Willingness Of Health Care Providers Research Articles

Willingness of healthcare providers to perform population-based cancer screening: a cross-sectional study in primary healthcare institutions in Tianjin, China

ObjectiveTo evaluate the willingness of healthcare providers to perform population-based screening in primary healthcare institutions in China.MethodsHealthcare providers of 262 primary healthcare institutions in Tianjin were invited to fill out...

Integration of COVID-19 and TB screening in Kampala, Uganda: healthcare provider perspectives

BackgroundFollowing the first wave of the COVID-19 outbreak, Uganda experienced a 40% drop in tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCPs) at a National Referral Hospital in Kampala, Uganda.Design/methodsWe conducted a cross-sectional study using in-depth interviews with 12 HCPs involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral Hospital, Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and we denoted the emergent themes as barriers to and facilitators of COVID-19/TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation, and Behavior (COM-B) model.ResultsThe facilitators to integrated COVID-19 and TB screening included the availability of TB focal persons and already existing training forums at the hospital that could be utilized to strengthen the capacity of HCP to integrate COVID-19 and TB screening. The barriers included HCP’s inadequate knowledge on how to integrate screening of COVID-19 and TB, the absence of simple easy-to-use standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), understaffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training.ConclusionsThese findings provided a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19. Future studies should evaluate the effect of addressing these barriers to the integration of COVID-19 and TB as well as the effect of this on TB case finding in high-burden TB settings.

Psychological variables, beliefs and barriers associated with willingness of healthcare providers to be vaccinated against COVID-19 virus

Psychological variables, beliefs and barriers associated with willingness of healthcare providers to be vaccinated against COVID-19 virus

Provider and patient knowledge gaps on biosimilars: insights from surveys

Beyond the legal and regulatory limitations associated with biosimilar availability in the United States, the adoption of biosimilars is contingent on the willingness of health care providers (HCPs) to prescribe them and of patients to accept them. In this dynamic market, it is of paramount importance to understand the current awareness, attitudes, and preferences of a broad spectrum of stakeholders if uptake of biosimilars is to be optimized. In this article, we highlight knowledge gaps among US HCPs and patients regarding biosimilars for immune-mediated inflammatory diseases as assessed in published survey literature over the last 5 years. Although HCP familiarity and understanding of biosimilars appears to have improved over the last 5 years, survey data suggest that some physicians and pharmacists still approach use of biosimilars with caution owing to concerns regarding nonmedical switching, interchangeability, pharmacist-led substitution, and the extent of any cost savings. Patients understand the potential cost benefits of biosimilars but share many of the HCPs' concerns. A large majority of patients were also concerned that biosimilars would not treat their disease as well as the reference product and that switching may cause more adverse effects. Consequently, nonmedical switching is a major concern for patients, with the majority reporting that they would attempt to avoid a switch. Although patients trust their physicians' treatment recommendations and express confidence in biosimilars, they have mixed views on automatic substitution by pharmacists. The areas of concern identified can be used to guide further education programs for HCPs and patients, and, in doing so, improve biosimilar uptake.

Willingness of health care providers to offer HIV self-testing from specialized HIV care services in the northeast of Brazil

BackgroundThe insufficient knowledge regarding the serological status of people affected with human immunodeficiency virus (HIV) is a concern in Brazil. HIV self-testing (HIVST) has been proved to have great potential for increasing testing, especially among vulnerable populations. The large-scale distribution of HIVST by the Brazilian public health system has increased in recent years. We aimed to investigate the awareness of HIVST among health care providers (HCP) from specialized HIV/AIDS care services in the state of Bahia, Northeast Brazil. Further we investigated HCP acceptability and willingness to offer its use.MethodsA cross-sectional study on HCP from 29 specialized care services (SCS) located in 21 cities in the state of Bahia. HCP working in the service for at least 6 months were included. Sociodemographic, occupational, and behavioral data were collected using a questionnaire. Descriptive statistics were carried out. Bivariate, and multivariate analyses estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using logistic regression were conducted.ResultsThe awareness and acceptability of HIVST and the willingness to provide it were 79.8, 55.2, and 47.1%, respectively. Few HCP reported that the SCS where they worked dispensed HIVST (3.6%), and 13.5% received some information or training on HIVST. Factors associated with willingness to offer HIVST were: HIVST acceptability (aOR = 9.45; 95% CI: 4.53–19.71), willingness to use HIVST on themselves (aOR = 4.45; 95% CI: 1.62–12.24), confidence in offering HIVST to clients (aOR = 5.73; 95% CI: 2.26–12.72), and considering everyone eligible for HIVST (aOR = 2.88; 95% CI: 1.25–6.59).ConclusionsAlthough most HCP were aware of HIVST, acceptability and willingness to provide it to the clients was moderate. The scale up of HIVST as a mean for the HIV prevention and control policy in Brazil, requires further training of HCP and better implementation of this program.

Exception from informed consent for biomedical research in emergency settings: A study from Jordan

BackgroundResearch conduction in emergency settings is of paramount importance to promote knowledge and experiences related to treating acutely ill patients. However, the complexity of situations creates a considerable ethical challenge facing researchers who basically deal with emergent cases. This study aimed to determine attitudes of healthcare providers (HCPs) towards exception from informed consent (EFIC) and enrollment willingness in emergency research in Jordan. MethodsA quantitative research with face-to-face questionnaire was conducted by an interviewer during 6-month period in 2019. Survey measures included items related to EFIC policy and overall willingness of HCPs to participate or support their family members’ participation in emergency research. ResultsA total of 151 HCPs in the emergency departments (EDs) in Jordan was recruited. Positive attitude toward emergency research dominated among participants; about 21.9% of participants reported previous experience in the conduction of emergency research and 12.3% had related publications. Regarding EFIC policy, there was a general consensus of disagreement to most of the examined items. There was a trend for little support of EFIC policy when questioned about the enrollment of family members or public in emergency research, however, the application of EFIC was accepted for self-enrollment of respondents in emergency research. No significant differences (P = 0.37), among participants from different disciplines, were reported regarding the attitudes towards EFIC items or willingness to enroll in emergency research. ConclusionsGenerally, HCPs reported an overall positive support to emergency research despite a consensus of disagreement related to EFIC terms. Therefore, it is recommended to pursue future studies to compare well-informed subjects; recruited from well-developed institutions in regard to emergency research potentials; with the present basic attitudinal surveillance in order to dissipate the effect of such confounder and to get better insight of the actual attitudes related to emergency research and EFIC. In addition, efficient multidisciplinary communication channels between researchers and policy makers can lather the way to collaborative research with simultaneous innovative delivery of quality emergency care.

Clinical Recognition of Substance Use Disorders in Medicaid Primary Care Associated With Universal Screening, Brief Intervention and Referral to Treatment (SBIRT)

Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been effective for moderate reductions of alcohol use among participants in universal settings. However, there has been limited evidence of effectiveness in referring individuals to specialty care, and the literature now often refers to screening and brief intervention (SBI). This study examines documentation of substance use disorder (SUD) diagnoses in a low-income Medicaid population to evaluate the effect of universal SBIRT on healthcare system recognition of SUDs, a first step to obtaining a referral to treatment (RT) for individuals with SUDs. SBI patient data from Wisconsin's Initiative to Promote Healthy Lifestyles (WIPHL) were linked to Wisconsin Medicaid claims data. A comparison group of Medicaid beneficiaries was identified from a matched sample of non-SBIRT clinics (total study N = 14,856). Hierarchical generalized linear modeling was used to assess rates of SUD diagnosis in the 12 months following receipt of SBIRT in WIPHL clinics compared with rates in non-SBIRT clinics. Analysis controlled for clinic, individual patient's health status, demographics, and baseline substance use diagnoses. SBIRT was associated with greater odds of being diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol abuse or dependence as well as drug abuse or dependence over the 12 months subsequent to receipt of the screen. The overall diagnostic rate for any DSM-IV substance abuse or dependence was 9.9% at baseline and 12.2% during the follow-up year. SBIRT patients had 42% (p = .003) greater odds of being diagnosed with a substance use disorder within 12 months relative to comparison clinic patients. However, there were very few claims for specialty SUD services. The presence of SBIRT in a primary care clinic appears to increase the awareness and recognition of patients with SUDs and a greater willingness of healthcare providers to diagnose patients with an alcohol or drug use disorder on Medicaid claims. Further research is needed to determine if this increase in diagnosis reflects integrated care for SUDs or if it leads to improved access to specialty care, in which case abandonment of the RT component of SBIRT may be premature.

Are Healthcare Professionals in Jordan Willing to Work and Provide Care for Covid-19 Patients?

Introduction The outbreak of the novel coronavirus (COVID-19) has overwhelmed healthcare systems and exposed healthcare providers (and their families) to a high risk of infection and death. This study aimed to assess the willingness of healthcare providers in Jordan to report for duty and provide care to COVID-19 patients. Methods An online questionnaire was developed including questions about demographics, willingness to report to work and provide care to COVID-19 patients, and potential associated factors. Results A total of 253 participants completed the survey (mean age 33.8 years, 58.6% male). The sample included physicians (14.9%), nurses (61.1%) and paramedics (23%). Most participants (96.4%) were willing to come to work during the pandemic, although only 64.7% showed a willingness to provide care to COVID-19 patients. Being male (OR 3.21; 95% CI: 1.75-5.90) or having adequate training on COVID-19 (OR 5.16; 95% CI: 2.32-11.46) were the major predictors for willingness to care for COVID-19 patients, whereas concerns for family safety (OR 0.25; 95% CI: 0.14-0.47) or lack of information about COVID-19 (OR 0.43; 95% CI: 0.23-0.80) were the major predicting barriers for willingness to care for COVID-19 patients. Conclusion Although most participants were willing to report for duty, less than two-thirds were willing to care for COVID-19 patients. Being male and receiving training are associated with willingness; whereas concern for family is associated with less willingness to care for COVID-19 patients.

Nurses’ knowledge of and willingness to promote female condom use in Johannesburg Health District

The female condom is the only current method for female partners to simultaneously prevent both pregnancy and sexually transmitted infections. Studies of various contraceptive methods suggest that providers’ acceptance and endorsement may be a key factor in their clients’ uptake and continued use of a method. Our aim in this study was to assess the relationship between nurses’ knowledge of and their willingness to promote female condom use in 18 public healthcare facilities within the Johannesburg District. The mean score of correct answers of 398 nurses completing an anonymous, self-administered, six-item questionnaire was 4 out of a maximum of 6. Data analysis included the use of descriptive statistics and a chi-square test. It was found that 79% of participants were knowledgeable but only 59% were willing to promote female condom use. There was no association between knowledge of and willingness to promote female condom use. The following significant associations with knowledge and willingness to promote female condom use were found: family planning experience, being employed by a local government authority, working in a primary care clinic and having had informal training on female condom use. Informal training of nurses within the family planning unit in the clinics has the potential to improve nurses’ knowledge and willingness to promote female condom use.
 Significance:
 
 This is the first study conducted in South Africa on the knowledge of and willingness of healthcare providers to promote female condom use.
 An effective strategy is needed to motivate healthcare workers to promote female condom use with their patients.
 Informal training of nurses within the family planning unit has the potential to improve nurses’ knowledge of and willingness to promote female condom use.

Correlates of Recreation- Versus Academic-Motivated Misuse of Prescription Stimulants

Our goal was to compare and contrast the correlates of academic- and recreation-motivated misuse of prescription stimulants (MPS). Questionnaires were distributed to a probability sample of students attending two universities. We used a series of logistic regression analyses to examine intrapersonal, interpersonal, and environmental correlates of use among academic-motivated users (versus nonacademic-motivated users) and recreation-motivated users (versus nonrecreation-motivated users; N = 257 students with MPS experience). Sensations seeking, older age, academic concern, family perception of MPS, family and faculty endorsement of MPS, perceived prevalence of MPS among friends, and financial stress were unique correlates of recreation-motivated MPS. Inattention, friends’ perception of MPS, friend endorsement of MPS, perception of willingness of health care providers to write prescriptions and negative expectancies were unique correlates of academic-motivated MPS. Variables that were correlates of both motives were race/ethnicity, year in school, avoidance self-efficacy, diversion, positive MPS expectancies, MPS intention, and other substance use. These findings have important prevention and intervention implications.

A Simple Pre-Exposure Prophylaxis (PrEP) Optimization Intervention for Health Care Providers Prescribing PrEP: Pilot Study.

BackgroundPre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Lack of knowledge and willingness of health care providers (HCPs) to prescribe PrEP is an important barrier to implementation.ObjectiveThe objective of this study was to describe and examine the feasibility and acceptability of a PrEP Optimization Intervention (PrEP-OI) targeted at HCPs. The ultimate purpose of this intervention was to increase PrEP uptake, adherence, and persistence among those at risk for HIV acquisition.MethodsThis intervention included the following: (1) a Web-based panel management tool called PrEP-Rx, which provides comprehensive HIV risk assessment, automates reminders for follow-up, and reports patients’ history of PrEP use; and (2) centralized PrEP coordination by a clinical support staff member (ie, the PrEP coordinator) who can identify individuals at risk for HIV, provide medical insurance navigation, and support multiple HCPs. Feasibility was evaluated based on HCPs’ ability to log in to PrEP-Rx and use it as needed. Acceptability was assessed via individual formative qualitative interviews with HCPs after 1 month of the intervention.ResultsThe intervention was feasible and acceptable among HCPs (N=6). HCPs identified system-level barriers to PrEP provision, many of which can be addressed by this intervention. HCPs noted that the intervention improved their PrEP knowledge; increased ease of PrEP prescription; and was likely to improve patient engagement and retention in care, enhance communication with patients, and improve patient monitoring and follow-up.ConclusionsGiven the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact the PrEP continuum of care is needed.

Data Transparency as a “Source of Truth” to Support Regional Health Systems Change

Advancing quality and improving patient outcomes is critically intertwined with information exchange technology but hinges on the willingness of healthcare providers and health systems to openly share clinical, patient-level data in a supportive, collegial environment. The primary aim for detailing this journey to establish a data sharing health systems collaborative is to illustrate our strides within the complexities of information processing in developing a culture of data transparency within a large and diverse geographical region. The processes within this “big data” warehouse are provided in detail to allow for replication in varied arenas to facilitate diverse goals for information exchange.

Perceptions of Family Members, Nurses, and Physicians on Involving Patients' Families in Delirium Prevention.

Delirium occurs in up to 80% of patients admitted to an intensive care unit. Nonpharmacologic delirium-prevention strategies, which are commonly used by the bedside nurse, have reduced the incidence and duration of delirium in patients in the intensive care unit. With increasing demands on the nurse, strategies such as including the patient's family in delirium prevention activities should be investigated. OBJECTIVE To determine opinions and willingness of health care providers to involve patients' families in nonpharmacologic delirium-prevention activities in the intensive care unit, and of patients' families to be involved. Two surveys, one for intensive care unit nurses and physicians and one for patients' families, were developed and administered. The provider survey focused on current delirium-prevention practices and opinions about family involvement. The family survey concentrated on barriers and willingness to participate in prevention activities. Sixty nurses and 58 physicians completed the survey. Most physicians (93%) and all nurses believed families could assist with delirium prevention. Only 50% reported speaking with family members about delirium and delirium prevention. The family survey was completed by 60 family members; 38% reported a provider spoke with them about delirium. Family members reported high levels of comfort in participating in delirium-prevention activities. Health care providers and family members are supportive of the latter performing delirium-prevention activities. Family of patients in the intensive care unit may work collaboratively with nurses to reduce the incidence and duration of delirium in these patients.

Factors Influencing Receipt of Mental Health Services Among Medicaid Beneficiaries With Breast Cancer.

This study examined associations of state-level Medicaid reimbursement and other policies and patient characteristics with receipt of mental health diagnostic and treatment services for beneficiaries with cancer. Data (2006-2008) from Medicaid beneficiaries with breast cancer were analyzed to examine predictors of receiving mental health diagnostic services and mental health treatment services. Independent variables included state-level Medicaid policies for reimbursements for mental health services and consultations (requests from one health care provider to another for advice regarding evaluation or management of a specific problem), required patient copayments, and requirements governing the timing of Medicaid eligibility recertification (eligibility recertification period). Generalized estimating equations were used to assess factors influencing receipt of mental health services while controlling for clustering by state. The analysis of diagnostic services included 7,441 Medicaid beneficiaries, and the analysis of treatment services included 7,511 beneficiaries. Medicaid reimbursements for mental health services were not associated with receiving these services. However, increased Medicaid reimbursement for consultations significantly increased the likelihood of receiving mental health diagnostic and treatment services. Increased comorbidities were also associated with increased likelihood of receiving mental health services. The association of higher Medicaid reimbursements for consultations with receipt of mental health services suggests that consultation reimbursement has a "gatekeeper" effect-after a patient received an initial consultation, lower reimbursements for mental health services were not barriers to subsequent mental health care. Increased Medicaid reimbursement for consultations with a mental health professional may increase willingness of health care providers to provide mental health care services for Medicaid beneficiaries.

Facilitating and inhibiting factors to implement telemonitoring: A qualitative study

Objective: Despite the added value of telemonitoring (TM) in the management of chronic care, widespread implementation and continuation is failing. The aim of this qualitative study was to explore the facilitators and inhibitors for successful implementation among field experts and health care providers in the projects of TM in primary care. Methods: An exploratory qualitative design using semi-structured interviews with field experts of TM projects in Belgium. Results: The eight interviewees reported an overall positive perception on the actual use of TM. They emphasized that TM provides a promising approach to the ageing population with an increasing burden of chronic diseases. TM was said to increase disease awareness in patients with chronic heart failure. The interviewees were willing to use the new technology. Sharing patient data between health care professionals optimizes care continuity and transmural collaboration, with the focus on problem detection. However, TM in their projects was perceived as an additional task as it was not embedded in regular care. Coordination of care using TM was felt to be incomplete. Agreements on tasks and responsibilities in sharing patient data were unclear. The management and centralisation of data was difficult and impeded implementation in regular care. Furthermore, the interviewees noted that sustainability of their efforts was hampered as the projects would not be financed in the future. Conclusions: Field experts of pilot TM projects believe in benefits of TM and the willingness of health care providers to use the technology. To successfully implement TM in regular care the reported barriers need to be considered. Transmural collaboration with interaction and involvement of the chronic patient and a proactive team of care professionals is required. Efforts should be made to integrate TM in regular care, both structurally and financially.

Reducing unnecessary Pap smears in a community clinic: Is the U.S. still over-screening for cervical cancer?

Objective: The primary purpose of this study was to determine whether an educational intervention would result in an increased willingness of health care providers to extend the time intervals of cervical cancer screening (Papanicolau [Pap] test) among women who meet guideline criteria. Background: The changes required of clinicians for performing appropriate Pap testing, initially introduced by American College of Obstetrician and Gynecologist to decrease unnecessary Pap testing, have encountered some translational difficulties among community clinics. When audited in January 2012, adherence to the changed guidelines by clinicians in a community clinic was only 60%. Methods: A quasi-experimental study was designed to determine if multi-modal education would encourage adoption of the changes, as measured by increased adherence to guideline recommendations. Clinic personnel were divided into two groups for educational sessions; one consisting of providers/clinicians (N = 6) and the other consisting of medical assistants (N = 28). Fifty-two charts of patients who came to the clinic for well-woman examinations including Pap tests were reviewed to determine adherence to the guidelines to establish a baseline prior to the intervention. Fifty charts of patients who came to the clinic for well-woman examinations including Pap tests three months after the intervention were reviewed to determine the extent to which clinicians were adhering to the guidelines. Results: After the intervention, adherence significantly improved to 90% ( p = .016). Educational sessions accounted for the majority of variance occurring in the increase of appropriate and decrease in inappropriate Pap testing ( p = .003). Conclusions: This research was focused on the steps used to increase providers’ adherence to current guidelines in a community clinic setting. Eliminating unnecessary Pap smears for women who meet the criteria is cost effective, less invasive, and reduces procedures that lead to reproductive risks, complications and anxiety.

Perceived barriers of non-US healthcare providers to responding during mass casualty incidents

Nurses and other healthcare providers (HCPs) have a long history of providing care during extreme emergencies, disasters, or mass casualty incidents (MCIs). Surveys have been conducted in U.S. metropolitan areas to determine the ability and willingness of HCP to respond to an MCIs. Various barriers were identified in those studies. The purpose of this study was to examine the perceptions and attitudes of HCPs in other countries and cultures to barriers they may have in their ability or willingness to respond during an MCI. The study participants were 42 nurses completing their master's degree, representing 26 different countries and territories, and they were assigned to one of eight focus groups based on the location of their country of origin. The findings revealed several themes, the first being that in some countries there were no perceived barriers to either ability or willingness to respond to an MCI. In other countries, the perceived barriers to ability were lack of transportation, staff shortages, equipment shortages, personal illness, and lack of infant care, whereas the perceived barriers to willingness were dimensions of fear and employment status. Cultural differences played a significant role in the ability and willingness of the HCPs to respond to an MCI.