Search Results (44)

Current structural barriers experienced by First Nations in Canada shape access and engagement for testing and treatment of hepatitis C virus (HCV) infections. This non-systematic informative review considers transdisciplinary perspectives, regional data, and published literature connecting context to the disproportionate HCV burden experienced by First Nations populations in the prairie provinces of Canada, and offers examples of participatory and community-led initiatives working toward the elimination of HCV as a public health threat. First Nations in Canada are disproportionately impacted by chronic HCV infection, with a reported rate of newly diagnosed HCV cases in First Nations communities five times the respective rate in the general Canadian population in 2022. This review explores the reasons underlying the disproportionate burden of HCV infection. Significant over-representation of First Nations in the Canadian Prairies is seen in the major risk categories for HCV acquisition, and the impact of these risk factors is aggravated by barriers to accessing healthcare services and medication coverage. These barriers stem from the legacy of colonialism, discrimination, disenfranchisement, and are exacerbated by stigmatization, victimization, and racism in the justice and healthcare systems. Other contributory factors that impede access to care include inadequate healthcare clinic staffing and infrastructure in First Nations communities, and significant geographical distances between First Nations reserves and laboratories, pharmacies, and treating/prescribing healthcare providers. Recent recognition of historical harms and early steps towards nation-to-nation reconciliation, along with support for culturally connected, holistic, and First Nations-led wellness programs, instill hope that elimination strategies to eradicate HCV infection in First Nations populations will be successful in Canada. Full article

Background/Objectives: The INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) network introduces an innovative model of psychogeriatric care, combining tertiary mental healthcare with primary care for older adults in low-resource settings in Greece via telemedicine. This study explores viewpoints of healthcare professionals on care delivery within the frames of old-age mental telehealth services in low-resource settings. Methods: All healthcare professionals, including 13 medical and 11 non-medical professionals from diverse healthcare units in urban, rural, and insular areas, participated in a semi-structured survey. Thematic analysis identified key insights. Results: Most participants (N = 19) highlighted the high usability of the INTRINSIC services and their high satisfaction for being members of the network (N = 17) was attributed to the collaborative delivery of integrated, specialized healthcare services in primary healthcare (N = 17). Further identified advantages of the services included the positive impact on timely care delivery (N = 6), cost effectiveness, and alleviation of hospital strain. Healthcare professionals valued the holistic approach of the INTRINSIC services to psychogeriatric care (N = 8) and their role in the improvement of it in communities in low-resource settings (N = 13). However, challenges were also reported, including the low openness and reluctance of service users (N = 7), difficulties in using the INTRINSIC digital platform (N = 5), and increased workload (N = 5). Conclusions: Despite these issues, the INTRINSIC services embody an innovative telehealth model for delivering high-quality, tertiary, mental, and cognitive healthcare services to older adults in underserved areas. Full article

To explore Indigenous patients’ use of a primary urgent care centre (PUCC) at a co-located general medical practitioner (GP)-led primary healthcare service (GP service) in regional Queensland, Australia, secondary data analysis was conducted using the 65,420 deidentified PUCC patients from 1 July 2020 to 30 June 2021, including Indigenous status. A Mann–Whitney U test and Chi-Square test were used to analyse patients’ arrival times, reasons to attend PUCC, and frequency of attendance. The proportion of Indigenous patients from the communities attending the PUCC was 9.8% while the proportion of Indigenous people in the general population was only 3.8%. Indigenous patients were more likely to be new patients to the GP service (13.6% never visited the GP service prior to PUCC) compared to non-Indigenous (9.6%) patients. The peak hours of attendance for Indigenous people were 11 a.m.–12 p.m. and 2 p.m.–3 p.m. while it was 10 a.m.–12 p.m. for non-Indigenous patients. The most common reason for attending PUCC for both patient groups was superficial injuries. The second most common reason was digestive issues for Indigenous patients and musculoskeletal issues for non-Indigenous patients. These findings provide insights for enhancing future PUCC models to better meet the community needs, especially the underserved Indigenous population in regional areas. Full article

This study investigates the evolutionary game dynamics of medical knowledge sharing (KS) among Chinese hospitals under government regulation, focusing on the strategic interactions between general hospitals, community health service centers, and governmental bodies. Leveraging evolutionary game theory, we construct a tripartite evolutionary game model incorporating replicator dynamics to characterize the strategic evolution of the involved parties. Our analysis examines the regulatory decisions of the government and the strategic choices of Chinese hospitals, considering critical factors such as KS costs, synergistic benefits, government incentives and penalties, and patient evaluations. The model is analyzed using replicator dynamic equations to derive evolutionary stable strategies (ESSs), complemented by numerical simulations for sensitivity analysis. Key findings reveal that the system’s equilibrium depends on the balance between KS benefits and costs, with government regulation and patient evaluations significantly influencing Chinese hospital behaviors. The results highlight that increasing government incentives and penalties, alongside enhancing patient feedback mechanisms, can effectively promote KS. However, excessive incentives may reduce willingness to regulate, suggesting the need for balanced policy design. This research provides novel theoretical insights and practical recommendations by (1) pioneering the application of a tripartite evolutionary game framework to model KS dynamics in China’s hierarchical healthcare system under government oversight, (2) explicitly integrating the dual influences of government regulation and patient evaluations on hospital strategies, and (3) revealing the non-linear effects of policy instruments. These contributions are crucial for optimizing Chinese medical resource allocation and fostering sustainable collaborative healthcare ecosystems. Full article

Background: Primary healthcare (PHC) at the community level is essential to improving access to health services and reducing healthcare costs. However, compared to developed countries where PHC is well developed, PHC in developing countries is not as well developed. The worldwide prevalence of COVID-19 has put a tremendous strain on the healthcare systems of all countries. Interestingly, we found that the impact of COVID-19 on the global healthcare system has brought about a new opportunity for PHC in developing countries. Methods: Based on community-scale panel data from Beijing, China, in the period from 1 January 2018 to 30 June 2021, this paper employed the Anderson model to reveal the impact of COVID-19 on community health service utilization. Two-way fixed effects models and double-difference models were used to analyze the data for robustness. Results: The results show that COVID-19 significantly reduced visits to the Community Health Center, but meanwhile, it raised the cost of single visits. While the costs of treatment, together with medical materials, were significantly lower during the pandemic, COVID-19 has affected the cost control of family physicians, resulting in the cost of contracted patients being significantly lower than that of non-contracted patients. Conclusions: While the COVID-19 pandemic significantly reduced routine visits to established medical centers, it served as a catalyst for the increased utilization of community health services. If appropriate measures to contain COVID-19 were taken, it would be possible to extend the scope of community health services and strengthen the PHC system. Full article

Linguistic inequity drives systemic disparities in healthcare for non-native English speakers. This study evaluates a project to train and provide qualified medical interpreters (QMI) to assist volunteer and safety-net clinics and community-based organizations in supporting healthcare for immigrants and refugees. We provided scholarships to bilingual community members to take a medical interpreter training course and developed a workforce for those who passed the training course. We focused on lesser-spoken foreign languages such as Arabic, Amharic, Pashto, Dari, and Burmese. Those who passed the course participated in a semi-structured interview to learn about their experiences in the training program, as well as barriers and facilitators to becoming a QMI. To date, 23 people have passed the training and are part of the QMI workforce program that has provided 94 h of interpreter services over four months, serving 66 individual patients. The evaluation showed that community members have interest in becoming QMIs and many have the required language proficiency to enroll and pass training. Finding full-time employment for less spoken languages has proven to be challenging. Full article

Community-based medical rehabilitation encompasses diverse programs that cater to patients outside of inpatient settings, such as home rehabilitation, day rehabilitation centers, and ambulatory clinics. While inpatient rehabilitation principles are widely standardized, outpatient programs display significant variability influenced by healthcare models, local environments, economic constraints, and available resources. This narrative review aims to explore and synthesize the various models of non-inpatient rehabilitation services, evaluating their effectiveness, cost-efficiency, and patient satisfaction. The review also seeks to identify optimal practices and strategies to enhance community-based rehabilitation, alleviate the burden on inpatient facilities, and improve patient outcomes through multidisciplinary and patient-centered approaches. Additionally, the study examines the critical role of a professional program coordinator and the importance of effective clinical communication in outpatient rehabilitation. A comprehensive search of peer-reviewed literature was conducted across multiple databases, focusing on studies that examined community-based rehabilitation models. The findings suggest that community-based rehabilitation programs are generally more cost-effective than inpatient programs, with their success being heavily dependent on the intensity and timing of interventions. Multidisciplinary approaches and high-intensity rehabilitation have shown promise in improving patient quality of life, though their effectiveness varies by condition. Despite limited research, the involvement of a Physical and Rehabilitation Medicine (PRM) physician as a program coordinator appears vital for ensuring continuity of care. Moreover, effective clinical communication is essential, impacting all aspects of patient care and interprofessional collaboration, with continuous adaptation required to meet the evolving needs of diverse patient populations. Full article

Poor medication adherence is a significant public health issue, especially among the vulnerable elderly, leading to increased morbidity, mortality, and healthcare costs. This study aimed to explore, identify, and understand the barriers and facilitators to medication adherence among vulnerable elderly individuals. We conducted a qualitative study using focus group interviews with 31 participants, including community nurses, social care services, volunteers from non-governmental organizations, patient association members, and informal caregivers, using semi-structured questions and inductive content analysis to gather and analyze qualitative data. Two main categories, “Perceived barriers” and “Facilitative interventions” were developed. The findings revealed multiple barriers, including medication-related barriers, patient-related barriers and barriers related to the healthcare system and healthcare personnel. Participants also highlighted the importance of facilitating interventions like medication management, health education, supportive social networks, and ensuring continuity of care. The study underscores the need for targeted strategies to improve medication adherence among the vulnerable elderly. Full article

The Calgary–Cambridge Guide is a widely recognised framework for teaching communication skills to healthcare professionals that has become a cornerstone of communication training programs in medicine and other healthcare fields. In the context of veterinary medicine, its integration into communication training programs has become an asset improving communication, education, interaction, and quality of service, enhancing the veterinary–client–patient relationship (VCPR). In veterinary medicine, however, a more challenging consultation dynamic involves the veterinarian, the owner, and the animal. The addition of a veterinary assistant that acts as an interpreter or translator is common in Hong Kong where the native language (Cantonese) coexists with English when consultations are led by non-native language speakers. This addition converts this commonly dyadic model into a triadic communication model. The addition of an assistant interpreter influences the way consultations are conducted, how information is conveyed, and how interpersonal cues and empathy are delivered. In this report we depict challenges applying the Calgary–Cambridge Guide in multicultural and multilingual veterinary medical centres in Hong Kong and highlight the role of veterinary supporting staff in these scenarios, specifically veterinary assistant interpreters. Full article

Background: Chronic cough (CC), characterized as a cough lasting >8 weeks, is a common multi-factorial syndrome in the community, especially in older adults. Methods: Using a pre-existing algorithm to identify patients with CC within the 2011–2018 Medicare beneficiaries, we examined trends in gabapentinoid use through repeated cross-sectional analyses and identified distinct utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Individuals without CC but with any respiratory conditions related to cough served as a comparator group. Results: Among patients with CC, gabapentinoid use increased from 18.6% in 2011 to 24.1% in 2018 (p = 0.002), with a similar upward trend observed in the non-CC cohort but with overall lower usage (14.7% to 18.4%; p < 0.001). Patients with CC had significantly higher burdens of respiratory and non-respiratory comorbidities, as well as greater healthcare service and medication use compared to the non-CC cohort. The GBTM analyses identified three distinct gabapentinoid utilization trajectories for CC and non-CC patients: no use (77.3% vs. 84.5%), low use (13.9% vs. 10.3%), and high use (8.8% vs. 5.2%). Conclusions: Future studies are needed to evaluate the safety and effectiveness of gabapentinoid use in patients with refractory or unexplained CC in real-world settings. Full article

Background: Telemedicine offers the opportunity to provide clinical services remotely, thereby bridging geographic distances for people engaged in the medical system. Following the COVID-19 pandemic, the widespread adoption of telemedicine in clinical practices has persisted, highlighting its continued relevance for post-pandemic healthcare. Little is known about telemedicine use among people from socially marginalized groups. Methods: The No One Waits (NOW) Study is a single-arm clinical trial measuring the acceptability, feasibility, and safety of an urban point-of-diagnosis hepatitis C (HCV) treatment initiation model delivered in a non-clinical community setting. Participants enrolled in the NOW Study are recruited via street outreach targeting people experiencing homelessness and injecting drugs. Throughout the NOW Study, clinical care is delivered through a novel staff-facilitated telemedicine model that not only addresses geographic and transportation barriers, but also technology and medical mistrust, barriers often unique to this population. While clinicians provide high-quality specialty practice-based care via telemedicine, on-site staff provide technical support, aid in communication and rapport, and review the clinicians’ instructions and next steps with participants following the visits. Research questionnaires collect information on participants’ experience with and perceptions of telemedicine (a) prior to treatment initiation and (b) at treatment completion. Discussion: For people from socially marginalized groups with HCV infection, creative person-centered care approaches are necessary to diagnose, treat, and cure HCV. Although non-clinical, community-based staff-facilitated telemedicine requires additional resources compared to standard-of-care telemedicine, it could expand the reach and offer a valuable entrance into technology-delivered care for socially marginalized groups. Trial registration: NCT03987503. Full article

Information obtained from children themselves regarding the characteristics of the ideal hospital that ensure well-being during a hospital stay is scarce. Here, we report the opinions, perceptions, and expectations of 700 children and adolescents about their experiences, assessed through a mixed-method research approach with age-appropriate questionnaires, three open-ended questions, and an analysis of optional pictorial and textual narratives. Most children indicated that, while they acknowledged the expertise of hospital staff, they also noted several shortcomings, e.g., insufficiently understandable medical information as well as emotional and cognitive support. The continuity of schooling and the right to suffer as little as possible were also critical issues. Adolescents valued in particular the quality of care and services provided, the hospital’s adherence to equality and non-discrimination rights, and protection systems but negatively perceived several aspects related to play and participation. Significant differences in the co-occurrences of the most frequently used text terms with the keywords “hospital” and “child/adolescent” between age groups highlight variations in the way patients perceive and articulate their experiences within the hospital setting depending on the cognitive processes linked to age. In drawings, prevailing attention was placed on the physical context of the hospital room, with figures expressing mostly negative emotions. Specifically, in this regard, the main emotion in children was sadness, and, in adolescents, it was fear. Overall, these insights are pivotal in the context of our research objectives as they shed light on the nuanced preferences, needs, and perspectives of children and adolescents during their hospital stays. Recognizing the identified shortcomings, we propose recommendations emphasizing the improvement of medical communication clarity, enhancement of emotional and cognitive support, and the improvement of programs to avoid instructional gaps during hospital stays. Addressing these specific needs is critical for a more comprehensive approach to pediatric healthcare provision. Full article

In Saudi Arabia, community pharmacies offer healthcare services for different conditions. However, clarity of the competence of pharmacists in managing migraines is lacking. This study aimed to explore the current knowledge, attitude, and practice patterns of community pharmacists concerning migraine management in the northwestern part of Saudi Arabia. A cross-sectional study was carried out between June and September 2022 among 215 Saudi community pharmacists. Data analysis was performed by descriptive and inferential statistics using SPSS version 27. Most community pharmacists (87.9%) feel that migraine management is essential to their practice, and 83.3% suggest between one and five over-the-counter (OTC) migraine products daily. Among the study pharmacists, 83.7% feel migraine patients should try OTC before prescription medications. Only 9.3% of the community pharmacists do not believe that migraine is a neurological disorder. The medications most prescribed for migraine were triptans, representing 52.1% of prescriptions. There were significant differences between the gender of the pharmacists and their knowledge, attitude, and practice overall score (p-value = 0.04). Male pharmacists exhibited higher knowledge, attitude, and practice scores than female pharmacists. Although many community pharmacists acknowledge their expertise and involvement in managing migraines, there is a requirement for further education and training to enhance their capacity to offer complete care to migraine patients. Pharmacists should also consider non-pharmacological interventions and complementary therapies when treating migraine symptoms. Full article

Attacks on health have become a significant concern for non-belligerents of war, including healthcare personnel and facilities, as witnessed in the ongoing Sudan conflict. About 1.5 billion people in fragile and conflict-affected settings (FCAS) have a heightened need for essential health services. Conflicts often lead to the disruption of the building blocks of health systems, a lack of access to health facilities, the failure of essential medical supply chains, the collapse of political, social and economic systems, the migration of health care workers, and upsurges in illness. While health indicators often decline in conflict, health can also bring peace and harmony among communities. An investment in building resilient health systems and health diplomacy is a neutral starting point for mitigating the repercussions of conflicts. The international commitment towards Sustainable Development Goals (SDGs) provides the impetus to emphasise the relationship between health and peace with the amalgamation of SDG 3, SDG 16, and SDG 17. The inspection of how health diplomacy should be used as a ‘tool for peace’ and not as leverage in conflict settings must be reiterated by the international community. Full article

Cloud-computing capabilities have revolutionized the remote processing of exploding volumes of healthcare data. However, cloud-based analytics capabilities are saddled with a lack of context-awareness and unnecessary access latency issues as data are processed and stored in remote servers. The emerging network infrastructure tier of fog computing can reduce expensive latency by bringing storage, processing, and networking closer to sensor nodes. Due to the growing variety of medical data and service types, there is a crucial need for efficient and secure architecture for sensor-based health-monitoring devices connected to fog nodes. In this paper, we present publish/subscribe and interest/resource-based non-DHT-based peer-to-peer (P2P) RC-based architecture for resource discovery. The publish/subscribe communication model provides a scalable way to handle large volumes of data and messages in real time, while allowing fine-grained access control to messages, thus enabling heightened security. Our two − level overlay network consists of (1) a transit ring containing group-heads representing a particular resource type, and (2) a completely connected group of peers. Our theoretical analysis shows that our search latency is independent of the number of peers. Additionally, the complexity of the intra-group data-lookup protocol is constant, and the complexity of the inter-group data lookup is O(n), where n is the total number of resource types present in the network. Overall, it therefore allows the system to handle large data throughput in a flexible, cost-effective, and secure way for medical IoT systems. Full article