Pacific Islanders' perspectives on heart failure management.
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OBJECTIVE: To identify the health beliefs, attitudes, practices, and social and family relations important in heart failure treatment among Pacific Islanders. METHODS: Four focus groups were convened with 36 Native Hawaiians and Samoans with heart failure and their family caregivers. Thematic data analysis was used to categorize data into four domains: health beliefs and attitudes, preferred health practices, social support systems, and barriers to heart failure care. RESULTS: Common coping styles and emotional experiences of heart failure in this population included avoidance or denial of illness, hopelessness and despair, and reliance on spiritual/religious beliefs as a means of support. Among study participants, more Samoans preferred to be treated by physicians whereas more Native Hawaiians preferred traditional Hawaiian methods of healing. Two types of social support (informational and tangible-instrumental) were identified as important in heart failure care. Barriers to heart failure care included poor knowledge of heart failure, lack of trust in physicians' care, poor physician-patient relations, finances, dietary changes, and competing demands on time. CONCLUSION: The recruitment, retention, and adherence of Pacific Islanders to heart failure interventions is affected by an array of psychosocial and socio-cultural factors. PRACTICE IMPLICATIONS: Interventions might be improved by offering participants accurate and detailed information about heart failure and its treatment, engaging the extended family in providing necessary supports, and providing tools to facilitate physician-patient relationships, among others, within the context of a larger socio-cultural system. (+info)
A patient-instructor program to promote dental students' communication skills with diverse patients.
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This article describes the design and evaluation of a patient-instructor (PI) program that was developed to teach and assess dental student communication skills with patients, with an emphasis on cross-cultural patient encounters. The PIs were individuals from the community trained to portray specific simulated patients. One hundred eighteen dental students (three graduating classes) completed two half-day rotations that occurred in the junior year; seventy-nine of those students (two graduating classes) also completed a third rotation that occurred in the senior year. On each rotation, students worked with several simulated patients in mock clinic appointments. PIs used a standardized rating scale and case-specific content checklists to assess students' ability to elicit and provide essential information. Across counterbalanced cases, students improved as they progressed through encounters. Rate of improvement varied by rotation, but students improved most during their first rotation. Overall performance was best on the final rotation. Qualitative review of content checklist items indicated areas of strengths and weaknesses in communication regarding medical, dental, psychosocial, and cultural content. Results can direct curriculum changes to improve communication skills. Future research should address the effects of the PI program on students' diversity-related attitudes and behaviors. (+info)
Primary care at the Alaska Native Medical Center: a fully deployed "new model" of primary care.
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OBJECTIVES: Beginning in the 1940s health care for Alaska Native people was delivered by the United States Indian Health Service. The transition to Alaska Native ownership was completed in 1998-9 with the transfer of the Alaska Native Medical Center to Alaska Native corporations. METHODS: The Native leaders of Southcentral Foundation made a conscious decision to redesign the medical primary care system around the core premise of optimizing long-term, trusting, accountable relationships. The medical system was reoriented to optimize these relationships, assure whole system intentional and integrated design, and remove barriers to these relationship being formed. RESULTS: . The transformed system allowed Alaska Native individuals and families to choose a primary care provider, enter into long-term trusting relationship with the provider, and partner in the journey towards wellness. It was a fully integrated approach that used every part of the system to best advantage, put the power in the hands of the individual and family, and effectively focused on the underlying determinants of health. CONCLUSIONS: The primary care system created and managed by Southcentral Foundation at the Alaska Native Medical Center demonstrated a system built on similar premises to the "New Model" of family medicine. (+info)
Improved and expanded pharmacy care in rural Alaska through telepharmacy and alternative methods demonstration project.
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OBJECTIVES: To describe innovative use of technology to improve the level of pharmacy care in remote villages in rural Alaska. STUDY DESIGN: Cross-sectional study. METHODS: The Alaska Native Medical Center and outlying health clinics formed the Southcentral Foundation Pharmacy Network to provide pharmacy services to Native and non-Native patients living in the rural Anchorage Service Unit. The Alaska Native Medical Center served as the central pharmacy, purchasing drugs on behalf of the network and dispensing those drugs to patients of the network. In April 2003, four remote pharmacies began a 6 month comparison of two different telepharmacy equipment systems. The systems were assessed for various factors such as hardware and software capabilities and the customer support offered. The program was then expanded to include 12 participating sites. RESULTS: During fiscal year 2006, 22665 prescriptions were processed utilizing telepharmacy and prospective pharmacist review. There were 990 documented pharmacist consultations and interventions (4.4% of all prescriptions processed). CONCLUSIONS: Incorporation of recent technological advancements enabled the pharmacy department of the Alaska Native Medical Center to improve and expand the provision of pharmacy services to rural, isolated communities. Based upon the success of the program, future sites are being targeted for telepharmacy inclusion. (+info)
Provider and clinic cultural competence in a primary care setting.
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Kids Identifying and Defeating Stroke (KIDS): development and implementation of a multiethnic health education intervention to increase stroke awareness among middle school students and their parents.
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