Views Of Health Care Providers Research Articles

English

Poor use of fistula repair services has contributed to the continued consequences of obstetric fistula that are physical, psychological, social, financial and economic among the afflicted women. The study was designed to assess views of health care providers on factors hindering women with obstetric fistula in seeking fistula repair services. A descriptive cross sectional design was used. Sixty-five (65) health care providers were selected through convenient sampling method to participate in the study. A structured interview schedule was used to collect data. Reliability was ensured using test retest and alpha value of 0.7 for the views scale Statistical analysis was performed with the IBM SPSS Statistics 20 software. Data was expressed as descriptive summary measures. Factors found to be hindering women in seeking fistula repair services were lack of knowledge that repair services exist, anxiety, loss of dignity, stigma, transportation challenges, financing for the procedure, myths and misconception on obstetric fistula and health systems barriers. Therefore, there is need to engage the individual, communities, organisations and policy makers in order to improve women’s use of fistula repair services. Key words: Health care providers, women with obstetric fistula, fistula repair services, obstetric fistula, Views, Zambia.  

Disability benefits in patients with psychogenic nonepileptic seizures: a survey of physicians' opinions

ObjectivesThe aim of the current study was to gather the views of healthcare providers practicing in the field of psychogenic nonepileptic seizures (PNES) on the issue of “disability benefits eligibility and PNES”. MethodsThis was a questionnaire study that was sent to all neurologists and psychiatrists practicing in Fars province, Iran. The survey included seven questions: one question about professional qualifications, one question on the participants' personal experience with the topic of interest (i.e., PNES), and five questions probing their opinions about the matter of interest (i.e., the issue of disability benefits eligibility in PNES). ResultsThe response rate was 72%. Respondents included 32 psychiatrists and 31 neurologists. In response to the question “Do you think that patients with PNES should be counseled to avoid performing all jobs or professions as long as they have active PNES?”, 47 (75%) physicians answered “no” (22 neurologists and 25 psychiatrists; P = .5). In response to the question “Do you think that patients with PNES should be qualified for disability benefits?”, 47 (75%) physicians answered “Patients with specific jobs or professions should be qualified for disability benefits” (23 neurologists and 24 psychiatrists; P = 1); while, nobody believed that “All of them should be qualified for disability benefits”. ConclusionWhile collection of the opinions of physicians is valuable, this is just one piece of the puzzle; future studies should investigate the opinions of other stakeholders. More importantly, investigators should explore whether patients with PNES have any job-related difficulties.

Caregiver and Pediatric Health Care Provider Views on Social Needs Identification.

Background: The American Academy of Pediatrics recommends that pediatricians address the social determinants of health (SDOH) through research, community partnership, and policy development. Objective: This study aimed to identify the unmet SDOH of the patients served by the Pasadena-Pediatric and Adolescent Health Center (PA-PAHC) and to understand provider perspectives on screening for SDOH. Methods: The PA-PAHC is a low-income pediatric clinic in southeast Houston. A cross-sectional survey eliciting potential SDOH concerns was administered to caregivers of children presenting for their well-child exam, along with pediatric residents and staff/faculty. Staff/faculty and residents were asked about their perceptions of SDOH screening. Statistical analysis calculated frequencies for categorical data and mean/median for continuous variables. Secondary data analysis consisted of chi-square test and logistic regression. Results: A total of 110 caregivers, 22 residents, and 21 staff/faculty participated in the study. Caregivers listed health care access the most frequently (15.5%), followed by childcare, school, and immigration status as SDOH concerns. Residents (31.8%) and staff/faculty (23.8%) also identified health care access as a concern. When comparing topic selection by survey role, there was no statistically significant difference among the 3 groups (P = .257). Residents were more likely to indicate that screening was more time-consuming than were faculty/staff (P = .004). Conclusion: Staff/faculty and residents agree that SDOH affect child health and screening is valuable in the patient encounter. There were no differences in the needs identified by the 3 groups. Further evaluation to assess caregiver perspectives on standardized SDOH screening versus obtaining routine social history needs to be undertaken.

A systematic review of the integration of palliative care in dementia management.

Dementia is a progressive illness with a complex biopsychosocial constellation of symptoms faced by millions of individuals and families worldwide. Palliative care teams have specialized in symptom management and end-of-life care for decades; however, the role of palliative care in dementia management is not yet well elucidated. The aim of this systematic review was to understand the impact of palliative care in dementia management. This systematic review was conducted using a prospective study protocol. Medline and PubMed were searched from January 1, 1998 to October 2017. Eligible studies included single-blind cluster, two-arm parallel cluster, or unblinded randomized controlled trials (RCTs), observational studies, retrospective cohort studies, cross-sectional studies, concurrent mixed methods study, qualitative study, and Delphi studies. Four key themes were identified in this review: goals of care and end-of-life conversations, symptom management, emergency room visits, and prescribing behavior. In each domain, palliative care consultation either showed benefit or was postulated to have benefit if implemented. Although the literature to support or refute thematic conclusions is not large, there was a trend toward patient care benefit across several domains. Large RCTs with longer follow-up across different settings should be undertaken to solidify the themes and trends outlined in this review. Understanding the views of healthcare providers including referral sources (i.e., general practitioners and specialists) through qualitative research could optimize palliative care referrals, implement palliative care recommendations, and improve a targeted palliative care education curriculum.

846-P: Patients with T2D Are Willing To Do More than Their HCPs Expect to Overcome Therapeutic Inertia

Few patients on basal insulin (BI) reach suggested glycemic goals despite repeated dose titration attempts and availability of other support services/medications. An online quantitative survey was used to explore differences between patient and healthcare provider (HCP) priorities and perceptions of therapeutic regimens and approaches. It was completed by 305 T2D patients on BI >1 year and 240 HCPs. Patient and HCP preferences were compared regarding treatment priorities, estimated time to reach A1C goals, impact of not reaching goals, and willingness to change treatment and do more to reach goals. Results showed the similarities and differences in patient and HCP views and priorities. Top patient priorities were to: maintain goals long term (62%), stay healthy (44%), and avoid weight gain (43%) vs. HCPs: avoid side effects (55%), consider treatment affordability (53%), and maintain goals long term (45%). It took longer than expected to meet A1C goals (35% each group); of patients, 49% expected goals would not be met; 61% wanted to reach goals faster; 80% were frustrated by slow progress to reach goals. More patients expected to reach goals in 1-5 years (42% vs. HCPs 16%); both groups wanted to reach goals in 6-12 months. More patients would try harder to reach goals than HCPs expected (37% vs. 16%), be willing to visit their HCP more often (42% vs. 17%), consider treatment changes (40% vs. 18%), and try a different injectable (45% vs. 34%). Within 12 months of starting BI, 17% of patients (vs. 68% of HCPs) expected no treatment addition. More endocrinologists (29% vs. PCPs 16%) anticipated titrating BI dose ≥100 U/day. In patients, 61% felt frustrated not reaching goals on BI, whereas HCPs estimated only 36% of patients would be frustrated. In summary, patients are willing to do more than their HCPs expect. A better understanding of the disparate perceptions and preferences of patients and HCPs could enhance outcomes for T2D patients on BI not reaching glycemic goals and reduce unwarranted complications. Disclosure J. Chamberlain: Speaker's Bureau; Self; Merck & Co., Inc., Novo Nordisk Inc., Sanofi-Aventis. R. Wood: Other Relationship; Self; Multiple companies in the diabetes field (>10 companies). M. Roberts: None. S. Edelman: Advisory Panel; Self; BrightSight, InPen, Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc. Board Member; Self; Senseonics. Speaker's Bureau; Self; AstraZeneca, Lilly Diabetes, MannKind Corporation, Merck Foundation, Sanofi-Aventis. Funding Sanofi U.S.

“There is no time for knowing each other”: Quality of care during childbirth in a low resource setting

ObjectiveTo explore women's and healthcare provider's perspectives of what quality of care during childbirth means to them and how this can be improved. Design14 Focus Group Discussions (FGD) with women and 27 Key Informant Interviews (KII) with healthcare providers. Thematic framework analysis was used. Setting14 public healthcare facilities across two districts in Malawi. Mothers who had given birth at a healthcare facility within the last 7–42 days and healthcare providers who were directly involved in maternity care. FindingsPerceptions of what constitutes good quality of care differed substantially. For healthcare providers, the most important characteristics of good quality care included structural aspects of care such as availability of materials, and sufficient human resources. For women, patient-centred care including a positive relationship and experience was prioritised. However, both groups had similar views on what constitutes poor quality of care; unwelcoming reception on admission, non-consented care, physical and verbal abuse were described as examples of poor care. Shortage of staff, poor labour room design and a non-functional referral system were key barriers identified. Key conclusionsWomen as well as healthcare providers want good quality, professional care at birth and are disappointed if this is not in place. Implication for practiceThere is a need to incorporate women as well as healthcare provider's views when designing, implementing, monitoring and evaluating maternal health programmes. For a positive birth experience, a healthcare facility needs to have an enabling environment and good communication between healthcare providers and women should be actively promoted.

Views of psycho-oncologists, physicians, and nurses on cancer care-A qualitative study.

BackgroundAs worldwide cancer prevalence continues to increase, the challenges facing cancer care are also increasing. Various topics related to deficiencies in cancer care have been discussed repeatedly in the literature. The most frequently stated topics are the unmet psychosocial support needs of cancer patients, difficulties in multidisciplinary teamwork, difficulties in communication between physicians and patients, and issues in palliative care settings. However, there is little research regarding the views of health care providers on these topics. With the aim of gaining abundant information regarding the care of German cancer patients, this study explores the stances of psycho-oncologists, physicians, and nurses regarding the quality of cancer care.Materials and methodsSemi-structured interviews were conducted at the University Medical Center Hamburg-Eppendorf (UKE) and in different oncological outpatient offices in Hamburg; twenty-five interviews in total were conducted with health care providers. Interviews were semi-structured to gain a broad range of information on cancer care. The data were analyzed using thematic analysis by Braun and Clarke with an inductive, constant comparison approach to identify themes and categorized codes.ResultsThe following five principle themes were identified in the interviews: “psycho-oncological care”, “cooperation of health care providers”, “palliative care”, “health care provider-patient contact”, and “coordination and organization of care”. Participants seemed satisfied with the overall quality of cancer care in Germany. Nevertheless, the results showed deficiencies regarding communication among different health care providers and between health care providers and patients. Important findings in conjunction with these communication problems were a lack of psycho-oncological support, shortages in the oncology work force, language and cultural barriers, and deficient education in the communication of providers.ConclusionsThe statements of psycho-oncologists, physicians, and nurses on cancer care provide a suitable basis to conduct further focused research on the studied deficiencies in cancer care. In particular, communication in psycho-oncological care, communication within multidisciplinary teams, and health care provider-patient communication should be further explored with the aim of developing new ideas for improvements and thereby enhancing the quality of cancer care.

Investigating the service provision challenges by healthcare providers in selected comprehensive health centers.

INTRODUCTION:The healthcare program has opponents and supporters with its multiple policies and also its difficult implementation, which requires that its barriers and problems be addressed comprehensively and extensively. This study was conducted aimed to determine the service provision challenges by healthcare providers, from their point of view, in selected comprehensive health centers of Isfahan.MATERIALS AND METHODS:The present study is a descriptive-analytic one. One-hundred and ninety-seven healthcare providers were selected by census sampling method from the population of female healthcare providers in Isfahan comprehensive health centers in 2017. The data collection tool was a researcher-made questionnaire in the field of individual–professional, managerial–organizational, and executive challenges. Data analysis was done by repeated measures ANOVA and post hoc test.RESULTS:The findings indicated that there was a significant difference between the mean score of individual–professional, managerial–organizational, and executive challenges (P < 0.001) from the point of view of healthcare providers. According to least significant difference post hoc test, the mean score of individual challenges was significantly lower than that of managerial and executive challenges (P < 0.001). However, there was no significant difference between the mean score of managerial–organizational and executive challenges (P = 0.46).CONCLUSION:Based on the results, healthcare providers have put forward several challenges during the implementation of the healthcare program. Meanwhile, executive and managerial challenges have been considered more than individual challenges. Considering that this could lead to improper service provision to the clients, the role of policymakers in this program to remove obstacles and to provide satisfaction to healthcare providers is emphasized.

Multidisciplinary views towards the clinical pharmacist: a hospital palliative cancer care team perspective in Malta

To explore the views of the multidisciplinary healthcare team towards the role of the clinical pharmacist within the palliative care unit of an oncology hospital in Malta. At present, in Malta, clinical pharmacists are not routinely involved in care provision with palliative cancer care teams and there is a need to consider their role. Three 60 min audio-recorded heterogeneous focus groups were conducted with eligible healthcare providers at Sir Anthony Mamo Oncology Centre in Mater Dei Hospital. The topic guide was based on literature and was assessed for face and content validity by an expert panel. The transcripts were analysed using the framework method whereby emerging categories and themes were devised. A total of four doctors, ten ward nurses, two Hospice community nurses, three nursing aides, one psychologist and six allied healthcare professionals consented to participate. The framework analysis resulted in four main categories namely: (1) pharmacists as the expert reference point; (2) availability of clinical pharmacists in providing clinical services on ward level; (3) attitudes towards potential clinical services provided by clinical pharmacists; and (4) clinical pharmacists as a link with the community on pharmaceutical matters. The general view of healthcare providers on the clinical pharmacist's role in palliative cancer care was largely supportive and positive. This should encourage policy makers to introduce clinical pharmacy services within this setting.

Patient and healthcare provider views on a patient-reported outcomes portal.

Over the past decade, public interest in managing health-related information for personal understanding and self-improvement has rapidly expanded. This study explored aspects of how patient-provided health information could be obtained through an electronic portal and presented to inform and engage patients while also providing information for healthcare providers. We invited participants using ResearchMatch from 2 cohorts: (1) self-reported healthy volunteers (no medical conditions) and (2) individuals with a self-reported diagnosis of anxiety and/or depression. Participants used a secure web application (dashboard) to complete the PROMIS® domain survey(s) and then complete a feedback survey. A community engagement studio with 5 healthcare providers assessed perspectives on the feasibility and features of a portal to collect and display patient provided health information. We used bivariate analyses and regression analyses to determine differences between cohorts. A total of 480 participants completed the study (239 healthy, 241 anxiety and/or depression). While participants from the tw2o cohorts had significantly different PROMIS scores (p < .05), both cohorts welcomed the concept of a patient-centric dashboard, saw value in sharing results with their healthcare provider, and wanted to view results over time. However, factors needing consideration before widespread use included personalization for the patient and their health issues, integration with existing information (eg electronic health records), and integration into clinician workflow. Our findings demonstrated a strong desire among healthy people, patients with chronic diseases, and healthcare providers for a self-assessment portal that can collect patient-reported outcome metrics and deliver personalized feedback.

Healthcare Provider Views on Transitioning from Task Shifting to Advanced Practice Nursing in Tanzania: Erratum.

Healthcare Provider Views on Transitioning from Task Shifting to Advanced Practice Nursing in Tanzania: Erratum.

Are there unmet needs in contraceptive counselling and choice? Findings of the European TANCO Study

Introduction: Effective use of contraception requires women to make an informed choice about methods that match their individual needs and expectations. The European Thinking About Needs in Contraception (TANCO) study is a quantitative, online survey of healthcare provider and women’s views on aspects of counselling around contraception and contraceptive use.Methods: Healthcare providers and women attending their practices for contraceptive counselling were invited to complete online questionnaires. The women’s survey explored knowledge and use of contraceptive methods, satisfaction with current method, and interest in receiving more information about all methods. Healthcare provider views were gathered in parallel.Results: A total of 676 healthcare providers and 6027 women completed the online surveys in 11 countries. There was a high prevalence of contraceptive use and general satisfaction with current method across the countries. Fifty-five percent of women were using short-acting contraception (SAC) methods; 19% were using a long-acting reversible contraception (LARC) method. Sixty percent of women were interested in receiving more information about all methods; 73% of women said they would consider LARC if they received more comprehensive information. Healthcare providers tend to underestimate women’s interest in receiving information on contraception in general and, more specifically, LARC methods.Conclusions: Despite high levels of use and satisfaction with current methods, women were interested in receiving more information about all contraceptive methods. Greater exploration of women’s views on their needs and expectations of contraception could lead to increased knowledge, more effective discussions with healthcare providers and the greater likelihood of informed contraceptive choice.

A Review of the Essential Components of Quality Palliative Care in the Home.

The home is an important and often preferable setting of palliative care. While much research has demonstrated the benefits of specialized palliative homecare on patient and system outcomes, there has been little delineation of the underlying components of these efficacious programs. We synthesized the essential elements of palliative homecare from a combined review of successful programs, perspectives of patients and caregivers, and views of healthcare providers in palliative care. Five unique palliative homecare studies were included in the rapid review and synthesis-(1) systematic review of the components of efficacious programs; (2) in-depth analysis of 11 effective community-based teams; (3) survey of bereaved caregivers; (4) survey of the general public; and (5) interviews of providers and administrators. A qualitative approach was used to identify transcending themes across the studies. Six essential elements of quality palliative homecare were common across the studies: (1) Integrated teamwork; (2) Management of pain and physical symptoms; (3) Holistic care; (4) Caring, compassionate, and skilled providers; (5) Timely and responsive care; and (6) Patient and family preparedness. Our metasynthesis of effective palliative homecare models, as well as, the values of those who use and provide these services, illuminates the underpinning elements of quality home-based care for patients with a life-limiting illness. However, the application of these elements must be relevant to the local community context. To create impactful, sustainable homecare programs, it is critical to capitalize on existing processes, partnerships, and assets.

Healthcare Provider Views on Transitioning From Task Shifting to Advanced Practice Nursing in Tanzania.

The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shifting-delegation of tasks from professionals to other healthcare team members with less training, such as medical attendants-is practiced, compromising quality of care. Advanced practice nursing is underutilized. The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses. A descriptive, qualitative design was used. Purposeful sampling was used to select 20 participants. An in-depth interview guide was used to obtain information. Interviews were conducted in Swahili or English. Content analysis was used to identify themes. Shortage of human resources in rural primary healthcare facilities was identified as a major rationale for implementation of the advanced practice nurse practitioner role because the current health providers in rural health facilities are less trained and doctors are not ready to work in these settings. Opposition from physicians is expected during the course of implementing the nurse practitioner role. Professional bodies and government should reach consensus before the implementation of this role in such a way that they should agree on scope and standards of practice of nurse practitioners in Tanzania. Shortage of human resources for health is greater in rural primary healthcare facilities. Task shifting in Tanzania is neither effective nor legally recognized. Transition to advanced practice nursing roles-particularly the nurse practitioner role-can facilitate provision of optimal care. Nurse practitioners should be prepared to work in rural primary healthcare facilities.

The role of pain in pulmonary rehabilitation: a qualitative study.

IntroductionOne third of individuals with chronic obstructive pulmonary disease (COPD) report pain. To help inform a COPD-specific pain intervention, we explored the views of health care providers (HCPs) and individuals with COPD on pain during pulmonary rehabilitation (PR).MethodsThis is a qualitative study using inductive thematic analysis. Eighteen HCPs familiar with PR and 19 patients enrolled in PR participated in semi-structured interviews. Demographic data were recorded, and the patients completed the Brief Pain Inventory (Short Form).Results1) Interaction between pain and COPD: pain is a common experience in COPD, heightened by breathlessness and anxiety. 2) Pain interfering with PR: a) Communicating pain: HCPs rarely ask about pain and patients are reluctant to report it for fear of being removed from PR. b) PR is a short-term aggravator but long-term reliever: although pain limits exercise, concentration, and program adherence, PR may reduce pain by increasing muscle strength and improving coping. c) Advice and strategies for pain: some attention is given to pain management but this is often counterproductive, encouraging patients to cease exercise. 3) An intervention to manage pain: HCPs were enthusiastic about delivering a pain intervention within their knowledge and time constraints. Early group education was preferred.ConclusionA pain intervention seems warranted in PR and may improve adherence and therefore clinical benefit. A pain intervention could be provided as part of PR education with HCP training.

Gaps in care for patients with memory deficits after stroke: views of healthcare providers

BackgroundStroke is a common cause of physical disability but is also strongly associated with cognitive impairment and a risk for future dementia. Despite national clinical guidelines, the service provided for stroke survivors with cognitive and memory difficulties varies across localities. This study critically evaluated the views of healthcare professionals about barriers and facilitators to their care.MethodsSeventeen semi-structured individual interviews were conducted by a single interviewer with both primary and secondary care clinicians in regular contact with stroke-survivors. This included stroke medicine specialists, specialist nurses, physiotherapists, occupational therapists, general practitioners and primary care nurses. Topics included individual experiences of the current care offered to patients with cognitive impairment, assessment processes and inter-professional communication. Interviews were audio recorded and transcribed verbatim. Transcripts were thematically analysed and themes grouped into broad categories to facilitate interpretation.ResultsData analysis identified four key themes as barriers to optimal care for stroke-survivors with memory difficulties: 1) Less focus on memory and cognition in post-stroke care; 2) Difficulties bringing up memory and cognitive problems post-stroke; 3) Lack of clarity in current services; and, 4) Assumptions made by healthcare professionals introducing gaps in care. Facilitators included stronger links between primary and secondary care in addition to information provision at all stages of care.ConclusionsThe care provided by stroke services is dominated by physical impairments. Clinicians are unsure who should take responsibility for follow-up of patients with cognitive problems. This is made even more difficult by the lack of experience in assessment and stigma surrounding potential diagnoses associated with these deficits. Service development should focus on increased cohesiveness between hospital and community care to create a clear care pathway for post-stroke cognitive impairment.

Do words matter? health care providers’ use of the term prediabetes

Communication of risk is not solely the transfer of information; it is an interaction and exchange of ideas between concerned individuals. Health care provider communication about type 2 diabetes risk status may influence individual participation in behaviours that prevent or delay the disease, which is concerning from a public health perspective. The term prediabetes is used to convey risk status and little is known about how health care providers view or use the term. In this article, we describe health care provider use and perceptions of the term prediabetes drawing on data from interviews conducted between August and November 2011 of 15 health care providers practicing in Southeast Wyoming and Northern Colorado USA. We used a grounded theory research design to guide data collection and analysis and in the interviews invited providers to describe their use and perception of the term prediabetes. We found that providers’ use of the term ‘prediabetes’ depended on their view of the term’s meaning (e.g. whether patients were likely to understand or be confused by it) and impact (in terms of motivating patients to mitigate risk). We found there were differences in providers’ perceptions of the negative and positive associations of the term and this influenced whether or not they used it. These findings are not surprising given the lack of consensus over definitions and diagnosis criteria for prediabetes. Given this lack of agreement, there are difficulties about the use of the term prediabetes and its use should take place within effective risk communication. Health care providers must consider essential aspects of risk communication in order to enable individuals at risk of type 2 diabetes to mitigate the risk and by doing so reduce incidence and prevalence rates of the disease.

Keep in Touch (KIT): feasibility of using internet-based communication and information technology in palliative care

BackgroundConfinement to an in-patient hospital ward impairs patients’ sense of social support and connectedness. Providing the means, through communication technology, for patients to maintain contact with friends and family can potentially improve well-being at the end of life by minimizing social isolation and facilitating social connection. This study aimed to explore the feasibility of introducing internet-based communication and information technologies for in-patients and their families and to describe their experience in using this technology.MethodsA cross-sectional survey design was used to describe patient and family member experiences in using internet-based communication technology and health care provider views of using such technology in palliative care. Participants included 13 palliative in-patients, 38 family members, and 14 health care providers. An iPad or a laptop computer with password-protected internet access was loaned to each patient and family member for about two weeks or they used their own electronic devices for the duration of the patient’s stay. Quantitative and qualitative data were collected from patients, families, and health care providers to discern how patients and families used the technology, its ease of use and its impact. Descriptive statistics and paired sample t-tests were used to analyze quantitative data; qualitative data were analyzed using constant comparative techniques.ResultsPalliative patients and family members used the technology to keep in touch with family and friends, entertain themselves, look up information, or accomplish tasks. Most participants found the technology easy to use and reported that it helped them feel better overall, connected to others and calm. The availability of competent, respectful, and caring technical support personnel was highly valued by patients and families. Health care providers identified that computer technology helped patients and families keep others informed about the patient’s condition, enabled sharing of important decisions and facilitated access to the outside world.ConclusionsThis study confirmed the feasibility of offering internet-based communication and information technologies on palliative care in-patient units. Patients and families need to be provided appropriate technical support to ensure that the technology is used optimally to help them accomplish their goals.

Healthcare provider perceptions of accessible exam tables in primary care: Implementation and benefits to patients with and without disabilities

BackgroundRecent healthcare mandates require availability of accessible medical exam equipment, which may reduce barriers to care for patients with disabilities (PWD). However, more research is needed to explore healthcare provider views on implementation and routine use of accessible equipment. ObjectiveThis study qualitatively explored healthcare provider perceptions of: (1) daily use of accessible medical examination tables with PWD; and (2) recommendations for addressing challenges to using this equipment. MethodsQualitative interviews and focus groups were conducted with physicians, nurse practitioners and registered nurses at a clinic where accessible examination tables were recently implemented in all clinic rooms. Data were coded and thematically analyzed by two researchers trained in qualitative methods. ResultsA total of 17 providers participated in focus groups or interviews. Participants were mostly female (82%; N = 14), and registered nurses (47%; N = 8), but also included nurse practitioners (29.4%; N = 5), and physicians (23%; N = 4). Common themes were: (1) Ease of use and functionality of tables; and (2) Challenges with use and available training. Overall, providers reported satisfaction with the tables' ability to accommodate patients who are PWD, although they expressed challenges with functionally using the tables with specific populations, such as pediatric patients. ConclusionsHealthcare organizations seeking to implement height-adjustable tables should account for structural requirements of the height-adjustable tables (e.g. accommodating clearance needed when planning room sizes). Practical recommendations and policies for integrating height-adjustable tables into routine clinical care are needed to ensure equitable care for PWD.

Attitudes towards insulin initiation in type 2 diabetes patients among healthcare providers: A survey research

AimsTo describe the views of healthcare providers about starting insulin in patients with type 2 diabetes and to determine the specific factors that contribute to delay insulin initiation. MethodsTwo-phases observational descriptive study. In the quantitative phase we conducted a cross-sectional survey of a sample of 380 healthcare professionals (general practitioners (GPs), endocrinologists, internists and nurses). In the qualitative phase, a discussion group reviewed the results of the survey to propose solutions. ResultsIn poorly controlled patients, 46% of GPs vs. 43.2% of internists and 31.3% of endocrinologists waited 3–6months before starting insulin, and 71.4% of GPs vs. 66.7% of internists vs. 58.8% of endocrinologists need to confirm twice the HbA1c levels. The upper level of basal glucose more frequently considered as good control is 130mg/dL for GPs (35.7%), and 120mg/dL for internists (35.8%) and endocrinologists (37.5%). In patients without comorbidities, 32.5% of endocrinologists vs. 27.2% of internists vs. 17.9% of GPs initiated insulin when HbA1c was >7% while 26.3% of endocrinologists vs. 28.4% of internists vs. 38.4% of GPs initiated insulin when HbA1c was >8%. The interference of the therapy with the patient’ social life and the need for time management were the most accepted barriers to initiate insulin. ConclusionsThere are significant differences between GPs and endocrinologists regarding the insulin initiation and GPs and internists felt less empowered to manage patients with diabetes. Specific training for professionals and joint work with patients could improve the glycemic control.