scholarly journals Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

2019 ◽  
Vol 64 (1) ◽  
pp. 65-78 ◽  
Author(s):  
Tayyab I. Shah ◽  
Andrew F. Clark ◽  
Jamie A. Seabrook ◽  
Shannon Sibbald ◽  
Jason A. Gilliland
Keyword(s):  
Primary Care ◽  
Urban Areas ◽  
Primary Care Providers ◽  
Care Providers ◽  
Rural And Urban Areas ◽  
Geographic Accessibility ◽  
Rural And Urban

scholarly journals THE UTILIZATION OF GOLDEN PERIOD OF ISCHEMIC STROKE IN PATIENTS IN PRODUCTIVE AGES

2020 ◽  
Vol 15 (3) ◽  
pp. 258
Author(s):  
Vidya Tri Huttami ◽  
Atik Choirul Hidajah
Keyword(s):  
Ischemic Stroke ◽  
Health Care Providers ◽  
Urban Areas ◽  
Signs And Symptoms ◽  
Care Providers ◽  
Rural And Urban Areas ◽  
Early Admission ◽  
Rural And Urban ◽  
Stroke Prevalence ◽  
Neurology Clinic

The 2007 Basic Health Survey shows the highest number of deaths in Indonesia rural and urban areas was caused by stroke. In 2007-2013, the stroke prevalence in  productive age increased up to 22‰. Stroke that attacks productive age can impair individual’s ability to do activities, and thus they might have family financial constraint. Disabilities can be prevented and minimized if patients utilize a golden period of an ischemic stroke. This study identified the utilization of golden period of ischemic stroke in patients and analyzed causes of delayed patient admission to the Neurology Clinic of Sidoarjo Hospital. This study was a descriptive study conducted to 39 post-stroke ischemic patients in productive ages under further therapy at the Neurology Clinic of Sidoarjo Hospital in 2016. The data were collected through interview from January-February 2017. The results present 62% of stroke ischemic patients utilized the golden period of a ischemic stroke. The average respondents' admission took  29.87±47.46 hours after patients experienced first stroke ischemic attacks (ranging from 1-168 hours). The respondents were admitted to the hospital late or >4.5 hours after the stroke attacks because most of them did not know stroke signs and symptoms. Therefore, hospitals or health care providers have to provide counseling service to patients and family members about stroke signs and symptoms, as well as the importance of early admission for treatment as soon as patient gets the first stroke attack. Keywords: utilization of the golden period, ischemic stroke, productive age.

scholarly journals Opioid Use Among Rural Medicare Beneficiaries

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 335-335
Author(s):  
Yvonne Jonk ◽  
Heidi O'Connor ◽  
Karen Pearson ◽  
Zachariah Croll ◽  
John Gale
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Providers ◽  
Community Dwelling ◽  
Prescribing Patterns ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Opioid Prescription ◽  
Opioid Prescribing

Abstract This study examines differences in opioid prescribing rates among a nationally representative sample of Medicare beneficiaries across rural and urban areas, as well as among beneficiaries with chronic overlapping pain conditions (COPCs). We assess whether prescribing patterns exceed the Centers for Disease Control and Prevention guidelines for dose and duration, and identify socioeconomic and health risk factors associated with opioid prescribing using logistic regression analyses. Data were from the 2010-2017 Medicare Current Beneficiary Survey files. Rural-Urban Commuting Area codes were used to identify patients’ residential location. The Area Health Resource Files were used to identify market characteristics such as primary care and mental health shortage areas. With the exception of 2010, over years 2011-2017, higher percentages of community-dwelling rural beneficiaries received opioid prescriptions (21.8-25.4%) compared to their urban counterparts (19.1-23.7%). During the same time period, facility-dwelling rural beneficiaries were more likely to receive opioid prescriptions (39.8-47.2%) compared to their urban counterparts (28.8-35.0%). Higher percentages (18.8%) of the community dwelling population in rural had COPCs compared to urban (15.2%), and a higher percentage of rural beneficiaries with COPCs (31.4%) received an opioid prescription than their urban counterparts (22.2%). Previous research points to other factors contributing to a lack of alternatives to opioids for pain management in rural areas, including greater reliance on primary care providers, lack of access to chronic pain specialists and alternative therapies, and travel barriers. Improving the capacity of rural primary care to deal with COPCs and expanding access to specialists via telehealth warrants further attention from policymakers.

scholarly journals Rural and urban general practice: a comparison in 34 countries

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
P Groenewegen ◽  
M Bosmans ◽  
W Boerma
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Care Services ◽  
Multilevel Regression ◽  
Rural And Urban Areas ◽  
Care Services ◽  
Rural And Urban ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Rural areas have problems in attracting and retaining primary care workforce. Comparable problems but with a different background occur in deprived urban areas. Here we focus on primary care practices that do work in rural areas and not on the shortage or lack of access for the rural population. We answer the question whether these practices have a different organisation, lack resources and have different service profiles, compared to practices in semi-rural and urban areas. Methods We used data from the QUALICOPC study, conducted among approximately 7,000 GPs in 34 (mainly European) countries, on the organisation of practices, their human resources and equipment and their service profiles. Data were analysed using multilevel regression analysis, with countries and GPs as levels. Results In general the practices in rural areas are more often single-handed and have less other primary care workers available. In most countries they have more equipment and their service profiles are broader, in particular as compared to inner-city urban practices. Conclusions The combination of increasing demand for care and undersupply of health care services can lead to a primary care shortage in rural areas. However, the practices that are currently located in rural area in most countries seem to be able to cope with the situation by providing a broader range of services, compared to service-rich urban areas. Against growing health needs of an ageing and often poorer population, there is a risk of lack of facilities and equipment and ageing staff. Until now this is not manifest in the primary care practices in most countries.

Description, utilisation and results from a telehealth primary care weight management intervention for adults with obesity in South Carolina

2018 ◽  
Vol 26 (1-2) ◽  
pp. 28-35 ◽  
Author(s):  
Joshua D Brown ◽  
Sarah Hales ◽  
T Ed Evans ◽  
Tonya Turner ◽  
David O Sword ◽  
...  
Keyword(s):  
Primary Care ◽  
South Carolina ◽  
Weight Management ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Providers ◽  
Care Providers ◽  
Access To Treatment ◽  
Financial Barriers ◽  
Rural Primary Care

Introduction In the US, obesity rates are higher in rural areas than in urban areas. Rural access to treatment of obesity is limited by a lack of qualified clinicians and by transportation and financial barriers. We describe a telemedicine weight management programme, Wellness Connect, developed through a partnership of academic clinicians and rural primary care providers in South Carolina, and present utilisation and weight outcomes from seven patient cohorts. Methods Eight bi-weekly sessions were provided via telemedicine videoconferencing for groups of patients at these rural primary care clinics. Protocol-based sessions were led by registered dietitians, exercise physiologists and clinical psychologists at a central urban location. Results Of 138 patients who started the programme, 62% ( N = 86) of patients met the criteria for completion. Completers lost an average of 3.5% (standard deviation (SD) = 3.9%) body weight, which was statistically significant ( p < .001) and corresponded with an average loss of 3.8 kg (SD = 4.5 kg). There were no differences in weight change among clinics ( p = .972). Overall, patients and providers reported satisfaction with the programme and identified several challenges to sustainability. Discussion The use of innovative telemedicine interventions continues to be necessary to alleviate barriers to accessing evidence-based services to reduce chronic diseases and decrease obesity rates among rural populations.

scholarly journals The primary care workforce in Europe: a cross-sectional international comparison of rural and urban areas and changes between 1993 and 2011

2020 ◽  
Vol 30 (Supplement_4) ◽  
pp. iv12-iv17 ◽  
Author(s):  
Peter P Groenewegen ◽  
Mark W G Bosmans ◽  
Wienke G W Boerma ◽  
Peter Spreeuwenberg
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Procedures ◽  
Cross Sectional ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Primary Care Workforce ◽  
Practice Population ◽  
The Individual

Abstract Rural areas have problems in attracting and retaining primary care workforce. This might have consequences for the existing workforce. We studied whether general practitioners (GPs) in rural practices differ by age, sex, practice population and workload from those in less rural locations and whether their practices differ in resources and service profiles. We used data from 2 studies: QUALICOPC study collected data from 34 countries, including 7183 GPs in 2011, and Profiles of General Practice in Europe study collected data from 32 countries among 7895 GPs in 1993. Data were analyzed using multilevel analysis. Results show that the share of female GPs has increased in rural areas but is still lower than in urban areas. In rural areas, GPs work more hours and provide more medical procedures to their patients. Apart from these differences between locations, overall ageing of the GP population is evident. Higher workload in rural areas may be related to increased demand for care. Rural practices seem to cope by offering a broad range of services, such as medical procedures. Dedicated human resource policies for rural areas are required with a view to an ageing GP population, to the individual preferences and needs of the GPs, and to decreasing attractiveness of rural areas.

scholarly journals Fakes and chemicals: indigenous medicine in contemporary Kenya and implications for health equity

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Olivia Howland
Keyword(s):  
Decision Making ◽  
Urban Areas ◽  
Herbal Medicines ◽  
Care Providers ◽  
Community Members ◽  
Indigenous Healing ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Urban Study ◽  
Rural Settings

Abstract Background Access to effective biomedical treatments for humans and livestock in Kenya is far from universal. Indigenous healing has a significant role to play in contemporary society in Kenya, yet access is not the only reason for this. Beliefs surrounding the composition of biomedicines, people’s experiences of biomedical care, and issues of counterfeit biomedicines sold over the counter have led to patients seeking care outside of biomedical institutions. Methods This study explores local realities of treatment seeking in one rural and one urban study site, for both humans and their livestock, including when, where and how people access certain types of medicines. Using an ethnographic approach to interviews, focus groups and observations, I explore the role that indigenous healing, both herbal and occasionally spiritual, plays within this context with healers and community members. Results Indigenous healing remains important for many people due to their mistrust and suspicion of biomedicine and big pharma. Their interactions with the healer or doctor, and the equity of these interactions, influence their decisions whether to access herbal or biomedical care, or a combination of the two. Indigenous healing bridges the gap many people experience when they are unable to access biomedical treatments and effectively creates a broader, more equitable coverage for healthcare. The plurality of reasons surrounding decision making is complex, but it is clear that many people often use indigenous healing, improvements in the regulation of both formulas and practice would assist people to access more effective treatment. Conclusions Indigenous healing is an important way in which Kenyans in rural and urban areas access healthcare for themselves and their animals. Issues of counterfeit biomedicines have led to broad mistrust and people favour indigenous healing, depending on the illness or severity of symptoms. Indigenous healing is a vital way in which people in underserved rural and urban populations access care. Herbal medicines and indigenous healing are trusted due to the greater transparency in their creation, and the more equitable relationship between indigenous doctor and patient. The study demonstrates that a pluralistic system is appropriate to increasing equity in access to healthcare in both urban and rural settings, as well as the importance of biomedical care providers respecting indigenous healing and viewing it with legitimacy. By taking a One Health perspective to understand the intersection of humans, livestock and the environment, we can better understand critical aspects affecting decision making for treatment and implications for healthcare equity in a rapidly changing world.

scholarly journals The scope of practice of primary health care physicians in rural and urban areas in Brazil

2021 ◽  
Vol 37 (9) ◽  
Author(s):  
Ana Cristina van Stralen ◽  
Cristiana Leite Carvalho ◽  
Sábado Nicolau Girardi ◽  
Celia Regina Pierantoni ◽  
Ilka Afonso Reis ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Urban Areas ◽  
Primary Care Physicians ◽  
Online Survey ◽  
Scope Of Practice ◽  
Factors Associated ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Main Factors

This study aimed to identify differences in the scope of practice of primary care physicians and find the main factors associated with expanded practice in rural and urban areas of Brazil. Data from an online survey with 2,277 primary care physicians, conducted between January and March 2016, were used. Differences regarding activities and procedures performed by physicians per area were verified using Kruskal-Wallis/Dunn’s post hoc and chi-square tests. Multivariate linear regression analyses were done using a bootstrap technique to identify the main factors associated with an expanded scope of practice. Regardless of the location, the results showed that the practices of the primary care physicians are below their competences. Rural physicians performed a higher number of procedures and activities compared with their peers from intermediate and urban municipalities. Within the overall sample, the variables related to a broader scope of practice included: male gender, work in rural municipalities, participation in training and continuing education programs and consultation of clinical protocols, articles and books. This study contributes with evidence that the medical scope of practice varies according to location. Recognizing and understanding the differences and associated factors for an expanded scope of practice is necessary to determine the skills and resources required for practice in rural and urban areas, collaborating in proposals of strategies to improve quality and access of health care services.

Management of minor ailments in primary schoolchildren in rural and urban areas

1996 ◽  
Vol 22 (3) ◽  
pp. 167-174
Author(s):  
J A Cantrill ◽  
B Johannesson ◽  
M Nicholson ◽  
P R Noyce
Keyword(s):  
Urban Areas ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Primary Schoolchildren ◽  
Minor Ailments

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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