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City mouse, country mouse: a mixed-methods evaluation of perceived communication barriers between rural family physicians and urban consultants in Newfoundland and Labrador, Canada.

ABSTRACT: To examine perceived communication barriers between urban consultants and rural family physicians practising routine and emergency care in remote subarctic Newfoundland and Labrador (NL).This study used a mixed-methods design. Quantitative and qualitative data were collected through exploratory surveys, comprised of closed and open-ended questions. The quantitative data was analysed using comparative statistical analyses, and a thematic analysis was applied to the qualitative data.52 self-identified rural family physicians and 23 urban consultants were recruited via email. Rural participants were also recruited at the Family Medicine Rural Preceptor meetings in St John's, NL.Rural family physicians and urban consultants in NL completed a survey assessing perceived barriers to effective communication.Data confirmed that both groups perceived communication difficulties with one another; with 23.1% rural and 27.8% urban, rating the difficulties as frequent (p=0.935); 71.2% rural and 72.2% urban as sometimes (p=0.825); 5.8% rural and 0% urban acknowledged never perceiving difficulties (p=0.714). Overall, 87.1% of participants indicated that perceived communication difficulties impacted patient care. Primary trends that emerged as perceived barriers for rural physicians were time constraints and misunderstanding of site limitations. Urban consultants' perceived barriers were inadequate patient information and lack of native language skills.Barriers to effective communication are perceived between rural family physicians and urban consultants in NL.

SUBMITTER: Renouf T

PROVIDER: S-EPMC4861124 | biostudies-other | 2016

REPOSITORIES: biostudies-other

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Project description:BackgroundActive school transport (AST) can increase children's and adolescents' physical activity. The proportion of children and adolescents who engage in AST has declined internationally in recent decades. This study examines the prevalence, correlates, and perceived barriers to AST in the city of Leipzig, Germany.MethodsThe study sample includes 1070 participants, 364 children and 706 adolescents, aged between 6 and 18 years, as well as their parents. The parents as well as adolescents age 10 and above completed questionnaires concerning sociodemographic variables, means of transport/AST and perceived barriers to AST. The distance between home and school was calculated as the network distance from the home to school address using the Dijkstra algorithm. Based on these data, logistic models were fitted in a two-step variable selection process, using AST as the dependent variable.ResultsApproximately half of the children (59%) and adolescents (51%) engaged in AST. The prevalence of AST exhibited a negative correlation with age (Odds Ratio (OR) = 0.94, 95% confidence interval (CI) = 0.9-0.99, p = 0.015) and did not significantly differ by gender (children: ORgirls = 1.5, CI = 0.95-2.25, p = 0.075, adolescents: ORgirls = 1.01, CI = 0.75-1.37, p = 0.924). A high socioeconomic status was positively correlated to AST on the morning trip (OR = 1.7, CI 1.3-2.21, p < 0.01) but negatively on the afternoon trip (OR = 0.7, CI = 0.53-0.9, p < 0.01) in the summer. Common barriers for children (from their parents' perspective) and for adolescents (from their own and their parents' perspective) were distance and a heavy load to carry. The parents of adolescents did not perceive any other specific barriers as a serious impediment. Further significant barriers perceived by the younger children's parents were adults giving a lift on the way to other errands, no other children to walk or cycle with, and too much traffic. Too much traffic was also a significant barrier for adolescents, as were taking too much time and bad weather conditions.ConclusionsFuture interventions promoting AST in an urban environment should be guided by the identified perceived barriers.Trial registrationLIFE Child has been retrospectively registered with ClinicalTrials.gov (NCT02550236).

Project description:OBJECTIVE:The study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare (PHC) services in Canada. DESIGN:A qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research approach. Focus group discussions were conducted to collect the qualitative data where thematic analysis was applied. SETTING:The focus group discussions were held in various community centres such as individual meeting rooms at public libraries, community halls and so on arranged in collaboration with community organisations while ensuring complete privacy. PARTICIPANT:Thirty-eight adults, Bangladeshi immigrant men, living in Calgary were selected for this study and participated in six different focus groups. The sample represents mostly married, educated, Muslim, Bangla speaking, aged over 25 years, full-time or self-employed and living in an urban centre in Canada >5 years. RESULT:The focus groups have highlighted long wait time as an important barrier. Long wait at the emergency room, difficulties to get access to general physicians when feeling sick, slow referral process and long wait at the clinic even after making an appointment impact their daily chores, work and access to care. Language is another important barrier that impedes effective communication between physicians and immigrant patients, thus the quality of care. Unfamiliarity with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in Canada. However, no gender-specific barriers unique to men have been identified in this study. CONCLUSION:The barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority immigrants. It is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.

Project description:Most non-dialysis dependent chronic kidney disease (CKD) patients are cared for by their primary care physicians (PCPs). Studies suggest many CKD patients receive suboptimal care. Recently, CKD clinical practice guidelines were updated with additional emphasis on albuminuria.We performed an internet-based, cross-sectional survey of active PCPs in the United States using the American Medical Association Physician Masterfile. We explored CKD guideline familiarity, self-reported practice behaviors, and attitudinal and external barriers to implementing guideline recommendations, including albuminuria testing.Of 12,034 PCPs targeted, 848 opened a study email, 165 (19.5%) responded. Most respondents (88%) spent ?50% of their time in clinical care. Respondents were generally in private practice (46%). Most PCPs (96%) felt that eGFR values were helpful. Approximately, 75% and 91% of PCPs reported testing for albuminuria in non-diabetic hypertensive patients with an eGFR?>?60 ml/min/1.73 m2 and?<?60 ml/min/1.73 m2, respectively. Barriers to albuminuria testing included a lack of effect on management, limited time, and the perceived absence of guidelines recommending testing. While PCPs expressed high levels of agreement with the definition of CKD, 30% were concerned with overdiagnosis in older adults with an eGFR in the CKD stage 3a range. Most PCPs felt that angiotensin converting enzyme inhibitor (ACEi)/ angiotensin II receptor blockers (ARBs) improved outcomes in CKD, though agreement was lower with severe vs. moderate albuminuria (78% vs. 85%, respectively, p?=?0.03). Many PCPs (51%) reported being unfamiliar with CKD guidelines, but were receptive to systematic interventions to improve their CKD care.PCPs generally agree with CKD clinical practice guidelines regarding CKD definition and albuminuria testing. However, future interventions are necessary to improve PCPs' familiarity with CKD guidelines, overcome barriers to albuminuria testing and, assist PCPs in targeting ACEi/ARBs to the patients most likely to benefit.

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City mouse, country mouse: a mixed-methods evaluation of perceived communication barriers between rural family physicians and urban consultants in Newfoundland and Labrador, Canada.

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