Physicians In Rural Areas Research Articles

Physician retention and migration in rural clinics designated for areas without physicians in Japan: descriptive epidemiological study using the national physicians’ survey

BackgroundIn Japan, local governments have rural clinics designated for areas without physicians (RCDA) to secure physicians for rural medical care. Moreover, a medical policy of dispatching physicians between the RCDA and core hospitals for rural areas (CHRA) exists. This study aimed to assess the actual situation of physician migration from RCDAs and those who migrated, and examine the factors associated with their migration.MethodsThis retrospective cohort study used biennial national physicians’ survey data from 2012 to 2018. It targeted physicians who worked at RCDAs in 2012 and participated in all four surveys (n = 510). The physicians were divided into two groups. One group consisted of physicians who worked continuously at the RCDA over the four study periods (retained physicians, n = 278), and the other included physicians who migrated to other institutions midway through the study period (migrated physicians, n = 232). We tracked the types of facilities where RCDA physicians worked from 2012 to 2018, also examined the factors associated with their migration.ResultsAmong physicians from RCDAs who migrated to other institutions (n = 151) between 2012 and 2014, many migrated to hospitals (n = 87/151, 57.6%), and some migrated to CHRA (n = 35/87, 40.2%). Physicians in their 40s (Hazard ratio 0.32 [95% CI 0.19–0.55]), 50s (0.20 [0.11–0.35]), and over 60 years (0.33 [0.20–0.56]) were more likely to remain at RCDAs. Changes in their area of practice (1.82 [1.34–2.45]) and an increase in the number of board certifications held by physicians between 2012 and 2018 (1.50 [1.09–2.06]) were associated with migration.ConclusionsMany migrating physicians choose to work at hospitals after migrating from RCDAs. It was seemed that the physician dispatch system between RCDA and CHRA has been a measure to secure physicians in rural areas. Young age, obtaining board certification, and changes in areas of practice were associated with physician migration from RCDAs.

The output of cataract surgery performed by trained non-ophthalmologist physicians in rural areas: study of cataract outcomes and up-take of services report 7.

Cataract is the leading cause of blindness worldwide and surgery can restore vision in most patients. Some patients have little access to surgical services due to lack of cataract surgeons and the unaffordable costs. In 2005 we built a service model that trained rural non-ophthalmologist physicians to perform cataract surgeries in rural China. This study evaluates the long-term impacts of this model. We conducted a retrospective cohort study to analyze patients' hand-written medical records and electronic outpatient record between January 2005 and December 2019 at two rural health clinics in Southern China. In total, 34,601 patients (49,942 eyes) underwent cataract surgery by non-ophthalmologist physicians from 2005 to 2019.Visual acuity was clearly documented in 38,251 eyes. Before surgery, the unaided distance visual acuity (UDVA) of 60.7% (23,205/38,251) eyes was less than 0.05 decimal. On the first day after surgery, the percentage of UDVA < 0.05 eyes was reduced to 6.0%, and 96.7% (36,980/38,251) of the eyes achieved a better UDVA compared to pre-operation. Surgical-related complications occurred in 218 eyes. The most common complication was posterior capsule rupture (114, 0.23%). 44.3% (15,341/34,601) of the patients chose to have a second eye cataract surgery (SECS) in the same clinic. At one of the outpatient clinics, 21,595 patients received basic eye care apart from cataract surgery between 2018 and 2020. Non-ophthalmologist physicians trained for cataract surgeries in rural clinics can improve cataract related visual acuity and basic eye care to the local population.

Результаты целевого трудоустройства медицинских работников в городах и сельской местности.

Targeted training of future medical workers and their guaranteed employment is one of the state measures to address the issue of the shortage of specialists. The key mission of targeted training is the balanced regulation by the organization of training and employment. Currently, there are not enough scientific studies on the results and effectiveness of this measure in the health care system, but many researchers emphasize the problems of targeted employment of medical workers. According to the studies of a number of authors, the imperfection of normative legal regulation of issues of targeted training allows graduates not to fulfill the obligations of employment in medical organizations upon graduation [3–9]. The purpose of the study. Conduct an analysis of indicators reflecting the specifics of targeted employment of health workers in organizations located in urban and rural areas in 2022 and 2023. Materials and methods. The study used statistical data for 85 constituent entities of the Russian Federation on the basis of an operative documented request to the health protection authorities of the constituent entities of the Russian Federation, containing information on the number of employed doctors and nursing staff within the framework of targeted training, as well as the planned values of targeted employment in accordance with the concluded contracts. The study period is 2022 and 2023. The total data on targeted employment of medical workers after completion of the specialty program and completion of residency in the context of the names of positions of doctors and nursing staff were analyzed. Analytical and descriptive statistics methods were used in the research process. Results. The share of doctors and nursing staff employed after completion of targeted training from the total number of medical workers in organizations located in rural areas is higher than the share of those recruited to work in urban medical organizations. On average, 1.3% of doctors and 0.21% of nursing staff are annually recruited to urban medical organizations as part of targeted employment out of the total number of the respective key medical personnel as of the end of the reporting year. In rural areas, these figures are 2.6% and 0.30%, respectively. Specialists are predominantly employed in urban medical organizations, while in rural areas – district doctors. The study revealed that in 2023 there were 128.1 target recruitments per 10,000 doctors in urban areas in a given year, and in 2022–124.8, i. e. the intensity of employment by target recruitment in urban areas increased by 2.6% in two years. In rural areas, there were 260.2 target recruitment admissions per 10,000 physicians in 2023 and 262.8 in 2022, that is, the intensity of target recruitment employment of physicians in rural areas decreased by 1% in two years. When analyzing the indicator comparatively, it is noted that in rural areas it is almost twice as high as in urban areas. Conclusions. Targeted employment of medical workers is an effective and efficient measure to attract medical personnel to organizations experiencing a shortage of them. The analysis has shown that the intensity rate of targeted employment per 10,000 physicians in urban areas of the country is lower than in rural areas, which amounted to 128.1 and 260.2, respectively. According to the results of the last two years, 60% of the doctors planned for targeted employment fulfilled their obligations, including 50% in rural areas. The main reason for the current level of employment is the failure to meet the planned indicators of targeted admission to training due to the violation of obligations by students and graduates, which requires the development of a special methodology for assessing the reasonable formation of the plan for targeted recruitment to educational organizations in the context of each medical organization. When comparing the number of vacant positions of doctors and the number of employed graduates within the framework of targeted recruitment, a significant range of the indicator among the subjects of the Russian Federation was revealed, which is presented in the interval from 1 to 29% (9.0±15.95). In this regard, it can be assumed that the number of persons employed under targeted recruitment does not depend on the additional demand for doctors and does not cover the existing deficit.

AT: Asynchronous Teleconsultation for Health Centers in Rural Areas of Peru

AT: Asynchronous Teleconsultation for Health Centers in Rural Areas of Peru

Labor shortage of physicians in rural areas and surgical specialties caused by Work Style Reform Policies of the Japanese government: a quantitative simulation analysis.

Objective: The Japanese government's physician workforce reform, which commenced in April 2024, introduced regulations on physicians' working hours. However, in areas facing physician shortages such as rural regions and surgical medical specialties, healthcare provision relies heavily on the extended working hours of each physician. The anticipated impact of this reform, when implemented, was significant. Materials and Methods: Using publicly available government data, we estimated the current working hours of physicians in various medical specialties in each prefecture across Japan. Subsequently, we calculated the ratio of surplus or deficit physicians when hypothetically assuming that all physicians adhered to the regulatory upper limit of 58.4 working hours per week nationwide. Results: Assuming that all physicians work to the regulated maximum, there would be a shortage of doctors in various medical specialties across Japan, such as surgery, neurosurgery, orthopedic surgery, obstetrics and gynecology, and emergency medicine. Geographically, shortages of doctors are observed in rural prefectures such as those in the Tohoku region, particularly in emergency- and surgery-related specialties, indicating a critical shortage of physicians in rural areas. Additionally, it has become evident that even in medical specialties with a calculated surplus of physicians nationwide, the margin of surplus is generally only a few percentage points. Conclusion: Currently, rural areas and surgical medical specialties in Japan have limited leeway in the physician workforce, and the strict application of workforce reform may lead to a severe shortage of physicians in these areas. It is noteworthy that as similar reforms may subsequently be implemented in other countries, analogous challenges would arise. Thus, the implementation of workforce reform requires a flexible approach to minimize its negative effects, which widen the existing disparity in the workforce.

Infantile Colic: A Survey of Physicians in Pakistan.

Infantile colic diagnostic criteria were established by Rome IV. A universally accepted management remains to be established. We aimed to evaluate diagnostic criteria, management strategies, and perceived regional prevalence of infantile colic in Pakistan, as well as its effect on physicians and parents. A questionnaire was distributed amongst 1,256 physicians. We received 800 replies. Wessel and Rome IV criteria were used by most physicians for diagnosis; however, the response "any infant who cries a lot" was selected by older physicians (48% of those over 60 years), physicians in rural areas (32%), physicians practicing in private clinics (27%), and general physicians (30%). Estimated prevalence of infantile colic ranges from 21-40%. Reassurance was the most widely recommended management strategy followed by herbal teas (51%), switching to a different formula (49%), probiotics (28%) and antibiotics (26%), discontinuation of breastfeeding (14%), elimination of dairy products from the breastfeeding mothers' diet (6%), and the administration of colic drops (1%). Most physicians considered the negative impact of colic on their personal lives and the parents as mild-to-moderate. Notably, 38% of percent of physicians routinely screened for maternal depression, and 45% of physicians were aware of the association between infantile colic and shaken baby syndrome. Most physicians in Pakistan diagnose and manage infantile colic according to the established guidelines. However, the guidelines pertaining to treatment planning are not followed. Educational efforts directed toward general physicians and doctors practicing in rural areas and clinics must be implemented to avoid unnecessary testing and treatment burden.

Gender difference of geographic distribution of physicians in Japan: three-point analysis of 1994, 2004 and 2014

BackgroundJapan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of physicians in rural areas. This study examined this issue, focusing on gender and considering years of physician experience, demographic and geographic factors.MethodsWe analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians’ gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience.ResultsThe number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4% to 20.4%. We found that 87.7% of physicians were concentrated in the top 1/3 municipalities in terms of population. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficient for all physicians was 0.315–0.298–0.298 (male physicians: 0.311–0.289–0.283, female physicians: 0.394–0.385–0.395) The Gini coefficients for female compared to male physicians were higher in all age groups, showing that The distribution of female physicians is skewed toward urban areas.ConclusionFemale physicians are less distributed in rural areas than male physicians. In addition, despite the fact that the number of female physicians has increased more than male physicians over the past 20 years, the geographic ubiquity of female physicians has not improved. Since the trend of increasing the number of female physicians is expected to continue in the future, it is necessary to take some measures, such as providing a work-life balance suitable for female physicians.

Ethical issues arising from the government allocation of physicians to rural areas: a case study from Japan

The geographically inequitable distribution of physicians has long posed a serious social problem in Japan. The government tackled this problem by establishing and managing Jichi Medical University (JMU) and regional...

Policy Analysis of Retention of Physicians in Deprived Areas in Iran Using a Framework of Policy Analysis Triangle

Background: The retention of physicians' policy is recommended by the World Health Organization (WHO) to achieve the goals of the health system and justice in access to health services. The aim of this study was policy analysis of retention of physicians in deprived areas and providing some recommendations for improvement of this plan.&#x0D; Methods: This was a qualitative study regarding policy which used Walt and Gilson's triangle framework and Kingdon's multiple streams. Data were collected using a deep semi-structured interview with 30 participants and a review of upstream laws and regulations. After that, all the interviews were recorded, transcribed, and reviewed. Then, data were analyzed through MAXQDA/12 and content analysis.&#x0D; Results: The findings of this study were categorized according to the policy context, content, and process, and actors who played a significant role in designing and implementing this policy.&#x0D; Conclusion: The policy of retaining physicians in rural areas requires the support of the majority of the country's political and health authorities, and providing infrastructure for health providers. This policy not only increases the quality of services, but also is effective in increasing the patients' access to healthcare services in deprived areas.

Eliciting primary healthcare physicians’ preferences for job characteristics in rural China: a discrete choice experiment

IntroductionThe outflow and scarcity of physicians in rural areas can adversely affect universal health coverage and population health outcomes, which are critical concerns in China. This study explored primary healthcare...

Step-by-Step Process for Assessing the Economic Impact of Regional Medical Campuses in Canada

Background: Regional medical campuses (RMCs) create positive economic impacts in communities and small cities. RMCs increase educational capacity, medical services, and address the shortage or maldistribution of physicians in rural areas. Our paper answers the question: How do you assess the economic impact of a RMC? Methods: The Canadian Input-Output (I-O) model and the Simplified American Council on Education (ACE) model are adapted to assess the economic impact of an individual RMC using a step-by-step process. The models are tested using data from three Canadian RMCs. Results: A comparison of the two models found similarities with data requirements and spreadsheet calculations. However, the Canadian I-O model spreadsheet is linked to Statistics Canada multipliers and calculations are more complex. Outputs are calculated for multiple economic variables. The Simplified ACE model, in contrast, uses a single multiplier and provides a single number by input category and a cumulative total of all impacts. Conclusion: Both models successfully assess economic impacts of RMC. The step-by-step process allows RMC administrators and others to understand the limitations of each model, but also facilitates an in-house economic assessment of RMC. The authors provide guidance on choosing the best model.

Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021

Physician work hours are an underexplored facet of the physician workforce that can inform policy for the rapidly changing health care labor market. To examine trends in individual physician work hours and their contribution to clinical workforce changes over a 20-year period. This cross-sectional study focused on active US physicians between January 2001 and December 2021 who were included in the Current Population Survey. Outcomes for physicians, advanced practice professionals (APPs), and nonphysician holders of doctoral degrees were compared, and generalized linear models were used to estimate differences in time trends for weekly work hours across subgroups. Physician and APP workforce size, defined as the number of active clinicians, 3-year moving averages of weekly work hours by individual physicians, and weekly hours contributed by the physician and APP workforce per 100 000 US residents. A total of 87 297 monthly surveys of physicians from 17 599 unique households were included in the analysis. The number of active physicians grew 32.9% from 2001 to 2021, peaking in 2019 at 989 684, then falling 6.7% to 923 419 by 2021, with disproportionate loss of physicians in rural areas. Average weekly work hours for individual physicians declined by 7.6% (95% CI, -9.1% to -6.1%), from 52.6 to 48.6 hours per week from 2001 to 2021. The downward trend was driven by decreasing hours among male physicians, particularly fathers (11.9% decline in work hours), rural physicians (-9.7%), and physicians aged 45 to 54 years (-9.8%). Physician mothers were the only examined subgroup to experience a statistically significant increase in work hours (3.0%). Total weekly hours contributed by the physician workforce per 10 000 US residents increased by 7.0%, from 13 006 hours in 2001 to 2003 to 13 920 hours in 2019 to 2021, compared with 16.6% growth in the US population over that time period. Weekly hours contributed by the APP workforce per 100 000 US residents grew 71.2% from 2010 through 2012 to 2019 through 2021. This cross-sectional study showed that physician work hours consistently declined in the past 20 years, such that physician workforce hours per capita lagged behind US population growth. This trend was offset by rapid growth in hours contributed by the APP workforce. The gap in physician work hours between men and women narrowed considerably, with diverging potential implications for gender equity. Increasing physician retirement combined with a drop in active physicians during the COVID-19 pandemic may further slow growth in physician workforce hours per capita in the US.

From the Editor

The Fall 2022 issue of the Journal of Appalachian Studies brings together a series of articles investigating historical and contemporary inequalities in Appalachia. We open with a historical account of how specific forms of anti-Blackness through industrialization and de-industrialization have influenced the contemporary impression of Appalachia as a primarily white space. Drawing on the scholarly traditions of Black geographies and Black Studies, Gabe Schwartzman traces the impact of residential and labor segregation, unequal exposures to environmental hazards, and the pull of more promising places on the construction of Appalachia as a white space, and the discounting of Black space-making in dominant accounts of the region.Next, Meike Schleiff and David Peters explore the historical trajectories of health policy and the community health workers who have in various iterations been deployed as key personnel in public health initiatives in Appalachia and other rural spaces. Due to a lack of access to physicians in rural areas, community health workers have been needed to fill the gap and address the complex determinants of ill health in rural and low-income communities. This article concentrates on lessons that can be gleaned from federally led programs, ranging from the New Deal era to the Affordable Care Act, to improve policy and address persistent health inequalities in rural spaces.Julia M. Miller, Julie N. Zimmerman, Kathryn Engle, and Cameron McAlister conduct a comparative study of rural and urban food prices in Appalachia and how changes over an eleven-year period have impacted people's access to food. Contrary to the popular idea that prices are lower in rural areas, they find that food prices in selected rural Appalachian counties have risen more rapidly than they have in selected urban counties. Economic distress, de-industrialization, and population loss are factors to consider in food policy that specifically meets the complex needs of rural communities.The last article, by Marjorie Darrah, Kimberly Cowley, Christopher Wheatley, Leah McJilton, and Roxann Humbert, evaluates the growth and impact of a National Science Foundation funded project, the First2 Network, in its efforts to encourage persistence in STEM fields in West Virginia higher education. The authors note that although the number of STEM majors in West Virginia has increased, the number actually graduating with a degree or certificate has remained flat. The network has a goal of increasing the number of students who choose a STEM major, and then providing them with the support they need to persist and graduate.The articles are followed by a research note by Julie Tritz, Daniel Eades, Doug Arbogast, Allison Tomlinson, and Lorrie Wright. Their note explores the impact of quilt trails—a form of cultural heritage tourism—on the communities where they are located. Quilt trails consist of barns or outbuildings adorned with square quilts of various traditional patterns that decorate the building and honor a traditional Appalachian art form. The authors present an exploratory qualitative study of how this form of heritage tourism has impacted participating farmers in West Virginia.This issue of JAS also includes a wide range of book and media reviews. Carson E. Benn reviews Lost in Transition: Removing, Resettling, and Renewing Appalachia, edited by Aaron D. Purcell; Ladetra Morgan reviews an exhibit honoring the life and work of the late bell hooks; Crystal Good reviews the film Homegrown Foodways in West Virginia: Foraging and Relations with Jonathan Hall, filmed and produced by Mike Costello and Amy Dawson for the American Folklife Center, with support from the West Virginia Folklife Program; Mai Perkins reviews a performance by Sparky and Rhonda Rucker; Amanda Page and Cassie Rosita Patterson review the multi-media site BLACK BY GOD | The West Virginian; Yair Golan reviews Episode 3 of the Smoky Mountain Air podcast mini-series Sepia Tones: Exploring Black Appalachian Music; and Roy Andrade reviews the complete recorded works of the musician Blind Alfred Reed.Finally, I would like to thank everyone involved in the work of producing this issue of JAS: the University of Illinois Press staff; the editorial board of the Journal of Appalachian Studies; the JAS production team: Christopher L. Leadingham, Mary K. Thomas, Ann E. Bryant, Carson E. Benn; and our new media review editor, Matthew Sparks; all the reviewers who generously shared their time and labor with us; and the entire Appalachian studies community.

Geographic distribution of family physicians in Japan and the USA: a cross-sectional comparative study.

Solutions for geographic maldistribution of physicians is challenging around the world, but primary care specialists are expected to resolve this issue. This study compares the geographic distribution of family physicians in Japan and the USA, both of which are developed countries without a major system for physician allocation by the public sector; however, the two countries differ greatly in the maturity of family medicine (ie length of its history as part of the healthcare system and the population of qualified family medicine experts). This cross-sectional comparative study used publicly available online databases for Japan in 2018 and 2017 in the USA. The municipalities in Japan and counties in the USA were divided into quintile groups according to population density. The number of family physicians per unit population in each group of areas was calculated, and was evaluated with a residual analysis. The geographic distribution of all physicians in Japan was simulated assuming that the proportion of family physicians among all physicians in Japan (0.16%) was increased to match that in the USA (11.8%). Of 320 084 physicians in Japan and 899 244 in the USA, 519 (77.2%) family physicians in Japan and 105 999 (100%) in the USA were included. The distribution of family physicians in Japan was noticeably shifted to areas with the lowest population density. In contrast, family physicians in the USA were distributed equally across areas. The distribution of physicians of other specialties (general internists, pediatricians, surgeons and obstetricians/gynecologists) was shifted heavily to areas with the highest population densities in both countries. The simulation analysis showed the geographic maldistribution of the total number of physicians improved substantially if the proportion of family physicians in Japan is increased to match that in the USA. The distribution of family physicians is more equitable than that of other medical specialists; however, an immature family medicine system can lead to an aggregation of family physicians in rural areas. This aggregation supports equity due to the broader scope of practice required by family physicians in rural areas. In countries where family medicine has not yet matured as a specialty, provided that the equitable aggregation of family physicians in rural areas can be maintained, increasing the number of family physicians as a proportion of the total number of physicians may improve the geographic maldistribution of the total number of physicians.

To stay or not to stay: the role of sense of belonging in the retention of physicians in rural areas

ABSTRACT Rural communities across the circumpolar region and worldwide perennially suffer from physician shortages despite decades of attempting targeted strategies for recruitment. Particularly in rural Canada, financial incentives have attracted but not retained a medical workforce. Although the importance of social connection or belonging is a long-established source of well-being, such information has not infiltrated the dialogue or action on physician retention in rural areas. A physician’s sense of belonging, arising from that emotional need for social connectedness, is built via bilateral active efforts at community engagement, reciprocity, social integration of family and workplace collegiality. Links between rural upbringing, rural training opportunities and subsequent rural practice likely rest upon fostering this sense of belonging. Policymakers and recruiters might consider how to help physicians adapt, “fit in”, and consider they have “come home” when they venture off to rural settings. Empowering the community to be involved in the recruitment and retention of rural physicians may also be effective. Perhaps this approach would better address the age-old battle to retain physicians in rural Canada and around the world.

Family Medicine and Emergency Redeployment: Unrealized Potential.

Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare's 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

Traditional Chinese Medicine Automated Diagnosis Based on Knowledge Graph Reasoning

Syndrome differentiation is the core diagnosis method of Traditional Chinese Medicine (TCM). We propose a method that simulates syndrome differentiation through deductive reasoning on a knowledge graph to achieve automated diagnosis in TCM. We analyze the reasoning path patterns from symptom to syndromes on the knowledge graph. There are two kinds of path patterns in the knowledge graph: one-hop and two-hop. The one-hop path pattern maps the symptom to syndromes immediately. The two-hop path pattern maps the symptom to syndromes through the nature of disease, etiology, and pathomechanism to support the diagnostic reasoning. Considering the different support strengths for the knowledge paths in reasoning, we design a dynamic weight mechanism. We utilize Naïve Bayes and TF-IDF to implement the reasoning method and the weighted score calculation. The proposed method reasons the syndrome results by calculating the possibility according to the weighted score of the path in the knowledge graph based on the reasoning path patterns. We evaluate the method with clinical records and clinical practice in hospitals. The preliminary results suggest that the method achieves high performance and can help TCM doctors make better diagnosis decisions in practice. Meanwhile, the method is robust and explainable under the guide of the knowledge graph. It could help TCM physicians, especially primary physicians in rural areas, and provide clinical decision support in clinical practice.

Abstracts for the 40th emergencies in medicine conference

Abstracts for the 40^th emergencies in medicine conference

Rural and Urban Difference in Longitudinal Trends in Prevalence of Dementia in Medicare Claims and Survey Data

Shortage of physicians in rural areas can lead to lower diagnosis and underestimation of dementia prevalence in these communities. We used data from the nationally representative Health and Retirement Study and a 20-percent sample of Medicare claims to study rural-urban differences in dementia prevalence. The survey dementia diagnosis is free from medical assessment while the claims diagnosis needs a physician diagnosis. We estimated the trends in dementia prevalence from (2002-2016) based on cognitive tests (using survey data) and diagnosis codes (using claims data) utilizing ordinary least squares regression. Dementia prevalence based on diagnosis codes declined in both urban and rural areas over the course of the study, with a sharper decline in urban areas. Dementia prevalence using diagnosis codes showed significantly higher rates in urban areas during all years (0.024 vs 0.018 in 2002 and 0.017 vs 0.013 in 2014 in rural vs urban areas, respectively). Dementia in the cognitive test sample was higher in rural areas (0.11 vs 0.08 in 2000 and 0.08 vs 0.7 in 2014 in rural vs urban areas), a difference that was significant only in 2004. Our results indicate lower dementia prevalence rates in rural areas in claims based sample compared to survey sample which its dementia prevalence is free medical assessment. Claims data are valuable sources for tracking dementia in the US population, however they are based on medical diagnosis.In rural areas, where there is shortage of physicians and a lack of access to health care services, claims based studies may underestimate dementia rates.

'We can bear it!' Unpacking barriers to hepatocellular carcinoma screening among patients with hepatitis B: Aqualitative study.

To explore barriers to hepatocellular carcinoma screening among patients with hepatitis B. Hepatitis B-related hepatocellular carcinoma is a major cause of cancer-related mortality globally. A preventive strategy for screening is needed to improve early tumour detection and overall survival. However, utilisation remains suboptimal and barriers are understudied and largely focused on clinical factors. A qualitative study based on the preventive health model using phenomenological hermeneutical approach. Face-to-face semi-structured interviews were conducted with 23hepatitis B patients from November 2020 to February 2021. Interpretative phenomenological analysis was used. The COREQ checklist was followed. Four themes were identified: (i) miscognition, (ii) cultural stigma and taboo, (iii) social norms of enduring hardship and (iv) social barriers at the community, health system and policy levels. Patients had misconceptions about inactive carriers, asymptomatic nature of chronic hepatitis B, hepatocellular carcinoma risks and screening recommendations. Influenced by the taboo of hepatocellular carcinoma, stigma against hepatitis B and enduring hardship norms, they perceived screening as divination, avoided utilisation to hide disease status and endured symptoms until they were intolerable. Insufficient community support, a lack of shared decision-making in health systems, and inadequate rural reimbursement policy and hepatocellular carcinoma detection capacity further precluded utilisation. Cognitive and sociocultural barriers precluded individuals' intention, utilisation and persistence of hepatocellular carcinoma screening. The results highlight intervention targets for miscognition, stigma, taboo and social norms; propose family-focused, community-based education programs; suggest health systems to introduce decision aids; and inform policymaking and upskilling of physicians in rural areas. Collaborative efforts are needed to improve real-world hepatocellular carcinoma screening, including education to address knowledge deficiencies, psychological counselling to reduce stigma and taboo beliefs, support for shared decision-making and reimbursement policies.