Les défis de la médecine d'urgence et la qualité de vie au travail des médecins

Les urgences jouent un rôle central dans le système de santé dans la mesure où elles constituent un important filet de sécurité pour répondre aux besoins de soins immédiats des personnes n’ayant pas de source habituelle de soins ou ne pouvant pas avoir un accès immédiat à des soins de première ligne. Cependant, les problématiques sur les urgences diffèrent qu’on soit en milieu urbain ou en milieu rural et il existe un très grand écart entre les pays développés et les pays en développement. Toutefois, malgré cet écart, les problématiques sur les urgences en milieu rural ont plusieurs grands thèmes semblables dans la plupart des pays. À titre d’exemple, le Canada, les États-Unis (É.-U.) et l’Australie qui sont les grands leadeurs mondiaux dans les domaines de la recherche sont confrontés aux mêmes problématiques en milieu rural. En Afrique Subsaharienne (ASS), les professionnels de santé du milieu rural doivent composer aussi avec un accès quasi inexistant des services diagnostiques et spécialisés. Également, des distances très importantes entre les centres ruraux et les centres spécialisés ont été rapportées dans la littérature. Par ailleurs, il important de noter que tous les facteurs mentionnés ci-haut ont un impact considérable sur la qualité de vie au travail des médecins. En effet, la surcharge du travail et les horaires irréguliers entrainent un énorme stress et conduisent à un épuisement professionnel et une détresse psychologique, laquelle situation impacte négativement la qualité de vie des médecins au travail. En outre, une gestion des ressources humaines ouvertement tournée vers la qualité de vie au travail permet de prendre en considération plusieurs problématiques rencontrées par les médecins sur le lieu de travail.Emergency departments (ED) play a central role in the health care system to the extent that they are an important safety net to meet the immediate health needs of people with no usual source of care or cannot have immediate access to primary health care. However, issues on emergencies that differ either in urban or in rural areas and there is a very large gap between the developed and developing countries. Despite this difference, the issues on rural emergencies remain the similar in most countries. For example, Canada, the United States (the U.S.), and Australia are major global leaders in the areas of research are faced with the same rural issues. In sub-Saharan Africa, the rural health professionals must also deal with almost no access to diagnostic and specialized services. Also, great distances between rural centers and specialized centres. Furthermore, it should be noted that all the above latter mentioned factors have a significant impact on the quality of work life of emergency doctors. In fact overwork and irregular hours result in enormous stress, leading to burnout and psychological distress, which situation negatively impact doctors quality life at work. Moreover, human resource management openly turned to work the quality of life can take into consideration all the issues encountered by doctors at work

Assessing the feasibility, acceptability, and fidelity of a tele-retinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: a protocol

Background: Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attend screening. Screening rates are even lower in immigrants to Canada including people from China, Africa, and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French-speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. // Methods: We will work with our health system and patient partners to conduct a 6-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50–150 patients and 5–10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, and we will use a survey informed by the National Institutes of Health framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention-related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. // Discussion: This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention

Assessing the feasibility, acceptability, and fidelity of a tele-retinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: a protocol

Abstract Background Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attend screening. Screening rates are even lower in immigrants to Canada including people from China, Africa, and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French-speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. Methods We will work with our health system and patient partners to conduct a 6-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50–150 patients and 5–10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, and we will use a survey informed by the National Institutes of Health framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention-related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. Discussion This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention