Rural Healthcare Clinics Research Articles

Challenges and possible improvements for healthcare teams at outreach clinics in Nepal – a qualitative study

ABSTRACT Background All Nepalese citizens have the right to high-quality healthcare services free of charge. To achieve this, healthcare services for the rural population in Nepal need to be improved in terms of personnel, medicines, and medical equipment. Objectives To explore challenges and possible improvements healthcare personnel experience when travelling to rural parts of Nepal to provide healthcare. Method Data was collected from various health professionals using focus group discussions at Dhulikhel Hospital in Nepal. The data were transcribed and analysed using Systematic text condensation. Results Twenty-two professional healthcare personnel participated in five group discussions. Four categories emerged from the collected material: Finding ORC services being underutilised, Wanting to fulfil tasks and do a good job, Facing inadequate resources, and Seeing the need for improved organisation and cooperation. There was consensus that rural clinics are important to maintaining health for the rural population of Nepal. However, there was frustration that the rural population was not benefitting from all available healthcare services due to underutilisation. Conclusion Rural healthcare clinics are not utilised appropriately, according to healthcare workers at the rural outreach clinics. Potential ways of overcoming the perceived challenges of underutilising available healthcare services include financial and human resources. The rural population´s health awareness needs to be increased, and the work environment for rural healthcare workers needs to be improved. These issues need to be prioritised by the government and policymakers.

Advances in the Design of Renewable Energy Power Supply for Rural Health Clinics, Case Studies, and Future Directions

Globally, effective and efficient healthcare is critical to the wellbeing and standard of living of any society. Unfortunately, several distant communities far from the national grid do not have access to reliable power supply, owing to economic, environmental, and technical challenges. Furthermore, unreliable, unavailable, and uneconomical power supply to these communities contributes significantly to the delivery of substandard or absence of qualitative healthcare services, resulting in higher mortality rates and associated difficulty in attracting qualified healthcare workers to the affected communities. Given these circumstances, this paper aims to conduct a comprehensive review of the status of renewable energy available to rural healthcare clinics around the globe, emphasizing its potential, analysis, procedures, modeling techniques, and case studies. In this light, several renewable energy modeling techniques were reviewed to examine the optimum power supply to the referenced healthcare centers in remote communities. To this end, analytical techniques and standard indices for reliable power supply to the isolated healthcare centers are suggested. Specifically, different battery storage systems that are suitable for rural healthcare systems are examined, and the most economical and realistic procedure for the maintenance of microgrid power systems for sustainable healthcare delivery is defined. Finally, this paper will serve as a valuable resource for policymakers, researchers, and experts in rural power supply to remote healthcare centers globally.

Configuring a computer-based nursing process form to support nursing diagnosis in rural healthcare clinics in Nigeria.

Poor internet infrastructure limits the use of computer-based nursing process forms in rural areas. This study aimed to configure a computer-based nursing process form to support nursing diagnosis and care evaluation in rural healthcare clinics in Africa. This study utilized a methodological design. The design process utilized a three-stage procedure involving planning, configuration, and testing. Seven faculty members volunteered to participate in the laboratory verification process. Each simulation session lasted 45 min and span from patient admission to exit. The experts independently scored the software functionality dichotomously as Not Suitable (score 0) and Suitable (score 1) for nursing practice. The agreement between the faculty volunteers was 0.857. The configuration of a readily available Microsoft Access computer application to support nursing diagnosis without internet service is possible. Health facilities in rural areas without internet connectivity should resort to such local configurations to maximize the benefits of electronic-based documentation.

Abstract 12770: Using the Socioecological Model to Explore Barriers to Healthcare Provision in Rural Communities in the Philippines

Background: Basic healthcare in the Philippines is provided via rural healthcare clinics (RHC) located in barangays and supervised by provincial health centers. These RHC are the cornerstone of the country's public health system and were designed to promote and prevent disease through basic healthcare services and education. However, RHC became nonfunctional during the COVID pandemic leaving the community without the resources necessary to address the acute problems associated with COVID and chronic conditions. Given the crucial role of RHC in disease prevention and control, identifying barriers to providing its services and programs is warranted. Aims: The purpose of this qualitative study was to explore multilevel barriers to the provision of healthcare services and education in RHC. Methods: We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting resource access at RHC. Four public health nurses and fifteen community healthcare workers (CHW) from five RHC across the country participated in individual interviews and group discussions. Traditional content analysis was used to examine the data. Results: Findings revealed barriers at the individual (insufficient motivation, incorrect beliefs), interpersonal (insufficient ability of CHW to provide services, and lack of training, unrealistic expectations, and lack of supervision and monitoring of CHW), organizational (excessive workload for CHW, lack of resources, inadequacy of evaluation and monitoring of CHW), community (lack of trust in CHW by people, lack of motivation to seek healthcare, continued belief in traditional healers), and policy (lack of financial support for RHC, lack of an organized system to meet community needs) levels. Conclusion: Examining individual, interpersonal, community, and policy level determinants that affect RHC can inform community-based health promotion interventions for the country's rural communities. Given the multidimensional barriers identified, it is recommended that a comprehensive program be developed and implemented in collaboration with licensed healthcare providers, CHW, district and regional healthcare department representatives, and healthcare policymakers.

Impact of a Pharmacist-led COPD Clinic on Patient Outcomes in a Rural Healthcare Clinic

Background While it is well documented that pharmacists improve disease state outcomes, there are currently no studies evaluating a pharmacist’s impact on quality of life (QOL), lung function, and adherence in COPD patients, specifically in a rural healthcare setting. We aimed to compare changes in patient QOL with and without participation in a pharmacist-led COPD clinic in a rural healthcare setting. Methods This was a single-center, prospective, open-label, case/control study performed at a rural healthcare center during December 2018 through June 2019. Enrolled patients were assigned to either the case or control arm on an alternating basis. Case participants received individualized patient care including PFT, QOL assessment utilizing the St. George’s Respiratory Questionnaire (SGRQ), disease state education, and medication management for a total of 3 appointments during a 6-month period. Control subjects did not receive the individualized intervention during the 3 appointments and only completed the PFT, SGRQ, and medication adherence counseling. Results A total of 20 patients participated in the complete 6-month COPD clinic. At the end of the 6-month clinic, there was not a statistically significant difference between the groups in regard to SGRQ values (p=0.191), medication adherence (p=0.279), and lung function (p=0.321). Limitations included randomization methods and sample size. Conclusions Although there was not a statistically significant difference between the groups; significant mediation management interventions were made for participants in both the intervention and control groups. Pharmacists are well positioned in multiple practice settings to contribute to the improvement of quality of life for these patients.

Usability and Acceptability of an Electronic Clinical Decision Support Tool for Antibiotic Selection for Common Pediatric Infections in Outpatient Rural Healthcare Clinics

Usability and Acceptability of an Electronic Clinical Decision Support Tool for Antibiotic Selection for Common Pediatric Infections in Outpatient Rural Healthcare Clinics

Usability and Acceptability of an Electronic Clinical Decision Support Tool for Antibiotic Selection for Common Pediatric Infections in Outpatient Rural Healthcare Clinics

Background: Inappropriate antibiotic prescribing is a major contributor to antibiotic resistance, a rising cause of morbidity and mortality in the world. It is estimated that 30% of all outpatient antibiotic prescriptions are unnecessary; an additional 20% may include inappropriate selection, dose, and duration. Multiple guidelines are available to help health care providers care for children with common infections, but those are often lengthy and may not be easily accessible. The major objective of this study was to determine the usability and acceptability of an electronic clinical decision support (ECDS) tool for optimizing outpatient antibiotic prescribing practices in a rural clinical practice for common pediatric …

Evaluation of a Nurse Practitioner Pregraduate Clinical Residency Model

Abstract A new clinical residency education model was implemented in response to a nurse practitioner program's difficulty in securing and maintaining qualified preceptors and clinical sites for students in the program, and a community hospital's shortage of nurse practitioners for their rural healthcare clinics. The new model is described. An evaluation on the clinical residency pilot was found to meet standards of nurse practitioner education, to incorporate nursing leader recommendations for new clinical models, and to be an effective model to clinically educate students. Recommendations are shared from the pilot experience.

The Effect of Waiting Time on Patient Perceptions of Care Quality

ABSTRACTThis research explores the effect of waiting time on patient satisfaction in the context of rural healthcare clinics, with data from a three-year time period. Patient satisfaction was measured by overall quality of care, likelihood of recommending the care provider, and likelihood of recommending the practice. The authors' analysis shows that waiting times impact patient satisfaction, with differences being more pronounced by gender and clinic type. A deeper analysis using ordinal logistic regression and additional time-related variables reveals some interesting results. For example, in this setting, only when waiting time was 45 minutes or greater was there an effect on overall patient satisfaction. Male patients tended to be more satisfied if kept abreast of delays. Female patients were more tolerant of delays, but receiving delay information did not link to satisfaction. Finally, patients who were highly satisfied with the time spent with their care provider were 94 percent likely to refer the practice to others. However, patients who were very dissatisfied with the time spent with the care provider were 81 percent likely to not recommend the care provider. Understanding what aspects of a patient's experience drive care quality and patient satisfaction is useful to healthcare managers who operate with increasingly limited resources.

Evaluation of specialist referrals at a rural health care clinic.

Transition to a value-based care system involves reducing costs improving population health and enhancing the patient experience. Many rural hospitals must rely on specialist referrals because of a lack of an internal system of specialists on staff. This evaluation of the existing specialist referrals from primary care was conducted to better understand and improve the referral process and address costs, population health, and the patient experience. A 6-month retrospective chart review was conducted to evaluate quality and outcomes of specialty referrals submitted by 10 primary care providers. During a 6-month period in 2015, there was a total of 13,601 primary care patient visits and 3814 referrals, a referral rate of approximately 27%. The most striking result of this review was that nearly 50% of referred patients were not making the prescribed specialist appointment. Rather than finding a large number of unnecessary referrals, we found overall referral rates higher than expected, and a large percentage of our patients were not completing their referrals. The data and patterns emerging from this investigation would guide the development of referral protocols for a newly formed accountable care organization and lead to further quality improvement projects: a LEAN effort, dissemination of results to clinical and executive staff, protocols for orthopedic and neurosurgical referrals, and recommendations for future process improvements.

Assessment of Mobile Device and SMS Use for Diet and Exercise Information Among Rural Mexican-American Adolescents

This is a pilot study regarding the use of mobile technology and short message service (SMS) for diet and exercise among rural Mexican American adolescents (RMAA). Authors used convenience sampling to recruit RMAA seeking care at a rural healthcare clinic and conducted three focus groups (n=12). Content analysis was used to identify categories and subcategories. Participants applied diet and exercise information in their lives based on an interaction with community and through the use of use mobile devices. Culturally sensitive use of mobile devices and SMS may be a tool to provide rural adolescent populations with resources.

Regional variation in the utilization of carotid endarterectomy

In different regions of the United States, highly variable rates have been documented for a wide range of procedures, such as prostatectomy and caesarean section. It is generally held that this variation is due to inconsistent physician practice patterns or other nonmedical considerations. Only limited research has been conducted regarding vascular surgical operations. We examined national data on the utilization of carotid endarterectomy (CEA) to determine the extent and diversity of regional variations. Medicare discharge data quantified the per capita rate of CEA in 50 states and the District of Columbia in 2003. Multiple metrics pertaining to risk factors, socioeconomic status, access to care, provider density, and local health care capacity were quantified. We performed bivariate analysis, Pearson (PC) or Spearman (SC) correlations, and multiple regression modeling. In 2003, 83,164 CEAs were performed on 28,767,985 enrollees. CEA rates were 28.9 +/- 7.8 per 10,000 (range, 5.6-44.7 per 10,000). The rate of CEA was highly correlated with the number of heart disease deaths (PC = 0.575, P < .0001), deaths by stroke (PC = 0.504, P = .0002), and percentage of adult smokers in a state (PC = 0.643, P < .0001). These three factors held the strongest association with variation in CEA rates. Statistically, they explained 51% of the variation in total number of CEAs (R(2) = 0.5074, P < .0001). Median annual income (PC = -0.608, P < .0001) and percentage of college degrees (PC = -0.606, P < .0001) displayed inverse relationships to CEA rates. Per capita hospital beds (SC = 0.540, P < .0001) and rural health care clinics (SC = 0.518, P < .0001) exhibited positive correlations. The number of physicians or vascular surgeons did not predict higher utilization of CEA. The strongest correlations for CEA were three markers associated with atherosclerotic disease: percentage of adult smokers and deaths from heart disease or stroke. Geographic variation in this vascular procedure is chiefly associated with variance in markers of disease prevalence, not physician preference or other nonmedical factors. The increased utilization of carotid stenting, accompanied by the participation of a much wider range of medical specialists, may affect this relationship in the future.

Partner Violence Screening in Rural Health Care Clinics

We sought to determine the frequency of intimate partner violence by type in a large, clinic-based, nurse-administered screening and services intervention project. A brief intimate partner violence screen, which included items to measure sexual and physical assaults and psychological battering (using the Women's Experience With Battering scale) was administered to consenting women receiving care at 1 of 8 rural clinics in South Carolina. Between April 2002 and August 2005, 4945 eligible women were offered intimate partner violence screening, to which 3664 (74.1%) consented. Prevalence of intimate partner violence in a current (ongoing) relationship was 13.3%, and 939 women (25.6%) had experienced intimate partner violence at some point in the past 5 years. Of those ever experiencing intimate partner violence, the majority (65.6%) experienced both assaults and psychological battering; 10.1% experienced assault only, and 24.3% experienced psychological battering only. Most women (85.5%) currently experiencing both psychological battering and assaults stated that violence was a problem in their current relationship. The intimate partner violence screening technique we used was feasible to implement, acceptable to women seeking health care at the targeted clinics, and indicated a high proportion of women reporting intimate partner violence in the past 5 years, with a majority of those women stating that such violence was a problem in their relationships. These findings demonstrated the viability of the screening technique, which supports the growing importance of implementing intimate partner violence screenings in clinical settings in order to reduce the prevalence of violence in intimate relationships.

Screening for Violence against Women in a Rural Health Care Clinic

The purpose of this study was to compare the incidence of violence against women served at a rural health care center after introducing a violence screening protocol. All women 18-years and older who were served in the clinic in a one-year period (N=1690) were asked about episodes of violence. The number of positives responses was assessed in a retrospective chart review of all women’s charts seen in the clinic before and after an educational intervention and screening protocol were added to the intake procedures. Previous to the intervention, no charts of women were identified who reported current violent against them. A second retrospective chart review was conducted after the intervention. Six women were identified and referred to support agencies for violence against them. The investigators concluded that education of staff and adding the screening protocol about violence against women visits can increase the ability to identify violence against women.

The Process of Changing Health Risk Behaviors: An Oregon Rural Clinic Experience

A counseling intervention was conducted by nurse practitioners (NPs) at a rural clinic in Oregon. The intervention was designed to help individuals change health risk behaviors. Three focus groups were conducted to aid in understanding the barriers to changing health behaviors and to identify resources that rural individuals needed to succeed in behavior change. Quantitative data were collected using appraisal forms that were specific to five behaviors. Qualitative data were from written comments submitted by focus group participants in answer to questions sent prior to each meeting and from written summaries of focus group meetings submitted by the focus group leader. Most participants were not successful in changing their health behaviors. The issues raised in the focus group discussions provide an overview of the barriers to health behavior change as perceived by a group of adults in a rural environment. Both individual lack of will and the rural community environment were barriers to adopting new health behaviors. NPs in rural health care clinics could provide important support for individuals attempting to adopt new health behaviors. Specific suggestions from focus group participants included discussing risky behaviors more often, forming support groups that do not charge a fee, and developing a peer-mentoring program.

Domestic violence among patients at two rural health care clinics: prevalence and social correlates.

Despite a growing body of knowledge concerning family abuse, there is little research focusing on domestic violence in rural settings. Likewise, there is a paucity of research on family abuse among Hispanics. This study examined the prevalence of spousal abuse among predominately low income Hispanic patients of two rural health care clinics. The correlation of certain social factors to domestic violence also was examined. Survey data was collected from 155 adult female patients. Findings revealed a 19% prevalence rate. This rate corresponds to recent measures of domestic abuse nationwide. A bivariate analysis showed a significant positive relationship between spousal abuse and drug/alcohol use by victims' intimate partners. Abuse also was significantly related to the community location of the health care clinics. The article concludes by discussing implications of the study for rural domestic violence intervention, treatment, and research.