Eastern Regional Health Authority Research Articles

Healthcare Resilience in Trinidad and Tobago: A short report on the Healthy Hospital Initiative at the Sangre Grande Hospital

Objective: To describe the establishment of the Healthy Hospital Initiative (HHI), its activities and accomplishments, challenges and future steps. Methods: The initiative was implemented at the Sangre Grande Hospital in the Eastern Regional Health Authority (ERHA), one of five Regional Health Authorities in Trinidad and Tobago. A review of personal records maintained by members of the Healthy Hospital Initiative was undertaken. These records included descriptions of the activities, accomplishments and obstacles that the team experienced. Results: The Healthy Hospital Initiative was launched in November 2019 with the aim of creating an environmentally sustainable health system and improving the physical and mental health of staff and patients. A senior doctor led the initiative and team members included a range of staff, including both clinical and non-clinical professionals who were all volunteers. This allowed for a multi-directional, inclusive approach and created a sense of ownership amongst the staff. In 2022, several activities were implemented: green spaces, recycling bins, a kitchen garden and staff exercise sessions. In addition, team members participated in training on Pan-American Health Organization (PAHO) Smart hospitals and collaborated with a local non-governmental organisation as well as the University of the West Indies, St. Augustine campus engineering department to develop further projects. Conclusion: Next steps include promoting similar projects in community health facilities, developing a hydroponics system and, assessing the disaster resilience and carbon footprint of the hospital.

Using eGFR and Albumin Creatinine Ratio as an Initial Screening Tool in Trinidadian Primary Care to Identify High-risk Population for CKD: A Cross-Sectional Study.

Chronic kidney disease (CKD) is a major public health burden and is often undiagnosed in the primary care setting. Untested and untreated, this often leads to renal failure and dialysis. This was a cross-sectional study of adults aged 20 years and over, diagnosed with type 2 diabetes mellitus and/or hypertension, with no previous history or record of CKD, and attending three chronic disease clinics in the Eastern Regional Health Authority (ERHA). Patients were screened for risk of CKD by using the albumin creatinine ratio. The eGFR was calculated based on serum creatinine by using the CKD Epidemiology Collaboration (EPI) 2009 equation. In total, 430 patients agreed to participate with 61.2% of response rate. Of the 385 with complete data, 357 (92%) were detected as having a high risk for CKD; older patients (>66 years) and those with both diabetes and hypertension had high proportions of risk for CKD. There were significant associations between age, systolic hypertension, and the severity of risk for CKD. CKD is common at the primary care level among adults with NCDs in Trinidad, with many patients having been left out without being tested for CKD. Primary care physicians must take this into consideration in caring for NCD patients.

Changes in Diabetes Management during the COVID-19 Pandemic in Trinidad: A Retrospecting Qualitative Study

Abstract Introduction: Studying the impact of the COVID-19 pandemic impact on diabetes care is crucial for identifying the barriers and developing strategies to overcome them. Methodology: This retrospective qualitative study included diabetic patients from clinics in Eastern Regional Health Authority and private medical institutions, as well as private citizens. Participants were selected through snowball sampling, and data were collected using a 29-item questionnaire. Results: The study had 34.2% males, 65.8% females of those 71.0% were living with diabetes for <10 years. In terms of diabetes management, 68.4% attended clinic/hospital physically. Regarding waiting time, 43% experienced an increase, 7% saw a decrease and 50% noticed no change. Managing diabetes during the pandemic, 50% had no problems. Access to medical care changed for 48.4% of participants, while 6.4% did not seek care. Access to medication remained unaffected for most with 26.3% experienced reduced access and 5.3% saw improvement. Conclusion: This adaptability of preventive and clinical care interventions is crucial for ensuring continuous and effective care during a public health crisis.

Antimicrobial Consumption from 2017 to 2021 in East Trinidad and Tobago: A Study in the English-Speaking Caribbean

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, co-amoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using the World Health Organization's Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the 'Access', 'Watch' and 'Reserve' classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the 'Watch' group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of 'Watch' group antibiotics increased from 2017 to 2021, with a drop in consumption of 'Access' antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020.

A Physician Mentorship Programme in the Eastern Regional Health Authority: A Pilot Study

ABSTRACT Objective Mentorship programmes have been shown to boost camaraderie, enlightenment and positive motivation, as well as, generate a mentoring culture in the workplace. There is limited literature focusing on medical mentorship programmes in Trinidad and Tobago. The research team plans to implement and evaluate a year-long mentorship programme within the Eastern Regional Health Authority on the island. Prior to this undertaking, a pilot study was conducted at the Sangre Grande Hospital to identify potential obstacles. Methods The pilot was conducted between September 1st and November 30th, 2020 with participants being recruited from three departments at the Sangre Grande Hospital. Mentors were pre-selected and mentees matched based on responses from a pre-pilot study questionnaire. Participants were required to complete a questionnaire once per month during the three-month pilot to evaluate programme effectiveness. Descriptive statistics were used to analyze data. Results Participants included five mentors and seven mentees. This resulted in an overall participation rate of 15%. Post-mentorship questionnaire indicated that time commitment was a major challenge in participation. Even though each participant was required to complete a monthly feedback questionnaire at the end of each month, there was only a 38% mentee and 33% mentor feedback response rate. Conclusion Implementation of a mentorship programme may face many challenges including obtaining participants and feedback during the programme. For the planned continuation and expansion of this mentorship programme, modifications would be made to increase participation rates and encourage feedback. Keywords: Mentorship, Caribbean, mentor, mentee

A retrospective study on the outcomes of cataract surgery in an Eastern Regional Health Authority hospital of Trinidad and Tobago.

Background. Worldwide, cataract is a major cause of blindness. The paper aims to evaluate factors associated with borderline and poor outcomes of cataract surgery at an Eastern Regional Health Authority (ERHA) hospital in Trinidad and Tobago.Materials and Methods. A hospital-based, retrospective study was done on 401 patients who had undergone cataract surgery (unilateral and bilateral) at an ERHA Hospital between March 2009 and September 2014. Data was collected on variables concerning demographic, medical history, surgical history, ocular findings and visual acuity (VA). The outcome variable of interest was Snellen’s post-operative (presenting) VA which was transformed into a dichotomous variable with borderline and poor outcomes as one and good outcomes as the other. Data were analysed using univariate and multivariate logistic regression analyses.Results. Good outcome (presenting VA 6/18 or better) was seen in 350 (67%) eyes. The fitted model consisted of ocular co-morbidity (OR =2.133; 95% CI [1.346–3.380]), hypertension (OR = 0.520; 95% CI [0.381–0.928]), surgical procedure (OR = 1.56; 95% CI [1.004–2.425]), good preoperative VA (OR = 0.388, 95% CI [0.211–0.714]), borderline preoperative VA (OR = 0.485; 95% CI = [0.278–0.843]) and year of first visit to clinic (OR = 2.243; 95% CI [1.215–4.141]).Conclusion. There is a need for community-based outreach to increase awareness of eye health and diseases. It is recommended that the general population is encouraged to take responsibility for personal management. The facilities at the Hospital should also be enhanced.

Cervical Smears at Public Health Centres in Eastern Trinidad: Coverage and Follow-up, 2009-2010.

The objective was to examine the cervical screening programme at selected health centres in the Eastern Regional Health Authority (ERHA), Trinidad and Tobago, specifically regarding Pap smear coverage, frequency distribution of abnormal smears and the adequacy of follow-up of abnormal smears, according to the Caribbean Frameworks for Developing National Screening and Clinical Guidelines for Cervical Cancer Prevention and Control. A retrospective analysis of secondary data from five health centres in the ERHA over the two-year period 2009-2010 was conducted. Data were entered into Microsoft Excel, cleaned and imported into SPSS (v 12) for analysis. Descriptive and Chi-squared analyses were carried out. The cumulative cervical screening coverage for the years 2009 and 2010 was 2600 Pap smears for a population of 28 811 women (9% coverage). The proportion of cervical smears done per age group ranged from 1.6% to 8.6% in 2009 and from 1.9% to 12.9% in 2010. The proportion of Pap smears for the target population, 25-49 years, stood at 11% in 2009 and 13.2% in 2010. The distribution of abnormal Pap smears (n = 155) was: atypical squamous cell of undetermined significance (ASCUS), 68.4%; low-grade squamous intra-epithelial lesion (LSIL), 14.2%; atypical squamous cells - high-grade squamous intra-epithelial lesion cannot be excluded (ASC-H), 4.5%; atypical glandular cells of undetermined significance (AGUS), 1.3% and invasive squamous cervical carcinoma, 0.6%. Human papillomavirus was detected in 7.7% of the study population. More than half of the women with abnormal smears did not follow-up on recommendations for further care and there was a significant loss to follow-up especially among the women who were referred for repeat Pap smear. The significant predictor to whether follow-up care occurred or not was age (p < 0.05). The cervical screening services in the ERHA in Trinidad did not provide adequate coverage to the target population or adequate follow-up care for women with abnormal smears in 2009 and 2010.

Quality of Work Life of Novice Nurses

This qualitative research study examines factors influencing the quality of work life of novice nurses (less than 2 years' experience) in the Eastern Regional Health Authority in St. John's, Newfoundland and Labrador, Canada. Although novice nurses are highly motivated to provide quality patient care, they encounter many sources of stress, including "difficult personalities," inadequate orientation and mentoring, and horizontal violence from nursing and medical colleagues. These stressors are compounded by staffing shortages and heavy workloads. Supportive mentoring and adequate orientation are key factors to successful transition.

A review of physician preparedness in response to a systemic crisis: The case of Eastern Regional Health Authority, Newfoundland, Canada, estrogen receptor (ER) breast cancer (BC) errors

e17551 Background: From March until October 2008, a Commission of Inquiry was held in St. John's, Canada, investigating systemic errors leading to incorrect ER results in BC patients. 386 ER negative BC samples tested between 1997 and 2005 were incorrect. Of 91 witnesses, 26 physicians testified about their roles in this “crisis.” Physicians have traditionally been trained to respond to individual clinical crises and acute traumatic situations. This study summarizes the physicians’ training and preparedness in response to a systemic organizational crisis. Methods: Inquiry exhibits, submissions, and transcripts of physician testimony were reviewed for evidence of education and experience in crisis management (CM) as applied to a complex organization. Education and experience with organizational health care crisis were tabulated and prevalent themes relevant for physicians summarized. Results: Evidence was reviewed from 5 oncologists, 17 pathologists, 1 health information analyst, and 3 senior physician leaders. 20 physicians held departmental or divisional leadership roles, one had an advanced degree in Public Health and one had direct experience in a complex private organization. 5 out of province expert consultants had direct experience with continuous quality control applied to large organizations. No physicians were formally trained in CM in terms of acute crisis response. Two prevailing concerns were expressed: 1) delayed and incomplete disclosure of information to patients and public, and 2) numerous preceding systems problems identified by physicians that did not translate into necessary systemic changes to prevent the crisis. Conclusions: The practice of CM recognizes the need to eliminate technological and human systems failure and to develop formal communication systems to avoid or to manage crisis situations. Large-scale organizational crisis management is an important concept for physicians to understand and actively participate in their professional roles. At present most physicians do not receive formal training in CM. No significant financial relationships to disclose.

Management of hepatitis C among drug users attending general practice in Ireland: Baseline data from the Dublin Area Hepatitis C in General Practice Initiative

Objective: In Ireland, general practice is increasingly providing long-term care for injecting drug users, 62–81% of whom are infected with hepatitis C (HCV). Clinical guidelines for the management of HCV among drug users have recently been developed in Ireland, and this study aimed to describe HCV care among drug users attending general practice in the greater Dublin area, prior to the implementation of the clinical practice guidelines. Methods: The clinical records of 196 patients attending 25 general practices in the Eastern Regional Health Authority area of Ireland for methadone maintenance treatment were examined on site and anonymized data collected on HCV care processes. Results: Patients had been attending general practice for methadone maintenance treatment for a mean of 30.7 months, 72% were male and 51% had provided a urine sample testing positive for metabolites of drugs of abuse other than methadone in the previous 3 months. There was evidence that 77%, 69% and 60% had been screened for HCV, human immunodeficiency virus (HIV) and hepatitis B (HBV), respectively. Among those who had been tested, the prevalence of HCV, HIV and HBV infection was 69%, 10% and 11%, respectively. Of those known to be HCV positive, 36 (35%) had been tested for HCV-RNA (29 testing positive), 31 (30%) had been referred to a hepatology clinic, 24 (23%) had attended a clinic, 13 (13%) had a liver biopsy performed and three (3%) had started treatment for HCV.Conclusion: While the majority of patients have been screened for blood-borne viruses, a minority of those infected with HCV have had subsequent investigations or treatment. New interventions to facilitate optimum care in this regard need to be considered.

Capacity and equity in cardiac rehabilitation in the eastern region: good and bad news

To document current baseline eligibility for Phase 3 cardiac rehabilitation (CR) and the capacity to meet this need in hospitals in the Eastern Regional Health Authority. Information on the eligible population and the capacity for CR was collected in all nine hospitals retrospectively (February-March 2001). Forty-seven per cent of eligible patients were invited to participate with only two-thirds attending. Completion rates were very high (89%) in attenders. Age and health board area were significant independent predictors of being invited to CR. Gender was not independent of age. Fifty-three per cent of the need for this service was met by capacity in the region's nine hospitals in 2000 rising to 59% in 2002. Many eligible patients are not invited to CR. Lack of capacity is a problem. Among the invited, non-participation is a factor. Inequity in age and inter-hospital variation in invitation is noted.

Hepatitis C infection among drug users attending general practice.

The prevalence of hepatitis C (HCV) infection among injection drug users is high and addiction-related care is increasingly being provided by GPs in Ireland. To determine the prevalence and associated factors of HCV infection among injecting drug users attending general practice. The records of 571 patients attending 42 general practices in the Eastern Regional Health Authority (ERHA) area for methadone maintenance treatment were reviewed. The HCV status was recorded in 380 cases (67%). Of these, 193 had a test performed by their GP, 74 had been tested by another service and 113 had no evidence of being tested, but HCV status was recorded based on information provided by the patient himself. A total of 276 cases were identified as being HCV positive (prevalence 73%), with no difference in prevalence between the three sources of information (p = 0.12). A history of injecting drug use was the major determinant of testing for HCV. While a large proportion of drug users attending GPs for methadone maintenance treatment are known to be HCV positive, a considerable number have not been tested. Barriers to testing need to be explored to facilitate comprehensive screening.

Under-prescribing of cardiovascular therapies for diabetes in primary care

To determine the extent to which cardiovascular therapies are prescribed in primary care for those with diabetes, compared with those without diabetes. Population study of patients with and without diabetes identified using a national primary care prescribing database. All patients receiving a prescription for any diabetes therapy, including insulin and oral hypoglycaemic drugs, or diagnostic test kit for glucose ( n=8523) and those receiving no such therapies ( n=145,756) during a 1-year period (September 1999-August 2000) in the Eastern Regional Health Authority of Ireland were identified. In addition, a sub-set of patients receiving a nitrate prescription, a marker for ischaemic heart disease (IHD), were also identified ( n=14,826). Odds ratios and 95% confidence intervals for prescribing of cardiovascular therapies between those with diabetes and those without, adjusted for age and gender, were calculated using logistic regression. The proportion of those (and 95% CES) with diabetes and IHD prescribed secondary preventative therapies was 37.3% (35.0, 39.6) for statins, 55.3% (53.0, 57.6) for angiotension converting enzyme inhibitors, 34.7% (32.5, 36.9) for beta blockers, 73.3% (71.2, 75.4) for aspirin, 4.4% (3.4, 5.4) for angiotensin-II antagonists and 2.5% (1.8, 3.2) for fibrates. The adjusted odds ratios for prescribing in those with diabetes compared with those without are 1.44 (1.30, 1.61) for statins, 3.09 (2.79, 3.42) for angiotension converting enzyme inhibitors, 0.82 (0.74, 0.91) for beta blockers, 1.23 (1.09, 1.38) for aspirin, 1.47 (1.13, 1.87) for angiotensin-II receptor blockers and 4.23 (2.88, 6.14) for lipid-lowering fibrates. The greater rate of prescribing of cardiovascular therapies in those with diabetes relative to those without is not unexpected given the higher risk of coronary heart disease in those with diabetes. However, the proportion of patients with diabetes, particularly those with established IHD, prescribed cardiovascular therapies is considerably below that recommended in local and international guidelines.

What Families Want in Family Support: An Irish Case Study

In recent years, Family Support has been given increased attention in Ireland, including the development of more community-based early intervention programmes and the publication of an Irish Government policy regarding children and their universal need for recognition and support. In the light of these developments and from recent research on Family Support involving two health authorities, specific issues relating to policy and practice are considered. Two case studies are presented. One study in the Western Health Board area involved consultation with service users regarding their perception of Family Support and how best professionals should provide help to families. The second study by the Eastern Regional Health Authority focused on lay family support workers and key aspects of their helping role in relation to cases of domestic violence. Common themes that emerge from both pieces of research are discussed, including the importance of valorisation of the worker-client relationship, the need for targeted support within universal frameworks, the importance of timing of interventions and the potential of non-directive interventions with families experiencing adversity.