Exploring the potential link between Medicaid access restrictions, physician location, and health disparities. (57/324)

OBJECTIVE: To determine whether a given doctor treating Medicaid patients is likely to practice in a predominantly minority area, and whether a minority patient is likely to be treated by a physician who is heavily influenced by Medicaid policy decisions. STUDY DESIGN: Retrospective pharmacy claims database analysis combined with zip-5-level demographic analysis. METHODS: Data extracted from a large prescription claims database were used to categorize all active prescribers in the United States by the proportion of prescription claims paid by state Medicaid programs from May 31, 2003, to April 30, 2004. US Census data from 2000 were used to assess the ethnic composition of each physician's zip code. Descriptive analyses were conducted to explore any associations between zip code racial composition and proportion of prescriber prescription claims adjudicated by state Medicaid programs. RESULTS: Physicians with more than 75% of their prescriptions adjudicated through Medicaid versus those with fewer than 1% of their prescriptions adjudicated through Medicaid practiced in zip codes that were 47% versus 24% nonwhite, respectively. Residents in Medicaid-intense zip codes were 59% nonwhite versus 31% nonwhite in the nation as a whole. CONCLUSION: Nonwhite residents are much more likely than white residents to live in a zip code where Medicaid prescribing rules will affect their physician. Any legislation-induced changes in prescribing patterns seem likely to disproportionately impact both Medicaid and non-Medicaid minority residents in these areas.  (+info)

Psychosocial and professional characteristics of burnout in Swiss primary care practitioners: a cross-sectional survey. (58/324)

OBJECTIVE: To measure the prevalence of burnout and explore its professional and psychosocial predictors among Swiss primary care practitioners. METHODS: A cross-sectional postal survey was conducted to measure burnout, work-related stressors, professional and psychosocial characteristics among a representative sample of primary care practitioners. Answers to the Maslach burnout inventory were used to categorize respondents into moderate and high degree of burnout. RESULTS: 1784 physicians responded to the survey (65% response rate) and 1755 questionnaires could be analysed. 19% of respondents had a high score for emotional exhaustion, 22% had a high score for depersonalisation/cynicism and 16% had a low score for professional accomplishment; 32% had a high score on either the emotional exhaustion or the depersonalisation/cynicism scale (moderate degree of burnout) and 4% had scores in the range of burnout in all three scales (high degree of burnout). Predictors of moderate burnout were male sex, age 45-55 years and excessive perceived stress due to global workload, health-insurance-related work, difficulties to balance professional and private life, changes in the health care system and medical care uncertainty. A high degree of burnout was associated with male sex, practicing in a rural area, and excessive perceived stress due to global workload, patient's expectations, difficulties to balance professional and private life, economic constraints in relation to the practice, medical care uncertainty and difficult relations with non-medical staff at the practice. CONCLUSION: About one third of Swiss primary care practitioners presented a moderate or a high degree of burnout, which was mainly associated with extrinsic work-related stressors. Medical doctors and politicians in charge of redesigning the health care system should address this phenomenon to maintain an efficient Swiss primary care physician workforce in the future.  (+info)

Development of a questionnaire measuring student attitudes to working and living in rural areas. (59/324)

INTRODUCTION: Student attachments in rural locations have been instigated, in part to foster positive attitudes to rural practice and encourage rural recruitment. Based on medical and allied health literature, it was hypothesised that students' attitudes to rural practice and rural life encompasses the following three dimensions: (1) community and social issues; (2) family and personal issues; and (3) professional issues. However, there are limited studies assessing attitudinal change before and after rural placement and no valid and reliable tools which examine change across all three dimensions. This article reports on the development, reliability and validity of such a tool to fill this gap in the rural health research literature. METHODS: Students who undertook a rural placement in South Australia or a rural placement organised by the Mt Isa Centre for Rural and Remote Health in Queensland, Australia, during 2001 were invited to complete a pre- and post-placement questionnaire (n = 243). The response rate for the pre-placement questionnaire was 74.9% (n = 182) and 50.2% (n = 122) for the post-placement questionnaire. A literature review informed the content of the initial questionnaire, which consisted of a series of statements to which respondents were instructed to indicate how strongly they agreed or disagreed on a Likert scale of one to six. The assessment of validity and reliability of the questionnaire involved three main processes. Content validity was assessed by discussion and rating by academics and students, resulting in 18 questionnaire items. Exploratory factor analysis was used to provide evidence of construct validity. The internal consistency reliability of the questionnaire was assessed using Cronbach's alpha. RESULTS: The Cronbach's alpha coefficient for the post-questionnaire was 0.68, acceptable for newly developed scales. Exploratory factor analysis and varimax rotation was conducted for pre- and post-placement (n = 110) questionnaires. The pre-placement questionnaire did not lend itself to logical interpretation, probably due to the diverse attitudes students may have pre-rural placement. However the factors on the post-placement questionnaire were interpretable. The Scree Plot indicated four factors, explaining 60.82% of the total variance. The factors were rotated using the normalised varimax rotation method. The factors extracted were: (1) friendliness and support in rural areas; (2) isolation and socialisation problems associated with living and working in rural areas; (3) enjoyable aspects of living in a rural area; and (4) opportunities that working in a rural area provides. CONCLUSIONS: Analysis of the Student Attitudes to Rural Practice and Life Questionnaire provides evidence of validity. The study identified four factors associated with student attitudes to living and working in rural areas, which differ from those hypothesised. The main deviation was Factor 2, grouping all the negative aspects of isolation and socialisation in a rural area. The resulting factors provide a more integrated reflection of the rural experience, rather than the rigid categorisation of professional, social and personal issues. Reliability was found to be adequate. The questionnaire is able to measure student attitudes to rural practice and rural life, and may be used to evaluate the impact of rural placement on student attitudes.  (+info)

Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish Highlands. (60/324)

INTRODUCTION: Many westernised countries face ongoing difficulties in the recruitment and retention of health professionals in remote and rural communities. Predictors of rural working have been identified by the international literature, and include: the individual having been born or educated in a rural location; exposure to rural healthcare during training; access to continuing professional education; good relationships with peers; spousal contentedness; adoption of a rural 'lifestyle'; successful integration into local communities; and educational opportunities for children. However, those themes remain unverified in the UK. The present study aimed to ascertain whether the internationally identified determinants of recruitment and retention of the rural health workforce apply in the Highlands of Scotland, which includes the most sparsely populated area of the UK mainland, as well as an urban area. METHODS: In 2003, a questionnaire was sent to all 2070 primary healthcare professionals working in the Highlands (which makes up one-third of Scotland's land area (9800 square miles) and has just 4% of the country's population (209,000)). Approximately one-quarter of the Highland's population live in Inverness. The area is ideal for investigating the rural workforce due to its population sparsity and the inclusion of small towns and Inverness, allowing urban/rural comparisons. The questionnaire asked about places of birth and education; intentions to stay/leave current location; professional isolation; access to amenities; and perceptions of belonging to the local community. RESULTS: The response rate was 53%. Compared with respondents working in urban areas, those working in rural areas were more likely to have been born in rural areas. Professionals living in rural areas were more likely to have been born outside Scotland and to have completed their secondary education and professional training outside Scotland, compared with those living in urban areas. Approximately one-third (34%) had lived in their current location for more than 10 years, and that proportion was higher for the urban group compared with rural dwellers. Similarly, the urban dwellers were more likely to have been in their current job for more than 10 years. Respondents' perceptions of being isolated, of their caring roles extending beyond their work; and of an inability to get away from work for holidays and study leave, were more common among rural dwellers. Eighty-one percent of respondents said that they felt part of their community and that proportion was higher for those working in rural areas, than for urban residents. Respondents indicated their perceived ease of access to five amenities and services: children's education (preschool, primary and secondary); access to a job for spouse; and health care. With the one exception of access to primary education, access was perceived to be most difficult by the professionals working in rural areas. CONCLUSIONS: Our survey confirms, in the UK, the association between rural background and rural working, and highlights the contribution of healthcare professionals from other parts of the UK to the Scottish rural workforce. It also suggests that professional isolation and perceived lack of access to amenities are important issues for those working in rural areas.  (+info)

A database to record, track and report health student rural placements. (61/324)

The Spencer Gulf Rural Health School (SGRHS), South Australia, is funded by the Australian Commonwealth Government to deliver health education in the rural setting. The SGRHS required a database to record, track and report on student rural placements to satisfy Commonwealth reporting requirements, and for internal academic and administration staff use. Staff in widely separate rural locations needed to be able to access the database. A web-based relational database was created using Microsoft Access. The student rural placement database has been successfully utilised as the primary tool to record and track student placements in the SGRHS for 2 years, and has generated data for eight Commonwealth reports in this time. Future database developments include student accessible sections. With few alterations the database could be utilised by other Australian Rural Clinical Schools and University Departments of Rural Health.  (+info)

Factors that influence students in choosing rural nursing practice: a pilot study. (62/324)

INTRODUCTION: Nursing shortages continue globally and are especially critical in rural and remote communities. Attracting nurses to work in less populated regions presents challenges that differ from those in urban areas. METHODS: This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and under graduate programs of nursing, and were attending an international rural nursing conference. RESULTS: Findings from the pencil and paper short answer survey found those who have life experiences and connections in small communities are more likely to choose this setting. Post-graduation employment preference was reinforced by ongoing exposure to rural theory and practice settings in their programs of study. Nursing scholars may find this study useful to further examine students' employment preferences, and to develop targeted strategies to better prepare those having an interest in rural practice. CONCLUSION: Evidence based findings are critically needed to recruit and retain nurses to address critical nursing shortages in rural regions in North America and globally.  (+info)

Biotelemetry: could technological developments assist healthcare in rural India. (63/324)

CONTEXT: In India 60-70% of the population live in rural villages. The rural population suffers from a burden of disease and disorders due to the non-availability of appropriate healthcare personnel and facilities. Since 1950, the Indian Government has responded with a series of five-year plans but has been unable to address the lack of healthcare professionals prepared to work in isolated and rural areas. ISSUE: The use of biotelemetry is proposed as a solution, its advantages and disadvantages are discussed. LESSONS: The development of biotelemetry in India will improve healthcare for the rural and remote population and ease the effects of the shortage of rural healthcare professionals. However, a number of questions remain and require further consideration.  (+info)

Do benefits accrue from longer rotations for students in Rural Clinical Schools? (64/324)

INTRODUCTION: The Australian Government has provided funding for Rural Clinical Schools (RCS) to provide substantial rural clinical experience to medical students. The strategy aims to acculturate students into rural living with the intended long-term outcome of increasing the availability and viability of rural health services. When evaluators from two of the Rural Clinical Schools discussed findings and insights relating to rural rotations from their in-depth evaluation studies of their respective schools they found a range of similarities. This article is a collaboration that articulates parallel findings from evaluations over 2 years, using three different approaches to students' placements across the two RCS: (1) students based long term in one centre (with only a few days away at a time); (2) students based long term in one centre with short-term rotations of 3-6 weeks away from home base; and (3) week rotations without a home base. METHOD: The two RCS, as part of their initial establishment, put comprehensive internal evaluation processes in place, including the employment of dedicated evaluators extant from the teaching and assessment of the rural medical curriculum. Data were collected and analysed according to standard education evaluation procedures. RESULTS: Home-base preference: most students preferred having a home base in one centre and having as little time as possible away from that centre, while recognising that sometimes the requirement to go and learn elsewhere was useful. The reasons for this were three-fold: academic, clinical and social. Academic benefits: students enjoyed the excellence of teaching and learning opportunities in their rural sites and did not want their discipline of learning interrupted by what they perceived as unnecessary change. Students with a home base used their learning opportunities qualitatively differently from those students who had 6 week rotations. Their learning became self-directed and students sought opportunities to extend and consolidate areas of need. Clinical benefits: contributions to the clinical team: students in their clinical years want to feel useful and to be allowed to become contributors to the medical care, even as they are learning. A longer rotation allows them to become known to their teachers who are then able to easily assess the type of contribution that is appropriate for their students to undertake. Students then become full participating members of the healthcare team, rather than observing learners. Social benefits: all students with a home base actively participated in a wide range of community activities outside their role as medical students. Those students undertaking short rotations without a home base seldom connected in the same way to any rural community. CONCLUSION: Evaluation from these two RCS has shown that short rotations are likely to be less optimal than longer rotations for meeting the broader goals of the RCS to build future workforce capacity. Our results suggest that one opportunity to acculturate students into the rural lifestyle is lost when students' placements are insufficiently long for them to put down roots in their community, and to understand how to 'live' there more broadly. Good rural experiences and teaching and learning opportunities are not sufficient in themselves. Students' emotional attachment to rural living comes from experience related to time and the connection to local people that comes as a result of time spent in the community. Students on short rotations do not make that local connection.  (+info)