Early Access to Health Care Services Through a Rural School-Based Health Center

ABSTRACT: School-based health centers (SBHCs) and school-linked health centers (SLHCs) represent relatively new models for health care service delivery. This article examines the question: Are SBHCs accessible as defined by four criteria of accessibility: available, community-based, affordable, and culturally acceptable? A literature review and an examination of a rural SBHC providing care to young children are presented in this paper. Both support the hypothesis that SBHCs are accessible to children and families in the school community. In particular, this SBHC's enrollment rate of 98% and its usage rate of 99% provide strong evidence that SBHCs are culturally acceptable. Ten strategies for a successful SBHC are presented to assist in planning and implementation of other SBHCs.     

Effect of Inservice Training on Implementation of a Health Curriculum in Nova Scotia, Canada

The effect of different types of inservice training on the degree of implementation of a fourth grade health curriculum in Nova Scotia, Canada, was investigated. Using a quasiexperimental, nonequivalent control group design with posttest only, teachers (N = 41) were assigned to one trial group and two comparison groups. The distal comparison group received no inservice training, the local comparison group received a single session, and the trial group received ongoing, inservice training. The Health Program Component Checklist developed for this study was used to measure implementation. Data were collected by personal interview. Based on the Mann-Whitney U test, a significantly greater degree of implementation occurred in the trial group than in the proximal comparison group, but not the distal comparison group.     

Geographic Barriers to Child Health Services in Rural Northern New England: 1980 to 1989

Despite substantial recent increases in the number of rural physicians, it is unknown whether rural children still face significant barriers to medical care. To address this question, we determined travel times in 1980 and in 1989 to child health services for the rural pediatric population of northern New England--the area with the highest per-capita primary care physician supply of any non-metropolitan region in the United States. The study population in 1989 included 363,443 children living in 936 nonmetropolitan towns. The study revealed important spatial relationships in health service supply and demand not identified using other methods of assessing physician availability. Although travel times to physicians decreased slightly during the decade, we found that 15.5 percent of the children in our population were more than 30 minutes from pediatricians in 1989, and travel time to emergency rooms was more than 30 minutes for 9.9 percent of the children. In contrast, only 1.8 percent of children faced excessive travel times to family/general practitioners. While towns with pediatricians were likely to also have a family physician or an emergency room, the majority of towns with family physicians had neither a pediatrician nor an emergency room. Towns with poor geographic access to pediatricians and emergency rooms had low population densities and were distant from metropolitan areas. The analysis indicates that even in rural areas of high physician supply, access to pediatricians and emergency rooms for many children remains limited, and family physicians are the dominant medical providers for children.(ABSTRACT TRUNCATED AT 250 WORDS)     

Measuring Aspects of Devolved Health Authority Performance: Nova Scotia Patients Who Travel Further than Necessary to Obtain Hospital Care

This article presents a set of performance indicators measuring how well devolved health authorities do at providing secondary-level hospital services to residents in their jurisdictions. The study is based on an analysis of Nova Scotia discharge abstract data from 1992–93 to 1999–00. While most residents of Nova Scotia obtain this level of care in their own districts, wide variations persisted over time in hospitals' commitment to residents within their own districts.     

A Literature Review of the Use of GIS-Based Measures of Access to Health Care Services

The increasing availability of Geographical Information Systems (GIS) in health organisations, together with the proliferation of spatially disaggregate data, has led to a number of studies that have been concerned with developing measures of access to health care services. The main aim of this paper is to review the use of GIS-based measures in exploring the relationship between geographic access, utilisation, quality and health outcomes. The varieties of approaches taken by researchers concerned with teasing out the relative importance of geographical factors that may influence access are examined. To date, in the absence of detailed data on health utilisation patterns, much of this research has focused on developing measures of potential accessibility. This paper then critically evaluates the situation with regard to the use of such measures in a broad range of accessibility studies. In particular, there has been less research to date that examines the relationship between such measures and health outcomes. In the final sections of the paper, I draw on the review to outline areas where a broader research agenda is needed, particularly in relation to more recent innovations in health care delivery.     

关于农村基本卫生保健服务发展的若干思考

人人享有基本卫生保健服务,人民群众健康水平不断提高,是人民生活质量改善的重要标志,是全面建设小康社会、推进社会主义现代化建设的重要目标.我国农村基本卫生保健服务体系的建设和功能的完善是当前医疗体制改革亟待解决的问题,同时也是医疗体制改革的主攻方向.建立健全的农村基本卫生保健服务网络体系有助于进一步解决农村居民看病贵、看病难的问题.     

Health Care Services for HIV-Positive Substance Abusers in a Rural Setting: An Innovative Program

ABSTRACT

Agencies that deliver health care services to HIV-positive substance abusers living in rural areas of the United States face particular treatment challenges and barriers to care. Rural consumers of HIV/AIDS health care–related services identified long travel distances to medical facilities, lack of transportation, lack of availability of HIV-specific medical personnel, a shortage of mental health and substance abuse services, community stigma, and financial problems as leading barriers to access to care. This article discusses barriers to care for rural HIV-positive substance abusers, and challenges for rural health care providers. In addition, it presents a case study of Health Services Center, a model program that has devised innovative practices in the delivery of health care services to HIV-positive substance abusers in rural northeastern Alabama.     

The Role of Physician Assistants in Rural Health Care: A Systematic Review of the Literature

Purpose: A literature review was performed to assess the role of physician assistants (PAs) in rural health care. Four categories were examined: scope of practice, physician perceptions, community perceptions, and retention/recruitment. Methods: A search of the literature from 1974 to 2008 was undertaken by probing the electronic bibliographic databases of English language literature. Criterion for inclusion was original data published on rural PAs. Each paper was assessed and assigned to the four categories. Findings: A total of 51 papers were identified; 28 papers had a primary focus on research and specified PAs in a rural setting. Generally, the literature suggests that PAs provide cost‐efficient and supplemental medical services to underserved rural populations and that these services are valued. It also appears that rural PAs possess a larger scope of practice than urban PAs. This broad range of skills and procedures may be necessary to match the extensive health care needs of underserved rural populations. Over a 35‐year period of examination, the literature improved in numbers of PAs studied and the quality of research. However, the lack of longitudinal studies was considered a shortcoming of rural health PA observational research. Conclusions: Through this review, some insights about the role of PAs emerged. Overall, they seem well adapted to rural health. Important issues regarding the recruitment and retention of PAs to rural populations also emerged. Improvement in enabling legislation contributes to the utilization of PAs in America.     

Building Capacity for Behavioral Health Services and Clinical Research in a Rural Primary Care Clinic: A Case Study

Integrating sustainable, evidence-based, and collaborative depression screening and follow-up treatment into primary care clinics is a significant challenge in health care. In this article a case study approach is used to describe the process of building capacity for a depression screening program in a rural federally qualified health center (FQHC). A conceptual framework addressing the clinical, operational, and financial perspectives of a primary care setting is applied restrospectively to identify 1) the barriers and facilitating factors associated with integrating a depression screening program into standard practice and 2) how the program was leveraged to conduct clinical research to improve self-management in patients with diabetes and elevated depressive symptoms.     

Adapting the Advocate Health Care Taxonomy of Chaplaincy for a Pediatric Hospital Context: A Pilot Study

There is increasing pressure to provide an evidence base for chaplaincy with children and young people. This is an underresearched area, and current evidence is often anecdotal. Advocate Health Care in Chicago (funded by the Templeton Foundation working in partnership with the Health Care Chaplaincy Network) developed a 100-item taxonomy that was the starting point for a wider international initiative in developing a taxonomy for use in health care chaplaincy. The team at Birmingham Children’s Hospital is part of this wider project and have sought to adapt and develop the original taxonomy for use in a specialist pediatric hospital. The Advocate structure of intended effect (why chaplains do what they do), method (what they do), and intervention (how they do it) was adapted by adding items generated from the chaplaincy team’s research, writing, and experience. A total of 80 taxonomy charts were collected from 12 chaplaincy team members representing three world faiths. Quantitative data from the chart were analyzed and summarized. The findings were subsequently reviewed by the research team and a revised version of the taxonomy was produced based on the frequency of use of the additional items.     

Impact of the Rural Health Clinics Services Bill: A projection

A survey of directors of midlevel practitioner training programs was conducted to analyze the projected impact of the Rural Health Clinics Services Bill (PL95-210). Sixty-eight percent of the directors responded. The majority of the respondents agreed that the bill would have a positive impact on accessibility and continuity of care and would increase the number of practitioners in rural areas. The directors of nurse practitioner programs disagreed with the directors of physician assistant programs over the issue of physician supervision and midlevel practitioner responsibility for care. Almost half of the respondents believed that the legislated method of reimbursment was not optimal, and 58% felt that financial abuses of the bill may occur. The legal implications of the bill and its impact on cost of care are discussed.     

Co-Location of Health Care Services for Homeless Veterans: A Case Study of Innovation in Program Implementation

ABSTRACT

This case study examines how the Veterans Affairs Greater Los Angeles Healthcare System (GLA) improved homeless veteran service utilization through program innovation that addressed service fragmentation. The new program offered same-day co-located mental health, medical, and homeless services with a coordinated intake system. The program is analyzed using a framework proposed by Rosenheck (2001) Rosenheck, R. A. 2001. Stages in the implementation of innovative clinical programs in complex organizations. The Journal of Nervous and Mental Disease, 189(12): 812–821. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] that has four phases: the decision to implement, initial implementation, sustained maintenance, and termination or transformation. GLA was able to successfully implement a new program that remains in the sustained maintenance phase five years after the initial decision to implement. Key factors from the Rosenheck innovation model in the program's success included coalition building, linking the project to legitimate goals, program monitoring, and developing communities of practicing clinicians. The key lesson from the case study is the need for a coalition to persistently problem solve and act as advocates for the program, even after successful initial implementation. Social work leadership was critical in all phases of program implementation.     

Children's Special Health Care Services Program: Impact of Administrative Changes on Rural Needs

This study measured the impact of 1993 Children's Special Health Care Services (CSHCS) program changes on the health care needs of rural children with chronic conditions who, in a 1991 study, were found to have significantly higher unmet health care needs compared to their urban counterparts. A follow-up survey was conducted in 1994 to 1995. The percentage of rural families indicating unmet needs declined for nearly all health-care-related items from 1991 to 1994-1995. The 1993 administrative changes in the CSHCS program have improved access to medical care and social support services for rural families, eliminating much of the urban-rural gap.     

Emergency Care in the Occupied Palestinian Territory: A Scoping Review

The development of robust emergency care systems as a critical platform for addressing the global burden of disease has been increasingly recognized by global health policy makers over the past decade. A human rights-based approach to securing the right to quality emergency care is also essential to respond to the structural and political determinants of poor health outcomes. In the occupied Palestinian territory, human rights violations have contributed to significant deficiencies in health and quality of health care. In this scoping review, we identify deficiencies in the management of high-risk presentations to emergency departments in the Palestinian health care system for traumatic injury, acute myocardial infarction, and stroke. We subsequently apply a human rights-based analysis to demonstrate how structural racism in the administration of the occupation has contributed to deficiencies in emergency care. Specifically, deficiencies in resource and system organization within the Palestinian emergency care system arise due to occupation-related restrictions on freedom of movement, the procurement of essential drugs and medical equipment, and the development of a national Palestinian health care system. Further research and intervention are needed to understand gaps in emergency care for Palestinians and, in turn, to improve the management of emergency medical and traumatic conditions through capacity building of a Palestinian emergency care system. Importantly, deconstruction of the structural determinants of poor health for Palestinians in the occupied territory is needed to improve public health and ensure the protection of human rights.