RESUMEN
BACKGROUND: Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited. OBJECTIVE: This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health. METHODS: A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided. RESULTS: Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website. CONCLUSIONS: The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants.
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Médicos , Telemedicina , Humanos , Perú/epidemiología , Femenino , Masculino , Adulto , Proyectos Piloto , Médicos/psicología , Servicios de Salud Rural/organización & administración , Población Rural , Salud Mental , Servicios de Salud Mental , Evaluación de Programas y Proyectos de Salud , Investigación CualitativaRESUMEN
Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas.
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Atención Primaria de Salud , Investigación Cualitativa , Servicios de Salud Rural , Humanos , Brasil , Servicios de Salud Rural/organización & administración , Masculino , Femenino , Atención Primaria de Salud/organización & administración , Adulto , Médicos de Atención Primaria/educación , Persona de Mediana Edad , Accesibilidad a los Servicios de Salud/organización & administración , Entrevistas como AsuntoRESUMEN
Health informatics has significantly advanced global technology, yet challenges persist in public health and rural nursing in Mexico due to social inequalities, limited technology access, and suboptimal infrastructure, compounded by the absence of nurse informaticians as viable career options. Overcoming these barriers necessitates international collaboration, empowering Mexican nurses to contribute to universal health access and advocate for health equity. Interventions must extend beyond nursing curricula to existing workforces, ensuring they can address the needs of vulnerable populations in Mexico. Long-term international support is crucial to bridge these gaps and unleash the full potential of Mexican nurses in influencing global health.
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Informática Aplicada a la Enfermería , México , Servicios de Salud Rural/organización & administración , Informática Médica , Humanos , Enfermería en Salud PúblicaRESUMEN
Objective: To describe the Factors to Effective Clinical Experience and Willingness to pursue Career in Rural Health Facilities among Nursing Students on Clinical Placement in southeast Nigeria. Methods: The study was conducted among 48 rural health centres and general hospitals with 528 respondents from different higher institutions of learning serving in these health facilities for their clinical experience. The study applied survey design and utilized questionnaire instrument for data collection. Results: Majority of the students (60%) agreed that their school lacked functional practical demonstration laboratory for students' clinical practice, 66.7% agreed that their school lab lacked large space for all the students to observe what is being taught, 79.9% that their school lab lacked enough equipment that can enable many students to practice procedures; majority of the students (79.9%) answered that the hospitals where they are on clinical placement lacked enough equipment needed for the students on each shift of practice, 59.9% agreed that student/client ratio in each ward during clinical experience periods was not enough for students' practice under supervision, while 73.3% indicated that their school lacked library with current nursing texts for references. Personal, socioeconomic and institutional factors explain the 76% of the variance of effective clinical experience and the 52% of the variance of the willingness to work in rural health facilities in the future if offered employment. Conclusion: The factors surrounding effective clinical experience in rural healthcare facilities in southeastern Nigeria are unfavorable and could discourage future nurses from working there. It is necessary to implement strategies to improve the management of these centers in order to promote the perspective of improving sustainable rural health in this region.
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Selección de Profesión , Servicios de Salud Rural , Estudiantes de Enfermería , Humanos , Nigeria , Estudiantes de Enfermería/psicología , Encuestas y Cuestionarios , Femenino , Masculino , Adulto , Adulto Joven , Servicios de Salud Rural/organización & administración , Actitud del Personal de Salud , Estudios TransversalesRESUMEN
During the COVID-19 pandemic, populations living further away from urban centers faced immense difficulties accessing health services. This study aims to analyze how Brazilian remote rural municipalities faced the COVID-19 pandemic based on their political, structural, and organizational response to access to healthcare. A qualitative study of multiple cases was conducted with thematic and deductive content analysis of 51 interviews conducted with managers and healthcare professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas. With their socio-spatial dynamics and long distances to reference centers, the remote rural municipalities responded to the demands of the pandemic but did not have their needs met promptly. They preserved communication with the population, reorganized the local system centered on primary health care (PHC), and changed the functioning of healthcare units, exceeding the limits of their responsibilities to provide the necessary care and awaiting referral to other levels of complexity. They faced a shortage of services, gaps in assistance in the regional network, and inadequate healthcare transport. The pandemic reiterated PHC's difficulties in coordinating care, exposing care gaps in reference regions. The equitable and resolute provision of the local health system in the remote rural municipalities implies inter-federative articulation in formulating and implementing public policies to ensure the right to health.
Na pandemia de COVID-19, as populações que vivem mais afastadas dos centros urbanos enfrentaram imensas dificuldades no acesso aos serviços de saúde. O objetivo deste estudo é analisar como os municípios rurais remotos brasileiros enfrentaram a pandemia de COVID-19, tendo como base sua resposta política, estrutural e organizativa ao acesso à saúde. Trata-se de estudo qualitativo de casos múltiplos com a análise de conteúdo temática e dedutiva de 51 entrevistas conduzidas com gestores e profissionais de saúde em 16 municípios rurais remotos dos estados de Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais e Amazonas. Com dinâmicas socioespaciais próprias, grandes distâncias até os centros de referência, os municípios rurais remotos responderam às demandas da pandemia, mas não tiveram suas necessidades atendidas oportunamente. Preservaram a comunicação com a população, reorganizaram o sistema local centrado na atenção primária à saúde (APS), alteraram o funcionamento das unidades de saúde, ultrapassando os limites de suas atribuições para prestar o cuidado necessário e aguardar o encaminhamento aos demais níveis de complexidade. Enfrentaram a escassez de serviços, as lacunas assistenciais da rede regional e o transporte sanitário inadequado. A pandemia reiterou as dificuldades da APS em coordenar o cuidado e expôs os vazios assistenciais nas regiões de referência. A provisão equitativa e resolutiva do sistema local de saúde nos municípios rurais remotos implica na articulação interfederativa à formulação e implementação de políticas públicas de modo a assegurar o direito à saúde.
En la pandemia de COVID-19, las poblaciones que viven más alejadas de los centros urbanos enfrentaron inmensas dificultades para acceder a los servicios de salud. El objetivo de este estudio es analizar cómo los municipios rurales remotos de Brasil enfrentaron la pandemia de COVID-19, a partir de su respuesta política, estructural y organizativa al acceso a la salud. Se realizó el estudio cualitativo de casos múltiple con el análisis de contenido temático y deductivo de 51 entrevistas realizadas con gestores y profesionales de la salud en 16 municipios rurales remotos de los estados de Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais y Amazonas. Con dinámicas socioespaciales propias y alejados de los centros de referencia, los municipios rurales remotos respondieron a las demandas de la pandemia, pero no se atendieron sus necesidades de manera oportuna. Preservaron la comunicación con la población, reorganizaron el sistema local centrado en la atención primaria de salud (APS), modificaron el funcionamiento de las unidades de salud, superando los límites de sus atribuciones para proporcionar la atención necesaria, y esperar la derivación a los demás niveles de complejidad. Enfrentaron la falta de servicios, las lagunas asistenciales de la red regional y el transporte sanitario inadecuado. La pandemia reafirmó las dificultades de la APS para coordinar la atención y expuso las lagunas asistenciales en las regiones de referencia. La provisión equitativa y resolutiva del sistema de salud local en los municipios rurales remotos implica en la articulación interfederativa para elaborar e implementar políticas públicas para asegurar el derecho a la salud.
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COVID-19 , Accesibilidad a los Servicios de Salud , Pandemias , Investigación Cualitativa , Servicios de Salud Rural , COVID-19/epidemiología , Humanos , Brasil/epidemiología , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud Rural/organización & administración , Atención Primaria de Salud/organización & administración , Población Rural , SARS-CoV-2 , Atención a la Salud/organización & administraciónRESUMEN
Rationale: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. Objectives: As part of the HAPIN (Household Air Pollution Intervention Network) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced, and a road network analysis was performed. Measurements and Main Results: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately resourced facility was 41 ± 19 minutes in J-GUA, 99 ± 64 minutes in P-PER, 40 ± 19 minutes in K-RWA, and 31 ± 19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all P < 0.001). Conclusions: Most healthcare facilities in low-resource settings of the HAPIN study area were inadequately resourced to care for severe pediatric pneumonia. Early identification of cases and timely referral is paramount. The provision of pulse oximeters to all health facilities may be an effective approach to identify cases earlier and refer them for care and in a timely manner.
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Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Neumonía/diagnóstico , Neumonía/terapia , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/estadística & datos numéricos , Adolescente , Niño , Preescolar , Femenino , Geografía , Guatemala , Humanos , India , Lactante , Recién Nacido , Masculino , Oximetría , Perú , Pobreza/estadística & datos numéricos , Población Rural/estadística & datos numéricos , RwandaAsunto(s)
Atención Ambulatoria/organización & administración , COVID-19/epidemiología , Educación en Farmacia/organización & administración , Internado no Médico/organización & administración , Servicio Ambulatorio en Hospital/organización & administración , Educación a Distancia/organización & administración , Política de Salud , Humanos , Pandemias , Servicios de Salud Rural/organización & administración , SARS-CoV-2 , Telemedicina/organización & administración , Estados Unidos/epidemiología , Flujo de TrabajoRESUMEN
Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.
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Competencia Cultural/educación , Educación de Pregrado en Medicina/organización & administración , Medicina Tradicional/estadística & datos numéricos , Servicios de Salud Rural/organización & administración , Estudiantes de Medicina/estadística & datos numéricos , Adulto , Actitud del Personal de Salud , Colombia , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Medicina Tradicional/psicología , Investigación Cualitativa , Adulto JovenRESUMEN
OBJECTIVES: Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities. METHOD: We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator. RESULTS: Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0-1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5-576.7). DISCUSSION: Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.
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COVID-19/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Pobreza/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Factores de Edad , Anciano , COVID-19/terapia , Femenino , Humanos , Masculino , México/epidemiología , Servicios de Salud Rural/organización & administración , Servicios Urbanos de Salud/organización & administraciónRESUMEN
BACKGROUND: The ways of life in the Amazon are diverse and not widely known. In addition, social inequities, large geographic distances and inadequate health care network noticeably limit access to health services in rural areas. Over the last decades, Brazilian health authorities have implemented fluvial mobile units (FMU) as an alternative to increase access and healthcare coverage. The aim of the study was to identify the strategies of access and utilization of primary health care (PHC) services by assessing the strengths and limitations of the healthcare model offered by the FMU to reduce barriers to services and ensure the right to healthcare. METHODS: Qualitative and ethnographic research involving participant observation and semi-structured interviews. Data collection consisted of interviews with users and health professionals and the observation of service organization and healthcare delivered by the FMU, in addition to the therapeutic itineraries that determine demand, access and interaction of users with healthcare services. RESULTS: Primary care is offered by the monthly locomotion of the FMU that serves approximately 20 rural riverside communities. The effectiveness of the actions of the FMU proved to be adequate for conditions such as antenatal care for low-risk pregnancy, which require periodic consultations. However, conditions that require continued attention are not adequately met through the organization of care established in the FMU. The underutilization of the workforce of community health workers and disarrangement between their tasks and those of the rest of the multi-professional team are some of the reasons pointed out, making the healthcare continuity unfeasible within the intervals between the trips of the FMU. From the users' perspective, although the presence of the FMU provides healthcare coverage, the financial burden generated by the pursuit for services persists, since the dispersed housing pattern requires the locomotion of users to reach the mobile unit services as well as for specialized care in the urban centers. CONCLUSIONS: The implementation of the FMU represents an advance in terms of accessibility to PHC. However, the organization of their activity uncritically replicates the routines adopted in the daily routine of health services located in urban spaces, proving to be inadequate for providing healthcare strategies capable of mitigating social and health inequalities faced by the users.
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Accesibilidad a los Servicios de Salud/organización & administración , Unidades Móviles de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Servicios de Salud Rural/organización & administración , Brasil , Agentes Comunitarios de Salud/organización & administración , Femenino , Humanos , Entrevistas como Asunto , Embarazo , Atención Prenatal/organización & administración , Investigación Cualitativa , Recursos Humanos/organización & administraciónRESUMEN
INTRODUCTION: This study aimed to understand and analyze the work process of fluvial family health teams in the context of riverside populations in the Brazilian Amazon. METHODS: Action research was undertaken, conducting focus groups, individual interviews and participant observation with 27 workers of municipal teams of the state of Pará, in the Brazilian Amazon. The analysis was performed by the content, following the theoretical framework of the work process. RESULTS: The following themes emerged: work object of the teams; work agents (who are the workers?); work technologies (the instruments of the process in fluvial health teams); and challenges for achieving the purpose of the work process. CONCLUSION: Recognition of the work object centered on the needs of the individual, family and community. The center for permanent education, supply of materials and inputs to the teams were implemented, and improved workflow for referring users was observed.
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Agentes Comunitarios de Salud/organización & administración , Salud de la Familia/estadística & datos numéricos , Promoción de la Salud/organización & administración , Servicios de Salud Rural/organización & administración , Población Rural/estadística & datos numéricos , Brasil , Femenino , Grupos Focales , Humanos , Masculino , Atención Primaria de Salud/organización & administraciónAsunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Servicios de Salud Rural/organización & administración , Betacoronavirus , COVID-19 , Comunicación , Procedimientos Quirúrgicos Electivos , Hospitales Rurales/organización & administración , Hospitales de Enseñanza/organización & administración , Humanos , New York , Pandemias , Pennsylvania , Equipo de Protección Personal/provisión & distribución , SARS-CoV-2 , Telemedicina , Centros de Atención TerciariaRESUMEN
In this study the author address rural Guatemala's poor maternal health and HIV status by integrating an effective evidence-based HIV intervention (SEPA), with local implementing health partners to extend the capacity of comadronas (traditional Mayan birth attendants) to encompass HIV prevention. I employed a multi-method design consisting of a focus group, an interview, and participant observation to identify important factors surrounding comadrona receptivity towards expanding their capacity to HIV prevention. I analyzed data using thematic analysis and identified four categories: Project logistics, HIV knowledge and risk assessment, condom perceptions, and HIV testing perceptions. I affirm comadrona receptivity toward HIV prevention, and that will guide future cultural adaptation and tailoring of SEPA for comadrona training. I will use my results to create a prototype intervention that could be applied to other similarly underserved indigenous communities.
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Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud/etnología , Promoción de la Salud/métodos , Servicios de Salud Materna/organización & administración , Partería , Servicios de Salud Rural/organización & administración , Adulto , Condones , Femenino , Grupos Focales , Guatemala/epidemiología , Guatemala/etnología , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Humanos , Indígenas Centroamericanos , Persona de Mediana Edad , Salud Rural , Población Rural , Sexo SeguroRESUMEN
PURPOSE: The barriers and solutions to the current prior-authorization (PA) process at an integrated health system were evaluated. METHODS: Focus groups were conducted with patients at an integrated health system who also had insurance from an affiliated health plan and at least 1 denial for a medication in the past year. Semistructured interviews were conducted with medical staff (physicians, office staff, and PA experts). Both focus groups and interviews were audio-recorded and transcribed. Inductive analysis was used to code transcripts and develop themes. RESULTS: Three focus groups were conducted with 13 patients, and 9 medical staff (3 staff physicians, 2 office staff, and 4 PA staff) who have interactions with the PA process interviewed. Several themes were identified including the complexity of the PA process, consequences experienced, and ineffective communication between key stakeholders. A cross-cutting theme was that stakeholders expressed feelings of frustration, anxiety, and anger throughout the PA process. All stakeholders offered insights on how the process could be improved to better facilitate their preferences, such as access to the list of medications that require PA and the need for a patient advocate. CONCLUSION: Results of this study revealed that the PA process was frustrating, upsetting, and infuriating to patients and medical staff involved in the process. Three main themes identified included the complexity of the PA process, consequences experienced from the PA process, and ineffective communication between stakeholders.
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Prestación Integrada de Atención de Salud/organización & administración , Autorización Previa , Servicios de Salud Rural/organización & administración , Participación de los Interesados/psicología , Actitud del Personal de Salud , Toma de Decisiones Clínicas/métodos , Comunicación , Prestación Integrada de Atención de Salud/economía , Femenino , Grupos Focales , Frustación , Personal de Salud/psicología , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Servicios de Salud Rural/economía , Factores de TiempoRESUMEN
BACKGROUND: Health needs and access to health care is a huge challenge in developing countries, especially in some isolated indigenous communities. Amantani is an island located at 3854 m above sea level in Lake Titicaca, Peru. There is no official date on key local health needs and determinants, which precludes the prioritization and efficient implementation of health interventions. The objective of this study is to validate a health need assessment tool and ascertain the main health needs of the indigenous high-altitude population living on Amantani. METHODS: We conducted a cross-sectional study to describe the health needs of the indigenous population of Amantani using a questionnaire based on the "Peruvian Demographic and Health Survey". The questionnaire underwent expert and field-work validation. We selected a random sample of the island residents using two-stage cluster sampling. We estimated the prevalence of key health needs and determinants, and evaluated their distribution by age, sex and education through prevalence ratio. All analyses accounted for the complex sampling design. RESULTS: We surveyed 337 individuals (223 adults and 144 children) in 151 houses. The most frequent health needs were: (i) lack of access to medical screening for a)non-communicable diseases (> 63.0%) and b)eye problems (76.5%); and (ii) poor knowledge about communicable diseases (> 54.3%), cancer (71.4%) and contraception (> 32.9%). Smoking and alcohol use was more frequent in males (PR = 4.70 IC95%:1.41-15.63 and PR = 1.69 95% CI:1.27-2.25, respectively). People with higher education had more knowledge about TB/HIV and cancer prevention (p < 0.05). Regarding children's health, > 38% have never undergone eye or dental examination. Corporal punishment and physical bullying at school in the last month were relatively common (23 and 33%, respectively). CONCLUSION: The main health needs in Amantani are related to poor healthcare access and lack of awareness of disease prevention. Our findings can be used to develop and implement efficient health interventions to improve the health and quality of life of indigenous populations living in the islands in Southern Peru/Northern Bolivia.
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Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Evaluación de Necesidades/estadística & datos numéricos , Grupos de Población/estadística & datos numéricos , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Altitud , Niño , Preescolar , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , Lactante , Recién Nacido , Islas , Lagos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Prevalencia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
INTRODUCTION: The health workforce is crucial to reduce inequalities in health and health care in rural areas, and nurses, although there are few professionals and these are poorly distributed compared to other professionals. There are few studies addressing nurses' work in the rural context. This study aimed to investigate the satisfaction and difficulties of the work of primary health care (PHC) nurses in rural areas. METHOD: This is a case study with a qualitative approach, whose subject was the health units in the rural area of a large city in the state of Paraíba, Brazil, with Family Health Strategy teams. Eleven nurses working in rural areas participated in the study. Data were collected through interviews with semi-structured scripts and submitted to content analysis. RESULTS: The study revealed that nurses working in rural areas have experienced job satisfaction with the recognition and gratitude of families, one of the major motivations for professionals interviewed. The nurses are committed and have adequate training in their area of activity. The working conditions, infrastructure, forms of access to the workplace and distance from the decision center are factors that stand out as difficulties of work. CONCLUSIONS: The nurses appreciate each other in their work, establish good relations with the population and work as a team despite the difficulties. The study reveals that nurses and the population experience isolation in the rural area as well as difficulty in accessing the workplace, in the case of practitioners, and in consolidating policies maintained in the urban area. It evidences the nurse as an essential element for PHC in the rural setting, which can make the difference in the care of populations often in the sideline of health services.
Asunto(s)
Satisfacción en el Trabajo , Personal de Enfermería/psicología , Lealtad del Personal , Servicios de Salud Rural/organización & administración , Población Rural/estadística & datos numéricos , Lugar de Trabajo/psicología , Adulto , Brasil , Humanos , Masculino , Área sin Atención Médica , Satisfacción PersonalRESUMEN
BACKGROUND: Trauma is a major cause of death and disability in the United States, and significant disparities exist in access to care, especially in non-urban settings. From 2007 to 2017 New Mexico expanded its trauma system by focusing on building capacity at the hospital level. METHODS: We conducted a geospatial analysis at the census block level of access to a trauma center in New Mexico within 1â¯h by ground or air transportation for the years 2007 and 2017. We then examined the characteristics of the population with access to care. A multiple logistic regression model assessed for remaining disparities in access to trauma centers in 2017. RESULTS: The proportion of the population in New Mexico with access to a trauma center within 1â¯h increased from 73.8% in 2007 to 94.8% in 2017. The largest increases in access to trauma care within 1â¯h were found among American Indian/Alaska Native populations (AI/AN) (35.2%) and people living in suburban areas (62.9%). In 2017, the most rural communities (aOR 58.0), communities on an AI/AN reservation (aOR 25.6), communities with a high proportion of Hispanic/Latino persons (aOR 8.4), and a high proportion of elderly persons (aOR 3.2) were more likely to lack access to a trauma center within 1â¯h. CONCLUSION: The New Mexico trauma system expansion significantly increased access to trauma care within 1â¯h for most of New Mexico, but some notable disparities remain. Barriers persist for very rural parts of the state and for its sizable American Indian community.
Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud/estadística & datos numéricos , Centros Traumatológicos/organización & administración , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Hispánicos o Latinos , Humanos , Indígenas Norteamericanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , New Mexico , Estudios Retrospectivos , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/provisión & distribución , Centros Traumatológicos/estadística & datos numéricos , Adulto JovenRESUMEN
AIMS: To describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. METHODS: Dominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. RESULTS: 1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4â¯years, BMI 27.4â¯kg/m2, HbA1c 8.8% (73â¯mmol/mol), BP 133/81â¯mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP and HbA1c assessments, and proportions reaching quality measures improved over time, especially after clinic goal setting. Modeling of BP, BMI and HbA1c values revealed important differences in outcomes by clinic over time. CONCLUSIONS: Improvements in process and health outcomes are attainable in rural DR when medical teams have support and access to data. Scalability and sustainability are continuing goals.
Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Mejoramiento de la Calidad , Servicios de Salud Rural , Adulto , Anciano , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea/métodos , Determinación de la Presión Sanguínea/normas , Diabetes Mellitus Tipo 2/complicaciones , República Dominicana/epidemiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/normas , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/normas , Población Rural/estadística & datos numéricosRESUMEN
Peru secured a legislative advance for mental health care with a 2012 law mandating that mental health services be available in primary care. One of the main challenges faced by this reform is implementation in remote regions. This column describes a pilot project in Peru that took place from 2010 to 2014 to develop capacity for including mental health services in primary care in one of the most isolated, high-needs regions of the country. The authors describe use of accompaniment-based training and supervision of clinicians and comprehensive, engaged regional partnerships formed to increase the impact and sustainability of the service expansion.