Mainstream Health Care System Research Articles

Breaking barriers: How transwomen meet their healthcare needs.

Transgender women - individuals assigned male at birth but who identify as female - are disproportionately affected by, among others, human immunodeficiency virus (HIV), other sexually transmitted diseases (STIs) and mental health issues. Studies show that transgender women often encounter discrimination and stigma when seeking healthcare from health facilities. This study assessed the healthcare needs of transgender women, their experiences of the mainstream healthcare system and alternative strategies for navigating the healthcare system. The study was carried out in the City of Ekurhuleni Metropolitan Council in South Africa's Gauteng province. A case study design was followed. Participants were purposively selected and included 10 transgender women aged 26-50. Individual semi-structured interviews were conducted over 2 months. Participants expressed a need for hormone replacement therapy, HIV treatment and prevention and treatment for STIs. Experiences of participants within the healthcare system were predominantly negative, with instances of discrimination, stigma and privacy violations being commonplace. Alternative strategies to meet their healthcare needs included the use of self-medication, consulting traditional healers and utilising non-governmental organisations. There is an urgent need for equitable and inclusive health management of transgender women in South Africa.Contribution:This study provided a first look in a South African context into how and to what extent transwomen employ alternative healthcare strategies such as self-medication and utilising non-governmental organisations when faced with mainstream healthcare access barriers. The use of traditional doctors was identified as a novel, alternative strategy used by transwomen to access healthcare and treatment.

Experiences and observations from a care point for displaced Ukrainians: a community case study in Antwerp, Belgium.

A total of 7,307 Ukrainian refugees moved to Antwerp, Belgium, during the study period (01 April 2022 to 31 December 2022). The city's administration set up three care centers where these people were introduced to the Belgian primary care system, a medical file was created, and acute/preventive/chronic care was delivered. This community case study analyzes the organization and contents of care and reflects upon its meaning for the mainstream healthcare system. This is an observational study using routine electronic medical record data to measure the uptake of care. For a sample of 200 subjects, a retrospective chart review was conducted. All refugees with a medical file at one of the three participating care centers were included. For the observational study, 2,261 patients were reached (30% of the potential users), and 6,450 contacts were studied. The nurses (including midwives) conducted 4,929 out of 6,450 (76%) of all consultations, while the general practitioners (GPs) conducted 1,521 out of 6,450 (24%). Of the nurse consultations, 955 (19%) were followed by another nurse consultation and 866 (18%) by a GP consultation. In the structured case reviews, most contacts were concerned with acute problems (609 out of 1,074, 57%). The most prevalent reasons for encounters and diagnoses were typical primary care issues. The nurses were able to manage half of the cases independently (327, 55%), referred 37% (217) of cases to the GP, and consulted a GP (live, by telephone, or a dedicated app) for 8% (48) of cases. GPs mostly prescribed drugs, referred to a medical specialist, and advised over-the-counter drugs, while nurses more often advised over-the-counter drugs (mostly paracetamol, nose sprays, and anti-inflammatory drugs), provided non-medical advice, or ordered laboratory tests. The medical care points delivered mostly typical acute primary care in this first phase, with a key role for nurses. The care points did not sufficiently take up chronic diseases and mental health problems. These results will inform policymakers on the use of primary care centers for newly arriving patients in times of a large influx. A nurse-first model seems feasible and efficient, but evaluation of safety and quality of care is needed. Once the acute phase of this crisis fades away, questions about the comprehensiveness, continuity, and integration of care for migrants remain relevant.

Vaidya Bhagwan Dash – a renowned clinician, researcher, and litterateur of Ayurveda

Abstract Vaidya Bhagwan Dash was a highly respected Ayurvedic physician and a distinguished luminary in Ayurveda who dedicated his life to preserving and promoting Ayurvedic knowledge. He has been a man of great acumen and erudition, with the capacity of felicitous literary expression of Ayurveda. These qualities place him in the pantheon of modern India as one of the greatest pioneers of Ayurveda. Vaidya Bhagwan Dash acquired proficient knowledge in Ayurveda, and his work has been recognized and awarded globally. His achievements serve as an inspiration to those who wish to contribute to the field of Ayurveda. He was a proponent of Ayurveda and recognized its growing importance in the international community. He believed that Ayurveda’s popularity stems from its accessibility, affordability, and potential to heal without toxic side effects. His books and writings provide insights into Ayurveda’s therapeutic potential and fundamental principles. He was a visionary who emphasized the need to understand traditional systems of medicine before exploring new drugs and played a pivotal role in encouraging people to adopt herbal remedies instead of modern medicine. His dedication to the field, extensive knowledge, and tireless efforts to promote Ayurveda globally have made him a highly revered and renowned figure. His contributions to Ayurveda through his translations, research, education, and establishment of research institutions have helped to promote the integration of Ayurveda into mainstream healthcare systems.

Health Seeking Patterns among Tribal Women in Lahaul Spiti and Kinnaur Districts of Himachal Pradesh: Addressing Healthcare Challenges

The present study investigates the health seeking behaviour of tribal women in the remote regions of Lahaul Spiti and Kinnaur. It emphasizes the role of supply side factors as key determinants in healthcare access. Despite governmental efforts to enhance healthcare reach, our study uncovers significant shortcomings that adversely affect service quality. Through primary survey and focus group discussions, the study explores the challenges faced by tribal women. These challenges include a constantly changing roster of medical professionals, limited access to experienced doctors, and a notable lack of specialized care, especially in gynaecology. The frequent dysfunction of vital diagnostic tools forces local residents to undertake long, costly journeys for medical care, leading to potential delays in receiving treatment. The study also observes the prevalent use of traditional medicine, deeply ingrained in local traditions, serving as both a supplement and an alternative to the mainstream healthcare system. This research sheds light on how these deficiencies in supply side healthcare, compounded by environmental and infrastructural barriers, influence the health related decisions of women, often pushing them towards alternative treatments and increasing their socio economic strain. The findings emphasize the urgent need for an integrated approach to bridge the healthcare gap and ensure the provision of quality medical services to these isolated and vulnerable communities.

Mental Health Stigma in Minority Communities: Understanding Cultural Perceptions and Access to Care

Purpose: The general purpose of this study was to understand how cultural perceptions and beliefs about mental health in minority communities influence their access to mental health care services. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to mental health stigma in minority communities. Preliminary empirical review revealed that cultural perceptions heavily influenced access to care. It emphasized the necessity of cultural competence in mental health advocacy and intervention, stressing the importance of engaging community leaders. The research identified significant barriers to care, including language barriers and distrust of mainstream healthcare systems. Recommendations included increasing diversity among mental health professionals and implementing policies to address disparities. Overall, the study highlighted the need for comprehensive, culturally sensitive approaches to destigmatize mental health and improve access to care in minority communities. Unique Contribution to Theory, Practice and Policy: The Social Cognitive theory, Intersectionality theory and Cultural Adaptation theory may be used to anchor future studies on mental health stigma in minority communities. The study on "Mental Health Stigma in Minority Communities" offered recommendations that contributed significantly to theory, practice, and policy. It emphasized the importance of culturally sensitive interventions, community engagement, education, policy changes, research, and intersectionality in addressing mental health stigma. By advocating for tailored approaches, collaborative efforts, awareness-raising campaigns, systemic reforms, and inclusive strategies, the study aimed to reduce barriers to mental health care access and promote a more supportive environment for individuals within minority communities.

Exploration the Potential of Artificial Intelligence in Ayurveda Diagnostics through the Machine Learning Approach

Ayurveda, as a holistic system of medicine originating in ancient India, has gained recognition for its emphasis on balance and harmony within the body, mind, and spirit. This ancient healing practice has evolved over centuries and incorporates the concept of doshas – the biological energies that govern an individual's physical and mental well-being. Ayurveda focuses on bringing balance to the doshas through various treatments, including herbal medicines, lifestyle practices, and therapies. In recent years, Ayurveda has experienced significant growth and recognition in India, with the government promoting it as a mainstream healthcare system. Additionally, Ayurveda practices such as yoga and meditation have gained international acclaim. However, with the integration of modern technology, Ayurveda is poised to undergo further advancements. This research study explores the integration of artificial intelligence (AI) and machine learning techniques in Ayurvedic treatment, particularly in the Saharanpur and Dehradun regions. With personalized and holistic healthcare being the cornerstone of Ayurveda, the use of AI and machine learning algorithms can improve accuracy in diagnosis and treatment. Leveraging large datasets, these algorithms can identify patterns and correlations that may not be immediately evident to human practitioners. The majority of respondents in the study have been practicing Ayurveda treatment consultancy for 1-3 years (60%), while 40% had more than 3 years of experience. 70% of respondents believed that AI-driven diagnosis approaches are more effective than generalized approaches in Ayurveda. It was revealed that all respondents used AI tools primarily for Sparshana diagnosis, with no utilization reported for Darshana or Prashna. 80% of respondents believed that the integration of AI into Ayurveda has the potential to greatly improve various aspects of the practice. 50% of respondents were satisfied, and 40% were very satisfied with the current AI-driven diagnosis, while 10% expressed neutrality. These findings indicate a general acceptance and optimism towards AI in Ayurveda diagnosis, with recognition of its potential benefits and effectiveness. However, further research is needed to explore specific factors contributing to satisfaction and neutrality, as well as any concerns or areas for improvement.

Black People, Spirituality, and Mental Health

The influence of spirituality and religiosity in the Black community has historically been significant. While spirituality and religiosity are important for the majority of Americans, compared to other races/ethnicities, Black people report the highest valuation for religion in their individual lives. Spirituality and religiosity have known protective effects on health, although, compared to the general relationship between these factors and general health care, the role of spirituality and religiosity within the mental health system is not well characterized. In significant ways for the Black community, while serving a protective and positive function, spirituality and religiosity can also create tensions for patients within mainstream mental health care systems that emphasize a biopsychosocial framework, leaving out key dimensions of spiritual well-being and formation. The complexity of the relationship between Black people's mental health and their religion and spirituality also has roots in a history of colonialism and racism. In this article, we describe some ways in which religion and spirituality have been important to the health and well-being of the Black community, as well as certain ways these factors have created tension within the community. [ Psychiatr Ann . 2023;53(12):540–544.]

Challenges for Developing Palliative Care Services in Resource- Limited Settings of Kazakhstan.

Background: Approximately 40 million people in need of palliative care worldwide, while 80% of them live in low- and middle-income countries. Kazakhstan, a low-to middle-income country with a reforming healthcare system, is committed to improving quality and accessibility of care for its 100,000 terminal patients in need of palliative care. Policy Options and Recommendations: To join the group of countries where palliative care is available, accessible, and affordable, Kazakhstan must integrate palliative services into the mainstream healthcare system at all levels, from primary healthcare to hospices, and from major cities to remote villages. Based on the evidence thoroughly collected directly from the Ministry of Health, authors propose a feasible set of recommendations regarding palliative policy, pain relief, infrastructure, workforce, and education, which could be implemented in LMICs beyond Kazakhstan. Conclusion: This study presents an analysis of challenges, recent developments, and needs of palliative care in Kazakhstan, including funding, policy, workforce, education, and infrastructure, providing an evidence base and recommendations for future development of palliative care in Kazakhstan and in other LMICs.

“How Do I Learn More About this?”: Utilization and Trust of Psychedelic Information Sources Among People Naturalistically Using Psychedelics

ABSTRACTThere is a surge of interest in psychedelics, including new stakeholders and greater media attention. There is a need to examine the information-seeking behavior of people using psychedelics naturalistically, given the importance of preparation and harm-reduction. We examined sources of information for people using psychedelics naturalistically, and the degree to which they are trusted in a large, anonymous, online survey (N = 1221). The most common source of participants’ information on psychedelics was their own experimentation and experiences (79.52%). Most also sought information from Internet websites (61.67%), friends (61.02%), Internet discussion forums (57.08%), books (57%), and articles in peer-reviewed scientific journals (54.55%). Few sought information from their primary health care provider (4.83%). Articles published in scientific journals, psychedelic nonprofits, and researchers based in colleges or universities were the most trusted sources of psychedelic information. Government agencies and pharmaceutical companies were the least trusted. Few participants thought that the popular media accurately stated the benefits and risks of psychedelics and most thought that the popular media failed to distinguish between different types of psychedelics. Our results indicate a high level of information seeking among psychedelic users, with a diverse array of information sources typically outside of mainstream health and medical care systems.

Considering the Consequences of Cybersickness in Immersive Virtual Reality Rehabilitation: A Systematic Review and Meta-Analysis

VR rehabilitation is a rapidly evolving field, with increasing research and development aimed at improving its effectiveness, accessibility, and integration into mainstream healthcare systems. While there are some commercially available VR rehabilitation programs, their adoption and use in clinical practice are still limited. One of the limitations is defined as cybersickness, which is dependent on human contact with virtual reality products. The purpose of this essay is to raise awareness of the associated elements that contribute to cybersickness in rehabilitation using immersive VR. The common factors that influence the amount of cybersickness are user characteristics and device software and hardware. The Simulator Sickness Questionnaire (SSQ) was used as one of the formal models for determining the variables related to virtual reality sickness. The systematic review of the literature and the meta-analysis were chosen by whether the Simulator Sickness Questionnaire in the articles matched the research criteria. Based on PRISMA guidelines, a systematic review of the literature was conducted. Twenty-six publications from the recent past were totaled, comprising 862 individuals with ages ranging from 19 to 95, and 49% were female. The highest overall SSQ mean score for different kinds of symptoms was determined to be 21.058 for brain injuries, with a 95% confidence interval (CI) of 15.357 to 26.760. Time, content, locomotion, control, and display types were other elements that contributed to cybersickness and had significant p-values in the SNK Q-test. The future direction of immersive VR rehabilitation involves the development of immersive and interactive environments that simulate real-world situations, providing patients with a safe and controlled environment in which to practice new skills and movements.

‘It’s so simple’ Lessons from the margins: a qualitative study of patient experiences of a mobile health clinic in Hamilton, Ontario, Canada

ObjectiveOur study explored the experiences of clients of HAMSMaRT (Hamilton Social Medicine Response Team), a mobile health service, in the context of their experiences of the overall healthcare system.DesignWe conducted...

Phytopharmaceutical properties and quality assessment of two Himalayan medicinal plants, Meconopsis horridula and Meconopsis simplicifolia

IntroductionBhutanese traditional medicine (BTM) is an integral part of the mainstream health care system in Bhutan. It uses more than 230 species of medicinal plants, including the Meconopsis species. Although traditional BTM methods are used to check the quality of medicinal plants, these methods have limitations in differentiating the closely related species. There is a need for integrating traditional methods with modern analytical techniques to efficiently monitor the quality and safety of medicinal plants. Here, we studied two closely related Meconopsis species using both traditional and modern analytical approaches. Materials and methodsMeconopsis horridula Hook. F & Thompson and Meconopsis simplicifolia (D. Don) Walpers were collected from Lingzhi, Bhutan. The samples were tested and compared for physicochemical properties and extractive values. Their microscopy and High-Performance Thin-Layer Chromatography (HPTLC) profiles were also compared. A literature review was performed to document isolated phytochemicals and their biological activities. ResultsTwo Meconopsis species revealed distinct macro-and microscopic characteristics. The physicochemical analysis and the HPTLC fingerprinting generated adequate data to authenticate these two species while preparing 16 essential traditional medicine drugs (ETMDs) in BTM. A literature review revealed that the two Meconopsis species contain alkaloids and flavonoids, which can be used as biomarker compounds for quality screening. ConclusionsM. horridula and M. simplicifolia could be differentiated based on their taxonomical features, macroscopic and microscopic characteristics, HPTLC fingerprint profiles, and physicochemical values. The accomplished pharmacognostic properties of the two species can be used as important parameters in ensuring the quality and safety of BTM.

Pain management by alternative therapies and herbal bioactive

Herbal medicines and other complementary & alternative therapies are now a part of the mainstream healthcare system. Adults frequently utilizing herbal remedies to treat pain, which is one of the most prevalent ailments. Although herbal remedies are frequently not the most effective analgesics in the market, they can be very helpful for mild to moderate pain. Herbal bioactive substances may reduce the effectiveness of conventional treatments for pain. Life quality suffers, and excessive medical costs rise as a result of pain. Western medicine may have too many negative effects, such as addiction and tolerance. Alternative pain-management approaches may be offered by herbal medicines. Neuropathic pain is one of the many types of chronic pain that results from damage to the neurological system, including the peripheral nerves. There are few treatments for neuropathic pain now available. Recent studies have also shown the value of dietary bioactive compounds in the management of pain like Ginger, Curcumin, Omega-3 polyunsaturated fatty acids, soy isoflavones and Lycopene. The goal of this review paper is to determine the function of various bioactive and some traditional alternative therapies in the treatment of pain.

Why freebirth in a maternity system with free midwifery care? A qualitative study of Danish women’s motivations and preparations for freebirth

ObjectiveEven in maternity care systems with free midwifery care, some women intentionally choose to birth unattended by any health professional (freebirth). Women who choose freebirth represent an enigma for many, and a provocation to some. However, people who do not conform to dominant medical practices are a source of valuable insights that can reveal shortcomings in the mainstream health care system. Thus, the aim of this study was to explore and understand women's motivations and preparations for freebirth. MethodsThe study was informed by the theoretical lens of the 'undisciplined patient'. Qualitative, in-depth interviews were performed with ten Danish women, who for their most recent birth had planned to freebirth. Data were analysed using reflexive thematic analysis. ResultsFour themes were identified. “The standard system is not for me” describes negative experiences during previous births and the desire for more individualised support. “Re-establishing trust in myself” describes the women's quest for recognizing their own needs and re-building autonomy and inner strength. “I do my research” describes how the women sought new ways of knowing and prioritised experiential knowledge. And finally, “I create my safe space” describes the women's efforts to create the best possible physical and emotional space for themselves and their babies in order to have a safe and autonomous birth experience. ConclusionFreebirth is not undertaken lightly or without preparation by women. Improved continuity of care as well as greater flexibility in hospital guidelines could accommodate some of these women's demand for autonomy in birth.

2.O. Workshop: Initial health assessments and catch-up vaccination for forcibly displaced migrants to Europe

Abstract Objectives Recent crises in Ukraine, Afghanistan, Syria and other countries have, again, resulted in large populations of asylum seekers and other migrant groups arriving in Europe. However, European countries still grapple with questions about what level of health care should be offered to forcibly displaced people (emergency care, preventative care, multi-disease screening and catch-up vaccination?), and when and where in the migration trajectory provision should be made (should it be at borders, reception centres, once settled via the national health system, via specialist or routine services, or left to non-governmental organisations?), and what their subsequent level of right to access the mainstream health-care system should be. Countries do not have a uniform approach to the provision of health care for these populations, with some countries more inclusive than others, and wide discrepancies between evidence and implementation in policy and practice. In this workshop we will discuss current approaches, implementation, research and policy gaps, and models of good practice from the clinic to the community to ensure both the immediate and long-term health needs of these diverse mobile populations are met. Workshop plan The workshop will start with 10-minute presentations by each of the 4 speakers (to include a short Q&A after each talk). This will then move into a 20-minute audience discussion centred seeking specific feedback on examples of successful interventions, good practice, and lessons learned across EU/EEA countries in delivering multi-disease and catch-up vaccination and holistic and inclusive healthcare approaches. Key messages • Governments should develop clear short-term and long-term policy and evidence-led research strategies to ensure the equitable provision of health services. • Strategies must include multi-disease and catch-up vaccination approaches, alongside meaningful access to mainstream health systems.

Sustainable development goals and ending ECC as a public health crisis.

Early Childhood Caries (ECC) remains a global issue despite numerous advancements in research and interventional approaches. Nearly, 530 million children suffer from untreated dental caries of primary teeth. The consequences of such untreated dental caries not only limit the child's chewing and eating abilities but also, significantly impact the child's overall growth. Research has demonstrated that ECC is associated with nearly 123 risk factors. ECC has also been associated with local pain, infections, abscesses, and sleep pattern. Furthermore, it can affect the child's emotional status and decrease their ability to learn or perform their usual activities. In high-income countries, dental care continues to endorse a "current treatment-based approach" that involves high-technology, interventionist, and specialized approaches. While such approaches provide immediate benefit at an individual level, it fails to intercept the underlying causes of the disease at large. In low-income and middle-income countries (LMICs), the "current treatment approach" often remains limited, unaffordable, and unsuitable for the majority of the population. Rather, dentistry needs to focus on "sustainable goals" and integrate dental care with the mainstream healthcare system and primary care services. Dental care systems should promote "early first dental visits," when the child is 1 year of age or when the first tooth arrives. The serious shortages of appropriately trained oral healthcare personnel in certain regions of the world, lack of appropriate technologies and isolation of oral health services from the health system, and limited adoption of prevention and oral health promotion can pose as critical barriers. The oral health care systems must focus on three major keystones to combat the burden of ECC-1. Essential oral health services are integrated into healthcare in every country ensuring the availability of appropriate healthcare accessible and available globally, 2. Integrating oral and general healthcare to effectively prevent and manage oral disease and improve oral health, 3. Collaborating with a wide range of health workers to deliver sustainable oral health care tailored to cater to the oral health care needs of local communities.

Perceived Quality of Traditional Chinese Medicine Care in Community Health Services: A Cross-Sectional Survey in Hangzhou of China.

Background Traditional Chinese medicine (TCM) is an integral part of the mainstream health care system in China. Public community health services are required by the government to deliver TCM services. This study aimed to assess patient perceived quality of TCM care in community health services. Methods A cross-sectional questionnaire survey was conducted on 471 TCM users in four community health centers in Hangzhou. Respondents were asked to rate their experiences on a Likert scale about tangibility, reliability, responsiveness, assurance and empathy of the TCM services they received. Linear regression models were established to determine the sociodemographic and services factors associated with the ratings. Results Average ratings on the five aspects of the TCM care ranged from 78 to 88 out of a possible 100, with assurance attracting the highest and empathy attracting the lowest score. Overall, higher perceived quality of TCM care (except for assurance) was associated with a choice of TCM in preference to western medicine. Those who reported higher cost (≥100 yuan) of TCM care rated higher on responsiveness and empathy of the care. But higher frequency of visits to community TCM services was associated with lower ratings on reliability, assurance and empathy. Those who received two or more TCM modalities also perceived lower tangible care. In addition, higher ratings on reliability and responsiveness were found in women. The respondents with a university qualification gave higher ratings on reliability and responsiveness; by contrast, those with a highest education of senior high school rated lower on assurance and empathy. Lower perceived tangibility and assurance was also associated with rural residency. Compared with those working in the public sector, the respondents from the retail and services sector gave a higher rating on assurance but a lower rating on empathy. Conclusion Overall, the TCM users perceived high quality of TCM care in community health services in Hangzhou. However, there is a need to further improve TCM care from all quality perspectives in order to attract and maintain consumer trust in TCM.

Use and Attitudes of Complementary and Alternative Medicines Among Allied Health Sciences Students, University of Peradeniya

Background: Complementary and Alternative Medicine (CAM) consists of a group of medical and health care systems, practices, and products delivered outside the mainstream health care system. CAM treatments can be used not only to treat diseases but also to promote wellness, disease prevention, and manage symptoms. However, someone’s attitudes toward health may contribute to seeking CAM treatments. This study aimed to investigate the use and attitudes of CAM among Allied Health Sciences (AHS) students at the University of Peradeniya.Methods: An online questionnaire was used and all AHS students at the University of Peradeniya were invited to participate. The questionnaire comprised three parts: Part A) demographic data, Part B) usage of complementary and alternative medicines and Part C) attitudes toward complementary and alternative medicines. CAM usage and attitude differences between different degree programs and academic years were compared.Results: Of the 601 students invited, 314 (52.2%) responded to the questionnaire. Among them, 143 participants (45.5%) had used CAM during the past 12 months. Of them, vitamins were the most used CAM. Most participants (70.1%) had used CAM to improve their health, while (68.5%) had selected CAM to reduce side effects. More than one-third of students showed positive attitudes towards CAM. There were significant differences in CAM usage between students of pharmacy/nursing and MLS/Radiography/Physiotherapy, while there was no difference in attitudes regarding CAM. There were differences in attitudes concerning CAM between senior and junior students, however no difference in CAM usage.Conclusion: This study found that AHS students commonly reported using CAM. A comparison between Pharmacy/Nursing and MLS/Radiography/Physiotherapy students suggests that pharmacy/nursing education is associated with improved awareness and use of CAM among AHS undergraduate students in a Sri Lankan university.

Extending Palliative Approaches to Care Beyond the Mainstream Health Care System: An Evaluation of a Small Mobile Palliative Care Team in Calgary, Alberta, Canada.

Background:People experiencing houselessness (PH) endure worse health outcomes than their housed counterparts and often have inadequate care when nearing end of life. Innovative palliative care approaches are necessary when considering socially vulnerable populations.Aim:Evaluate the implementation and early outcomes of the Calgary Allied Mobile Palliative Program (CAMPP) after the first four years of servicing people experiencing extreme social marginality.Setting/Participants:Participants include CAMPP clients and service providers (SPs) who work adjacently to CAMPP in the social services/health sectors.Design:This is a mixed-methods evaluation, including an SP survey (n = 31); client interviews (n = 5); collection of program metrics; and case note reviews.Results:The CAMPP has served 128 clients to date. The CAMPP supported clients by connecting them to 62 services, programs, agencies, and/or resources totaling 485 connections. The most referred-to resource was for social support in the community for PH at 61 referrals. The second was for transportation with 57 referrals, followed by referrals to palliative and Home Care programs (n = 53 referrals). Another common referral was for food assistance with 30 referrals. The survey showed that 97% of SPs agreed that CAMPP is “an essential service in the area of palliative care.” Twenty-six of 30 (87%) “Strongly Agreed” or “Agreed” that their knowledge in working with people with life-limiting illnesses has improved since working with CAMPP. The SPs suggested that the team should focus on referral clarity and improved communication with the wider health care team. Finally, clients reported high levels of satisfaction with CAMPP services. Clients also reported challenges navigating the complexity of care in the social/health services sector.Conclusions:The CAMPP bridges the gap in care between health/social services. The CAMPP connects clients to community resources and is effective in adapting to client needs. This evaluation provides four recommendations to improve and build on the existing program.

Telemedicine in Ghana: Insight into the past and present, a narrative review of literature amidst the Coronavirus pandemic

The Coronavirus pandemic has destabilized many healthcare systems globally since the outbreak was announced. The mode of transmission of the virus has affected the traditional face-to-face mode of seeking healthcare. The world health organization recommends measures, including limiting physical contact as a means of preventing the spread of the virus. Many countries across the world are utilizing telemedicine during this pandemic to provide basic healthcare to their citizens. The implementation of telemedicine in sub– Saharan Africa has encountered many challenges. The surge in the number of covid-19 cases in Ghana calls for drastic measures to contain the repercussions of the pandemic. The Government of Ghana and other private organizations continue to scale up efforts to integrate telemedicine into the mainstream healthcare system. This study seeks to explore and provide insight into the state of telemedicine in Ghana prior to and during the Coronavirus pandemic. This study is a narrative review of literature on the use of telemedicine in Ghana. Data was obtained from PubMed, Embase, ScienceDirect, Scopus and Google Scholar. A secondary search was conducted on government of Ghana health agencies’ websites and other relevant websites that published information on telemedicine in Ghana. Literature was analysed and topically discussed based on identified themes. There is an improvement in the number of information and communication technology coordinated healthcare services in Ghana since the outbreak was confirmed. Public-private partnership is required to boost the integration of telemedicine into mainstream healthcare in Ghana.