University of New Mexico, Albuquerque, New Mexico; the Uniformed Services University of the Health Sciences, Bethesda, Maryland; the Northern Navajo Medical Center, Shiprock, New Mexico; the Mid-Columbia Medical Center, The Dalles, Oregon; the University of Texas Rio Grande Valley, Edinburg, Texas; the Alaska Native Medical Center, Anchorage, Alaska; the University of Mississippi Medical Center, Jackson, Mississippi; the Oregon Health and Science University, Portland, Oregon; and the American College of Obstetricians and Gynecologists, Washington, DC.
Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.
Drawing upon a comparative, qualitative study of the experiences of rural women accessing maternity care in two Canadian provinces, we demonstrate that availability of services, having economic and informational resources to access the services offered, and the appropriateness of those services in terms of gender, continuity of care, confidentiality, quality of care, and cultural fit are key to an accurate understanding of health care access. We explore the implications of living rurally on each of these dimensions, thereby revealing both gaps in and solutions to rural maternity care access that narrower, proximity-based definitions miss.
To study people's views on the accessibility and continuity of primary medical care provided by different providers: a public primary healthcare centre (PPHC), occupational healthcare (OHC), and a private practice (PP).
A nationwide population-based questionnaire study.
A total of 6437 (from a sample of 10,000) Finns aged 15-74 years.
Period of time (in days) to get an appointment with any physician was assessed via a single structured question. Accessibility and continuity were evaluated with a five-category Likert scale. Values 4-5 were regarded as good.
Altogether 72% had found that they could obtain an appointment with a physician within three days, while 6% had to wait more than two weeks. Older subjects and subjects with chronic diseases perceived waiting times as longer more often than younger subjects and those without chronic diseases. The proportion of subjects who perceived access to care to be good was 35% in a PPHC, 68% in OHC, and 78% in a PP. The proportion of subjects who were able to get successive appointments with the same doctor was 45% in a PPHC, 68% in OHC, and 81% in a PP. A personal doctor system was related to good continuity and access in a PPHC.
Access to and continuity of care in Finland are suboptimal for people suffering from chronic diseases. The core features of good primary healthcare are still not available within the medical care provided by public health centres.
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Despite overall decreasing mortality from cervical cancer, selected groups of Canadian women continue to have suboptimal access to diagnostic and treatment interventions for cervical cancer. In this paper, we present an evaluation of a colposcopy program developed to improve attendance for colposcopy in a lower socio-economic and immigrant population.
All women attending the North Hamilton Community Health Centre (CHC) who required colposcopic assessment and were referred to a newly developed colposcopy program based at the CHC were evaluated. Attendance rates for consultation, follow up and treatment in women referred for colposcopy were compared retrospectively for the CHC-based colposcopy program and concurrently with the regional colposcopy clinic (RCC).
Women referred to the CHC colposcopy program had a significant reduction in their no-show rate after the introduction of the locally based colposcopy program (17.2% vs. 1.3%, p
Comment In: Can J Public Health. 2004 Sep-Oct;95(5):325-815490919
BACKGROUND: In 2002 the Norwegian Board of Health made a survey of the accessibility of general practitioners in Troms county in North Norway. MATERIAL AND METHODS: In a telephone interview one secretary in each surgery informed about telephone response time, planned time for telephone consultations, recorded numbers of urgent consultations, and waiting time to obtain a routine consultation. RESULTS: On average, the planned telephone time was two hours per week. Telephone time was in inverse proportion to the number of patients on the doctor's list. Rural doctors spent twice as much time as urban colleagues on the telephone with their patients. Doctors with lists between 500 and 1500 patients had a higher proportion of urgent consultations compared with doctors with shorter or longer lists. INTERPRETATION: Telephone response time below two minutes and waiting times for routine consultations below 20 days appear to be within acceptable norms. When patient lists are above 1500, doctors' capacity to offer telephone contact and emergency services to their patients seems reduced.
In 2010, an accreditation system for occupational health services (OHS) in Norway was implemented.
To examine OHS experiences of the accreditation system in Norway 4 years after its implementation.
A web-based questionnaire was sent to all accredited OHS asking about their experiences with the accreditation system. Responses were compared with a similar survey conducted in 2011.
The response rate was 76% (173/228). OHS reported that the most common changes they had had to make to achieve accreditation were: improvement of their quality assurance system (53%), a plan for competence development (44%) and increased staffing in occupational hygiene (36%) and occupational medicine (28%). The OHS attributed improved quality in their own OHS (56%) and in OHS in Norway (47%), to the accreditation process.
The accreditation system was well accepted by OHS, who reported that it had improved the quality of their OHS and of OHS in Norway. The results are similar to the findings of a 2011 survey.
Cites: Int J Occup Med Environ Health. 2002;15(2):159-6312216773
Cites: Int J Occup Med Environ Health. 2002;15(2):173-712216775
Assertive Community Treatment (ACT) programs provide community-based services for individuals with severe mental illness. In Ontario, these programs are funded by the Ministry of Health and Long-Term Care and administered through sponsoring agencies (hospitals, mental health facilities, and "other" community-based organizations). This article reports on the results of a survey of ACT programs and investigates the relationship between sponsoring agency type and ACT program operations. Findings and implications for policy makers and administrators are discussed.
Despite the negative physical and mental health outcomes of sexual assault, a minority of sexually assaulted women seek immediate post-assault medical and legal services. This study identified the number and types of acute forensic medical procedures used by women presenting at a hospital-based urgent care centre between 1997 and 2001 within 72 hours following a reported sexual assault. The study also examined assault and non-assault factors associated with the use of procedures. It was hypothesized that assault characteristics resembling the stereotype of rape would be associated with the use of more procedures. The multiple regression indicated that injury severity, coercion severity, homelessness, and delay in presentation were significantly associated with the number of procedures received. Findings provide partial support for the hypothesis that post-assault procedures would be associated with the stereotype of rape, and highlight homeless women as a group particularly at risk for not receiving adequate medical treatment following a sexual assault.