Diversity in the lines of public institutions, such as hospitals, schools, and police forces, is thought to improve provision for minority group members. Nonetheless, whether and how diversity in ...public institutions shapes majority citizens' prejudice toward minorities are unclear. Building on insights from the intergroup contact literature, I suggest that diversity in public institutions can facilitate positive intergroup contact between majority group members and minorities in elevated social positions. Such unique interactions, which exceed the equal status condition for effective intergroup contact, can serve to reduce prejudice and facilitate more inclusive attitudes among majority group members. To test this expectation, I focus on health care provision-a leading sector with regard to minority representation. Leveraging a natural experiment unfolding in 21 Israeli medical clinics where Jewish patients are haphazardly assigned to receive care from Jewish or Arab doctors and embedding prejudice-related questions in a routine evaluation survey, I demonstrate that brief contact with an Arab doctor reduces prejudice. Specifically, contact with an Arab doctor reduces Jewish patients' exclusionary preferences toward Arabs by one-sixth of an SD and increases Jewish patients' optimism about peace by a 10th of an SD. The modest magnitude of these effects is similar to the impact of well-powered interventions recently reviewed in a meta-analysis of prejudice reduction experiments. These findings emphasize how the demographic makeup of public institutions can reduce mass prejudice, even in a context of intractable conflict.
•Patients regard sexuality communication as essential and feel comfortable with it.•Patient-provider sexual health communication does not meet the needs of patients.•Providers should take the ...initiative in discussing sexuality when necessary.•Providers should model a sense of comfort and openness in conversations.•Healthcare professional programs should incorporate sexuality into its curricula.
The objective of this scoping review was to explore patients’ and providers’ perspectives on sexual health communication.
A literature search was conducted in three databases, Medline (OVID), CINAHL (Ebsco), and PsycINFO (Ebsco) covering January 1, 2000—May 12, 2020. A coding sheet with a list of questions was created in Qualtrics to extract information from each article.
Thirty-three (33) studies were included in this review. The findings indicated that 1) the current sexual health discussion does not meet the needs of the patients; and 2) patients and providers hold uniquely different perspectives on the importance of the discussion, the responsibility of conversation initiation, and the comfort level of the discussion.
There remains a significant gap between providers’ perceptions and patients’ needs regarding sexual health discussion. More efforts should be made to promote the necessary sexual health communication.
Providers should initiate the discussion when necessary because it is very likely that patients welcome the discussion. Medical education and training should incorporate sexual health into its curricula to enhance health care professionals’ abilities in addressing sexual health issues. Providers should model a sense of openness and comfort in conversation to encourage patients to discuss sexual health.
In a longitudinal study involving nearly 4000 health care workers in Israel who had received two doses of BNT162b2 vaccine, levels of spike-binding IgG and neutralizing antibody decreased and did so ...to a greater extent in men, persons 65 years of age or older, and persons with immunosuppression. Obese persons had higher levels of antibody than nonobese persons.
ABSTRACT
BACKGROUND
A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. Many protective factors from ...burnout are characteristics of patient-centered medical home (PCMH) models, though even positive organizational transformation is often stressful. The existing literature on the effects of PCMH on burnout is limited, with most findings based on small-scale demonstration projects with data collected only among physicians, and the results are mixed.
OBJECTIVE
To determine if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in a national medical home transformation, the VA Patient Aligned Care Team (PACT).
DESIGN
Web-based, cross-sectional survey and administrative data from May 2012.
PARTICIPANTS
A total of 4,539 VA primary care personnel from 588 VA primary care clinics.
MAIN MEASURES
The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffing, delegation of clinical responsibilities, working to top of competency, and collective self-efficacy. We also included administrative measures of workload and patient comorbidity.
KEY RESULTS
Overall, 39 % of respondents reported burnout. Participatory decision making (OR 0.65, 95 % CI 0.57, 0.74) and having a fully staffed PACT (OR 0.79, 95 % CI 0.68, 0.93) were associated with lower burnout, while being assigned to a PACT (OR 1.46, 95 % CI 1.11, 1.93), spending time on work someone with less training could do (OR 1.29, 95 % CI 1.07, 1.57) and a stressful, fast-moving work environment (OR 4.33, 95 % CI 3.78, 4.96) were associated with higher burnout. Longer tenure and occupation were also correlated with burnout.
CONCLUSIONS
Lower burnout may be achieved by medical home models that are appropriately staffed, emphasize participatory decision making, and increase the proportion of time team members spend working to the top of their competency level.
OBJECTIVE:The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care ...providers (PCPs).
RESEARCH DESIGN AND METHODS:Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics. Emergency department and outpatient analyses used negative binomial models; hospitalizations used logistic regression. Costs were analyzed using generalized linear models.
RESULTS:PCPs were physicians, NPs, and PAs for 74.9% (n=276,009), 18.2% (n=67,120), and 6.9% (n=25,352) of patients respectively. Patients of NPs and PAs have lower odds of inpatient admission odds ratio for NP vs. physician 0.90, 95% confidence interval (CI)=0.87–0.93; PA vs. physician 0.92, 95% CI=0.87–0.97, and lower emergency department use (0.67 visits on average for physicians, 95% CI=0.65–0.68; 0.60 for NPs, 95% CI=0.58–0.63; 0.59 for PAs, 95% CI=0.56–0.63). This translates into NPs and PAs having ~$500–$700 less health care costs per patient per year (P<0.0001).
CONCLUSIONS:Expanded use of NPs and PAs in the PCP role for some patients may be associated with notable cost savings. In our cohort, substituting care patterns and creating similar clinical situations in which they practice, NPs and PAs may have reduced costs of care by up to 150–190 million dollars in 2013.
Background
The current study was conducted to assess self‐reported comfort levels of pediatric primary care providers (PCPs) in providing acute medical care to patients with childhood cancer who ...currently were receiving therapy (on‐therapy patients) and health maintenance care to childhood cancer survivors, independently and in conjunction with pediatric oncologists, along with confidence levels regarding knowledge about immunizations for survivors. All levels were measured using 7‐point Likert scales.
Methods
A cross‐sectional, 23‐item survey mailed to practicing PCPs affiliated with a tertiary children's hospital was analyzed.
Results
The response rate was 64.4% (259 of 402 eligible PCPs). The mean PCP comfort level was higher when collaborating with a pediatric oncologist to provide acute medical care for on‐therapy patients and health maintenance care for childhood cancer survivors (mean ratings of 6.0 ± 1.5 and 6.4 ± 1.3, respectively) compared with independently providing such care (mean ratings of 4.6 ± 1.8 and 5.0 ± 1.7, respectively; P < .0001). Only approximately 30% of PCPs were confident in their knowledge regarding immunizations for survivors. Certain factors were found to be associated with PCP comfort in providing care in conjunction with a pediatric oncologist. For acute care, these factors were rural location compared with urban location (odds ratio OR, 5.0; 95% CI, 1.9‐13.1 P = .03) and having cared for ≥6 on‐therapy patients within the past year versus none (OR, 3.8; 95% CI, 1.9‐7.5 P = .0001). For survivor health maintenance care, practice location <50 miles from pediatric oncology specialty care versus ≥50 miles was the only factor found to be associated with PCP comfort (OR, 2.8; 95% CI, 1.3‐6.1 P = .009).
Conclusions
The findings of the current study underscore the need for collaboration between pediatric oncologists and PCPs when caring for children with cancer across the spectrum of care.
The results of the current study demonstrate that the majority of pediatric primary care providers are uncomfortable providing health care to patients with childhood cancer and survivors and prefer collaboration with pediatric oncologists. In addition, the majority also are not confident in their knowledge concerning immunizations for childhood cancer survivors.
Objective
Israel is one of the first countries to incorporate chromosomal microarray analysis into routine prenatal care. We explored attitudes of Israeli healthcare professionals (HCPs) towards the ...disclosure of challenging findings: variants of uncertain clinical significance (VUS), susceptibility loci (SL) for neurodevelopmental disorders and variants associated with adult‐onset (AO) conditions. Particularly, we sought their views on providing parental choice regarding the disclosure of these findings.
Methods
Twenty‐nine in‐depth interviews were conducted with genetic counselors (n = 19), medical geneticists (n = 4), medical geneticists that are trained in and practice fetal medicine (n = 3), and fetal medicine experts (n = 3).
Results
Most participants (n = 24) supported parental choice regarding uncertain genetic information. Engaging parents in disclosure decisions allows avoidance from potentially anxiety‐provoking information, practicing parental autonomy, and better preparation in cases where uncertain findings are identified. HCPs believed that given appropriate preparation, parents can make informed decisions. Four participants believed that disclosure should be based on professional judgment and one supported full‐disclosure. Unlike VUS or SL, all interviewees agreed that in cases of medically actionable AO conditions, the benefit of disclosure outweighs the damage.
Conclusion
HCPs attitudes are largely in‐line with the Israeli practice of involving parents in disclosure decisions regarding uncertain information. This may mitigate disclosure dilemmas and allow personalized disclosure based on parents' views.
Key points
What's already known about this topic?
Around the world, disclosure practices of uncertain findings identified in prenatal chromosomal microarray analysis (CMA) testing range from full‐to nondisclosure.
Guidelines largely support disclosure of prenatal CMA findings associated with medically actionable adult‐onset (AO) conditions.
There is currently no consensus regarding parental involvement in disclosure decisions and whether choice regarding uncertain findings should be given.
What does this study add?
Participating healthcare professionals who have long‐term experience with prenatal CMA, generally support parental choice regarding uncertain findings.
Participants acknowledge parents' ability to differentiate between various types of CMA findings.
All participants find it important to disclose risks for AO conditions.
This systematic review identified papers that described epilepsy misconceptions or stigma in sub-Saharan Africa (SSA) and research interventions focused on reducing these misconceptions.
Publications ...in the English language from January 2000 to October 2017 that described original research conducted in SSA on misconceptions about epilepsy were utilized.
Twenty-three publications were identified. Studies were from Nigeria (N = 4), Cameroon (N = 4), Uganda (N = 3), Zambia (N = 2), Ethiopia (N = 2), Tanzania (N = 2), Kenya (N = 2), Ghana, Zimbabwe, Benin, and Mali (N = 1 each). The studies included assessments of misconceptions among healthcare providers and medical students (N = 3), high school students (N = 2), teachers (N = 2), the general public (N = 10), people with epilepsy (N = 7), and traditional healers (N = 1). Only two studies had stigma-focused interventions. Majority of the studies reported limitations to socialization with people with epilepsy and various beliefs associated with epilepsy.
Epilepsy misconceptions, stigmatizing cultural beliefs, and perceptions were widely prevalent in SSA, and there are a few studies targeting epilepsy stigma. Existing stigma-reduction educational approaches may be impractical for general population implementation. Scalable approaches to reduce stigma are urgently needed within SSA.
•Epilepsy misconceptions are prevalent in sub-Saharan Africa.•None or few interventions are targeting stigma in SSA.•Misconception targeted interventions are necessary to tackle stigma.
Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working ...conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps.
To evaluate the effect of SCE interventions on health worker motivation and experiences with clients.
The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation.
Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked lowest. Intervention health facilities that were assessed by female community groups (Coef. = 0.2720, p = 0.0118) and informal groups with organized leadership structures like Artisans (Coef. = 0.2268, p = 0.0368) associated positively with higher intrinsic motivation levels of staff.
Community-based approach to health worker motivation is a potential complementary strategy that needs policy deliberation to explore its prospects. Albeit financial incentives remain critical sources of staff motivation, innovative non-financial approaches like SCE should complement the latter.
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