This thesis examines the contribution that geographical analysis can make to the study of the variation in the patterns of human health and subsequently to the discussion on the type and level of use of the public health service in a rapidly developing country. The current study was conducted in Jeddah Governorate, Kingdom of Saudi Arabia during the period 1994 and 2000. One of the main aims was to examine the pattern of health services provided in Saudi Arabia and this aim was achieved by investigating the provision and use of the Public Healthcare services. An attempt was made to clarify the complex web of relations that existed between, on the one hand, the different socioeconomic and geographic factors and on the other, the distribution of common ailments together with the level of utilization of health services. Shortcomings in the nature of the official health statistics regarding socioeconomic conditions of the patients were remedied through the use of a questionnaire. A tot al of 1000 patients from the eight PHCCs were surveyed for their use of the public health service. Data was collected from the same patients on their socio-economic, education and habitation details. This sample was used to supplement the data collected from the official government health statistics. These two data sets permitted an evaluation of the occurrence of different ailments and the variations in geographic distribution among the eight selected PHCCs. Difficulties persisted in the availability of official 1992 census data until publication of census data became available in 1999. In contrast to the problems of the census data, the availability of accurate and up-to-date patient records compiled by Ministry of Health staff was of considerable benefit to this research project. Use was made of Geographic Information Systems software for the analysis of data collected at the level of the PHCC. This allowed visual identification of the spatial variation in the use of the different health services and also allowed the identification of gaps in healthcare provision. The study showed that a density of habitation index used as a prime indicator of socio-economic status could be used as an indicator of the occurrence level for a number of common diseases. A pattern of disease was observed that suggested that the number of visits to PHCCs was substantially higher in low socio-economic districts compared to medium and higher socio-economic districts. It can be shown that the most common ailment was Upper Respiratory Tract Infections followed by Dental and Gingival diseases. Persons aged between 15 and 44 years made most visits to PHCCs although children under 15 years made proportionately greater use of PHCC facilities. No difference could be found between Saudi and Non Saudi as regards the occurrence of the most common ailments and diseases. The lack of difference was probably due to the close integration of the two population groups and the sharing of the same local environment. This similarity occurred despite considerable differences in income levels and socio-economic status. The level of utilisation of health centers in the selected districts showed differences, being higher in those districts categorized as low socio-economic in the south of Jeddah when compared to higher socio-economic districts in the north of the city. It was evident that the difference in socio-economic factors had an impact on the occurrence of some frequently occurring diseases e.g. URI, Dental, Ophthalmic, musculoskeletal and skin diseases. Although not primarily concerned with private health care facilities, for completeness sake some information was collected on the use of private health care in conjunction with public health care facilities. The author was surprised to discover that greatest use of private facilities occurred among women and children patients from Al Nuzla al Yamaneyyah and Al Thaalebah, districts that were characterised by low socio-economic conditions. The use of traditional folk healing was also briefly studied as this form of treatment remains important for some patients. Results showed that there was no difference between the educational standards of patients and their use of traditional folk healers. Again, children and women constituted the majority (86.6%) of users of traditonal healing with Saudi users (18.9%) higher than non Saudi (11.4%). There remains the supposition that alternative medicine may be of far greater importance than the sparse official data suggests. The unquantified illegal immigrant population may be totally reliant on unofficially operating alternative medicine centres. The thesis concludes by recommending a number of improvements to the existing public health care system. Some changes in the policy and practice of PHCC services will inevitably require more financial resources. These include an extension of the opening times of PHCCs and an increase in the number of specialist facilities such as dental surgeries. Other changes may not require more finances. These include a strengthening of communication and co-operation between PHCCs and hospitals to improve the referral of patients. Expansion of the existing computer network connecting PHCCs with hospitals should be given high priority.

Class of 2017 Abstract / Objectives: (1) To assess the access to and quality of primary care for patients living with a psychiatric condition(s). (2) To identify demographic factors that may influence the access and quality of primary care services. Methods: Subjects were recruited at HOPE Inc., a behavioral health resource center, in Tucson, Arizona, during pharmacy student-run health fairs. Participants were surveyed using the Primary Care Assessment Tool (PCAT) a questionnaire developed by Johns Hopkins, which assess four domains of primary care. Participants were also surveyed about demographics, mental health diagnosis and their SMI designation. For objective (1): Descriptive statistics for each domain of the PCAT were performed to assess the level of access and quality of care, including comparison to a hypothesized score. For objective (2): Due to the small sample size only descriptive analysis of the demographic data was performed. Results: A total of 11 subjects were surveyed using the PCAT with an average score of 67.64±12.18. This was higher than the hypothesized score of 46. On average, in all four PCAT domains participants scored higher than the hypothesized, value. The lowest scoring domains were, “Care at first contact - Access” and “Coordination of care” (10.45±3.62, Hypothesized score: 8) and (12.36±5.82, Hypothesized score: 10) respectively. The highest scoring domain was “Care at first contact - utilization” (11.09±1.92, Hypothesized score: 12). Conclusions: This study helped to provide a framework for future studies of primary care services using the PCAT survey.

Nearly a third of all emergency department (ED) visits are for non-emergent conditions. Several factors contribute to non-emergent ED use, though the relative importance of these factors and how non-emergent ED users differ from those seeking similar care in primary care (PC) settings are less clear. Surveys were administered to adult, English-speaking, primary care patients seeking same-day, non-emergent care in the ED and PC clinic at an urban, safety-net hospital during normal clinic hours. ED patients were eligible if they had a primary care physician (PCP) located at the hospital and thus the ability to seek same-day care in the PC clinic. Surveys assessed sociodemographics and six major care-seeking factors (perceived urgency, cost, convenience, beliefs about alternative sites, access, and referral). Patient characteristics were compared between sites using t-tests and Fisher’s exact test, and multivariable logistic regression identified predictors of ED use. Compared to PC patients (n=61), ED patients (n=59) were significantly more likely to be male, middle-aged, homeless, Medicaid-insured, and unmarried with a trend toward being non-White and less educated. ED patients were significantly more likely to perceive the cost of an ED and PC visit to be the same/free (69.1% vs. 37.1%; p<0.01) and to believe the ED would provide higher quality care (24.6% vs. 3.6%; p<0.001). PC patients were more likely to consider their doctor’s office as their usual source of care (83.1% vs. 37.9%; p<0.0001) and believe it is easy to make PCP appointments on short notice (74.5% vs. 54.2%; p=0.04). In the adjusted model, patients whose usual source of care was not the doctor’s office had the highest odds of non-emergent ED use (aOR 4.25, 95% CI 1.28–15.20), and patients reporting ease of scheduling PCP appointments on short notice had significantly lower odds of ED use (aOR 0.19, 95% CI 0.04–0.67). Non-emergent patients in the ED and primary care clinic differed by sociodemographics, usual source of care, and perceptions of cost, care quality, and ease of scheduling appointments. Opportunities exist to reduce unnecessary ED use in similar populations by promoting the primary care clinic as a routine and easily accessible source of high-quality care. / 2019-11-08T00:00:00Z

Patients who have chronic diseases are often readmitted to the hospital within 30 days of being discharged. In the United States preventable hospital readmissions cost approximately $12-$17.4 billion annually. The Institute of Healthcare Improvement [IHI] has identified one key measure for reducing preventable readmissions and that is a timely post hospital follow-up visit. Although this seems to be a simple task, studies have revealed that as many as one-third of patients discharged from the hospital are not following up with their primary care provider. In North Dakota the percentages of patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, type 2 diabetes, and pneumonia have steadily increased over the last several years. A North Dakota critical access hospital report revealed a high percentage of patients with a chronic disease are being readmitted within 30 days. Identifying barriers to care in North Dakota can help to reduce the rate of readmission within the state. This study seeks to identify perceived barriers as observed by primary care nurse practitioners to improve patient outcomes and reduce hospital readmission rates.

The purpose of this study is to describe South Sudanese refugee women's perceptions of access to, use of, and their culture's influence on their access to and use of healthcare after resettling in the United States. Background: The prolonged civil-war and famine in the African nation of Sudan has displaced millions of women and children over the last two decades. Refugee women who are resettled to the United States must make adjustments to learn how to live in American society and culture. There is little known about healthcare access and use by South Sudanese refugee women in the United States. Conceptual Framework: The theory of Cultural Universality and Diversity was the conceptual framework guiding the study. Methods: Qualitative description method was used to describe Sudanese refugee women's perception of their access to, use of, and cultural influences on access and use of healthcare after resettling in the United States. Results: South Sudanese refugee women's perception of accessing healthcare is understood through themes: Women's means of accessing healthcare, types of healthcare institution. Perception of healthcare use is understood through the relationship between these themes: Care of self, concerns of the women, and the experience of using healthcare. Perception of cultural influence on accessing and using of healthcare is understood through these themes: Coping, South Sudanese healthcare culture, and role of family. Implications: The findings of this study may facilitate understanding healthcare access and use by refugee women. The knowledge from this study can lead to the development of culturally congruent interventions for resettled refugee women, in hopes of improving their access to and use of healthcare.

Abstract Introduction and Background: Minority populations struggle to gain access to equitable healthcare due to cultural variations and language barriers. It is paramount for providers to accommodate to the differing needs of underserved minority groups. Purpose Statement: We analyzed information on the effects of community-based interventions aimed at improving healthcare access for minorities. Literature Review: We used PubMed as our main database. For our search, we looked up the keywords “Healthcare Access AND Minorities.” Next, we filtered articles that had been published since 2017 and sorted to include clinical trials, randomized control trials, and meta-analyses. After that, we came across ninety-eight total articles, and picked five of the most critical. Findings: From the first two articles, patient navigators have been shown to be effective in helping minorities navigating the information and decisions presented to them in healthcare. The researchers in the third study found that minority groups are at a greater risk for a health literacy deficit. Our next article found that African Americans treated with computerized cognitive behavioral therapy saw a significant decrease in anxiety and depression. Our final document found that lack of access to healthcare resources decreased dementia outcomes by missing the early onset of symptoms. Conclusions: It is evident that minorities face healthcare disparities that keep them from receiving access to equitable healthcare. As a nurse, it is important to identify gaps in access to healthcare in minority patients. Interventions aiming to increase health literacy and access in minorities have shown to be effective.

>Magister Scientiae - MSc / Parkinson’s disease (PD) is a neurodegenerative disorder that occurs due to a loss of dopaminergic neurons in the substantia nigra. It is one of the most common neurodegenerative disorders, ranking second only to Alzheimer’s disease. Research on the genetic causes of PD over the past two decades has led to the discovery of several PD-associated genes. Currently, researchers have identified 23 genes that are linked to rare monogenic forms of PD with Mendelian inheritance. In sub-Saharan Africa (SSA), PD has received little attention due to factors such as underfunded healthcare infrastructure, the absence of epidemiological data, and a scarcity of neurologists. In the relatively few published studies, it has been shown that the known PD mutations play a minor role in disease etiology in SSA populations. In the current study, we follow up on previous work done in an MMed study investigating a South African family with several family members (mother and three sons) suffering from PD. / 2023

Access to health care services is critical to both personal health outcomes and health equity within a community. While non-monogamous behavior is widespread, stigma surrounding consensual non-monogamy can create barriers to health care access. This research outlines the experiences of non-monogamous women during sexual health care visits, how class acts to modify those experiences, the barriers to health care access that they encounter, and the adaptive strategies they employ. The sample for this research was 23 consensually non-monogamous women. Participants were contacted through online support groups, message boards, and snowball sampling. In-depth interviews about their sexual health care experiences were conducted. Interviews were recorded, transcribed, and analyzed for themes related to the intersection of non-monogamy and health care experiences. The interactions between health care professionals and non-monogamous women, whether or not those women disclose their non-monogamous status, were often perceived as stigmatizing. Increased class status, both of participant and of provider, was described as increasing experiences of stigma and barriers to care. The information provided by this research may be used to better understand, and thus improve, the barriers health care access experienced by non-monogamous women. Suggestions given by the participants for improving their health care access and decreasing experiences of stigma are included.

Background: Refugees and refugee claimants experience health needs upon arrival in Canada. Retrenchments to the Interim Federal Health program (IFHP) in 2012 greatly reduced healthcare access for refugee claimants, generating concerns among healthcare providers and other stakeholders affected by the reforms. In 2014 a new IFH program temporarily reinstated access to some health services however, little is known about the reforms and more information is needed to map its impact on key stakeholders. This study aims to examine the perception of key stakeholders regarding the impact of the 2014 reforms on the policy’s intermediary goals: access and provision of healthcare. Methodology: Data was collected using semi-structured key informant interviews with refugee health policy stakeholders (n=23), refugees and refugee claimants (n=6), policy makers and government officials (n=5), civil society organizations (n=6) and professionals and practitioners (n=6). Data was analysed using a constant comparative approach with NVivo 10 (QSR International). A stakeholder analysis was used to map out key stakeholder perceptions, interests and influences in refugee health policy and a content analysis was further employed to abstract themes associated with barriers and facilitators to access and provision of healthcare in the current situation. Results: The findings provide information for management of stakeholder engagement revealing the perceptions of key stakeholders on the 2014 reforms: eight were opposed to the reforms, eight held mixed positions, four supported the reforms and one did not comment. Five facilitators to accessing healthcare were identified. Eighteen themes emerged under four health care access and provision barrier categories: cognitive, socio-political, structural and financial. There were four common themes perceived among all stakeholder groups: lack of communication and awareness of refugee and provider, lack of care provider training leading to unfamiliarity with IFHP, lack of continuity and comprehensive care and the political discourse leading to refugee and claimant social exclusion. Other common barrier themes included healthcare affordability for refugees and the healthcare system, fear of the healthcare system, and interaction with the Ontario Temporary Health Program. Conclusion: The study highlights that reforms to the IFHP in 2014 have transferred refugee health responsibility to provincial authorities and healthcare institutions resulting in bureaucratic strains, inefficiencies, overburdened administration and increased health outcome disparities as refugees and claimants choose to delay seeking healthcare due to existing barriers. There are some benefits to the reforms, but the lack of support and mixed opinions among the majority of stakeholders emphasize the need for reformulation of policy with stakeholder engagement. This study recommends future refugee health reform strategies incorporate stakeholder leadership, cooperation and perspectives, as revealed in this research, to successfully move healthcare policy from theory to practice. / Thesis / Master of Science (MSc)

INTRODUCTION: The OTPN at Massachusetts General Hospital works to reduce barriers to care and implement tailored accommodations to improve patients with ASD/IDD access to and participation in healthcare. A quality improvement project was conducted to understand the OTPN interventions perceived as valuable by the recipients of care. THEORETICAL PERSPECTIVE AND EVIDENCE: Patients with ASD/IDD experience unmet healthcare needs and low patient satisfaction when accessing healthcare. Wagner’s Chronic Care Model was used as a framework to understand the factors that contribute to this problem. Current literature provides evidence-based strategies to improve the quality of care for patients with ASD when accessing healthcare services, but lacks descriptive evidence from the patient and caregiver perspective. DESCRIPTION OF PROJECT: Semi-structured interviews were conducted with three clients of the OTPN (one former patient with ASD and two parents of former patients). Using the phenomenological method, data was collected and analyzed to develop themes identified among participants. A follow-up interview with the OTPN obtained the OT perspective that informed the interventions valued by project participants. RESULTS: Participants identified barriers to care prior to collaborating with the OTPN, as well as valued OTPN interventions that involved patient-centered anticipatory planning, advocacy, and coordination of care. The OTPN used her OT perspective to understand the intersection of the person, environment and occupation to inform interventions that improved the patient experience. CONCLUSION: Customized interventions provided by the OTPN were highly valued by previous clients and were perceived to improve their healthcare experience by addressing unique patient needs and preferences.