Search

Background: The 22q11.2 Deletion Syndrome (22q11.2 DS) presents unique healthcare challenges for affected individuals, families, and healthcare systems. Despite its rarity, 22q11.2 DS is the most common microdeletion syndrome in humans, emphasizing the need to understand and address the distinctive healthcare requirements of those affected. This paper examines the multifaceted issue of health service access and caregivers' quality of life in the context of 22q11.2 DS in Brazil, a condition with diverse signs and symptoms requiring multidisciplinary care. This study employs a comprehensive approach to evaluate health service accessibility and the quality of life of caregivers of individuals with 22q11.2 DS. It utilizes a structured Survey and the WHOQOL-bref questionnaire for data collection., Results: Individuals with 22q11.2 DS continue to receive incomplete clinical management after obtaining the diagnosis, even in the face of socioeconomic status that enabled an average age of diagnosis that precedes that found in sample groups that are more representative of the Brazilian population (mean of 3.2 years versus 10 years, respectively). In turn, caring for individuals with 22q11.2 DS who face difficulty accessing health services impacts the quality of life associated with the caregivers' environment of residence., Conclusions: Results obtained help bridge the research gap in understanding how caring for individuals with multisystem clinical conditions such as 22q11.2 DS and difficulties in accessing health are intertwined with aspects of quality of life in Brazil. This research paves the way for more inclusive healthcare policies and interventions to enhance the quality of life for families affected by this syndrome., (© 2024. The Author(s).)

Objectives: Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community., Methods: This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework., Results: Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers., Conclusion: Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Obi, Ojiakor, Etiaba and Onwujekwe.)

Access to health care is a universal human right and key indicator of health system performance. Spatial access encompasses geographic factors mediating with the accessibility and availability of health services. Equity of health service access is a global issue, which includes access to the specialized nursing workforce. Nursing research applying spatial methods is in its infancy. Given the use of spatial methods in health research is a rapidly developing field, it is timely to provide guidance to inspire greater application in cardiovascular research. Therefore, the objective of this methods paper is to provide an overview of spatial analysis methods to measure the accessibility and availability of health services, when to consider applying spatial methods, and steps to consider for application in cardiovascular nursing research., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Rationale: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. Objectives: As part of the HAPIN (Household Air Pollution Intervention Network) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced, and a road network analysis was performed. Measurements and Main Results: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately resourced facility was 41 ± 19 minutes in J-GUA, 99 ± 64 minutes in P-PER, 40 ± 19 minutes in K-RWA, and 31 ± 19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all P  < 0.001). Conclusions: Most healthcare facilities in low-resource settings of the HAPIN study area were inadequately resourced to care for severe pediatric pneumonia. Early identification of cases and timely referral is paramount. The provision of pulse oximeters to all health facilities may be an effective approach to identify cases earlier and refer them for care and in a timely manner.

Background: To control and eventually eliminate vivax malaria, radical treatment with primaquine (PQ) is essential after completion of blood-stage treatment. Although in many malaria-endemic countries, village health volunteers (VHVs) are engaged in diagnostic treatment of malaria in remote communities, they principally provide blood-stage treatment. In such a situation, access to PQ following blood-stage treatment can be a barrier to complete treatment. However, studies on access to PQ treatment have been scarce and limited in health facility-based settings. This study aimed to identify factors associated with access to PQ treatment in rural Papua New Guinea (PNG) from the community case management perspective., Methods: A community-based, cross-sectional survey was conducted to collect sociodemographic information on children under 15 years of age, their households, and their caretakers in East Sepik Province, PNG. Data collection lasted from February to March, 2015. Information on the diagnoses of potential non-falciparum malaria and prescription of PQ in preceding year (January to December 2014) were obtained from child health-record books. Then, multilevel logistic regression model was used to determine the factors associated with formal health facility visits for PQ treatment among children with potential non-falciparum malaria., Results: Of 420 episodes diagnosed as potential non-falciparum malaria, 46 (11%) were immediately given PQ. The rest were instructed to visit formal health facilities (HFs) for PQ, and the patients obtained PQ during the second visit to HFs was 44%. Consequently, the overall proportion of PQ prescription was 50%. Logistic regression analysis suggested that among the patients who were instructed to visit HFs for PQ treatment, the initial visit to VHV and higher transportation costs to HF were inversely associated with PQ prescription during the second visit to an HF., Conclusions: Few children received PQ treatment during the second visit to HFs following diagnosis of potential non-falciparum malaria. These findings suggest a need to establish a policy to reduce structural and economic barriers and improve rural inhabitant access to PQ treatment.

Purpose: The Patient Protection and Affordable Care Act (ACA) expanded coverage to roughly 12 million individuals by mid-2014 and 20 million by 2016, raising concern about the capacity of the primary care system to absorb these individuals. We set out to determine how justified the concern was., Methods: We used an audit design in which simulated patients called primary care practices seeking new-patient appointments in 10 diverse states (Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas) from November 2012 through March 2013 and from May 2014 through July 2014, before and after the major ACA insurance expansions. Callers were randomly assigned to scripts specifying either private or Medicaid insurance and called only offices identified as "in network" for each plan., Results: We completed 5,385 private insurance and 4,352 Medicaid calls in 2012-2013 and 2,424 private insurance and 2,474 Medicaid calls in 2014. Overall appointment rates for private insurance remained stable from 2012 (84.7%) to 2014 (85.8%) with Massachusetts and Pennsylvania experiencing significant increases. Overall, Medicaid appointment rates increased 9.7 percentage points (57.9% to 67.6%) with substantial variation by state. Across all callers, median wait times for those obtaining an appointment were 7 days in 2012 and 5 days in 2014, but the difference was not statistically significant., Conclusions: Contrary to widespread concern, we find no evidence that the millions of individuals newly insured through the ACA decreased new-patient appointment availability across 10 states as shown by stable wait times and appointment rates for private insurance as of mid-2014., (© 2017 Annals of Family Medicine, Inc.)

Objective: To explore the experiences of women from a remote and rural setting who had a termination of pregnancy (TOP), in relation to any barriers they may have experienced trying to access TOP., Design: Qualitative interview study., Setting: Scottish Highlands and Western Isles., Population: Women who had undergone TOP in the Scottish Highlands National Health Service between October 2014 and May 2015., Methods: Sixteen semi-structured, audio-recorded telephone interviews were conducted by a researcher with women who had consented to be interviewed at their initial assessment. Six stages of thematic analysis were followed to explore themes in and across participant accounts., Main Outcome Measures: Themes derived from interview transcripts., Results: Four themes emerged relating to barriers to access and experience: (1) the impact of travel for TOP, (2) temporal factors unique to this population and how they affected women, (3) the attitude of health professionals, notably general practitioners, as a result of local culture, and (4) stigma surrounding TOP and the expectation that abortion will be traumatising., Conclusion: Women in remote and rural areas experience barriers to accessing TOP. Prompt referrals, more providers of TOP and tackling stigma associated with TOP could make delivery of this service more equitable and improve women's journey through TOP., Tweetable Abstract: Women in remote and rural areas of Scotland face multiple barriers to accessing termination of pregnancy., (© 2016 Royal College of Obstetricians and Gynaecologists.)

Purpose: Although the relevance of dental intervention before transplant is recognized, many patients are undergoing transplantation without receiving dental care. The objective of this study was to identify the searching profile, access, and use of dental services by candidates to hematopoietic stem cell transplantation (HSCT), and the difficulties faced by those candidates., Methods: All candidates for an allogeneic HSCT from a bone marrow transplant unit were invited to take part in this research from March 2014 to March 2015. A questionnaire was developed consisting of five sections with questions about personal information, hematologic disease, access to dental services, and history of dental treatment, patient's preferences, and knowledge., Results: One hundred and ten candidates for allogeneic HSCT participated in this study. Fifty-five participants received professional oral care in the previous year of interview. The majority of patients (64 %) went to a dentist not linked to transplant staff, and private dental service was the most visited (42 %). To visit a dentist during the previous year was statistically associated with the habit of going to a dentist outside the hospital (p < 0.001), which was statistically associated with the family income (p = 0.001). The main barriers to access to dental treatment were lack of guidance (66 %), apprehension (45 %), and lack of confidence (29 %) in an "external" dentist., Conclusions: Most of the barriers seem to be associated to lack of confidence and information among patients and professionals, as well as a lack of parameters for scheduling or referrals to dental care, especially for those with a low-socioeconomic background.

Background & Aims: Equality of access to organ transplantation is a mandatory public health requirement. Referral from a local to a university hospital and then registration on the national waiting list are the two key steps enabling access to liver transplantation (LT). Although the latter procedure is well defined using the Model for End-stage Liver Disease score that improves equality of access, the former is mostly reliant on the practices of referring physicians. The aim of this study was to clarify the factors determining this initial step., Methods: This observational study included consecutive inpatients with cirrhosis of whatever origin in a cohort constituted between 2003 and 2008, using medical records and structured questionnaires concerning patient characteristics and the opinions of hospital clinicians. Candidates for LT were defined in line with these opinions., Results: Four hundred and thirty-three patients, mostly affected by alcoholic cirrhosis, were included, 21.0% of whom were considered to be candidates for LT. Factors independently associated with their candidature were: physician empathy [odds ratio (OR) = 10.8; 95% CI: 4.0-29.5], adherence to treatment (OR = 16.6; 95% CI: 3.7-75.2), geographical area (OR = 6.8; 95% CI: 2.2-21.3) and the patient's physiological age (OR = 2.3; 95% CI: 1.1-4.7)., Conclusions: Several subjective markers restrict the referral of patients from local hospitals to liver transplant centres. Their advancement to this second step is thus markedly weakened by initial subjectivity. The development of objective guidelines for local hospital physicians to assist them with their initial decision-making on LT is now necessary., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To identify and describe the needs and problems of the immigrant population related to access and utilization of health services., Method: A descriptive, qualitative, phenomenological study was conducted using focus groups. The study area was the county of Campo de Gibraltar (Spain), which represents the gateway to Europe for immigration from Africa. The final sample size (51 immigrants from 11 countries) was determined by theoretical saturation. A narrative analysis was conducted with QSR NVivo9 software., Results: Immigrants' discourse showed four categories of analysis: response to a health problem, system access, knowledge of social and health resources, and health literacy needs. Responses to health problems and the route of access to the health care system differed according to some sociodemographic characteristics (nationality/culture of origin, length of residence, and economic status). In general, immigrants primarily used emergency services, hampering health promotion and prevention. The health literacy needs identified concerned language proficiency and the functioning of the health system., Conclusions: There is a need to promote interventions to enhance health literacy among immigrants. These interventions should take into account diversity and length of residence, and should be based on an action-participation methodology., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: The Afghan population suffers from a long standing armed conflict. We investigated patients' experiences of their access to and use of the health services., Methods: Data were collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member., Results: To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year., Conclusions: Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare., (© The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Access to an optimal treatment is determined by several factors, like availability, pricing/funding, and acceptability. In Latin America (LA), one of the regions with more disparities particularly on healthcare in the world, access is affected by other factors, including socio-demographic factors like poverty, living in rural regions, and/or health coverage. Regarding rheumatoid arthritis (RA), an inadequate access to specialists leads to diagnosis and treatment delays diminishing the probability of remission or control. Unfortunately, in almost every LA country, there are cities with more than 100,000 inhabitants without rheumatologists; furthermore, a primary care reference system is present in only about half the countries. In the public health system, coverage of biologic disease-modifying antirheumatic drugs occurs for less than 10 % of the patients in about half of the countries. Also, as healthcare providers based their funding decisions mainly in direct costs instead of on patient-centered healthcare quality indicators, access to new drugs is more complicated in this region than in high-income countries. More accurate epidemiological data from LA need to be obtained in order to improve the management of patients with rheumatic diseases in general and RA in particular.

The article introduces the Leadership and Education for Advanced Practice Provider (LEAPP) fellowship, an innovative postgraduate program designed to address the shortage of qualified cystic fibrosis (CF) providers by offering specialized training across various CF care centers. Topics include the program's unique blended learning approach, its focus on leadership and quality improvement, and its potential application to other complex conditions requiring specialized care.

Introduction. Mental health has historically been overlooked in public policies in Mexico, with up to 80% of people with mental health and substance-related disorders in Mexico lacking adequate care. Objective. To characterize the mental health provider (psychiatrists and psychologists) shortage in the Mexican public sector. Method. Descriptive study. Data from SINERHIAS (Ministry of Health of Mexico) up to the first half of 2023 were analyzed. Results. A total of 1,504 psychiatrists worked in the public sector (1.1 per 100,000 population). The Health Ministry (Secretaría de Salud; Spanish acronym SS) employed 55.9%, IMSS 25.9%, ISSSTE 7.2%, while 1.0% were affiliated to other public institutions. There were 8,668 psychologists in the public sector (6.9 per 100,000 population), of which the SS employed 78.9%, IMSS 6.3%, ISSSTE 2.4%, while 12.3% worked at other public institutions. Thirty-four per cent of psychiatrists were in Mexico City, while 21 states, accounting for 70% of the population, had one psychiatrist or fewer per 100,000 population. Hospital units employed 83.3% of psychiatrists. Discussion. Mexico has an insufficient number of mental health providers at public institutions, with disparities between states and most providers affiliated to hospital units. Conclusion. There is an acute mental health provider shortage in the Mexican public sector, together with limited resources for community mental health care, affecting the treatment of mental health and substance use disorders. [ABSTRACT FROM AUTHOR]

Background: Global crises and disease pandemics, such as COVID-19, negatively affect dental care utilization by several factors, such as infection anxiety, disrupted supply chains, economic contraction, and household income reduction. Exploring the pattern of this effect can help policy makers to be prepared for future crises. The present study aimed to investigate the financial impact of COVID‐19 disruptions on dental service utilization. Methods: Data on the number of dental services offered in Dental School Clinics of Tehran University of Medical Sciences was collected over a period of two years, before and after the initial COVID-19 outbreak in Iran. School of Dentistry operates two clinics; one with competitive service fees and one with subsidies. Regression analyses were performed to determine the effect of the pandemic on the number of dental services divided by dental treatment groups and these clinics. The analyses were adjusted for seasonal patterns and the capacity of the clinics. Results: There was a significant drop in dental services offered in both clinics across all dental groups in the post-COVID period (on average, 77 (39.44%) fewer services per day). The majority of the procedure loss happened in the Private clinic. Adjusting for seasonal patterns and the service capacity, regression results documented 54% and 12% service loss in Private and Subsidized clinics following the pandemic, respectively. Difference-in-difference analysis documented that the Subsidized clinic performed 40% more treatments than the Private clinic in the post-COVID period. Conclusions: Pandemic –reduction in dental care utilization could have long-term ramifications for the oral health of the population, and policymakers need to provide supportive packages to the affected segments of the economy to reverse this trend. [ABSTRACT FROM AUTHOR]

Spatial accessibility to health services influences service utilisation and eventually impacts the disease burden. This cross-sectional study analysed the spatial accessibility of schoolchildren to public oral health facilities and school dental services (SDS) and vice versa in Selangor. Overlay and proximity analysis from geo-mapping software was employed to map the primary dental clinics with SDS, the public schools, and the proximity between primary dental clinics with SDS and public schools by travelling distance (5 km, 10 km, 20 km) and travelling time (15 min, 30 min). Over half of the schoolchildren in Selangor are within 5 km of accessibility to primary dental clinics and SDS teams. Meanwhile, nearly half of the primary and secondary schools, particularly in rural areas, are located within a more than 5 km service area of public oral health facilities. The SDS teams have a travel burden of more than 20 km to the public schools in Selangor's northern and north-western districts of large geographical areas. Simultaneously, most public primary and secondary schools are within 15 min of driving time from primary dental clinics. Geo-mapping highlights the inequalities in spatial accessibility to public oral health facilities with SDS among schoolchildren in Selangor. It is time to prioritise the resources, SDS, and preventive programmes to reduce inequalities in oral health accessibility among schoolchildren in Selangor. [ABSTRACT FROM AUTHOR]

The humanitarian crisis precipitated by the ongoing conflict in Sudan poses profound risks to the health and welfare of the country's children. This paper explores essential policy interventions to safeguard child mental health services under these challenging circumstances. Crucial strategies include enhancing healthcare accessibility for children and their caregivers, promoting education, and improving household living conditions. Additionally, it is vital to provide improved access to information about nutritious food and strengthen health systems in areas directly exposed to conflict. Cooperation with international aid organizations is paramount to delivering medical supplies to functioning health facilities. The paper also recommends partnerships with local non-governmental and humanitarian organizations to execute public health programs effectively. These multi-faceted policy measures underscore the importance of a comprehensive response to ensure the health and well-being of children amid the turmoil in Sudan. Through these strategies, we aim to provide a blueprint for policymakers and humanitarian organizations to mitigate the devastating impacts of the conflict on the country's most vulnerable population. [ABSTRACT FROM AUTHOR]

Australia is rapidly moving towards 'living with COVID‐19', with relaxation of some public health measures. The number of severe cases of COVID‐19 may be mitigated by vaccination, but 'living with COVID‐19' will be associated with higher number of patients seeking emergency care. This impending impact on the emergency care system requires recognition, monitoring and co‐ordinated management. Current challenges include a lack of emergency care monitoring systems, staff shortages and patient flow processes that are quickly overwhelmed by large numbers, particularly in a system already operating at capacity. Effective monitoring systems are required for health systems to proactively detect and respond to stresses. Additional solutions include public health messaging and clinical innovation to facilitate care of the right patient in the right place at the right time. Optimising staff numbers and morale, and efficient patient flow, are integral steps to increasing capacity within the emergency care system. [ABSTRACT FROM AUTHOR]

Background: Thailand is a member of the Association of Southeast Asian Nations, comprised of 10 countries, with a population of approximately 567 million, with workers moving into Thailand from neighboring countries due to higher wages. It is likely that major infectious, deadly, emerging, or re-emerging infectious diseases to spread to the Thai population. This research aimed to study factors affecting the quality of life and access to health services of migrant workers in Health Area 8, Upper Northeastern Region, Thailand. The results of the research will be used to further develop migrant workers’ health care systems. Methods: This research is a cross-sectional descriptive study. The data were collected from Lao migrant workers in District 8, the upper northeastern region by using n = P(1-P)[Z1-α+Z1-β]2/[B(1-B)(P0-P1)2] with the total of 574 participants. The data were analyzed by frequency, means, Standard deviation and multiple logistic regression. Results: Analysis results used Multiple Logistic Regression by Backward elimination found that the variable with the highest Adjusted Odds ratio is overtime. It found that those who did not work overtime were 12.43 times more likely to have lower access to health care than those who had overtime. (ORadj = 12.43, 95%CI= 8.84-16.39) followed by earning overtime wages. It found that Those who did not receive overtime wages were 11.43 times more likely to have poor quality of life and access to health care than those who had overtime wages. (ORadj = 11.43, 95%CI= 8.85-16.39) Educational level factors found no relationship with quality of life and access to public health services. Conclusion: There were 13 variables that were statistically significant when testing the association with quality of life and access to public health services. The highest ORadj was overtime followed by receiving overtime wages. Therefore, these data should be used for enhancing the living and access to public health services further. [ABSTRACT FROM AUTHOR]

Immigrant populations experience diverse barriers to access healthcare services in the host countries. Among them, undocumented immigrants have more restricted legal access conditions and higher risk of having poorer health. Likewise, women are more likely to seek healthcare and face gender-based factors that hinder their access. This thesis analysed the access of undocumented immigrants and immigrant women to public healthcare services in the Basque Country (Spain). The thesis contained three sub-studies, carried out with qualitative and quantitative methods. For the quantitative approach, the trend in the number of consultations in a free clinic for undocumented immigrants was analysed before and after the launch of a new law, using a negative binomial regression analysis (n = 9,272). For the qualitative approach, qualitative content analysis was applied to 25 in-depth interviews with 14 immigrant women and 11 free clinic healthcare professionals. No clear relationship was found between the application of more restrictive legal conditions for immigrants to access public healthcare services and the trend of attendance of undocumented immigrants to a free clinic. Access of undocumented immigrants and immigrant women to healthcare services was subject to barriers dependent on their characteristics, health system functioning, legal requirements and a stereotyped and poor social consideration of immigrants, shared by professionals at the health centres. Meanwhile, provision of legal information and support by individual professionals, social organizations and personal networks represented main facilitators for accessing. For the access of undocumented immigrants and immigrant women, structural and individual barriers based on their social vulnerability were found. Among others, gender-based violence reduced women's possibility to access healthcare services and being undocumented led to restricted access entitlement and to fear rejection at health centres. Therefore, besides ensuring immigrants' legal entitlement, there is need of promoting rights-based attention to get more inclusive health systems. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: The waiting times for medical attention constitutes one of the main barriers to access to the Healthcare System in Argentina. Objective: Analyse different times that people have to keep in the waiting room and between the request for an appointment and the medical attention with a specialist according to their socio-economic and demographic characteristics, the type of health coverage and place of residence. Method: quantitative, based on the analysis of secondary data. It was implemented in the Survey of "La Deuda Social Argentina" of the year 2013, conducted by the "Observatorio de la Deuda Social Argentina (Universidad Católica Argenitna)". Results: The waiting time to see a doctor it's socially stratified according to socioeconomic characteristics, type of medical coverage and place of residence of the population. There are no significant differences between gender and across age groups. [ABSTRACT FROM AUTHOR]

Background: The Afghan population suffers from a long standing armed conflict. We investigated patients' experiences of their access to and use of the health services. Methods: Datawere collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member. Results: To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year. Conclusions: Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare. [ABSTRACT FROM AUTHOR]

Pharmacists have shown to increase clinical and humanistic outcomes in medically underserved populations through non-dispensing services. Limited information is available regarding the pharmacy workforce's involvement and ability to serve in this role. The objectives were to measure the proportion of pharmacists working with underserved populations and to assess barriers they encountered when trying to assist. 363 licensed Ohio pharmacists responded to an electronic survey between December 2011 and March 2012 (response rate 19.7 %). The survey assessed personal and environmental barriers that prevent pharmacist involvement with underserved populations using 5-point Likert scales. Multiple logistic regressions identified barriers that influenced pharmacists' involvement in providing non-dispensing services to underserved populations. 43 % of respondents were assisting underserved populations mostly in their place of work (83 %). Environmental barriers were indicated to effect pharmacists most. Uninvolved pharmacists most agreed with environmental barriers of 'Hesitant to volunteer before knowing commitment', 'Never approached to assist', and 'Not enough time during shifts'. Logistic regression 1 incorporated all pharmacists and indicated barriers of 'Not interested in this area of work' (OR = 0.589) and 'Unsure where to volunteer' (OR = 0.660) as significant. Logistic regression 2 was limited to pharmacists with access to patients at place of work and indicated 'Not interested in this area of work' (OR = 0.443), 'Employer never approached to assist' (OR = 0.557), 'No time during work shifts' (OR = 0.537), and 'Work location low underserved accessibility' (OR = 0.487) as significant predictors. More pharmacists might become engaged as volunteers. Increasing communication between community and pharmacists may reduce reported volunteering barriers. [ABSTRACT FROM AUTHOR]

Purpose: Study purposes were to: (I) validate information of New York State (NYS) pediatric dental Medicaid/CHIP providers registered on lnsureKidsNow.gov (IKN); and (2) compare dental access to available IKN pediatric dental Medicaid provider locations by NYS region and population density of young children in poverty Methods: Information on 4,634 dental provider locations was obtained by collapsing 21,921 listings; 160 locations were randomly telephoned to verify consistency and provision of pediatric restorative treatment. Dental provider locations to poor child population ratios were compared. Results: Over 90 percent of locations were in less than a third of NYS counties. New York City/Long Island locations had 5.68 higher odds of accepting new pediatric patients compared to locations in the rest of NYS. Of phone numbers called, 22 percent were invalid. Nearly 40 percent of valid calls were inconsistent with IKN. Over 90 percent of counties had at least one IKN dentist. The median child-in-poverty to provider ratio was 85:1. Conclusions: Improved oversight of InsureKidsNow.gov is required to ensure validity and usefulness. Research on the quantity and type of child Medicaid/CHIP dental procedures in private practice is needed to accurately assess dental access. [ABSTRACT FROM AUTHOR]

Background Patient flow is a major problem in hospitals. Delays in accessing inpatient rehabilitation have not been well studied. Aims Measure the time taken for key processes in the patient journey from acute hospital admission through to inpatient rehabilitation admission in order to identify opportunities for improvement. Methods Retrospective open cohort study. All patients admitted over 8- and 10-month periods during 2008 into two inpatient rehabilitation units in Melbourne, Australia. Main outcome measures were the duration of the following key processes: acute hospital admission until referral for rehabilitation, referral until assessment by the rehabilitation service, assessment until deemed ready for transfer to rehabilitation, ready for transfer until rehabilitation admission. Results Three hundred and sixty patients were in the study sample (females = 186; 51.7%); mean age = 58.4 (standard deviation = 15.0) years. There was a median of 7 (interquartile range [ IQR] 4-13) days from acute hospital admission till referral for rehabilitation, a median of 1 ( IQR 0-1) day from referral till assessment, a median of 0 ( IQR 0-2) days from assessment till deemed ready for transfer and a median of 1 ( IQR 0-3) day from ready till admission into rehabilitation. Overall, patients spent 12.0% (804/6682) of their acute hospital admission waiting for a rehabilitation bed. Conclusions There are opportunities to improve the efficiency of key processes in the acute hospital journey for patients subsequently admitted to inpatient rehabilitation; in particular, reducing the time from acute hospital admission till referral for rehabilitation and from being deemed ready for transfer to rehabilitation till admission. [ABSTRACT FROM AUTHOR]

This study determines asthma-related health care access and utilization patterns for Latino children of Puerto Rican and Dominican origin residing in Rhode Island (RI) and Latino children residing in Puerto Rico (Island). Data included 804 families of children with persistent asthma recruited from clinics. Island children were less likely to receive regular asthma care and care from a consistent provider and more likely to have been to the emergency department and hospitalized for asthma than RI children. Island children were 2.33 times more likely to have used the emergency department for asthma compared with RI non-Latino White (NLW) children. Latino children residing in both Island and RI were less likely to have used specialty care and more likely to have had a physician visit for asthma in the past year than RI NLW children. The differences might reflect the effects of the different delivery systems on pediatric health care utilization and asthma management. [ABSTRACT FROM AUTHOR]

The article focuses on the effect of a temporary medical ward closure on Emergency Department (ED) and hospital service delivery outcomes. A study was conducted among ED attendees in a hospital in Queensland. In this study, the researchers compared a 3-week period of ward closure with equal time periods before and after. Based from the result of the study, it is concluded that there is a negative effect on some ED and hospital outcomes when a medical ward is temporarily closed.

Seeking appropriate help for early signs and symptoms of psychological distress can reduce the long-term impact of many mental disorders. This article describes practice implications and new initiatives for promoting early access and help-seeking among young people. Relevant help-seeking research is reviewed, and prominent help-seeking barriers are discussed. Prominent barriers for young people include: incomplete mental health and emotional literacy, beliefs about having little need for help versus having a need for autonomy, and the process of help-negation for different symptoms of psychological distress. To improve early access to appropriate help and mental health services, barriers that can be reduced, and in particular, psychological distress symptoms that promote the help-negation process, must be reduced as soon as they can be. Strategies that can be used by clinicians, parents and others, including young people, to encourage appropriate help-seeking are provided. Examples of how these strategies are implemented in several innovative programs and approaches are discussed. [ABSTRACT FROM AUTHOR]

Aim: This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. Methods: In 2001, the Early Assessment Service for Young People with Psychosis programme was launched in Hong Kong, providing both educational and service components. Public education includes promotion of timely help-seeking, accessible channels to service and knowledge of psychosis. The 2-year phase-specific intervention includes intensive medical follow-up and individualized psychosocial intervention. The programme has adopted the case-management approach, in which case managers provide protocol-based psychosocial intervention. The programme collaborates with non-governmental organizations and community networks in the provision of rehabilitation service. Results: An average of over 600 young patients enter the programme for intensive treatment each year. Based on preliminary data from a 3-year outcome study, patients in the programme have remarkable reductions in hospital stay accompanied by improvements in vocational functioning. Conclusions: The results suggested that the programme improved patients' outcome. Additional costs such as extra medical staff and medications may be offset by the shortened hospital stay. Further directions in early intervention are also discussed. [ABSTRACT FROM AUTHOR]

Objective. To study people's views on the accessibility and continuity of primary medical care provided by different providers: a public primary healthcare centre (PPHC), occupational healthcare (OHC), and a private practice (PP). Design. A nationwide population-based questionnaire study. Setting. Finland. Subjects. A total of 6437 (from a sample of 10 000) Finns aged 15–74 years. Main outcome measures. Period of time (in days) to get an appointment with any physician was assessed via a single structured question. Accessibility and continuity were evaluated with a five-category Likert scale. Values 4–5 were regarded as good. Results. Altogether 72% had found that they could obtain an appointment with a physician within three days, while 6% had to wait more than two weeks. Older subjects and subjects with chronic diseases perceived waiting times as longer more often than younger subjects and those without chronic diseases. The proportion of subjects who perceived access to care to be good was 35% in a PPHC, 68% in OHC, and 78% in a PP. The proportion of subjects who were able to get successive appointments with the same doctor was 45% in a PPHC, 68% in OHC, and 81% in a PP. A personal doctor system was related to good continuity and access in a PPHC. Conclusions. Access to and continuity of care in Finland are suboptimal for people suffering from chronic diseases. The core features of good primary healthcare are still not available within the medical care provided by public health centres. [ABSTRACT FROM AUTHOR]

Legislative restrictions in immigrants' access to health care and local governmental funding shortfalls in the US and Western Europe have raised fears that public clinic patients might delay care for communicable diseases. To help quantify the potential impact of both policies on public clinics providing sexually transmitted disease (STD) services, we surveyed 234 patients from five LA clinics regarding their alternative sources of health care. Of the 215 providing complete information (response rate = 91%), 52 (24%) reported they had no legal rights to reside in the US. Compared to the legal resident control group, illegal immigrants were more likely to indicate that they had no alternative access to medical care (27% vs 44%; P = 0.03). We conclude that for a substantial proportion of patients, particularly illegal immigrants, the STD clinics are indeed essential. Restricting access to these clinics may have unpredictable public health consequences. [ABSTRACT FROM AUTHOR]

Background: Sweden has nearly 300 youth clinics that have been offering services since the 1970s. However, no evaluation has been done to assess their youth-friendliness. This study aims to assess: i) to what extent youth clinics are perceived as youth-friendly by the young people using them; and ii) if the level of youth friendliness is equally perceived across different sociodemographic groups of users.Methods: The four northernmost counties of Sweden were included in the study. Of the total identified 22 youth clinics, 20 participated by giving out questionnaires to the youth after their visits to the respective youth clinics. In total 1110 youth participated in the study and answered questions according to the World Health Organization's criteria of accessibility, equity, respect, privacy and confidentiality, no judgement, and quality. Means and frequencies were calculated, and t-test and ANOVA were used to compare means by sociodemographic variables.Results: Participants perceived the youth clinics as very youth friendly across the measured domains, with scores as high as 4.8 and 4.9 (of a maximum of 5). Youth clinics were perceived in a similar way regardless of gender, but other sociodemographic factors influenced some of the domains, especially ethnic background.Conclusions: The perception of youth friendliness in youth clinics was very high. Nonetheless, younger users; users who did not categorize themselves as either heterosexual, homosexual, or bisexual; users with trans-experiences; and users with non-Swedish backgrounds gave youth clinics lower scores for certain domains. [ABSTRACT FROM AUTHOR]