<Emphasis Type="Italic">"They think we're OK and we know we're not"</Emphasis>. A qualitative study of asylum seekers' access,knowledge and views to health care in the UK

Background  

The provision of healthcare for asylum seekers is a global issue. Providing appropriate and culturally sensitive services requires us to understand the barriers facing asylum seekers and the facilitators that help them access health care. Here, we report on two linked studies exploring these issues, along with the health care needs and beliefs of asylum seekers living in the UK.     

Self‐responsibility,rationing and treatment decision making – managing moral narratives alongside fiscal reality in the obesity surgery clinic

Background

Addressing the prevalence of severe obesity and its concomitant morbidities is widely acknowledged as one of the most pressing global health priorities. Nevertheless, a paucity of effective interventions and universal pressure on health‐care budgets means that access to obesity treatments is often limited. Although health‐care rationing can be conceived as a socially constructed process, little is known about how decisions emerge within the context of face‐to‐face doctor–patient interactions.

Methods

In this study, we used in‐depth interviews and clinic observations to investigate clinicians’ (n = 11) and patients’ (n = 22) experiences of the rationing of obesity surgery and to examine how broader cultural assumptions around personal responsibility for health emerged in the context of clinical interactions.

Results

Patients and clinicians worked within similar frameworks when it came to self‐responsibility for health and the appropriateness of providing publicly‐funded weight loss surgery. Issues around personal accountability dominated consultations, and patients were expected to provide narratives of the development of their obesity and to account for the failure of previous interventions. Clinicians faced the added pressure of having to prioritise a limited number of patients for surgery, which was predominantly managed through mandating pre‐referral weight loss targets.

Discussion

Although clinicians sought to maintain an empathic attitude towards individual patients, in practice they were conflicted by their responsibility to ration health‐care resources and tended to rely on entrenched models of behaviour change to allocate treatment. As a result, the content of consultations was mostly focused on issues of personal responsibility, reflecting wider stigmatized attitudes towards extreme obesity.     

Health literacy, health status, and healthcare utilization of taiwanese adults: results from a national survey

Background  

Low health literacy is considered a worldwide health threat. The purpose of this study is to assess the prevalence and socio-demographic covariates of low health literacy in Taiwanese adults and to investigate the relationships between health literacy and health status and health care utilization.     

What doctors think about the impact of managed care tools on quality of care,costs, autonomy,and relations with patients

Background  

How doctors perceive managed care tools and incentives is not well known. We assessed doctors' opinions about the expected impact of eight managed care tools on quality of care, control of health care costs, professional autonomy and relations with patients.     

Burnout and use of HIV services among health care workers in Lusaka District, Zambia: a cross-sectional study

Background  

Well-documented shortages of health care workers in sub-Saharan Africa are exacerbated by the increased human resource demands of rapidly expanding HIV care and treatment programmes. The successful continuation of existing programmes is threatened by health care worker burnout and HIV-related illness.     

Evaluation of maternal and child health services in El-Minia City, Egypt

Background  

Primary health-care centers provide outpatient health care and primary preventive activities for people in general and for mothers and children in particular. Medical care aims not only to improve health status, but also to respond to patients’ needs and wishes and to ensure their satisfaction with care. The patient-clinician relationship is a central feature of primary care.     

Provider performance in treating poor patients - <Emphasis Type="Italic">factors influencing prescribing practices in lao PDR: a cross-sectional study</Emphasis>

Background  

Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs) have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors.     

Falls Assessment Clinical Trial (FACT): design,interventions, recruitment strategies and participant characteristics

Background  

Guidelines recommend multifactorial intervention programmes to prevent falls in older adults but there are few randomised controlled trials in a real life health care setting. We describe the rationale, intervention, study design, recruitment strategies and baseline characteristics of participants in a randomised controlled trial of a multifactorial falls prevention programme in primary health care.     

Empowerment interventions,knowledge translation and exchange: perspectives of home care professionals,clients and caregivers

Background  

Few studies have examined empowerment interventions as they actually unfold in home care in the context of chronic health problems. This study aims to document the empowerment process as it plays out in interventions with adults receiving home care services.     

Trends in health services utilization, medication use, and health conditions among older adults: a 2-year retrospective chart review in a primary care practice

Background  

Population aging poses significant challenges to primary care providers and healthcare policy makers. Primary care reform can alleviate the pressures, but these initiatives require clinical benchmarks and evidence regarding utilization patterns. The objectives of this study is to measure older patients' use of health services, number of health conditions, and use of medications at the level of a primary care practice, and to investigate age- and gender-related utilization trends.     

Are health care professionals able to judge cancer patients' health care preferences correctly? A cross-sectional study

Background  

Health care for cancer patients is primarily shaped by health care professionals. This raises the question to what extent health care professionals are aware of patients' preferences, needs and values.     

Integrating mental health into primary care for displaced populations: the experience of Mindanao, Philippines

Background  

For more than forty years, episodes of violence in the Mindanao conflict have recurrently led to civilian displacement. In 2008, Medecins Sans Frontieres set up a mental health program integrated into primary health care in Mindanao Region. In this article, we describe a model of mental health care and the characteristics and outcomes of patients attending mental health services.     

"There's no kind of respect here" A qualitative study of racism and access to maternal health care among Romani women in the Balkans

Introduction  

Roma, the largest minority group in Europe, face widespread racism and health disadvantage. Using qualitative data from Serbia and Macedonia, our objective was to develop a conceptual framework showing how three levels of racism--personal, internalized, and institutional--affect access to maternal health care among Romani women.     

Association between obesity,quality of life,physical activity and health service utilization in primary care patients with osteoarthritis

Objective  

To assess the association of obesity with quality of life, health service utilization and physical activity in a large sample of primary care patients with osteoarthritis (OA).     

The relations between symptoms,somatic and psychiatric conditions,life satisfaction and perceived health. A primary care based study

Background  

In spite of the fact that self-rated health is such an important factor, little is known about the aetiological background to poor perceived health and also less is known about the impact of life satisfaction on health in a primary care practice population. The aim of this study was to evaluate the effect of socio-demographic characteristics, lifestyle factors, symptoms, somatic and psychiatric conditions as well as health status measures and life satisfaction on perceived health in a multi-ethnic Swedish health practice population.     

Multidisciplinary cancer care in Spain,or when the function creates the organ: qualitative interview study

Background  

The Spanish National Health System recognised multidisciplinary care as a health priority in 2006, when a national strategy for promoting quality in cancer care was first published. This institutional effort is being implemented on a co-operative basis within the context of Spain's decentralised health care system, so a high degree of variability is to be expected. This study was aimed to explore the views of professionals working with multidisciplinary cancer teams and identify which barriers to effective team work should be considered to ensure implementation of health policy.     

Minimising harm from heatwaves: a survey of awareness,knowledge, and practices of health professionals and care providers in Victoria,Australia

Objectives  

Heatwaves cause illness and death, and are likely to become more severe and frequent in the future. This study has investigated the awareness, knowledge and practices of health professionals and care providers regarding heatwaves and health of older clients, in order to inform harm minimisation strategies for Victoria, Australia.