This consensus policy paper reviews the history, use and significance of telehealth in primary care. The emergence of telehealth as a primary strategy to continue to deliver value based, timely primary care during COVID-19 is discussed with recommendations for future applications, payment and preparation of providers to continue to provide quality care of clients in the future using telehealth.

Thesis (M.S.P.H.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / BACKGROUND: As critically ill patients approach the end of life in an intensive care unit (ICU), their families are often asked to make difficult decisions surrounding the withholding or withdrawal of aggressive care or resuscitative measures. Families are asked to exercise “substituted judgment” by making decisions from the imagined standpoint of the patient. ICU physicians work with families to support them through the decision-making process, but conflict commonly arises between physicians and family members regarding the optimal course of care for a critically ill patient. Existing qualitative data regarding physician perspectives and practical approaches to negotiating and managing these conflicts is limited. OBJECTIVE: To investigate and characterize how critical care physicians approach and manage conflict with surrogates with respect to decisions on withdrawing or withholding aggressive care in the ICU. METHODS: Semi-structured interviews were conducted with eighteen critical care physicians, recruited from two large academic medical centers in Boston. Interview transcripts were analyzed using methods of grounded theory to identify emergent themes and concepts, along with illustrative quotes. RESULTS: Physicians described an initial process of gauging surrogate receptiveness to provider input and recommendations. When faced with resistance to their recommendations for less aggressive care, provider approaches ranged from deference to family wishes to various negotiation strategies designed to change families’ minds. The likelihood of deferring to family in the event of conflict was associated with the perceived sincerity of the family’s “substituted judgment” approach and the ability of the provider to manage patient pain and suffering. Providers described a common theme of concern for the family’s emotional needs; manifestations of this concern included efforts to alleviate guilt and stress associated with end-of-life decision-making by assuming some of the decision-making burden and strategies to repair damage to the provider-family relationship in the aftermath of conflict or disagreement. Providers also described personal stress and anxiety associated with contentious end-of-life decision-making, and the effect of career experience on their approach to conflict with families. CONCLUSIONS: Critical care physicians describe a multi-layered approach to physician-family conflict surrounding end-of-life decision-making in the ICU, including adaptive strategies to achieve optimal outcomes for both patient and family. These findings may help to inform future research and quality-improvement initiatives. / 2031-01-01

Dental phobia, also referred to as "dental anxiety," or "odontophobia," is a significant and intense fear of visiting the dentist for oral treatments. Individuals who experience high levels of this anxious condition avoid going to the dentist. It is estimated that 9 to 15% of both children and adults in America, about 30 – 40 million individuals, experience a level of dental phobia that causes them to avoid visiting the dentist. Individuals affected with this specific form of anxiety often neglect necessary dental visits for varying periods of time, which can, obviously, lead to health concerns in the oral cavity and other parts of the human body, as well as result in mental health and image concerns. When dental phobic patients do manage to attend a dental session, the individual often experiences great levels of anxiety and stress throughout the entire experience, not only creating pain and discomfort for the patient, but also creating adverse treatment circumstances for the dental practitioners that serve to help the patient. Efforts have been made in investigating the effectiveness of various techniques and approaches that could be implemented in the dental setting to ease phobic patients, granting them a less-stressful experience and allowing the dental staff to do their jobs more efficiently in providing the patient with appropriate oral care. There are several techniques used in the dental office today to reduce anxiety such as distraction, controlled breathing techniques, attention focusing, and several sedating methods employing various types of medication, as well as different types of administration. Distraction, controlled breathing, and attention focusing require special attention and an extension of time on the end of not only the patient, but also of the dental staff. These techniques, while possibly offering a reduction in feelings of anxiety, may require multiple attempts and a greater investment of time to show substantial results. Sedation methods may consist of various medications used alone or in a combination to successfully achieve a reduction in anxiety. With the various types of medications and techniques that can be used when sedating a patient, along with the various routes of administration, such as oral, intravenous, and intranasal, sedation methods can be adapted to best suit a patient in terms of their personal preferences and level of comfort, as well as to accommodate time requirements for specific procedures. Each of the techniques and methods used in today’s dental setting should be carefully and strategically evaluated and customized for the anxious or phobic patient in mind. Some methods are favored for certain attributes, varying from ease of use, time required, and speed of onset, to the efficiency in reducing a patient’s anxious or phobic symptoms. Professionals in the field of dentistry must act as providers of the treatment options and resources of the information in regards to the methods so that patients may become aware of the current tactics used in aiding such affected people.

No description available.

No description available.

A thesis submitted to the school of graduate studies in partial fulfilment of the requirements for the degree doctor of philosophy. / Experiencing intimate partner violence (IPV) is associated with a wide range of mental and physical health conditions that often have profound and enduring consequences in the lives of people, families and communities who are affected. Evidence suggests that many of these health concerns can be mitigated with timely access to medical care which addresses patient safety and needs for support. This has led to health policymakers framing IPV as a “health issue” which physicians are uniquely situated to address. Previous research suggests, however, that many physicians are ill-equipped to respond to patients who have experienced IPV, giving rise to questions about how physicians learn about IPV in the course of their training and how this training might be enhanced in order to improve medical care for people affected by IPV. This dissertation is comprised of three original studies that lie at the nexus of health policy and health professions education scholarship. The first study combines environmental scanning and critical discourse analysis to examine how physicians’ roles related to IPV are represented in training resources created for a Canadian medical audience. The second study uses qualitative description to identify physicians’ perceptions of their own roles in caring for patients affected by IPV and highlights the sites and sources of insight that are impactful in shaping these perceptions. The third study integrates key informant technique and interpretive description to synthesize recommendations from stakeholders outside of medicine about physicians’ roles in addressing IPV, and opportunities to improve medical education and practice in the future. Together, these studies offer a critical perspective on broader implications of constructing IPV as a “health issue” that informs practice for physicians, medical educators, researchers, policymakers, and organizers working to improve health care for people affected by IPV. / Dissertation / Doctor of Philosophy (PhD) / People who experience intimate partner violence (IPV) are at a higher risk of experiencing a wide range of serious and long-lasting health issues. Politicians and other policymakers framing IPV as a “health issue” have suggested that doctors are well-placed to address these concerns and to support patients who are dealing with IPV, but research suggests that many doctors lack knowledge or skills that are needed to address IPV with appropriate sensitivity. This dissertation examines how doctors learn about IPV in the course of their medical training by 1) analyzing how doctors’ roles related to IPV are presented in educational resources and policy documents, 2) interviewing doctors about their perceptions of IPV and their related training, and 3) talking to people who do work related to IPV outside of medicine about their suggestions for improving medical education in the future. Taken together, the studies that make up this dissertation can help to inform educators, politicians, and other policymakers working to improve health care for people affected by IPV.

no abstract provided by author / M.A.

This paper considers the Aboriginal population in Canada (composed of First Nations, Métis and Inuit peoples) and explores the hypothesis that the degree to which traditional knowledge concepts, specifically in the area of mental health, is impacted by the extent to which a given population has achieved self-government. Additionally, from a public policy standpoint, this study – using a single case comparison methodology – examines the gap between intentions outlined in policy formulation stage guidance documents, indicating that the Canadian federal government intends to incorporate traditional knowledge to a greater degree, and evidence present at the policy implementation and budgeting stage, where it is clear that the application of the guidance does not always result in the stated outcome. By looking at similarities and differences between the case populations, this study will highlight some successes in the field of mental health policy, assess the challenges that policymakers face in the area of Aboriginal health, and offer suggestions to arrive at a place in the future where fundamental mental health disparities have been reduced for Aboriginal people in Canada.

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH. / Bibliography: leaves 96-100. / by Janis Valdis Liepins. / M.C.P.

Thesis (Ph.D.)(Political Science) --University of Limpopo, 2009. / The primary aim of this study was to advocate for a collaborated health care delivery system that includes indigenous African medicine and is administered and controlled by the government. The objectives were:  To demonstrate how apartheid disrupted the natural development of indigenous healing practices. To dispel the misconception about the use of indigenous African medicine in the treatment of diseases. To demonstrate the need to protect both indigenous African and western European medicine. To demonstrate that African patients consult both indigenous African and western European doctors for various aspects of their treatment in their health care choices. To demonstrate that patients expect the government to provide an effective health delivery system. The main research question was: How can South Africa develop a collaborated health care delivery system using both indigenous African and biomedical health professionals that is effective and open to everyone on an equal basis? The theoretical framework for this study was the Afro-centric worldview in which events and ideas are perceived from an African perspective with the African people as the main players rather than victims. At the centre of the study were the African people, their health, disease pattern and healing practices. The Afro-centric qualitative research design was used. A sample size of 15 indigenous African doctors, 50 western European oriented health professionals and 84 patients participated in the study. The open coding method of data analysis was used to analyze data obtained from semi-structured in-depth interviews. The major findings of the study are that:  The belief of the African people in the existence of the ancestors and spirituality remains unshakeable. The strong belief n the ancestors make the diagnosis and treatment of diseases essentially religious practices. In the African culture, there are no preventative measures against natural illnesses, but there are preventative measures that are used against witchcraft/sorcery from entering a homestead and causing illness among members of a family. African people utilize both health care systems simultaneously and/or interchangeably depending on the seriousness of the illness and the knowledge and experiences that the illness can be effectively treated using indigenous African medicine or biomedicine. Both indigenous African doctors and biomedical health professionals play an important role in the provision of health. Recommendations The study recommends that when policy guidelines on the collaboration of indigenous African and western European medicine are drawn up, the following should be considered: Legislation to protect indigenous knowledge on African medicine Legislation that controls the qualification and registration of indigenous African doctors. Inclusion of indigenous African medicine in the curricula of all health professionals. / N/A