rare diseases (RD) are extremely complex health conditions. Persons affected by these conditions in Cameroon are often neglected in society and health systems through the inexistence of policies and ...programs. In Cameroon, there exists no program or policy conceived to address their needs in terms of access to quality health care, timely and reliable diagnosis, treatments, education, etc. The consequence is that persons living with a RD (PLWRD) and their families do not participate in social life. The unique fate of PLWRD reveals that the principle of social justice and equity is flawed in Cameroon. However, patients, in order to survive in society, rely on patients' organizations (PO) to improve their quality of life (QoL) and advocate for a better consideration in the society. The aim of this paper is to highlight how initiatives from a grassroot perspective like POs can inform decision-makers to address the needs of PLWRD and their families.
the study associated a systematic literature review and semi-structured interviews with parents of children suffering from a RD and who are members of a PO. Through the systematic literature review we highlighted the impact POs have in the development of research on RDs, patient literacy, patient empowerment and advocacy while semi-structured interviews brought out the needs of patients and their families.
findings, on the one hand show that, in Cameroon PLWRD face a number of challenges like the incurability of their condition, catastrophic medical expenses, stigmatization and marginalization, etc. and though in POs their QoL still remains poor. On the other hand, where POs are empowered they are key actors in research on RDs and help decision-makers on having a better insight into the type of RD that exists across a geographical area, the sociodemographic profile of patients, etc. for a better management of PLWRD.
the study suggests that the ministry of public health should create a network with existing RD POs to adequately meet the needs of PLWRD.
Improvements to the world’s food supply chain are needed to ensure sufficient food is produced to meet increasing population demands. Growing food in soilless hydroponic systems constitutes a ...promising strategy, as this method utilizes significantly less water than conventional agriculture, can be situated in urban areas, and can be stacked vertically to increase yields per acre. However, further research is needed to optimize crop yields in these systems. One method to increase hydroponic plant yields involves adding plant growth-promoting bacteria (PGPB) into these systems. PGPB are organisms that can significantly increase crop yields via a wide range of mechanisms, including stress reduction, increases in nutrient uptake, plant hormone modulation, and biocontrol. The aim of this review is to provide critical information for researchers on the current state of the use of PGPB in hydroponics so that meaningful advances can be made. An overview of the history and types of hydroponic systems is provided, followed by an overview of known PGPB mechanisms. Finally, examples of PGPB research that has been conducted in hydroponic systems are described. Amalgamating the current state of knowledge should ensure that future experiments can be designed to effectively transition results from the lab to the farm/producer, and the consumer.
Background
In 2015, the Veterans Health Administration (VHA) incorporated nurse practitioners (NPs) into remote triage call centers to supplement registered nurse (RN)–handled calls.
Objective
To ...assess 7-day healthcare use following telephone triage by NPs compared to RNs. We hypothesized that NP clinical decision ability may reduce follow-up healthcare.
Design
Retrospective observational comparative effectiveness study of clinical and administrative databases. NP routed calls were matched to RN calls based on chief complaint with propensity score matching and multivariate count data models, adjusting for differences in call severity and patient comorbidity.
Participants
Callers to a VHA regional call center, April 2015 to March 2019.
Main Measures
Primary care, specialty care, and emergency department (ED) visits plus hospitalizations within 7 days.
Key Results
NP-handled calls (
N
= 1554) were matched to RN calls (
N
= 48,024) for the same chief complaint. NP-handled calls, compared to RNs, had lower comorbidities, fewer hospitalizations, and less urgent complaints. Seven-day healthcare use was lower for NP compared to RN calls for specialty care (0.15 vs. 0.20 visits per person VPP;
p
< 0.001), ED (0.11 vs. 0.27 VPP;
p
< 0.001), and hospitalizations (0.01 vs. 0.04 VPP;
p
< 0.001), but not primary care (0.43 vs. 0.42 VPP;
p
= 0.80). In adjusted analyses, estimated avoided in-person visits per 100 calls routed to NPs were 0.7 primary care visits (95% confidence interval CI 0.4, 1.0), 2.6 specialty care visits (95% CI 0.0, 5.1), 5.9 ED visits (95% CI 2.7, 9.1), and 1.4 hospital stays (95% CI 0.1, 2.6). Propensity score–matched models comparing NP (
N
= 1533) to RN (
N
= 2646) calls had adjusted odds ratios for 7-day healthcare use of 0.75 (primary care), 0.75 (specialty care), and 0.73 (ED) (all
p
< 0.003).
Conclusion
Incorporating NPs into a call center was associated with lower in-person healthcare use in the subsequent 7 days compared to routine RN-triaged calls.
Background
Persons who experience homelessness (PEH) have high rates of depression and incur challenges accessing high-quality health care. Some Veterans Affairs (VA) facilities offer ...homeless-tailored primary care clinics, although such tailoring is not required, within or outside VA. Whether services tailoring enhances care for depression is unstudied.
Objective
To determine whether PEH in homeless-tailored primary care settings receive higher quality of depression care, compared to PEH in usual VA primary care.
Design
Retrospective cohort study of depression treatment among a regional cohort of VA primary care patients (2016–2019).
Participants
PEH diagnosed or treated for a depressive disorder.
Main Measures
The quality measures were timely follow-up care (3 + completed visits with a primary care or mental health specialist provider, or 3 + psychotherapy sessions) within 84 days of a positive PHQ-2 screen result, timely follow-up care within 180 days, and minimally appropriate treatment (4 + mental health visits, 3 + psychotherapy visits, 60 + days antidepressant) within 365 days. We applied multivariable mixed-effect logistic regressions to model differences in care quality for PEH in homeless-tailored versus usual primary care settings.
Key Results
Thirteen percent of PEH with depressive disorders received homeless-tailored primary care (
n
= 374), compared to usual VA primary care (
n
= 2469). Tailored clinics served more PEH who were Black, who were non-married, and who had low income, serious mental illness, and substance use disorders. Among all PEH, 48% received timely follow-up care within 84 days of depression screening, 67% within 180 days, and 83% received minimally appropriate treatment. Quality metric attainment was higher for PEH in homeless-tailored clinics, compared to PEH in usual VA primary care: follow-up within 84 days (63% versus 46%; adjusted odds ratio AOR = 1.61,
p
= .001), follow-up within 180 days (78% versus 66%; AOR = 1.51,
p
= .003), and minimally appropriate treatment (89% versus 82%; AOR = 1.58,
p
= .004).
Conclusions
Homeless-tailored primary care approaches may improve depression care for PEH.
Background/Objective
Optimizing patients’ access to primary care is critically important but challenging. In a national survey, we asked primary care providers and staff to rate specific care ...processes as access management challenges and assessed whether clinics with more of these challenges had worse access outcomes.
Methods
Study design: Cross sectional. National Primary Care Personnel Survey (NPCPS) (2018) participants included 6210 primary care providers (PCPs) and staff in 813 clinics (19% response rate) and 158,645 of their patients. We linked PCP and staff ratings of access management challenges to veterans’ perceived access from 2018–2019 Survey of Healthcare Experiences of Patients-Patient Centered Medical Home (SHEP-PCMH) surveys (35.6% response rate). Main measures: The NPCPS queried PCPs and staff about access management challenges. The mean overall access challenge score was 28.6, SD 6.0. The SHEP-PCMH access composite asked how often veterans reported always obtaining urgent appointments same/next day; routine appointments when desired and having medical questions answered during office hours. Analytic approach: We aggregated PCP and staff responses to clinic level, and use multi-level, multivariate logistic regressions to assess associations between clinic-level access management challenges and patient perceptions of access. We controlled for veteran-, facility-, and area-level characteristics.
Key Results
Veterans at clinics with more access management challenges (> 75
th
percentile) had a lower likelihood of reporting always receiving timely urgent care appointments (AOR: .86, 95% CI: .78–.95); always receiving routine appointments (AOR: .74, 95% CI: .67–.82); and always reporting same- or next-day answers to telephone questions (AOR: .79, 95% CI: .70–.90) compared to veterans receiving care at clinics with fewer (< 25
th
percentile) challenges.
Discussion/Conclusion
Findings show a strong relationship between higher levels of access management challenges and worse patient perceptions of access. Addressing access management challenges, particularly those associated with call center communication, may be an actionable path for improved patient experience.
Background
Civility, or politeness, is an important part of the healthcare workplace, and its absence can lead to healthcare provider and staff burnout. Lack of civility is well-documented among ...mostly female nurses, but is not well-described among the gender-mixed primary care provider (PCP) workforce. Understanding civility and its relationship to burnout among male and female PCPs could help lead to tailored interventions to improve civility and reduce burnout in primary care.
Objective
To analyze gender differences in civility, burnout, and the relationship between civility and burnout among male and female PCPs.
Design
Multi-level logistic regression analysis of a cross-sectional national survey.
Participants
A total of 3216 PCP respondents (1946 women and 1270 men) in 135 medical centers from a 2019 national Veterans Health Administration (VA) survey.
Main Measures
Outcomes: burnout; predictors: workplace civility and gender; controls: race, ethnicity, VA tenure, and supervisory status.
Key Results
Workplace civility was rated higher (
p
<0.001) among male (mean = 4.07, standard deviation SD = 0.36, range 1–5) compared to female (mean = 3.88, SD = 0.33) PCPs. Almost half of the sample reported burnout (47.6%), but this difference was not significant (
p
= 0.73) between the genders. Higher workplace civility was significantly related to lower burnout among female PCPs (odds ratio OR = 0.46, 95% confidence interval CI = 0.31 to 0.69), but not among male PCPs (OR = 0.71, 95% CI = 0.42 to 1.22). Interactions between civility and other demographic variables (race, ethnicity, VA tenure, or supervisory status) were not significantly related to burnout.
Conclusion
Female PCPs report lower workplace civility than male PCPs. An inverse relationship between civility and burnout is present for women but not men. More research is needed on this phenomenon. Interventions tailored to gender- and primary care-specific needs should be employed to increase civility and reduce burnout among PCPs.
Background
Although they are a minority of patients served by the Veterans Health Administration (VHA), women Veterans comprise a fast-growing segment of these patients and have unique clinical ...needs. Women’s health primary care providers (WH-PCPs) are specially trained and designated to provide care for women Veterans. Prior work has demonstrated that WH-PCPs deliver better preventative care and have more satisfied patients than PCPs without the WH designation. However, due to unique clinical demands or other factors, WH-PCPs may experience more burnout and intent to leave practice than general PCPs in the VHA.
Objective
To examine differences in burnout and intent to leave practice among WH and general PCPs in the VHA.
Design
Multi-level logistic regression analysis of three cross-sectional waves of PCPs within the VHA using the national All Employee Survey and practice data (2017–2019). We modeled outcomes of burnout and intent to leave practice as a function of WH provider designation, gender, and other demographics and practice characteristics, such as support staff ratio, panel size, and setting.
Participants
A total of 7903 primary care providers (5152 general PCPs and 2751 WH-PCPs; response rates: 63.9%, 65.7%, and 67.5% in 2017, 2018, and 2019, respectively).
Main Measures
Burnout and intent to leave practice.
Key Results
WH-PCPs were more burned out than general PCPs (unadjusted: 55.0% vs. 46.9%,
p
<0.001; adjusted: OR=1.29, 95% confidence interval CI 1.10–1.55) but did not have a higher intention to leave (unadjusted: 33.4% vs. 32.1%,
p
=0.27; adjusted: OR=1.07, CI 0.81–1.41). WH-PCPs with intentions to leave were more likely to select the response option of “job-related (e.g., type of work, workload, burnout, boredom)” as their primary reason to leave.
Conclusions
Burnout is higher among WH-PCPs compared to general PCPs, even after accounting for provider and practice characteristics. More research on causes of and solutions for these differences in burnout is needed.
Harassment of servicewomen during military service has been well-documented, but harassment of women veterans in Veterans Affairs (VA) health care settings has not been studied systematically. We ...assessed the prevalence and impacts of harassment among women veterans who use VA health care.
From January to March 2015, we conducted computer-assisted telephone interviews of randomly sampled women veterans with three or more primary care and/or women's health visits at 1 of 12 VA medical centers. We asked if patients had experienced inappropriate/unwanted comments or behavior from male veterans at VA in the past year. We measured sociodemographics, health status, perceptions of VA care, delayed/unmet health care need, and care preferences. All analyses were weighted to account for the disproportionate sample design and nonresponse. Brief, open-ended descriptions of harassment were transcribed and coded.
Approximately one in four women veterans (25.2%; n = 1,395, response rate 45%) reported inappropriate/unwanted comments or behavior by male veterans on VA grounds. Site prevalence ranged from 10% to 42%. Incident descriptions were wide-ranging (e.g., catcalls, sexual/derogatory remarks, propositioning, stalking, and denigration of veteran status). Reports of harassment were more common among women with histories of military sexual trauma; other trauma exposures (e.g., combat, childhood); positive screens for anxiety, depression, and/or posttraumatic stress disorder; and fair/poor health. Those who reported harassment were significantly less likely to report feeling welcome at VA, and more likely to report not feeling safe, and delaying/missing care.
One-quarter of women veteran VA users experienced harassment in VA health care settings; these experiences negatively impacted women's health care experiences and use.
Abstract
Background
The scope of care coordination in VA primary care increased with the launch of the Veterans Choice Act, which aimed to increase access through greater use of non-VA Community ...Care. These changes may have overburdened already busy providers with additional administrative tasks, contributing to provider burnout. Our objective was to understand the role of challenges with care coordination in burnout. We analyzed relationships between care coordination challenges with Community Care reported by VA primary care providers (PCPs) and VA PCP burnout.
Methods
Our cross-sectional survey contained five questions about challenges with care coordination. We assessed whether care coordination challenges were associated with two measures of provider burnout, adjusted for provider and facility characteristics. Models were also adjusted for survey nonresponse and clustered by facility. Trainee and executive respondents were excluded. 1,543 PCPs in 129 VA facilities nationwide responded to our survey (13 % response rate).
Results
51 % of our sample reported some level of burnout overall, and 46 % reported feeling burned out at least once a week. PCPs were more likely to be burned out overall if they reported more than average challenges with care coordination (odds ratio OR 2.04, 95 % confidence interval CI 1.58 to 2.63). These challenges include managing patients with outside prescriptions or obtaining outside tests or records.
Conclusions
VA primary care providers who reported greater than average care coordination challenges were more likely to be burned out. Interventions to improve care coordination could help improve VA provider experience.
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