Lack Of Appointments Research Articles

Magnitude and associated factors of early Implanon discontinuation among rural women in public health facilities of central Ethiopia: a community-based cross-sectional study

BackgroundAdvocating for and promoting contraception use is critical in reducing mother and child morbidity and mortality. Early Implanon discontinuation may result in unwanted pregnancies and induced abortions. Although there has been research in Ethiopia on long-acting reversible contraceptives, there has been none on early Implanon removal among rural women who have used and removed it. Hence, this study aimed to investigate the magnitude of Implanon discontinuation and related characteristics among women who had the Implanon removed in central Ethiopian public health facilities.MethodsA community-based cross-sectional study was conducted among all women of the reproductive age group who had removed Implanon after using it. A simple random sampling technique was used to select 373 women after proportional allocation to each health facility. Data were collected using a pretested semi-structured interviewer-administered questionnaire adapted from previous studies. Data were entered using EpiInfo and exported to SPSS version 21 for analysis. A binary logistic regression model was used to determine the association between the outcome variable and independent variables. A p-value less than 0.25 was used as a cutoff point to select candidate variables for the final model. Then, a p value less than 0.05, AOR, and a 95% confidence level were used to declare statistical significance.ResultA total of 360 participants responded to the questionnaires, making a response rate of 96.5%. In this study, the early discontinuation rate was 42% (95% CI 36.9–47.7). No formal education (AOR = 0.53 [95% CI 0.3–0.94], having medium monthly income (AOR = 3.02 [95% CI 1.38–6.6]), inadequate pre-insertion counseling (AOR = 0.55 [95% CI 0.31–0.98]), lack of appointment for follow up (AOR = 0.16 [95% CI 0.05–0.54]), didn`t satisfy with service provided (AOR = 0.067 [95% CI 0.015–0.29] and developed side effect (AOR) = 4.45 [95% CI 2.37–8.36] were significantly associated with Implanon discontinuation.ConclusionThe discontinuation rate of Implanon among those who removed it after using it in this study was high. Lack of formal education, having a medium-income, inadequate pre-insertion counseling, lack of appointments for the follow-up, poor satisfaction, and problems with side effects were the factors associated with early discontinuation rate. Hence, quality family planning service provision is essential to reduce the discontinuation rate.

Investigating the impact of distance on the use of primary care extended hours.

IntroductionPoor access to general practice services has been attributed to increasing pressure on the health system more widely and low satisfaction among patients. Recent initiatives in England have sought to expand access by the provision of appointments in the evening and at weekends. Services are provided using a hub model. NHS national targets mandate extended opening hours as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. However, research has shown that other factors affect access to healthcare and it may not simply be appointment availability that limits an individual’s ability to access general practice services.ObjectivesTo determine whether distance and deprivation impact on the uptake of extended hours GP services that use a hub practice model.MethodsWe linked a dataset (N = 25,408) concerning extended access appointments covering 158 general practice surgeries in four Clinical Commissioning Groups (CCGs) to the General Practice Patient Survey (GPPS) survey, deprivation statistics and primary care registration data. We used negative binomial regression to estimate associations between distance and deprivation on the uptake of extended hours GP services in the Greater Manchester City Region. Distance was defined as a straight line between the extended hours provider location and the patient’s home practice, the English Indices of Multiple Deprivation were used to determine area deprivation based upon the home practice, and familiarity was defined as whether the patient’s home practice provided an extended hours service.ResultsThe number of uses of the extended hours service at a GP practice level was associated with distance. After allowing for distance, the number of uses of the service for hub practices was higher than for non-hub practices. Deprivation was not associated with rates of use.ConclusionThe results indicate geographic inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub and spoke model does not address barriers to access. Findings may help to inform the choice of hub practices when designing an extended access service. Providers should consider initiatives to improve access for those patients located in practices furthest away from hub practices. This is particularly of importance in the context of closing health inequality gaps.

Identifying Barriers to Healthcare Access for New Immigrants: A Qualitative Study in Regina, Saskatchewan, Canada.

Despite universal healthcare, immigrants often face unique challenges accessing healthcare. Employing an interpretative phenomenological analysis approach, four focus groups were conducted with 29 women and eight men from 15 different countries attending English language classes hosted at a non-governmental organization in Regina, Saskatchewan, Canada in 2016 and 2017. Personal factors such as language barrier, lack of transportation, childcare and others interacted with systemic factors such as lack of appointment, long wait times, etc. delaying access at each point of contact with the healthcare system. Participants expressed dissatisfaction with the potency of medications, time spent in appointments and the way healthcare professionals communicated health information. The referral process and wait times were viewed as barriers to accessing specialist, diagnostic and acute care services. Participants were concerned that appropriate healthcare will be unavailable when needed. Strategies addressing systemic and person-specific barriers are needed to provide equitable client-centered care.

The effect of the COVID-19 lockdown on childhood vaccinations in Jeddah: a crosssectional study

Background: A lot of countries worldwide had reported a decrease in routine immunization during the coronavirus disease 2019 (COVID-19) pandemic. In the Kingdom of Saudi Arabia, the same was observed. This study aimed to assess the percentage of children who delayed vaccination and the difficulties their caregivers faced to vaccinate them since the start of the COVID-19 lockdown. Method: A cross-sectional study was carried out from December 2020 to February 2021 on 269 caregivers of children below 6 years in Jeddah, Saudi Arabia. An Arabic questionnaire was used to collect data about missing vaccines during the Coronavirus disease (COVID-A19) pandemic, missed vaccines, causes of missing vaccines, and awareness of the importance of vaccination. Results: During the lockdown, 65.8% of the participants said that their child’s vaccine was delayed. Fear of infection (37.5%), lack of appointments (18.2%), and difficulty getting to the healthcare clinics were the most common reasons for the delay (14.1%). Most participants agreed that delaying the child’s vaccination could affect their health, and 88.1% agreed that their awareness about vaccinations increased after the COVID-19 infection. Almost half of the participants (47.2%) heard about home vaccinations and 76.2% supported these services. Participants who had never attended home vaccination services had a far higher chance of delaying their child’s vaccination during the lockdown. Conclusion: During the COVID-19 pandemic, most pediatric vaccines in Jeddah were postponed, according to this study. Increasing the awareness of childhood vaccinations for caregivers to prevent the delay of childhood vaccinations during the pandemic is needed.

Satisfacción laboral y compromiso organizacional de docentes en una universidad pública de Perú

El objetivo de esta investigación fue evaluar la relación entre satisfacción laboral y compromiso organizacional de docentes de una universidad pública en el Perú, utilizando el diseño explicativo secuencial (QUAN → qual) del enfoque mixto. La población de estudio consistió en 256 docentes. El análisis cuantitativo de encuestas obtenidas de 114 docentes elegidos mediante el muestreo intencional, se realizó mediante estadísticas descriptivas y análisis de regresión logística multivariada. El análisis cualitativo de entrevistas obtenidas de 8 docentes elegidos de manera propositiva, se realizó mediante el análisis etnográfico. Los resultados indicaron que: los docentes satisfechos laboralmente tienen 3.39 veces mayor la posibilidad de tener compromiso organizacional, comparado con los docentes insatisfechos ; el 48.3% tienen insatisfacción laboral y el 70.2% no tienen compromiso de continuidad; las principales razones fueron bajas remuneraciones, falta promoción y nombramiento, inconformidad con el reconocimiento y escasas oportunidades de crecimiento. Sin embargo, el 82.5% tienen compromiso afectivo y el 57% compromiso normativo, como reconocimiento a la oportunidad laboral que encontraron en la universidad. En conclusión, existe relación directa significativa entre la satisfacción laboral y el compromiso organizacional; el descuido de los factores higiénicos y motivacionales, ocasionan la insatisfacción laboral y falta de compromiso de continuidad.

Geographical factors in access: investigating the impact of distance on the use of primary care extended hours, an administrative data study.

IntroductionNHS national targets mandate extended opening hours of doctors’ surgeries as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. Research has shown that other factors impact access and it may not simply be availability that limits an individual’s ability to access healthcare.
 Aims and Objectives To determine whether distance, familiarity and deprivation impact on the uptake of extended hours GP services that use a hub practice model.
 MethodsWe linked an appointments dataset to publicly available population datasets. With that linked dataset, we used negative binomial regression to model count data relating to uses of the extended hours service in one care commissioning group in the Greater Manchester city region. The dataset included 32,693 appointments across 4 hubs serving 37 practices.
 ResultsFamiliarity and distance are important in predicting the number of uses of the extended hours service at a GP practice level. For a theoretical pair of practices collocated at the hub location, the model predicts a use rate of 101.2 for the non hub compared with 283.7 for the hub, a 180% uplift. For a pair of non-hub practices, one located the mean distance from the hub, the other located one mile further away, the model predicts 64.8 uses for the nearer practice, and 46.5 uses for the far practice, a 28% penalty.
 ConclusionThe results indicate geographical inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub model does not address barriers to access. Providers should consider whether or not this type of model actually works to facilitate access. This is particularly of importance in the context of closing health inequality gaps.

Caretakers' Perspectives on Return Pediatric Emergency Department Visits: A Qualitative Analysis of Focus Groups.

Approximately 5% of pediatric patients return to the emergency department (ED) within 72 hours of initial evaluation. The goal of this study was to identify reasons for return visits from the caretaker perspective. Two parent focus groups were conducted in November 2012. Parents were excluded from participation if the return visit was unrelated to the initial visit or the child was asked to return (e.g., wound check). The focus groups were audiotaped, transcribed, and analyzed using a thematic content analysis approach. A total of 13 parents participated. Children were 10 months to 11 years of age (median, 3.1 years). Primary symptoms and diagnoses were related to respiratory (n = 6); gastrointestinal (n = 2); dermatologic (n = 2); musculoskeletal (n = 2); and ear, nose, throat and mouth diseases (n = 1). Return visits occurred 12 to 50 hours (median, 24 hours) after the initial visit. Reasons for return visits were divided into 4 domains: (1) the caretaker's response to the initial visit (e.g., dissatisfaction with medical staff, medical care, or information provided), (2) the child's illness (e.g., continued, worsening, or concerning symptoms), (3) the nature of the ED itself (e.g., subspecialist availability, convenient hours), and (4) follow-up care (e.g., lack of appointments with primary physicians or subspecialists). Several of the reasons parents identify for return visits are within the locus of control of the ED, and several could be addressed by improving regional health care coordination. Surveys based on these themes will quantitate the reasons for return visits and prioritize future strategies to address the perceived need for return visits.

Assessing the needs of pharmacists and physicians in caring for patients with epilepsy.

To obtain primary care physicians' and community pharmacists' opinions of the Pharmacist Note, a model epilepsy patient profile maintained by the pharmacist and transmitted to the physician as needed, and the information it contains. A cross-sectional descriptive study design was used for collecting and analyzing data. Separate surveys were developed and mailed to physicians and pharmacists. 554 primary care physicians and 114 community pharmacists in Ohio who interact regularly with epilepsy patients. Pharmacist and physician opinions on the Pharmacist Note program. Physicians ranked seizure frequency as their most useful piece of information, followed by medication compliance and drug interaction screening. For medication profile and drug interaction screening, most physicians currently use themselves as their primary source of information, although a significant number would prefer to use pharmacists as information sources in these areas (p < .05). A majority (62%) would like to have pharmacists more involved in the care of their patients. Pharmacists identified lack of time and lack of appointments with patients, inadequate pharmacy staff, and insufficient reimbursement as barriers to implementing the Pharmacist Note program. Physicians desire pharmacist involvement in specific areas of care for patients with epilepsy, and the feasibility of implementing the Pharmacist Note and similar programs appears promising. However, pharmacists identified barriers to implementation, and these barriers need to be addressed if this type of program is to be successful.