuscitation specialists at the stage of APE.

  6. Perceptions of organizational justice among nurses working in university hospitals of shiraz: a comparison between general and specialty settings.

    Science.gov (United States)

    Hatam, Nahid; Fardid, Mozhgan; Kavosi, Zahra

    2013-12-01

    Justice has gained much attention in social and human studies and has many consequences on employees and the organizations, especially on health system workers such as nurses who are among the key factors in health care systems. The purpose of this study was to investigate perception of organizational justice among nurses in educational hospitals of Shiraz University of Medical Sciences (SUMS), and to compare the results of general and specialty hospitals. In this research, 400 nurses at SUMS hospitals were selected by random sampling method. A 19-item questionnaire was applied to measure distributive, procedural and interactional justice. Data analysis was performed using descriptive statistics, including percentage, frequency, mean, and standard deviation. Also, the t-test and one way ANOVA were used to measure the differences between different hospitals and wards. Of 400 nurses, 66% perceived a high level of organizational justice. In this study the mean scores of total perceived organizational justice (P = 0.035), procedural justice (P = 0.031), and interactional justice (P = 0.046) in specialty hospitals were higher than general ones. Furthermore, the mean score of interactional justice was higher than the other components of organizational justice, respectively 3.58 ± 1.02 for general and 3.76 ± 0.86 for specialty hospitals. Significant differences were observed between overall perceived justice (P = 0.013) and its components (P = 0.024, P = 0.013, and P = 0.036) in different wards. Most nurses who participated in this study had a high perception of organizational justice. The mean score of organizational justice was higher in specialty hospitals. Health care policy makers and hospital managers should support their employees, especially nurses through fairness in distributions, procedures, and interactions.

  7. Health Care Seeking Behavior among Caregivers of Sick Children Who Had Cerebral Malaria in Northwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Edwin E. Eseigbe

    2012-01-01

    Full Text Available Cerebral malaria is a significant cause of childhood morbidity in our region. The challenges of effective management include time and quality of treatment. The study appraised the health care seeking behavior of caregivers of sick children who developed cerebral malaria, in Zaria, northwestern Nigeria. Caregivers indentified were parents 29 (87.9% and grandparents 4 (12.1%. Most of them were in the upper social classes. Health care options utilized before presentation at our facility were formal health facility 24 (72.7%, patent medicine seller 12 (36.4%, home treatment 10 (30.3%, and herbal concoction 6 (18.2% with majority 24 (72.7% using more than one option. Antimalarial therapy was instituted in 25 (75.6% of the cases. Mortality was significantly associated with the use of herbal concoction, treatment at a formal health facility and patent medicine seller, multiple convulsions, age less than 5 years, and noninstitution of antimalarial therapy before presentation. The study showed use of inappropriate health care options by caregivers and highlighted the need to pursue an awareness drive among caregivers on the use of health care options.

  8. Parameters of care for craniosynostosis

    DEFF Research Database (Denmark)

    Vargervik, Karin; Rubin, Marcie S; Grayson, Barry H

    2012-01-01

    A multidisciplinary conference was convened in March 2010 with the charge to develop parameters of care for patients with craniosynostosis. The 52 participants represented 16 medical specialties and 16 professional societies. Herein, we present the dental, orthodontic, and surgical care...

  9. A checklist approach to caring for women seeking pregnancy testing: effects on contraceptive knowledge and use.

    Science.gov (United States)

    Lee, Jessica; Papic, Melissa; Baldauf, Erin; Updike, Glenn; Schwarz, E Bimla

    2015-02-01

    To assess how a checklist reminding clinicians to deliver a bundled intervention affects contraceptive knowledge and use 3 months after women seek walk-in pregnancy testing. Pre-intervention, an inner-city family planning clinic provided unstructured care; during the intervention period, clinic staff used a checklist to ensure women received needed services. Women seeking walk-in pregnancy testing who wished to avoid pregnancy for at least 6 months were asked to complete surveys about their contraceptive knowledge and use immediately after and 3-months after visiting the study clinic. To assess the significance of changes over time, we used logistic regression models. Between January 2011 and May 2013, over 1500 women sought pregnancy testing from the study clinic; 323 completed surveys (95 pre-intervention and 228 during the intervention period). With this checklist intervention, participants were more likely to receive emergency contraception (EC) (22% vs. 5%, [aOR 4.66 (1.76-12.35)], [corrected] have an intrauterine device or implant placed at the time of their clinic visit (5% vs. 0%, p=0.02), or receive a contraceptive prescription (23% vs. 10%, pcontraception and were more likely to report at 3-month follow-up a method of contraception more effective than the method they used prior to seeking pregnancy testing from the study clinic (aOR=2.02, 95% CI=1.03-3.96). The authors would like to apologize for any inconvenience caused. [corrected]. Women seeking walk-in pregnancy testing appear more likely to receive EC and to have switched to a more effective form of birth control in the 3 months following their visit when clinic staff used a 3-item checklist and provided scripted counseling. A checklist reminding clinic staff to assess pregnancy intentions, provide scripted counseling about both emergency and highly-effective reversible contraception, and offer same-day contraceptive initiation to women seeking walk-in pregnancy testing appears to increase use of

  10. Student perceptions of the care of children: impacts of pre-clerkship pediatric and primary care clinical teaching

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    Beverley Karras

    2014-12-01

    Conclusions: Students had already formed positive attitudes toward the medical care of children and intended to care for children in their future practice. Further research is needed into the effects of pre-clerkship experiences in the care of children on choice of medical specialty.

  11. ‘I Was a Model Student’: Illness Knowledge Seeking and Self-care Among Finnish Kidney Recipients

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    Susanne Ådahl

    2012-11-01

    Full Text Available The customer based ideology currently in use in the Finnish welfare state, as elsewhere, has transformed health care. Responsibility for health, that used to be lodged within society, has become the responsibility of the individual. Self-care is part of this growing trend, where there is an inherent assumption that informed patients are more capable of making decisions about their medical regime, which in turn empowers them. Finnish kidney transplant recipients are, through various sources and forms of health information, encouraged to follow the moral imperative of engaging in certain types of health maintaining behaviour that safeguards the transplant kidney. Being informed and sharing illness related information with peers is a manner of showing gratitude towards the state; a way to, in some fashion, reciprocating the valuable gift of a kidney through caring. Taking my lead from Mol’s (2008 notion of care as a practice, as something that is done by all those involved in giving care, I ask how knowledge seeking and sharing on illness can be a form of self-caring. The aim of the article is, thus, to discuss what role illness-related information has in the process of caring for kidney failure. The data consists of in-depth interviews with 18 kidney transplant recipients narrating their illness trajectory, and additional information solicited on a number of central themes, two of which were the access to illness-related information and involvement in peer support activities.

  12. Memory Complaints Associated with Seeking Clinical Care

    Science.gov (United States)

    Pires, Carolina; Silva, Dina; Maroco, João; Ginó, Sandra; Mendes, Tiago; Schmand, Ben A.; Guerreiro, Manuela; de Mendonça, Alexandre

    2012-01-01

    Diagnosis of mild cognitive impairment relies on the presence of memory complaints. However, memory complaints are very frequent in healthy people. The objective of this study was to determine the severity and type of memory difficulties presented by elderly patients who seek for clinical help, as compared to the memory difficulties reported by subjects in the community. Assessment of subjective memory complaints was done with the subjective memory complaints scale (SMC). The mini-mental state examination was used for general cognitive evaluation and the geriatric depression scale for the assessment of depressive symptoms. Eight-hundred and seventy-one nondemented subjects older than 50 years were included. Participants in the clinical setting had a higher total SMC score (10.3 ± 4.2) than those in the community (5.1 ± 3.0). Item 3 of the SMC, Do you ever forget names of family members or friends? contributed significantly more to the variance of the total SMC score in the clinical sample (18%) as compared to the community sample (11%). Forgetting names of family members or friends plays an important role in subjective memory complaints in the clinical setting. This symptom is possibly perceived as particularly worrisome and likely drives people to seek for clinical help. PMID:22536537

  13. Care-Seeking for Diarrhoea in Southern Malawi: Attitudes, Practices and Implications for Diarrhoea Control

    Directory of Open Access Journals (Sweden)

    Salule Masangwi

    2016-11-01

    Full Text Available This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average of 17%. Using hierarchically built data from a survey of 1403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour. The results show that 68% of mothers used oral rehydration solutions (ORS the last time a child in their family had diarrhoea. However, when asked on the action they take when a member of their household has diarrhoea two thirds of the mothers said they visit a health facility. Most respondents (73% mentioned distance and transport costs as the main obstacles to accessing their nearest health facility and the same proportion of respondents mentioned prolonged waiting time and absence of health workers as the main obstacles encountered at the health facilities. The main predictor variables when a member of the family had diarrhoea were maternal age, distance to the nearest health facility, school level, and relative wealth, household diarrhoea endemicity, and household size while the main predictor variables when a child had diarrhoea were existence of a village health committee (VHC, distance to the nearest health facility, and maternal age. Most households use ORS for the treatment of diarrhoea and village health committees and health surveillance assistants (HSAs are important factors in this choice of treatment. Health education messages on the use and efficacy of ORS to ensure proper and prescribed handling are important. There is need for a comprehensive concept addressing several dimensions of management and

  14. The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey

    Directory of Open Access Journals (Sweden)

    Peipins Lucy A

    2012-07-01

    Full Text Available Abstract Background Preventive health care services, such as cancer screening can be particularly vulnerable to a lack of paid leave from work since care is not being sought for illness or symptoms. We first describe the prevalence of paid sick leave by broad occupational categories and then examine the association between access to paid sick leave and cancer testing and medical care-seeking in the U.S. workforce. Methods Data from the 2008 National Health Interview survey were analyzed by using paid sick leave status and other health-related factors to describe the proportion of U.S. workers undergoing mammography, Pap testing, endoscopy, fecal occult blood test (FOBT, and medical-care seeking. Results More than 48 million individuals (38% in an estimated U.S. working population of 127 million did not have paid sick leave in 2008. The percentage of workers who underwent mammography, Pap test, endoscopy at recommended intervals, had seen a doctor during the previous 12 months or had at least one visit to a health care provider during the previous 12 months was significantly higher among those with paid sick leave compared with those without sick leave after controlling for sociodemographic and health-care-related factors. Conclusions Lack of paid sick leave appears to be a potential barrier to obtaining preventive medical care and is a societal benefit that is potentially amenable to change.

  15. Radiation oncology career decision variables for graduating trainees seeking positions in 2003-2004

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, Lynn D [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States); Flynn, Daniel F [Department of Radiation Oncology, Holy Family Hospital, Methuen, MA (United States); Haffty, Bruce G [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States)

    2005-06-01

    academic career path. The following variables were ranked significantly differently in hierarchy (p < 0.05) by those seeking an academic versus private practice path with respect to having influence on the career decision: lifestyle, income, case-mix, autonomy, ability to sub-specialize, basic research, clinical research, teaching, patient care, board structure, practice environment, and mentoring. Conclusion: These data offer descriptive information regarding variables that lead to radiation oncology trainee career path decisions. Such information may be of use in modification of training programs to meet future personnel and programmatic needs within the specialty.

  16. Radiation oncology career decision variables for graduating trainees seeking positions in 2003-2004

    International Nuclear Information System (INIS)

    Wilson, Lynn D.; Flynn, Daniel F.; Haffty, Bruce G.

    2005-01-01

    academic career path. The following variables were ranked significantly differently in hierarchy (p < 0.05) by those seeking an academic versus private practice path with respect to having influence on the career decision: lifestyle, income, case-mix, autonomy, ability to sub-specialize, basic research, clinical research, teaching, patient care, board structure, practice environment, and mentoring. Conclusion: These data offer descriptive information regarding variables that lead to radiation oncology trainee career path decisions. Such information may be of use in modification of training programs to meet future personnel and programmatic needs within the specialty

  17. "They Told Me to Take Him Somewhere Else": Caregivers' Experiences Seeking Emergency Dental Care for Their Children.

    Science.gov (United States)

    Meyer, Beau D; Lee, Jessica Y; Lampiris, Lewis N; Mihas, Paul; Vossers, Sarah; Divaris, Kimon

    2017-05-15

    The purpose of this mixed-methods study was to examine pediatric emergency dental trends in two safety net clinics and care-seeking experiences of young children's caregivers. Administrative data were used to describe and compare emergency first visits of children ages zero to six years in a community-based (CC) and a University-based (UC) safety net clinic from 2010 to 2014. In-person interviews were conducted with 11 caregivers of children ages zero to six presenting for nontrauma-related emergency visits at the UC from January to August 2016. Interviews were transcribed verbatim, coded, and analyzed inductively using Atlas. ti.7.5.9. The UC experienced significantly more emergency first visits (33 percent) than the CC (five percent, P<0.001), and the majority of these UC visits were referrals. Caregivers were dissatisfied with the experienced barriers of access to care and lack of child-centeredness, specifically the referral out of the dental home for emergency dental care. A considerable proportion of children's first visits at dental safety net clinics was emergency related. Children's caregivers voiced issues related to access to care and lack of child-centered care. Discordance was apparent between how professional organizations define the dental home and how caregivers experience it in the context of emergency care.

  18. Fostering clinical engagement and medical leadership and aligning cultural values: an evaluation of a general practice specialty trainee integrated training placement in a primary care trust.

    Science.gov (United States)

    Ruston, Annmarie; Tavabie, Abdol

    2010-01-01

    To report on the extent to which a general practice specialty trainee integrated training placement (ITP) developed the leadership skills and knowledge of general practice specialty trainees (GPSTRs) and on the potential of the ITP to improve clinical engagement. A case study method was used in a Kent primary care trust (PCT). Sources of data included face-to-face and telephone interviews (three GPSTRs, three PCT clinical supervisors, three general practitioner (GP) clinical supervisors and three Deanery/PCT managers), reflective diaries, documentary sources and observation. Interview data were transcribed and analysed using the constant comparative method. All respondents were positive about the value and success of the ITP in developing the leadership skills of the GPSTRs covering three dimensions: leadership of self, leadership of teams and leadership of organisations within systems. The ITP had enabled GP trainees to understand the context for change, to develop skills to set the direction for change and to collect and apply evidence to decision making. The ITP was described as an effective means of breaking down cultural barriers between general practice and the PCT and as having the potential for improving clinical engagement. The ITP provided a model to enable the effective exchange of knowledge and understanding of differing cultures between GPSTRs, general practice and the PCT. It provided a sound basis for effective, dispersed clinical engagement and leadership.

  19. Skin cancer concerns and genetic risk information-seeking in primary care.

    Science.gov (United States)

    Hay, J; Kaphingst, K A; Baser, R; Li, Y; Hensley-Alford, S; McBride, C M

    2012-01-01

    Genomic testing for common genetic variants associated with skin cancer risk could enable personalized risk feedback to motivate skin cancer screening and sun protection. In a cross-sectional study, we investigated whether skin cancer cognitions and behavioral factors, sociodemographics, family factors, and health information-seeking were related to perceived importance of learning about how (a) genes and (b) health habits affect personal health risks using classification and regression trees (CART). The sample (n = 1,772) was collected in a large health maintenance organization as part of the Multiplex Initiative, ranged in age from 25-40, was 53% female, 41% Caucasian, and 59% African-American. Most reported that they placed somewhat to very high importance on learning about how genes (79%) and health habits (88%) affect their health risks. Social influence actors were associated with information-seeking about genes and health habits. Awareness of family history was associated with importance of health habit, but not genetic, information-seeking. The investment of family and friends in health promotion may be a primary motivator for prioritizing information-seeking about how genes and health habits affect personal health risks and may contribute to the personal value, or personal utility, of risk information. Individuals who seek such risk information may be receptive to interventions aimed to maximize the social implications of healthy lifestyle change to reduce their health risks. Copyright © 2011 S. Karger AG, Basel.

  20. Beyond the caveman: rethinking masculinity in relation to men's help-seeking.

    Science.gov (United States)

    Farrimond, Hannah

    2012-03-01

    Statistically, men make less use of health-care services than women. This has been interpreted as the result of the 'hegemonic' masculine code in which 'real' men are understood to be physically fit, uninterested in their health and self-reliant. However, less attention has been paid to understanding how hegemonic masculinity intersects with the wider western socio-cultural contexts of men's help-seeking, particularly the valorization of health as a form of social achievement. This article presents the results of interviews with 14 higher socio-economic status (SES) men to uncover their 'interpretive repertoires' in relation to health and illness, help-seeking and masculinity. Although many interviewees drew on the stereotype of the 'Neanderthal Man' who avoids the doctors to explain help-seeking by men 'in general', they constructed their own experiences of help-seeking in terms of being responsible, problem-solving and in control. It is argued that the framing of help-seeking in terms of 'taking action' chimes with an increasingly pro-active 'expert patient' approach within western health-care. This conceptual reconstruction of the dominant masculine code in relation to help-seeking, from 'Neanderthal Man' to 'Action Man', may lead to greater gender equality in terms of accessing health-care. However, it has the potential to exacerbate social inequalities between men from different SES groups.

  1. What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries

    Science.gov (United States)

    Cumming, Oliver; Hunter, Paul R

    2018-01-01

    Patient satisfaction with healthcare has clear implications on service use and health outcomes. Barriers to care seeking are complex and multiple and delays in seeking care are associated with significant morbidity and mortality. We sought to assess the relationship between water, sanitation and hygiene (WASH) provision in healthcare facilities (HCF) and patient satisfaction/care seeking behaviour in low-income and middle-income countries. Pubmed and Medline Ovid were searched using a combination of search terms. 984 papers were retrieved and only 21 had a WASH component warranting inclusion. WASH was not identified as a driver of patient satisfaction but poor WASH provision was associated with significant patient dissatisfaction with infrastructure and quality of care. However, this dissatisfaction was not sufficient to stop patients from seeking care in these poorly served facilities. With specific regard to maternal health services, poor WASH provision was the reason for women choosing home delivery, although providers’ attitudes and interpersonal behaviours were the main drivers of patient dissatisfaction with maternal health services. Patient satisfaction was mainly assessed via questionnaires and studies reported a high risk of courtesy bias, potentially leading to an overestimation of patient satisfaction. Patient satisfaction was also found to be significantly affected by expectation, which was strongly influenced by patients’ socioeconomic status and education. This systematic review also highlighted a paucity of research to describe and evaluate interventions to improve WASH conditions in HCF in low-income setting with a high burden of healthcare-associated infections. Our review suggests that improving WASH conditions will decrease patience dissatisfaction, which may increase care seeking behaviour and improve health outcomes but that more rigorous research is needed. PMID:29765776

  2. Stumbling Blocks at the Clinic: Experiences of Seeking HIV Treatment and Care in South Africa.

    Science.gov (United States)

    Maughan-Brown, Brendan; Kuo, Caroline; Galárraga, Omar; Smith, Philip; Lurie, Mark N; Bekker, Linda-Gail; Harrison, Abigail

    2018-03-01

    Prompt antiretroviral therapy (ART) initiation maximises the therapeutic and prevention benefits of a treat-all strategy for HIV therapy. Using in-depth semi-structured interviews with men and women 18 years and older (N = 41), who were highly motivated and seeking treatment, this study examined salient factors that were associated with delays in treatment access and initiation. Results revealed clinic-related barriers including an onerous, inefficient multi-step process to initiate ART. Participants experienced additional delays due to difficulties accessing care (e.g., being turned away from clinics and referred elsewhere) and health service challenges. Health service challenges included difficulty securing appointments, administrative mistakes (especially lost clinic folders and test results), difficulty navigating the clinic system (e.g., failure to collect a queue card or waiting for incorrect services) and negative clinic-patient interactions. Overall, there was a pervasive negative perception of clinics. Results strongly indicate the need for more patient-centred models of care and the need to reduce unnecessary patient-days at clinics.

  3. Temperamental traits may be associated with medical students’ specialty preferences – pilot study

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    Agnieszka Pawełczyk

    2010-06-01

    Full Text Available Objective: This study was aimed at checking a hypothesis about a possible correlation between medical students’ temperamental traits and specialty preferences. Material and methods: The study was carried out among 202 students of the 6th year at the Medical University of Łódź in academic year 2008/2009. The examined group consisted of 140 women (69% and 62 men (31%. The average age of the students included into the study was 24.7 years (range: 23-29. The subjects were asked to fill in a questionnaire on demographic variables and the Formal Characteristics of BehaviourTemperament Inventory (FCB-TI by Zawadzki and Strelau. Results: The students taking part in the study preferred specialties in internal diseases (22%, surgery (18% and paediatrics (11%. Two point five percent of the students were indecisive in the specialty choice, 26% preferred surgical specialty and 71% – non-surgical specialty. Differences in temperamental traits were indicated between the students preferring different specialties. Students preferring surgery scored higher than those preferring internal medicine in Endurance (p=0.0036, d=0.63 and Activity (p=0.0292, d=0.63. Significantly higher average values were observed within two temperamental traits: Briskness (p=0.0083, d=0.5 and Endurance (p=0.0070, d=0.49 in students preferring surgical specialties, as compared to those choosing non-surgical specialties. Conclusions: Students’ preferring different medical specialties differ in temperamental traits. They obtained different results on the scales of Briskness, Endurance and Activity. The obtained results may be useful in vocational guidance within the choice of medical specialty.

  4. Factors influencing patients seeking oral health care in the oncology dental support clinic at an urban university dental school setting.

    Science.gov (United States)

    Corrigan, Dale M; Walker, Mary P; Liu, Ying; Mitchell, Tanya Villalpando

    2014-01-01

    The purpose of this study was to identify predictors and/or factors associated with medically compromised patients seeking dental care in the oncology dental support clinic (ODSC) at the University of Missouri-Kansas City (UMKC) School of Dentistry. An 18-item survey was mailed to 2,541 patients who were new patients to the clinic from 2006 to 2011. The response rate was approximately 18% (n = 450). Analyses included descriptive statistics of percentages/frequencies as well as predictors based on correlations. Fifty percent of participants, 100 females and 119 males, identified their primary medical diagnosis as cancer. Total household income (p dental care (p dental health. Perceived overall health (p Care Dentistry Association and Wiley Periodicals, Inc.

  5. Prevalence, care-seeking, and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon.

    Science.gov (United States)

    Doocy, Shannon; Lyles, Emily; Hanquart, Baptiste; Woodman, Michael

    2016-01-01

    Given the large burden of non-communicable diseases (NCDs) among both Syrian refugees and the host communities within which they are settled, humanitarian actors and the government of Lebanon face immense challenges in addressing health needs. This study assessed health status, unmet needs, and utilization of health services among Syrian refugees and host communities in Lebanon. A cross-sectional survey of Syrian refugees and host communities in Lebanon was conducted using a two-stage cluster survey design with probability proportional to size sampling. To obtain information on chronic NCDs, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences in household characteristics by care-seeking for these conditions were examined using chi-square, t-test, and adjusted logistic regression methods. Over half (50.4 %) of refugee and host community households (60.2 %) reported a member with one of the five NCDs. Host community prevalence rates were significantly higher than refugees for all conditions except chronic respiratory diseases ( p  = 0.08). Care-seeking for NCDs among refugees and host community households was high across all conditions with 82.9 and 97.8 %, respectively, having sought care in Lebanon for their condition. Refugees utilized primary health care centers (PHCC) (57.7 %) most often while host communities sought care most in private clinics (62.4 %). Overall, 69.7 % of refugees and 82.7 % of host community members reported an out-of-pocket consultation payment ( p  = 0.041) with an average payment of US$15 among refugees and US$42 for the host community ( p Syrian crisis and the burden on the Lebanese health system, implications for both individuals with NCDs and Lebanon's health system are immense. The burden of out of pocket expenses on persons with NCDs are also substantial, especially given the tenuous economic status of many refugees

  6. Specialty Drug Spending Trends Among Medicare And Medicare Advantage Enrollees, 2007–11

    OpenAIRE

    Trish, Erin; Joyce, Geoffrey; Goldman, Dana P.

    2014-01-01

    Specialty pharmaceuticals include most injectable and biologic agents used to treat complex conditions such as rheumatoid arthritis, multiple sclerosis, and cancer. We analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007–11 pharmacy claims data from a 20 percent sample of Medicare beneficiaries. Annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, from $2,641 to $8,976. H...

  7. Meeting the health and social care needs of pregnant asylum seekers; midwifery students' perspectives: part 3; "the pregnant woman within the global context"; an inclusive model for midwifery education to address the needs of asylum seeking women in the UK.

    Science.gov (United States)

    Haith-Cooper, Melanie; Bradshaw, Gwendolen

    2013-09-01

    to describe the conceptualisation and development of an inclusive educational model. The model is designed to facilitate pre-registration midwifery students' learning around the health and social care needs of pregnant women seeking asylum in the United Kingdom. current literature has identified a concern about the standard of maternity care experienced by asylum seeking women accessing maternity services in the United Kingdom. In response to this, a doctorate study was undertaken which focused on examining the way in which a group of midwifery students approached the provision of care for asylum seekers. This study revealed difficulties that these students had both in identifying these women's needs and also in the wider care issues in practice. Consequently, one of the recommendations was to ameliorate these difficulties through midwifery education. the key findings from this study were used together with relevant supporting literature to construct "the pregnant woman within the global context" model for midwifery education. The model is designed to facilitate a holistic assessment of need rather than focusing on the physical assessment at the expense of other aspects of care. It incorporates wider factors, on a global level, which could impact on the health and social care needs of a pregnant woman seeking asylum. It also prompts students to consider the influence of dominant discourses on perceptions of asylum seek;ing and is designed to encourage students' to question these discourses. this model can be used in midwifery education to prepare students in caring for pregnant women seeking asylum. It may be especially helpful when students have close contact with pregnant women seeking asylum, for example through caseloading. Further research is recommended to evaluate the effectiveness of this model in enhancing the care of asylum seeking women in the United Kingdom. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  8. A Methodology for Using Workforce Data to Decide Which Specialties and States to Target for Graduate Medical Education Expansion.

    Science.gov (United States)

    Fraher, Erin P; Knapton, Andy; Holmes, George M

    2017-02-01

    To outline a methodology for allocating graduate medical education (GME) training positions based on data from a workforce projection model. Demand for visits is derived from the Medical Expenditure Panel Survey and Census data. Physician supply, retirements, and geographic mobility are estimated using concatenated AMA Masterfiles and ABMS certification data. The number and specialization behaviors of residents are derived from the AAMC's GMETrack survey. We show how the methodology could be used to allocate 3,000 new GME slots over 5 years-15,000 total positions-by state and specialty to address workforce shortages in 2026. We use the model to identify shortages for 19 types of health care services provided by 35 specialties in 50 states. The new GME slots are allocated to nearly all specialties, but nine states and the District of Columbia do not receive any new positions. This analysis illustrates an objective, evidence-based methodology for allocating GME positions that could be used as the starting point for discussions about GME expansion or redistribution. © Health Research and Educational Trust.

  9. Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

    Science.gov (United States)

    Metz, Anneke M

    2017-01-01

    Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating

  10. The Price Elasticity of Specialty Drug Use: Evidence from Cancer Patients in Medicare Part D.

    Science.gov (United States)

    Jung, Jeah Kyoungrae; Feldman, Roger; McBean, A Marshall

    2017-12-01

    Specialty drugs can bring substantial benefits to patients with debilitating conditions, such as cancer, but their costs are very high. Insurers/payers have increased patient cost-sharing for specialty drugs to manage specialty drug spending. We utilized Medicare Part D plan formulary data to create the initial price (cost-sharing in the initial coverage phase in Part D), and estimated the total demand (both on- and off-label uses) for specialty cancer drugs among elderly Medicare Part D enrollees with no low-income subsidies (non-LIS) as a function of the initial price. We corrected for potential endogeneity associated with plan choice by instrumenting the initial price of specialty cancer drugs with the initial prices of specialty drugs in unrelated classes. We report three findings. First, we found that elderly non-LIS beneficiaries with cancer were less likely to use a Part D specialty cancer drug when the initial price was high: the overall price elasticity of specialty cancer drug spending ranged between -0.72 and -0.75. Second, the price effect in Part D specialty cancer drug use was not significant among newly diagnosed patients. Finally, we found that use of Part B-covered cancer drugs was not responsive to the Part D specialty cancer drug price. As the demand for costly specialty drugs grows, it will be important to identify clinical circumstances where specialty drugs can be valuable and ensure access to high-value treatments.

  11. Specialty Guidelines for Forensic Psychology

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    In the past 50 years forensic psychological practice has expanded dramatically. Because the practice of forensic psychology differs in important ways from more traditional practice areas (Monahan, 1980) the "Specialty Guidelines for Forensic Psychologists" were developed and published in 1991 (Committee on Ethical Guidelines for Forensic…

  12. [Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties].

    Science.gov (United States)

    Pizarro, Margarita; Solís, Nancy; Rojas, Viviana; Díaz, Luis Antonio; Padilla, Oslando; Letelier, Luz María; Aizman, Andrés; Sarfatis, Alberto; Olivos, Trinidad; Soza, Alejandro; Delfino, Alejandro; Latorre, Gonzalo; Ivanovic-Zuvic, Danisa; Hoyl, Trinidad; Bitran, Marcela; Arab, Juan Pablo; Riquelme, Arnoldo

    2015-08-01

    Feedback is one of the most important tools to improve teaching in medical education. To develop an instrument to assess the performance of clinical postgraduate teachers in medical specialties. A qualitative methodology consisting in interviews and focus-groups followed by a quantitative methodology to generate consensus, was employed. After generating the instrument, psychometric tests were performed to assess the construct validity (factor analysis) and reliability (Cronbach’s alpha). Experts in medical education, teachers and residents of a medical school participated in interviews and focus groups. With this information, 26 categories (79 items) were proposed and reduced to 14 items (Likert scale 1-5) by an expert’s Delphi panel, generating the MEDUC-PG14 survey, which was answered by 123 residents from different programs of medical specialties. Construct validity was carried out. Factor analysis showed three domains: Teaching and evaluation, respectful behavior towards patients and health care team, and providing feedback. The global score was 4.46 ± 0.94 (89% of the maximum). One teachers’ strength, as evaluated by their residents was “respectful behavior” with 4.85 ± 0.42 (97% of the maximum). “Providing feedback” obtained 4.09 ± 1.0 points (81.8% of the maximum). MEDUC-PG14 survey had a Cronbach’s alpha coefficient of 0.947. MEDUC-PG14 survey is a useful and reliable guide for teacher evaluation in medical specialty programs. Also provides feedback to improve educational skills of postgraduate clinical teachers.

  13. Professional Competencies of Cuban Specialists in Intensive Care and Emergency Medicine.

    Science.gov (United States)

    Véliz-Martínez, Pedro L; Jorna-Calixto, Ana R; Oramas-González, René

    2016-10-01

    INTRODUCTION The quality of medical training and practice reflects the competency level of the professionals involved. The intensive care and emergency medicine specialty in Cuba has not defined its competencies. OBJECTIVE Identify the competencies required for specialty practice in intensive care and emergency medicine. METHODS The study was conducted from January 2014 to December 2015, using qualitative techniques; 48 professionals participated. We undertook functional occupational analysis, based on functions defined in a previous study. Three expert groups were utilized: the first used various group techniques; the second, the Delphi method; and the third, the Delphi method and a Likert questionnaire. RESULTS A total of 73 specific competencies were defined, grouped in 11 units: 44 in the patient care function, 16 in management, 7 in teaching and 6 in research. A competency map is provided. CONCLUSIONS The intensive care and emergency medicine specialty competencies identified will help improve professional standards, ensure health workforce quality, improve patient care and academic performance, and enable objective evaluation of specialists' competence and performance. KEYWORDS Clinical competency, competency-based education, professional education, intensive care, emergency medicine, urgent care, continuing medical education, curriculum, medical residency, Cuba.

  14. Pathways Utilized for Antenatal Health Seeking Among Women in ...

    African Journals Online (AJOL)

    Background: Ghana's maternal mortality ratio has been declining over the last two decades but at a rather slow pace. Poor access to effective maternity care is identified as one of the key challenges of maternity care. The current study mapped out the pathways to pregnancy care seeking among urban-dwelling adult women ...

  15. Social Influences of Help-Seeking Behaviour Among Patients With Type 2 Diabetes Mellitus in Malaysia.

    Science.gov (United States)

    Low, Lee Lan; Tong, Seng Fah; Low, Wah Yun

    2016-01-01

    This qualitative study aimed to explore the influence of social networks such as family members, friends, peers, and health care providers toward the help-seeking behaviour (HSB) of patients with type 2 diabetes mellitus in the public and private primary care settings. In-depth interviews of 12 patients, 9 family members, and 5 health care providers, as well as 3 focus groups among 13 health care providers were conducted. All interviews were audio-taped and transcribed verbatim for qualitative analysis. Social influences play a significant role in the help-seeking process; once diagnosed, patients source information from people around them to make decisions. This significant influence depends on the relationship between patients and social networks or the level of trust, support, and comforting feeling. Thus, the impacts on patients' help-seeking behavior are varied. However, the help-seeking process is not solely an individual's concern but a dynamic process interacting with the social networks within the health care system. © 2015 APJPH.

  16. No longer diseases of the wealthy: prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India.

    Science.gov (United States)

    Bhojani, Upendra; Beerenahalli, Thriveni S; Devadasan, Roopa; Munegowda, C M; Devadasan, Narayanan; Criel, Bart; Kolsteren, Patrick

    2013-08-13

    The burden of chronic conditions is high in low- and middle-income countries and poses a significant challenge to already weak healthcare delivery systems in these countries. Studies investigating chronic conditions among the urban poor remain few and focused on specific chronic conditions rather than providing overall profile of chronic conditions in a given community, which is critical for planning and managing services within local health systems. We aimed to assess the prevalence and health- seeking behaviour for self-reported chronic conditions in a poor neighbourhood of a metropolitan city in India. We conducted a house-to-house survey covering 9299 households (44514 individuals) using a structured questionnaire. We relied on self-report by respondents to assess presence of any chronic conditions, including diabetes and hypertension. Multivariable logistic regression was used to analyse the prevalence and health-seeking behaviour for self-reported chronic conditions in general as well as for diabetes and hypertension in particular. The predictor variables included age, sex, income, religion, household poverty status, presence of comorbid chronic conditions, and tiers in the local health care system. Overall, the prevalence of self-reported chronic conditions was 13.8% (95% CI = 13.4, 14.2) among adults, with hypertension (10%) and diabetes (6.4%) being the most commonly reported conditions. Older people and women were more likely to report chronic conditions. We found reversal of socioeconomic gradient with people living below the poverty line at significantly greater odds of reporting chronic conditions than people living above the poverty line (OR = 3, 95% CI = 1.5, 5.8). Private healthcare providers managed over 80% of patients. A majority of patients were managed at the clinic/health centre level (42.9%), followed by the referral hospital (38.9%) and the super-specialty hospital (18.2%) level. An increase in income was positively associated with the use

  17. Trust and memory: organizational strategies, institutional conditions and trust negotiations in specialty clinics for Alzheimer's disease.

    Science.gov (United States)

    Beard, Renée L

    2008-03-01

    Clinicians aim to establish trust during medical encounters because, without it, health consumers may not seek medical care, consider their diagnoses legitimate, or adhere to treatment regimens. This paper examines the identification and treatment of memory loss within two specialty clinics to understand how cultural dynamics, such as organizational ethos and work practices, influence the social fabric of cognitive evaluations. Ethnographic data suggest important historical and cultural differences in the approaches to Alzheimer's disease (AD). Organizational routines, however, support a common goal, that of moving individuals from "potential patients" to patients, and ultimately research subjects, through establishing trust. Although the processes through which trust is potentially achieved, or the social conditions of trust, were similar at the sites, the object of trust was different. Whereas one clinic encouraged trust in collective medical expertise, the other focused on trust in specific clinicians. These conditions affect the clinical consequences of trust, particularly how and when the diagnosis is delivered, use of the AD label and other terminology, and the level of standardization. The individual consequences include perceptions of patients and depictions of the prognosis. Whether cognitive impairment is viewed as a scientific puzzle to be solved or is seen as a chronic illness significantly shapes the organizational processes of clinical evaluation. Alzheimer's disease, as a cultural object, is a particularly salient exemplar of the clinical negotiation of ambiguous diagnostic categorizations and the unpredictable patient in daily biomedical practice.

  18. Associations between the severity of obstructive lower urinary tract symptoms and care-seeking behavior in rural Africa: A cross-sectional survey from Uganda.

    Directory of Open Access Journals (Sweden)

    Lynn Stothers

    Full Text Available A cross sectional survey.Global estimates indicate that by 2018 2.3 billion individuals worldwide will suffer from lower urinary tract symptoms (LUTS, with 1.1 billion having LUTS related to bladder outlet obstruction (BOO. Left untreated BOO in men causes irreversible changes to the urinary tract leading to urinary retention, the need for catheterization, renal failure and even death. Estimates suggest that Africa will be one of the continents with the greatest increase in (LUTS by 2018 however direct measures in Africa are lacking. The objectives were to: (1 measure of prevalence of LUTS/BOO in a community-based sample of men in Africa, (2 compare community-based LUTS/BOO frequency to those seeking care for LUTS in a local clinic (3 quantify bother, interference with daily living, worry and quality of life related to LUTS/BOO between community and clinic settings and (4 examine relationships between socioeconomic and demographics related to LUTS/BOO.473 men from a rural Ugandan community (238 residents living with their symptoms and 177 presenting at a clinic for care completed the International Prostate Symptom Scale (IPSS and a 53-item validated LUTS symptom, bother and quality of life index. Severity of symptoms was categorized based on reference ranges for mild, moderate and severe levels of the IPSS, comparing those in the community versus those seeking care for symptoms. IPSS indicated that 55.9% of men in the community versus 17.5% of those at the clinic had mild symptoms, 31.5% in the community versus 52.5% of those at the clinic had moderate symptoms and 12.6% of those in the community versus 29.9% of those at the clinic had severe symptoms (p<0.001. Men seeking care for LUTS/BOO had a lower quality of life (p<0.05, were more bothered by their urinary symptoms (p<0.05, had more interference with daily activity and worry (p<0.05 but this did not have an impact on their general sense of wellbeing.The burden of disease of LUTS/BOO in

  19. Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

    Science.gov (United States)

    Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C

    2012-12-01

    Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. 75 FR 42431 - Onyx Specialty Papers, Inc; Notice Soliciting Applications

    Science.gov (United States)

    2010-07-21

    ... Papers, Inc; Notice Soliciting Applications July 14, 2010. On April 29, 2009, Onyx Specialty Papers, Inc... is located in the basement of MeadWestvaco's paper mill. There are no transmission lines associated... information from the licensee, please contact Mr. John Clements, Counsel for Onyx Specialty Papers, Inc., Van...

  1. A survey of sub-specialty preferences of radiography students of the University of Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    E T Namah

    2013-01-01

    Full Text Available Background: Technological advances and computing have expanded both the scope and capacity of diagnostic medical imaging (the radiography profession. This has created many diverse imaging modalities which in turn, have culminated in different sub-specialties in the profession. Objective: The aims of the study were to determine the level of awareness of imaging sub-specialties, preferred sub specialties and reasons for preferences of sub-specialties in senior level radiography students of the University of Lagos. Methods: The study was a prospective cross-sectional survey. Consents were obtained before the students were recruited for the study. Data Collection and Analysis: A questionnaire semi-structured in line with objectives of the study was used in data collection. A computer software Epi Info version 3.3 was used to analyze data while results were expressed as percentages of responses and were presented in tables and pie charts. Results : Greater than 90% showed awareness of sub-specialties in the radiography profession whereas 35% preferred ultrasonography to other sub-specialties. The least preferred sub-specialty was conventional radiography (4.3%. Remuneration (73.3% and less physical exertion (73.3% were major attractors to preferred sub-specialties whereas concerns over radiation hazard were major detractors (58.3%. Conclusion : Awareness of sub-specialties in the radiography profession was high amongst students studied. Furthermore, ultrasonography was the most preferred sub-specialty among the respondents. Remuneration was the main attractor to sub-specialties whereas fears over effects of ionizing radiation were the major detractors to some sub-specialties.

  2. Exploring the feelings of Iranian women of reproductive age about health care seeking behavior: a qualitative study

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Morowatisharifabad

    2018-01-01

    Full Text Available Background: Despite the important role of feelings in health care seeking behavior (HCSB, this subject has not yet been adequately investigated. HCSB-related feelings begin with the onset of disease symptoms and persist in different forms after treatment. The aim of current study was to explore the feelings that women of reproductive age experience when they seek health care.Methods: In this deductive, qualitative content analysis, participants were selected by purposeful sampling. Semi-structured, in-depth interviews with 17 women of reproductive age and 5 healthcare staffs in Qom, Iran were carried out until data saturation was achieved. Qualitative data were concurrently analyzed by deductive content analysis, using the Health Promotion Model (HPM. The MAXQDA10 software was used to manage qualitative data analysis.Results: Three main categories were drawn from data to explain the HCSB-related feelings of participants consisting of (1 feeling of inner satisfaction with the treatment with 2 subcategories including "peace of mind" and "feeling alive", (2 multiple roles of fear with 5 subcategories including "fear about the consequences of delay", "fear of having hidden diseases", "fear of unknown experiences", "fear of hearing bad news" and "fear of medical errors" and (3uncomfortable feelings with 3 subcategories including "feeling uneasy when attending health facility", "feeling embarrassed" and "feeling worthless due to dealing the doctor".Conclusion: This study revealed that the inner feelings of women varied widely, ranging from positive or motivating feelings to negative or inhibitory ones, given their experiences with the formal health care system and the current situation of medical and health services. Highlighting patients’ perceived inner satisfaction and reducing fear and uncomfortable feelings by adopting culture-based practical strategies can enhance women’s HCSB.

  3. Delivering Patient-Centered Care in a Fragile State: Using Patient-Pathway Analysis to Understand Tuberculosis-Related Care Seeking in Pakistan.

    Science.gov (United States)

    Fatima, Razia; Haq, Mahboob Ul; Yaqoob, Aashifa; Mahmood, Nasir; Ahmad, Khawaja Laeeq; Osberg, Mike; Makayova, Julia; Hymoff, Aaron; Hanson, Christy

    2017-11-06

    Pakistan has the sixth largest population in the world and boasts the fifth greatest burden of tuberculosis. The Government of Pakistan has set the ambitious goal of zero deaths due to tuberculosis and universal access to tuberculosis care by 2020. Successfully reaching these goals is dependent on the country's capacity to diagnose and successfully treat an estimated 200000 unnotified or missing patients with tuberculosis. A patient-pathway analysis (PPA) was conducted at the national level, as well as for each of the 4 provinces, to assess the alignment between patient care seeking and the availability of tuberculosis diagnostic and treatment services. Almost 90% of patients initiated care in the private sector, which accounts for only 15% of facilities with the capacity for tuberculosis diagnosis and treatment. Across the country, nearly 50% of tuberculosis microscopy laboratories were located in public-sector-basic health units and regional health centers. However, very few patients initiated care in these facilities. Overall, tuberculosis case detection was high given the low likelihood of patients reaching facilities with the capacity for tuberculosis service delivery during their first visit. Improving the engagement of the informal sector and lower-level clinicians will improve the efficiency and timeliness of tuberculosis diagnosis for patients in Pakistan. Concurrently, the apparent strength of the referral networks connecting community-level workers and private clinicians to the public sector for tuberculosis diagnosis and treatment suggests that strengthening the capacity of the public sector could be valuable. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  4. Tuberculosis knowledge, attitudes and health-seeking behaviour in rural Uganda.

    Science.gov (United States)

    Buregyeya, E; Kulane, A; Colebunders, R; Wajja, A; Kiguli, J; Mayanja, H; Musoke, P; Pariyo, G; Mitchell, E M H

    2011-07-01

    To assess tuberculosis (TB) knowledge, attitudes and health-seeking behaviour to inform the design of communication and social mobilisation interventions. Iganga/Mayuge Demographic Surveillance Site, Uganda. Between June and July 2008, 18 focus group discussions and 12 key informant interviews were conducted, including parents of infants and adolescents and key informant interviews with community leaders, traditional healers and patients with TB. People viewed TB as contagious, but not necessarily an airborne pathogen. Popular TB aetiologies included sharing utensils, heavy labour, smoking, bewitchment and hereditary transmission. TB patients were perceived to seek care late or to avoid care. Combining care from traditional healers and the biomedical system was common. Poverty, drug stock-outs, fear of human immunodeficiency virus (HIV) testing and length of TB treatment negatively affect health-seeking behaviour. Stigma and avoidance of persons with TB often reflects an assumption of HIV co-infection. The community's concerns about pill burden, quality of care, financial barriers, TB aetiology, stigma and preference for pluralistic care need to be addressed to improve early detection. Health education messages should emphasise the curability of TB, the feasibility of treatment and the engagement of traditional healers as partners in identifying cases and facilitating adherence to treatment.

  5. Hospitals need to customise care according to patients' differing information-seeking behaviour

    DEFF Research Database (Denmark)

    Riiskjær, Erik; Ammentorp, Jette; Nielsen, Jørn Flohr

    2014-01-01

    INTRODUCTION: The aim of the study was to describe how often patients seek information about their disease in connection with contact to a hospital and to elucidate how information-seeking behaviour is related to the patients' perception of this contact. MATERIAL AND METHODS: The study was based...... on patient surveys from the Danish county of Aarhus from 1999 to 2006 including eight public hospitals. The patients' information-seeking behaviour was related to patient characteristics, organisational context and patient perceptions. RESULTS: Among the 75,769 patients who responded, 33.4% had actively...

  6. Interventional radiology as clinical specialty and how this affects the radiology specialty as a whole

    International Nuclear Information System (INIS)

    Tsetis, D.

    2015-01-01

    maintain high quality clinical standards, Radiology departments must carry out regular audit and where available submitting data to national or international registries. Furthermore, IRs have a duty of care to ensure that the IR procedures are safe and effective which can only be demonstrated by high quality research. For IR to survive as clinical specialty, IR training must be adapted in order to ensure that future IR’s will acquire both clinical knowledge and confidence in the disease processes as well as in dealing with patients. Core IR training must include communication skills, clinical assessment and knowledge of the various alternative treatments to IR both surgical and medical. In order to fulfill these expectations, IR training must move to a certified residency program; an attractive format would be one year of internship, three years of Diagnostic Radiology, and then two years of IR. this IR certification will hopefully have a huge impact on local organizational issues so that at a local institution the IR service will be listed next to surgery and medicine. towards this direction, appropriate curricula and formal assessment of the appropriate skills such as the european Board of Interventional Radiology (eBIR) examination are available to ensure the high standards of the future IR workforce. the CIRSe Clinical Practice in IR Manual provides a comprehensive approach to patient care, including numerous well-structured forms for gathering data on patient or social history and conducting examinations are part of its content (www.cirse.org/Clinical_Practice) In my opinion the continuous effort to upgrade IR practice, also points to the only direction for the entire Radiology specialty to survive: the radiologist should be part of clinical decision-making, a true active clinical partner, with up-to-date clinical knowledge about a medical subspecialty. the reality is that clinicians have started to learn about the images in their subspecialty territory, and through

  7. Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil.

    Science.gov (United States)

    Martins, Renata Castro; Reis, Clarice Magalhães Rodrigues Dos; Matta Machado, Antonio Thomaz Gonzaga da; Amaral, João Henrique Lara do; Werneck, Marcos Azeredo Furquim; Abreu, Mauro Henrique Nogueira Guimarães de

    2016-01-01

    This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

  8. Ocular injuries and eye care seeking patterns following injuries ...

    African Journals Online (AJOL)

    However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in ... policy exists in Ghana for the occupational health and safety of ...... Cambridge,. UK:University Press.1963. 29.

  9. Improving the quality of depression and pain care in multiple sclerosis using collaborative care: The MS-care trial protocol.

    Science.gov (United States)

    Ehde, Dawn M; Alschuler, Kevin N; Sullivan, Mark D; Molton, Ivan P; Ciol, Marcia A; Bombardier, Charles H; Curran, Mary C; Gertz, Kevin J; Wundes, Annette; Fann, Jesse R

    2018-01-01

    Evidence-based pharmacological and behavioral interventions are often underutilized or inaccessible to persons with multiple sclerosis (MS) who have chronic pain and/or depression. Collaborative care is an evidence-based patient-centered, integrated, system-level approach to improving the quality and outcomes of depression care. We describe the development of and randomized controlled trial testing a novel intervention, MS Care, which uses a collaborative care model to improve the care of depression and chronic pain in a MS specialty care setting. We describe a 16-week randomized controlled trial comparing the MS Care collaborative care intervention to usual care in an outpatient MS specialty center. Eligible participants with chronic pain of at least moderate intensity (≥3/10) and/or major depressive disorder are randomly assigned to MS Care or usual care. MS Care utilizes a care manager to implement and coordinate guideline-based medical and behavioral treatments with the patient, clinic providers, and pain/depression treatment experts. We will compare outcomes at post-treatment and 6-month follow up. We hypothesize that participants randomly assigned to MS Care will demonstrate significantly greater control of both pain and depression at post-treatment (primary endpoint) relative to those assigned to usual care. Secondary analyses will examine quality of care, patient satisfaction, adherence to MS care, and quality of life. Study findings will aid patients, clinicians, healthcare system leaders, and policy makers in making decisions about effective care for pain and depression in MS healthcare systems. (PCORI- IH-1304-6379; clinicaltrials.gov: NCT02137044). This trial is registered at ClinicalTrials.gov, protocol NCT02137044. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Initial treatment seeking from professional health care providers for eating disorders: A review and synthesis of potential barriers to and facilitators of "first contact".

    Science.gov (United States)

    Regan, Pamela; Cachelin, Fary M; Minnick, Alyssa M

    2017-03-01

    The objective of this study is to provide a comprehensive review of empirical research exploring barriers to and facilitators of initial treatment seeking ("first contact") from professional health care providers by adults and young adults with eating disorders (EDs). A search of databases PsycINFO and MEDLINE using the terms "treatment" and "eating disorder*" yielded 9,468 peer-reviewed articles published from January 1945 to June 2016. Screening identified 31 articles meeting the following criteria: (1) participants were 16 or older and presented with a self-reported or clinically diagnosed ED; (2) studies focused on (a) initial treatment seeking (b) for an ED (c) from professional health care providers; (3) articles were empirical, and (4) peer reviewed. Quantitative studies revealed few consistent correlates of treatment seeking, perhaps because most variables were examined in only one or two investigations. Variables with some degree of predictive utility (i.e., produced significant results in multiple studies) were age (older), ethnicity (nonethnic minority), ED type (anorexia, purging BN), specific ED-related behaviors (i.e., purging), and time spent on a treatment waitlist following referral (less). Although BMI was one of the most investigated variables, it did not predict treatment seeking. Qualitative studies revealed the following perceived barriers: (1) personal feelings of shame/fear, (2) ED-related beliefs/perceptions, (3) lack of access/availability, and (4) aspects of the treatment process. Perceived facilitators included (1) health-related concerns, (2) emotional distress, and (3) social support. Implications for clinical practice and areas for further research are discussed. Results highlight the need for shared definitions and methodologies across studies of treatment seeking. © 2017 Wiley Periodicals, Inc.

  11. The Orientation and Development of the Public Affair Management Specialty

    Science.gov (United States)

    Li, Chenghui; Fu, Yongxian; Chen, Rongxiang; Hu, Xueqi

    2010-01-01

    Though the specialty of the public affair management has been developed for ten years, but it is still facing the actuality that the orientation and development are difficult. Only by confirming the cultivation target and the development orientation, the development of the specialty could find the development approach and method. According to the…

  12. Stability of and Factors Related to Medical Student Specialty Choice of Psychiatry.

    Science.gov (United States)

    Goldenberg, Matthew N; Williams, D Keith; Spollen, John J

    2017-09-01

    Targeted efforts are needed to increase the number of medical students choosing psychiatry, but little is known about when students decide on their specialty or what factors influence their choice. The authors examined the timing and stability of student career choice of psychiatry compared with other specialties and determined what pre- and intra-medical school factors were associated with choosing a career in psychiatry. Using survey data from students who graduated from U.S. allopathic medical schools in 2013 and 2014 (N=29,713), the authors computed rates of psychiatry specialty choice at the beginning and end of medical school and assessed the stability of that choice. A multivariate-adjusted logistic regression and recursive partitioning were used to determine the association of 29 factors with psychiatry specialty choice. Choice of psychiatry increased from 1.6% at the start of medical school to 4.1% at graduation. The stability of psychiatry specialty choice from matriculation to graduation, at just over 50%, was greater than for any other specialty. However, almost 80% of future psychiatrists did not indicate an inclination toward the specialty at matriculation. A rating of "excellent" for the psychiatry clerkship (odds ratio=2.66), a major in psychology in college (odds ratio=2.58), and valuing work-life balance (odds ratio=2.25) were the factors most strongly associated with psychiatry career choice. Students who enter medical school planning to become psychiatrists are likely to do so, but the vast majority of students who choose psychiatry do so during medical school. Increasing the percentage of medical students with undergraduate psychology majors and providing an exemplary psychiatry clerkship are modifiable factors that may increase the rate of psychiatry specialty choice.

  13. Pre-Vaccination Care-Seeking in Females Reporting Severe Adverse Reactions to HPV Vaccine. A Registry Based Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Kåre Mølbak

    Full Text Available Since 2013 the number of suspected adverse reactions to the quadrivalent human papillomavirus (HPV vaccine reported to the Danish Medicines Agency (DMA has increased. Due to the resulting public concerns about vaccine safety, the coverage of HPV vaccinations in the childhood vaccination programme has declined. The aim of the present study was to determine health care-seeking prior to the first HPV vaccination among females who suspected adverse reactions to HPV vaccine.In this registry-based case-control study, we included as cases vaccinated females with reports to the DMA of suspected severe adverse reactions. We selected controls without reports of adverse reactions from the Danish vaccination registry and matched by year of vaccination, age of vaccination, and municipality, and obtained from the Danish National Patient Registry and The National Health Insurance Service Register the history of health care usage two years prior to the first vaccine. We analysed the data by logistic regression while adjusting for the matching variables.The study included 316 cases who received first HPV vaccine between 2006 and 2014. Age range of cases was 11 to 52 years, with a peak at 12 years, corresponding to the recommended age at vaccination, and another peak at 19 to 28 years, corresponding to a catch-up programme targeting young women. Compared with 163,910 controls, cases had increased care-seeking in the two years before receiving the first HPV vaccine. A multivariable model showed higher use of telephone/email consultations (OR 1.9; 95% CI 1.2-3.2, physiotherapy (OR 2.1; 95% CI 1.6-2.8 and psychologist/psychiatrist (OR 1.9; 95% CI 1.3-2.7. Cases were more likely to have a diagnosis in the ICD-10 chapters of diseases of the digestive system (OR 1.6; 95% CI 1.0-2.4, of the musculoskeletal system (OR 1.6; 95% CI 1.1-2.2, symptoms or signs not classified elsewhere (OR 1.8; 95% CI 1.3-2.5 as well as injuries (OR 1.5; 95% CI 1.2-1.9.Before receiving the

  14. [Specialty specific reference values in linen use in public health and social service as a basis for determining laundry capacities].

    Science.gov (United States)

    Rietdorf, M; Häse, I

    1990-01-01

    The use of linen in health and social care should primarily be seen from a hygienic angle. Disproportions between the use of linen in the various fields of health care and the available laundry capacities have a negative hygienic and economic effect. Laundry capacities should, therefore, be calculated on the basis of specialty-specific guidevalues. The authors propose indicators suitable to this aim and present the results of a comprehensive analysis for the inpatient departments of internal medicine, surgery, urology, ophthalmology and otorhinolaryngology.

  15. Impact of national policy on the health of people seeking asylum.

    Science.gov (United States)

    Joels, Claire

    Recent Department of Health policy has modified the stage in the application process that people seeking asylum are entitled to free NHS health care. This has caused confusion, not only among asylum seekers and settled refugees, but also among healthcare professionals. In turn, this has led to increased difficulty for people seeking asylum in accessing healthcare services. This article identifies when in the process asylum seekers are entitled to free NHS care. It considers how current legislation and the government stance on immigration are having a negative effect on the health of people seeking asylum while they are in the U.K., and to what extent nurses and other health professionals can help.

  16. Doctors who considered but did not pursue specific clinical specialties as careers: questionnaire surveys.

    Science.gov (United States)

    Goldacre, Michael J; Goldacre, Raph; Lambert, Trevor W

    2012-04-01

    To report doctors' rejection of specialties as long-term careers and reasons for rejection. Postal questionnaires. United Kingdom. Graduates of 2002, 2005 and 2008 from all UK medical schools, surveyed one year after qualification. Current specialty choice; any choice that had been seriously considered but not pursued (termed 'rejected' choices) with reasons for rejection. 2573 of 9155 respondents (28%) had seriously considered but then not pursued a specialty choice. By comparison with positive choices, general practice was under-represented among rejected choices: it was the actual choice of 27% of respondents and the rejected choice of only 6% of those who had rejected a specialty. Consideration of 'job content' was important in not pursuing general practice (cited by 78% of those who considered but rejected a career in general practice), psychiatry (72%), radiology (69%) and pathology (68%). The surgical specialties were the current choice of 20% of respondents and had been considered but rejected by 32% of doctors who rejected a specialty. Issues of work-life balance were the single most common factor, particularly for women, in not pursuing the surgical specialties, emergency medicine, the medical hospital specialties, paediatrics, and obstetrics and gynaecology. Competition for posts, difficult examinations, stressful working conditions, and poor training were mentioned but were mainly minority concerns. There is considerable diversity between doctors in their reasons for finding specialties attractive or unattractive. This underlines the importance of recruitment strategies to medical school that recognize diversity of students' interests and aptitudes.

  17. In Situ Measurement of Seeking Speed and Seeking Induced Head-Disk Interface Instability in Hard Disk Drives

    Directory of Open Access Journals (Sweden)

    Yu Wang

    2015-01-01

    Full Text Available This paper investigated the instability of head-disk interface caused by the voice coil motor (VCM end crashing the crash stop during the seeking of magnetic head. To make the whole process of that clear, an in situ measurement method based on maximum likelihood estimation and extended Kalman filter for seeking speed at component level was developed first and was then calibrated by a high speed camera. Given a crash between VCM end and crash stop that may be a consequence of the continuous increasing seeking speed, the seeking speed was carefully controlled by using our developed method to find a critical value that may induce vigorous head-disk interface instability. Acoustic emission sensor and laser Doppler vibrometer were used to capture the transient dynamic behaviors of magnetic head when the crash is happening. Damage analysis and mode identification were carried out to reveal the relationship between the damage patterns on disk surface and head dynamics. The results of this study are helpful to optimize the track seeking profile during the HDD operation, as well as the design of components such as head and head arm.

  18. Danger Signs of Childhood Pneumonia: Caregiver Awareness and Care Seeking Behavior in a Developing Country

    Directory of Open Access Journals (Sweden)

    Ikenna K. Ndu

    2015-01-01

    Full Text Available Background. Efforts to reduce child mortality especially in Africa must as a necessity aim to decrease mortality due to pneumonia. To achieve this, preventive strategies such as expanding vaccination coverage are key. However once a child develops pneumonia prompt treatment which is essential to survival is dependent on mothers and caregiver recognition of the symptoms and danger signs of pneumonia. Methods. This community based cross-sectional study enrolled four hundred and sixty-six caregivers in Enugu state. It aimed to determine knowledge of caregivers about danger signs of pneumonia and the sociodemographic factors that influence knowledge and care seeking behaviour of caregivers. Results. There is poor knowledge of the aetiology and danger signs of pneumonia among caregivers. Higher maternal educational attainment and residence in semiurban area were significantly associated with knowledge of aetiology, danger signs, and vaccination of their children against pneumonia. Fast breathing and difficulty in breathing were the commonest known and experienced WHO recognized danger signs while fever was the commonest perceived danger sign among caregivers. Conclusion. Knowledge of danger signs and health seeking behaviour among caregivers is inadequate. There is need for intensified public and hospital based interventions targeted at mothers to improve their knowledge about pneumonia.

  19. Women otolaryngologist representation in specialty society membership and leadership positions.

    Science.gov (United States)

    Choi, Sukgi S; Miller, Robert H

    2012-11-01

    To determine the proportion of female otolaryngologists in leadership positions relative to their number in the specialty, their membership in various otolaryngology organizations, and age. Cross-sectional analyses of otolaryngology organization membership with a subgroup analysis on female membership and leadership proportion comparing 5-year male/female cohort groups. Information on the number of members and leaders was obtained from various specialty societies by direct communication and from their Web sites between June and December 2010. The number of female and male otolaryngologists and their age distribution in 5-year age groups was obtained from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Statistical analyses were used to determine whether women had proportional membership and leadership representation in various specialty societies. Additionally, female representation in other leadership roles was analyzed using the male/female ratio within the 5-year cohort groups. Female otolaryngologists were found to constitute approximately 11% of practicing otolaryngologists. The American Society of Pediatric Otolaryngology had a higher proportion of female members (22%) compared to five other societies. When the gender composition within each organization was taken into account, female representation in specialty society leadership positions was proportionate to their membership across all societies. When gender and age were considered, women have achieved proportionate representation in each of the specialty societies' leadership positions. There was also proportionate representation of females as program directors, American Board of Otolaryngology directors, Residency Review Committee members, and journal editors/editorial board members. Finally, fewer female chairs or chiefs of departments/divisions were seen, but when age was taken into consideration, this difference was no longer significant. Women have achieved parity in

  20. Health seeking behavior of the mothers for the special care new-born unit discharged children: a comparative study.

    Science.gov (United States)

    Jeet, Gursimer; Sharma, Atul; Mohanta, Tulika Goswami; Trakroo, Ajay

    2013-01-01

    Establishment of special care new-born units (SCNU) in hospitals not only serves to provide the intensive care to sick neonates, but presents with opportunities to enhance knowledge and modify attitude and practices of their parents through behavior change communication (BCC). A cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011 to assess differences in health-care seeking behavior of these mothers from mothers of newborns who were born at home and mothers who had normal uneventful institutional deliveries. Mothers of 29 SCNU discharged, 34 institutions delivered and 26 home delivered children were interviewed using a semi-structured interview schedule and a knowledge, attitude and practice (KAP) survey tool. Mothers of children admitted to SCNU scored better in questions related to vaccination, contraception, protection of child from infections and cold and perceptions about traditional healers, but overall KAP scores in the three groups were not found significantly different.

  1. 78 FR 60766 - Clarification on Fireworks Policy Regarding Approvals or Certifications for Specialty Fireworks...

    Science.gov (United States)

    2013-10-02

    ... 173 [Docket No. PHMSA-2013-0206; Notice No. 13-15] Clarification on Fireworks Policy Regarding Approvals or Certifications for Specialty Fireworks Devices AGENCY: Pipeline and Hazardous Materials Safety... applications for specialty fireworks devices. Specialty fireworks devices are fireworks devices in various...

  2. Stage at diagnosis and delay in seeking medical care among women with breast cancer, delhi, India.

    Science.gov (United States)

    Pakseresht, Sedigheh; Ingle, Gopal Krishna; Garg, Suneela; Sarafraz, Nahid

    2014-12-01

    Patients with cancer often delay seeking medical advice in developing countries. It can adversely influence the outcome of disease. The present study was performed to determine the stage at diagnosis and delay in seeking medical care among women with breast cancer in Delhi, India. This was a cross-sectional study based on a census (case series) approach to reach all women (172) diagnosed with primary breast cancer "detected in surgery Out Patient Department (OPD) from January 2007 to December 2009" at Lok Nayak Hospital, Delhi, India. Patients were interviewed using a self-structure questionnaire. Seeking behavior variables were awareness of problem, first consultation, followed physician's advice, detection of problem, system of medicine and gap between knowing the problem and consultation (patient delay). Statistical Analysis was performed using the Microsoft SPSS-pc version 14.0 statistical program. The analytic methods were used (mean, standard deviation, X(2), Fisher's Exact Test, K-S, Kruskal-Wallis) for variables. All statistical tests were performed at a significance level of 5% (P cancer at the time of diagnosis. The mean duration of gap between knowing the problem and consulting a physician (patients delay) was 10.90 months. There was no significant association between stage of cancer and consultation gap. A significant association was found between the stage of breast cancer and income; women with lower income had a higher stage of breast cancer (P breast cancer. It seems necessary to design educating programs for women in both clinical and community settings, about breast cancer and early detection practices.

  3. Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model.

    Science.gov (United States)

    Dubowitz, Howard; Feigelman, Susan; Lane, Wendy; Kim, Jeongeun

    2009-03-01

    Effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0-5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment

  4. Online examiner calibration across specialties.

    Science.gov (United States)

    Sturman, Nancy; Wong, Wai Yee; Turner, Jane; Allan, Chris

    2017-09-26

    Integrating undergraduate medical curricula horizontally across clinical medical specialties may be a more patient-centred and learner-centred approach than rotating students through specialty-specific teaching and assessment, but requires some interspecialty calibration of examiner judgements. Our aim was to evaluate the acceptability and feasibility of an online pilot of interdisciplinary examiner calibration. Fair clinical assessment is important to both medical students and clinical teachers METHODS: Clinical teachers were invited to rate video-recorded student objective structured clinical examination (OSCE) performances and join subsequent online discussions using the university's learning management system. Post-project survey free-text and Likert-scale participant responses were analysed to evaluate the acceptability of the pilot and to identify recommendations for improvement. Although 68 clinicians were recruited to participate, and there were 1599 hits on recordings and discussion threads, only 25 clinical teachers rated at least one student performance, and 18 posted at least one comment. Participants, including rural doctors, appeared to value the opportunity for interdisciplinary rating calibration and discussion. Although the asynchronous online format had advantages, especially for rural doctors, participants reported considerable IT challenges. Our findings suggest that fair clinical assessment is important to both medical students and clinical teachers. Interspecialty discussions about assessment may have the potential to enrich intraspecialty perspectives, enhance interspecialty engagement and collaboration, and improve the quality of clinical teacher assessment. Better alignment of university and hospital systems, a face to face component and other modifications may have enhanced clinician engagement with this project. Findings suggest that specialty assessment cultures and content expertise may not be barriers to pursuing more integrated

  5. 76 FR 2148 - Specialty Minerals, Inc., Franklin, VA; Notice of Revised Determination on Reconsideration

    Science.gov (United States)

    2011-01-12

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,057] Specialty Minerals, Inc...) applicable to workers of Specialty Minerals, Inc., Franklin, Virginia (the subject firm). The Notice was... workers of Specialty Minerals, Inc., Franklin, Virginia, who are engaged in employment related to the...

  6. Clinical information seeking in traumatic brain injury: a survey of Veterans Health Administration polytrauma care team members.

    Science.gov (United States)

    Hogan, Timothy; Martinez, Rachael; Evans, Charlesnika; Saban, Karen; Proescher, Eric; Steiner, Monica; Smith, Bridget

    2018-03-01

    The polytraumatic nature of traumatic brain injury (TBI) makes diagnosis and treatment difficult. To (1) characterise information needs among Veterans Health Administration (VHA) polytrauma care team members engaged in the diagnosis and treatment of TBI; (2) identify sources used for TBI related information; and (3) identify barriers to accessing TBI related information. Cross-sectional online survey of 236 VHA polytrauma care team members. Most respondents (95.8%) keep at least somewhat current regarding TBI, but 31.5% need more knowledge on diagnosing TBI and 51.3% need more knowledge on treating TBI. Respondents use VHA affiliated sources for information, including local colleagues (81.7%), VHA offsite conferences/meetings (78.3%) and onsite VHA educational offerings (73.6%); however, limited time due to administrative responsibilities (50.9%), limited financial resources (50.4%) and patient care (50.4%) were prominent barriers. Medical librarians are in a unique position to develop information services, resources and other electronic tools that reflect the clinical context in which polytrauma care team members practice, and the different tasks they perform. Polytrauma care team members could benefit from additional information regarding the diagnosis and treatment of TBI. Addressing their information needs and supporting their information seeking requires a mulit-pronged approach to time and financial constraints. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  7. Questionnaire survey on the process of specialty training in neurology in Japan.

    Science.gov (United States)

    Sonoo, Masahiro; Nishiyama, Kazutoshi; Ando, Tetsuo; Shindo, Katsuro; Kanda, Takashi; Aoki, Masashi; Kamei, Satoshi; Kikuchi, Seiji; Kusunoki, Susumu; Suzuki, Norihiro; Sobue, Gen; Nakashima, Kenji; Hara, Hideo; Hirata, Koichi; Mizusawa, Hidehiro; Murai, Hiroyuki; Murata, Miho; Mochizuki, Hideki; Takahashi, Ryosuke; Kira, Jun-Ichi

    2017-07-29

    Documentation of the current status of specialty training to become a neurologist in Japan would represent an important basis for constructing better neurology training program in the planned reform of the specialty training system in Japan. The committee for future neurology specialty system of Japanese Society of Neurology (JSN) conducted a questionnaire survey on the process of specialty training of each trainee for neurology in board-certified educational facilities and semi-educational facilities throughout Japan. The response rate was 46.2% in all facilities and 87.5% in medical universities. The training process of 905 trainees over 5 grades was clarified, which was estimated to be about 80% of all the relevant subjects. Specialty training dedicated to neurology was started at the 3rd year of residency in 87.8% of subjects. During the 3 years following junior residency, 51.3% of subjects ran the rotation training between university and city hospital, whereas 36.5% was trained within the sam