Local Community Health Care Research Articles

Community Nursing Practice in Hypertension Management in China: Qualitative Analysis Using a Bourdieusian Framework.

This study explores the practices of Chinese community nurses in hypertension management, using Pierre Bourdieu's theory of practice to understand how their routines are shaped by sociocultural and institutional forces, along with their professional dispositions. A qualitative descriptive study was conducted in Shenzhen, China, between March and June 2024, and is reported following the COREQ guidelines. Eighteen nurses, each with at least 1 year of full-time experience in hypertension care within the local community healthcare system, were recruited from a participant pool established through prior research. Face-to-face individual semistructured interviews were conducted using a structured interview protocol, and data were analyzed through thematic analysis. Community nurses face tensions between traditional health beliefs and modern hypertension care, as well as institutional pressures that prioritize efficiency over personalized care. Power imbalances, particularly the authority of doctors, complicate their role. However, nurses adapt their care strategies through embodied practices, balancing clinical standards with patient needs. Community nurses are not mere enforcers of guidelines but adaptive professionals who navigate complex sociocultural norms, institutional demands, and power dynamics in hypertension care. This study underscores the necessity for flexible, culturally sensitive practices to improve public health outcomes.

Asynchronous teledentistry program in two long-term care facilities: Iowa's virtual dental home pilot project.

Older adults living in long-term care facilities (LTCFs) often have poor oral health and difficulty accessing dental services. The aim was to implement a virtual dental home (VDH) program for residents in two LTCFs utilizing asynchronous teledentistry techniques and mobile dental equipment. This pilot project was a 6-month longitudinal cohort study in two LTCFs. Dental hygienists and dentists from a local community health care center utilized asynchronous teledentistry to provide diagnostic and preventive dental services onsite and to establish a dental home for additional comprehensive care services. Data were collected, including resident's demographics, oral health status, and dental services received. Descriptive data analyses, Wilcoxon signed rank, and McNemar tests were conducted. Thirty-four residents completed in-person baseline oral exams and 16 residents completed the recall exams. Ninety-two percent (n=23) of dentate residents (n=25) had untreated caries and 64% (n=16) of dentate residents had at least one sextant of severe gingival inflammation. The median number of teeth with active untreated caries (p=.01) significantly decreased and arrested caries (p=.02) significantly increased from baseline. Iowa's VDH pilot project was successful in establishing a dental home using asynchronous teledentistry for residents in two LTCFs and providing resident access to preventive and disease control dental services.

Opting out of cardiac rehabilitation in local community healthcare services: Patients'perspectives and reflections.

Despite cardiac rehabilitation and medical treatment being integrated parts of the pathway of patients with cardiovascular disease, as well as the well-establish positive effect, cardiac rehabilitation remains underutilised. In recent years, cardiac rehabilitation has increasingly been moved from the hospitals to the community healthcare services. This transition may be challenging for patients with cardiovascular disease. To investigate reflections and perspectives of patients opting out of cardiac rehabilitation in community healthcare services to improve participation and adherence to cardiac rehabilitation in the future. A total of eight patients opting out of cardiac rehabilitation participated in individual interviews. Opting out of cardiac rehabilitation is defined as never enroled or did not complete cardiac rehabilitation. The Interpretive Description methodology was used in the analysis where two themes and six subthemes were identified: (1) 'Structural and organisational factors' with three subthemes; Being a patient in the healthcare system, Enroling into CR when it is meaningful, and Getting back to work is vital, and (2) 'Patients'internal factors' with three subthemes; Feeling a desire to regain control, Seeing yourself as recovered, and Being aware of own needs. The analysis indicates that patients'decision to opt out of CR was multidimensional and based on a combination of factors. Ensuring that the healthcare professionals in the community have sufficient information regarding the patient and a clear communication plan between the healthcare professionals and the patient may reduce the transition causing confusion and frustrations for patients. Incorporating a vocational element in CR and ensuring that employers understand the importance of CR may hamper returning to work as a challenge to CR. Ensuring timely CR referral and enrolment and a transition coordinator may reduce the challenge of patients not viewing CR as meaningful. However, further studies are needed to fully understand how CR could become meaningful for patients opting out of CR.

Predictors of Medical and Dental Clinic Closure by Machine Learning Methods: Cross-Sectional Study Using Empirical Data.

Small clinics are important in providing health care in local communities. Accurately predicting their closure would help manage health care resource allocation. There have been few studies on the prediction of clinic closure using machine learning techniques. This study aims to test the feasibility of predicting the closure of medical and dental clinics (MCs and DCs, respectively) and investigate important factors associated with their closure using machine running techniques. The units of analysis were MCs and DCs. This study used health insurance administrative data. The participants of this study ran and closed clinics between January 1, 2020, and December 31, 2021. Using all closed clinics, closed and run clinics were selected at a ratio of 1:2 based on the locality of study participants using the propensity matching score of logistic regression. This study used 23 and 19 variables to predict the closure of MCs and DCs, respectively. Key variables were extracted using permutation importance and the sequential feature selection technique. Finally, this study used 5 and 6 variables of MCs and DCs, respectively, for model learning. Furthermore, four machine learning techniques were used: (1) logistic regression, (2) support vector machine, (3) random forest (RF), and (4) Extreme Gradient Boost. This study evaluated the modeling accuracy using the area under curve (AUC) method and presented important factors critically affecting closures. This study used SAS (version 9.4; SAS Institute Inc) and Python (version 3.7.9; Python Software Foundation). The best-fit model for the closure of MCs with cross-validation was the support vector machine (AUC 0.762, 95% CI 0.746-0.777; P<.001) followed by RF (AUC 0.736, 95% CI 0.720-0.752; P<.001). The best-fit model for DCs was Extreme Gradient Boost (AUC 0.700, 95% CI 0.675-0.725; P<.001) followed by RF (AUC 0.687, 95% CI 0.661-0.712; P<.001). The most significant factor associated with the closure of MCs was years of operation, followed by population growth, population, and percentage of medical specialties. In contrast, the main factor affecting the closure of DCs was the number of patients, followed by annual variation in the number of patients, year of operation, and percentage of dental specialists. This study showed that machine running methods are useful tools for predicting the closure of small medical facilities with a moderate level of accuracy. Essential factors affecting medical facility closure also differed between MCs and DCs. Developing good models would prevent unnecessary medical facility closures at the national level.

A Survey Study on Discharge Process of Critically Ill Patients: for Residents at a Tertiary Hospital in Korea

Purpose: The number of severely ill patients requiring post-acute care has been increasing. Careful discharge planning minimizes unplanned emergency room visits and readmissions. This study aimed to survey the knowledge, experience, confidence, and obstacles faced by medical residents and fellows regarding the discharge process of severely ill patients.Methods: A survey consisting of 27 questions was sent electronically to residents and fellows who had experience in discharging severely ill patients from a tertiary hospital in Korea. The survey was conducted over a two-week period from September 29, 2022.Results: A total of 98 residents and fellows responded to the survey. Of these, 94% experienced difficulties related to the discharge process. The main obstacle was changes in the patient’s condition during discharge planning (92.3%). Although 95% of the respondents acknowledged the need for providing discharge information, only 53.1% of the residents and fellows practiced this. Only 42.9% of the respondents and 20.4% of residents and fellows explained local community healthcare and welfare resources to patients because of a lack of relevant knowledge (69.7%) and feeling no responsibility to explain (40.4%).Conclusion: This study revealed that residents and fellows experienced difficulties in devising discharge plans and providing post-acute care related information, despite recognizing the importance of these. These gaps result from the lack of a discharge planning curriculum regarding critically ill patients and appropriate training in the discharge process. This suggests that an integrated discharge planning curriculum should be developed and adopted in residents’ training programs for the differentiated treatment of critically ill patients.

Establishing Robust Data Sharing Through a Blockchain-Driven Standardization Framework in Local Community Healthcare System

The healthcare industry's digitalization has sparked innovation and improved various aspects of the services. Community hospitals in Pangasinan still use conventional paper-based methods for managing patients' health records. However, the healthcare information system is still in a traditional structured excel platform and lacking of communication among healthcare providers. This study aims to design a blockchain-driven standardization framework to establish robust data sharing and increase the confidentiality and security of stakeholders in using the healthcare system. In gathering data, a focus group was organized to give a valuable perspective on the present state of the healthcare system through conducting an online survey, seven respondents are direct users of the healthcare system. The study adopted the IS4H assessment maturity tool concerning data management and information technology in identifying the gaps and challenges in the existing healthcare system. A comprehensive review of related literature regarding the usability of access control models in the study and the potential of blockchain technology in the healthcare system is also essential. Blockchain technology provides features that enhance the accessibility and immutability of the healthcare system and to the stakeholders. The research underscores the paramount importance of integrating blockchain, access control, and security measures to safeguard privacy in the system. The implication of the integration of blockchain is seamless, secure, and patient-centric which has a great potential to contribute to improving the digitalization of healthcare quality of services in the healthcare system.

The efficacy of a visiting surgical service versus that of a hospital-based surgical service in providing endoscopic endonasal surgery to remove nonfunctioning pituitary adenomas in rural communities.

To satisfy the increasing demand for endoscopic endonasal approach (EEA) to treat pituitary tumors, especially in rural areas, the "mobile EEA" system, a visiting surgical service, has been established We report this unique system for maintaining community healthcare and evaluate the surgical results of mobile EEA. A retrospectively acquired database of 225 consecutive cases of EEA at Shinshu University Hospital (i.e., "home EEA") and its affiliated hospitals (i.e., "away EEA") between May 2018 and May 2022 was reviewed. A total of 105 consecutive patients who fulfilled the criterion of a diagnosis of new-onset nonfunctioning pituitary adenoma (PA) were included. Clinical characteristics and postoperative clinical outcomes were statistically compared between the home EEA and away EEA groups to assess the presence of a home advantage and/or an away disadvantage. Patients were stratified into two cohorts: patients treated at our hospital (home EEA: n = 41 [39.0%]) and those treated in the visiting surgical service at an affiliated hospital (away EEA: n = 64 [61.0%]). Postoperative clinical outcomes, such as the extent of tumor resection (p = 0.39), operation time (p = 0.80), visual function (p = 0.54), and occurrence of surgical complications (p = 0.53), were comparable between the groups. There were no visiting surgical service-related adverse events or accidents caused by physicians' driving to away hospitals. Pituitary surgeries performed via the mobile EEA system for nonfunctioning PAs may help maintain local community healthcare. Furthermore, this system can also contribute to the efficient training of surgeons by the same experienced pituitary surgeon using the same protocol.

Tools for assessing child and adolescent stunting: Lookup tables, growth charts and a novel appropriate-technology "MEIRU" wallchart - a diagnostic accuracy study.

Stunting affects 149 million children worldwide and is a form of chronic malnutrition defined by low height-for-age. Surveys and intervention programmes depend on effective assessment and identification of affected individuals. Gold standard assessment is based on height-for-age Z-score (HAZ): HAZ <-2 defines stunting; HAZ <-3 defines severe stunting. However, a major problem for field-based programmes is that Z-scores can be time-intensive and challenging to calculate. We thus developed a novel wallchart that we have coined 'MEIRU wallchart' to easily and accurately identify stunted children and adolescents. Our study aim was to evaluate its performance and acceptability against other methods used in current clinical/field practice. We undertook a non-interventional diagnostic accuracy study in Malawi. We recruited 244 participants aged 8-19 years and determined each individual's stunting status using, in varying order: the MEIRU wallchart, traditional lookup tables, and traditional growth charts. All were compared against 'gold standard' HAZ, calculated using AnthroPlus WHO software. Local community healthcare workers performed all the assessments. The wallchart method was strongly preferred by both participants and staff. It had an overall accuracy of 95.5%(kappa = 0.91) and was faster than lookup tables by an average of 62.5%(41.4sec; p<0.001) per measurement. Lookup tables and growth charts had overall agreements of 59.4%(kappa = 0.36) and 61.9%(kappa = 0.31) respectively. At the HAZ-2 cut-off, the wallchart had a sensitivity of 97.6%(95%CI: 91.5-99.7) and specificity of 96.3%(95%CI: 92.1-98.6). We conclude that the MEIRU wallchart performs well and is acceptable for screening and identification of stunted children/adolescents by community-level health workers. It fulfils key criteria that justify a role in future screening programmes: easy to perform and interpret; acceptable; accurate; sensitive and specific. Potential future uses include: conducting rapid stunting prevalence surveys; identifying affected individuals for interventions. Current field methods, lookup tables and growth charts performed poorly and should be used with caution.

Estimated total cardiovascular risk in a rural area of Bangladesh: a household level cross-sectional survey done by local community health workers

ObjectiveThe aim of this study was to estimate 10-year cardiovascular disease (CVD) risk among Bangladeshi rural community residents, using the 2014 WHO/International Society of Hypertension (WHO/ISH) risk prediction charts.Study designCross-sectional...

Adopting and implementing an innovative model to organize diabetes care within First Nations communities: A qualitative assessment

BackgroundDiabetes care remains suboptimal in First Nations populations. Innovative and culturally relevant approaches are needed to promote systematic and proactive organization of diabetes care for people living with diabetes on-reserve in Canada. The RADAR model is one strategy to improve care: an integrated disease registry paired with an electronic health record for local community healthcare providers with remote care coordination. We qualitatively assessed adoption and implementation of RADAR in First Nations communities in Alberta to inform its potential spread in the province.MethodsWe used the RE-AIM framework to evaluate adoption and implementation of RADAR in 6 First Nations communities. Using purposeful sampling, we recruited local healthcare providers and remote care coordinators involved in delivering RADAR to participate in telephone or in-person interviews at 6- and 24-months post-implementation. Interviews were digitally recorded, transcribed, and verified for accuracy. Data was analyzed using content analysis and managed using ATLAS.ti 8.ResultsIn total, we conducted 21 semi-structured interviews (6 at 6-months; 15 at 24-months) with 11 participants. Participants included 3 care coordinators and 8 local healthcare providers, including registered nurses, licensed practical nurses, and registered dietitians. We found that adoption of RADAR was influenced by leadership as well as appropriateness, acceptability, and perceived value of the model. In addition, we found that implementation of RADAR was variable across communities regardless of implementation supports and appropriate community-specific adaptations.ConclusionsThe variable adoption and implementation of RADAR has implications for how likely it will achieve its anticipated outcomes. RADAR is well positioned for spread through continued appropriate community-based adaptations and by expanding the existing implementation supports, including dedicated human resources to support the delivery of RADAR and the provision of levels of RADAR based on existing or developed capacity among local HCPs.Trial registrationNot applicable to this qualitative assessment. ISRCTN14359671.

A farewell to ears: Hearing the call and answering

A semi-humorous autobiographical account of one first-year MSOT student trying to do their part to support the local healthcare community and its clients during the time of COVID-19 and self-quarantine.

A farewell to ears: Hearing the call and answering

A semi-humorous autobiographical account of one first-year MSOT student trying to do their part to support the local healthcare community and its clients during the time of COVID-19 and self-quarantine.

Children in the Blind Spot of Social Medical Concerns: Supporting Children with Mentally Ill Parents in Korea.

Children whose parents have mental disorders are more likely to be vulnerable and exposed to an environment where they may not be cared for by parents or guardians in Korea. Particularly, young children often develop mental disorders or maladaptive behaviors. This study aimed to implement a structured program to enhance the resilience of school-aged children whose parents have mental disorders and to analyze its effectiveness through a single-group pretest-posttest experimental design. The Korean Child Personality Inventory for Self-Report self-resilience and clinical scales were used, and daily behavioral observation logs showed decreases in psychosis scores among all children, anxiety scores among girls, and somatization and physical development among boys. Self-efficacy, social competency, and acceptance toward families increased. Therefore, the improvement of resilience and clinical symptoms was confirmed through this program, suggesting it should be expanded and developed in local community healthcare sites to help support children with mentally ill parents.

Socially Accountable Medical Education: Our Story Might Not Be Yours

Socially Accountable Medical Education is a global educational movement transforming the development and delivery of medical schools in higher education. It is described as an upstream policy approach that seeks to align medical education and local community healthcare needs. To better understand social accountability as a policy initiative, we conducted a narrative review to identify key themes in the literature around frameworks of implementation. Our findings illustrate that social accountability has been mostly defined to date in terms of outcomes and related-actions and that there is a lack of focus on critical social constructs, such as power and place, that can reorient processes and inequities within health systems and educational institutions. We conclude that while socially accountable medical education is a promising paradigm shift in higher education, we call for a more complexified, contextualized, and nuanced approach.

The opioid-impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety.

The opioid-impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety.

Quantifying Inequitable Access to Rapid Burn and Reconstructive Care through Geospatial Mapping.

Summary:Time-critical pathologies, such as the care of burn-injured patients, rely on accurate travel time data to plan high-quality service provision. Geospatial modeling, using data from the Malaria Atlas Project, together with census data, permits quantification of the huge global discrepancies in temporal access to burn care between high-income and low-resource settings. In this study, focusing on the United Kingdom and Ghana, we found that a 3-fold population difference exists with, respectively, 95.6% and 29.9% of the population that could access specialist burn care within 1-hour travel time. Solutions to such inequalities include upscaling of infrastructure and specialist personnel, but this is aspirational rather than feasible in most low- to middle-income countries. Mixed models of decentralization of care that leverage eHealth strategies, such as telemedicine, may enhance quality of local burns and reconstructive surgical care through skills transfer, capacity building, and expediting of urgent transfers, while empowering local healthcare communities. By extending specialist burn care coverage through eHealth to 8 district hospitals in rural Ghana, we demonstrate the potential to increase specialist population coverage within 1-hour travel time from 29.9% to 45.3%—equivalent to an additional 5.1 million people.

Building Novel Research Capacity in a Regional Medical Campus Emergency Medicine Program: 1.0 Origins and Partnerships

The Emergency Medicine Researchers of Niagara (EMRoN) program is an evolving research incubator with the Niagara Regional Campus (NRC) of McMaster University’s Michael G DeGroote School of Medicine and Niagara Health (NH) that is becoming a productive research organization aligned with the strategic priorities of its partner organizations (NRC and NH). EMRoN is committed to advancing local community health care standards and sharing best practices with provincial and national peers. In its first two years of operation EMRoN has achieved success in new structures, processes and outcomes that position it well to be a fulsome research organization for years to come.

An educational collaboration for student nurse engagement on the essential skill of delegation

A common goal for healthcare providers and nursing faculty is the provision of effective delivery of care and safe practice settings. Decisions around the delegation of care are critical for quality patient outcomes. The purpose of this collaborative project between schools of nursing and a local community healthcare facility was to provide educational training to prelicensure nursing students on the delegation expectations for nursing professionals.

Developing future medical educators in an Australian medical program: supervisors’ reflections on the first four years of MD Professional Project implementation

ABSTRACT Background Increasingly, professional bodies expect doctors to not only provide patient care but also educate students, trainees and patients. Few medical students, however, receive formal tuition in terms of the theory and practice of medical education. A curriculum restructure from an MBBS to a Doctor of Medicine (MD) program provided an opportunity to develop three Masters streams: Clinical research, Capstones and educational Professional Projects. This submission describes how one Australian medical school is preparing some students for their future roles as medical educators through MD Professional Projects. Design Framed by the 12 roles of the medical ‘teacher’, most students undertaking these projects take on Resource Developer (including simulation) and Assessor roles. For those choosing resource development (excluding simulation) or assessment, the Association for Medical Education (AMEE) Student Essential Skills in Medical Education (ESME) Course is compulsory. For those choosing educational research, the ESME Course is optional. Outcomes By December 2020, four MD cohorts will have graduated with 69 students having undertaken educational MD Professional Projects, with fifty-one completing the ESME Course. MD students have created a range of resources for the curriculum, their colleagues and the local healthcare community. In addition to the expected learning we identified additional value-added outcomes for learners (e.g. skill development), the curriculum (e.g. areas of difficulty), academic supervisors’ roles (e.g. role-modelling) and for the health care community (e.g. as expert reviewers). Conclusions Engaging in scholarly activities such the ESME Course and developing learning resources not only provided MD students with a more in-depth theoretical knowledge in a range of clinical areas, but also developed skills that would prepare them for their future roles as medical educators. As supervisors, we identified the value these projects add to the broader health community as well as personal and professional benefits for ourselves.

Using a Nursing Salon to Identify and Develop an Initiative for Family Caregivers of Older Adults.

The purpose of the Aging Well Nursing-Interprofessional Salon was to explore current local community healthcare issues for older adults and to develop innovative strategies that support and enhance their health. An initiative emerged from the salon that focuses on identifying caregivers to ensure their awareness of available support resources. We are in the process of developing a pilot plan that includes collaboration of PhD and doctorate of nursing practice students, nursing faculty, and community agencies that support older adults.