Health Care Provider Characteristics Research Articles

Perspectives of midwives on respectful maternity care

BackgroundRespectful maternity care forms the foundation of maternity services; however, delivery of dignified, efficient, and effective care in these settings remains inconsistent. Research has identified several factors that influence respectful maternity care. To understand the South African context, these factors were explored and described from the perspectives of midwives. MethodsA qualitative descriptive inquiry was conducted, with participants recruited through snowball sampling on the social networking site Facebook. Semi-structured questions were used to collect data, to which participants responded in writing, detailing factors that influenced respectful care, including words and practices they associated with respectful maternity care. The data was analyzed using content analysis to identify common categories.ResultsTwenty-five responses from participants were analyzed; four categories and six sub-categories emerged as representations of respectful maternity care. The categories and sub-categories were as follows: healthcare professional behavior (ethical conduct and professional attributes related to education and training), managerial support (conducive work environment), interpersonal facet of care (characteristics of healthcare providers), and the birth environment (caring within the birth environment and client-centered care).ConclusionMidwives emphasized the importance of understanding respectful maternity care to ensure optimal outcomes for women, families, and communities. However, given the complexity of maternity care, it is crucial for policymakers, administrators, and midwives to comprehend and appreciate the various elements that define respectful care, as this understanding can significantly enhance its successful implementation.

Design and cohort characteristics of TRACK, a prospective study of hyperkalaemia management decision-making.

Guideline-recommended hyperkalaemia management includes dietary potassium (K+) restriction, bicarbonate correction, diuretics and K+ binders with dose reduction of renin-angiotensin-aldosterone system inhibitors as a last resort. The extent to which these recommendations are implemented is uncertain, as real-world data on hyperkalaemia management are limited. The Tracking Treatment Pathways in Adult Patients with Hyperkalemia (TRACK) study is a multinational, prospective, longitudinal study that is being conducted to address this knowledge gap. We report the design and baseline cohort characteristics of this real-world study of hyperkalaemia management decision-making. This study enrolled participants within 21days of an episode of hyperkalaemia in four European countries (UK, Spain, Germany, Italy) and the USA. During the 12-month follow up, data collected will include participant and healthcare provider characteristics (specialty and practice setting), hyperkalaemia treatment objectives and strategies, rationale for management decisions and indicators of response and patient-reported perceptions of their hyperkalaemia treatment. The enrolled cohort includes 1330 participants, mean age 68years, of whom 31% were women. At baseline, 6% reported heart failure, 55% chronic kidney disease, 29% both and 9% neither. Most participants (57%) were taking an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker or angiotensin receptor/neprilysin inhibitor at baseline. Mineralocorticoid receptor antagonist use was lower (14%). The prospective TRACK study will shed light on practitioners' hyperkalaemia management decision-making and assess the impact of their decisions on hyperkalaemia recurrence. Understanding practitioners' underlying thought processes will facilitate efforts to improve hyperkalaemia management.ClinicalTrials.gov: NCT05408039.

Patterns and determinants of patient sharing in end-of-life health services: Empirical evidence from the Italian National Health Service

ABSTRACT End-of-life (EoL) care is critical for cancer patients, who tend to have high service needs that are dispersed across organizations and different levels of care. Although EOL has been widely studied, little is known about the patterns of coordination among EoL health care providers and how they contribute to the care of cancer patients. This study adopts a network perspective to examine the complex patterns of patient sharing among health care providers involved in EoL care, using data on the use of EoL health care services by 266 cancer patients in a large Local Health Authority in Italy. We conducted a social network analysis of the structural properties of the emerging network and used logistic regression-quadratic assignment procedures (LR-QAP) to explore how characteristics of health care providers, their collaborative network, and their distances predict the likelihood of observing patient sharing relationships. Our results show that complementarities in terms of medical specialization and co-location of services positively predict the likelihood of cancer patient sharing. This probability is also positively related to the difference in terms of eigenvector centrality as well as the degree of network transitivity. We discuss the policy implications of our findings.

Assessment of relevance and actual implementation of person-centeredness in healthcare and social support services for women with unintended pregnancy in Germany (CarePreg): results of expert workshops

IntroductionPerson-centeredness is a key principle in the German healthcare system. However, access to high-quality care for women with unintended pregnancy is limited due to social stigma and legal restrictions. There is little research on the adoption of person-centeredness in care for women with unintended pregnancy. The aim of this study was to analyze relevance and actual implementation of dimensions of person-centeredness in psycho-social and medical abortion care from the view of abortion care providers.MethodsCounselors and gynecologist working in psycho-social or medical abortion care participated in one of two digital workshops. Discussions were semi-structured based on the 16 dimensions of an integrative model of person-centeredness, audio-recorded and transcribed verbatim. During qualitative content analysis, deductive categories based on the integrative model of person-centeredness were applied and inductive categories were developed. Additionally, participants rated relevance and actual implementation of the dimensions in an online survey.ResultsThe 18 workshop participants most intensively discussed the dimensions “access to care”, “person-centered characteristics of healthcare providers” and “personally tailored information”. Four additional categories on a macro level (“stigmatization of women with unintended pregnancy”, “stigmatization of healthcare providers”, “political and legal aspects” and “corona pandemic”) were identified. Most dimensions were rated as highly relevant but implementation status was described as rather low.ConclusionsIn Germany, high quality person-centered care for women with unintended pregnancy is insufficiently implemented through limited access to information, a lack of abortion care providers, and stigmatization. There is a need for changes in health care structures to enable nationwide person-centered care for women with unintended pregnancy. Those changes include a more easy access to evidence-based information and person-centered abortion care, more education on abortion care for healthcare providers, integration of topics of abortion care in medical schools and promotion of de-stigmatizing actions to enable abortions as part of the general healthcare.

“They just knew, and that makes all the difference”: understanding positive healthcare experiences among trans people in Canada

Background Trans people face persistent systemic challenges and barriers in healthcare systems. Despite these obstacles, many trans people have had positive healthcare experiences, however little is known regarding their commonalities. Aims This study aims to better understand factors that influence positive healthcare experiences among trans people. Methods 33 longform interviews were conducted with trans individuals, with 29 being used for the final sample. Interviews were recorded, transcribed verbatim, and analyzed using NVIVO 12 software. Thematic analysis was conducted for the coding process with a combination of inductive and deductive approaches used to develop the coding frame. Results Four healthcare provider (HCP) characteristics and two patient attributes were identified as promoters of positive healthcare experiences. Positive HCP characteristics included having a provider who was 1) a member of the LGBTQ community, 2) knowledgeable, experienced, and willing to learn about trans health, 3) transparent and empowered patients regarding their medical decisions; and 4) sensitive, accepting, and validating of patients’ gender identities. The two patient attributes included: 1) engaging in self-advocacy regarding their care, and 2) being connected to a variety of supportive trans communities, both online and in-person. Discussion Better understanding these positive healthcare experiences can help in the development of curricula and policy to facilitate improved quality healthcare for trans people in Canada.

A qualitative study exploring the factors influencing maternal healthcare access and utilization among Muslim refugee women resettled in the United States.

Although a large number of Muslim refugees have resettled in the United States for the last decades, few studies have looked into maternal healthcare access and utilization among Muslim refugee women in the country. This qualitative study was conducted to explore the factors influencing maternal healthcare access and utilization among Muslim refugee women resettled in the United States. In-depth interviews were conducted among Afghan, Iraqi, and Syrian refugee women (n = 17) using an interview guide informed by Social Cognitive Theory and its key constructs. The interviews were recorded and transcribed verbatim, imported into MAXQDA 2020 (VERBI Software), and analyzed based on qualitative content analysis. Data analysis revealed several themes at the micro, meso, and macro-levels. Micro-level factors included women's attitudes toward hospitals and prenatal care, as well as their life skills and language proficiency. Meso-level factors, such as cultural norms and practices, social support and network, as well as health care provider characteristics, were also identified. Macro-level factors, such as the complex healthcare system and access to insurance, also appeared to influence maternal healthcare access and utilization. This study revealed the complex contextual factors that refugee populations face. Given the population's heterogeneity, a more nuanced understanding of refugee maternal health is required, as are more tailored programs for the most vulnerable groups of refugee women.

2665. Health Care Provider Characteristics Associated with Anal Cancer Screening in an Academic Medical System

Abstract Background Anal cancer disproportionally affects persons living with HIV (PWH), sexual and gender minorities, and those with gynecologic cancers, condyloma acuminata, and solid organ transplantation. While expert guidance on anal cancer screening exists for PWH, there are no national guidelines for screening any of these populations. We analyzed clinician characteristics associated with anal cancer screening among providers who care for high-risk populations at an academic medical center including infectious disease (ID) specialists, primary care providers (PCPs), and obstetrician/gynecologists (OBGYNs). Methods We retrospectively reviewed medical charts for patients with HIV, gynecologic cancers, condyloma acuminata, solid organ transplantation, and sexual or gender minority status at Beth Israel Deaconess Medical Center and two affiliated clinics from 01/01/2015 - 08/01/2022. We extracted provider specialties, clinic locations, patient panel demographics, and dates of anal cytology and human papillomavirus (HPV) screening tests. We used chi-squared tests to identify provider factors associated with screening. Results Of 1,093 providers, at least one anal cytology test was performed by 93.8% (75/80) of ID providers, 55.2% (376/681) of PCPs, 28.3% (41/145) of OBGYNs, and 24.1% (45/187) of other providers (p < 0.001); among screeners, anal HPV co-testing was performed equally across specialties (54.2%, p = 0.23). Providers were more likely to screen if they cared for PWH (91.8% with 10-49 PWH vs 3.7% for no PWH, p < 0.001), majority cis-men (55.2%, p=0.003), or majority publicly insured patients (51.8%, p < 0.001). Providers were less likely to screen if they cared for majority cis-women (40.9%, p< 0.001) or majority privately insured patients (24.0%, p< 0.001). Screening practices did not differ by the racial composition of providers’ patient panels (p=.21). Conclusion While many ID specialists performed anal cancer screenings, other providers were less likely to screen. Providers caring for many PWH, cis-men, or publicly insured patients were more likely to screen. Additional research is needed to clarify screening guidance and optimize screening practices for all higher-risk populations, especially non-PWH groups. Disclosures Douglas Krakower, MD, Gilead: Grant/Research Support|Merck: Grant/Research Support|U. North Texas Health Sciences Center: Funding for mentoring|UAB: Advisor/Consultant|UpToDate, Inc.: Royalties|Virology Education: Honoraria

2321. Prevalence and determinants of depression among healthcare workers during the COVID-19 pandemic in Khujand, Tajikistan, 2022

Abstract Background Healthcare workers experienced substantial work overload and stress during the COVID-19 response. Increase in prevalence of mental health conditions among healthcare workers have been reported globally. Low-resource settings, such as Tajikistan, experienced additional challenges related to the COVID-19 pandemic and have scare resources to mitigate mental health consequences. To inform program planning, we aimed to determine prevalence of depression, associated factors, and care gap among healthcare workers. Methods We conducted a cross-sectional study of all healthcare providers (physicians, nurses, and nurse assistants) working from July to August 2022 in three COVID-19 referral hospitals and three polyclinics in Khujand city, Tajikistan. We systematically sampled every fifth provider. Depression was assessed using the Hospital Anxiety and Depression Scale. We used multivariable logistic regression model adjusting for random effect of hospital to identify factors associated with depression. Results Among 400 healthcare workers, 277 (69%) had depression (Table 1). Half (44%) no longer enjoyed the things they used to (Figure 1). Prevalence of depression was significantly higher (p< 0.01) among females than males (71% vs 59%), nurses than physicians (77% vs 56%). Among providers with depression, 20% had received professional services, 32% had taken a vacation, 32% had severe COVID-19, and 53% experienced frequent respiratory issues, and 56% felt people avoided them because of work. In multivariable analysis depression was associated with being a nurse (adjusted odds ratio [aOR]=3.5; 95% confidence ratio [CI]: 1.7-7.2), having had severe COVID-19 disease (aOR=4.0; 95% CI: 1.4-11.8) and having felt that people avoided them because of work (aOR=1.6; 95% CI: 1.0-2.6) (Table 2). Providers who used respirators >3 hours had lower odds of depression (aOR=0.4; 95% CI: 0.2-0.9). General characteristics of healthcare providers by depression, Tajikistan, 2022 External pressures, physical conditions and supportive services among and depression among healthcare workers, Tajikistan, 2021 Factors associated with depression among healthcare workers, Tajikistan, 2021 Conclusion We found high prevalence of depression among healthcare workers in Khujand city, Tajikistan. Timely screening and increase in provision of supportive services for providers is needed. These services should be offered to all providers, and especially targeted towards those with prior severe COVID-19 disease and nurses. Disclosures All Authors: No reported disclosures

The Use of Remote Consultations and Associated Factors in Rheumatology: A Large Retrospective Cohort Study of Follow-Up Consultations Before, During, and After COVID-19.

To investigate the use of remote consultations (RCs) and the influence of consultation, health care provider (HCP), and patient characteristics on the choice for remote or face-to-face consultation. A monocenter retrospective cohort study was conducted on follow-up consultations of patients with rheumatic diseases from January 1, 2019 to January 16, 2023, using data from electronic health records. Trends in the proportion of RCs before, during, and after COVID-19 were studied. Cross-classified multilevel logistic regression models were built to account for clustering of consultations (level 1) within both patients and HCPs (level 2). The influence of consultation, patient, and HCP characteristics on the type of consultation was assessed. 157,028 consultations of 30,215 unique patients seen by 64 HCPs were included in the data set. After an initial sharp increase in RC use at the beginning of the COVID-19 pandemic, the proportion of RCs decreased toward a seemingly steady state at around 30%. 90% of the variance in the use of RCs can be attributed to the consultation level, whereas 4% and 6% can be attributed to the patient and HCP level. Longer consultation durations and time since last consultation decreased the odds for a RC, as did higher patient age, shared care, and longer disease duration. Higher travel distance, consultation density, and patient digital access increased the odds for a RC. The COVID pandemic resulted in a structural increase in the use of RCs. Although several patient characteristics are associated with the type of consultation, most variance resulted from consultation characteristics compared with patients and HCPs.

Patient-centered care and geriatric knowledge translation among healthcare providers in Vietnam: translation and validation of the patient-centered care measure

BackgroundPeople are living longer, and the majority of aging people reside in low- and middle-income countries (LMICs). However, inappropriate healthcare contributes to health disparities between populations of aging people and leads to care dependency and social isolation. Tools to assess and evaluate the effectiveness of quality improvement interventions for geriatric care in LMICs are limited. The aim of this study was to provide a validated and culturally relevant instrument to assess patient-centered care in Vietnam, where the population of aging people is growing rapidly.MethodsThe Patient-Centered Care (PCC) measure was translated from English to Vietnamese using forward-backward method. The PCC measure grouped activities into sub-domains of holistic, collaborative, and responsive care. A bilingual expert panel rated the cross-cultural relevance and translation equivalence of the instrument. We calculated Content Validity Indexing (CVI) scores at both the item (I-CVI) and scale (S-CVI/Ave) levels to evaluate the relevance of the Vietnamese PCC (VPCC) measure to geriatric care in the Vietnamese context. We piloted the translated instrument VPCC measure with 112 healthcare providers in Hanoi, Vietnam. Multiple logistic regression models were specified to test the a priori null hypothesis that geriatric knowledge is not different among healthcare providers with perception of high implementation compared with low implementation of PCC measures.ResultsOn the item level, all 20 questions had excellent validity ratings. The VPCC had excellent content validity (S-CVI/Ave of 0.96) and translation equivalence (TS- CVI/Ave of 0.94). In the pilot study, the highest-rated PCC elements were the holistic provision of information and collaborative care, while the lowest-rated elements were the holistic attendance to patients’ needs and responsive care. Attention to the psychosocial needs of aging people and poor coordination of care within and beyond the health system were the lowest-rated PCC activities. After controlling for healthcare provider characteristics, the odds of the perception of high implementation of collaborative care were increased by 21% for each increase in geriatric knowledge score. We fail to reject the null hypotheses for holistic care, responsive care and PCC.ConclusionThe VPCC is a validated instrument that may be utilized to systemically evaluate the practice of patient-centered geriatric care in Vietnam.

A qualitative study of patients’ experience during vaginal examination & transvaginal ultrasound in a tertiary hospital in singapore

<h3>Objectives</h3> Pelvic examination via vaginal digital examination & transvaginal ultrasound are routinely performed during gynaecological assessment. This is crucial in screening for gynaecological cancers, testing for infections, evaluating pelvic pain, and other important health-related factors. Many women find gynecological examinations uncomfortable, embarrassing and stressful. Past negative experiences can increase anxiety and discomfort experienced during subsequent examinations. Emotional distress & fear of pain result in women having reduced adherence in undergoing gynaecological screening & follow-up with implications from delayed diagnosis. Traumatic pelvic exams have been reported as a potential cause of vaginismus with associated impact on sexual function, relationship and fertility.This study uses qualitative methods with the aim of exploring the experience of patients who have undergone pelvic examination at the outpatient setting in a tertiary hospital in Singapore. The findings will provide new insights into aspects of care experienced by these patients including what is most valued or can be improved during pelvic examinationto lead improvement in the delivery of care. <h3>Methods</h3> We used qualitative methods to explore the patients' subjective experiences. Twelve patients (age 30-57) were interviewed. The interviews were audio-recorded, transcribed, audited and analysed iteratively based on grounded theory. Emergent themes were first externally validated, and then finalized after rounds of deliberations amongst the investigators. The outcome measures included descriptions & concepts reflecting the most important matters experienced by these women. <h3>Results</h3> The patients found pelvic examination unpleasant and uncomfortable. Four overarching themes emerged from the interviews: the environment & clinic physical set up, patient characteristics, healthcare provider characteristics & attitude and patient information or education. <h3>Conclusions</h3> This study has provided some insight into key facilitating factors contributing to improved patient experience as well as barriers faced. Further work and studies are required to look into sociocultural aspects and what must be done to ensure improvement in this aspect. <h3>Conflicts of Interest</h3> nil

The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh.

Low- and middle-income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016-2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service-related factors with patients' preferences for healthcare services. The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%)and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio[RRR] = 0.71; 0.56-0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80-9.86) or affordability of healthcare services (RRR = 3.13; 2.25-4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15-1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70-5.04) than the quality of treatment in the health facility, when compared with private service providers. Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. Our research team includes four researchers (co-authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases.

Can non-responding mask or mimic drug effects on pregnancy outcome? Evaluation of case characteristics based on the national Embryotox cohort

Women and their health care provider (HCP) often seek advice for drug safety in pregnancy at Teratology Information Services (TIS). In turn, TIS ask for details of drug exposure and pregnancy outcome. These data constitute a valuable basis for research on prenatal drug risks in many countries. Non-response to follow-up questionnaires, however, may cause biased study results. To assess the potential of non-response bias, this study based on the German Embryotox cohort compares maternal and HCP characteristics of responders and non-responders. Change in loss of follow-up rates over time is investigated using logistic regression. From 2010 until the end of 2020, 48,410 pregnant women and/or their HCP consented to participation in follow-up. Of these, 25.0 % did not return follow-up questionnaires. Loss rates were similar for patients and HCP but increased over time. Participants from semi-dense populated areas had a smaller loss rate (20.4 %) than those from rural (28.4 %) or urban areas (25.6 %). Responding women were older than non-responders, had a lower BMI, a more positive attitude towards pregnancy, a higher educational level, a lower number of previous pregnancies, smoked less, and indicated alcohol consumption more but social drugs less often. Non-response bias cannot be ruled out in studies based on observational data on drug use in pregnancy as those collected by TIS. However, differences between the complete and lost-to follow-up cohort do not suggest a particularly high or low risk profile for one of the cohorts that might substantially confound study results or even mask or mimic potential drug toxicity.

Association of Healthcare Workers Characteristics with Exposure to any form of Violence at the Hospitals of Karachi

Objectives: To determine the prevalence and association of healthcare provider characteristics with exposure to any form of violence. To determine the frequency of change of workplace due to violence among medical doctors. Methods: The study was conducted at three Karachi government hospitals. Anyone who worked in outpatient, ward, or emergency department units of any age or gender was eligible to participate in the study. Surveys were conducted using a WHO-validated questionnaire, which included questions about exposure to violence and socio-demographic information. Results: Out of 300 people 52.7% were females and 47.3% were males. Chief Medical Officer /Medical Officers were twelve times more expected to be exposed to workplace violence than house officers. 26% of medical doctors had previously changed jobs. However, 19% of medical doctors had changed their workplace due to workplace violence. Conclusion: Violence of any kind was more common in doctors over the age of 35, and men were more vulnerable to violence. CMO/MO were more likely to engage in any form of violence than the rest of the profession. Last but not least, the frequency of medical doctors changing jobs due to violence was low. Keywords: workplace violence, healthcare workers, medical doctors, house officer, chief medical officer.

Experiences of and attitudes towards HIV testing for Asian, Black and Latin American men who have sex with men (MSM) in the SELPHI (HIV Self\u2010Testing Public Health Intervention) randomized controlled trial in England and Wales: implications for HIV self-testing

BackgroundHIV self-testing (HIVST) could play an important role in improving access to testing and therefore reducing inequalities related to late diagnosis of HIV, while also improving access to HIV prevention interventions such as HIV pre-exposure prophylaxis. This study sought to understand the potential role of HIVST by exploring the experiences of Asian, Black and Latin American men who have sex with men (MSM) accessing the gay scene and the circulation of HIV testing norms; experiences of accessing HIV testing services; HIVST acceptability and preferences for intervention adaptations.MethodsTwenty-nine qualitative interviews were conducted with Asian, Black and Latin American MSM who had participated in SELPHI, an HIVST randomised controlled trial. Topics included HIV testing history, HIV testing patterns, experiences of accessing sexual health services, mental health, engagement with HIVST and SELPHI, and experiences of the gay scene. Interviews were audio recorded, transcribed and then analysed using a thematic framework.ResultsThe gay scene was identified as an important site for learning about HIV and being exposed to norms reinforcing the importance of protective behaviours. However, experiences of discomfort due to perceptions of ‘whiteness’ on the scene or experiences of racism may hinder the protective function the scene could play in developing norms influencing HIV testing behaviour. Discomfort in clinic waiting rooms was identified as a substantial barrier to accessing clinical services and many interviewees expressed preferences regarding the personal characteristics of healthcare providers. HIVST was found to be acceptable and some interviewees suggested potential adaptations of the HIVST offer, such as packaging HIVST with at home sexually transmitted infections testing options.ConclusionsHIVST responds to some service access barriers experienced by Asian, Black and Latin American MSM. The decoupling of HIV testing and clinic attendance may be particularly valuable for MSM of minority ethnic backgrounds who are likely to experience anxiety and discomfort in clinic waiting rooms more acutely than White MSM due to concerns around implied disclosure. This suggests that HIVST may have the potential to increase testing uptake and frequency, particularly for those with complex relationships with clinical services.Trial RegistrationSELPHI was prospectively registered with the ISRCTN (ref: ISRCTN 20312003).

Racial Disparities in the Emergency Department Evaluation of Adolescent Girls.

Racial disparities and differences exist in emergency care. Obtaining a sexual history is standard of care for adolescents with abdominal pain. Testing for sexually transmitted infections (STIs) and pregnancy should be based on historical findings. The objective of this study was to determine whether differential care was provided to adolescent female patients with abdominal pain based on patient race or healthcare provider characteristics by evaluating the documentation of sexual history, STI testing, and pregnancy testing. This was a retrospective chart review of female patients between the ages of 14 and 18 years with abdominal pain presenting to a pediatric emergency department. Patient and provider characteristics, sexual history documentation, STI, and pregnancy testing were abstracted. Data were analyzed using χ 2 test and logistic regression model. Eight hundred eighty-six encounters were included in the analysis. Median patient age was 16 years (range, 14-18 years); 359 (40.5%) were non-White. Differential care was provided. Non-White patients compared with White patients were more likely to have a documented sexual history (59.9% vs 44.0%, P < 0.001), STI testing (24.8% vs 7.8%, P < 0.001), and pregnancy testing (76.6% vs 66.2%, P < 0.001). Among sexually active female patients, the racial disparity for STI testing persisted ( P = 0.010). Provider type and sex did not result in differences in sexual history documentation, STI, or pregnancy testing for non-White compared with White patients ( P > 0.05). Differential care was provided to non-White adolescents with abdominal pain compared with White adolescents. They were more likely to have a documented sexual history, STI testing, and pregnancy testing. Healthcare provider characteristics did not impact patient care. This racial disparity resulted in better medical care for non-White adolescents, but this may be the consequence of underlying implicit bias.

Factors influencing quality nutrition service provision at antenatal care contacts: Findings from a public health facility-based observational study in 21 districts of Bangladesh.

Malnutrition during pregnancy is associated with increased maternal morbidity and mortality and has a long-term negative impact on child growth and development. Antenatal care (ANC) is the formal point of contact for pregnant women to receive preventive health and nutrition services. We assessed the quality of nutrition service delivery during ANC and examined its influencing factors related to the health facility, health care provider (HCP) and client characteristics. We conducted a cross-sectional assessment in 179 facilities, including 1,242 ANC observations and exit interviews of pregnant women from 21 districts in Bangladesh. We considered four essential nutrition services at each ANC contact including maternal weight measurement, anaemia assessment, nutrition counselling and iron-folic acid (IFA) supplement provision. We defined a composite 'quality nutrition service' outcome by counting the number of services (out of four) provided at each ANC from observation data. We explored both the supply-side and the client-level factors of quality nutrition service using multilevel Poisson regression. Overall, only 15% of clients received all four nutrition services. Performance of weight measurement (79%) was higher than IFA provision (56%), anaemia assessment (52%) and nutrition counselling (52%). The multivariable analysis showed that quality nutrition service delivery is positively associated with good logistical readiness of the facilities (aIRR: 1.23, 95% CI: 1.08-1.39), consultation by paramedics (aIRR 1.23, 95% CI: 1.06-1.42) and community health care providers (aIRR 1.32, 95% CI: 1.12-1.57), HCPs' knowledge on maternal nutrition (aIRR 1.04; 95% CI: 1.01-1.08), better HCP-client communication (aIRR 1.14; 95% CI: 1.04-1.26) and use visual aids or ANC card (aIRR 1.18; 95% CI: 1.11-1.27). We found limited associations between HCP training and external supervision with the quality of nutrition services. In conclusion, the quality of nutrition service provision during ANC is suboptimal. Public health nutrition programmers should ensure the facilities' logistical readiness, and revisit and reinforce the content and modality of training and supportive supervision of the HCPs. They should also emphasize positive HCP-client communication and the use of job aids to improve the quality of nutrition service provision during ANC.

Encounter patterns and worker absenteeism/presenteeism among healthcare providers in Thailand

• We examined number of encounters made by healthcare providers in inpatient wards. • Wards were stratified by risk of respiratory virus transmission. • A median encounter duration was two minutes. Difference in encounter patterns by ward type was observed. • About one in five work shifts were staffed by HCPs with acute muscle pain and/or respiratory symptoms who continued to work while ill. • The encounter episodes were highest among physicians working working during the 8-hour evening shift in high-risk wards. We examined the characteristics of healthcare providers’ (HCPs) encounters, and the frequency of worker absenteeism/presenteeism, among HCPs in inpatient wards at a tertiary-level public hospital in Bangkok, Thailand. The wards were stratified by risk of respiratory virus transmission: low-risk (Surgery, Rehabilitation, Orthopedic, and Obstetrics and Gynecology) and high-risk (Medicine, Pediatric, Emergency, and Ear, Nose, and Throat) . Observers followed HCPs throughout one self-selected 8-hour work shift to record their interaction with others. An encounter was defined as a 2-way conversation with ≥3 words in the physical presence of ≥1 person at <3 feet distance; or a physical skin-to-skin touch. We administered structured questionnaires to document demographics, health and work history, past practice while ill, and recent and current acute muscle pain and/or respiratory symptoms. We collected data from time and attendance records of participants reporting illness within the past seven days. From July to August 2019, 240 HCPs were enrolled and observed during 395 work shifts; 15,878 total encounters were made with a median duration of two minutes (interquartile range, 1–3). Number of contacts ranged from 25 to 49 encounters/8 h in the low-risk wards and 40 to 66 encounters/8 h in the high-risk wards. Physicians working during the 8-hour evening shift in high-risk wards had the highest estimated number of contacts (66 encounters; 95% confidence interval [CI], 43–89) while nurses working during the 8-hour night shift in the low-risk wards had the lowest number of contacts (25 encounters; 95% CI, 22–28). Forty-two (11%) shifts were staffed by HCPs with acute muscle pain and/or respiratory symptom(s) at the time of interview, and 89 (23%) by HCPs who reported symptom(s) during the past seven days, for which none were absent from work. We observed difference in encounter patterns by ward type. About one in five work shifts were staffed by HCPs with acute muscle pain and/or respiratory symptoms who continued to work while ill. These findings have implications for preventing infectious disease transmission and the policy around sick leave in healthcare settings.

Health Care Provider Characteristics Associated With Colorectal Cancer Screening Preferences and Use

ObjectiveTo assess health care provider (HCP) preferences related to colorectal cancer (CRC) screening overall, and by HCP and patient characteristics. Participants and MethodsWe developed a survey based on the Theoretical Domains Framework to assess factors associated with CRC screening preferences in clinical practice. The survey was administered online November 6 through December 6, 2019, to a validated panel of HCPs drawn from US national databases and professional organizations. The final analysis sample included 779 primary care clinicians (PCCs) and 159 gastroenterologists (GIs). ResultsHCPs chose colonoscopy as their preferred screening method for average-risk patients (96.9% (154/159) for GIs, 75.7% (590/779) for PCCs). Among PCCs, 12.2% (95/779) preferred multi-target stool DNA (mt-sDNA), followed by fecal immunochemical test (FIT), (7.3%; 57/779) and guaiac-based fecal occult blood test (gFOBT) (4.8%; 37/779). Preference among PCCs and GIs generally shifted toward noninvasive screening options for patients who were unable to undergo invasive procedures; concerned about taking time from work; unconvinced about need for screening; and refusing other screening recommendations. Among PCCs, preference for mt-sDNA over FIT and gFOBT was less frequent in larger compared with smaller clinical practices. Additionally, preference for mt-sDNA over FIT was more likely among PCCs with more years of clinical experience, higher patient volumes (> 25/day), and practice locations in suburban and rural settings (compared to urban). ConclusionBoth PCCs and GIs preferred colonoscopy for CRC screening of average-risk patients, although PCCs did so less frequently and with approximately a quarter preferring stool-based tests (particularly mt-sDNA). PCCs’ preference varied by provider and patient characteristics. Our findings underscore the importance of informed choice and shared decision-making about CRC screening options.

Healthcare providers perception of therapeutic patient education efficacy according to patient and healthcare provider characteristics.

Therapeutic patient education improves numerous health and psychological outcomes in patients with chronic diseases. However, little is known about what makes a therapeutic patient education intervention more effective than another one. This study aims to identify in healthcare professionals the perceived determinants of therapeutic patient education efficacy at the individual level. Semi-structured individual interviews have been conducted with healthcare professionals (HCP, n=28, including 20 nurses) involved in therapeutic patient education programs (n=14) covering various chronic conditions (kidney and cardiovascular diseases, chronic pain, diabetes, etc.). A thematic content analysis following an inductive approach was used (Nvivo.11 software). Five themes were retrieved for patient characteristics: understanding and education, personality, readiness and motivation, social environment, and misinformation and beliefs. Four themes were retrieved for healthcare professionals' characteristics: medical knowledge, appropriate attitude and relational skills, pedagogical skills, and training. Patient personality is rarely discussed in the literature. Patients who are introverted, lack curiosity, or are not compliant might benefit from specific therapeutic patient education practices or formats. All these potential determinants regarding patients and healthcare professionals should be routinely assessed in future studies about therapeutic patient education efficacy to understand precisely what makes an intervention successful.