Types Of Health Care Providers Research Articles

The impact of vaginal surgical mesh devices on consultation rates by type and health care provider in UK primary care: A cohort study in the Clinical Practice Research Datalink.

To examine consultation rates by type of consultation and health care provider in women with stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP), with and without surgical mesh implants. Longitudinal open cohort study from April 2006 to November 2018 in the Clinical Practice Research Datalink (CPRD). Rates of consultations with general practitioners (GPs), nurses, other clinicians and administrators by consultation type (face-to-face, telephone or administrative), and types of administrative consultations, estimated using negative binomial regression. Of 220,544 women eligible for inclusion, 74% (n=162,687) had SUI, 37% (n=82,123) had POP, and 11% (n=24,266) had both. Face-to-face consultation rates were stable over time, at about 9 per year. Administrative consultations with GPs and administrators increased between 2006 and 2018, but averaged 31 per year. After adjustment, for both SUI and POP mesh surgery, there were lower rates of face-to-face consultations with GPs, higher rates of face-to-face consultations with other clinicians, higher rates of telephone consultations with GPs and other clinicians, and higher rates of administrative consultations with GPs, nurses and administrators. The higher rate of consultations with GPs coded as administrative consisted of results recording and administrative codes, and the higher rates of consultations with administrators were coded as repeat issue, other, administration and third-party consultations. Caring for women with mesh places a higher administrative burden on GPs and administrators. There may be potential to reduce this workload through a more streamlined care pathway.

Comparison of Outcomes Between Professions Following an Interprofessional Continuing Education Program to Enhance Trauma Care for Children

ABSTRACTThe prevalence of children exposed to a potentially traumatic event (PTE), or Adverse Childhood Experience (ACE) is high, with exposure to long-lasting and severe PTEs and ACEs associated with negative health outcomes. Health care professionals who predominantly work with the paediatric population have limited training on how to screen, assess, and treat children after exposure. This study aimed to assess differences in learner outcomes between three healthcare provider types (PCPs, behavioural health providers, and other care team members [e.g. nurses, community health workers]) after participating in a continuing education programme designed to improve health outcomes of paediatric patients experiencing trauma. Learner outcomes were assessed as pre- and post-series changes in self-reported knowledge, self-efficacy, skills, and attitudes related to the programme’s learning objectives. Self-reported learner outcomes of 31 participants revealed significant increases in knowledge among all provider types, and significant increases in self-efficacy and skills for behavioural health providers and care team members. Additionally, results revealed that behavioural health providers significantly outperformed medical providers in self-efficacy and skills outcomes. These findings suggest that interprofessional continuing education programmes to enhance trauma care can be successful at training PCPs, behavioural health providers, and care team members, but learner outcomes may vary by discipline.

Advanced Practice Providers in Departments of Family Medicine: Status, Supervision, and Services.

Nurse practitioners (NP), physician assistants (PA), and other advanced practice providers (APP) are one solution to meet health care workforce shortage. Our study examined clinical workforce decisions and perceptions of APPs and family physicians (FPs) from the perspective of a national survey chairs of Departments of Family Medicine. A survey was developed and distributed to family medicine department chairs as identified by the Association of Departments of Family Medicine (ADFM). In addition to demographic information, respondents were asked if their department directly employs APPs, major factors influencing departments of family medicine to hire APPs, services to patients currently being provided by APPs, and services preferentially provided by APPs. Descriptive statistics were reviewed. Bivariate analyses and Chi-square were computed comparing perceptions of APPs and FPs by how these types of health care providers are currently used in the respondent's clinical operation. The overall response rate for the survey was 48.4% (109/225). Most departments of family medicine (62.4%) use APPs. Access to care and filing gaps in team-based care are the primary factors for APP employment. Although most departments have APPs provide services that include complex chronic conditions complicated by coexisting conditions or not yet controlled, most department chairs do not prefer APPs provide these services. The role APPs in terms of specific patient care activities and services in the health care team of departments of family medicine is often in conflict with preferred roles as delineated by the chair.

Combining Physician Expertise and Women's Lived Experience to Educate Health Professionals about Preventing Fetal Alcohol Spectrum Disorders.

Physician Champions from the American College of Obstetricians and Gynecologists (ACOG) and trained women Speakers from FASD United, who have given birth to a child with a fetal alcohol spectrum disorder (FASD), co-present to healthcare providers (HCPs) in medical residency programs as part of an educational intervention. They present FASDs as a biological and social problem surrounded by stigma that prevent pregnant women from talking openly to their HCPs about their alcohol use or alcohol use disorder (AUD) and getting the medical help they need. Semi-structured interviews were conducted with 10 ACOG Champions and nine FASD United Speakers and a thematic analysis assessed how the co-presentations can enhance HCPs' understanding about FASDs and address stigma associated with alcohol use during pregnancy. Interview findings indicated that both Champions and Speakers emphasized the need for HCPs to be nonjudgmental and create a safe space for open dialogue. They reported that residents were moved by mothers' personal stories, wanted to understand AUD better, and asked about the type of help HCPs can offer women. Combining physicians' expertise with mothers' personal stories of lived experiences of FASDs directed at residents, who are more reflective and open at this phase of their careers, moved them from a fact-based to an empathy-based approach to learning that is critical to address the stigma surrounding women who may be using alcohol or struggling with an AUD during pregnancy. Collaboration between national organizations allowed this intervention to be widely implemented across the country.

Claims analysis of Medicare fee-for-service oral health care encounters, from 2019 through 2021

BackgroundMany qualifying people rely on Medicare fee-for-service (FFS) for their health care insurance, although it rarely provides coverage for oral health care services. The objective of this study was to gain insights into oral health care that is being provided by all health care provider types for Medicare FFS beneficiaries. MethodsThe authors used the Centers for Medicare & Medicaid Services Virtual Data Research Center to query 100% of Medicare FFS claims from 2019 through 2021 and identify all encounters for which there was either an oral health–related International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code or a CDT 2019-2021: Current Dental Terminology code recorded on the claim. The authors used a cross-sectional study design and calculated descriptive statistics to describe characteristics of identified oral health care encounters. The encounter level was the unit of analysis. ResultsA total of 2,098,056 oral health care encounters were identified through Medicare FFS claims during the study observation period, with a lower volume observed after 2019. Nearly 98% of encounters were related to those in which oral health diagnoses were recorded (International Classification of Diseases, Tenth Revision, Clinical Modification code on claim), and non–oral health care providers primarily submitted these claims. Most encounters included beneficiaries with chronic conditions, and a roughly equal proportion included those qualifying for Medicare on the basis of age and disability. ConclusionsPreviously unreported characteristics of oral health care encounters were identified through administrative claims, providing insights into oral health care being provided to a subset of Medicare FFS beneficiaries. Practical ImplicationsFuture research and policies should focus on strengthening medical-dental integration models and expanding access to oral health care for the Medicare FFS population.

Province-to-province variability in hepatitis C testing, care, and treatment across Canada.

Few countries have implemented the necessary policy changes to reduce the number of steps in the cascade of care to achieve hepatitis C virus (HCV) elimination, including Canada. The aim of this study was to describe and compare legislation, scope of practice, and policy as it relates to the provision of HCV care in each province. We reviewed grey literature and regulatory and legislative documents which affect various aspects of the HCV cascade of care. Findings were verified by content experts. HCV RNA reflex testing ensures those that are antibody positive get an HCV RNA test; however only 80% of provinces have reflex test. Point-of-care antibody testing can be offered in most community non-health care settings, yet many types of health care providers are unable to do this independently. Following a positive test, it may not be feasible to complete venipuncture; however only a single province processes HCV RNA dried blood spot cards. In many provinces, training and verification are required for novice prescribers, and in some provinces prescribing continues to be restricted to specialists. Only a single province has task-shifted treatment to a non-physician non-nurse practitioner model, where pharmacists can prescribe treatment. Finally, 80% of provinces require authorization forms, and 30% require proof of investigations for treatment. No single province is optimizing the use of diagnostic tools and task shifting and decreasing paperwork to expedite treatment initiation. Collaboration between provinces is needed to streamline practice, update policy, and promote equity in HCV diagnosis, care, and treatment.

E-mental health in Germany — what is the current use and what are experiences of different types of health care providers for patients with mental illnesses?

BackgroundAs a new and effective support option, e-mental health interventions can be useful in complementing treatment in mental health care. To date, little is known about how health care providers use these programs to treat patients with mental illnesses in Germany. The present study aims to examine the use of and experiences with e-mental health interventions from the point of view of different types of health care providers for patients with mental illnesses.MethodsData from a cross-sectional survey of routine care health care providers in Germany in 2021 were analysed. In this survey, data were collected from n = 107 general practitioners (GPs), n = 114 specialist doctors, n = 102 psychotherapists, and n = 102 inpatient clinicians. Assessments included professional use of digital media, as well as knowledge, use and experiences regarding e-mental health interventions in care of people with mental illness.ResultsIn the total sample of n = 425, 65.6% (n = 279) were female. The study participants had an average age of 47.7 years (SD = 11.0) and their average work experience was 20.0 years (SD = 11.1). Overall, the majority (83.8%, n = 353) had heard of e-mental health interventions, but few felt well informed. Only 28.5% (n = 121) had already used e-mental health interventions for treatment support. The most commonly recommended e-mental health interventions in the sample were deprexis (39.7%, n = 48), moodgym (24.8%, n = 30), and iFightDepression (22.3%, n = 27). The use was predominantly considered to be helpful and satisfactory. Insufficient knowledge about e-mental health interventions and lack of informational materials for patients were reported as relevant barriers to the use of e-mental health interventions.ConclusionsE-mental health interventions can be a useful support option, but they are rarely used in the treatment of patients with mental illnesses. There is a need to disseminate information specific to the various types of health care providers. Tailored implementation strategies need to be developed in order to capitalize on the potential of effective e-mental health interventions and to improve health care for patients with mental illnesses.

A mixed methods study to uncover impediments to accurate diagnosis of nonradiographic axial spondyloarthritis in the USA.

Delayed diagnosis of axial spondyloarthritis (axSpA) is well documented; little is known about the diagnostic journey and impediments for US patients with nonradiographic axSpA (nr-axSpA). It is hypothesized that impediments are varied and exist at both the healthcare provider (HCP) and patient levels. This study aims to understand patient experiences and contributors to delayed nr-axSpA diagnosis in the USA. Interviews of adults with rheumatologist-diagnosed nr-axSpA, recruited through Spondylitis Association of America outreach and patient panels, and of rheumatologists, explored the diagnostic journey and diagnostic barriers. Emerging themes were further explored in an online patient survey. A multiple logistic regression analysis evaluated the main outcome variable, factors affecting time to nr-axSpA diagnosis. Interviews were conducted with 25 patients and 16 rheumatologists. Survey responses from 186 eligible patients revealed median time from symptom onset to diagnosis of nr-axSpA was 3.25 years. Delayed diagnosis was significantly more likely for women and people in rural areas. Most patients consulted ≥4 different types of HCPs before a rheumatologist and ≥2 rheumatologists before diagnosis. Impediments to timely diagnosis included insidious chronic pain; episodic symptom patterns attributed to activity; symptoms other than chronic lumbosacral back pain requiring medical consultation; and unfamiliarity with and misperceptions about nr-axSpA among HCPs, radiologists, and rheumatologists. Delayed nr-axSpA diagnosis is common and reflects HCP knowledge gaps and frequent patient presentation with dominant nonaxial symptoms. Targeted HCP education, research into early disease patterns, and interventions sensitive to the broader spectrum of nr-axSpA manifestations are needed to improve timely diagnosis. Key Points • Patients with nr-axSpA often see multiple types of HCPs, and multiple rheumatologists, before receiving a diagnosis. • Both patients and HCPs are unfamiliar with nr-axSpA and its symptoms, lacking understanding that nr-axSpA can occur in young people, females, and those presenting with normal x-rays. • Disease recognition by nonrheumatology HCPs is key for early referral. • Education on cardinal features, epidemiology, burden, and benefits of timely nr-axSpA diagnosis is warranted for HCPs who commonly manage back pain.

1035-P: Area Deprivation Index and Rates of Specialty Care in Monogenic Diabetes Registry Participants

While diabetes is one of the most common chronic medical conditions, monogenic forms of diabetes represent a rare subtype, and face barriers to timely diagnosis similar to other rare diseases (RD), which are exacerbated by low health literacy (HL) and health care access barriers. The Monogenic Diabetes Registry (MDR) follows more than 1,200 participants with molecular diagnoses of monogenic diabetes who can offer insight into diagnostic barriers and facilitators. Aim: To assess area deprivation index (ADI- a measure of neighborhood disadvantage in the US) as a proxy of HL and health care provider type (specialist versus generalist) as a proxy of health care access in a subset of MDR participants with maturity-onset diabetes of the young (MODY). Methods: Cross-sectional analysis of REDCap data for 79 participants. ADI was constructed for each participant and descriptive statistics were analyzed with RStudio. Kruskal-Wallis was used for comparisons. Results: The median ADI of MDR participants was 26 (less than expected value of 50; p<0.001). Only 20% were from neighborhoods with >50th %ile deprivation. Sixty-two percent were under specialty care for diabetes. The median ADI for those under specialist care was lower than for those under generalist care (23 versus 36), but did not reach statistical significance. There was no difference in median ADI between participants receiving clinical versus research genetic testing or between those referred by providers versus self-referral. Discussion: ADI inversely correlates with HL and SES. MDR participants had ADI percentiles below the national median and a majority were under the care of diabetes specialists compared to ~15% of the general US population living with diabetes. These findings suggest inequity in who finds and enrolls in the Registry, and mimics the broader RD literature. Efforts are needed to better reach populations disproportionately affected by health disparities to ensure equity in monogenic diabetes diagnosis and management. Disclosure R.G.Son: None. R.N.Naylor: None. S.Uiversity of chicago monogenic diabetes registry : n/a. Funding National Institutes of Health (R01DK104942, P30DK020595, K23DK114564, UL1TR000430)

Experiences and preferences for advance care planning following a diagnosis of dementia: Findings from a cross-sectional survey of carers.

Future medical and financial planning is important for persons with dementia given the impact of the disease on capacity for decision making. To explore from the perspective of carers of persons with dementia: (1) Participation in future medical and financial planning by the person they care for, including when planning was undertaken and the characteristics associated with having an advance care directive completed; (2) The type of healthcare providers who discussed advance care planning following diagnosis; and (3) Preferences for timing of discussions about advance care planning following diagnosis. Recruitment and data collection took place between July 2018 and June 2020. Carers of persons with dementia aged 18 years and older were mailed a survey. Participants completed questions regarding completion of various future planning documents by the person they support, including time of completion and who discussed advance care planning following diagnosis. Participants were presented with information about the benefits and consequences of early and late discussions of advance care planning and asked when discussions about advance care planning were best initiated. 198 carers participated. Most participants were female (74%) and had been a carer for more than 2 years (82%). Most participants reported that the person with dementia they support had made a Will (97%) and appointed an Enduring Guardian (93%) and Enduring Power of Attorney (89%). Only 47% had completed an advance care directive. No significant associations were found between characteristics of persons with dementia and completion of an advance care directive. Geriatricians (53%) and GPs (51%) most often discussed advance care planning following diagnosis. Most carers thought that discussions about advance care planning should occur in the first few weeks or months following diagnosis (32%), at the healthcare provider's discretion (31%), or at the time of diagnosis (25%). More than half of persons with dementia do not have an advance care directive. There is variability in preferences for timing of discussions following dementia diagnosis.

Institutional Barriers to Healthcare Services Among Transgender Individuals in the Rural Midwest

ABSTRACT Often the barriers that arise in healthcare are due to healthcare professionals lack of education, exposure, and transphobia. Another potential barrier is due to geographical location of living in a rural area where there is a lack of healthcare services. This phenomenological study investigated barriers faced by transgender individuals who were transitioning in a rural area, focusing particularly on institutional barriers present in the healthcare system. Transgender individuals were recruited using convenience and snowball sampling. Data were collected via in-depth, face-to-face interviews in a rural area of the Midwest in the United States (n = 8). Transgender participants discussed themes of discrimination among healthcare providers based on gender. Participants reported gender markers as a barrier for healthcare services, such as inappropriate or incomplete response options on billing and medical forms. Participants perceived discrimination among gynecology, psychiatry, and medical emergency staff, and pharmacists. Overall, transgender individuals experienced mistreatment while transitioning in a rural area which created issues with participants’ progress in transitioning. This study shows that education for all types of healthcare providers is needed regarding transgender health. Particularly in rural areas—many of which continue to lack essential healthcare services for the general population—the transgender population might not receive the culturally sensitive and appropriate attention they require.

Health Care Providers' Knowledge of Tuberculosis and Diabetes Mellitus Comorbidity in Lubumbashi, Democratic Republic of the Congo (DRC).

Tuberculosis-Diabetes mellitus (TB-DM) co-morbidity is a growing scourge in the world. The new approaches and interventions for TB control implemented by the Tuberculosis National Control Program (TNCP) in DRC require the involvement of health care providers for their success. The objective of this study is to assess the knowledge of health care provider on different aspects of the management of TB-DM co-morbidity and to compare this knowledge according to the health care system, the type of providers and the number of years of experience. Cross-sectional and analytic study was conducted in 11 health care facilities in the Lubumbashi Health District, selected by reasoned choice, and an electronic questionnaire was administered to health care providers. These providers were interviewed on the different aspects of the management of the TB-DM comorbidity. The data were presented and compared in relation to knowledge about TB, DM, and TB-DM comorbidity. A total of 113 providers were interviewed, predominantly males and physicians. Questions related to knowledge about DM were better answered. Doctors compared to paramedics; tertiary-level providers compared to secondary-level providers had better responses to the different questions. There is a statistically significant correlation between the level of knowledge of TB, DM and the type of health care provider, the number of years of experience. The present study shows that there are gaps in the knowledge of our health care providers and community members on the recommendations of the DRC TB guidelines (Programme AntiTuberculeux Intégré 5: PATI 5) in general and on the management of TB-DM. It is therefore important and necessary to put in place strategies to improve this level of knowledge, which will focus on the extension of the guidelines, the awareness and the training of the stakeholders involved in the control.

Potential influence of nurses' implicit racial bias on maternal mortality.

Stark disparities persist in maternal mortality and perinatal outcomes for Black and other birthing people of color, such as Native Americans, and their newborns compared to White people in the United States. An increasing body of research describes the phenomenon of implicit racial bias among providers and how it may affect communication, treatment decisions, the patient care experience, and health outcomes. This synthesis of literature reviews and distills current research on the presence and influence of implicit racial bias among nurses as it may relate to maternal and pregnancy-related care and outcomes. In this paper, we also summarize what is known about implicit racial bias among other types of healthcare providers and interventions that can mitigate its effects, identify a gap in research, and recommend next steps for nurses and nurse researchers.

결핵 치료 중 사망에 대한 다수준 분석

Tuberculosis is an infectious disease with social determinants and is associated with individual and regional factors. In this study, multilevel logistic regression analysis was used to identify regional factors affecting mortality during treatment considering the individual level and regional level factors together in the early period (2012-2015) when the Korean tuberculosis PPM cooperation system was introduced. When PPM general hospitals, public health centers, and clinics were selected as treatment institutions, there was no difference in mortality according to regional PPM support rates. Non-PPM hospitals (slope 0.016, p<0.001) and non-PPM general hospitals (slope 0.017, p<0.001) showed a higher mortality rate in regions with higher PPM support rates. When PPM hospitals were selected as treatment institutions, the higher the PPM application rate, the higher the mortality rate (slope 0.033, p<0.001). Due to the institutional situation of adopting a treatment system centered on a small number of large hospitals, each region has a diverse distribution of regional PPM coverage depending on the circumstances, and accordingly, the type of healthcare providers selected creates a different context and leads to a difference in mortality during treatment.

Increasing Awareness of Naloxone-Induced Noncardiogenic Pulmonary and Peripheral Edema

AbstractIntroductionNaloxone use has increased in recent years in response to the nation’s opioid crisis. Once only available to health care professionals, it is now obtainable by prescription for persons at risk for substance overdose and their families. Increasing its availability is seen by some as an “over-the-counter solution” to the opioid problem. However, while naloxone has been viewed as relatively safe, with a low side effect profile when appropriately dosed and monitored, it is not without safety concerns that may go unrecognized or misattributed to other causes.MethodsHere we present a case study of a 41-year-old female who presented to our medication-assisted treatment (MAT) clinic complaining of sudden onset weight gain, shortness of breath, upper and lower extremity peripheral edema, tachycardia, insomnia, and nocturnal enuresis. These symptoms made it difficult for her to work at her housekeeping job, resulting in missed workdays. She had seen a primary care provider for her symptoms and been prescribed a rescue inhaler for her shortness of breath. This patient had previously been treated for opioid use disorder with buprenorphine/naloxone and experienced similar symptoms, which disappeared when she relapsed on opioids. However, symptoms reappeared upon resuming her prescribed treatment.ResultsThe patient was identified as experiencing side effects to naloxone, causing noncardiogenic edema. Her MAT medication was switched to buprenorphine. Within two weeks her heart rate had returned to normal, she had lost weight, and she no longer had nocturnal enuresis or needed the rescue inhaler. Her peripheral edema resolved so she was able to walk better and resume work. At the same time, buprenorphine continued to relieve her cravings.There is a dearth of information related to naloxone-induced edema. Our patient had not received a formal evaluation of pulmonary edema, but her pulmonary and cardiac symptoms were consistent with that diagnosis. Although pulmonary edema is mentioned in the product literature, peripheral edema is not. A literature search indicates that the number of case studies on naloxone-induced pulmonary edema have increased since 2018, but only one other case of naloxone-induced peripheral edema was discovered.Conclusions/ImportanceNaloxone is used in a variety of settings by differing types of health care providers. As the number of persons treated with naloxone increases, there will likely be a corresponding increase in incidences of pulmonary and/or peripheral edema as side effects. Providers and patients who are not aware of these manifestations and their relationship to naloxone treatment may easily attribute presenting symptoms to cardiogenic or other causes, as this case illustrates. It is important for providers in all settings to consider new onset shortness of breath and edema within the context of the person’s whole health and to be aware of their implications for mental as well as physical health.FundingNo Funding

ACR Presidential Address: Rheumatologists-Folks You Can Trust.

ACR Presidential Address: Rheumatologists-Folks You Can Trust.

Incidence and prevalence of systemic sclerosis in Thailand in year 2017-2020: a database from the Ministry of Public Health.

A better understanding of the epidemiological profile of systemic sclerosis (SSc) in Thais could improve care, human resource deployment, and public health budgeting. We aimed to determine the incidence and prevalence of SSc in Thailand between 2017 and 2020. A descriptive epidemiological study was performed using the Information and Communication Technology Center, Ministry of Public Health database, comprising all types of healthcare providers during the study period. Demographic data of patients having a primary diagnosis of M34 systemic sclerosis and over 18 years of age between 2017 and 2020 were reviewed. The incidence and prevalence of SSc were calculated as well as their respective 95% confidence intervals (CIs). The number of SSc cases in 2017 was 15,920 from a total Thai population of 65,204,797. The prevalence of SSc in 2017 was 24.4 per 100,000 populations (95% CI 24.0-24.8). The prevalence of SSc among women was 2 times greater than among men (32.7 vs. 15.8 per 100,000). The incidence of SSc was stable from 2018 to 2019 but dropped slightly in 2020 (7.2, 7.6, and 6.8 per 100,000 person-years, respectively). Most SSc cases were in northeastern Thailand (11.6, 12.1, and 11.1 per 100,000 person-years from 2018 to 2020, respectively) and the peak was between 60 and 69 years of age (24.6, 23.8, and 20.9 per 100,000 person-years from 2018 to 2020, respectively). SSc is a rare disease among Thais. The disease was commonly revealed in late middle-aged women with a peak at age 60-69 years, mainly from the northeast regions. The incidence remained stable during the study period, albeit during the emergence of the coronavirus pandemic a slight decline was recorded. Key Points • The incidence and prevalenceof systemic sclerosis (SSc) vary across ethnic populations. • There is a lack of epidemiology research of SSc since the 2013 ACR/EULAR Classification Criteria for Scleroderma was adopted among Thais included Asia-Pacific population as the population has some different clinical features than those reported among Caucasians. • SSc is a rare connective disease among Thaisand commonly presents in late middle-aged group of both genders,mainly in Thailand's northern and northeastern regions. • When compare to the epidemiology of SSc in Asia-Pacific, the prevalence of SSc in Thais was higher than among East Asians and the Indian population and the incidence of SSc among Thais was greater than the other Asia-Pacific population including Australian.

Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes

ObjectiveThe purpose of this study was to describe the utilization of health team practitioners among national-level athletes and report their injury profile as well as access to and knowledge of chiropractic care. MethodsThis study was a retrospective analysis of non-identifiable, cross-sectional survey data that were previously collected from members of the AthletesCAN organization who voluntarily completed a web-based, bilingual survey in July or August 2017. The sport of the athlete, number of years on a national team, number and type of injuries, health care practitioners visited, and specific details on chiropractic care were collected. Descriptive statistics were performed to summarize the responses in terms of frequencies and percentages. ResultsThere was an 11% response rate (198/1733), with 67 unique sports identified (21 winter sports [50 athletes] and 46 summer sports [148 athletes]). Athletics and swimming were the sports with the most respondents. Fewer than half (43.9%) of the 198 respondents were members of AthletesCAN for 2 to 5 years. Seventy percent reported 1 to 5 injuries over their career, with ankle, low back, and shoulder the most likely body parts affected. A majority of athletes (93.4%) reported visiting multiple practitioners, including medical physicians, physiotherapists, athletic therapists, massage therapists, and chiropractors. Two-thirds (67%) of athletes sought chiropractic treatment, most typically for neck or back pain (81.3%), despite nearly half (45.7%) being unsure about access to chiropractic care. ConclusionThis sample of Canadian national team athletes who experience an injury may seek care from multiple types of health care providers and include chiropractic as part of their approach to health care.

Association between disability status and health care utilisation for common childhood illnesses in 10 countries in sub-Saharan Africa: a cross-sectional study in the Multiple Indicator Cluster Survey.

Approximately 70 million children in sub-Saharan Africa (SSA) are disabled, yet little is known about the prevalence of and care-seeking patterns for common childhood illnesses, such as acute respiratory infection (ARI), diarrhoea, and fever. Data were from 10 SSA countries with data available from 2017 to 2020 in the UNICEF-supported Multiple Indicator Cluster Survey (MICS) online repository. Children aged 2-4 years who completed the child functioning module were included. Using logistic regression, we examined the association between disability and ARI, diarrhoea and fever in the past two weeks and care-seeking behaviour for these illnesses. Using multinomial logistic regression, we examined the association between disability and the type of health care providers from which caregivers sought care. There were 51,901 children included. Overall, there were small absolute differences in illnesses between disabled and non-disabled children. However, there was evidence disabled children had a greater odds of ARI (aOR=1.33, 95% C.I 1.16-1.52), diarrhoea (aOR=1.27, 95% C.I. 1.12-1.44), and fever (aOR=1.19 95% CI 1.06-1.35) compared to non-disabled children. There was no evidence that caregivers of disabled children had a greater odds of seeking care for ARI (aOR=0.90, 95% C.I 0.69-1.19), diarrhoea (aOR=1.06, 95% C.I. 0.84-1.34), and fever (aOR=1.07, 95% C.I 0.88-1.30) compared to caregivers of non-disabled children. Caregivers of disabled children had a higher odds of seeking care from a trained health worker for ARI (aOR=1.76, 95% C.I. 1.25-2.47) and fever (aOR=1.49, 95% C.I. 1.03-2.14) or non-health professional (aOR=1.89, 95% C.I. 1.19-2.98) for ARI than from an unspecified health facility worker compared to caregivers of non-disabled children, but no associations were not seen for diarrhoea. While the data showed relatively small absolute differences, disability was associated with ARI, diarrhoea and fever and caregivers of disabled children sought care from trained health workers for ARI and fever more than non-disabled children. The overall small absolute differences show closing gaps in illness and access to care may be possible, but highlights that more research on illness severity, care quality, and outcomes should be conducted to further assess health inequities for disabled children. SR receives funding from the Rhodes Trust.

Seeking Help for Tinnitus and Satisfaction With Healthcare Providers Including Diagnosis, Clinical Services, and Treatment: A Scoping Review.

The objective of this scoping review was to describe the extent and type of evidence related to seeking help for tinnitus and satisfaction with healthcare providers including diagnosis, services and treatments along the clinical pathway. The selection criteria were adults aged 18 and over with tinnitus who sought help and where patient satisfaction with healthcare providers was reported. Online databases MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP) and CINAHL plus (EBSCO) were searched for original studies in English. The search had no date limit. Twenty-one records were eligible for data extraction. Studies reported that the most common healthcare providers seen were general practitioners, ear, nose and throat specialists and audiologists. Depression and tinnitus severity were related to an increase in the number of times help was sought and the type of healthcare provider seen may also impact patient satisfaction. The majority of participants were unlikely to receive a referral to a specialist at the initial GP consultation. Although there is limited research in this area, help-seekers for tinnitus were generally dissatisfied and reported negative interactions with healthcare providers. However, once in a specialised tinnitus clinical setting, studies reported that most help-seekers were satisfied and had positive interactions with healthcare providers.