Access To Quality Health Care Research Articles

Effectiveness of behavioural change interventions on physical activity, diet and body mass index of public primary healthcare users in Kosovo: the KOSCO cohort

BackgroundPrevalent physical inactivity and poor nutrition contribute to high non-communicable disease (NCD) morbidity and mortality in Kosovo. To improve health services for patients with NCD the Accessible Quality Healthcare project...

Health Providers' Response to Female Adolescent Survivors of Sexual and Gender-Based Violence and Demand Side Barriers in the Utilization of Support Services in Urban Low-Income Communities of Nigeria.

Survivors of sexual and gender-based violence (SGBV) are often hindered in their quest to access quality healthcare. This has a significant effect towards the achievement of Sustainable Development Goal SDG Target 3.7. to ensure universal access to sexual and reproductive healthcare services. This study is focused on identifying some of the demand side barriers in accessing health care services, particularly among young girls who are survivors of SGBV within intimate relationships in poor urban areas in Nigeria. The study used an ethnographic approach to solicit information from health providers, adolescents, and young women (AYW) in 10 low-income communities in two major cities in Nigeria, Ibadan and Lagos. Findings showed that there are structural limitations within the primary health care (PHC) system that posed a great challenge for survivors of SGBV to access services. Some of these include non-existing counseling services, a lack of rehabilitation centers, poor referral, and a lack of training for health providers in handling survivors of SGBV. There is also a lack of skills among health service providers that have negative influence on support services to survivors of SGBV. On the demand side, poor knowledge of possible health seeking pathways, a lack of education, and social support are barriers to accessing appropriate services among adolescent and young SGBV survivors. The study concluded that integrated services at the PHC level should include adequate and timely treatment for survivors of SGBV and targeted intervention to upscale skills and knowledge of health care providers.

Digital health and Universal Health Coverage: Opportunities and policy considerations for low- and middle-income Pacific Island countries and territories

Introduction: Providing affordable, accessible, quality health services is critical to attaining Universal Health Coverage (UHC). Despite this, progress in many Pacific Island countries and territories could be faster. Digital health is an advancement in information communication technology that is anticipated to change health care delivery.
 Methods: A systematic review of the literature and 5-years of Pacific Heads of Health, Pacific Health Ministers, and WHO’s (Western Pacific) Regional Committee meeting reports was conducted. In addition, an umbrella review of the literature pertaining to digital health's use to address health systems challenges in low-and middle-income countries was undertaken and key-informant interviews with policymakers, digital health managers, technical advisors, development specialists, and donors were held. Data was thematically analysed using an inductive approach. Finally, a series of consultations were held with Pacific Health Information Network members to test findings and refine recommendations.
 Results/Discussion: Four broad UHC-related challenges and associated priority digital health responses were identified. The challenges identified were a need to: (i) build systems for the collection and timely exchange of health data to support clinical management and health system planning; (ii) address barriers to accessing quality health care services (particularly in rural areas); (iii) improve mechanisms for communication between health staff and functions of the health system, and (iv) address workforce training and essential skills development. Priority digital health responses identified include electronic health and patient information systems, telehealth, digital stock and supply chain management systems, technology-supported collection and linkage of population data, digitally enabled health worker-to health-worker communication and digital clinical decision-making.
 Conclusion: While digital health can enhance health system function through accelerated access to and exchange of information, it does not replace fundamental health systems components such as a sufficient skilled health workforce, supply chains, health reporting, financing, or governance. Where adopted appropriately, digital health offers opportunities to improve the efficiency and effectiveness of established health enterprises and improve access to equitable and quality health care.

Progress of island health in the Maldives

AbstractThe provision of equitable healthcare on remote islands is critical in the fight to attain the sustainable development goals (SDGs). Many island countries, particularly the Small Island Developing States (SIDS), are confronted with numerous obstacles to accessing quality healthcare. Many SIDS are located in the Asia‐Pacific region, and they suffer shared challenges such as a lack of infrastructure, logistical concerns, and a shortage of health staff. As a SIDS, the Maldives has made significant progress in the health sector, when compared to its neighbours. Part of this is due to spending a large portion of the national budget on the social sector, and a well‐structured health system. Despite these accomplishments, it continues to struggle to provide equitable health care across the whole nation, especially to the small and underpopulated islands. One contributing factor is the dispersed geography. The pandemic highlighted the importance of telemedicine and its capacity to bridge the barriers to healthcare delivery, and its potential in the Maldives is huge. There is also a need to strengthen integrated health services through primary healthcare, train a larger workforce, and upgrade hospitals to be able to provide comprehensive medical services. This will limit the frequency of travel to the capital and abroad in search of better healthcare.

Beyond Access: Can a School Health Initiative Facilitate Healthcare Services Utilisation for School-Going Children?

Accessing quality healthcare services is critical to addressing the different health challenges confronting school-going children, especially those in low-resource communities. However, the evidence of access to services is utilisation and not the mere availability of such services. This study explored caregivers' descriptions of the factors influencing the access and utilisation of quality healthcare services for school-going children and their perceptions of the services provided through the integrated school health programme in South Africa. Qualitative interviews were conducted with 17 caregivers of school-going children in three low-resource communities of KwaZulu-Natal province. The data was analysed using thematic analysis, and the themes were clustered using components of the Aday and Andersen framework for access. Despite the efforts to expand the coverage and range of services provided through the Integrated School Health Programme (ISHP), we identified various factors that undermine the overall aim of the ISHP. Financial constraints, distance to health facilities, poor communication and information dissemination systems, low literacy levels, healthcare workers' negative attitudes, and long waiting periods at the referral sites constitute barriers to service utilisation. Specific attention should be paid to improving the communication system between the school-health team and the caregivers, providing support for transportation, improving the attitude of the clinic staff, and providing follow-up services for children referred for further screening and treatment.

Utilization of health insurance by patients with diabetes or hypertension in urban hospitals in Mbarara, Uganda.

Diabetes and hypertension are among the leading contributors to global mortality and require life-long medical care. However, many patients cannot access quality healthcare due to high out-of-pocket expenditures, thus health insurance would help provide relief. This paper examines factors associated with utilization of health insurance by patients with diabetes or hypertension at two urban hospitals in Mbarara, southwestern Uganda. We used a cross-sectional survey design to collect data from patients with diabetes or hypertension attending two hospitals located in Mbarara. Logistic regression models were used to examine associations between demographic factors, socio-economic factors and awareness of scheme existence and health insurance utilization. We enrolled 370 participants, 235 (63.5%) females and 135 (36.5%) males, with diabetes or hypertension. Patients who were not members of a microfinance scheme were 76% less likely to enrol in a health insurance scheme (OR = 0.34, 95% CI: 0.15-0.78, p = 0.011). Patients diagnosed with diabetes/hypertension 5-9 years ago were more likely to enrol in a health insurance scheme (OR = 2.99, 95% CI: 1.14-7.87, p = 0.026) compared to those diagnosed 0-4 years ago. Patients who were not aware of the existing schemes in their areas were 99% less likely to take up health insurance (OR = 0.01, 95% CI: 0.0-0.02, p < 0.001) compared to those who knew about health insurance schemes operating in the study area. Majority of respondents expressed willingness to join the proposed national health insurance scheme although concerns were raised about high premiums and misuse of funds which may negatively impact decisions to enrol. Belonging to a microfinance scheme positively influences enrolment by patients with diabetes or hypertension in a health insurance program. Although a small proportion is currently enrolled in health insurance, the vast majority expressed willingness to enrol in the proposed national health insurance scheme. Microfinance schemes could be used as an entry point for health insurance programs for patients in these settings.

Barriers to Health Care for Transgender Individuals; Lisa A. Nelson, Kathleen Shurpin Stony Brook University

Abstract Introduction: The transgender non-conforming (TGNC) clients experience provider bias, erasure, refusal to treat and, violence. Aim: The purpose of this article is to identify barriers to health care for TGNC Individuals and discuss recommendations for Nurse Practitioner practice treating this population. Method: Literature review of prime research was conducted. Results: Evidence suggests barriers to TGNC health care, include lack of provider transgender knowledge and transgender sensitivity, lack of provider communication, lack of emotional and physical safe health care environments. Discussion: TGNC clients face barriers to accessing health care and specific recommendations to improve NP practice will decrease these barriers. Implications for practice: Lack of provider education affects transgender individuals accessing quality health care. Recommendations to improve NP practice are essential to improve care.

Impacts of language barriers on healthcare access and quality among Afaan Oromoo-speaking patients in Addis Ababa, Ethiopia

BackgroundEthiopia is a multilingual and multinational federation with Addis Ababa serving as both the capital city of Oromia regional state and the seat of the Ethiopian federal government. Nevertheless, only Amharic is considered as the working language of the city and federal offices, including hospitals. As a result, Afaan Oromoo-speaking patients may be facing language barriers in the healthcare settings in Addis Ababa. Language barriers have the capacity to affect patients’ experience of care and treatment outcomes. This study, hence, examined the impacts of language barriers on the healthcare access and quality for the Afaan Oromoo-speaking patients in public hospitals in Addis Ababa.MethodsIn-depth interviews with patients (N = 27) and key informant interviews with healthcare providers (N = 9) were conducted in six public hospitals found in Addis Ababa. All the interviews were audio-taped and transcribed verbatim. A thematic analysis technique was employed to address the study objectives.ResultsThe study participants indicated the widely existing problem of language discordance between patients and healthcare providers. The impacts of language barriers on the patients include preventable medical errors, low treatment adherence, low health-seeking behavior, additional treatment cost, increased length of hospital stays, weak therapeutic relation, social desirability bias, less confidence, and dissatisfaction with the healthcare. For the healthcare providers, language barriers are affecting their ability to take patient history, perform diagnoses and provide treatment, and have also increased their work burden. The use of ad hoc interpreters sourced from bilingual/multilingual patients, patient attendants, volunteer healthcare providers, and other casual people has been reported to deal with the problem of language barriers.ConclusionA significant number of Afaan Oromoo-speaking patients are facing language barriers in accessing quality healthcare in public hospitals in Addis Ababa, and this constitutes structural violence. As a way out, making Afaan Oromoo an additional working language of the public hospitals in Addis Ababa, the assignment of professional interpreters, and a hiring system that promotes the recruitment of qualified multi-lingual healthcare providers are suggested.

The 340B Program and Health Disparities Among Medicare Beneficiaries With Chronic Asthma.

The study objective was to determine whether the discounts provided under the 340B program help address disparities in drug treatment and adverse outcomes among Medicare Fee-For-Service (FFS) beneficiaries initially Medicare-diagnosed with moderate to severe chronic asthma. Using Medicare FFS claims data from 2017 to 2019, we conducted a cross-sectional study that compared risk-adjusted differences in 5 treatment measures and 5 adverse outcomes among beneficiaries treated within 340B and non-340B hospital systems that met the disproportionate share (DSH) criteria and the ownership classification requirement to qualify as a 340B DSH hospital. Our analysis focused on potential disparities that are historically associated with challenges to accessing quality health care. We did not observe fewer disparities in drug treatments or adverse outcomes for beneficiaries with moderate to severe asthma treated at 340B hospital systems compared to non-340B hospital systems. These results raise questions as to whether 340B hospital systems are effectively using discounts to focus on improved access and outcomes for vulnerable beneficiaries.

Identifying potential community barriers for accessing health care services context to health for all in rural-tribal geographical setting in India: A systematic review

This review article focuses on community barriers among tribes living in different parts of rural regions in India and placed to find out the possible resolution/passion. The access to health care services has a very low coverage in rural region of the country especially in tribal communities. A systematic search was covered since last two decades from 2000 to 2020 of articles were extracted from Google Scholar, PubMed, Science Direct, JSTOR, WHO portal, Research Gate, Census 2011, etc. The health indicators of tribes were originated alarming status quo as widely held malnourished and sufferer from different disease and illness. Findings towards accessing quality health care services revealed that difficult geographical situation, communication in own language, financial constraint, low level of education, illiteracy, approaching traditional medicine and ancient culture as community barriers were remained constant. Low level of education, strong cultural believes and traditional culture norms are the strongest community barriers reflected their self-decision-making for not accessing the modern health care facility. An approach as creating effective awareness in harmonic way could be useful for bridging the gaps by involving existing medical resources and staffs, which can play a critical role in reducing the barriers. Thus, review findings suggest the need for implementing awareness programs can divert towards quality health care and thereby can “connect the unconnected” to stay healthy.

The Experiences on Attempts and Challenges of Providing Free or Affordable Universal Health Care in Developing Countries: Review of Kenyan Situation

Ensuring the availability of quality and affordable health care for all citizens is a primary goal of every government. However, how they do it differs from country to country, but the bottom line is that many countries especially developing ones have challenges in providing accessible quality health care to all their citizens. Among the numerous approaches to providing health care to all, universal health care is the newest ‘kid in the block’ approach. Kenya has made numerous attempts to provide free or affordable health care to citizens but has encountered numerous challenges in the process. The approach has been mainly through health care reforms such as universal or categorical free health care or the introduction of health insurance and the expansion of its coverage. In Kenya, health care had been free since independence. Achieving quality health care requires concerted efforts aimed at diversifying and strengthening financing mechanisms and schemes as well as eliminating inefficiencies in health care. Moreover, there is a need to boost economic growth so as to raise GDP and income per capita which will go a long in improving the affordability of health care. This review article has looked at various mechanisms and challenges of financing health care in developing countries, with a particular focus on Kenya, in order to achieve universal health care. Nonetheless, there is a need for further research and comparative analysis on the cost-effectiveness of various financing mechanisms for health care in different countries. This is vital considering that health care is a right to all people.

The History of Medical Ethics in India

The History of Medical Ethics in India

P106 Where is the care in healthcare? Mother perspectives’ of caring for a child with narcolepsy

Abstract Introduction When caring for a child with a chronic illness, primary caregivers become care coordinators, system navigators, and illness experts. There is limited research on the challenges faced by family/carers of a child with narcolepsy. Methods Twenty participants who self-identified as a family/carer of a child with narcolepsy were interviewed, all of whom were mothers. Prior thematic analysis of submissions made by family/carers to the parliamentary inquiry informed interview questions. Interviews were analysed using the framework approach by a team of six multidisciplinary researchers. Results Three themes were identified. ‘Adjustment, communication and coping’ encapsulates challenges associated with diagnosis, the mental health toll it has on the whole family, and the limited support available to mothers. ‘Healthcare journey of narcolepsy families’ described challenges faced in the healthcare system, with mothers speaking of dismissal of their concerns and experiences of a lack of equity when accessing quality healthcare services for their child. ‘Independence, support, and resources’ unveiled the challenges carers faced accessing disability and academic supports at school and the workplace, underscoring mothers’ concerns for the future independence of their child. Discussion Mothers felt they had limited control over the trajectory of their child’s healthcare journey and emphasized the adverse psychological effect narcolepsy had on the entire family. There was an expectation that clinicians should be providing more information and support than currently is provided, across areas that traditionally are not within the healthcare domain. This raises important questions around who is responsible for providing this information and where is sourced from.

Mixed-methods study to assess an intervention for healthier lifestyles in primary healthcare

Abstract Background Smoking, physical inactivity, low fruit and vegetable consumption, and obesity are common in Kosovo. The Accessible Quality Healthcare project is implementing a primary healthcare intervention that entails nurse-guided motivational counselling to facilitate lifestyle behaviour change. This study assesses the uptake of counselling and the impact on health behaviours and participants’ stages of health behaviour change as well as describes experiences and perceived benefits of motivational counselling. Methods Study participants (n = 907) were recruited from 12 municipalities participating in the Kosovo Non-Communicable Disease Cohort study. For the quantitative study, data on lifestyle behaviours, use of counselling, and stages for behavioural change were used. For the qualitative study, in-depth interviews were conducted with 26 cohort participants who had undergone motivational counselling. Results Motivational counselling was received by only 22% of the eligible participants in the intervention municipalities. Unhealthy behaviours remain high even in persons who underwent counselling (of whom 13% are smokers; 86% are physically inactive; 93% with inadequate fruit and vegetable consumption; 61% are obese). According to the qualitative study results, the participants that received counselling were very satisfied with the services but requested additional services such as group physical activity sessions and specialized services for smoking cessation. Conclusions More tailored and additional primary healthcare approaches in accordance with patients’ views need to be considered for the motivational counselling intervention to reach patients and efficiently facilitate lifestyle behaviour change. Key messages • The following tailored approaches are suggested: a) strengthened referral mechanism b) specialized services for smoking cessation; c) delivery of group physical activity sessions. • More tailored and additional primary health care approaches in accordance with patients’ views need to be considered for the motivational counselling intervention.

Exposing Racial Bias to Confront Care Chasms: Innovations in the Sickle Cell Disease Curriculum at Rush Medical College.

Purpose: Sickle cell disease (SCD) is an autosomal recessive blood disorder that affects 100,000 Americans and 1 in 365 African American births. Individuals with SCD face lifelong complications, such as pain crises, infections, anemia, acute chest syndrome, gallstones, and strokes. Despite the severity and complexity of this condition, it is not uncommon for SCD patients to face significant challenges accessing quality health care. 1 Many providers have implicit biases surrounding treating pain crises with prescription pain medications, and others have not been adequately trained on how to prevent complications or identify changes in organ function. 2,3 Discontinuity of care, disease complexity, and the racialization of “drug seeking behavior” has led to poor outcomes, distrust of the health care system, and a failing therapeutic alliance. Approach: Our vision is to improve SCD patient care by empowering patients, improving care plans, and enhancing medical student education. The latter will be the focus of this abstract, and has been a key focus area in our efforts thus far. We started by formulating a survey to assess Rush students’ baseline knowledge in the domains of racial bias, health inequities, and pathophysiology (pulmonary, neurologic, hematologic, gastrointestinal, and immune systems). After uncovering gaps in knowledge, we began the process of transforming the preclerkship education modules to highlight the complex pathophysiology and psychosocial dynamics of SCD. Patient panels, antibias training, and lectures from specialists are key elements that we are working to incorporate. In addition, we are using Rush resources like the Micro-advocate Simulation Lab to teach empathy and advocacy skills. Outcomes: We gathered data on both preclerkship and clerkship students’ baseline knowledge level to gain insight into the optimal curricular design. Initial survey results of preclerkship students (MS2s, N = 77) in November 2021 showed that only 11.3% of respondents ranked their knowledge level as “knowledgeable/able to teach others about SCD”, with 47.9% of students ranking their knowledge level as “limited/low”. Particular knowledge gaps included medication mechanics, stem cell technology, important clinical labs and inflammatory markers, pathophysiology, screenings for pulmonary and neurologic function, blood transfusion criteria, and the politicization of the Sickle Cell Trait. Clerkship students (MS3s, N = 78) took a similar survey in August 2021, following a focused 2-hour workshop on SCD Pathophysiology & Bias that was piloted this year and featured personal reflections from three patients. Students showed an improvement in every knowledge domain, including qualitative knowledge regarding historic injustice. Of note, 76.8% of clerkship students agreed with the statement, “We need more training on the multiorgan system manifestations of SCD during M1 + M2 year.” Discussion: Our initial results underscore the importance of approaching curricular content with a critical lens that prioritizes equity, advocacy, and patient outcomes. Learners’ SCD knowledge grew significantly after interactive and informative modules that highlighted patient perspectives. Most learners felt these sessions would be best placed in the foundational preclerkship years alongside other “high yield” conditions like Cystic Fibrosis and Hemophilia (which each affect fewer than half the number of U.S. patients than SCD), further underlining the need to empower future generations of physicians to promote social justice. Significance: Our longitudinal project highlights the importance of making sustainable curriculum changes to include diseases that have traditionally been left out despite their prevalence, complexity, and severity. We are currently engaging in a myriad of other SCD initiatives, including planning a health fair in Lawndale, incorporating individualized pain plans into the EMR, designing training modules for different health care roles, and engaging in policy reform with our Illinois House Rep. We are hopeful that our efforts to address SCD-related health inequities will inspire innovative efforts at other hospitals, and we hope to collaborate with other institutions.

Inequalities in accessing quality healthcare, does insurance play a role? retrospective analysis of aortic emergencies from national inpatient sample 2019

Abstract Background Aortic emergencies, dissection and rupture, are rare but catastrophic entities, with the cornerstone to survival being prompt diagnosis and treatment. Insurance status often limits access to healthcare, and our study aims to determine if it plays a role in the outcomes of aortic emergencies. Method A retrospective analysis of the 2019 Nationwide Inpatient Sample was conducted to identify hospitalization (Age ≥18 &amp; non-elective) with aortic dissection and ruptured aortic aneurysms using ICD-10 codes. Discharge-level weight analysis was used to produce a national estimate. Variables were screened with univariate regression, and intermediate and co-linear variables were screened-out before a multivariable regression analysis model was built and performed to calculate the odds ratio. Results A total of 19,685 (0.06%) hospitalizations are identified for aortic emergencies (14965 dissections &amp; 4720 ruptured aneurysms). The mean age was 58.56, 62.7% were males, and ethnic distribution was 65.1% white, 19.5% blacks, 7.6% Hispanics, and others. 11.4% of the hospitalizations underwent diagnostic imaging with either CTA/MRA/TEE/Aortography within 24 hours. Hypotension/shock was present in 32% of these hospitalizations and was a risk factor for mortality OR 3.21 (p&amp;lt;0.00), increasing LOS by an average of 5.1 days and resource utilization by 156,000$. Another risk factor for mortality was stroke/TIA (OR-1.76, p&amp;lt;0.00), increasing LOS and resource utilization by 3.1 days and 80,662$, respectively. 3220 hospitalizations (16.4%) did not survive the course, and the mortality rate in uninsured, Medicare, and Medicaid was 17%, 20%,9% compared with 12% in privately insured. On crude analysis, uninsured and medicare patients appeared to have higher odds of mortality [OR 1.50, p&amp;lt;0.04, and OR 1.83 p-value &amp;lt;0.002 respectively], however upon adjusting for confounders, only uninsured patients showed statistically significant difference (OR 2.13, p&amp;lt;0.002). Similar results were corroborated on analyzing hospitalizations for aortic dissection; however, insurance status did not influence mortality in a ruptured aneurysm. When comparing hospitalization of median household income of ≥79,000$ with household of median income of 59,000–78,999 $, 46,000–58,999 $ and &amp;lt;46,000$ had higher odds of mortality (OR-1.38, p&amp;lt;0.04), (OR-1.44, p&amp;lt;0.02) and (OR-1.44, p&amp;lt;0.03) respectively. Of all the insurance types, a statistically significant difference compared with private insurance, Medicaid on average, had 2.8 more days and incurred an additional 62,912$ in resource utilization (p&amp;lt;0.00). Conclusion Inequalities in accessing healthcare, median household income, and insurance status are risk factors for mortality in aortic emergencies. Efforts are needed to bridge the gap in this particular facet of social determinants of health to find a sustainable and equitable solution for quality healthcare for aall regardless of their insurance status. Funding Acknowledgement Type of funding sources: None.

Investigating Healthcare Provider Bias Toward Patients Who Use Drugs Using a Survey-based Implicit Association Test: Pilot Study.

Negative bias against people who use illicit drugs adversely affects the care that they receive throughout the hospital. We hypothesized that emergency providers would display stronger negative bias toward these patients due to life-threatening contexts in which they treat this population. We also hypothesized that negative implicit bias would be associated with negative explicit bias. Faculty, nurses, and trainees at a midwestern tertiary care academic hospital were invited (June 26, 2019-September 5, 2019) to complete an online implicit association test and explicit bias survey. Mean implicit association test results did not vary across demographics (n = 79). There were significant differences in explicit bias scores between departments regarding whether patients who use drugs deserve quality healthcare access (P = 0.017). We saw no significant associations between implicit and explicit bias scores. Though limited by sample size, the results indicate that emergency and obstetrics/gynecology providers display more negative explicit bias toward this patient population than other providers.

Telemedicine and Telehealth: Gaining notoriety in scientific research during the COVID-19 pandemic

Background: Access to quality health services is a global challenge. However, telemedicine has been facilitating access to healthcare, especially since the advent of COVID-19. Objective: This review aimed to identify and highlight the main characteristics of research in telemedicine and telehealth, worldwide. Methods: This exploratory review employed a quantitative approach and searched the databases of Web of Science, Scopus, PubMed, SciELO, and SAGE for all fields that had the themes “telemedicine” and “telehealth” from the initial year, as per the databases, until 2020. Results: The exponential growth in research related to telemedicine and telehealth was evident; however, a substantial growth was observed in the year 2020 to provide quality care to distant places while observing safety criteria and cost-effectiveness. Moreover, thematic areas, methodologies, researchers, and university and organizational networks were also demonstrated. Conclusion: Telemedicine and telehealth enables quality healthcare access for all, even for those in remote areas, thus shortening distances between patients and health professionals.

The Impact of Stigma on Forensic Psychiatric Patients - a Case Report

AimsThe Royal College of Psychiatrists’ Fair Deal (RCPsych 2008) highlighted the far-reaching impact of stigma and discrimination on the lives of people with mental illness. The pervading nature of stigma has been acknowledged in recent national and international mental health policies (WHO). The World Health Organisation reiterates people affected by mental illness should not suffer social exclusion and marginalisation due to stigma.MethodsA sixty-year-old gentleman presented to the Emergency Department following self-inflicted stabbing to the neck resulting in pharyngeal tear and surgical repair. Previous psychiatric history included inpatient admission on Section 2 following a major depressive episode. On this admission, inpatient psychiatric review elicited three months of psychotropic medication non-adherence due to difficulties the patient had encountered in acquiring repeat medications from his GP. He had relapsed into alcohol misuse as a coping mechanism culminating in a suicide attempt at home with a knife. Upon recommencing of sertraline and risperidone during admission, he was assessed as euthymic with low risk to self. The patient had been previously abstinent from alcohol and described religion as a protective factor. Prior to discharge, the patient's GP stated he must present to the surgery in person with a form of identification. This is despite CQC guidance stipulating practices should not refuse patients registration if proof of identity cannot be produced.ResultsThis case illustrates the socioeconomic factors increasing likelihood of suicide including forensic history, low financial status, unstable housing and lack of social support. Substance dependence is a risk factor that can be reduced by supporting patients in accessing specialist misuse input from inpatient and community teams. The patient reported fear of stigmatisation and criminalisation which led to the avoidance of seeking treatment, deterioration in mental health and severe clinical consequences. It is imperative marginalised patients with mental illness can access quality health care and this starts with GP registration.ConclusionForensic mental health patients experience multiple stigmas impacting on well-being including social, institutional and media stigmatisation and high levels of internalised stigma. The Time to Change campaign focused on changing attitudes and behaviour however evaluation illustrated difficulties in tackling this issue. Healthcare professionals should be mindful to avoid stigmatising language and actions to ensure fairness in care. There is a need for the medical profession to continue striving for a tangible shift in attitudes. Advocating for those with mental illness can enhance quality of life for vulnerable patient groups.

Teaching Trans-Centric Curricular Content Using Modified Jigsaw.

IntroductionTransgender (trans) individuals have unique medical needs and difficulty accessing quality health care, exacerbated by inadequate provider knowledge. Incorporation of trans health care into medical school curricula has increased recently to address this gap. Jigsaw activities emphasize positive interdependence through structured cooperative learning, resulting in increased interest and self-confidence. We implemented a voluntary 2-hour modified jigsaw exercise on trans health care with changes designed to optimize the structure for medical students.MethodsThe session was implemented both in person and virtually over 2 years with preclerkship medical students at the end of their endocrine/reproduction physiology course. The session featured a knowledge test with answer discussion followed by a clinical correlation—either a case discussion or video discussion. A pre- and posttest design compared students’ knowledge, attitudes, and beliefs.ResultsEighty-nine students participated. Their initial attitudes and beliefs regarding trans health care were highly positive and remained elevated. Participants showed increases in knowledge and self-confidence discussing gender identity and clinical care postsession. All expressed interest in further training and felt the session enhanced their understanding of trans health and reproductive physiology. On 1-year follow-up, students showed decreased knowledge and self-confidence in discussing trans health; however, scores remained higher than presession. Student surveys suggested formal integration of more trans health education into the curriculum.DiscussionMedical students increased their knowledge and self-confidence regarding trans medicine and felt the modified jigsaw exercise was an effective teaching method. The results suggest that ongoing education is an important tool in optimizing trans health care.