Care Shortage Research Articles

Direct to Consumer Care in COVID-19 and Other Public Health Crises

Direct-to-consumer care (DTC) is a popular subset of telemedicine ideal for delivering large volumes of health care during a pandemic or other public health crisis conditions. DTC has the potential to relieve the burden of health care shortages and improve patient safety and outcomes during widespread disease. Below is a brief discussion exploring perspectives and evidence for DTC as a business modality, including the advantages and disadvantages of using DTC for providing health care during a pandemic.

How nursing students\u2019 placement preferences and perceptions of community care develop in a more \u2018community-oriented\u2019 curriculum: a longitudinal cohort study

BackgroundExtramuralisation in healthcare has influenced medical and nursing curricula internationally with the incorporation of themes related to primary/ community care. Despite this, students do not easily change their career preferences. The hospital is still favourite, leading to labour market shortages in extramural care. This study investigates how baccalaureate nursing students’ perceptions of community care and placement preferences develop over time in a more ‘community-care-oriented’ curriculum, to gain insights on which curriculum elements potentially influence career choices.MethodsA nursing student cohort of a University of Applied Sciences in the Netherlands (n = 273) underwent a new four-year curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). Data were collected each year of study. Descriptive statistics were used to investigate students’ placement preferences and perceptions, and linear mixed model techniques (LMMs) for measuring how students’ perceptions develop over time. Patterns of placement preferences at individual level were visualised.ResultsStudents’ perceptions of community care, as measured with SCOPE, show a slight decrease between year 1 and 4, while items mutually differ substantially. In contrast, the preference of community care for a placement increases from 2.6% in year 1 tot 8.2% in year 4. The hospital is favourite in year 1 (79.8%), and remains most popular. At individual level, students often change placement preferences, although a preference for the hospital is more consistent. The LMMs indicates that, at the four time-points, the estimated marginal means of students’ perceptions fluctuate between 6 and 7 (range 1–10). A placement in community care did not positively influence students’ perceptions, and an intensive 1 week theoretical programme was only temporarily influential.ConclusionsAlthough interest for placement in community care increased substantially, it was not clear which curriculum elements stimulated this, nor did the curriculum positively influence students’ perceptions. As most students do not look forward to the high responsibility of the field, other curricula with educational tracks for more mature students/ nurses with a vocational training may be an alternative contribution to solving the labour market problems in community care.

Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care.

The growing ranks of nurse practitioners (NPs) in rural areas of the United States have the potential to help alleviate existing primary care shortages. This study uses a nationwide source of claims- and EHR-data from 2017 to construct measures of NP clinical autonomy and complexity of care. Comparisons between rural and urban primary care practices reveal greater clinical autonomy for rural NPs, who were more likely to have an independent patient panel, to practice with less physician supervision, and to prescribe Schedule II controlled substances. In contrast, rural and urban NPs provided care of similar complexity. These findings provide the first claims- and EHR-based evidence for the commonly held perception that NPs practice more autonomously in rural areas than in urban areas.

Term Back / Detention Policy Revision Measures in Academic Medical and Allied Institutions of Pakistan in the COVID-19 Epidemic for the Session 2019-2020

The Pakistan Medical and Dental Council (PM&DC) is the body concerned for the medical and dental education in Pakistan.1 The council was dissolved by an order of the President of Pakistan in October 2019, 2 but the order was revoked by the decision of the High Court of Pakistan.3 According to the PM&DC return/detention policy, a medical student has two chances of exam for his promotion in the next academic class and if one of the students could not pass the two chances provided in at least one of his subjects, the student must pass the exam in 3rd attempt with loss of his / her academic year and must pursue medical studies with the junior class. If one of these students could not pass this or these subjects by exceeding the 3rd chance, the conceded institution offers the 4th and last opportunity to the student.1 If the student still cannot pass the subject in 4th and last opportunity, he is expelled from the establishment with the cancellation of his admission, and the dreams of such a student to become a doctor are fulfilled until he will only be readmitted upon reappearing in the PM&DC competitive entrance test. But due to the sudden and unexpected outbreak of Covid-19, the medical community was the most affected. In some countries, more death rates have been reported among physicians who performed Covid-19 patient care tasks.4 Due to the lockdown policy of Govt. of Pakistan across the country, academic medical institutions were closed as a result of academic months of medical and dental students have also been wasted like other academic fields. The lockdown has been continued and we expect further academic waste from these students. The Pakistan Higher Education Commission has asked for conducting online courses for these students, but the clinical subjects of medical students cannot be taught online as they require direct clinical exposure to patients for the transmission of learning. required. Therefore, as a result of Covid-19, there is expected to be a waste of courses from almost all students across the country. However, in such circumstances, detained / term-back students will suffer a greater and irreparable waste of time as there may be many other technical difficulties regarding the continuation of medical education and the examinations of these students due to the Covid-19 disaster. Therefore, it may be good to revise the Term-Back / Detain policy for these medical, dental, and related students. The authors made the following suggestions for the PM&DC and the institutions to consider this review.
 
 
 
 
 1) To Revise once the Term-Back / detention policy for the period 2019-2020 by allowing students to continue academic promotion during the next academic year with a unique relaxation in the policy.
 
 2) Students who have not passed four chances and who are expelled from the establishment can be relaxed to have an additional chance to continue their medical studies, applicable for the year 2019-2020.
 
 3) Relaxations are similar to those mentioned in the serial number. 1 and 2 for other courses such as Pharm-D, Bachelor of Nursing, etc.
 
 Health workers are the main force in the fight against Covid-19 in the exercise of their functions to manage the patients of Covid-19. Mortality rates among healthcare providers have also been reported due to high viral load. There may be a shortage of health care providers around the world. Therefore, facilitation attempts are necessary to help the bona fide medical profession maintain their numbers and needs in the health sectors and to meet the future needs of the world for these health workers. Consequently, in implementing the suggestions of the authors, hundreds to thousands of health professionals and paramedical services will be able to save and secure their future in the service of the sacred mission of saving and serving the sick community.

The influence of Jaminan Kesehatan Nasional (JKN) on the cost of delivery services in Indonesia.

The maternal mortality rate in Indonesia is still high, at 305 per 100,000 live births. Several studies indicated maternal financial burden as one of the dimensions of access that influence a pregnant woman’s ability to receive adequate, high-quality medical care. This study aims to identify the association between the use of Indonesia’s national health insurance (JKN) and out-of-pocket (OOP) expenditures in accessing delivery services, using data from the Indonesian Family Life Survey 5. In addition, this study also investigated the relationship of JKN and the potential reduction of catastrophic delivery expenditures (CDEs) for delivery services. The results show that JKN was associated with reduced OOP expenditures for delivery as well as reduced risk of incurring CDE. However, some OOP expenditure for cost of delivery services still exists among mothers who used JKN during delivery, potentially due to factors such as medicine stock availability and inpatient care shortages.

The Program for Enhanced Training in Cancer: An Initial Experience of Supporting Capacity Building for Oncology Training in Sub-Saharan Africa

PURPOSE Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals as a result of insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries. METHODS In its initial 2 years (2018 and 2019), the Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of 14 fellows for 3-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants before arrival and upon departure, and 8 participated in semistructured interviews. RESULTS Five themes emerged from the qualitative data: expectations of POETIC, differences in oncology between the United States and sub-Saharan Africa, positive elements of the program, areas for improvement, and potential impact. Fellows identified several elements of Western health care that will inform their practice: patient-centered care, research development, and collaboration among medical, radiation, and surgical oncologists. The time in Boston modeled a research infrastructure that participants expressed interest in emulating at their home hospitals. In addition, the fellowship inspired some participants to address prevention and survivorship efforts in their home countries. From the quantitative data, feedback was primarily around logistical areas for improvement. CONCLUSION POETIC was found to be feasible and valuable. The results from the first years justify the program’s continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future work will involve long-term follow up with participants and the development of an alumni network.

How advanced practice registered nurse practice barriers impact health care access in Michigan.

Despite the Affordable Care Act increasing the number of insured individuals in Michigan, many individuals cannot access care as the state continues to have a provider shortage that is likely to get worse. It is well documented that when individuals lack primary care access, their health suffers. Advanced practice registered nurses (APRN) could help reduce the state's health care shortage, as the care they provide is safe, cost effective, and high quality. Unfortunately, Michigan's APRN practice restrictions limit these professionals from autonomously providing care to the underserved and rural populations that need them the most. Indeed, Michigan is behind other states that offer full practice authority to APRNs, and its health outcomes reflect this stance. Eliminating the restrictive practice environment in Michigan will give citizens better access to primary care.

Health equity and distributive justice considerations in critical care resource allocation

Amid the possibility of resource shortages in health care during a public health crisis, guiding principles established by several groups advocate for allocating life-sustaining treatments on the basis of a patient's chances of survival, resulting in an approach of saving the most lives possible.1 To assist in this approach, many triage frameworks use acute illness scores to predict short-term mortality.1 The sequential organ failure assessment (SOFA)2 score has received attention as a mortality prediction tool during the COVID-19 pandemic and is likely to be used by hospitals in some manner as a triage tool.

Navigating the COVID-19 Pandemic: Lessons From Global Surgery.

Many hospitals in HIC rely on just-in-time inventory management, which can be an effective method to cut down on costs, as it calls for minimal reserves of healthcare supplies However, the widespread use of such strategies, which are reliant on consistent and tightly controlled supply chains, have made HIC vulnerable to PPE and supply shortages should demand sharply increase, as has been seen with the COVID-19 pandemic In some HIC hospitals, healthcare workers facing PPE shortages have already had to adopt common practices from LMIC, such as using bin liners instead of gowns and wearing reusable cloth masks HIC providers have also implemented evidence based adaptations, such as creating reusable elastomeric respirators, the development of open source ventilators, and reprocessing N95 masks using the hydrogen peroxide vapor sterilization technique Learning how LMIC providers manage resource limitations through global surgery collaborations can give surgeons working in HIC valuable perspective that has become increasingly relevant during the COVID-19 pandemic The rapid expansion of social media has facilitated such collaborations, and is a valuable tool for networking, mentorship, and information sharing Additionally, the rapid sharing of research findings via social media is enhancing our ability as a global health community to respond to this pandemic in a strong evidence based manner However, it is essential that social media be used responsibly, and that precautions are taken to prevent the spread of misinformation The most vulnerable populations, often linked to the underlying social determinants of health such as poverty, food security, literacy, sex, and racial and ethnic factors, are most at risk of adverse outcomes during these health and social shocks There is already data demonstrating that racial and ethnic minorities in the US and UK are at increased risk of death from COVID-19 Difficulty in accessing care for emergent conditions exists at baseline for these populations, and extensive backlogs for essential operations are commonplace, especially in LMIC This is likely only to get worse during the current crisis and underscores the importance of our professional commitment to health equity - regardless of geography New estimates of the "collateral damage" caused by the pandemic are very concerning and also illustrate the urgent need to mitigate this impact through local and global coordinated action

Analysis of Geographical Density of Dermatologists Compared to Dermatology Physician Assistants

In the past decade, the number of dermatologists in the United States (US) has increased, but distribution is skewed, with higher concentrations in academic centers and urban areas, resulting in a shortage in dermatological care.1,2 Non-physician practitioners, including, physician assistants (PAs), may fill this need, however, they are also unevenly situated.3 Therefore, our goals were to examine the distribution and ratio of dermatologists to dermatology PAs across the US.

COVID-19 During the Opioid Epidemic - Exacerbation of Stigma and Vulnerabilities.

COVID-19 During the Opioid Epidemic - Exacerbation of Stigma and Vulnerabilities.

Commentary: Embracing innovation is necessary to improve assessment and care for individuals with ASD: a reflection on Kanne and Bishop (2020).

This commentary is offered in response to Kanne and Bishop (2020) who urge caution in adopting new devices and processes for ASD assessment and advocate that that comprehensive, expert-driven, diagnostic models for ASD remain essential to maintain quality standards. While we agree that there is a critical shortage in current care, we propose that developing suites of tools and innovative approaches for screening, risk-classification, formal diagnosis, and rich assessment of abilities and challenges may be of great value to families and necessary to improve current systems of care. As well, the evaluation of 'assessment quality' should take into consideration both content and process, with a focus on achieving meaningful outcomes and optimizing family experience.

Examining variable nurse practitioner independence across jurisdictions: A case study of the United States

BackgroundNurse Practitioners have the potential to reduce primary care shortages for underserved populations. Yet, scopes of practice in some political jurisdictions (e.g. states, provinces) are more restrictive than others, and prevent Nurse Practitioners from working to the full extent of their training. The research is limited as to which intrastate or interstate characteristics contribute to understanding why scope of practice differences exist. ObjectivesTo estimate associations between intrastate/interstate characteristics and US state-level Nurse Practitioner Scope of Practice policy. Research designRetrospective study of state-level factors influencing Nurse Practitioner Scopes of Practice. SubjectsU.S. states from 2001 to 2015. MeasuresOur dependent variable is state-level Scope of Practice policy, indicating the extent to which Nurse Practitioners are autonomous in a state (Independent, Collaboration or Supervision). The intrastate characteristics that we include are numbers of Nurse Practitioners, Primary Care Physicians and rural hospitals per capita, state Board of Medicine governance and Nursing License Compact membership. We also measure the number of border-states that adopt specific policies in order to indicate the extent to which interstate characteristics influence focal states to adopt similar policies. ResultsAmong intrastate characteristics, we found that rural hospital concentrations (Odds Ratio=0.78; 95% Confidence Interval: 0.71–0.85) and Nursing License Compact membership (Odds Ratio=0.23; 95% Confidence Interval: 0.0–0.60) were associated with lower levels of restrictions, while Board of Medicine governance (Odds Ratio=27.36; 95% Confidence Interval: 5.75–130.20) was associated with increased levels of restrictions. Among interstate characteristics, higher numbers of border-states adopting Nursing License Compact membership (Odds Ratio=0.51; 95% Confidence Interval: 0.32–0.80) was associated with lower levels of restrictions. ConclusionsBarriers to Nurse Practitioner independence are largely attributable to unfavorable governance arrangements and non-participation in reciprocal licensing networks. Achieving Nurse Practitioner independence will require cooperation between nursing, medicine and policy makers. We offer some suggestions as to where parties interested in seeing increased Nurse Practitioner independence should focus their efforts when attempting to remove restrictions on Nurse Practitioner practice.

Global neurosurgery: a scoping review detailing the current state of international neurosurgical outreach.

Global neurosurgery is a rapidly emerging field that aims to address the worldwide shortages in neurosurgical care. Many published outreach efforts and initiatives exist to address the global disparity in neurosurgical care; however, there is no centralized report detailing these efforts. This scoping review aims to characterize the field of global neurosurgery by identifying partnerships between high-income countries (HICs) and low- and/or middle-income countries (LMICs) that seek to increase neurosurgical capacity. A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in five electronic databases and the gray literature, defined as literature not published through traditional commercial or academic means, to identify studies describing global neurosurgery partnerships. Study selection and data extraction were performed by four independent reviewers, and any disagreements were settled by the team and ultimately the team lead. The original database search produced 2221 articles, which was reduced to 183 final articles after applying inclusion and exclusion criteria. These final articles, along with 9 additional gray literature references, captured 169 unique global neurosurgery collaborations between HICs and LMICs. Of this total, 103 (61%) collaborations involved surgical intervention, while local training of medical personnel, research, and education were done in 48%, 38%, and 30% of efforts, respectively. Many of the collaborations (100 [59%]) are ongoing, and 93 (55%) of them resulted in an increase in capacity within the LMIC involved. The largest proportion of efforts began between 2005-2009 (28%) and 2010-2014 (17%). The most frequently involved HICs were the United States, Canada, and France, whereas the most frequently involved LMICs were Uganda, Tanzania, and Kenya. This review provides a detailed overview of current global neurosurgery efforts, elucidates gaps in the existing literature, and identifies the LMICs that may benefit from further efforts to improve accessibility to essential neurosurgical care worldwide.

Comparing quality of care in medical specialties between nurse practitioners and physicians.

The American health care system is facing a growing health care provider shortage in primary and specialty care settings. Research has established that nurse practitioners (NPs) match or exceed their physician colleagues in providing quality care in primary care settings. This systematic review aimed to compare the quality of NP versus physician-led care in outpatient specialty care setting for clinical outcomes patient satisfaction. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided the literature search (CINAHL, PubMed, and Cochrane Library) and interpretation of findings. Of the 228 articles that met the inclusion/exclusion criteria, 11 were selected for further review. Studies were conducted from 1995 to 2016 across four countries and spanned 10 distinct medical specialties. As a whole, these studies demonstrated that NPs in specialty settings perform as well as physicians terms of clinical safety and positive patient outcomes. Nurse practitioners matched or exceeded their physician counterparts in patient education and satisfaction. Nurse practitioners are a feasible option for addressing specialty care shortages. Further research should investigate whether NPs and physicians are equally prepared to provide equivalent care immediately following their respective postbaccalaureate programs. If not, studies should explore specific training duration and elements NPs require to provide equivalent care.

Elites, bureaucrats, and entrepreneurship in policy processes

Elites, bureaucrats, and entrepreneurship in policy processes

Outbreak of Respiratory Tract Infection Score (ORTIS): Objective Screening System for Children to Rule out COVID-19 and Prevent Nosocomial Spread

Since December 2019, over two million people worldwide have been affected by coronavirus disease 2019 (COVID-19). Because of quarantine measures, overcrowded healthcare facilities, fear of contracting the disease and forced behavioural modification to suspect every respiratory tract infection as a potential COVID-19 case - parents of sick children are hesitant to contact healthcare facilities in developing countries such as India. Acute shortage of specialist care has led to increased suffering of children affected by other diseases.

Evaluating the Feasibility and Acceptability of Internet-Based Cognitive Behavioral Therapy for Insomnia in Rural Women.

Background: Insomnia, one of the most common sleep disorders among women in midlife, is associated with multiple negative health outcomes. Rural Appalachian women are disproportionately affected by insufficient sleep, but their barriers to care (e.g., health care shortages, cultural norms) may prevent intervention. This study assessed the feasibility and acceptability of Sleep Healthy Using the Internet (SHUTi) an Internet-based version of cognitive behavioral therapy for insomnia in Appalachian women ages 45+ years.Materials and Methods: We used mixed methods to assess feasibility (through summaries of recruitment and retention data) and acceptability (quantitatively through online survey scales and qualitatively through interviews). Subject-level responses for satisfaction, adherence, and helpfulness scales were averaged over the multiple response domains and reported as percentages. Interviews were transcribed and coded using a multistage coding process.Results: Forty-six women (average age 55 years) enrolled; 38 completed the SHUTi program (retention = 82.6%). The majority of participants (61%) indicated that SHUTi made things “somewhat better” or “a lot better.” Seventy-six percent reported that they followed the SHUTi protocol “most of the time” or “consistently.” Most participants (84%) ranked SHUTi as “moderately” or “very” helpful. Participants expressed enthusiasm about SHUTi and offered minor suggestions for improvement.Conclusions: This study was the first to asses SHUTi in the health disparity population of Appalachian women. Rich insights gained through quantitative and qualitative data suggest that SHUTi was feasible and acceptable for middle-aged Appalachian women. Given rural Appalachian women's documented barriers to utilizing technology, these results hold promise for SHUTi's utility in other rural populations. Future research should incorporate a randomized case–control design within a larger sample and consider participants' suggestions for improvement.

Why do pregnant women in Iringa region in Tanzania start antenatal care late? A qualitative analysis

BackgroundWhen started early in pregnancy and continued up till childbirth, antenatal care (ANC) can be effective in reducing adverse pregnancy outcomes. While the proportion of women who attend ANC at least once in low income countries is high, most pregnant women attend their first ANC late. In Tanzania, while over 51% of pregnant women complete ≥4 visits, only 24% start within the first trimester. This study aimed to understand the factors that lead to delay in seeking ANC services among pregnant women in Tanzania.MethodsThis qualitative descriptive case study was conducted in two rural districts in Iringa Region in Tanzania. A total of 40 focus group discussions (FGDs) were conducted involving both male and female participants in 20 villages. In addition, 36 semi-structured interviews were carried out with health care workers, members of health facility committees and community health workers. Initial findings were further validated during 10 stakeholders’ meetings held at ward level in which 450 people participated. Data were analysed using thematic approach.ResultsKey individual and social factors for late ANC attendance included lack of knowledge of the importance of early visiting ANC, previous birth with good outcome, traditional gender roles, fear of shame and stigma, and cultural beliefs about pregnancy. Main factors which inhibit early ANC attendance in Kilolo and Mufindi districts include spouse accompany policy, rude language of health personnel and shortage of health care providers.ConclusionsTraditional gender roles and cultural beliefs about pregnancy as well as health system factors continue to influence the timing of ANC attendance. Improving early ANC attendance, therefore, requires integrated interventions that address both community and health systems barriers. Health education on the timing and importance of early antenatal care should also be strengthened in the communities. Additionally, while spouse accompany policy is important, the implementation of this policy should not infringe women’s rights to access ANC services.

Does Exposure to Primary Care Early in the Didactic Phase of the Physician Assistant (PA) Curriculum Influence Field Choice Post-Graduation?

BackgroundOver the past 10 years, the nation has witnessed a significant increase in the number of physician assistant (PA) education programs. Primary care shortages throughout the United States have reached a staggering deficiency. The purpose of this project was to expand the primary care workforce in the Commonwealth of Virginia by increasing exposure to primary care setting early in the academic didactic year of physician assistant schooling.MethodsThis innovative research project originated in 2017 and was inclusive of PA students ranging from 20 to 44 years of age, across multiple demographics, conducted during the first year of didactic studies. This cross-sections study examined a total size of 115 students over from three different cohort years that participated in the free medical clinic completed a pre/post exposure survey.ResultsThis study highlighted that an increased exposure to primary care in the early didactic phase of physician assistant graduate studies yielded a moderate increase in the interest to pursue a career in primary care upon graduation. Throughout the 2016 to 2017, 2017 to 2018, and 2018 to 2019 academic cohorts, 19% more from baseline indicated at the end of their primary care experience that they were more likely to practice in the field of primary care following the free medical clinic experience.ConclusionsThis study demonstrates a positive influence of early exposure to primary care for Physician Assistant students with the increased affinity to practice in the field upon graduation and has set a foundation for continuation of data collection in future PA cohorts.