Improving the accessibility of health services in urban and regional settings for Indigenous people

Introduction: Even though a wide range of health services exist in most urban and regional centres, they are not necessarily accessible. Accessible health services are physically accessible, affordable, appropriate and acceptable (that is, culturally competent and non-discriminatory). This paper draws on approximately 30 research studies as well as documented practice experience to explore how to improve accessibility of metropolitan, urban and regional health services for Indigenous Australians. Scrimgeour and Scrimgeour define urban and regional geographies as: major towns and cities, where the Aboriginal and Torres Strait Islander population is a minority within a larger total population, and where ‘mainstream’ (i.e. not Indigenous-specific) health services exist either as the only available health services or as alternative to Indigenous-specific services such as Aboriginal Community Controlled Health Services. Many of the principles outlined in this resource sheet would be readily applicable in remote settlements. However, remote settlements also have additional access challenges such as physical distance from a service, the difficulties of attracting appropriate staff to remote work locations and the need for an interpreter. These will not be specifically covered in this paper. The majority of studies are Australian, although international evidence has been used where gaps emerged in local evidence

“Where I am weak, they are strong”: Students’ Perceptions and Attitudes Toward Interprofessional Education

Purpose: Healthcare professionals strive for interprofessional practice to achieve optimal patient care. Extant research suggests that to best prepare students for interprofessional practice, interprofessional education (IPE) should be a key element in curriculum. The purpose of this mixed-methods study was to evaluate the impact of an IPE activity on participants’ attitudes and perceptions of IPE across five academic programs. Methods: This study utilized a modified version of the Readiness for Interprofessional Learning Scale Questionnaire (RIPLS) pre and post IPE and reflective essays. Participants included 67 students from nursing, occupational therapy, athletic training, dietetics, and speech-language pathology programs. After reviewing a hypothetical case study, participants collaboratively developed assessment and treatment recommendations. Questionnaires were analyzed using statistical procedures and reflective essays underwent thematic analysis. Results: Collectively, data revealed significant changes in participants’ perceptions, attitudes, and implementation readiness. Occupational therapy student participants had statistically significant increases in the RIPLS composite score, Teamwork and Collaboration, and the Positive Professional Identity components (p≤0.03). Participants with previous IPE experience scored 4-points higher on the RIPLS composite score (p=0.03). The reflective essays revealed the themes of barriers associated with collaboration, a deeper understanding and appreciation of other discipline’s roles and the value of teamwork in achieving optimal patient care. Participants reported beginning the interprofessional education experience with anxiety and uncertainty about not only their involvement but also the roles of other healthcare professionals. Throughout the experience, participants emerged with an increased knowledge of their role, others’ roles, and the value of working together within a professional setting to achieve the same goal, optimal patient care. Conclusions: Our findings reveal the benefits of interprofessional education and the necessity to include several healthcare professionals associated with rehabilitation in interprofessional research and education. With more disciplines represented, students receive a broader, more in-depth understanding of not only patient care but also the roles of multiple disciplines they will collaborate with during actual rehabilitative practice

Developing an Intervention Toolbox for the Common Health Problems in the Workplace

Development of the Health ↔ Work Toolbox is described. The toolbox aims to reduce the workplace impact of common health problems (musculoskeletal, mental health, and stress complaints) by focusing on tackling work-relevant symptoms. Based on biopsychosocial principles this toolbox supplements current approaches by occupying the zone between primary prevention and healthcare. It provides a set of evidence-informed principles and processes (knowledge + tools) for tackling work-relevant common health problems. The toolbox comprises a proactive element aimed at empowering line managers to create good jobs, and a ‘just in time’ responsive element for supporting individuals struggling with a work-relevant health problem. The key intention is helping people with common health problems to maintain work participation. The extensive conceptual and practical development process, including a comprehensive evidence review, produced a functional prototype toolbox that is evidence based and flexible in its use. End-user feedback was mostly positive. Moving the prototype to a fully-fledged internet resource requires specialist design expertise. The Health ↔ Work Toolbox appears to have potential to contribute to the goal of augmenting existing primary prevention strategies and healthcare delivery by providing a more comprehensive workplace approach to constraining sickness absence

Healthcare Personnel Opinion and their Implementation Obstacles

Context: Hemodialysis HD patients, as well as the dialysis staff, are vulnerable to contracting health-care-associated infections (HAIs) due to frequent and prolonged exposure to many possible contaminants in the dialysis environment. Aim: Assess healthcare personnel's HCP opinion and their implementation obstacles regarding standard precautions (SPs) in the hemodialysis unit. Methods: The study was conducted at the hemodialysis unit at Al Mouwasat University Hospital, Alexandria, Egypt. A descriptive research design was used to collect data for this study. All healthcare personnel working in the setting mentioned above were included. Two tools were used. The first tool is a standard precautions practices in hemodialysis observational checklist: The second tool is a structured interview questionnaire to assess the opinion of healthcare personnel regarding the applicability of standard precautions in the hemodialysis unit and their implementation obstacles. Results: The standard precautions practice score showed unsatisfactory practice among HCP. Regarding their opinion, the majority of HCP disagreed to follow the five moments and reported that the WHO technique of hand hygiene is so sophisticated and time-consuming; they disagreed with changing gloves between patients and considering gloves as a substitute to hand hygiene. The majority recap the needle by two hand techniques disagreed with following respiratory hygiene, and color-coding was accepted only by nurses. Also, it was found that there was a positive correlation between years of experience, infection control training programs, and the level of SPs practice score. Conclusion: Unsatisfactory SPs practices showed a high percentage of HCP. Healthcare personnel tends to agree to certain infection control practices over other practices. Availability and accessibility of equipment and supplies that interfere with the application of SPs practices and lack of knowledge concerning infection prevention and control were considered as implementation obstacles of SPs practices. Education and training of HCP on SPs, together with consistent and robust management support, are recommended. In addition to the development of national precautions after conducting researches that confirm its effectiveness

Intervening in domestic violence : interprofessional collaboration among social and health care professionals and the police

Encountering domestic violence victims, perpetrators and witnesses in the multiprofessional fields of health and social care and policing includes various challenges. Each professional group perceives domestic violence from its own perspective, linked to its position in the field, core tasks, institutional practices and organizational structures. In this study, we examine interprofessional collaboration among Finnish social and health care professionals and police officers, focusing on the practices and conceptions concerning domestic violence interventions. The data consists of 16 focus group interviews, involving a total of 67 interviewees from social and health care professions and the police. The results indicate that successful interprofessional collaboration requires comprehensive knowledge and education on domestic violence as a phenomenon, on the tasks and the duties of different professionals, as well as tolerance and flexibility in their joint efforts. However, the emphasis on professional relationships often shifts the focus from the institutional and structural challenges of interprofessional collaboration to individual interactions. Organizational barriers and differences in goals may impede good intentions from being materialized into concrete outcomes. These findings challenge all organizations and professionals working on domestic violence intervention to reconsider their training, practices and organizational arrangements.Peer reviewe

Improving the accessibility of health services in urban and regional settings for indigenous people

Accessible health services are those that are physically available, affordable (economic accessibility), appropriate and acceptable. Health services can be inaccessible if providers do not acknowledge and respect cultural factors, physical barriers and economic barriers, or if the community is not aware of available services.There are many strategies for successfully improving Indigenous access to urban and regional health services. Individual service providers need to consult with their local community to identify the specific issues relating to their context and selectively adapt the strategies outlined in this report

Primary health care for Aboriginal and Torres Strait Islander children

This final report presents the findings from each of the phases of the Engaging Stakeholders in Identifying Priority Evidence-Practice Gaps and Strategies for Improvement in Primary Health Care (ESP) Project. This report is designed for people working in a range of roles including national and jurisdictional policy makers, managers, community-controlled organisations and government health authorities, peak bodies, clinical leaders, researchers, primary health care staff and continuous quality improvement (CQI) practitioners who may have an interest in the interpretation and use of aggregated CQI data to drive decision making. Stakeholders across services and systems that deliver Aboriginal and Torres Strait Islander primary health care (PHC) engaged in a process to analyse and interpret national continuous quality improvement (CQI) data from 132 health centres. We used a consensus process to identify priority evidence-practice gaps in child health care, based on these data. Stakeholders drew on their knowledge and experience working in Aboriginal and Torres Strait Islander PHC to identify barriers and enablers to addressing the priority evidence- practice gaps, and to suggest strategies to overcome barriers and strengthen enablers to addressing the priority evidence-practice gaps. Important messages emerge from these findings

The Legacy of Hope Summit: A Consensus-Based Initiative and Report on Eating Disorders in the U.S. and Recommendations for the Path Forward

Background: Several unsuccessful attempts have been made to reach a cross-disciplinary consensus on issues fundamental to the field of eating disorders in the United States (U.S.). In January 2020, 25 prominent clinicians, academicians, researchers, persons with lived experience, and thought leaders in the U.S. eating disorders community gathered at the Legacy of Hope Summit to try again. This paper articulates the points on which they reached a consensus. It also: (1) outlines strategies for implementing those recommendations; (2) identifies likely obstacles to their implementation; and (3) charts a course for successfully navigating and overcoming those challenges. Methods: Iterative and consensual processes were employed throughout the Summit and the development of this manuscript. Results: The conclusion of the Summit culminated in several consensus points, including: (1) Eating disorder outcomes and prevention efforts can be improved by implementing creative health education initiatives that focus on societal perceptions, early detection, and timely, effective intervention; (2) Such initiatives should be geared toward parents/guardians, families, other caretakers, and frontline healthcare providers in order to maximize impact; (3) Those afflicted with eating disorders, their loved ones, and the eating disorders community as a whole would benefit from greater accessibility to affordable, quality care, as well as greater transparency and accountability on the part of in-hospital, residential, and outpatient health care providers with respect to their qualifications, methodologies, and standardized outcomes; (4) Those with lived experience with eating disorders, their loved ones, health care providers, and the eating disorders community as a whole, also would benefit from the establishment and maintenance of treatment program accreditation, professional credentialing, and treatment type and levels of care guidelines; and (5) The establishment and implementation of effective, empirically/evidence-based standards of care requires research across a diverse range of populations, adequate private and government funding, and the free exchange of ideas and information among all who share a commitment to understanding, treating, and, ultimately, markedly diminishing the negative impact of eating disorders. Conclusions: Widespread uptake and implementation of these recommendations has the potential to unify and advance the eating disorders field and ultimately improve the lives of those affected. A cross-disciplinary group of eating disorder professionals, thought leaders, and persons with lived experience have come together and reached a consensus on issues that are fundamental to the battle against the life-threatening and life-altering illnesses that are eating spectrum disorders. Those issues include: (1) the need for early detection, intervention, prevention, and evidenced-based standards of care; (2) the critical need to make specialized care more accessible and affordable to all those in need; (3) the importance of developing uniform, evidenced-based standards of care; (4) the need for funding and conducting eating spectrum disorder research; and (5) the indispensability of advocacy, education, and legislation where these illnesses are concerned. During the consensus process, the authors also arrived at strategies for implementing their recommendations, identified likely obstacles to their implementation, and charted a course for successfully navigating and overcoming those challenges. Above all else, the authors demonstrated that consensus in the field of eating spectrum disorders is possible and achievable and, in doing so, lit a torch of hope that is certain to light the path forward for years to come

The Strengths Perspective: Providing Opportunities for Teen Parents and their Families to Succeed

Majority of teen pregnancy literature and practice is deficit based, focusing on the consequences of teen pregnancy; significantly less research is devoted to the teens’ strengths. This article discusses the strengths-based perspective as a viable framework for clinicians and school social workers to implement to help teen parents and their families ameliorate some of the challenges they encounter. This article emphasizes the importance of clinicians, school social workers, and the community to adopt a strengths-based perspective when working with teen parents in order to cultivate strengths and opportunities for success. This article also provides specific strategies for practitioners to implement in order to identify and build strengths among teen parents and their families. An overview of the pivotal role academic institutions have in maximizing strengths through school-based services is also presented

Implementation of Tracking System for Sexual Assault Kits in South Dakota

The average number of sexual assaults occurring in South Dakota from 2012 thru 2017 was 759. Yet, there is no data collection system to track sexual assault exam kits. The main aspects of this paper are identifying the issue of sexual assault exam data collection in South Dakota and providing possible solutions to this issue. The recommendations provided are based off of a national review and analysis of successful programs currently in practice in other states, as well as public health theories for implementation of a new product or innovation. The process of how the national review was carried out is provided along with its successes and failures. No program is perfect, but the state of Idaho is pioneering in implementing a statewide sexual assault kit exam tracking system that is successfully catalyzing change. It is a free program designed to be shared with other public entities and with the capability to be modified to best fit the needs of the respective adopting agency. South Dakota is beginning at ground zero and would benefit from adopting the model that has been developed in Idaho. Idaho’s model makes it possible for an entire state and its respective agencies to collaborate efficiently with key information to better work together in fighting for best practices in response to sexual assault