Percentage Of Health Care Providers Research Articles

Changes in U.S. Healthcare Provider Practices Related to Emergency Contraception.

Emergency contraception (EC), including EC pills (ECPs) and the copper intrauterine device, can prevent pregnancy after sexual encounters in which contraception was not used or used incorrectly. The U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), initially released in 2013, provides evidence-based clinical recommendations on the provision of EC. The objective of this analysis was to assess the percentage of health care providers reporting frequent provision of select EC practices around the time of and after the release of the U.S. SPR. We conducted two cross-sectional mailed surveys using different nationwide samples of office-based physicians and public-sector providers in 2013 and 2014 (n=2,060) and 2019 (n=1,420). We compared the percentage of providers reporting frequent provision of select EC practices by time period, overall, and by provider type. In 2019, few providers frequently provided an advance prescription for ECPs (16%), an advance supply of ECPs (7%), or the copper intrauterine device as EC (8%), although 41% frequently provided or prescribed regular contraception at the same time as providing ECPs. Providers in 2019 were more likely than providers in 2013 and 2014 to provide or prescribe contraception at the same time as providing ECPs (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.001-1.59) and to provide a copper intrauterine device as EC (adjusted prevalence ratio, 3.87; 95% confidence interval 2.10-7.15); there were no other significant differences by time period. Few providers report frequent implementation of recommended EC practices. Understanding the barriers faced by providers and clinics in implementing these practices may improve access to EC.

Consensus and Divergence in Practice Patterns Among Experts and Community Healthcare Providers for the Treatment of Patients with Mantle Cell Lymphoma

Consensus and Divergence in Practice Patterns Among Experts and Community Healthcare Providers for the Treatment of Patients with Mantle Cell Lymphoma

Healthcare provider awareness and integration of immunotherapy for stage III NSCLC.

123 Background: In February 2018, immunotherapy was approved for patients with unresectable stage III NSCLC without progression after concurrent chemoradiotherapy (cCRT). The anti–PD-L1 inhibitor durvalumab is now considered by most experts to be the standard of care (SoC) in this setting based on improved survival outcomes. Methods: We conducted a series of 5 CME-certified symposia to provide healthcare providers (HCPs) with education that included expert and guideline recommendations on the optimal use of durvalumab therapy for patients with unresectable stage III NSCLC. These symposia were conducted at 3 major oncology conferences (NCCN Annual, AACR, ASCO Annual) and 2 managed care pharmacy (MCP) conferences (AMCP Annual, AMCP Nexus) over an 8-month period after durvalumab was approved (Table). Polling questions designed to assess key aspects of HCP knowledge and practice patterns were repeated at each symposium and responses were collected through an audience response system. Results: Across the 5 symposia, on average fewer than 45% of responding HCPs recommended durvalumab consolidation therapy for an ideal patient candidate with stage III NSCLC after cCRT (Table). Among responding HCPs across 4 symposia, on average fewer than 30% identified the optimal recommended duration of 1 year of durvalumab therapy based on current clinical evidence. Physicians did identify the optimal management of immune-related pulmonary toxicity associated with durvalumab treatment more often than other HCPs (Table). Conclusions: These pre-education data suggest that a large percentage of HCPs are not fully aware of the available clinical evidence and are delayed in the implementation of immunotherapy for unresectable stage III NSCLC. [Table: see text]

Evolving Areas of Consensus and Disagreement Among Experts in Treatment of Patients with Multiple Myeloma (MM)

Evolving Areas of Consensus and Disagreement Among Experts in Treatment of Patients with Multiple Myeloma (MM)

Performance and self-perceived competencies of enrolled nurse/midwives: a mixed methods study from rural Tanzania

BackgroundTanzania is experiencing a severe shortage of human resources for health, which poses a serious threat to the quality of health care services particularly in rural areas. Task shifting has been considered a way to address this problem. However, since a large percentage of health care providers in rural setting is comprised of Enrolled Nurse/Midwives (ENMs), most of the health care tasks are shifted to them. This article analyzes the performance and self-perceived competencies of ENMs at the dispensary level; the lowest health facility in Tanzania. Performance refers to routine duties performed by ENMs, and self-perceived competence means self-perceived proficiency in performing nursing/midwifery and medical duties.MethodsThis was a mixed methods study conducted in rural Tanzania. A purposeful sample of twelve (12) informants (six ENMs; two Community Leaders [CLs] and four Dispensary In-charges [DIs]) was recruited for semi-structured interviews. The interviews were supplemented with quantitative data from 59 ENMs. Both thematic and descriptive analysis approaches were used.ResultsThree themes emerged: (1) ‘Approval of the performances of ENMs in meeting community health needs’ underscores important services the community members got from ENMs at dispensaries. (2) ‘Experienced difficulties of meeting community health needs’ indicate the problems ENMs encountered while providing services to the community. In striving to serve a large number of demanding clients without adequate medical equipment and supplies, sometimes the ENMs ended up with prescription errors (3) ‘Appreciating the performances and competencies of ENMs’ shows the acknowledgement of community members towards ENMs’ performance and competencies within and beyond their scope of practice. The community members as well as ENMs and their supervisors knew that ENMs must sometimes provide care that is outside their scope of training and competency. Overall, the performance among ENMs above 38 years of age (P < 0.05) and participants of professional development courses (P < 0.01) was high.ConclusionsThe results highlight performance and self-perceived competencies of ENMs in struggling to meet community health needs. Additionally, these results highlight the health care system shortfalls in supporting and developing an adequate number of qualified health care professionals so that health care needs of all citizens, including those in rural areas, are met.

Post-marketing surveillance of adverse events following immunization with inactivated quadrivalent and trivalent influenza vaccine in health care providers in Western Australia

In 2015, inactivated quadrivalent influenza vaccine (QIV) was first introduced into the Australian market. A routine vaccine safety surveillance system in Western Australia was used to conduct post-licensure surveillance of adverse events following immunization with inactivated QIV and trivalent influenza vaccines (TIV) in a sample of 1685 healthcare providers (HCPs). A similar percentage of HCPs who received QIV reported having any reaction seven days post-vaccination as HCPs who received TIV (13.6 vs. 12.8%, respectively; p=0.66). However, a slightly higher percentage of HCPs who received QIV reported pain or swelling at the injection site as compared to HCPs who received TIV (6.9% vs. 4.2%, respectively; p=0.02). No serious vaccine-associated adverse events were detected during follow-up of either vaccine. Acknowledging the study limitations, the results of this post-marketing surveillance support the safety of QIV, suggesting there is little difference in the reactogenicity of QIV as compared to TIV.

Comparing healthcare providers and primigravida women’s attitudes towards normal vaginal delivery

Background and Aim: Pregnancy and delivery are among the most significant life events for women and their families. Currently, the rate of delivery by cesarean section has increased significantly due to women’s lack of knowledge about and negative attitudes towards normal vaginal delivery. Moreover, the complications of cesarean section have turned motherhood into an unpleasant experience. The aim of this study was to compare healthcare providers and primigravida women’s attitudes towards normal vaginal delivery. Methods: In total, 637 primigravida women and 154 healthcare professionals were recruited from Sanandaj city, Iran, to this descriptive-analytical study. The data collection instruments were a researcher-made demographic questionnaire and seventeen questions on attitude towards normal vaginal delivery. Questions were scored on a five-point Likert scale. The SPSS software as well as the Chi-square and the t tests were used for data analysis. Findings: The percentage of healthcare providers having a positive attitude towards normal vaginal delivery was significantly higher than primigravida women who did not have such an attitude (33.1 vs. 10 P value = 0.001). However, the percentage of primary health care providers (28.3) and clinical care providers’ (43.8) who had positive attitudes towards normal vaginal delivery was not statistically significant from each other (P = 0.143). Conclusion: Lack of knowledge about the routes of delivery and the mechanism of normal vaginal delivery as well as lack of psychological support during delivery have increased women’s tendency for having a delivery by cesarean section. Educational programs need to be implemented for enhancing women’s knowledge about the benefits of normal vaginal delivery.

Health care providers' opinions on abortion: a study for the implementation of the legal abortion public policy in the Province of Santa Fe, Argentina.

BackgroundIn Argentina, abortion has been decriminalized under certain circumstances since the enactment of the Penal Code in 1922. Nevertheless, access to abortion under this regulatory framework has been extremely limited in spite of some recent changes. This article reports the findings of the first phase of an operations research study conducted in the Province of Santa Fe, Argentina, regarding the implementation of the local legal and safe abortion access policy.MethodsThe project combined research and training to generate a virtuous circle of knowledge production, decision-making, and the fostering of an informed healthcare policy. The project used a pre-post design of three phases: baseline, intervention, and evaluation. It was conducted in two public hospitals. An anonymous self-administered questionnaire (n = 157) and semi-structured interviews (n = 27) were applied to gather information about tacit knowledge about the regulatory framework; personal opinions regarding abortion and its decriminalization; opinions on the requirements needed to carry out legal abortions; and service’s responses to women in need of an abortion.ResultsFirstly, a fairly high percentage of health care providers lack accurate information on current legal framework. This deficit goes side by side with a restrictive understanding of both health and rape indications. Secondly, while a great majority of health care providers support abortion under the circumstances consider in the Penal Code, most of them are reluctant towards unrestricted access to abortion. Thirdly, health care providers’ willingness to perform abortions is noticeably low given that only half of them are ready to perform an abortion when a woman’s life is at risk. Willingness is even lower for each of the other current legal indications.ConclusionsFindings suggest that there are important challenges for the implementation of a legal abortion policy. Results of the study call for specific strategies targeting health care providers in order to better inform about current legal abortion regulations and to sensitize them about abortion social determinants. The interpretation of the current legal framework needs to be broadened in order to reflect a comprehensive view of the health indication, and stereotypes regarding women’s sexuality and abortion decisions need to be dismantled.Electronic supplementary materialThe online version of this article (doi:10.1186/1742-4755-11-72) contains supplementary material, which is available to authorized users.

Use of Live-Attenuated Influenza Vaccine for Healthcare Providers

Healthcare institutions are being asked to immunize an increasingly higher percentage of healthcare providers against influenza each year, with an eventual target of ≥90%. The live-attenuated influenza vaccine (LAIV) is an attractive approach for needle-averse individuals, but concerns have persisted …

Low-Risk Human Papillomavirus Testing and Other Nonrecommended Human Papillomavirus Testing Practices Among U.S. Health Care Providers

To assess self-reported human papillomavirus (HPV) DNA testing practices by health care providers and clinics, including nonrecommended practices such as low-risk HPV testing, HPV cotesting in women younger than age 30 years, and HPV reflex testing for high-grade abnormal Pap test results. We analyzed responses to a cross-sectional survey of a nationally representative sample of Papanicolaou test providers administered in conjunction with the 2006 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Data analysis was performed on responses from 376 office-based health care providers and 216 outpatient clinics. Overall, 75.5% (95% confidence interval [CI] 68.7-81.2%) of health care providers and 77.2% (95% CI 60.3-88.3%) of clinics reported ever using the HPV DNA test. Of health care providers who used HPV testing, 28.5% (95% CI 21.6-36.6%) used both high-risk and low-risk HPV tests. Most health care providers (59.6%, 95% CI 48.5-69.7%) and clinics (66.0%, 95% CI 48.0-80.3%) used HPV cotesting in women younger than age 30 years. A high percentage of health care providers and clinics performed reflex HPV testing after Pap test results of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (71.4%, 95% CI 63.5-78.3% and 62.8%, 95% CI 49.0-74.9%, respectively) and high-grade squamous intraepithelial lesions (50.7%, 95% CI 42.4-58.9% and 49.0%, 95% CI 33.1-65.2%, respectively), results for which HPV testing is not recommended. Many health care providers reported inappropriate uses of HPV testing, which may lead to unnecessary follow-up and increased medical costs without added benefits. Interventions such as eliminating the low-risk HPV test from the U.S. market and educating health care providers and patients on appropriate indications for HPV testing are needed to discourage health care providers from such practices.

Increasing use of artemisinin-based combination therapy for treatment of malaria infection in Nigerian hospitals.

This study aimed at describing the pattern of outpatient antimalarial drug prescribing in a secondary and a tertiary hospital, and to assess adherence to the National Antimalarial Treatment Guideline (ATG). An audit of antimalarial prescription files from the two health facilities for a period of six months in 2008 was conducted. Semi structured questionnaires were used to collect information from the doctors and pharmacists on their awareness and knowledge of the National Antimalarial Treatment Guideline. Artemisinin-based combination therapies (ACTs) were the most prescribed antimalarials. Overall, 81.4% of the total prescriptions contained ACTs, out of which 56.8% were artemetherlumefantrine. However, adherence to the drugs indicated by national guideline within the DU90% was 38.5% for the tertiary and 66.7 % for the secondary hospital. The standard practice of prescribing with generic name was still not adhered to as evidenced in the understudied hospitals. The percentage of health care providers that were aware of the ATG was 88.2% for doctors and 85.1% for pharmacists. However, 13.3% and 52.2% of doctors and pharmacists respectively could not properly list the drugs specified in the guideline. Amodiaquine was the most commonly preferred option for managing children aged 0 - 3 months with malaria infection against the indicated oral quinine. This study showed an increased use of artemisinin-based combination therapy for the treatment of uncomplicated malaria compared previous reports in Nigeria. This study also highlights the need for periodic in-service quality assurance among health professionals with monitoring of adherence to and assessment of knowledge of clinical guidelines to ensure the practice of evidence based medicine.

Hurricane Katrina: The Jackson Veterans Affairs Medical Center Experience

O Sunday August 28, 2005, the National Weather Service advised that a category 5 hurricane (Katrina) would make landfall on the United States gulf coast centered at the Louisiana, Mississippi, and Alabama shorelines. That morning, the Veterans Healthcare Administration (VHA) placed key locales on disaster status, and preemptively began transferring patients to inland medical facilities. These, and the receiving institutions, mobilized resources and organized operations to prepare for both local effects of the storm and care of patients no longer able to receive medical care at centers likely to be affected by damaging winds and flooding. The need, in fact, would be much greater than anticipated as the Gulfport Veterans Affairs Medical Center (VAMC), and the military medical center at Keesler Air Force Base were obliterated by the storm and the New Orleans VAMC rendered inoperable by the levee breach. More than 100,000 veteran patients were displaced from the gulf coast areas. The G.V. (Sonny) Montgomery VAMC of Jackson, Mississippi (Jackson VAMC) is a 163-bed acute tertiary care medical center 120 miles north of the gulf coast and represented the closest large VAMC medical center to the landfall epicenter expected to escape significant direct damage from Katrina. Although still at category 1 strength when reaching Jackson, the hurricane’s effect on the hospital was largely limited to loss of electric power and water from municipal sources which did not limit its ability to function. Access to the VAs integrated electronic medical record was lost initially due to flood damage of regional servers in New Orleans. However within 1-week interfacility patient data access was restored allowing very effective care of those veterans presenting to remote sites for care. The greater Jackson metropolitan area suffered moderate damage to buildings from fallen trees and utility poles, and also widespread loss of electric power, landline and wireless communication, municipal water supplies in many areas, and (secondarily) an acute shortage of gasoline and other key commodities needed for the community. For the 8 days surrounding the hurricane landfall, the Jackson VAMC operated in disaster mode, suspending elective clinic visits, elective surgical and medical procedures, and other routine operations. Cancer care, renal dialysis, and other essential nonemergent services continued and were expanded to manage those veterans from the storm areas requiring care. The VAMC received approximately 100 evacuated inpatients from VAMCs in Biloxi and New Orleans during 3 evacuations (2 land and 1 air), self-transported patients, and unrelated individuals needing help. Inaccurate information forced the staff to prepare for possible evacuees 3–4 times this number, including ambulance groups of critical care patients which never arrived. Another 100 individuals who were not patients presented for assistance, including VAMC employees and their families, and others with no place else to turn. During the early stages of the event, when most communication mechanisms were nonfunctional and gasoline availability was extremely limited, most physicians, nurses, therapists, and pharmacists remained in-house. Once communications improved and gasoline supplies were secured, a larger percentage of health care providers were able to be available from home as needs arose. On Tuesday September 6, the Jackson VAMC resumed a normal schedule for nonemergent care delivery but continued to extend its reach to provide both local and distant patients with primary and emergency health care, pharmaceutical and medical supplies, referral specialty and subspecialty services, and other support for weeks, and in some cases months or years, after the catastrophe. The Jackson VAMC recorded no adverse events, no patient deaths, and no organizational or resource From the G.V. “Sonny” Montgomery Veterans Affairs Medical Center, Jackson, Mississippi. Submitted April 28, 2008; accepted in revised form May 14, 2008. Correspondence: Kent A. Kirchner, MD, G.V. (Sonny) Montgomery VAMC, 1500 East Woodrow Wilson Drive, Jackson, MS 39216 (E-mail: kent.kirchner@med.va.gov).

A Critical Concern: Pediatrician Self-care After Disasters

As of this writing, health care in the areas impacted by Hurricane Katrina has shifted from emergency to primary care mode. Disasters take a heavy toll not only on victims but also on professionals and volunteers who experience the immediate, short-term, and long-term impact through their patients. The impact may occur because of the helping professional's effort to empathize with and be compassionate to patients. There is a rich literature that discusses the risks and impact of vicarious traumatization on psychotherapists, rescue workers, and health care providers who work with survivors, including those who have experienced community traumas such as natural disasters, state-sponsored terrorism, torture, mass murder, and acts of war. The psychological impact of working with those who have suffered trauma has been variously referred to as “vicarious traumatization,” “compassion fatigue,” or, more simply, “burnout.” Vicarious traumatization is described as the emotional and psychological reactions that are triggered by the experience of empathic engagement with patients who are survivors of trauma. This reaction is considered an inescapable aspect of trauma work. Working with a large population of individuals who have been traumatized by a shared catastrophic event raises many challenges to the individual health care provider. Community traumas involve multiple threats to and actual losses of life but also can cause the breakdown of social structures such as family, communities, employment, and housing, thereby dealing a blow to the basic structure of social life by damaging connections between people and their sense of community. A large percentage of health care providers had to evacuate their homes and offices after Katrina and lost their livelihoods and sense of community. It is also likely that many experienced the loss of loved ones. As a result, the emotional toll on health care professionals continuing to treat a traumatized and dislocated population is … Address correspondence to Paula A. Madrid, PsyD, The Resiliency Program, National Center for Disaster Preparedness, Mailman School of Public Health, 722 W 168th St, 10th Floor, New York, NY 10032. E-mail: pam2109{at}columbia.edu

Prevention of Relapse in the Recovery of Arizona Health Care Providers

This project gathered survey information from physicians, physician assistants, dentists and pharmacists in Arizona who, while enrolled or following a completion of a monitored aftercare program, had relapsed back to active chemical dependency. The findings suggest several subjective factors that contributed to the subjects' relapse included (1) dishonesty to self, (2) not working a 12 step program, and (3) denial of the problem. Factors reported to be helpful for future relapse prevention were (1) abstinence from substance use, (2) working a 12 step program, and (3) having spiritual beliefs. In general, survey respondents were male, averaged 52 years of age, had relapsed several times and started abusing illicit drugs and alcohol in high school or college. By identifying the specific causes of relapse, future studies may attempt to decrease the percentage of health care providers who relapse by recognizing signs of problematic behavior before they occur.

Simpson, Semmelweis, and Transformational Change

The first anesthetic for childbirth and the first recognition of the importance of hand hygiene in obstetrics coincidentally occurred within 5 months of one another in 1847. More than 150 years later, one would have thought that these milestone events would have been fully integrated into practice. However, individuals resist transformational change, which is defined as a fundamental alteration in their beliefs, attitude, and behavior, even when they are confronted with incontrovertible facts. This resistance to change may explain why, in 2005, a large percentage of health care providers still do not practice acceptable hand hygiene, and the pain of childbirth continues to be extolled by some as a necessary part of womanhood, just as pharmacologic pain relief is discouraged.