Role Of Care Providers Research Articles

The role of care and the local economy in women’s labour force participation: evidence from Mexico and Colombia in the pandemic era

ABSTRACT Women face disproportionate care burdens on their time because of traditional gender roles, lack of public policies supporting them and the lack of government services for satisfying society's care needs. This unequal distribution of care responsibilities reduces their opportunities to fully participate in labour markets. We argue that all else equal, women's physical proximity to affordable care services is key to determining their accessibility to them. In addition, services may have different effects on women's labour force participation (LFP), depending on their care responsibilities and other characteristics of their social and economic local conditions, such as size and type of economic output. We use geospatial analysis to explore the relationship between the local supply of care services and women's LFP. We use the population census and the intercensal population survey of Mexico, together with data from economic censuses and directories of care and financial services. We also develop an exploratory data analysis model for the Colombian case. We find that, given gender roles in care provision and women's accessibility to economic sectors, the supply of care services and the type of local economies are quite significant in determining their LFP, regardless of their educational level. Accordingly, mere investment in care services may not be enough since the economic output and type of activities also interfere with LFP. Besides, this effect increased considerably during the COVID-19 pandemic.

Psychosocial Impact of Sickle Cell Disease and Diabetes Mellitus on Affected Children and Their Parents in Khartoum State, Sudan.

This study aimed to assess the psychosocial impact of sickle cell disease (SCD) and diabetes mellitus on children and their parents in Sudan, and the relationship between socioeconomic status and psychosocial issues. A descriptive, cross-sectional study was conducted among n = 320 children aged 6-12 years, of whom n = 170 were diagnosed with SCD, n = 150 children with diabetes mellitus and their parents. The strengths and difficulties questionnaire (SDQ scale) was used to assess the psychosocial aspect of children. Depression, Anxiety, Stress Scale -21 Items (DASS 21) was used to assess the psychological well-being of the caregivers. Data on psychological problems of children with SCD showed that 66.5% had emotional symptoms, 18.2% had conduct problems and 19.4% hyperactivity. Data of parents showed that 45.9% of parents did not experience depression; 27.9% were moderately depressed group. Data on psychological problems among children with diabetes showed that 57.3% experienced emotional symptoms, conduct problems were close to the average among 66%. Data on psychological problems among parents of children with diabetes showed that 45.3% of parents did not experience depression; 22.7% belonged to the moderately depressed group. Psychosocial problems were common both among children and parents. More research is needed in the context of caring for a child with chronic diseases and the role of health care providers in adapting and mitigating psychological problems among both parents and children.

Promise, Provision, and Potential: A Hopeful Trajectory for Spiritual Care in Long-Term Care.

This Canadian study aimed to better understand the provision of spiritual care in long-term care homes, its purpose/importance, the role of a spiritual care provider (SCP)/chaplain, effective practices, and challenges. Online survey responses revealed the need for spiritual care and the robust role of SCPs. Recommendations are made for more consistent employ and integration of SCPs, supported by sector-specific training and a system to connect LTC homes with skilled SCPs.

Bone Health in Metastatic Cancer.

This article reviews the epidemiology and treatment of bone metastases. Also, it revisits the mechanism of action, indications, benefits, and complications of antiresorptive agents; discusses the adverse event profile of these agents; and addresses the prevention and management of these side effects. For this review, peer-reviewed articles, research publications, and relevant clinical guidelines identified from PubMed were used. Bone metastases are common in advanced cancer and much more frequently than in primary bone cancer, especially in adults. Bisphosphonates and Denosumab are potent antiresorptives and significantly reduce the risk of skeletal-related events. These complications are related to poor quality of life, bone pain, functional disability, and decreased survival. Prolonged therapy with these antiresorptive agents in patients with advanced malignancy is generally well tolerated, but some side effects are potentially serious and require periodic monitoring. Furthermore, some of them can be avoided. The role of health care providers and specially nurses on identifying patients at risk of complications from these antiresorptive agents, and providing information on how to prevent them, is essential for health and quality of life maintenance in these patients.

Assessment need of nurses knowledge about nutrition for children with leukemia at hematology pediatric ward in medical city

Background: Leukemia in childhood is the second leading cause of death among children that stated in the bone marrow and affected for producing stem cells. The nurse's and health care provider role is to help children and their families to accept the disease based on their education and its treatment.Objectives: The study aim to assess the nurses' knowledge towards nutrition and identify the relationship between demographic characteristics of the nurses with the knowledge (such as age, sex, educational level, marital status and years of experience). Research Methodology: descriptive study dealt with object-analytical sample randomly from the 40 nurses working in the Hematology Center pediatric ward at Medical City. The questionnaire was designed to gather information, and conducted a study to test a pilot questionnaire questions period (18th April/2021 to 10th July/ 2021). Data was analyzed by applying descriptive statistics (frequency and percentage) and deductive statistics (Chi-Square test) SPSS version (20). Results: The study has shown that female participants in the study sample more than males, and the percentage (57.5%) and over the sample aged more than 34 years, and the proportion (37.5%).

Developing a primary care-initiated hepatitis C treatment pathway in Scotland: a qualitative study.

BackgroundThe ease of contemporary hepatitis C virus (HCV) therapy has prompted a global drive towards simplified and decentralised treatment pathways. In some countries, primary care has become an integral component of community-based HCV treatment provision. In the UK, however, the role of primary care providers remains largely focused on testing and diagnosis alone.AimTo develop a primary care-initiated HCV treatment pathway for people who use drugs, and recommend theory-informed interventions to help embed that pathway into practice.Design and settingA qualitative study informed by behaviour change theory. Semi-structured interviews were undertaken with key stakeholders (n = 38) primarily from two large conurbations in Scotland.MethodAnalysis was three-stage. First, a broad pathway structure was outlined and then sequential pathway steps were specified; second, thematic data were aligned to pathway steps, and significant barriers and enablers were identified; and, third, the Theoretical Domains Framework and Behaviour Change Wheel were employed to systematically develop ideas to enhance pathway implementation, which stakeholders then appraised.ResultsThe proposed pathway structure spans broad, overarching challenges to primary care-initiated HCV treatment. The theory-informed recommendations align with influences on different behaviours at key pathway steps, and focus on relationship building, routinisation, education, combating stigmas, publicising the pathway, and treatment protocol development.ConclusionThis study provides the first practicable pathway for primary care-initiated HCV treatment in Scotland, and provides recommendations for wider implementation in the UK. It positions primary care providers as an integral part of community-based HCV treatment, providing workable solutions to ingrained barriers to care.

Cancer Screening Among Rural and Urban Clinics During COVID-19: A Multistate Qualitative Study.

The effects of COVID-19 have been understudied in rural areas. This study sought to (1) identify cancer screening barriers and facilitators during the pandemic in rural and urban primary care practices, (2) describe implementation strategies to support cancer screening, and (3) provide recommendations. A qualitative study was conducted (N = 42) with primary care staff across 20 sites. Individual interviews were conducted through videoconference from August 2020 to April 2021 and recorded, transcribed, and analyzed using deductive and inductive coding (hybrid approach) in NVivo 12 Plus. Practices included federally qualified health centers, tribal health centers, rural health clinics, hospital/health system-owned clinics, and academic medical centers across 10 states including urban (55%) and rural (45%) sites. Staff included individuals serving in the dual role of health care provider and administrator (21.4%), health care administrator (23.8%), physician (19.0%), advanced practice provider (11.9%), or resident (23.8%). The interviews assessed perceptions about cancer screening barriers and facilitators, implementation strategies, and future recommendations. Participants reported multilevel barriers to cancer screening including policy-level (eg, elective procedure delays), organizational (eg, backlogs), and individual (eg, patient cancellation). Several facilitators to screening were noted, such as home-based testing, using telehealth, and strong partnerships with referral sites. Practices used strategies to encourage screening, such as incentivizing patients and providers and expanding outreach. Rural clinics reported challenges with backlogs, staffing, telehealth implementation, and patient outreach. Primary care staff used innovative strategies during the pandemic to promote cancer screening. Unresolved challenges (eg, backlogs and inability to implement telehealth) disproportionately affected rural clinics.

Clinicians' Perspectives on the Barriers and Facilitators to Implementation of An Evidence-Based Stroke Self-Management Program

<h3>Research Objectives</h3> To explore barriers and facilitators to stroke self-management and to elicit feedback on the implementation of an evidence-based self-management program for stroke survivors. <h3>Design</h3> A qualitative descriptive study conducted via Skype or Zoom. <h3>Setting</h3> Clinicians were recruited from a comprehensive stroke center in the US southwestern region. <h3>Participants</h3> Ten clinicians, who provide direct care or services to persons with stroke, participated in one-on-one semi-structured interviews. The multi-disciplinary group of clinicians included a nurse/care manager (n=1), speech-language pathologist (n=1), occupational therapists (n=2), physical therapists (n=2), and physicians (n=4). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Semi-structured interviews addressed facilitators and barriers to stroke self-management, the role of health care providers in facilitating stroke self-management, and feedback on how to implement successfully an evidence-based stroke self-management program. The clinician interviews lasted 30-45 minutes, were audio recorded, and transcribed by a professional transcription company. Two trained, independent coders analyzed and coded the transcripts. <h3>Results</h3> Thematic content analysis revealed a variety of facilitators and barriers to stroke self-management. Some facilitators identified include family/caregiver support, maintaining a healthy lifestyle, appropriate medication management, and having financial resources. Barriers to self-management include being uninsured, transportation, impaired cognition, lack of family support, limited financial resources, poor medication or blood pressure management, cultural beliefs, and poor health literacy. Clinicians provided a variety of profession-specific strategies to support patient self-management. Major considerations for implementing a stroke self-management program included timing, educational content, access for uninsured patients, addressing transportation needs, accounting for cognitive deficits, improving patient compliance, potential competition with other programs, funding to maintain the program, having a clear organizational structure, and need to evaluate the feasibility and implementation of the program. <h3>Conclusions</h3> The results of this study provides numerous considerations when implementing an evidence based stroke self-management program. Such programs should be low-cost, multidisciplinary in nature, incorporate family/caregivers, and consider the access and educational needs of stroke survivors from diverse backgrounds without transportation, insurance and financial resources. <h3>Author(s) Disclosures</h3> The authors have no disclosures to report.

Discerning Fact From Fiction: An Assessment of Coronavirus-19 Misinformation Among Patients in Rural Michigan.

Coronavirus-19 misinformation poses a unique challenge for public health communication efforts. In rural communities, COVID-19 misinformation is not well studied. We investigate patients’ ability to discriminate COVID-19 fact from fiction from their news sources, as well as general COVID-19 knowledge, perceptions, public health practices, and their primary news sources in 258 adult patients at a primary health clinic in rural Michigan. Most of the population surveyed was able to correctly differentiate reliable COVID-19 public health information from fabricated information. However, only 55.4% of participants reported that they would be somewhat or extremely likely to get a COVID-19 vaccine. The most reported news source was mainstream broadcast television channels such as CBS and ABC. Our data support those older participants are better informed and more likely to practice safe public health practices than younger participants. Based on our data, we offer strategies for public health campaigns in rural communities, such as targeted interventions towards younger people and utilizing local television stations and community institutions to disseminate public health communications and health promotions. Public health interventions beyond education should be considered to mitigate the gap between COVID-19 knowledge and prevention behaviors. Future studies should investigate the role of health care providers in COVID-19 communication with patients, understanding hesitations toward COVID-19 vaccination, and communication strategies to best increase COVID-19 vaccine uptake in rural communities.

Optimizing cancer survivorship in primary care: patient experiences from the Johns Hopkins Primary Care for Cancer Survivors clinic.

PurposeThe optimal delivery of survivorship care, particularly within primary care, remains poorly understood. We established the Johns Hopkins Primary Care for Cancer Survivors (PCCS) clinic in 2015 to address care challenges unique to cancer survivors. To better understand the care from the PCCS clinic, we interviewed patients about their perception of care delivery, survivorship care, and care coordination.MethodsWe conducted semi-structured interviews with adult survivors of any cancer type seen in the PCCS clinic. A priori and in vivo coding of verbatim transcripts was part of the thematic analysis.ResultsSeventeen cancer survivors were interviewed (ages 37–78). Themes that emerged were (1) optimal care and (2) the PCCS experience. Subthemes respectively included the ideal role of the primary care provider (1), telehealth/COVID-19 challenges and opportunities (1), patient-derived value from the PCCS clinic (2), and improving the PCCS model (2). Overall, PCCS patients expected and experienced high-quality, comprehensive primary care by providers with cancer survivorship expertise. Patients reported telehealth benefits and challenges for survivorship care during the COVID-19 pandemic.ConclusionsPCCS patients perceived receiving high-quality primary care and valued being seen in a primary care–based survivorship clinic. The PCCS clinic can serve as a model of primary care–based cancer survivorship.Implications for Cancer SurvivorsIdeal primary care provider roles and care coordination are important factors for high-quality survivorship care and can be provided by a specialized cancer survivorship clinic in primary care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-022-01166-3.

Implementing an Online Program to Change Benzodiazepine Prescription: Protocol of a Hybrid Type 1 Cluster-Randomised Trial

Introduction: Excessive benzodiazepine (BZD) prescription has long been considered a serious mental health concern in many countries. Many interventions using different methodologies have been implemented to change BZD prescription patterns in primary health care settings, with limited positive results. Objectives: The primary objective of our study was to analyse the effectiveness and implementation process of an intervention aimed at changing BZD prescription patterns in a primary health care setting in Portugal. Methodology: We chose as methodology an effectiveness-implementation hybrid type 1 intervention. Our intervention was based on the development of an online platform, named ePrimaPrescribe, which was delivered using a Digital Behaviour Change Intervention (DBCI), using a two-arm cluster-randomised clinical trial. Results: We primarily aimed to evaluate the effectiveness of our DBCI in changing BZD prescription patterns using the frequency of BZD prescriptions issued per month as an outcome measure. Secondarily, we aimed to analyse the effect of ePrimaPrescribe on antidepressant prescriptions, to study the effect of the platform on diagnosis registration associated with BZDs and antidepressant prescription, and to perform a cost analysis considering the monthly National Health Service spending on BZD co-payments. Finally, we aimed to analyse the implementation process using quantitative and qualitative methods. Conclusion: With this study, we expect to contribute with a cost-effective intervention to change the complex matter of excessive BZD prescriptions, and also to improve insight into the challenges to intervention implementation processes in primary health care settings. We believe that our findings are relevant not only to the specific setting where the study was implemented, but also to all countries where primary health care plays a central role in care provision.

Healthcare Provider Advocacy for Primary Health Care Strengthening: A Call for Action.

Primary Health Care (PHC) is the backbone of health systems and a cornerstone of Universal Health Coverage. In 2018, political commitment to PHC, including a comprehensive approach based on essential care throughout the lifespan, integrated public health functions, and community empowerment was reaffirmed by international stakeholders in Astana. As recent events exposed weaknesses of health care systems worldwide, growing attention has been paid to strengthening PHC. While the role of care providers as health advocates has been recognized, they may lack skills, opportunities, and resources to actively engage in advocacy. Particularly for PHC providers, guidance and tools on how to advocate to strengthen PHC are scarce. In this article, we review priority policy areas for PHC strengthening with relevance for several settings and health care systems and propose approaches to empower PHC providers—physician, non-physician, or informal PHC providers—to advocate for strengthening PHC in their countries by individual or collective action. We provide initial ideas for a stepwise advocacy strategy and recommendations for practical advocacy activities. Our aim is to initiate further discussion on how to strengthen health care provider driven advocacy for PHC and to encourage advocates in the field to reflect on their opportunities for local, national, and global action.

Nurses' Role in Identifying Elder Financial Abuse.

One of the current worldwide public health problems is elderly financial abuse (EFA). Although EFA remains a hidden social phenomenon, it has been recognized as a serious concern in the United States, and currently, one in 18 cognitively intact older adults is affected by EFA. Detecting EFA is difficult because the perpetrators are often family members, trusted friends, or guardians. Thus, EFA is frequently unrecognized and grossly under-reported. In the coming decades, EFA will increase as the elderly population continues to grow rapidly worldwide. This article highlights the magnitude of the problem and the role of nurses and other health care providers in identifying, intervening in, and reporting EFA. [J Contin Educ Nurs. 2022;53(1):30-34.].

Adolescents and Young Adults with Cancer: Survivorship and Special Considerations.

Adolescents and young adults (AYAs) who have cancer face a distinct set of challenges beginning during the initial diagnosis, extending throughout treatment, and continuing into survivorship. Owing to significant strides made in cancer therapy in recent decades, more than 80% of this group will go on to become long-term survivors. Despite these improvements, however, many AYAs continue to have poorer outcomes when compared with older and younger patients. The purpose of this article is to underscore the unique set of multifaceted obstacles that this vulnerable group encounters and to pinpoint critical areas of attention and intervention throughout the health care journey. Moreover, it aims to highlight the importance of the role of the primary care provider as a constant partner in safeguarding the long-term physical and mental health of this diverse population within a complex and, at times, trying health care system. [Pediatr Ann. 2022;51(1):e27-e33.].

Bullying: An Update.

Bullying is a complex and widespread public health issue that affects children of all ages and adults. For decades, childhood bullying has been viewed as an unpleasant but generally harmless rite of passage that carries with it few long-term consequences. Research has increasingly documented the serious and long-term behavioral and health consequences of bullying. This article addresses several features of bullying including epidemiology, psychological and physical impact, and the role of health care providers in bullying detection, intervention, and prevention.

The Direct to Consumer Stem Cell Market and the Role of Primary Care Providers in Correcting Misinformation.

Introduction:Direct to consumer stem cell and regenerative interventions (SCRIs) for various medical conditions have increased in popularity due to unmet medical needs and the promise of SCRIs to meet those needs. These interventions may have varying levels of safety and efficacy data and many lack sufficient scientific data to be marketed. The direct to consumer SCRI industry has received significant attention due to potential physical, economic, and emotional harms to patients. Patients may seek the counsel of their primary care providers when considering stem cell therapy for their condition.Methods:Here we describe strategies primary care providers can utilize when counseling patients.Results:Although we recommend constructing these discussions around individual patients’ needs, one can utilize a general approach consisting of 4 parts. First, providers should recognize what information the patient is seeking and what is their understanding of stem cell and regenerative medicine. Next, providers should convey evidence-based information at the level of patients understanding so that they are aware of the risks, benefits, and descriptions of possible procedures. Throughout the conversations, attempts should be made to guide patients to a trusted resource that can provide additional information. Finally, providers should make an effort to address misinformation in a way that is nonjudgmental and patient-centered to make the patient feel safe and comfortable.Conclusion:Effectively communicating risk information by primary care providers to patients is important given the harms reported from direct-to-consumer SCRIs. Correcting misinformation remains a priority when discussing SCRI’s. Providers should strive to offer patients with additional resources such as the opportunity for consultation with a specialist or a consultation service dedicated to informing patients about regenerative medicine.

Implications of the COVID-19 Pandemic on Adult Day Services

Adult day service (ADS) centers serve an important role in care provision for people living with dementia (PLWD). These programs provide socialization, activities, and access to many therapies for PLWD. Additionally, they offer respite to family caregivers so they can work, run errands, and recharge. In March 2020, like much of the nation, ADS sites across the nation were shut down. This left many PLWD and their caregivers without access to the services they depended on to manage day to day care. It also left many sites without a revenue source to pay employees and maintain buildings. Almost a year later, many states have still not reopened ADS and sites that have reopened have done so with a lower census, increased costs, and the lingering fear of a second closure. Much focus has been on the care of older adults in nursing homes or other residential long-term care settings but the challenges of ADS and the people they serve has been mostly ignored. The purpose of this symposium is to highlight the implications of the COVID-19 pandemic on ADS centers. Holly Dabelko-Schoeny will present data gathered from ADS Centers across Ohio. Lauren Parker, will then present data from ADS sites across the United States that examines the effect of COVID-19 on closures and programming during the closures. Katherine Marx will present the effect of ADS closures on family caregivers of persons living with dementia. Finally, Joseph Gaugler will explore this from a policy perspective and provide recommendations moving forward.

Role of Primary Care Physician in COVID-19 Response: A Review

All healthcare providers have had to adapt and be flexible in order to respond to COVID-19. Nonetheless, the emphasis, particularly at the start of the outbreak, was on the impact and response of secondary and tertiary care. The primary care sector's responsibilities in the response focused on how it could help secondary and tertiary care centers respond. A small percentage of current research and evidence focuses on health services implications or applied public health approaches, with even fewer on the role of primary care and family medicine providers. So, while our scientific understanding of the virus and its subsequent clinical consequences has grown exponentially, information about primary care responses to COVID-19 in a variety of settings, as well as the interaction with patient perspectives and priorities, and broader public health responsibilities, remains significantly hazier.

Hospital-Based Palliative and End-of-Life Care in the COVID-19 Pandemic: A Scoping Review.

Aim: To identify the nature of the evidence reporting hospital-based palliative and end-of-life care during the COVID-19 pandemic. Background: The COVID-19 pandemic has seen an increase in the numbers of seriously ill people being cared for across all health services worldwide. Due to the rapid progression of severe symptoms, the majority of staff working in hospitals and other healthcare centres were providing end-of-life care. Little is known about the level of hospital-based palliative care service provided during the COVID-19 pandemic, particularly during surges in admission rates with an increased number of deaths accruing. Methods: A scoping review was conducted to search and select potential studies. The scoping review was guided by the framework of Arskey and O’Malley and advanced by the use of the methodology of the Joanna Briggs Institute. Results: Eighteen studies published between March 2020 and July 2021 were identified. Three broad categories included overall management strategy and logistics, symptom prevalence and management of patients with COVID-19 and end-of-life care needs within the current pandemic. Conclusions: This review highlights increased awareness and knowledge of palliative and end-of-life care provided in hospitals. The review also highlights the response of hospital-based palliative care teams to an evolving crisis, within the context of developed health systems under sustained and overwhelming pressure. Implications: Newly established clinical links and referral pathways developed during the initial COVID-19 surge between hospital-based palliative care and other healthcare teams, be continued and further enhanced. Understanding of the role of specialist palliative care providers in supporting palliative and end-of-life care within the hospital setting needs further investigation.

The Role of Primary Care Providers for Uveitis

Uveitis, a treatable sight-threatening condition, may often be misdiagnosed and treated as pink eye, a common ophthalmic condition encountered in the primary care setting. Although more than 50% of cases of uveitis are idiopathic, a variety of underlying medical conditions, such as genetic, traumatic, systemic immune-mediated conditions, or infectious mechanisms can trigger uveitis. An accurate and prompt diagnosis is critical for initiating vision-saving treatment. Because a high percentage of uveitis was reported in the primary care setting, the role of primary care providers should focus on identifying the condition, initiating first-line therapy, and promptly referring to an ophthalmologist.