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1 – 10 of over 39000
Article
Publication date: 3 July 2021

Emily Samuels and Nicola Moran

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general…

Abstract

Purpose

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general population. This paper aims to explore the experiences of individuals accessing primary health care following discharge from secure services, and the practitioners who support them.

Design/methodology/approach

Face-to-face qualitative interviews were conducted with service users (n = 4) and mental health practitioners (n = 4) within a forensic community mental health team in one NHS Trust in England in 2019. Data were analysed using the Interpretative Phenomenological Analysis.

Findings

Four super-ordinate themes emerged: perceived importance of physical health, agency, responsibility and relationships. Service users mostly saw themselves as passive recipients of health care and prioritised their mental health over their physical health. Close working relationships meant that mental health practitioners were often the first contact for service users with any health issue and thus felt a sense of responsibility for their physical health care. Service users who did access primary care reported that consistency of professional, feeling understood and listened to without judgement or stigma were important.

Practical implications

Interventions for service users that include practicalities and strategies to facilitate independence in physical health care, and collaborative working between primary care and forensic mental health services, are encouraged.

Originality/value

This study highlights some of the unique challenges in forensics around improving physical health outcomes for individuals with SMI.

Details

The Journal of Forensic Practice, vol. 23 no. 2
Type: Research Article
ISSN: 2050-8794

Keywords

Article
Publication date: 21 October 2022

Rudra Dahal, Kalpana Thapa Bajgain, Bishnu Bahadur Bajgain, Kamala Adhikari, Iffat Naeem, Nashit Chowdhury and Tanvir C. Turin

Canada has a globally recognized universal health-care system. However, immigrants experience a number of obstacles in obtaining primary health care (PHC) that may differ within…

Abstract

Purpose

Canada has a globally recognized universal health-care system. However, immigrants experience a number of obstacles in obtaining primary health care (PHC) that may differ within various communities due to the intersection of culture, gender and other identities. To date, no research has been done on the difficulties Nepalese immigrant women in Canada may face accessing PHC. The purpose of this study was to learn about their perceptions of barriers to PHC access and to share the findings with a wide range of stakeholders, including health-care providers and policymakers.

Design/methodology/approach

The authors conducted a community-engaged qualitative study in Calgary, Alberta, Canada. A total of six focus group discussions (FGD) among 34 participants (each FGD consisted of 5–7 participants) were conducted. The authors collected demographic information before each focus group. The FGDs were audio recorded and transcribed verbatim. The transcriptions were coded and analysed thematically.

Findings

The focus groups identified long wait times as a major barrier to receiving PHC services. Long wait times in emergency rooms, unable to see family doctors when they were sick, tedious referral procedures, long waits at the clinic even after scheduling an appointment, family responsibilities and work all impacted their access to PHC. Further, a lack of proficiency in English was another significant barrier that impeded effective communication between physicians and immigrant women patients, thus compromising the quality of care. Other barriers mentioned included lack of access to medical records for walk-in doctors, insufficient lab/diagnostic services, a lack of urgent care services and unfamiliarity with the Canadian health-care system.

Originality/value

Accessible PHC is essential for the health of immigrant populations in Canada. This study recognizes the extent of the barriers among a relatively less studied immigrant population group, Nepalese immigrant women, which will help effectively shape public policy and improve access to PHC for the versatile immigrant population fabric in Canada.

Details

International Journal of Migration, Health and Social Care, vol. 18 no. 4
Type: Research Article
ISSN: 1747-9894

Keywords

Article
Publication date: 20 October 2010

Jeremy Gibson and Rory O'Connor

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body functions…

Abstract

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body functions, structures and activities and participation, as well as contextual factors (environmental and personal factors), interact with the health condition to limit this access. The AMED, CINAHL, EMBASE, Medline and psychINFO databases were searched for original study articles in English, dating from 1974 to 2008. Review articles and expert opinion were excluded. Each study had two independent reviews by either a general practitioner or specialist in rehabilitation medicine. Each study was critically appraised according to the National Service Framework for Long‐term Conditions (Department of Health, 2005a) methodology and recorded on standardised data extraction sheets. Studies of poor quality were excluded. Sixty studies were included. No randomised controlled trials were identified. Studies broadly fell into the following three main groups: database studies (n=27), quantitative surveys (n=20) and qualitative interviews (n=13). Disabled people are restricted in accessing health care and report less satisfaction with their medical care. Many of the identified studies were from the United States (US) and based on subjective reporting. More objective evidence is needed, especially in the UK, to clarify the true level of access to health care in people with disabilities. The complex, interdependent factors in providing health care to disabled people require complex solutions.

Details

Social Care and Neurodisability, vol. 1 no. 3
Type: Research Article
ISSN: 2042-0919

Keywords

Article
Publication date: 15 August 2011

Wendel Abel, Clayton Sewell, Eulalee Thompson and Teisha Brown

The aim of this paper is to review strategies implemented to improve access to mental health care in Jamaica.

Abstract

Purpose

The aim of this paper is to review strategies implemented to improve access to mental health care in Jamaica.

Design/methodology/approach

The paper is a review of peer‐reviewed articles, official documents, service data and the WHO AIMS data.

Findings

Despite limited resources, Jamaica was able to shift from institutional care to community care by implementing the appropriate policy framework, building on primary care services, providing mental health beds at the community level, the training of specialized community mental health nurses (mental health officers) and improving access to psychotropic drugs. As a result, the country has developed a more accessible mental health service; the number of patients treated in the community has doubled over the past decade and 67 percent of inpatients are now treated outside of the mental hospital and there has been a reduction in the population of the mental hospital.

Originality/value

The paper illustrates the approach that serves as a model for mental health services in resource‐limited countries.

Details

Ethnicity and Inequalities in Health and Social Care, vol. 4 no. 3
Type: Research Article
ISSN: 1757-0980

Keywords

Article
Publication date: 1 April 2008

Andrew Nocon, Liz Sayce and Zenobia Nadirshaw

It is well documented that the health of people with learning disabilities is worse in many ways than that of the rest of the population, and their lives are shorter. The article…

Abstract

It is well documented that the health of people with learning disabilities is worse in many ways than that of the rest of the population, and their lives are shorter. The article reports on the results of a wide and diverse research programme, including reviews of the relevant literature, consultation, area studies and an inquiry panel, designed to gather the most complete picture possible of these health inequalities and the aspects of health services that permit them. The areas covered are morbidity, access to services, diagnosis, health problems, health promotion, health checks and services for people from black and minority ethnic populations. Inequalities are found in all these areas, some arising from professional prejudice, some from inadequate responses to characteristics shown by learning‐disabled people and some from unidentified causes. The article concludes with a summary of the measures needed to rectify the situation.

Details

Tizard Learning Disability Review, vol. 13 no. 1
Type: Research Article
ISSN: 1359-5474

Article
Publication date: 4 May 2022

Hamza Kamran, Hadi Hassan, Mehr Un Nisa Ali, Danish Ali, Moizzuddin Taj, Zara Mir, Munj Pandya, Shirley R. Steinberg, Aamir Jamal and Mukarram Zaidi

This study examined 46 articles in total, which yielded 5 recurring themes: perceived discrimination, language barriers, socioeconomic barriers, cultural barriers and…

Abstract

Purpose

This study examined 46 articles in total, which yielded 5 recurring themes: perceived discrimination, language barriers, socioeconomic barriers, cultural barriers and educational/knowledge barriers. The two most dominant themes found were the inability to speak the country's primary language and belonging to a culture with different practices and values from the host country. The review provides vital insights into the numerous challenges that immigrants and refugees encounter as they navigate through the primary care systems of English-speaking (E-S) countries and potential solutions to overcome these barriers.

Design/methodology/approach

Access to adequate healthcare plays a central part in ensuring the physical and mental wellbeing of society. However, vulnerable groups such as immigrants and refugees, face numerous challenges when utilizing these healthcare services. To shed further light on the barriers impacting healthcare quality, the authors’ team performed a scoping thematic review of the available literature on immigrant and refugees' experiences in primary healthcare systems across E-S countries. Articles were systematically reviewed while focusing on healthcare perceptions by immigrants, potential barriers and suggestions to improve the quality of primary care.

Findings

This work looked at qualitative and quantitative information, attempting to combine both paradigms to give a rich and robust platform with which to devise a further study through focus groups. Qualitative inquiry accounted for 28/46, or 61%, of studies, and quantitative inquiry made up 9/46, or 20%, while 9/46 or 20% combined both qualitative and qualitative. Emerging themes are -perceived ethnic discrimination faced by immigrants accessing primary care, language barriers, socioeconomic barriers, cultural barriers and educational barriers.

Research limitations/implications

Most medical journals rely on quantitative data to relate “results” and cases. The authors set out to change ways in which medical reports can be done. Most of the authors were solely trained in quantitative research; consequently, they had to learn to isolate themes and to use a narrative approach in the article.

Practical implications

Research implications clearly indicated that using a qualitative (phenomenological) approach with quantitative data created a human and reachable discourse around patient comfort and the realities of immigrants and refugees to E-S countries. The use of this research opens medical practitioners (and patients) to a richer understanding within a usually difficult arena.

Social implications

By understanding the qualitative nature of medical research, practitioners, students and mentors are able to bridge medical quantitivity to the human, widening doors to social science and medical collaboratory research.

Originality/value

As stated above, this work is important as it understands the human/patient element and de-emphasizes the medical obsession with quantifying the lives of patients through hard data. This is a unique collaboration that relies on the qualitative to pinpoint and define the difficulties of newcomers to E-S countries.

Details

Qualitative Research Journal, vol. 22 no. 3
Type: Research Article
ISSN: 1443-9883

Keywords

Article
Publication date: 1 September 1997

Frederic Stansfield and Andrew Taylor

General medical practitioners (GPs) in the UK are working from increasingly sophisticated premises. UK Government consultations have highlighted that inadequate premises are…

329

Abstract

General medical practitioners (GPs) in the UK are working from increasingly sophisticated premises. UK Government consultations have highlighted that inadequate premises are currently a barrier to improvements in primary health care. Therefore the National Health Service (Primary Care) Act 1997 permits pilot schemes for primary health care which may encompass property improvements. Provision of quality buildings has implications for the willingness of patients to consult GPs, the range of services offered by family doctors and the cost‐effectiveness of primary health care delivery. The decentralized nature of primary health care raises issues about the evolution of building design knowledge to cater for technical and organizational innovations in health care. As primary health care facilities become more sophisticated, advances in construction management techniques need to be applied so that they are procured efficiently. Current real estate arrangements for the provision of primary health care facilities are causing concern. The capital investment involved is increasingly burdensome for GPs. Lack of Government finance is leading to pressures for the employment of private capital, with accompanying new opportunities for property managers.

Details

Property Management, vol. 15 no. 3
Type: Research Article
ISSN: 0263-7472

Keywords

Article
Publication date: 5 March 2020

Philippa Miskelly, Ngaire Kerse and Janine Wiles

Managing patients in advanced age is complex, especially when it comes to multi-morbidities and polypharmacy. The purpose of this qualitative study is to investigate challenges…

Abstract

Purpose

Managing patients in advanced age is complex, especially when it comes to multi-morbidities and polypharmacy. The purpose of this qualitative study is to investigate challenges, opportunities and potential solutions from a primary healthcare provider perspective.

Design/methodology/approach

Fifty-seven participants joined in group discussions on challenges and opportunities of working with advanced age. Participants included general practitioners (GPs), practice nurses, students and administration staff working in ten general practices. A thematic analysis was developed, supported by NVivo software.

Findings

Poor lines of communication and fragmentation of services between differing levels of health care services available for older people were highlighted. This has implications for quality of care and equity of services. Participants also reported challenges in treatment and funding regimes.

Research limitations/implications

The small sample size and regional nature of the study, along with the semi-structured nature of the group discussions and rigorous thematic analysis, indicate that this qualitative data is transferable, dependable, confirmable and credible. Comparing the views of tertiary and community services would be useful.

Practical implications

A range of potential strategies and solutions to the current fragmented services was offered by GPs. For example, adequately funded and staffed community-based health hubs; IT platforms enabling timely flow of patient information between primary and tertiary health providers and creation of medical, nursing and allied health roles aimed at improving synergy between GP and tertiary services.

Originality/value

Obtaining the perspectives of general practice highlights the challenges and complexities of caring for those in advanced age brings. These insights have not been previously been explored in-depth within this setting in New Zealand.

Details

Quality in Ageing and Older Adults, vol. 21 no. 1
Type: Research Article
ISSN: 1471-7794

Keywords

Article
Publication date: 25 May 2023

Barnali Biswas, Piyal Basu Roy, Ankita Saha and Abhijit Sarkar

The locational disadvantage of a health-care centre often restricts adequate delivery of health-care services in an area. The purpose of this study is to examine the status of…

117

Abstract

Purpose

The locational disadvantage of a health-care centre often restricts adequate delivery of health-care services in an area. The purpose of this study is to examine the status of primary health-care services in such a geographically disadvantageous area which is confined by forests, tea gardens and undulating topography.

Design/methodology/approach

Necessary secondary data of 13 primary health centres and 236 sub-centres has been collected from the Office of the Chief Medical Officer of Health. Based on obtained data, Health-care Infrastructure Index has been prepared which has been validated by an expert panel, and subsequently, the Thiessen Polygon method has been applied through Arc GIS software to show spatial variation of health-care services delivered by different health-care centres.

Findings

In the study area, there is wide variation found in the case of physical facilities, caregivers and connectivity of road networks, which altogether affect the overall status of health-care services. Among all the indicators, some health-care centres experience staff shortages for prolonged non-recruitment, inaccessibility and inconsistent patient load in different health centres.

Originality/value

In spite of the unfavourable geographical landscape, health-care centres have to be set up wherever possible. There is a need to make new roads and simultaneously the existing road connectivity should be improved so that patients and caregivers can move quickly whenever required. Existing physical facilities need to be renewed or redeveloped along with increasing the number of doctors and other health-care providers as per the need of people with an adequate and optimum level of services.

Details

International Journal of Human Rights in Healthcare, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2056-4902

Keywords

Article
Publication date: 9 August 2023

Davllyn Santos Oliveira dos Anjos, Magda Duarte dos Anjos Scherer, Juliana Leal Ribeiro Cantalino and Everton Nunes da Silva

In 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over…

Abstract

Purpose

In 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how the PMAQ was implemented locally and whether this variation in implementation affects performance, particularly, in terms of work process indicators. This study compared different cases of municipal-level PMAQ implementation (bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of the work processes, actions and services of FHTs.

Design/methodology/approach

This was a cross-sectional analytical study using secondary data from an external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3 of the program (2013–2019). Variables regarding work processes, actions and services were classified as “Quality Assurance – QA” or “Continued Quality Improvement – CQI”, and an individual score was assigned based on the average score of each variable.

Findings

The four clusters displayed an increase in overall QA and CQI scores between the two program cycles; though this increase was small between the set of primary health care teams that received bonuses and those that did not.

Originality/value

This paper contributes to bridging the gap in the scientific literature for evaluative studies on the relationship between direct payment for performance to health professionals and better quality actions and services in low and middle-income countries.

Details

International Journal of Public Sector Management, vol. 36 no. 6/7
Type: Research Article
ISSN: 0951-3558

Keywords

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