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Accessing maternity care in rural Canada: there's more to the story than distance to a doctor.

https://arctichealth.org/en/permalink/ahliterature155499
Source
Health Care Women Int. 2008 Sep;29(8):863-83
Publication Type
Article
Date
Sep-2008
Author
Rebecca Sutherns
Ivy Lynn Bourgeault
Author Affiliation
Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Source
Health Care Women Int. 2008 Sep;29(8):863-83
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Alberta
Female
Health Care Surveys
Health Services Accessibility
Humans
Maternal Health Services - methods - trends
Medically underserved area
Needs Assessment
Ontario
Pregnancy
Prenatal Care - methods - trends
Quality of Health Care
Risk assessment
Rural Health Services - standards - trends
Rural Population
Abstract
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.
PubMed ID
18726796 View in PubMed
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[Access to general practitioners in a county in Troms]

https://arctichealth.org/en/permalink/ahliterature70574
Source
Tidsskr Nor Laegeforen. 2005 Aug 25;125(16):2210-2
Publication Type
Article
Date
Aug-25-2005
Author
Anne Helen Hansen
Ivar J Aaraas
Jorun Støvne Pettersen
Gerd Ersdal
Author Affiliation
Tromsø kommune, Rådhuset, 9299 Tromsø. anne.helen.hansen@tromso.kommune.no
Source
Tidsskr Nor Laegeforen. 2005 Aug 25;125(16):2210-2
Date
Aug-25-2005
Language
Norwegian
Publication Type
Article
Keywords
Comparative Study
Emergency Medical Services - standards - statistics & numerical data
English Abstract
Family Practice - standards - statistics & numerical data
Female
Health Services Accessibility - standards - statistics & numerical data
Humans
Interviews
Male
Norway
Physicians, Family
Physicians, Women
Referral and Consultation - standards - statistics & numerical data
Rural Health Services - standards - statistics & numerical data
Telephone
Urban Health Services - standards - statistics & numerical data
Abstract
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.
PubMed ID
16138139 View in PubMed
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Acute myocardial infarction: quality of care in rural Alberta.

https://arctichealth.org/en/permalink/ahliterature167771
Source
Can Fam Physician. 2006 Jan;52:68-9
Publication Type
Article
Date
Jan-2006
Author
Trustin Domes
Olga Szafran
Cheryl Bilous
Odell Olson
G Richard Spooner
Author Affiliation
University of Alberta, Edmonton.
Source
Can Fam Physician. 2006 Jan;52:68-9
Date
Jan-2006
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Aged, 80 and over
Alberta
Emergency Service, Hospital - standards
Exercise Test - utilization
Female
Hospitals, Rural - standards
Humans
Inpatients
Male
Medical Audit
Middle Aged
Myocardial Infarction - therapy
Quality of Health Care
Retrospective Studies
Rural Health Services - standards
Abstract
To assess the quality of care of acute myocardial infarction (AMI) in a rural health region.
Clinical audit employing multiple explicit criteria of care elements for emergency department and in-hospital AMI management. The audit was conducted using retrospective chart review.
Twelve acute care health centres and hospitals in the East Central Health Region, a rural health region in Alberta, where medical and surgical services are provided almost entirely by family physicians.
Hospital inpatients with a confirmed discharge diagnosis of AMI (ICD-9-CM codes 410.xx) during the period April 1, 2001, to March 31, 2002, were included (177 confirmed cases).
Quality of AMI care was assessed using guidelines from the American College of Cardiology and the American Heart Association and the Canadian Cardiovascular Outcomes Research Team and Canadian Cardiovascular Society. Quality of care indicators at three stages of patient care were assessed: at initial recognition and AMI management in the emergency department, during in-hospital AMI management, and at preparation for discharge from hospital.
In the emergency department, the quality of care was high for most procedural and therapeutic audit elements, with the exception of rapid electrocardiography, urinalysis, and provision of nitroglycerin and morphine. Average door-to-needle time for thrombolysis was 102.5 minutes. The quality of in-hospital care was high for most elements, but low for nitroglycerin and angiotensin-converting enzyme (ACE) inhibitors, daily electrocardiography, and counseling regarding smoking cessation and diet. Few patients received counseling for lifestyle changes at hospital discharge. Male and younger patients were treated more aggressively than female and older patients. Sites that used care protocols achieved better results in initial AMI management than sites that did not. Stress testing was not readily available in the rural region studied.
Quality of care for patients with AMI in this rural health region was high for most guideline elements. Standing orders, protocols, and checklists could improve care. Training and resource issues will need to be addressed to improve access to stress testing for rural patients. Clinical audit should be at the core of a system for local monitoring of quality of care.
Notes
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Cites: Can J Cardiol. 2003 Jul;19(8):893-90112876609
Cites: J Rural Health. 2004 Spring;20(2):99-10815085622
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Cites: J Rural Health. 2000 Spring;16(2):168-7610981369
PubMed ID
16926968 View in PubMed
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Advocates for culture, advocates for health.

https://arctichealth.org/en/permalink/ahliterature189176
Source
Nurs BC. 2001 Oct;33(4):18-22
Publication Type
Article
Date
Oct-2001
Author
G. Moore
Source
Nurs BC. 2001 Oct;33(4):18-22
Date
Oct-2001
Language
English
Publication Type
Article
Keywords
Awards and Prizes
British Columbia
Community Health Nursing - standards
Culture
Humans
Indians, North American
Rural Health Services - standards
Transcultural Nursing - standards
Abstract
For the first time in its history, the Health Advocacy Award has been granted to a group of nurses--the Nuu-chah-nulth Community and Human Services Community Health Nurses on Vancouver Island. They have been recognized for their advocacy in providing culturally sensitive nursing care to the Nuu-chah-nulth First Nations.
PubMed ID
12152471 View in PubMed
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The Alberta Ambassador Program: delivering Health Technology Assessment results to rural practitioners.

https://arctichealth.org/en/permalink/ahliterature169962
Source
BMC Med Educ. 2006;6:21
Publication Type
Article
Date
2006
Author
Saifudin Rashiq
Pamela Barton
Christa Harstall
Donald Schopflocher
Paul Taenzer
Author Affiliation
Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton AB, Canada. srashiq@ualberta.ca
Source
BMC Med Educ. 2006;6:21
Date
2006
Language
English
Publication Type
Article
Keywords
Alberta
Chronic Disease
Decision Making
Education, Medical, Continuing - methods
Evidence-Based Medicine - education
Humans
Pain Management
Physician's Practice Patterns
Program Development
Program Evaluation
Regional Medical Programs
Rural Health Services - standards
Teaching - methods
Teaching Materials
Technology Assessment, Biomedical
Abstract
The purpose of Health Technology Assessment (HTA) is to make the best possible summary of the evidence regarding specific health interventions in order to influence health care and policy decisions. The need for decision makers to find relevant HTA data when it is needed is a barrier to its usefulness. These barriers are highest in rural areas and amongst isolated practitioners.
A multidisciplinary team developed an interactive case-based instructional strategy on the topic of chronic non-cancer pain (CNCP) management using clinical evidence derived by HTA. The evidence for each of 18 CNCP interventions was distilled into single-sheet summaries. Clinicians and HTA specialists ('Ambassadors') conducted 11 two-hour interactive sessions on CNCP in eight of Alberta's nine health regions. Pre- and post-session evaluations were conducted.
The sessions were attended by 130 individuals representing 14 health and administrative disciplines. The ambassador model was well received. The use of content experts as ambassadors was highly rated. The educational strategy was judged to be effective. Awareness of the best evidence in CNCP management was increased. Although some participants reported practice changes as a result of the workshops, the program was not designed to measure changes in patient outcome.
The ambassador program was successful in increasing awareness of the best evidence in CNCP management, and positively influenced treatment decisions. Its teaching methods were felt to be unique and innovative by participants. Its methods could be applied to other clinical content areas in order to increase the uptake of the results of HTA.
Notes
Cites: J Contin Educ Health Prof. 2002 Fall;22(4):214-2112613056
Cites: J Health Soc Policy. 2002;15(3-4):23-3712705462
Cites: BMJ. 1998 Jul 25;317(7153):273-69677226
Cites: J Eval Clin Pract. 2003 Nov;9(4):385-9014758960
Cites: J Contin Educ Health Prof. 2004 Spring;24(2):68-7515279131
Cites: Lancet. 2003 Oct 11;362(9391):1225-3014568747
PubMed ID
16579855 View in PubMed
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"And then you'll see her in the grocery store": the working relationships of public health nurses and high-priority families in northern Canadian communities.

https://arctichealth.org/en/permalink/ahliterature141042
Source
J Pediatr Nurs. 2010 Oct;25(5):327-34
Publication Type
Article
Date
Oct-2010
Author
Nancy J Moules
Martha L P MacLeod
Lorraine M Thirsk
Neil Hanlon
Author Affiliation
Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada. njmoules@ucalgary.ca
Source
J Pediatr Nurs. 2010 Oct;25(5):327-34
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Alberta
Attitude of Health Personnel
Family
Female
Humans
Male
Nurse's Practice Patterns - standards - trends
Nurse's Role - psychology
Nurse-Patient Relations
Nursing Methodology Research
Professional Competence
Professional-Family Relations
Public Health Nursing - methods
Quality of Health Care
Rural Health Services - standards - trends
Vulnerable Populations - psychology - statistics & numerical data
Abstract
The aim of the study is to examine and articulate the nature of working relationships of public health nurses and high-priority families in small communities in northern Canada. Public health nurses working in northern, rural, and remote communities face unique and varied challenges. Reportedly, the hardest part of their job is working with families who have been deemed high priority or high risk. Working with these families in these contexts relies on relationships of reciprocity, trust, and communication. This qualitative research was guided by an interpretive hermeneutic inquiry; 32 families, 25 public health nurses, and three lay home visitors were interviewed from July 2005 through July 2006. Analysis was completed individually and through teamwork of the researchers. Findings suggest that the working relationship of public health nurses and high-priority families in northern communities is complex and multifaceted. Nurses carefully negotiate the process of engaging and entering relationships, maintaining the relationships, and negotiating boundaries. The analysis offers insight into the everyday practices and problems that public health nurses and families encounter in providing care to a vulnerable, isolated, and often marginalized population while navigating the complexity of living and working in the same small communities.
PubMed ID
20816554 View in PubMed
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An obstetric and gynecologic clerkship's influence on a medical community. The Washington, Alaska, Montana, and Idaho Anchorage obstetric and gynecologic clerkship.

https://arctichealth.org/en/permalink/ahliterature4545
Source
Am J Obstet Gynecol. 1997 Jun;176(6):1363-5; discussion 1366-7
Publication Type
Article
Date
Jun-1997
Author
H B Hanson
Author Affiliation
Department of Obstetrics and Gynecology, University of Washington Medical School, Anchorage, AK, USA.
Source
Am J Obstet Gynecol. 1997 Jun;176(6):1363-5; discussion 1366-7
Date
Jun-1997
Language
English
Publication Type
Article
Keywords
Alaska
Clinical Clerkship
Communication
Community Health Services - standards
Consultants
Education, Medical - standards
Female
Gynecology - education
Humans
Idaho
Montana
Obstetrics - education
Perception
Pregnancy
Program Evaluation
Questionnaires
Rural Health Services - standards
Washington
Abstract
OBJECTIVES: Our purpose was to explore the influences of an obstetric and gynecologic medical student clerkship on a remote medical community. Return of physicians to Alaska and faculty perceptions of their experience were central foci. STUDY DESIGN: Data were obtained on former clerks to determine choice of specialty and location of practice. Data regarding all physicians new to Alaska was correlated with the University of Washington Medical School graduate data. Additionally, a questionnaire with a Likert-type scale evaluated the 10 clinical faculty members participating in the clerkship. RESULTS: Between 1978 and 1991 we trained 266 clerks. A total of 77 of 374 (21%) new physicians in Alaska (1978 to 1991) were graduates of the University of Washington; 26 of those 77 (34%) were our former Anchorage obstetrics and gynecology clerks. The clinical faculty reported both positive and negative effects of their participation in the clerkship. CONCLUSION: The desired benefit, the return of new physicians to Alaska, seemed supported. Questionnaire results hinted at additional benefits for the supervising faculty physicians in this isolated community. The formal affiliation effected by the clerkship seemed to have a positive impact on patient care, communication, consultation, and shared action among the participating physicians.
PubMed ID
9215198 View in PubMed
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Application of business case analysis in planning a province-wide telehealth network in Alberta.

https://arctichealth.org/en/permalink/ahliterature198712
Source
J Telemed Telecare. 2000;6 Suppl 1:S87-9
Publication Type
Article
Date
2000
Author
L. Weaver
D. Spence
Author Affiliation
TecKnowledge Healthcare Systems Inc., Dartmouth, Nova Scotia, Canada. linda.weaver@tecknowledge.ca
Source
J Telemed Telecare. 2000;6 Suppl 1:S87-9
Date
2000
Language
English
Publication Type
Article
Keywords
Alberta
Education, Medical - methods
Emergency Medical Services - methods
Health Plan Implementation
Health Services Accessibility - standards
Humans
Mental Health Services - organization & administration
Radiology - methods
Rural Health Services - standards
Telemedicine - organization & administration
Abstract
A strategy for implementing telemedicine throughout Alberta was developed. The model was based on a comprehensive evaluation of the four clinical specialties chosen as representative telemedicine services--radiology, psychiatry, emergency services and continuing education. The goals of the telemedicine network were to improve access to health services, provide support for rural health-care providers and increase the efficiency of specialized services. The findings showed that the success factors in a national telemedicine programme depend on a clear organizational structure, with appropriate technical standards and support.
PubMed ID
10793983 View in PubMed
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The application of telehealth to rheumatology.

https://arctichealth.org/en/permalink/ahliterature183586
Source
Clin Rheumatol. 2003 Sep;22(3):168-72
Publication Type
Article
Date
Sep-2003
Author
P. Davis
Author Affiliation
Division of Rheumatology, University of Alberta ,Faculty of Medicine, 562 Heritage Medical Research Centre, Edmonton, Alberta T6G 2S2, Canada. paul.davis@ualberta.ca
Source
Clin Rheumatol. 2003 Sep;22(3):168-72
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Canada
Forecasting
Humans
Male
Remote Consultation - standards - trends
Rheumatic Diseases - diagnosis - therapy
Rheumatology - standards - trends
Rural Health Services - standards - trends
Sensitivity and specificity
Telemedicine - standards - trends
PubMed ID
14505205 View in PubMed
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Assessing the standard of care for child and adolescent attention-deficit hyperactivity disorder in Elgin County, Ontario: a pilot study.

https://arctichealth.org/en/permalink/ahliterature173481
Source
Can J Rural Med. 2005;10(3):149-54
Publication Type
Article
Date
2005
Author
Natalie Kotowycz
Susan Crampton
Margaret Steele
Author Affiliation
Faculty of Medicine, University of Western Ontario, London, Ont.
Source
Can J Rural Med. 2005;10(3):149-54
Date
2005
Language
English
Publication Type
Article
Keywords
Adult
Attention Deficit Disorder with Hyperactivity - diagnosis - epidemiology - therapy
Attitude of Health Personnel
Child
Clinical Competence - standards
Critical Pathways - standards
Diagnosis, Differential
Family Practice - standards
Female
Health Services Research
Humans
Male
Needs Assessment - statistics & numerical data
Ontario
Pilot Projects
Professional-Family Relations
Questionnaires
Rural Health
Rural Health Services - standards
Rural Population - statistics & numerical data
Abstract
To examine the current practice of rural family physicians in managing children with attention-deficit hyperactivity disorder (ADHD).
Chart review of children and adolescents with a recorded diagnosis of ADHD. The data collected include the patient's age at diagnosis, the diagnosing physician, the number and type of presenting symptoms, whether the Diagnostic Statistical Manual, 4th ed (DSM-IV) criteria were met, pertinent treatment regimens, family history and comorbid conditions. Participating physicians were asked to complete a questionnaire.
Elgin County, Ontario.
Thirty-six family physicians were contacted and 11 agreed to participate. Thirty-nine charts were reviewed. The average number of presenting symptoms was 2.9 for ADHD-inattentive subtype and 2.1 for ADHD-hyperactivity subtype. A diagnostic protocol was included in 20.5% of the charts. Of the 39 charts reviewed, 25.6% had sufficient information for the patients to meet the ADHD criteria. Family physicians diagnosed 5.1% of the cases, and the duration of time between referral to specialist and appointment was 47.2 weeks.
Together the lack of symptom recording, the long duration between referrals, and the low percentage of family physicians diagnosing ADHD all suggest the need for developing diagnostic protocols for family physicians and increasing their knowledge of diagnosing and managing ADHD.
PubMed ID
16079030 View in PubMed
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50 records – page 1 of 5.