The experiences of rural British Columbians accessing surgical and obstetrical care

The attrition of small volume surgical and maternity services in rural Canada over the past three decades has made access to these services especially challenging for rural citizens. While many of these closures have occurred as consequences of regionalization, a strategy to regionally centralize healthcare services, many studies investigating outcomes of regionalization have focused on costs and medical endpoints rather than the direct experiences of the rural patients affected. In this study, we aimed to understand and document the experiences of rural residents accessing procedural and maternity care both locally and away from home. This study is part of a larger evaluation framework which prioritizes the insight of rural residents regarding healthcare issues. We conducted focus groups and interviews with 54 participants in six communities across British Columbia’s southeastern and northern regions. Thematic analysis showed that rural residents experienced unique challenges when leaving their communities to access care. This included logistics of travel, poor coordination of care between multiple providers, and financial and psychosocial issues. Despite being mostly content with the medical care received, participants expressed needing more attention to their unique needs and preferences as patients leaving their home communities for care. Understanding these challenges facilitates the planning of healthcare services in a more equitable manner. Our findings suggest that we need increased patient-centered healthcare planning that aims to alleviate the financial and psychosocial strain on rural residents. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Learners’ experiences of an enhanced surgical skills training program for family physicians

Background: Family Physicians with Enhanced Surgical Skills (FPESS) have sustained rural operative care, including local access to caesarean section, in many communities across rural Canada and internationally. The contemporary role of FPESS within the health system, however, has not been without challenges. The 12-month Prince Albert Enhanced Surgical Skills (ESS) program intakes two learners a year and is one of only two accredited programs in Canada offering a scope of surgical practice beyond operative delivery.Methods: This paper highlights the results of an evaluation of graduates’ experiences of training and the post-training environment. Graduates were practicing in Western and Northern Canada after completing the ESS training program, specifically in British Columbia, Alberta, Manitoba, and the Northwest Territories.Results: Findings suggest the overall success of the program in meeting learners’ needs. There was a close match between the training curriculum and post-training practice. Conclusion: The findings from the post training experience suggest that sustainability of ESS is linked to 1) creating pathways to privileges between the ESS community and the Health Authorities, 2) building functional and trusting relationships with surgical specialists, and 3) creating a web of accessible effective rurally appropriate surgical Continuing Professional Development (CDP). Ongoing CPD is identified as essential in increasing the comfort of FPESS

GP Surgeons’ Experiences of Training in British Columbia and Alberta: A Case Study of Enhanced Skills for Rural Primary Care Providers

Background: There has been a steady erosion of family physicians with enhanced surgical skills providing care for rural residents. This has been largely due to the lack of formal training avenues and continuing medical education (CME) opportunities afforded to those interested and attrition of those currently practicing.. Methods: A qualitative study was undertaken using an exploratory policy framework to guide the collection of in-depth interview data on GP surgeons’ training experiences. A purposive sample of GP surgeons currently practicing in rural BC and Alberta communities yielded interviews with 62 participants in person and an additional 8 by telephone. Interviews were audio recorded and transcribed then subjected to a process analysis. Results: Participants thematically identified motivations for acquiring advanced skills training, resources required (primarily in the area of solid mentorship), the most efficacious context for a training program (structured) and differences in mentorship between obstetricians and general surgeons. Conclusions: Mentors and role models were the most salient influencing factor in the trajectory of training for the participants in this study. Mentorship between specialists and generalists was constrained at times by inter-professional tensions and was accomplished more successfully within a cirriculum-based, structured environment as opposed to a learner-responsive training environment

The Experience of GP Surgeons in Western Canada: The Influence of Interprofessional Relationships in Training and Practice

Background: Challenges to the sustainability of rural healthcare in Canada demands innovative solutions to human resources shortages in rural communities.One solution is to support generalists with enhanced skills to meet some of the surgical needs of rural residents. Despite favourable outcomes, generalist surgical care is becoming a vanishing option due to the lack of interprofessional support garnered in education and practice.Methods and Findings: Data were gathered through semi-structured interviews with 28 general practitioner surgeons (GPS) face-to-face and 12 GPS over the telephone. Interview participants articulated four themes, including their beliefs about GP surgery, the context of interprofessional relationships between general surgeons and GPS, and qualities of and barriers to interprofessional practice.Conclusions: The importance of establishing positive interprofessional relationships within healthcare in relation to quality of care, outcomes, and system efficiency demands addressing interprofessional challenges at a macro (systems) and micro (personal interaction) level

Essences and imperatives: An investigation of technology in childbirth

This paper explores the connection between our cultural inclination towards technology, the nature of technology itself, and birthing women's attitudes towards obstetrical technology using an analytical framework that includes literature on the philosophy of technology, as well as the sociology of childbirth. Data were gathered using a survey instrument and semi-structured interviews to contrast women's attitudes towards technology and experiences of childbirth in a large Canadian city: 25 women who planned a home birth assisted by a midwife and 25 low-risk women who planned a hospital birth. The results reveal that the total number of interventions the women experienced correlates in part to their attitudes towards technology: resistance to it on the part of home birthers and flexibility on the part of hospital birthers. Home birthers' resistance to technology stemmed from a consciousness of its overuse which blocks awareness of a sacred and authoritative "birthing force." Rather than rejecting technology, however, home birthers made conscious decisions about its appropriate use and relied upon access to a range of secondary technologies.Obstetrical technology Childbirth Home birth Canada

Cultures of risk and their influence on birth in rural British Columbia

Abstract Background A significant number of Canadian rural communities offer local maternity services in the absence of caesarean section back-up to parturient residents. These communities are witnessing a high outflow of women leaving to give birth in larger centres to ensure immediate access to the procedure. A minority of women choose to stay in their home communities to give birth in the absence of such access. In this instance, decision-making criteria and conceptions of risk between physicians and parturient women may not align due to the privileging of different risk factors. Methods In-depth qualitative interviews and focus groups with 27 care providers and 43 women from 3 rural communities in B.C. Results When birth was planned locally, physicians expressed an awareness and acceptance of the clinical risk incurred. Likewise, when birth was planned outside the local community, most parturient women expressed an awareness and acceptance of the social risk incurred due to leaving the community. Conclusions The tensions created by these contrasting approaches relate to underlying values and beliefs. As such, an awareness can address the impasse and work to provide a resolution to the competing prioritizations of risk.</p

Cultures of risk and their influence on birth in rural British Columbia

Background: A significant number of Canadian rural communities offer local maternity services in the absence of caesarean section back-up to parturient residents. These communities are witnessing a high outflow of women leaving to give birth in larger centres to ensure immediate access to the procedure. A minority of women choose to stay in their home communities to give birth in the absence of such access. In this instance, decision-making criteria and conceptions of risk between physicians and parturient women may not align due to the privileging of different risk factors. Methods In-depth qualitative interviews and focus groups with 27 care providers and 43 women from 3 rural communities in B.C. Results When birth was planned locally, physicians expressed an awareness and acceptance of the clinical risk incurred. Likewise, when birth was planned outside the local community, most parturient women expressed an awareness and acceptance of the social risk incurred due to leaving the community. Conclusions The tensions created by these contrasting approaches relate to underlying values and beliefs. As such, an awareness can address the impasse and work to provide a resolution to the competing prioritizations of risk.Family Practice, Department ofMedicine, Faculty ofReviewedFacult

The Costs of separation : the birth experiences of women in isolated and remote communities in British Columbia

Cet article est le résultat d’une enquête qualitative des expériences d’accouchées dans les communautés éloignées de la Colombie-Britannique. Les résultats donnent une plus haut taux de mortalité causée par l’obligation pour les femmes de quitter leur communauté pour accoucher.Medicine, Faculty ofFamily Practice, Department ofReviewedFacult