Disparities In Access To Health Care Research Articles

Challenges in provision of anesthesia to transgender patients in India: A scoping review

Abstract The care of transgender individuals has gained increasing attention in health-care settings, encompassing a wide range of medical specialties. Anesthesia is vital in perioperative care for them despite challenges like health-care access disparities, stigma, and discrimination. As they undergo routine surgeries or specific gender-affirming surgeries, anesthesia providers must be cognizant of anatomical, physiological, and psychosocial considerations that may impact the perioperative experience. Anesthesia for transgender individuals requires gender identity assessment, understanding of surgical needs, hormone therapy impact, preoperative assessments evaluating comorbidities, medication history, and psychosocial factors. Anesthesiologists should modify airway care and pain management techniques to accommodate patients’ preferences and gender-affirming surgical goals. They should also take into account any potential differences in the airways of transgender patients and optimize postoperative pain management in accordance with each patient’s particular surgical recovery. This article aims to focus on the perioperative care of transgender individuals, highlighting the distinct challenges encountered and potential solutions to address these unique issues.

Healthcare Disparities among Socioeconomic Groups

Purpose: This study sought to explore the socioeconomic factors contributing to disparities in healthcare access and outcomes. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to healthcare disparities among socioeconomic groups. Preliminary empirical review revealed that individuals from lower socioeconomic backgrounds faced multiple barriers to healthcare access, leading to inequalities in health outcomes. The study highlighted the complex interplay between social factors such as income, education, and wealth, emphasizing the need for comprehensive, multisectoral approaches to address healthcare disparities. Despite progress, gaps in research, policy, and practice remained, underscoring the importance of continued efforts to achieve health equity through collaborative initiatives and evidence-based interventions. Unique Contribution to Theory, Practice and Policy: The Social Determinants of Health theory, Health Benefit model and Critical Medical Anthropology theory may be used to anchor future studies on healthcare disparities among socioeconomic groups. The study provided comprehensive recommendations to advance theory, practice, and policy. It contributed to theoretical frameworks by highlighting the complex interplay between socioeconomic factors and healthcare disparities. In practice, it emphasized the importance of patient-centered care and collaborative models to address social determinants of health. Policy recommendations focused on structural interventions to improve social and economic conditions and expand healthcare coverage. Capacity building efforts aimed to enhance skills and competencies, while improved data collection and monitoring systems were advocated for tracking progress. Finally, a research agenda prioritized understanding the mechanisms underlying disparities and evaluating intervention effectiveness. These recommendations aimed to promote health equity and ensure equitable access to healthcare services.

Disparities in Telemedicine Use among Native Hawaiian and Pacific Islander Individuals Insured through Medicaid

Abstract States have implemented policy changes to increase access to telemedicine services for individuals receiving Medicaid benefits. Native Hawaiian and Pacific Islander (NHPI) individuals suffered disproportionate harms from COVID-19 and have long experienced disparities in health care access compared to other racial and ethnic groups, making the issue of telemedicine access particularly salient for NHPI individuals on Medicaid. Utilizing 100% 2020-2021 Medicaid claims, we compared trends in telemedicine use between NHPI and non-Hispanic White individuals on Medicaid in Washington State and conducted a decomposition analysis to identify drivers of underlying disparities. In both years, NHPI individuals were 38-39% less likely to use any telemedicine than White individuals after adjusting for patient- and area-level characteristics. Decomposition analysis revealed that most of this difference was due to differential effects of characteristics, rather than group differences in characteristics. Namely, several characteristics that were associated with increased telemedicine use had more muted associations for NHPI versus White individuals, such as English as primary spoken language and female sex. These findings suggest the presence of limited acceptability of or group-specific barriers to telemedicine for NHPI individuals, including potential discrimination in being offered telemedicine visits. These issues should be understood and mitigated through close collaboration between health care leaders and NHPI communities.

Health system inequities in Lao People's Democratic Republic: Evidence from a nationally representative phone survey.

Despite substantial economic growth in Lao People's Democratic Republic (PDR) over the past 20 years, high levels of income inequality and poverty persist and have likely been exacerbated by the COVID-19 pandemic. In this article, we use novel survey data to assess the extent to which socioeconomic status is associated with access to quality care in Lao PDR. We utilised data from the Lao People's Voice Survey (PVS), which was designed to measure health system performance from the perspective of the population. The survey was conducted between May and August 2022. Primary outcomes of interest were having a usual source of healthcare, using a government health centre (rather than a hospital or private clinic) as the usual source for care, receiving preventive health services, experiencing unmet healthcare needs, the quality of recent healthcare visit, and confidence in accessing and affording healthcare when needed. Poverty was measured using household asset ownership. We used logit models to assess the associations between poverty and health system performance measures, and additionally assessed differences between these associations in urban vs. rural areas by interacting urban residence with poverty. Poverty was negatively associated with having a regular provider for care (adjusted odds ratio (aOR) 0.45, 95% CI 0.26-0.78), receiving preventive health services (aOR 0.54, 95% CI 0.37-0.80), and confidence in the ability to receive care (aOR 0.50, 95% CI 0.34-0.72) and afford care (aOR 0.50, 95% CI 0.34-0.73) when needed. Poverty was positively associated with using government managed health centres as a usual source or for care (aOR 2.16, 95% CI 1.35-3.48). Poverty was not significantly associated with user experience or perceived quality of care in the last visit to the health facility. No differences in the associations between poverty and access to quality care were found between rural and urban settings. The results presented in this article suggest socioeconomic disparities in health care access in Lao PDR despite major national efforts to provide universal access to care. Universal health care policies may not be reaching the poor and additional targeted efforts may be needed to meet their healthcare needs.

Can We Realize a Real State of Medical Equity?

Achieving a real state of medical equity remains a challenging and complex goal within the healthcare system. Despite efforts to address disparities in healthcare access, treatment, and outcomes, significant barriers persist for marginalized communities. Structural inequalities rooted in race, socioeconomic status, geography, and education play a critical role in perpetuating inequities in healthcare delivery. To realize true medical equity, it is imperative to address these underlying factors through innovative policies and initiatives that prioritize equitable resource allocation, culturally competent care practices, and community engagement. Collaborative efforts between policymakers, healthcare providers, researchers, and community leaders are essential to reshaping our current healthcare system and ensuring that all individuals have equal opportunities to receive high-quality, person-centered care regardless of their background or circumstances. By working together towards the common goal of achieving medical equity, we can create a more just and inclusive healthcare system for everyone.

Exploring experiences and perspectives of inclusivity amongst community pharmacists in their practice: a survey study

Abstract Introduction Inclusive healthcare is an essential component of promoting sustainable good health and wellbeing. The General Pharmaceutical Council (GPhC) published their equality, diversity, and inclusivity (EDI) strategy 2021-2026 to tackle discrimination and reduce health inequalities;[1] however, there are still significant disparities in healthcare access and outcomes faced by minority groups. Discrimination leads to higher rates of distrust, non-adherence, and poorer physical and mental health outcomes.[2] Community pharmacists can break down barriers to healthcare, but must feel a sense of inclusion themselves. Aim To explore the experiences and perspectives of inclusivity amongst community pharmacists in their practice, including training, and to investigate inclusivity-related interventions available in pharmacies. Methods Following a pilot study with 14 pharmacists, an online survey using Google Forms was distributed via email to 335 community pharmacists (based on Raosoft calculator at 95% confidence interval) in multiple London boroughs within a two-month period. To maximise response rates, paper surveys were distributed in person to pharmacies. The survey comprised 48 mixed-style questions, and was divided into four sections: experiences of inclusivity and discrimination, inclusive services provided in the pharmacy, pharmacist training, and demographics. The data were analysed using descriptive and inferential statistics, using Microsoft Excel and SPSS. Results The response rate was 55% (n=184/335). 72% were <40 years old. 55% were men, 43% women and 2% identified as ‘Other’. 59% pharmacists were Asian, 7% Black (of any origin), 4% White and 32% ‘Other’ (including mixed heritage). 68% worked in independent pharmacies (<4 branches), 27% in small chains and 25% in large chains (>10 branches). 18% (n=33) self-reported they had experienced discrimination, primarily from patients (88%; n=29/33), with the majority experiencing racial discrimination (79%; n=26/33), followed by 30% (n=10/33) against age. A higher proportion (24%; n=44) experienced microaggressions and 25% (n=47) reported witnessing discrimination against a patient or colleague, with 98% (n=46/47) witnessing racial discrimination. Pharmacists who had experienced microaggression were statistically less likely to feel included in the workplace. Despite this, 86% (n=159) felt their services were inclusive. However, low levels of pharmacies offered sign language interpreters (3%; n=5), pictograms (11%; n=21), pronoun badges (13%; n=23) and hearing loop systems (19%, n=35), the latter of which large chain pharmacies were statistically more likely to provide. 43% (n=79) have completed some EDI training, but under a quarter of pharmacists undertook focused training, for example, identifying skin conditions on different skin tones (22%; n=17), or making services inclusive to the LGBTQ+ community (8%, n=6). Conclusion Although limited with a relatively small sample size, and limited but diverse geographical area, the findings suggest discrimination continues to persist in community pharmacy, especially related to race.[2] Accessible and culturally responsive resources such as discrimination reporting mechanisms are necessary. Although most pharmacists felt their services were inclusive, the findings demonstrate this was lacking in most pharmacies, with issues surrounding funding and structural barriers. Pharmacists must raise their awareness of simple, effective measures such as free pronoun badges but also require specific EDI training to fulfil their potential as inclusive practitioners.

Agents of Change: Geriatrics Workforce Programs Addressing Systemic Racism and Health Equity.

Many factors impact how individuals and populations age, including race, ethnicity and diversity, which can contribute to increased disease risk, less access to quality health care, and increased morbidity and mortality. Systemic racism - set of institutional policies and practices within a society or organization that perpetuate racial inequalities and discrimination - contributes to health inequities of vulnerable populations, particularly older adults. The National Association of Geriatrics Educators (NAGE) recognizes the need to address and eliminate racial disparities in healthcare access and outcomes for older adults who are marginalized due to the intersection of race and age. In this paper, we discuss an anti-racist framework that can be used to identify where an organization is on a continuum to becoming anti-racist and to address organizational change. Examples of NAGE member Geriatric Workforce Enhancement Programs (GWEPS) and Geriatrics Academic Care Awardees (GACA) activities to become anti-racist are provided to illustrate the framework and to guide other workforce development programs and healthcare institutions as they embark on the continuum to become anti-racist and improve the care and health of vulnerable older adults.

Cost-Effectiveness Analysis of Using Digital Platforms to Alleviate the Gap in Access to Healthcare Services for the Elderly in China

The issue of healthcare access has transcended individual concerns to become a major societal challenge, especially in the context of an aging population. The problem of access to health care has led to a growing healthcare divide. The approach presented in this paper aims to delve into the intricate interplay of social, economic, political, and cultural determinants, the reasons why these factors contribute to the widening disparities in healthcare access experienced by older adults, and the proposed feasible solutions. The implementation of this solution requires a multi-faceted strategy, including an important part - hypothesis-driven experimental research driven by university student volunteers. By proposing hypothetical principles and analyzing data to make a comprehensive economic assessment, this paper aims to propose a pragmatic solution to this pressing problem. Ultimately, we aim to significantly mitigate disparities in healthcare access for older adults, aiming to minimize the impact of the problems of older adults themselves due to the uneven distribution of physician resources, and insufficiently comprehensive government policies.

Health Care Facilities for Unorganised Sectors - Beedi, Cine, and Non-Coal Mine Workers: A Comprehensive Sociological Overview

This paper provides an in-depth review of healthcare facilities for unorganized sector workers in general and particularly in India. It also looks into the systemic lapse ealier in all governments across the globe and a serious and administrative, logistical support now being provided to the unorganised workers in India, particularly focusing on beedi workers, cine industry employees, and non-coal mine workers. Based on a systematic review of existing literature and analysis of dispensary-wise patient data from February 2024, sourced from the Directorate General of Labour Welfare, the study illuminates the disparities in healthcare access and quality across different states. The data includes a detailed breakdown of patient visits across 206 dispensaries, highlighting the heavier reliance on static (on-site) healthcare services compared to mobile services, with notable variations among states such as Karnataka and Madhya Pradesh. This quantitative analysis is graphically represented through charts that depict the distribution of healthcare services and the socio-economic factors influencing healthcare utilization in these sectors. Through critical evaluation of literature the review explores the necessity for more inclusive health insurance schemes and enhanced private sector involvement to mitigate the healthcare challenges faced by these workers. The findings suggest a significant gap in the provision and utilization of healthcare, influenced by logistical, financial, and informational barriers. Recommendations include the implementation of targeted health interventions, expansion of mobile health units, and the development of comprehensive health insurance models that cater specifically to the needs of the unorganized sectors. The study contributes to the broader goal of achieving health equity and improving socio-economic outcomes for these essential yet vulnerable segments of the workforce. Keywords: Unorganized sectors, healthcare accessibility, data analysis, health disparities, beedi workers, cine workers, non-coal mine workers, India, health policy, empirical research.

LEADERSHIP IN GLOBAL HEALTH: NAVIGATING CHALLENGES AND OPPORTUNITIES FOR IMPACTFUL OUTCOMES IN AFRICA AND SRI LANKA

Effective leadership is paramount in addressing the complex challenges and harnessing the opportunities in global health, particularly in regions such as Africa and Sri Lanka. This review explores the multifaceted dimensions of leadership within the context of global health, highlighting the unique challenges and opportunities faced by these regions. In Africa, leadership in global health is confronted with a myriad of challenges including limited resources, political instability, and infrastructural deficiencies. The burden of infectious diseases, inadequate healthcare access, and socio-economic disparities further exacerbate the complexities. However, amidst these challenges lie opportunities for transformative leadership. Visionary leaders can leverage partnerships, innovative technologies, and community engagement to strengthen health systems, promote preventive healthcare, and address the root causes of health inequities. Similarly, in Sri Lanka, leadership in global health faces its own set of challenges and opportunities. Despite notable achievements in healthcare infrastructure and disease control, the country grapples with emerging health threats, non-communicable diseases, and disparities in healthcare access. Effective leadership is essential in mobilizing resources, fostering intersectoral collaboration, and implementing evidence-based interventions to ensure equitable health outcomes for all segments of the population. In both regions, transformative leadership in global health necessitates a multidisciplinary approach that integrates political commitment, scientific innovation, and community participation. Leaders must possess strong communication skills, cultural competence, and a deep understanding of local contexts to navigate the intricate socio-political landscapes. Furthermore, fostering leadership capacity at all levels of the healthcare system is crucial for sustainability and resilience in the face of evolving health challenges. By examining the challenges and opportunities for leadership in global health within the contexts of Africa and Sri Lanka, this review underscores the importance of visionary leadership in driving impactful outcomes. Empowering leaders to navigate complexities, foster collaboration, and innovate solutions is essential for advancing the global health agenda and achieving health equity on a global scale.
 Keywords: Leadership, Global Health, Africa, Sri Lanka, Healthcare, Review

Telemedicine in diabetic eye care: A meta-analysis of its effectiveness in underserved populations

Telemedicine has emerged as a promising tool in diabetic eye care, particularly for underserved populations facing barriers to accessing traditional healthcare services. This meta-analysis aims to evaluate the effectiveness of telemedicine interventions in managing diabetic eye conditions within underserved communities. Through a systematic review of existing literature, encompassing diverse telemedicine approaches such as remote screening, teleconsultation, and telemonitoring. These studies were conducted across various regions with underserved populations, including rural areas, low-income urban neighborhoods, and underserved ethnic groups. The meta-analysis revealed significant improvements in several key outcome measures. Firstly, telemedicine interventions led to increased rates of early detection of diabetic retinopathy and other diabetic eye complications, facilitating timely intervention and preventing progression to more severe stages of the disease. Secondly, telemedicine facilitated better access to specialist care, overcoming geographical barriers and reducing the burden of travel for patients. Thirdly, telemedicine interventions were associated with improved patient compliance with follow-up appointments and treatment regimens, leading to better long-term management of diabetic eye conditions. Moreover, subgroup analyses revealed that telemedicine was particularly effective in reaching vulnerable populations such as elderly individuals, those with limited mobility, and ethnic minorities, thereby addressing disparities in healthcare access. Telemedicine holds great promise as an effective tool for diabetic eye care in underserved populations, offering a scalable and cost-effective approach to improving access to timely screening, diagnosis, and management of diabetic eye conditions. Further research and implementation efforts are warranted to optimize telemedicine interventions and ensure equitable access to quality eye care for all.

“Neutrality Is Affirming”: How Do Sexual and Gender Minority Adults Find and Define Affirming Healthcare?

Sexual and gender minority (SGM) individuals have unique healthcare needs yet frequently encounter negative healthcare experiences. These negative encounters with the healthcare system may lead to SGM individuals delaying or avoiding healthcare, which may exacerbate health disparities. We sought to qualitatively examine the healthcare experiences of SGM adults to better understand how SGM adults define SGM-affirming healthcare experiences. We also aimed to add to the literature by asking SGM participants about their future aging and healthcare concerns such as family involvement in medical decisions and end-of-life care. Nineteen semistructured individual interviews were conducted with SGM adults to gather information about the process of finding an SGM-affirming provider, coming out in a medical setting, the components of affirming care, the results of affirming care, the components of nonaffirming care, the consequences of nonaffirming experiences, and aging concerns regarding healthcare. A thematic analysis approach was used to analyze interview data. Results showed unique insights into the techniques used to find SGM-affirming providers and what SGM adults hope for in their healthcare encounters. This qualitative study builds on a body of literature that has documented significant disparities in healthcare access and quality for SGM individuals. The results of this study highlight important aspects of SGM-affirming care, outline understudied healthcare concerns for SGM people, and may guide healthcare providers in improving the quality-of-care experiences for their SGM patients.

Necessary, burdensome, or threatening? Awareness of Black-White disparities in health care access and self-rated health for Black and White Americans.

Awareness of racial health care inequities is one prerequisite to eliminating them. Although extant research has described awareness of racial health care inequities in the United States, the health impacts of such awareness on communities that are most impacted by these inequities remains unknown. Therefore, we examined associations between awareness of Black-White racial health care inequities and self-rated health for Black and White adults in the United States. We used survey data from non-Hispanic Black and White participants (N = 6,449) who responded to the national American Health Values Survey (2015-2016) to test associations between awareness of Black-White inequities in health care and self-rated health. Accurate awareness of health care inequities was associated with 47% higher odds of poorer self-rated health for Black individuals. Inaccurate awareness was associated with 36% higher odds of poorer self-rated health for White individuals. Accurate awareness may be adaptive, yet place an additional burden on Black individuals. Inaccurate awareness may harm White individuals' health. Health care system changes and alleviation of racism-related stress may be preventive supports for the health of Black individuals. Accurate awareness should be a goal for White individuals, not only to prevent health risks, but to also facilitate structural change for racial equity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Access to Healthcare Among Young Adult Probationers Participating in a Pilot Health-Focused Reentry Program.

Justice-involved adults experience disparities in healthcare access. This pilot study examines healthcare access among young adult probationers (n = 66) receiving 6-months of Service Navigation and Health Coaching support implemented between 2017 and 2021. Data are from baseline, 6-month follow-up and satisfaction surveys. Between baseline and follow-up, the proportion of insured young adult participants (66%-88%; p < .001) and those using healthcare services (36%-71%; p < .001) increased significantly; report of unmet physical healthcare needs decreased significantly (44%-26%; p = .003). Satisfaction data revealed increased self-efficacy, motivation, focus, and improved organizational, goal setting, and communication skills. The program improved healthcare access by increasing health insurance and recent use of healthcare services. Longitudinal studies are needed to assess maintenance of these outcomes and potential impacts on disparities in health status and access to care indicators. Integrating navigation and coaching supports to advance the well-being of justice-involved young adults is a promising mechanism to facilitate healthcare access.

Inequalities in time to diagnosis of Down Syndrome in Bolivia

Down Syndrome is the most common genetic condition and a leading cause of intellectual disability. Individuals in rural areas, particularly those with disabilities, often face disparities in healthcare access. Analyzing clinical records of patients diagnosed with Down Syndrome between 2013 and 2022 by the Institute of Genetics at the Universidad Mayor de San Andrés in La Paz, Bolivia, this study examined the time to diagnosis for 250 patients with Down Syndrome. The findings revealed that patients from rural areas with Down Syndrome take an average of five months to receive a diagnosis, compared to two months in urban areas (p<0.001). No significant differences were found in the time to diagnosis based on gender. However, a higher proportion of males from rural areas was observed (p=0.03). The results suggest that individuals in rural areas face challenges in receiving a timely diagnosis. On the other hand, women may not be brought to cities for proper diagnosis and treatment due to gender biases in certain communities. The importance of improving access to early diagnosis and treatment in rural areas is emphasized.

Epidemiology of Irritable Bowel Syndrome in a Large Academic Safety-Net Hospital.

(1) Background: Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut-brain interaction (DGBI) that is known to reduce the quality of life and raise healthcare costs. The aim of this study was to describe the epidemiology of IBS in a large multiracial academic safety-net hospital. (2) Methods: An electronic query was performed using ICD-9 codes to identify 740 IBS outpatients seen at the Boston Medical Center (BMC) between 1 January 2005 and 30 September 2007. Demographic data were collected from electronic medical records. Bivariate analyses using chi-square tests and ANOVA were used to calculate the significance of categorical and continuous dependent variables, respectively. (3) Results: Compared with the general BMC outpatient population, the IBS cohort consisted of significantly higher proportions of White and Asian patients and lower proportions of Black and Hispanic patients (p < 0.0001). White and Asian patients predominantly had private insurance, while Black and Hispanic patients mostly had government/state-funded or no insurance (p < 0.0001). The IBS subgroup frequencies were similar across racial groups; however, Hispanic patients had IBS with constipation (32%, p < 0.02) more often compared to non-Hispanic patients. (4) Conclusions: Significant differences were found across the racial groups studied in this large outpatient IBS cohort. These findings are likely attributed to racial and socioeconomic disparities in healthcare access and utilization.

Factors Associated with Delayed Care Among Women Veterans Actively Engaged in Primary Care.

Background: Delaying needed medical care contributes to greater health risks and higher long-term medical costs. Women Veterans with complex medical and mental health needs face increased barriers to timely care access. Objectives: In a sample of women Veterans with recent engagement in Veterans Administration (VA) primary care, we aimed to compare characteristics of women Veterans who delayed care in the past 6 months with those who did not and examine factors associated with self-reported delayed care. Our study aims to inform interventions focused on eliminating health care access disparities among women Veterans. Materials and Methods: An innovation to improve women Veterans' engagement and retention in evidence-based health care for cardiovascular (CV) risk reduction (CV Toolkit) was implemented across five primary care sites within the VA. Women Veterans who were exposed to at least one CV Toolkit component participated in a mailed survey (n = 253). We used multivariate logistic regression to model factors associated with delaying care, including trust in VA providers, positive mental health screening (i.e., positive screen for either depression or anxiety), traumatic experience, self-rated health, and age. Results: Women with any mental health symptoms (odds ratio [OR] 2.42, 95% confidence interval [CI]: 1.23-4.74) and women who had experienced a traumatic event (OR 2.61, 95%CI: 1.11-6.14) were significantly more likely to report delaying care. Conclusions: Our study identified high rates of delayed care-over one-third of respondents-among women Veterans with recent primary care engagement. Mental health symptoms were the most common reported reason for delay among those who delayed care. Clinical Trial registration: NCT02991534.

Evaluating geographical disparities on clinical outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BackgroundRural Australians typically encounter disparities in healthcare access leading to adverse health outcomes, delayed diagnosis and reduced quality of life (QoL) parameters. These disparities may be exacerbated in advanced malignancies, where treatment is only available at highly specialised centres with appropriate multidisciplinary expertise. Thus, this study aims to determine the association between patient residence on oncological, surgical and QoL outcomes following cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC).MethodsA retrospective analysis was conducted on consecutive patients undergoing CRS and HIPEC at Royal Prince Alfred Hospital from January 2017 to March 2022. On the basis of their postcode of residence, patients were stratified into metropolitan and regional groups. Data encompassing demographics, oncological, surgical and QoL outcomes were compared. Statistical analysis included chi-square test, t-tests and Kaplan–Meier survival curves.ResultsAmong the 317 patients, 228 (72%) were categorised as metropolitan and 89 (28%) as regional. Metropolitan patients presented higher rates of recurrence (61.8% versus 40.0%, p = 0.014) and shorter overall mean survival [3.8 years (95% CI: 3.44–4.09) versus 4.2 years (95% CI: 3.76–4.63), p = 0.019] compared with regional patients. No other statistically significant differences were observed in oncological, surgical and QoL outcomes.ConclusionsMost oncological, surgical and QoL parameters did not differ by geographical location of patients undergoing CRS and HIPEC for peritoneal malignancies at a high-volume quaternary referral centre. Observed differences in recurrence and survival may be attributed to the selective nature of surgical referrals and variable follow-up patterns. Future research should focus on characterising referral pathways and its influence on post-operative outcomes.

Strengthening Healthcare Delivery in the Democratic Republic of Congo through Adequate Nursing Workforce

The Democratic Republic of Congo (DRC) grapples with a critical shortage of nurses, exacerbating disparities in healthcare access and outcomes. This mini-review examines the factors impacting the nursing workforce in the DRC and presents potential solutions to strengthen it. Decades-long regional conflicts have endangered the nursing workforce, resulting in an imbalanced distribution that disproportionately favors urban areas over rural regions. Inadequate healthcare funding, compounded by mismanagement, has led to resource scarcity and inequitable distribution, further hampering nursing efforts. Additionally, stagnant policy reforms and ineffective advocacy have hindered improvements in nurse employment, wages, education, and working conditions. Infrastructure deficiencies and medical supply shortages have also contributed to reduced incentives for nursing professionals. Therefore, we undertook a mini-review aimed at offering a succinct and targeted overview of nursing care in the DRC. This involved analyzing available literature and data concerning the nursing workforce with a particular focus on the DRC. We believe that addressing these interlinked challenges necessitates comprehensive strategies that prioritize establishing regional stability, responsibly allocating and increasing healthcare funding, incentivizing nurse recruitment and retention through policy adjustments, enhancing healthcare infrastructure and nursing education, and fostering both local and global collaboration. Investing in nursing is paramount for transforming healthcare delivery in the DRC, particularly considering nurses' pivotal roles in delivering preventive, therapeutic, and palliative care services. Strengthening nursing capacity and addressing systemic challenges are essential steps toward mitigating healthcare disparities and enhancing population health, aligning with the objectives outlined in the United Nations Sustainable Development Goals.

Assessing Medical Emergency E-referral Request Acceptance Patterns and Trends: A Comprehensive Analysis of Secondary Data From the Kingdom of Saudi Arabia.

Introduction Patient transfers in emergencies have been linked to reduced mortality rates and enhanced quality of care. The Saudi Medical Appointments and Referrals Centre (SMARC), an e-referral system in the Kingdom of Saudi Arabia (KSA) since 2019, plays a crucial role in ensuring quality and continuity of care. The findings of this study can provide valuable insights into the effectiveness of the e-referral system and identify potential areas for improvement in the management of emergency cases. Objective This study aims to examine e-referral patterns for emergency medical cases throughout all 13 administrative regions of KSA. Concurrently, it estimates the acceptance rate of medical emergency referrals and investigates associated factors among KSA hospitals. Methods This retrospective study utilized secondary data from the SMARC e-referral system, specifically focusing on medical emergency e-referral requests in the entire KSAduring 2021. Descriptive univariate analyses were conducted to characterize the referral requests, followed by bivariate analyses to explore associations between factors and referral acceptance. Adjusted multiple logistic regression analyses were then performed to calculate adjusted odds ratios (ORs) and corresponding 95% confidence intervals, controlling for potential confounding variables. Results A total of 29,660 medical emergency referral requests were initiated across all regions of KSA during the study time frame, and, of these,20,523 (69.19%)were accepted. The average age of patients with a medical emergency referral was 52 years old, and referral requests were higher among Saudis (13,781; 54.18%), males (13,781; 54.18%), and those from the Western region (10,560; 35.60%). Nearly 20,854 (70%) were due to the unavailability of specialized doctors or specialties in facilities. Based on multi-logistic regression, referral request acceptance was high in some factors as follows: compared to the Central region, requests from the Northern, Southern, Eastern, and Western regions had higher acceptance rates at 123%, 64%, 54%, and 46%, respectively. In addition, referral requests that were due to the unavailability of a specialized doctor or medical equipment had higher acceptance rates (19% and 16%), respectively, than those due to the unavailability of a specific specialty. Conclusion This study provides valuable insights into regional variations, sociodemographic factors, and referral reasons within the medical emergency e-referral system in the KSA. By estimating the acceptance rate of medical emergency referrals and investigating associated factors, this analysis confirms the effectiveness of the e-referral system in facilitating access to quality care, particularly for marginalized patients. The study highlights the need for health policy improvements to ensure equitable resource allocation and reduce disparities in healthcare access.