Effects of Rurality and Geographical Distance on Unplanned Emergency Department Utilization for Children With Asthma: A Population Level Retrospective Cohort Study.

BACKGROUND: Asthma is a highly prevalent chronic disease among Ontario children; however, the extent to which rural status and distance are associated with unplanned emergency department (ED) use by this population is largely unknown. OBJECTIVE: To explore the impact of rurality and geographical distance to primary and specialist care services on healthcare utilization by analyzing the use of unplanned ED services. METHODS: A population level retrospective cohort study of Ontario children ages 5-14 with newly diagnosed asthma was conducted using health administrative data from Institute for Clinical Evaluative Sciences (ICES). Adjusted logistic regression models were used to analyze the association between unplanned ED use with rural status and distance to general practitioner/family physician (GP/FP) and specialist healthcare services, while controlling for confounders. RESULTS: In total, 19,732 individuals met the inclusion criteria. Individuals who lived in rural locations (OR 2.00, 95% CI 1.64-2.44) and travelled >50 km to a GP/FP (OR 1.25, 95% CI 1.06-1.48) or specialist (OR 1.20, 95% CI 1.05-1.38) were more likely to utilize an ED. CONCLUSION: Children with asthma utilize healthcare services differently based on rural status and distance to services. To ensure equitable access to care, there is a need to accommodate for these factors in the planning and provision of asthma healthcare services.

Knowledge and Attitudes about Pain Management among Canadian Nursing Students.

BACKGROUND: Poorly managed pain is a problem that affects individuals, entire health care systems, and societies worldwide. Nurses are involved in pain management, yet little is known about the knowledge and attitudes of nursing students. AIMS: The aim of this study was to examine preregistration nursing students' knowledge and attitudes about the assessment and management of pain. DESIGN: This was a cross-sectional, descriptive survey. SETTINGS: Four education sites from two post-secondary institutions in Ontario, Canada. PARTICIPANTS/SUBJECTS: A convenience sample of 336 final year Bachelor of Science in Nursing and practical nursing students. METHODS: Participants were recruited in the classroom setting to complete the Knowledge and Attitudes Survey Regarding Pain. A score of eighty percent is considered a pass. RESULTS: Ninety percent of students who were in class on the day of the survey agreed to participate (n = 336/373). Fifteen (4.5%) participants passed the Knowledge and Attitudes Survey Regarding Pain, and the mean score was 66.7% (standard deviation 9.1). English as primary language, institution attended, and prior experience caring for someone with pain were independently associated with higher scores (p < .05). Students were found to have major gaps in knowledge and attitudes related to understanding the risk of respiratory depression after opioid therapy, calculating medication dosages, administrating medication, and understanding pharmacology. CONCLUSIONS: The majority of nursing students in this sample did not have adequate knowledge and positive attitudes about pain assessment and management.