Experiences of primary healthcare professionals and patients from an area of urban disadvantage: a qualitative study.

Reath, Jennifer; King, Marlee B; Kmet, Walter; O’Halloran, Diana; Brooker, Ronald; Aspinall, Diana; Bittar, Hani; Seelan, Thava; Burke, Michael; Usherwood, Tim

doi:10.3399/bjgpopen19x101676

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…The main aim of health services is to fulfill the need of healthcare facilities to all people at all times (Daskin & Dean, 2004;Murad, 2007;Tripathi et al, 2020a). The need for healthcare is more pronounced in urban areas where the population increases continuously due to the migration of people from rural areas that resulted in a disparity of access to such services (Dell'Ovo et al, 2018;Reath et al, 2019;Shahbod et al, 2020). However, healthcare is often ignored by the governments during budget allocation and infrastructure development.…”

Section: Introductionmentioning

confidence: 99%

Comparison of GIS-based AHP and fuzzy AHP methods for hospital site selection: a case study for Prayagraj City, India

2021

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Identification of hospital sites and their ranking is important for the planning and development of any country's health infrastructure. The site selection problem is a typical multi-criteria decision making problem involving multiple stakeholders and their interests. Multi-Criteria Decision Analysis (MCDA) is a promising approach to solve a location-based problem due to the constitution of various criteria involved in decision making. In this research, eleven criterion are chosen which are classified under three main criteria; socio-economic, geographical and environmental. This research aims to identify the appropriate MCDA method for the selection of a new hospital sites. Here, two MCDA methods named Analytical Hierarchy Process (AHP) and Fuzzy AHP (FAHP) are used. Further, Geographical Information System (GIS) based MCDA methodology is proposed in this paper. The results obtained with both AHP and FAHP methods are compared. This comparison is based on criterion rankings, proposed hospital locations and sensitivity analysis. The main difference in results is shown in the result of sensitivity analysis in which constant variation in site ranking is obtained when weight change analysis is performed using AHP. The FAHP result shows only one variation in site ranking after a change in weight from ?10 to ?20%. The result suggests that FAHP may be a better approach to the hospital site selection problem.

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Section: Introductionmentioning

confidence: 99%

Comparison of GIS-based AHP and fuzzy AHP methods for hospital site selection: a case study for Prayagraj City, India

2021

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Section: Discussionmentioning

confidence: 99%

“…Third, in the local context, this study enrolled a diverse population from the South Western Sydney area which is considered an area of socioeconomic disadvantage, putting this vulnerable population at risk of increased adverse health outcomes [30][31][32]. [30][31][32]. Outreach services such as the one studied facilitates access to essential health services, including specialist nurse review and early referral pathways.…”

Section: Discussionmentioning

confidence: 99%

“…The median age in the enrolled group was slightly younger than the non-enrolled group (81 years [IQR 73-87] vs 83 years [IQR 74-89], p <0.001). In the enrolled group there were slightly less females (40.6% vs. 50.6%, p = 0.055), lower mean left ventricular systolic function (median 33 [IQR [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] vs 35 [IQR 25-45], p 0.029) and lower median pulmonary artery systolic pressure in the enrolled group (40 mmHg [IQR 32-51] vs 41 mmHg [IQR 35-52], p = 0.028). Furthermore, the enrolled group had a significantly higher prevalence of ischemic cardiomyopathy (69.6% vs. 49.4%, p <0.001).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

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Personalised Cardiac Rehabilitation Outreach Service Reduces Mortality and Hospitalisations in Heart Failure with Reduced Ejection Fraction

Al-Falahi

Femia

Gardiner

et al. 2021

Preprint

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Background Heart failure (HF) has become a major cause of morbidity and mortality worldwide. Despite significant improvements in the management of HF, the overall outcomes remain poor. In addition to pharmacotherapy and device therapy, non-pharmacological interventions are needed to mitigate the effects of this illness. The aim of this study was to evaluate the impact of the heart failure outreach program on the rate of mortality, HF hospitalisations and guideline directed medical therapy (GDMT) for HF in South Western Sydney Local Health District (SWSLHD). Methods In this observational, registry based study, adult patients diagnosed with Heart failure with reduced ejection fraction (HFrEF) within the South Western Sydney Local Health District (SWSLHD) and invited to participate in the heart failure outreach service between March 2011 and January 2016 were included in the study. The primary outcome was all-cause mortality. In addition, we examined the rate of optimal medical therapy, HF hospitalisations and the total lengths of stay. Results A total of 818 patients were included in the study; 470 (57.5%) patients were enrolled and 348 (42.5 %) not enrolled into the program. At the end of the follow up period (median 978 days, interquartile range (IQR) 720-1237), the primary outcome of mortality was observed significantly less in the enrolled group (122 (26%) vs. 133 (38.2%), p<0.001) independently of other variables. In addition, significantly fewer enrolled patients had >3 hospital admissions for HF (16.2% vs. 35.6%, p<0.001) and reduced median admission days (14.5 days [IQR 8-25] vs 22 [IQR 12-37], p <0.001). Patients enrolled into the program were much more likely to be on GDMT (76.6% vs 56.6%, p<0.001). Conclusions Enrolment in the heart failure outreach program was associated with a significant reduction in mortality as well as a reduction in the frequency and length of hospital admissions. In addition, the rate of GDMT was significantly higher in the enrolled group. With the high prevalence of heart failure, these programs should be considered in the routine management of patients with HFrEF. Background Heart failure (HF) has become a major cause of morbidity and mortality worldwide. Despite significant improvements in the management of HF, the overall outcomes remain poor. In addition to pharmacotherapy and device therapy, non-pharmacological interventions are needed to mitigate the effects of this illness. The aim of this study was to evaluate the impact of the heart failure outreach program on the rate of mortality, HF hospitalisations and guideline directed medical therapy (GDMT) for HF in South Western Sydney Local Health District (SWSLHD). Methods In this observational, registry based study, adult patients diagnosed with Heart failure with reduced ejection fraction (HFrEF) within the South Western Sydney Local Health District (SWSLHD) and invited to participate in the heart failure outreach service between March 2011 and January 2016 were included in the study. The primary outcome was all-cause mortality. In addition, we examined the rate of optimal medical therapy, HF hospitalisations and the total lengths of stay. Results A total of 818 patients were included in the study; 470 (57.5%) patients were enrolled and 348 (42.5 %) not enrolled into the program. At the end of the follow up period (median 978 days, interquartile range (IQR) 720-1237), the primary outcome of mortality was observed significantly less in the enrolled group (122 (26%) vs. 133 (38.2%), p<0.001) independently of other variables. In addition, significantly fewer enrolled patients had >3 hospital admissions for HF (16.2% vs. 35.6%, p<0.001) and reduced median admission days (14.5 days [IQR 8-25] vs 22 [IQR 12-37], p <0.001). Patients enrolled into the program were much more likely to be on GDMT (76.6% vs 56.6%, p<0.001). Conclusions Enrolment in the heart failure outreach program was associated with a significant reduction in mortality as well as a reduction in the frequency and length of hospital admissions. In addition, the rate of GDMT was significantly higher in the enrolled group. With the high prevalence of heart failure, these programs should be considered in the routine management of patients with HFrEF.

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“…In line with previous research [12,16,17], practitioners viewed applying for approval to prescribe medicinal cannabis under the Australian Special Access Scheme as highly burdensome and noted that product costs were prohibitively high for some patients. This raises important concerns regarding equitable patient access, as this may disproportionately impact patients in lower socioeconomic areas who may be unable to afford the medication [41].…”

Section: Multiple Barriers To Prescribing Medicinal Cannabismentioning

confidence: 99%

‘The wild west of medicine’: A qualitative investigation of the factors influencing Australian health‐care practitioners' delivery of medicinal cannabis

Dobson,

Barber,

Graham

et al. 2024

Drug and Alcohol Review

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IntroductionStrong patient interest in the use of medicinal cannabis to treat various clinical indications has sparked global legislative changes. Practitioners are vital in implementing regulatory changes and facilitating patient access to medicinal cannabis, however, little is currently known about the factors influencing practitioners' uptake. Recent rapid increases in practitioner applications to prescribe medicinal cannabis in Australia provides a unique backdrop to examine the current factors influencing prescribing behaviours. This qualitative study examined Australian practitioners' perspectives on prescribing medicinal cannabis to provide a comprehensive exploration of the potential factors influencing uptake in clinical practice.MethodsSeventeen semi‐structured interviews were conducted with Australian health‐care practitioners. Transcripts were analysed using the Framework approach to thematic analysis and cross‐mapped to appropriate domains of the Theoretical Domains Framework.ResultsWe identified four themes related to the barriers and facilitators to prescribing medicinal cannabis: (i) clinical capabilities needed to prescribe; (ii) prescribing an unapproved therapeutic good; (iii) negative attitudes towards prescribers in the medical community; and (iv) divergent beliefs about clinical utility.Discussion and ConclusionsPractitioners face multiple pervasive barriers to prescribing medicinal cannabis. Beliefs about clinical utility appear to be highly influential in shaping prescribing behaviours. Moreover, our findings suggest that a medicinal cannabis ‘specialisation’ has emerged within the Australian medical community. Findings demonstrate that a range of complex and multifaceted factors influence practitioners' medicinal cannabis prescribing behaviours. We highlight several considerations for policy and practice to support safe and appropriate patient access to medicinal cannabis in this emerging area of clinical practice.

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Experiences of primary healthcare professionals and patients from an area of urban disadvantage: a qualitative study.

Cited by 7 publications

References 24 publications

Comparison of GIS-based AHP and fuzzy AHP methods for hospital site selection: a case study for Prayagraj City, India

Comparison of GIS-based AHP and fuzzy AHP methods for hospital site selection: a case study for Prayagraj City, India

Personalised Cardiac Rehabilitation Outreach Service Reduces Mortality and Hospitalisations in Heart Failure with Reduced Ejection Fraction

‘The wild west of medicine’: A qualitative investigation of the factors influencing Australian health‐care practitioners' delivery of medicinal cannabis

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