Campus Health Centers’ Lack of Information Regarding Providers: A Content Analysis of Division-I Campus Health Centers’ Provider Websites

Campus health centers are a convenient, and usually affordable, location for college students to obtain health care. Staffed by licensed and trained professionals, these providers can generally offer similar levels of care that providers at off-campus clinics can deliver. Yet, previous research finds students may forgo this convenient, on-campus option partially because of a lack of knowledge regarding the quality of providers at these campus clinics. This study sought to examine where this information deficit may come from by analyzing campus health centers’ online provider information. All Division-I colleges or universities with an on-campus health center, which had information on their websites about their providers (n = 294), had their providers’ online information analyzed (n = 2,127 providers). Results revealed that schools commonly offer professional information (e.g., provider specialties, education), but very little about their providers outside of the medical context (e.g., hobbies) that would allow a prospective student patient to more easily relate. While 181 different kinds of credentials were provided next to providers’ names (e.g., MD, PA-C, FNP-BC), only nine schools offered information to help students understand what these different credentials meant. Most schools had information about their providers within one-click of the homepage. Recommendations for improving online information about campus health center providers are offered.     

Knowledge of Sexuality and Reproductive Health of People with Physical Disabilities in Vietnam

This paper discusses the knowledge of sexual and reproductive health among people with physical disabilities in Vietnam. A qualitative research design was adopted. In-depth interviewing and photo elicitation methods were used to collect stories from 20 participants. The findings suggest that without formal education about sexual and reproductive health people with physical disabilities in Vietnam gain knowledge through their experiences and from informal sources of information. Participants perceived safe sex to include contraceptive methods, prevention of sexually transmitted diseases, having orgasm together and finding balance between health and sexual needs. Participants related reproductive health to fertility, restriction of family size, sexually transmitted diseases, and self-care in pregnancy. Reasons for insufficient knowledge included limited education due to: disability and poor family background; limited education on sexual and reproductive health issues; absence of family and community discourse about sexual and reproductive health; and lack of information resources. Participants acknowledged that their knowledge was inadequate. They wanted to know more about sexual and reproductive health but lacked access to the relevant information. Health care providers, researchers, and policy-makers in Vietnam should address the gaps in sexual and reproductive health care knowledge among people with disabilities in Vietnam and those that provide care to them.     

Previvors’ Uncertainty Management Strategies for Hereditary Breast and Ovarian Cancer

Individuals with a genetic predisposition to develop hereditary breast and ovarian cancer (HBOC), but who have not been diagnosed with cancer, are referred to as previvors. Although genetic testing may reduce previvors’ worries about whether or not they have a high genetic cancer risk, testing positive produces negative emotions and long-term uncertainty—thus requiring the management of uncertainty. Existing research indicates family, friends, and social support networks are limited in their assistance for previvors’ uncertainty management. Therefore, this study examined how health care providers may assist previvors in uncertainty management by asking: What strategies do BRCA-positive previvors enact with their health care providers to help manage their uncertainty about HBOC? Purposive sampling was employed to recruit participants via online social media. The final sample consisted of 34 BRCA-positive women. Interviews revealed four uncertainty management strategies—seeking health care providers as informational sources, seeking health care providers as partners for decision making, seeking health care providers for supportive communication, and seeking referrals from health care providers for social support networks. Findings indicate that health care providers who are knowledgeable about BRCA, provide information, answer questions, check understanding, and provide additional resources assist previvors in managing their uncertainties by distinguishing options and fostering meaning.     

Insights in Public Health: Healthy Mothers Healthy Babies: Awareness and Perceptions of Existing Breastfeeding and Postpartum Depression Support among Parents and Perinatal Health Care Providers in Hawai'i

Healthy Mothers, Healthy Babies Coalition of Hawai‘i (HMHB) is a local nonprofit organization dedicated to eliminating health disparities and improving Hawai‘i''s maternal, child, and family health though collaborative efforts in public education, advocacy, and partner development. A review of HMHB services revealed overwhelming requests for both breastfeeding and postpartum depression (PPD) support. The purpose of this article is to present the findings of two surveys that highlight the awareness of existing breastfeeding and PPD resources based on both parents and health care providers; perceptions of where and how care is accessed; and whether mothers throughout Hawai‘i have equitable access to support. Results helped assess gaps in resources and determine barriers to care, as well as provide suggestions for new services or resources.Web-based surveys were sent to 450 providers and 2,955 parents with response rates of 8.9% and 4.0%, respectively. Less than half of parent participants reported that their health provider discussed PPD with them. Participants identified a number of barriers to increasing access and utilization of PPD support resources, including: not feeling like symptoms were server enough, feeling embarrassed to seek help, not knowing where to find support/information, and not able to afford or insurance wouldn''t cover PPD support. Only 40% of providers reported screening for PPD and 33% felt they had not received adequate training. Barriers identified by providers were a lack of trained providers, lack of PPD specific support groups, cultural stigma, and lack of PPD awareness among providers.Of the women who did not exclusively breastfeed for the full six-month recommendation, the most common breastfeeding concerns included: perceptions of low milk supply; lack of lactation support; medical reasons; and pain. Providers described an environment of uneven distribution of resources, general lack of awareness of available resources, along with a widespread lack of support for breastfeeding efforts.Recommendations for future efforts include comprehensive breastfeeding and PPD training for health care providers enhanced support groups, and improving awareness and access to information and support resources.     

Identifying the Gaps Between Biodefense Researchers, Public Health, and Clinical Practice in a Rural Community

ABSTRACT:  Objective: It is essential for health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine how well biodefense and emerging infectious disease research information was being disseminated to rural health care providers, first responders, and public health officials. Methods: Semi-structured interviews were conducted at a federally funded research institution and a rural community in Washington state with 10 subjects, including researchers, community physicians and other health care providers, first responders, and public health officials. Results: The interviews suggest there is inadequate information dissemination regarding biodefense and emerging infectious disease research and an overall lack of preparedness for a bioterrorist event among rural clinicians and first responders. Additionally, a significant communication gap exists between public health and clinical practice regarding policies for bioterrorism and emerging infectious disease. There was, however, support and understanding for the research enterprise in bioterrorism. Conclusions: Biodefense preparedness and availability of information about emerging infectious diseases continues to be a problem. Methods for information dissemination and the relationships between public health officials and clinicians in rural communities need to be improved.     

Realising the potential of the family history in risk assessment and primary prevention of coronary heart disease in primary care: ADDFAM study protocol

Background  

Coronary heart disease (CHD) is the leading cause of death in the developed world, and its prevention a core activity in current UK general practice. Currently, family history is not systematically integrated into cardiovascular risk assessment in the UK, Europe or the US. Further, primary health care professionals' lack the confidence to interpret family history information and there is a low level of recording of family history information in General Practice (GP) records. Primary prevention of CHD through lifestyle advice has sometimes yielded modest results although, for example, behavioural interventions targeted at "at risk" patients have produced encouraging findings. A family history approach, targeted at those requesting CHD assessment, could motivate lifestyle change. The project will assess the clinical value of incorporating systematic family history information into CHD risk assessment in primary care, from the perspective of the users of this service, the health care practitioners providing this service, and the National Health Service.     

Health Training and Information Needs of Child Day Care Providers

This study sought to determine day care providers (day care center directors and family day care home providers) knowledge of the health status of children in their care, the availability of first and and emergency procedures, the management of acute conditions and illness, and provider interest in training and information on child health Although both types of providers need additional training, the needs of family day care home providers seem greater There was limited interest in topics that have become increasingly important, e g, care of children with disabilities or with chronic conditions To meet these health training and informational needs of day care providers, community-based health professionals and health agencies should become more involved as advocates, consultants, and resources for health promotion and disease prevention practices in day care settings.     

Evidence-based decision making: global evidence, local decisions

Variations in health care services have been well documented worldwide. The result is that increased health care spending is not uniformly associated with improved health. Interest in increasing the value obtained from health care investments has stimulated efforts to develop the best science and apply it to health care delivery. Advances in communications and information technology have made such developments of the scientific basis for health care a truly global enterprise, but its application must remain local. Consumers' use of evidence-based information to choose providers, make treatment decisions, and play a more active role represents the ultimate local application of scientific information.     

Clinical annotation of tobacco use in patient charts at Indian Health Service clinics and hospitals

Few clinicians would doubt the importance of obtaining smoking histories from their patients. Nevertheless a clinicians' practices of documenting tobacco use in medical records varies substantially among individual providers and between different health care systems. To investigate the chart documentation of patient smoking among Indian Health Service clinicians, we reviewed 545 randomly selected patient records from 22 different Indian Health Service affiliated clinics. We focused on differences in charting of tobacco use by type of clinic and by geographic area within the Indian Health Service. Documentation varied by area, ranging from no documentation in the Albuquerque, Navajo, and Phoenix areas to 51% in the Oklahoma area. We conclude that clinicians practices of documentation of tobacco use vary widely and recommend that this practice be more widely encouraged at all affiliated Indian Health Service clinics.The author gratefully acknowledges Dr. Nathaniel Cobb, IHS Hdqtrs West Cancer Prevention and Control Program, Dr. Eva Smith, Alcohol and Substance Program Branch IHS Hdqtrs West, and Ms. Roberta Paisano, IHS Hdqtrs West Cancer Prevention and Control Program for their assistance in helping to format the chart audit form and for their editing assistance. Also, the author would like to thank the IHS Area Tobacco Control Coordinators for their assistance in scheduling the actual chart audits and in many instances helping to collect the data.     

Heredity of asthma in Saudi population

In a cross-sectional study, the prevalence of asthma, hay fever and eczema was studied in 1150 schoolchildren attending school in Jeddah Western region of Saudi Arabia. The family histories of asthma, hay fever and eczema were examined in first degree relatives. The age range of children studied was 7–12 years, with a mean of 9.3 years (47% boys and 53% girls). A self-administered questionnaire was completed by the parents of the child to collect information concerning bronchial asthma, hay fever, and eczema in the target child and family history of respiratory allergy. A detailed family history and personal histories of asthma were available for 1035 Saudi children aged 7–12 years old. The rate of asthma and hay fever were significantly higher among siblings and offspring (cases) compared to their parents (p < 0.001). The results showed a high positive correlation between the relatives of affected children with respect to asthma and hay fever. These findings support the hypothesis that asthma and hay fever may be inherited in the Saudi population, but the mode of inheritance has yet to be determined.Corresponding author.     

Domestic violence and primary care. Attitudes, practices, and beliefs.

OBJECTIVE: To assess the attitudes and beliefs of the primary care provider team (physicians, physician assistants, nurses, and medical assistants) toward the identification and management of abused patients and perpetrators of domestic violence (DV). DESIGN: Survey of the health care team using a confidential questionnaire. SETTING AND SUBJECTS: Five primary care clinics with 240 providers at a large urban health maintenance organization. RESULTS: The response rate was 86% (206 respondents). Fifty percent of clinicians and 70% of nurses/assistants believed that the prevalence of DV in their practice was 1% or loss; 1 in 10 clinicians and nearly half of nurses/assistants had never identified an abused person; 45% of clinicians never or seldom asked about DV when examining injured patients; and all participants were much less confident in asking about DV than about smoking or consuming alcohol. Twenty-five percent believed the abused person's personality led to the violence; 28% believed they did not have strategies to help abused persons; and 20% were concerned for their personal safety in discussing DV. Only 10% believed they had management information, but 77% had not attended any educational programs on DV in the past year. CONCLUSIONS: This study provides important information about current knowledge, attitudes, and beliefs of health care providers toward the diagnosis and management of DV. This information should prove useful to all who attempt to design clinical strategies and educational programs to address this issue.     

Male reproductive control of women who have experienced intimate partner violence in the United States

Women who have experienced intimate partner violence (IPV) are consistently found to have poor sexual and reproductive health when compared to non-abused women, but the mechanisms through which such associations occur are inadequately defined. Through face-to-face, semi-structured in-depth interviews, we gathered full reproductive histories of 71 women aged 18–49 with a history of IPV recruited from a family planning clinic, an abortion clinic and a domestic violence shelter in the United States. A phenomenon which emerged among 53 respondents (74%) was male reproductive control which encompasses pregnancy-promoting behaviors as well as control and abuse during pregnancy in an attempt to influence the pregnancy outcome. Pregnancy promotion involves male partner attempts to impregnate a woman including verbal threats about getting her pregnant, unprotected forced sex, and contraceptive sabotage. Once pregnant, male partners resort to behaviors that threaten a woman if she does not do what he desires with the pregnancy. Reproductive control was present in violent as well as non-violent relationships. By assessing for male reproductive control among women seeking reproductive health services, including antenatal care, health care providers may be able to provide education, care, and counseling to help women protect their reproductive health and physical safety.     

Support for family caregivers: what do service providers say about accessibility,availability and affordability of services?

This paper reports on a survey of providers of caregiver support services in Singapore ( N  =   36). The overall aim of the survey was to provide feedback to service planners and programme staff on the delivery of services to caregivers and opportunities for improvement. A questionnaire, comprising both closed and open-ended questions, was used to collect data. The results showed that most health and social service providers offer counselling, case management, caregiver assessment, financial assistance and information. A minority provide emergency, short-stay respite care and day care. About one in three provide transportation services, which featured as a barrier to service utilisation. Other barriers identified were time commitments, lack of awareness of services, cost of care, caregivers' sense of responsibility, lack of alternate care arrangements and distrust. The survey also characterises the hard-to-reach caregivers as homebound, illiterate, socially shy and isolated, of low income and poorly educated. Most service providers emphasise that financial support is necessary in order to improve the prospects of family caregivers.     

Providers’ Note-Writing Practices for Post-traumatic Stress Disorder at Five United States Veterans Affairs Facilities

The capacity of electronic health records (EHRs) to capture desired information depends on the practices of health care providers. These practices have not been well studied in relation to post-traumatic stress disorder (PTSD). This qualitative study investigated how providers write EHR notes on PTSD through 38 interviews with providers working at five Veterans Affairs (VA) hospitals across the United States of America. Two overarching themes were prominent in the results. Providers used progress notes primarily to remember and access details for direct patient care, but only rarely for care coordination. Providers infrequently recorded information not judged to directly contribute to improved care, sometimes deliberately omitting information perceived to jeopardize patients’ access to, or quality of, care. Omitted information frequently included sexual or non-military trauma. Understanding providers’ thought processes can help clinicians be aware of the limitations of EHR notes as a tool for learning the histories of new patients. Similarly, researchers relying on EHR data for PTSD research should be aware of likely areas of missing data.     

Family assessment: Systems theory and the genogram

General systems theory principles are used as a basis for assessment of a family system. The genogram is developed as a clear diagrammatic method of obtaining relevant information. Family genograms are demonstrated from case histories and the systems theoretical approach is utilized to interpret information. It is suggested that adoption of this assessment method will promote holistic health care for a child and his/her family.     

Understanding the role of health care providers during the transition of adolescents with disabilities and special health care needs.

PURPOSE: To evaluate the role of health care providers in the transition from pediatric to adult health care for adolescents with disabilities and special health care needs (SHCN) from both the families' and providers' perspectives. METHODS: A total of 753 parents of adolescents with SHCN (e.g. developmental, physical, behavioral/emotional, learning, or health-related disabilities) were surveyed by questionnaire to assess their perceptions of their health care provider's level of involvement in various transition activities and the extent to which they felt it was the provider's responsibility to assist in a particular activity. One hundred forty-one health care providers (primarily pediatricians) completed a parallel survey to assess their level of participation in the same transition activities and the extent to which they felt it was their responsibility to assist with each transition activity. The questionnaire listed 13 different transition activities health providers may engage in to help young people prepare for adulthood and also asked questions about areas such as employment and health insurance. To investigate whether parents and providers share the same views regarding the involvement and responsibility of providers across the 13 transition activities, two sets of Student's t-tests were calculated. RESULTS: There were significant differences between providers and parents concerning both the level of provider involvement and the extent to which it was the provider's responsibility to assist in various transition activities (e.g., health providers reported significantly more involvement than did parents for 11 of the 13 transition activities and, compared with parents, providers reported that it was more within their role to assist in these 11 transition activities). CONCLUSIONS: The findings suggest a need for health care providers and parents to have open discussions about the nature and extent to which providers assist families in key transition activities.