Rural Health Care Settings Research Articles

Practice Perspectives on Care Coordination in Rural Settings.

Social needs and nonmedical health determinants are increasingly incorporated into care coordination models. However, little is known about the practice of operationalizing enhanced care coordination, particularly in rural settings. The objective of this study was to determine care coordination practices in rural settings that integrate social services with health care. Staff and administrators in rural Missouri health and health care settings were interviewed about their organization's implementation of enhanced care coordination practices. This is a mixed-methods study; 16 key informant structured interviews were conducted across 14 organizations. Organizations reported a median care coordination population of 800 (range: 50-21,500) across a median of 11 case managers (range: 3-375). The percentage of organizations reporting social determinants of health services included the following: 100% transportation, 86% mental health, 79% food, 71% housing, and 50% dental. Implementation of the essential indicators of care coordination quality ranged from 41.7% to 100%. We report organizations' innovative solutions to care coordination barriers. This study contributes to a very limited literature on the practice of rural care coordination by assessing the quality of care provided compared with a recommended standard. This study also contributes an in-depth reporting on the variety of service models being implemented. Finally, this study uniquely contributes innovative interprofessional examples of enhanced care coordination initiatives. These examples may provide inspiration for rural health care organizations. As the care coordination landscape evolves to include social determinants of health, there remain important fundamental barriers to ensuring quality of care.

Evaluating the Impact of Mental Health Training on Awareness of Common Mental Disorders among Community Health Officers in Raisen District, Madhya Pradesh

Mental health constitutes an integral dimension of overall well-being, significantly influencing individuals' quality of life and societal harmony. In rural regions, like Madhya Pradesh, accessing adequate mental health care often poses substantial challenges due to various barriers. This study aims to evaluate the impact of training on the awareness of common mental disorders (CMDs) among Community Health Officers (CHOs) in Raisen District, Madhya Pradesh. Using a quasi-experimental design, 42 CHOs from Health & Wellness Centres in the Raisen district participated in a comprehensive two-day training program covering CMD identification, assessment, and management. Baseline knowledge assessment revealed a moderate pre-training score of 18.2 out of 30, while the post-training score significantly improved to 26.8. The study emphasizes the pivotal role of such training interventions in enhancing mental health care awareness and proficiency within underserved communities ultimately contributing to improved accessibility and quality of mental health care in rural settings.

Perceptions of Barriers to Using Opioid Analgesics: A Mixed Methods Study.

Availability and accessibility of opioids are a worldwide problem. In low-resource settings, such as Ethiopia, access to opioids is either limited or nonexistent and legally restricted in health care settings. This study aimed to identify barriers for the availability and accessibility of opioids in Ethiopian rural and regional health care settings. A mixed-method case study design was used. A total of 220 nurses from primary, secondary, and tertiary health care settings were invited to participate in a survey of knowledge and practice. For the qualitative interview, 38 participants were recruited from educational facilities, health services, and the community across a region. Barriers in availability and accessibility of opioid analgesics were expressing pain considered as a sign of weakness, lack of knowledge, side effect concerns about prescribing morphine, only doctors being authorized to prescribe morphine, lack of foreign currency to import morphine ingredients, and inequity in accessing morphine in hospitals and none in rural health care settings. The findings of this study indicate that opioids, particularly morphine, were not consistently available and accessible to all patients in need. Health professionals lacked knowledge about opioids. Strengthening the existing pain-free initiatives and improving the type, dose, and supply of morphine could help reduce needless suffering and enhance access to essential pain medicines for those in need.

"We Have Outgrown Our Space; Our Facility Is Old and Falling Apart": Physical Design Implications to Address the Needs and Priorities of a Critical Access Hospital (CAH).

This exploratory study examines a rural critical access hospital (CAH) staff's perception of current obstacles and needs concerning the physical environment. CAH intends to improve access to healthcare, coordinate with experts and providers, and serve as the rural population's healthcare hub. It is imperative to understand environmental qualities that impact the quality of care to develop effective policies and design guidelines for rural healthcare. Nevertheless, a limited number of studies have focused on user or organizational outcomes related to the physical environment of rural healthcare settings. This cross-sectional exploratory qualitative case study was conducted as part of the facility planning process for a CAH in rural North Carolina. Hospital staff participated in a survey exploring their satisfaction with the overall physical environment privacy, space allocation, and department adjacency. An open-ended question asked staff to elaborate on needed improvements and changes in their department. Findings show low satisfaction levels for space allocations for emergency department, lab, surgery, and wound care. Safety and quality were the two emerging outcomes of the physical environment's shortcomings. Two clusters emerged from the content analysis, representing facility needs (rightly sized spaces, functional needs, COVID-19 needs, and improved access) and ambient conditions (clutter, visibility, flooring quality, noise, privacy, cleanliness, aesthetics, and temperature). The findings from this study suggest that the interior and exterior facility and ambient conditions of the CAH play a key role in quality and safety outcomes.

A comparison of serum sodium levels measured using a colorimetric kit approach and those determined using direct and indirect ion selective electrode techniques- in a Hospital Central Lab

When electrolyte imbalances are not recognized, they are known to cause severe morbidity and mortality. Dyselectrolytemia is frequently curable. Hyponatremia is a common symptom seen in the elderly. Laboratory equipment may be lacking in rural healthcare settings. As a result, the purpose of this study was to investigate the feasibility of developing a screening technique that can aid in the detection of hyponatremia in such facilities. Serum sodium levels in 120 samples were determined by direct, indirect, and colorimetric ISE. SPSS version 17, NCSS 11, and MINITAB 18 software were used for statistical analysis. Statistical significance was defined as a p-value of 0.05. While comparing the instruments, a basic linear regression analysis was performed, and a regression equation for sodium levels was established. The Bland-Altman analysis yielded a 95% agreement limit between the instruments, which is well within the CLIA-recommended target value of 4 mmol/L in the hyponatremic and normonatremic ranges. The resulting regression equation computes a predicted value for direct and indirect ISE using the colorimeter readings, making it similar to all three instruments in the hyponatremic and normonatremic ranges. The colorimetric method can be used as a low-cost screening technique to identify hyponatremic elderly people for whom a tertiary hospital may be inaccessible, allowing for early care.

Measuring and exploring the barriers to translating palliative care knowledge into clinical practice in rural and regional health-care settings.

This study aims to measure and explore the barriers to translating theoretical knowledge of palliative care into clinical practice. A mixed-method study, combining a cross-sectional survey and key interviews was conducted. The quantitative data were obtained from 173 nurses and the key interviews were conducted with 42 health professionals drawn from multiple settings. For quantitative data analysis, Statistical Package for the Social Sciences software were conducted, and a thematic analysis supported with NVivo software were used for analyzing qualitative data. Of the 220 nurses invited, 173 completed the survey (79%). Most (78%) had a bachelor's degree in nursing. Fewer than half, 69 (40%) scored 75% or more for the knowledge test; 173 (100%) scored 50% or greater for attitude; and only 32 (18.5%) scored 75% or greater for self-reported practice. While there was a small, positive correlation between palliative care attitudes and self-reported practice (r=0.22, p=0.003), the qualitative findings indicated that nurses had significant challenges in translating their theoretical knowledge into clinical practice. Limited clinical practice was linked to inadequate knowledge resulting from insufficient integration of palliative care content in undergraduate curricula and a lack of follow-up training. This was further exacerbated by shortages of medicine, staff, and financial resources and was linked to limited attention accorded to palliative care by the government. While the results showed the majority held positive views toward palliative care, improving palliative care practices requires, and enhancing nurses' knowledge of palliative care. This requires changing teaching methods and engaging policymakers.

Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review.

Australians in rural areas experience limited access to services and poorer health outcomes than residents of metropolitan areas. Nurse practitioners (NPs) were introduced in 2000 to reduce pressure on the health system, address workforce shortages and improve rural populations' access to health care services. This scoping review sought to identify, examine and synthesise research evidence of NP practice in Australian rural primary health care services to better understand how NPs are addressing service gaps in rural areas and to identify existing gaps in our knowledge. Peer-reviewed and grey literature from July 2012 to June 2022 was accessed from seven electronic databases, grey literature and hand searching of reference lists and citations. From 154 articles, 19 articles of relevance were identified. Several projects describe the processes required for success, whilst others reported the challenges and barriers encountered. Limited research evidence of rural NP practice exists with a significant gap about how roles operate and their value in primary health care. Uptake and envisaged benefits of rural primary health care NP roles have yet to be realised, with barriers to implementing and sustaining NP roles persisting. Low-level awareness with ambiguity at health service and community level adversely impact on systematic implementation of NP roles. Robust evaluations demonstrating the value of NP skills and practice are needed in combination with bipartisan support from all levels of health care and government providing adequate funding to enable effective implementation of NP roles in poorly resourced rural areas.

Symptom burden and end of life care in patients with acute myeloid leukemia undergoing intensive induction chemotherapy in a rural setting.

e24117 Background: Patients with acute myeloid leukemia (AML) who receive intensive induction chemotherapy (IC) face a prolonged hospitalization and a life-threatening illness. As a result, patients experience a high physical, psychological, and emotional symptom burden which can significantly affect their quality of life (QOL).1 There is also a high mortality rate associated with IC, with one study showing 12.3% chance of in-hospital death and 3.7% discharge to hospice.2 Early integration of palliative care (IPC) has shown improvements in QOL, decrease in psychological stress and improved end-of-life care.3 The aim of this study was to examine the historic use of IPC during IC and assess the symptom burden in a rural healthcare setting and to provide a rationale for early incorporation of palliative care into IC. Methods: We performed an IRB approved retrospective study of all patients with AML who were admitted to Gundersen Health System for IC from January 2013 to September 2021. Data collection included basic demographics, disease and treatment specific variables, and admission variables. Symptom burden was also assessed by reviewing daily progress notes. Statistical analysis included descriptive statistics, Wilcoxon signed-rank test, and Fisher’s exact test and was performed in SAS version 9.4 at a significance level of 0.05. Results: Our study included 33 patients with an average age of 62 years. Our sample was 100% white, 58% male, 82% married and 58% former smokers. Average length of stay was 29 days and 5 (15%) patients died during this time. Individuals experienced an average of 9.8 (range 4-17) of the 20 recorded symptoms, most commonly pain (97%), fevers (88%), edema (73%), anorexia (67%), rash (61%), and diarrhea (61%). Only 6 patients (18%) received a palliative care consultation during IC. For patients without a palliative care consultation during IC, advanced care planning (ACP) documents were found in only 37% during or before IC. However, when palliative care was consulted, ACP documentation increased to 83% demonstrating a trend towards significance (p = 0.07). There was a significant difference between the number of symptoms observed in those who received a palliative care consultation (median = 13 symptoms) and those who did not (median = 9 symptoms, p = 0.007). Conclusions: Despite our patients experiencing a high symptom burden and a significant chance of death, there was a low rate of early integration of palliative care. This retrospective study was unable to determine if IPC improved symptom burden, but we did find that IPC increased the rate of ACP documentation from 37% to 83%. The presence of ACP documentation has been shown to significantly reduce ICU utilization and improve the quality of care at the end of life.4 Given these findings; we plan to move forward with routine integration of palliative care into the management of patients undergoing IC for AML.

Correlates for the severity of suicidal risk in participants with common mental disorders with comorbid chronic medical conditions in rural primary healthcare settings in India.

Suicide is on the rise in low- and middle-income countries (LMICs), including India. There are limited studies assessing factors linked to the severity of suicidal risk in patients with depression and comorbid chronic medical disorders in primary healthcare (PHC) settings. This study examines factors linked to suicidal risk among participants in a cluster randomized controlled trial of collaborative care intervention (Healthier Options through Empowerment (HOPE Study)). The setting was at 49 PHC in the rural Ramanagara District of Karnataka State in southern India. Study eligibility criteria included being ≥30 years with at least mild depression or generalized anxiety disorder and at least one medical condition (cardiovascular disorder or type 2 diabetes mellitus). The severity of suicidal risk at baseline was assessed using the Mini International Neuropsychiatric Interview (MINI), and other measures included the severity of depression (Patient Health Questionnaire-9-items (PHQ-9)), the severity of anxiety (Generalized Anxiety Disorder Scale-7-items (GAD-7)), disability, social support, quality of life, number of comorbid chronic medical illnesses, and body mass index (BMI). Chi-square tests and independent-samples t-tests were used to compare the demographic and clinical characteristics of the no-low and mod-high suicidal risk groups. Logistic regression analysis was used to identify correlates associated with the mod-high suicidal risk group. Mod-high suicidal risk was significantly positively associated with the severity of depression and disability and significantly negatively associated with social support. The severity of depression, higher disability scores, and lower social support were found to be independent correlates of mod-high suicidal risk. Screening, managing depression, and facilitating social support for patients with chronic medical illness in PHC settings may reduce suicidal risk.

Addressing COVID-19 Disparities Between Hispanic and Non-Hispanic White Populations of Arizona

Introduction: The coronavirus disease (COVID-19) pandemic1,2 contributed to over 1.03 million deaths in the United States (U.S.) and 30,768 deaths in Arizona3. Nationwide, Hispanics are at increased risk for infection, hospitalization, and death, when compared to non-Hispanic White (NHW)4. Although Hispanic COVID-19 disparities are clear in the U.S., study of Hispanic COVID-19 disparities in Arizona are less clear. Objective: To compare COVID-19 interventions and clinical outcomes between Hispanic and NHW populations in rural and urban healthcare settings of Arizona. Methods: A retrospective cohort of COVID-19 patients from January 1, 2020 through June 17, 2022 admitted to hospitals affiliated with the Midwestern University Graduate Medical Education consortium were assessed. Data was abstracted to counterbalance NHW and minority patients by date of admission. Data collected included patient demographics, presenting symptoms, vital signs, laboratory values at the time of emergency department presentation, treatment modalities, and clinical outcomes. Results: A total of 627 patients were analyzed with 31.7% (199/627) identifying as Hispanic, 41.8% (262/627) female, and 61.9% (388/627) allocated to the rural hospital group. No difference in mortality was seen in the rural or urban setting and there was no difference in administered COVID-19 therapeutics. Kaplan-Meier curves were parallel between Hispanic and NHW patients who survived COVID-19 with no difference in the length of stay (LOS) days. Kaplan-Meier curves differed between Hispanics and NHW patients who expired from COVID-19 with Hispanics at a greater LOS prior to mortality. Differences between Hispanic and NHW mortality patients included Hispanics presenting at a younger age, increased CRP elevations, and a greater delay between symptom onset and COVID-19 testing. Hispanics who expired were more likely to present with shortness of breath, hypoxia, and a documented bacterial infection during hospitalization as compared to Hispanics who survived. Conclusion: Following admission, patients regardless of Hispanic or NHW identification, received equitable care in our Arizona subset which resulted in comparable rates of mortality. Hispanics initially presented at increased disease severity, which is suggestive of factors outside of the hospital, prior to admission, responsible for the disparities seen at the national level with variation between states.

Prevalence of probable mental, neurological and substance use conditions and case detection at primary healthcare facilities across three districts in Ghana: findings from a cross-sectional health facility survey

BackgroundFew studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana.MethodsA cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders.ResultsNine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12–1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39–0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02–0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27–4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93–5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20–0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12–0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08–0.92) were associated with reduced risk of AUD.ConclusionsOur study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.

Nurses' preparedness for disaster response in rural and urban primary healthcare settings in Tanzania.

Nurses are often on the frontline of disaster management, providing care to patients with emerging physical, mental, and emotional turbulence, and acting as educators for health promotion and disaster prevention in both rural and urban contexts. However, the literature suggests that nurses are inadequately prepared for disaster response. This study examined preparedness for disaster response among nurses in rural and urban primary healthcare settings in Tanzania. This qualitative descriptive study involved purposefully selected qualified nurses and nurse administrators working in rural (n=20) and urban (n=11) primary healthcare facilities in Tanzania. Telephone-based interviews were conducted to gather data that were then analyzed thematically. Five themes emerged from the analysis: previous experiences, technical capacity, current strategies, challenges, and overall preparedness. Previous experiences included personally caring for victims, working in disaster response teams, working in administrative roles during disasters, and conducting community sensitization. Most nurses in rural contexts had not received training on disaster response and relied on past experience, knowledge from nursing school, observing peers, and knowledge from the internet and movies. Current strategies for disaster response included response teams (although these were considered 'weak'), ensuring the availability of equipment and supplies, and infrastructure for victim management. Challenges in disaster response included inadequate resources, understaffing, lack of expertise at primary healthcare facilities, nurses tasked with multiple responsibilities, inadequate technical capacity, fears of infection, poor interpersonal relationships, inadequate community knowledge, poor reporting systems, delayed healthcare seeking, long distances to facilities, and poor road infrastructure. These challenges were more pronounced in rural settings. Most nurses felt they were well prepared to respond to disasters, although this appeared to be rooted in a willingness to provide care rather than having adequate knowledge, skills, and resources for disaster response. Suggestions for better preparing nurses for disaster response included training, increasing essential equipment and medical supplies, increasing the nursing workforce, improving reporting systems, disseminating local guidelines, strengthening disaster response teams, and improving the nursing training curricula to cover disaster management. A range of institutional, individual, and community challenges affect nurses' preparedness for disaster response in rural and urban primary healthcare settings. Addressing these challenges requires multiple strategies that extend beyond the capacity building of nurses to strengthen health system disaster preparedness in general, prioritizing rural contexts.

Prevalence and Risk Factors for COPD in an Urbanizing Rural Area in Western China: A Cross-Sectional Study.

To investigate the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) in a rural area in western China with severe air pollution. 10% of local residents aged 40 years and above were included using a convenience sampling method. This was a cross-sectional study. A self-designed questionnaire was used to collect participants' demographic data. The screening program was comprised of two steps: First, a portable electronic spirometer was used for COPD screening. Those participants with FEV1/FVC ratio <0.7 were then referred to a confirmatory pulmonary function (PF) test. COPD was confirmed according to the 2020 Global Initiative for Chronic Obstructive Lung Disease criteria. A total of 4577 participants aged 40 years old or above were included in the final analysis. Examination with a mobile spirometer identified 1159 individuals for confirmatory testing; after that, of the 1159 individuals, 889 were diagnosed with COPD by the confirmatory PF test. The prevalence of COPD among the target group was 19.4%. Older age, male sex (odds ratio [OR] = 1.537, 95% confidence interval [CI] 1.246-1.894), smoking history (OR = 1.338, 95% CI 1.069-1.675), family history of respiratory disease (OR = 1.625, 95% CI 1.350-1.957), education level (OR = 0.735, 95% CI 0.617-0.876), overweight (OR = 0.614, 95% CI 0.517-0.730) and obesity (OR = 0.572, 95% CI 0.449-0.721) were identified as independent factors associated with COPD. The screening program helped earlier detection of COPD in 719 participants. COPD was highly prevalent in the rural area studied. Rural residents who were older, current or ever-smokers, male and those who had a lower education level were more vulnerable to developing COPD. The COPD screening program may be helpful for earlier disease detection in rural health-care settings.

MP46-15 SURVIVAL OF PATIENTS WITH SQUAMOUS DIFFERENTIATED UROTHELIAL CARCINOMA COMPARED TO PURE UROTHELIAL CARCINOMA FOLLOWING RADICAL CYSTECTOMY IN A RURAL HEALTHCARE SYSTEM

You have accessJournal of UrologyCME1 Apr 2023MP46-15 SURVIVAL OF PATIENTS WITH SQUAMOUS DIFFERENTIATED UROTHELIAL CARCINOMA COMPARED TO PURE UROTHELIAL CARCINOMA FOLLOWING RADICAL CYSTECTOMY IN A RURAL HEALTHCARE SYSTEM Alexander Battin, Mystie Chen, Jasmine Kashkoush, Wanyan Ma, Donovan Harris, Karl Schranz, Zhan Wu, and Matthew Meissner Alexander BattinAlexander Battin More articles by this author , Mystie ChenMystie Chen More articles by this author , Jasmine KashkoushJasmine Kashkoush More articles by this author , Wanyan MaWanyan Ma More articles by this author , Donovan HarrisDonovan Harris More articles by this author , Karl SchranzKarl Schranz More articles by this author , Zhan WuZhan Wu More articles by this author , and Matthew MeissnerMatthew Meissner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Approximately 80% of urothelial carcinoma (UC) is pure while the other 20% is comprised of variant histology. The most common histological variant is squamous differentiation urothelial carcinoma (SqUC). Small series suggest an overall poor prognosis for SqUC compared to pure UC (pUC). The aim of this study is to compare survival outcomes between patients with SqUC and pUC following radical cystectomy in a large, rural healthcare system. METHODS: A total of 335 patients were scheduled for cystectomy at a rural tertiary care center between 2008 to 2019. Patients were followed post-operatively and evaluated for recurrence. Recurrence free survival (RFS) was defined as time after cystectomy without clinical evidence of disease until last follow up or date of death. Patients that underwent planned cystectomy that were unable to be performed due to extent of disease or mixed variant/differentiation histology will be excluded from analysis. Pathology from TURBT and cystectomy will be reviewed for inclusion. Statistical significance will be determined using XLSTAT software with log-rank test using a p-value less than 0.05. RESULTS: Of the 333 patients that underwent planned cystectomy, 225 (67.6%) were pUC, 47 (14.1%) were SqUC, 42 (12.6%) were mixed variant/differentiated UC, and 19 (5.7%) were non-UC malignancies. Furthermore, 32 (9.6%) radical cystectomies were aborted due to extent of disease. Average age at time of cystectomy for SqUC and pUC were 68.4 and 68.7 years, respectively. Overall survival in SqUC was significantly lower with median of 28 months compared to 56 months for pUC (p=0.011). This is demonstrated as a Kaplan-Meier survival curve in Figure 1. The SqUC group also had significantly lower RFS with median of 15 months compared to 50 months for pUC group (p=0.032) (Figure 2). CONCLUSIONS: Urothelial carcinoma with squamous differentiation has significantly lower overall survival and recurrent free survival compared to pUC after radical cystectomy in the rural healthcare setting. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e638 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Battin More articles by this author Mystie Chen More articles by this author Jasmine Kashkoush More articles by this author Wanyan Ma More articles by this author Donovan Harris More articles by this author Karl Schranz More articles by this author Zhan Wu More articles by this author Matthew Meissner More articles by this author Expand All Advertisement PDF downloadLoading ...

Use of Long-Acting Injectable Antipsychotics in a Clinical Sample of Community-Dwelling Patients with Schizophrenia-Spectrum Disorders in Rural Greece.

Data on the use of long-acting injectable antipsychotics (LAIs) in rural community mental healthcare settings are scarce. This study aimed to investigate the prescription patterns of LAIs in a clinical sample of patients with schizophrenia-spectrum disorders in rural Greece. All patients with schizophrenia-spectrum disorders who regularly attend the Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia (MMHU I-T) in northwestern Greece were included in the study. The sample consists of 87 patients (59 males and 28 females) with a mean age of 54.4 years and a mean illness duration of 28 years. Most patients (72.4%) received antipsychotic monotherapy, and nearly 30% received an LAI formulation, mostly a second-generation LAI (20 of 26 patients, 76.9%). The treatment regimen comprised benzodiazepines in one-third of the patients and antidepressants in one-quarter. There was no statistically significant association between treatment regimen and the clinical and demographic variables studied, except for biological sex (female). The percentage of patients treated with LAIs in this study was almost three times higher than the rate previously reported in Greece and is higher than the rates reported in other countries. Patients with schizophrenia-spectrum disorders in rural Greece may have adequate access to innovative treatment with second-generation LAIs. Further research is needed to demonstrate the cost-effectiveness of LAI treatment in rural communities and to elucidate the factors associated with such treatment.

Debriefing after critical incidents in rural and remote healthcare settings - a remote clinician perspective.

Debriefing following a critical incident allows teams to reflect on the experience and to work together to improve future performance. Hot, warm and cold debriefs occur at various stages following the incident - each with its own structure and objectives. Effective debriefing requires training and practice, with a variety of tools available for this purpose. Healthcare professionals working in rural and remote areas face a variety of unique barriers, not encountered by colleagues in urban settings, that may make debriefing challenging. A hypothetical case example illustrates the complexities of a critical incident in a remote service. Evidence-based strategies are outlined to support team members in rural and remote areas to debrief effectively, including the use of technology, formal teaching in university curriculums and regular practice by simulation.

Nursing Workforce Retention in Rural Ghana: The Predictive Role of Satisfaction, Rural Fit, and Resilience

Introduction. High turnover of nurses in rural healthcare settings contributes to challenges in healthcare delivery. Various incentive packages have been introduced in rural healthcare settings to curb this phenomenon, but the canker still exists. The study aimed at assessing the predictive role of job satisfaction, rural fit, and resilience on nurses’ retention in rural Ghana. Materials and Methods. A multicentre cross-sectional design was adopted to collect data from 462 nurses. Analysis through descriptive statistics, one-way ANOVA, Pearson moment product correlation, and multiple regression was done. Results. There was low resilience and rural fit among nurses with higher turnover intention, which was predicted by average daily attendance (β = 0.108), rural fit (β = −0.144), resilience (β = −0.350), satisfaction with prospects (β = −0.187), and satisfaction with prospect and pay (β = −0.171) at the significance of 0.05. Conclusion. Policymakers can be assured that not just improving financial incentives to nurses, but the integration of nurses to rural settings, commensurate workload and improving pay and prospects for professional growth and resilience are needed for rural retention. Implications for nursing management, nurse managers, and policymakers have a role to develop sustainable strategies to integrate rural fit, resilience, and job satisfaction to help reduce turnover among nurses.

How do nurses use early warning system vital signs observation charts in rural, remote and regional health care facilities: A scoping review.

Physiological signs of clinical deterioration are known to occur in the hours preceding a serious adverse event. As a result, track and trigger systems known as early warning systems (EWS) were introduced and routinely implemented as patient observation tools to trigger an alert in the presence of abnormal vital signs. The objective aimed to explore the literature pertaining to EWS and their utilisation in rural, remote and regional health care facilities. The Arksey and O'Malley's methodological framework was used to guide the scoping review. Only studies reporting on rural, remote and regional health care settings were included. All four authors participated in the screening, data extraction and analysis process. Our search strategy yielded 3869 peer-reviewed articles published between 2012 and 2022, with six studies ultimately included. Collectively, the studies included in this scoping review examined the complex interaction between patient vital signs observation charts and recognition of patient deterioration. Whilst rural, remote and regional clinicians use EWS to recognise and respond to clinical deterioration, noncompliance dilutes the tool's effectiveness. This overarching finding is informed by three contributing factors: documentation, communication and challenges specific to the rural context. The success of EWS relies on accurate documentation and effective communication within the interdisciplinary team to support appropriate responses to clinical patient decline. More research is required to understand the nuances and complexities of rural and remote nursing and to address challenges associated with the use of EWS in rural health care settings.

Facing Healthcare Access Challenges With Specialty Care Clinics in Central Appalachia

Access to specialty care and diagnostic services in rural healthcare settings are required to achieve quality healthcare outcomes. St. Mary’s Health Wagon network of free clinics, established in 1980, serves a region with an array of health disparities and poor social determinants of health. In 2018, the administration envisioned implementation of an interprofessional team to deliver diagnostic services targeting healthcare access challenges in southwest Virginia, which is historically unprecedented. The cost of diagnostic services in the area was not equitable for the poor, uninsured, and underinsured. Many patients had to use the emergency department for radiologic exams, incurring more debt that cannot be afforded or paid or simply forgoing needed diagnostic services. The leadership team applied for and secured a United Health Foundation Grant that fulfilled their vision, employing ultrasound, diagnostic x-ray, mammogram, telecystoscopy, telecolposcopy, and dental visits into the network of clinics. To date, St. Mary’s Health Wagon has performed 3,587 exams (342 ultrasounds, 282 x-rays, 273 mammograms, 21 telecystoscopies, 16 telecolposcopies, and 2,669 dental visits) free of cost for the patients. While there were some challenges with the implementation of these services, the benefits yielded quick diagnosis and treatment, leading to optimal patient outcomes.

Practical applications of implementing integrated mental health practices with primary care providers.

Community Health Advanced by Medical Practice Superstars is a 1-year, Health Resources and Services Administration (HRSA)-funded fellowship for early career physicians and physician assistants/associates to become primary care transformational leaders. Fellows implement practice-based health care transformation projects in one of the three HRSA priority areas: childhood obesity, mental health, and opioid use disorder. The purpose of these projects is to expand on integrated health in primary care settings where there is a shortage of mental health professionals. The fellows identified areas in which they were able to incorporate mental health care provision to improve diagnostic capacity and whole health delivery, facilitate appropriate behavioral health outcomes, and improve patient physical health outcomes. Project modalities included initiating or increasing behavioral health screenings, aligning screenings with patient outcomes, and coordinating behavioral health care with physical health care. This article describes six mental health-related health care practice transformation projects implemented across rural health care settings, including Federally Qualified Health Centers and academic medical centers. The topics included (a) depression in pregnant and postpartum mothers; (b) adverse childhood experiences screening; (c) depression and chronic disease outcomes, especially diabetes; (d) the use of automated enhancements in patients' electronic medical records for management of clinical depression; (e) improving health outcomes and medication adherence of patients with opioid use disorder; and (f) the (in)adequacy of the Patient Health Questionairre-2 (PHQ-2) for the assessment of depression among patients with diabetes. Clinical specialties included family medicine, pediatrics, and women's health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).