Telemedicine: Bridging the Gap between Refugee Health and Health Services Accessibility in Hamilton, Ontario

Refugees face considerable challenges upon seeking asylum in Canada, and accessing health care services remains a prominent issue. Recurrent themes in the literature outlining barriers to health-services accessibility include geographic, economic, and cultural barriers. Drawing on the experiences of service providers in Hamilton, Ontario, we explored the efficacy of telemedicine services in bridging the gap between refugee health and health services accessibility. Research methodology included structured interviews with clinicians who provide health-care services to refugees, complemented by a scoping literature review. The results of this exploratory study demonstrate the efficacy of telemedicine in encouraging dialogue and policy change in the greater health-care setting, and its potential to increase access to specialist health-care services.Les réfugiés doivent faire face à des défis considérables lors du processus de demande d’asile au Canada, et l’accès aux services de santé demeure un enjeu important. Parmi les préoccupations qui reviennent fréquemment dans la documentation portant sur l’accessibilité aux services de santé sont les obstacles de nature géographique, économique, et culturelle. En nous basant sur l’expérience vécue des fournisseurs de service établis à Hamilton, en Ontario, nous étudions l’efficacité des services de télémédecine à combler l’écart entre les besoins en matière de santé des réfugiés et l’accessibilité aux services de santé. La méthodologiede recherche comportait des entrevues structurées avec le personnel traitant chargé de fournir des services de santé aux réfugiés, accompagnée d’une revue exploratoire de la documentation sur le sujet. Les résultats de cette étude exploratoire ont démontré l’efficacité de la télémédecine à stimuler le dialogue et le changement en matière de politique dans le contexte général des services de santé, ainsi que sa capacité à accroître l’accès aux services de santé spécialisés

Dilemmas in the Compassionate Supply of Investigational Cancer Drugs

In Australia, patients who want to access medicines that are not yet approved have only two options: to enrol in a clinical trial if they are eligible, or obtain their medicine through ‘compassionate supply’, which is provided at the discretion of the manufacturer. In this article, we explore ethical issues associated with the provision of oncology medicines that are still in development, either prior to regulatory approval or government reimbursement. Keywords: ethics; evidence-based medicine; health services accessibility; oncolog

Achieving Access: Professional Movements and the Politics of Health Universalism

[Excerpt] This book examines efforts to expand access to health care and AIDS medicine in Thailand, Brazil, and South Africa. Although these countries are geographi­cally far apart, they share many similarities as newly industrializing countries engaged in processes of democratic opening. Scholars have often suggested that expansionary social policy is the product of left-wing parties and labor unions or bottom-up people’s movements. From a strictly rational perspective, that these groups would be at the forefront of such change makes perfect sense. After all, expanding access to health care and medicine would seem to be in their interest, and they would appear to have a lot to gain. While this book recognizes the role they often play, it focuses on a different, more puzzling set of actors whose actions are sometimes even more decisive in expanding access to health care and medicine: elites from esteemed professions who, rationally speaking, aren’t in need of health care or medicine themselves and who would otherwise seem to have little to gain from such policies. This group includes doctors like Sanguan Nitayarumphong and Paulo Teixeira, whose work with the poor and needy informed their advocacy for universal health care in Thailand and Brazil while also putting them into conflict with the medical profession of which they were a part. How is it that these people would play such an important and active role in making change happen

Presumptive self-diagnosis of malaria and other febrile illnesses in Sierra Leone

Introduction: The objective of this study was to evaluate the prevalence of self-diagnosis of malaria and other febrile illnesses in Bo, Sierra Leone. Methods: All households in two neighboring sections of Bo were invited to participate in a cross-sectional survey. Results: A total of 882 households (an 85% participation rate) that were home to 5410 individuals participated in the study. Of the 910 individuals reported to have had what the household considered to be malaria in the past month, only 41% were diagnosed by a healthcare professional or a laboratory test. Of the 1402 individuals reported to have had any type of febrile illness within the past six months, only 34% had sought a clinical or laboratory diagnosis. Self-diagnosis of influenza, yellow fever, typhoid, and pneumonia was also common. Conclusion: Self-diagnosis and presumptive treatment with antimalarial drugs and other antibiotic medications that are readily available without a prescription may compromise health outcomes for febrile adults and children.Key words: Malaria, fevers, self-care, health services accessibility, community pharmacy services, West Afric

Conceitos e dimensões sobre acesso a medicamentos no Sistema Único de Saúde: protocolo de revisão de escopo

The aim is to map the scientific productions (year of publication, methodological approach, collection instruments) on access to medicines in Brazil published between 2011 and 2022 and; identify the concepts and dimensions of access used in studies on access to medicines in Brazil. The scope review will be prepared according to the steps of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and will follow the steps recommended by the Joanna Briggs Institute. The documents will be identified by two independent reviewers, in the PubMed, BVS and SciELO databases. Studies that answer the research question, presented in any language, will be considered. The selection of studies will be done blindly and independently, by two reviewers, using the Rayyan Intelligent Systematic Review software. Divergences will be appreciated by a third reviewer. A narrative summary will accompany the results, which will be expressed through figures, tables, charts, graphs, diagrams, and will describe the relationship with the objective and question of the review.Objetiva-se mapear as produções científicas (ano de publicação, abordagem metodológica, instrumentos de coleta) sobre acesso a medicamentos no Brasil publicadas entre 2011 e 2022 e; identificar os conceitos e dimensões de acesso utilizadas nos estudos sobre acesso a medicamentos no Brasil. A revisão de escopo será elaborada conforme as etapas do Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), e seguirá as etapas preconizadas pelo Joanna Briggs Institute. Os documentos serão identificados por dois revisores independentes, nas bases de dados PubMed, BVS e SciELO. Serão considerados estudos que respondam à pergunta de pesquisa, apresentados em qualquer idioma. A seleção dos estudos será feita de forma cega e independente, por dois revisores, por meio do software Rayyan Intelligent Systematic Review. Divergências serão apreciadas por um terceiro revisor.  Um resumo narrativo acompanhará os resultados, que serão expressados por meio de figuras, tabelas, quadros, gráficos, diagramas, e descreverá a relação com o objetivo e a questão da revisão

American Muslim Health Disparities: The State of the Medline Literature

Background: While religious beliefs and values influence health behaviors, conventional health disparities research rarely examines health outcomes by religious affiliation particularly within multi-ethnic minority communities. Methods: Using a systematic strategy we searched the Medline literature to identify empiric studies that report on health disparities between American Muslims and non-Muslim groups residing in America. In addition to use religious affiliation descriptors for Muslim groups we utilized geographic and ethnicity terms such as “South Asian” or “Pakistani” as proxy terms to help uncover studies of American Muslims. Results: 171 empirical studies were captured. South Asians and Arabs were the most commonly studied groups, and mental health was the most common studied health condition. The overwhelming majority of studies did not assess connections between the Islamic faith and health outcomes. Conclusion: Healthcare disparities among American Muslims remain under-investigated. The few empirical studies of American Muslim groups, or of ethnic groups with large numbers of Muslims, rarely examine relationships between Islam-related factors and health outcomes and thereby miss an opportunity to understand the relationships between religion and health disparities

Access issues: Transportation Challenges and healthcare delivery in rural settings

The aim of the work in this paper is to present the results from a study of how the quality of life in remote locations and rural settings of Bayelsa State, Nigeria can be enhanced through improvement in healthcare accessibility. The methodology comprised desktop study, questionnaire survey, participant observations and interviews. A survey comprising 2,000 distributed questionnaires was conducted between July 2016 and July 2017 within seven selected states in the Niger Delta region of Nigeria. A total of 1,800 questionnaires were completed and returned. Informal interviews were conducted with respondents from the public and health sectors within Bayelsa State; the focus state for the study. Data from most of the respondents revealed that physical barriers such as nature of terrain and transportation significantly influenced health services accessibility. Further analysis of the data revealed that lapses in the health policies and lack of initiatives were paramount drivers to the challenges around accessibility. Based on these findings a guide was developed to aid improvement on access to healthcare services. The guide provides recommendations for development of better transportation mechanisms that will resolve the long-standing logistics challenges that have impacted the healthcare needs of the rural population. Government action or involvement is a key influence on the actual outcomes from execution of the guid

Rural–Urban Differences in Dental Service Use Among Children Enrolled in a Private Dental Insurance Plan in Wisconsin: Analysis of Administrative Data

Background Studies on rural–urban differences in dental care have primarily focused on differences in utilization rates and preventive dental services. Little is known about rural–urban differences in the use of wider range of dental procedures. This study examined patterns of preventive, restorative, endodontic, and extraction procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI). Methods We analyzed DDWI enrollment and claims data for children aged 0-18 years from 2002 to 2008. We modified and used a rural and urban classification based on ZIP codes developed by the Wisconsin Area Health Education Center (AHEC). We categorized the ZIP codes into 6 AHEC categories (3 rural and 3 urban). Descriptive and multivariable analysis using generalized linear mixed models (GLMM) were used to examine the patterns of dental procedures provided to children. Tukey-Kramer adjustment was used to control for multiple comparisons. Results Approximately, 50%, 67% and 68 % of enrollees in inner-city Milwaukee, Rural 1 (less than 2500 people), and suburban-Milwaukee had at least one annual dental visit, respectively. Children in inner city-Milwaukee had the lowest utilization rates for all procedures examined, except for endodontic procedures. Compared to children from inner-city Milwaukee, children in other locations had significantly more preventive procedures. Children in Rural 1-ZIP codes had more restorative, endodontic and extraction procedures, compared to children from all other regions. Conclusions We found significant geographic variation in dental procedures received by children enrolled in DDWI

Provision of Fluoride Varnish Treatment by Medical and Dental Care Providers: Variation by Race/Ethnicity and Levels of Urban Influence

Objective: In 2004, Wisconsin Medicaid policy changed to allow medical care providers to be reimbursed for fluoride varnish treatment (FVT) to children\u27s teeth to improve access and utilization. To date, no study has been published on whether geographic and racial/ethnic variation in the provision of FVT in response to this policy change exists. This study\u27s objective is to examine the association of rates of FVT for children enrolled in Wisconsin Medicaid with race/ethnicity, urban influence codes (UIC), and dental health professional shortage area (DHPSA) designation based on county of residence. Methods: A retrospective, pre–post design was used based on FVT claims for children in the Wisconsin Medicaid program from 2002 to 2006. Poisson regression models were used to evaluate the association of rates of FVT claims with race/ethnicity, UIC, and DHPSA designation. Results: The rate of FVT claims varied by resident county-type according to UIC and DHPSA designation, age, and race/ethnicity. Post-policy, the largest increases were observed for Native Americans residing in non-DHPSA counties, enrollees living in rural counties, and for Hispanics living in partial and entire DHPSA counties. African-Americans residing in partial DHPSA and metropolitan counties displayed the lowest rates of FVT claims. Conclusions: Overall access and utilization of FVT increased, but substantial racial/ethnic and geographic variation in the provision of FVT for children enrolled in Wisconsin Medicaid was observed. Future policies should incorporate measures that will specifically address the racial and geographic variations identified in this study