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1.
Med Sci Educ ; 31(2): 535-547, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34457911

RESUMO

The Rural Medical Education (RMED) Program at the University of Illinois College of Medicine Rockford campus, and part of the National Center for Rural Health Professions, strives to recruit students from rural areas, who, after completing residency, return to rural Illinois as primary care physicians. RMED students meet monthly to learn about the community and public health in rural communities. Furthermore, they complete a 16-week rural preceptorship during their fourth year. During the fourth year of medical school, all RMED students, as well as the students following the regular curriculum, are asked to complete a survey, related to the understanding of medical students' views of community and interprofessional education. We aimed to identify how the community-based curriculum affects the students' understanding and appreciation of community as they go into rural health practice. The results showed that students in the RMED Program are more aware of the community they are part of, as well as being more interested in becoming part of their community. RMED students reported a statistically significantly higher rating of feeling appreciated and accepted by their community and rated their confidence in their abilities in the community statistically significantly higher. Interestingly, RMED students were not more likely to be more familiar with several health professions and programs within their community, compared to non-RMED students. Results comparing self-rated capabilities for RMED students within the community both before and after adding components of an interprofessional education curriculum showed no statistically significant changes. These results support previous research, while also providing more support for the development of successful interprofessional education courses.

2.
Hosp Pharm ; 56(4): 205-209, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34381250

RESUMO

Introduction: Readmission scoring systems are used to predict 30-day hospital readmission. These prediction tools do not considerlack of patient medication knowledge or adherence which can worsen disease outcomes or increase risk of readmissions. Objective: To determine if medication knowledge and adherence, as assessed by validated questionnaires, are associated with an increased rate of 30-day readmission. Methods: Adult medical inpatients were randomly selected for a prospective, single center study that was conducted from January to August 2017. Patients were asked the 4-question Morisky Green Levine Scale (MGLS) and the 4-question Medication Knowledge Score (MKS). Validated readmission score; MKS; and MGLS, as well as baseline information and readmission status within 30 days after the index admission were recorded. Mean or median scores were compared for patients readmitted within 30 days with those not readmitted using descriptive and univariate inferential statistics. Results: Data from 119 patients showed a mean age of 63 years (SD = 16). There was no difference in baseline information: age, sex, or number of scheduled home medications between those readmitted within 30 days and those not readmitted. Patients readmitted within 30 days had a statistically higher readmission score compared to patients not readmitted (66.4 vs 57.1, P = .017). There was no difference in median MKS or mean MGLS between patients readmitted within 30 days and those not readmitted (MKS: 4.0 vs 3.0, P = .753; MGLS: 1 vs 1.3, P = .162). Conclusions: In this prospective study, neither the MKS nor the MGLS scores were associated with 30-day hospital readmission.

3.
J Rural Health ; 37(4): 762-768, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34047399

RESUMO

PURPOSE: Nonmetropolitan communities are faced with health care professional shortages and prior reports suggest that general surgeons are no exception. The purpose of this brief is to evaluate the age difference and distribution of rural versus urban general surgeons to highlight the growing need to recruit medical students and residents for rural practice. METHODS: A secondary data analysis of residency graduated general surgeon demographics at the county level was performed using data from the Area Health Resource File. General surgeon demographic data were compared between nonmetropolitan and metropolitan areas. FINDINGS: The number of general surgeons practicing in rural communities is decreasing by a rate of approximately 0.5%-1.0% annually. Moreover, the entry of younger (<35 years of age) general surgeons into rural counties (8.7%) was less than urban regions (12.1%). Rural general surgeons tended to be older than their urban peers, and on average, rural general surgeon age exhibits a negative skewed, platykurtic distribution. CONCLUSIONS: Immediate action must be taken to generate more surgeons for rural practice. A failure to increase recruitment and retention of rural surgeons may have severe consequences on the health status of rural communities.


Assuntos
Internato e Residência , Serviços de Saúde Rural , Cirurgiões , Envelhecimento , Humanos , População Rural , Estados Unidos
4.
J Am Coll Clin Pharm ; 4(4): 459-464, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33821238

RESUMO

Introduction: The Anticoagulation Forum and Centers for Disease Control and Prevention (CDC) recommend drive-up international normalized ratio (INR) testing to combat INR non-adherence and increase safety during the coronavirus disease 2019 (COVID-19) pandemic. Patient perceptions and impact on attendance have not been studied. Objective: To assess appointment volume and patient perception after initiation of drive-up INR testing in a rural pharmacist-managed anticoagulation clinic. Methods: This cross-sectional cohort survey study offered each patient attending the anticoagulation clinic via drive-up or in-office visit a survey between May 27 and July 2, 2020. Patients testing off-site were excluded. Study end points included monthly patient volume, visit type preference, testing barriers, desired drive-up duration, and overall clinic satisfaction. Clinic appointment volume from October 2019 to June 2020 was collected retrospectively through a schedule review. Results: Sixty-four (80%) of 80 surveys offered were completed: 46.6% of respondents preferred drive-up testing, 26.7% indifferent, and 26.7% preferred in-office visits; 38.7% of respondents indicated a greater likelihood of continuing routine INR monitoring via drive-up testing. Of the respondents completing the survey curbside, 46% and 27% of respondents identified reduced COVID-19 transmission risk and ease of transportation as benefits of drive-up INR testing, respectively. March and April clinic volumes were 19% and 22% below average, respectively, returning to baseline after drive-up testing was implemented. Clinic rating before and after drive-up testing remained high at 2.75 on a scale of 0-3. While infection risk was identified as the biggest barrier to care by 32.8% of respondents, 59.3% of all respondents wanted drive-up testing to continue indefinitely. Conclusions: Drive-up INR testing improves patient attendance during the COVID-19 pandemic. Patient perception of drive-up testing is positive. About 46% of respondents preferred drive-up INR testing with telehealth follow-up and 59.3% of respondents want drive-up testing to continue indefinitely, which suggests this approach to INR testing as a potential method to allay barriers to routine monitoring beyond the scope of the pandemic.

5.
Health Soc Care Community ; 29(3): 867-875, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33533076

RESUMO

Eviction of renter-occupied homes is an emerging public health crisis adversely impacting populations already at risk. Although housing quality and home-owner foreclosures have been linked to health outcomes, the relationship between eviction of renter-occupied homes and health has not been well established. The demographics and socioeconomic status of renters differs from homeowners, as such any relationship with health outcomes should be distinguished between the two. The aim of this study is to provide a descriptive analysis of the relationship between renter-specific eviction and unhealthy behaviours at the census tract level. Using data from the Centers for Disease Control and Prevention 500 Cities Project, the Eviction Lab and the U.S. Census Bureau, this study assesses the relationship between eviction rates and health indicators for 1,267 urban census tracts in Illinois in 2016. Binge drinking, current smoking, no leisure-time physical activity, obesity and sleeping <7 hr were used as indicators of unhealthy behaviour as categorised by the Centers for Disease Control and Prevention500 Cities Project. Unadjusted and adjusted linear regression models were used to assess and describe the relationship between each of the dependent variables and each of the independent variables. All five of the unhealthy behaviour indicators were found to be significantly associated with eviction rates and eviction filing rates after adjustment for confounding variables. This study contributes to the understudied area of research focused on how eviction rates contribute to the social determinants of health for already at-risk populations.


Assuntos
Habitação , Classe Social , Humanos , Illinois/epidemiologia , Saúde Pública , Fatores de Risco
6.
BMC Med Educ ; 20(1): 376, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087080

RESUMO

BACKGROUND: Medical student burnout can cause emotional and physical exhaustion and detachment. The objectives of this study were to evaluate burnout using the Maslach Burnout Inventory-Student Survey (MBI-SS), identify factors that may predict burnout, and assess wellness initiatives effectiveness at reducing burnout. METHODS: The MBI-SS was administered to all medical students (Classes 2019 to 2022) at the University of Illinois College of Medicine (UICOM) from February to May 2019. Factor analysis and internal consistency of the MBI-SS were assessed. Mean MSBI-SS subscale scores for burnout were calculated for cynicism (CY), emotional exhaustion (EE), and academic efficacy (AE). Multiple regression analysis was used to identify student factors that may predict burnout. RESULTS: A total of 273 (21.6%) UICOM students completed the survey and 110 (40.3%) respondents reported self-perceived burnout. MBI-SS subscale scores were significantly higher for CY and EE, and significantly lower for AE in students who reported suffering from burnout versus students who did not report burnout. Mean ± SD subscale scores for CY, EE, and AE in burnout students were 14.44 ± 5.59, 23.23 ± 4.74, and 24.81 ± 5.35, respectively. In comparison, mean ± SD subscale scores for CY, EE, and AE in non-burnout students were 7.59 ± 5.16, 14.96 ± 5.71, and 28.74 ± 3.21, respectively. Regression analysis denoted significant associations between burnout and being out-of-phase in the curriculum, the effectiveness of wellness initiatives, and strength of motivation for medical school (SMMS) in both the two- and three-dimensional MBI-SS models. Gender was significantly associated with burnout in only the two-dimensional model. CONCLUSIONS: Self-reported burnout in medical students at UICOM was validated using the MBI-SS. Being out-of-phase in the curriculum, being female, rating wellness initiatives as less effective, and demonstrating lower motivation for continued medical school education may be used as predictors of medical student burnout. This investigation may act as a guide for measuring burnout in medical student populations and how the implementation of wellness initiatives may ameliorate burnout.


Assuntos
Esgotamento Profissional , Estudantes de Medicina , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/epidemiologia , Esgotamento Psicológico/epidemiologia , Estudos Transversais , Análise de Dados , Feminino , Humanos , Psicometria , Inquéritos e Questionários
7.
World J Surg ; 43(12): 2986-2993, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31506712

RESUMO

BACKGROUND: Recent match trends from the National Resident Matching Program suggest that the number of allopathic medical students (MD) pursuing general surgery is declining. This decline may have profound consequences given the surgeon shortage predicted by the Association of American Medical Colleges. Early exposure to surgery opportunities may increase a student's desire to pursue the specialty as a career. The aim of this study was to evaluate the effect surgical activities have on promoting student interest in surgery. METHODS: Medical students (years 1-3) at the University of Illinois at Rockford completed a two-component activity: a questionnaire and laparoscopic box activity. Differences in lifestyle factors, psychomotor aptitude, and future career interests were compared. RESULTS: A total of 64 medical students completed the activity. 45.3% of students reported that the activity positively influenced their decision to pursue a career in surgery. Rating of the importance of living in a rural versus urban community was an important lifestyle factor (p = 0.01) for students without rather than with an interest in surgery, 3.95 and 3.19, respectively. No differences were observed in other lifestyle factors. CONCLUSION: Early exposure to surgical activities may foster interest in students who lacked previous intention to pursue the specialty.


Assuntos
Escolha da Profissão , Tomada de Decisões , Educação de Graduação em Medicina/métodos , Cirurgia Geral/educação , Estudantes de Medicina/psicologia , Adulto , Feminino , Cirurgia Geral/tendências , Humanos , Illinois , Estilo de Vida , Masculino , Desempenho Psicomotor , População Rural , Estudantes de Medicina/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/psicologia , Inquéritos e Questionários , Adulto Jovem
8.
Educ Health (Abingdon) ; 27(2): 177-82, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25420981

RESUMO

BACKGROUND: A six-week rural interprofessional health professions summer preceptorship provided an interprofessional training experience (IPE) for upper level baccalaureate and post-baccalaureate/graduate level health professions students in Dixon, Illinois, USA. There are three distinct yet complementary components of this forty hours per week summer preceptorship: Numerous interprofessional clinical shadowing experiences, a community service-learning project carried out as a team and weekly classroom sessions. This study assesses knowledge and attitude changes about IPE among students who participated in this Rural Interprofessional Health Professions Summer Preceptorship between 2006 and 2011. METHODS: Fifty-two students over the six program years were asked to complete an identical pre-/post-questionnaire. The questionnaire included scales on seven topics, two of which addressed knowledge and attitudes about IPE: (i) Understanding of their own and other professions' work roles and (ii) Perceived ability to work effectively in interprofessional teams and make use of skills of other professions. Fifty of the fifty two (96.1%) students completed both the pre- and post-tests. RESULTS: Positive changes from the pre- to the post-tests were observed for the scales that related to interaction with other professions and assessment of their professional skills and students' understanding of the roles of other professions. Pre- versus post-preceptorship students also reported greater experience working as a member of an interprofessional team and an increase in their support for interprofessional education within a rural setting being required for all health professions students. CONCLUSION: A rural interprofessional health professions summer preceptorship that includes preceptor shadowing, a community service-learning project and classroom work proved to be an effective approach to developing interprofessional health care teams, increasing the knowledge and skills of participating students and creating positive attitudes toward interactions with other professions.


Assuntos
Relações Interprofissionais , Preceptoria , Competência Profissional , Estudantes de Ciências da Saúde/psicologia , Atitude , Humanos , Illinois , Serviços de Saúde Rural , Inquéritos e Questionários
9.
Acad Med ; 88(12): 1941-7, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24128632

RESUMO

PURPOSE: To report on the retention and practice outcomes of the University of Illinois College of Medicine at Rockford Rural Medical Education (RMED) Program and to examine distance from influential locations in relation to graduates' current practice location. METHOD: The RMED Program recruits candidates from rural backgrounds, provides a supplemental curriculum addressing rural topics and experiences, and tracks graduates' practice location and specialty choice outcomes. Practice location and specialty were compared for 160 RMED graduates and 2,663 non-RMED graduates, from 1997 to 2007. Rural status was based on rural-urban commuting codes. Comparisons were made using cross-tabulation with calculation of chi-square or odds ratios to assess differences. RESULTS: RMED graduates were 14.4 times more likely than non-RMED graduates to choose family medicine; 6.7 times more likely to choose a primary care practice specialty; 17.2 times more likely to be currently practicing in a rural location; and 12.8 times more likely to be currently practicing in a primary care shortage zip code. Analysis of current RMED graduates' practice locations indicates that 41.9% were within 90 miles of their fourth-year preceptorship community. Among RMED graduates practicing in Illinois, 62.1% and 73.3% were located within 60 and 90 miles, respectively, of their hometown. CONCLUSIONS: Recruitment of students combined with a rural-focused curriculum yielded positive outcomes related to primary care practice and decisions regarding practice location. RMED graduates were considerably more likely than non-RMED graduates to choose family medicine, choose a primary care specialty, and be currently practicing in a rural location.


Assuntos
Educação de Graduação em Medicina/organização & administração , Área Carente de Assistência Médica , Médicos de Atenção Primária/provisão & distribuição , Atenção Primária à Saúde , Serviços de Saúde Rural , Escolha da Profissão , Currículo , Educação de Graduação em Medicina/métodos , Feminino , Humanos , Illinois , Masculino , Médicos de Família/educação , Médicos de Família/provisão & distribuição , Médicos de Atenção Primária/educação , Avaliação de Programas e Projetos de Saúde , Recursos Humanos
10.
Rural Remote Health ; 12: 2176, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23088609

RESUMO

INTRODUCTION: A variety of studies have indicated that rural communities have fewer mental health services and professionals than their urban counterparts. This study will examine the shortages of mental health professionals in rural communities as well as the impact of inadequate mental health services access on rural hospitals. METHODS: A sample frame of 1162 rural hospitals was compiled, and a two-page survey was mailed to each hospital Chief Executive Officer (CEO). RESULTS: Of the 1162 surveys mailed, 228 were returned. The majority of CEOs agreed that there was a shortage of mental health professionals, that referral centers were too distant, and that there were many barriers to care including infrastructure, poverty, and substance abuse. Solutions offered by CEOs included telemedicine and residency training programs. CONCLUSIONS: This study shows that many rural areas have great need for more mental health professional recruitment and retention.


Assuntos
Diretores de Hospitais/psicologia , Acessibilidade aos Serviços de Saúde/normas , Hospitais Rurais , Serviços de Saúde Mental , Avaliação das Necessidades , Recursos Humanos em Hospital/provisão & distribuição , Agendamento de Consultas , Atitude do Pessoal de Saúde , Diretores de Hospitais/estatística & dados numéricos , Estudos Transversais , Seguimentos , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/economia , Humanos , Cobertura do Seguro/estatística & dados numéricos , Distribuição Normal , Seleção de Pessoal , Área de Atuação Profissional , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Viagem/estatística & dados numéricos , Estados Unidos , Recursos Humanos
11.
Am J Pharm Educ ; 76(10): 199, 2012 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-23275664

RESUMO

OBJECTIVES: To develop, implement, and assess an interprofessional rural health professions program for pharmacy and medical students. DESIGN: A recruitment and admissions process was developed that targeted students likely to practice in rural areas. Pharmacy students participated alongside medical students in completing the Rural Health Professions program curriculum, which included monthly lecture sessions and assignments, and a capstone clinical requirement in the final year.Assessment. Fourteen pharmacy students and 33 medical students were accepted into the program during the first 2 years of the Rural Health Professions program. Approximately 90% of the rural health professions students were originally from rural areas. CONCLUSIONS: The rural health professions program is an interprofessional approach to preparing healthcare providers to practice in rural communities.


Assuntos
Currículo , Educação em Saúde/métodos , Relações Interprofissionais , Saúde da População Rural/educação , Estudantes de Medicina , Estudantes de Farmácia , Avaliação Educacional , Educação em Saúde/organização & administração , Ocupações em Saúde , Humanos , Área de Atuação Profissional , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural , População Rural , Faculdades de Medicina , Faculdades de Farmácia
12.
AAOHN J ; 59(6): 253-63, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21627061

RESUMO

This pilot study assessed knowledge of blood pressure among employees in a midwestern manufacturing plant. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines were used to define blood pressure categories. The Roy Adaptation Model served as the framework. Results indicated two statistically significant relationships-one between knowledge of blood pressure and employees taking blood pressure medication, and one between employees' knowledge of blood pressure readings and increased interest in learning about lifestyle modifications impacting blood pressure. Of those correctly identifying the blood pressure ranges for prehypertension, 94.4% indicated interest in learning about lifestyle modifications to improve blood pressure. Occupational health nurses in industrial settings have a unique opportunity to influence employees' blood pressure knowledge, which can propel employees to consider lifestyle modifications or wellness programs that may favorably impact indirect and direct costs.


Assuntos
Pressão Sanguínea , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Hipertensão/psicologia , Modelos de Enfermagem , Adulto , Emprego , Feminino , Humanos , Hipertensão/enfermagem , Masculino , Pessoa de Meia-Idade , Enfermagem do Trabalho , Projetos Piloto
13.
Fam Community Health ; 34(2): 141-53, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21378511

RESUMO

This article discusses knowledge and encouragement of healthy lifestyles and health professions career awareness in rural youth. The Northern Illinois 4-H Health Jam, an innovative program targeting rural elementary school children to offer information and support related to exercise, wellness, nutrition, and health careers is described. From 2006 to 2008, a total of 262 youth have participated in the Health Jam, which is based on an experiential learning approach. Preevent versus postevent comparisons show statistically significant improvements in rural students' knowledge and attitudes about health topics and careers.


Assuntos
Promoção da Saúde/organização & administração , Estilo de Vida , Comportamento de Redução do Risco , População Rural , Criança , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Illinois
14.
Rural Remote Health ; 10(3): 1531, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20658893

RESUMO

INTRODUCTION: Regional or state studies in the USA have documented shortages of rural physicians and other healthcare professionals that can impact on access to health services. The purpose of this study was to determine whether rural hospital chief executive officers (CEOs) in the USA report shortages of health professions and to obtain perceptions about factors influencing recruiting and retention. METHODS: A nationwide US survey was conducted of 1031 rural hospital CEOs identified by regional/state Area Health Education Centers. A three-page survey was sent containing questions about whether or not physician shortages were present in the CEO's community and asking about physician needs by specialty. The CEOs were also asked to assess whether other health professionals were needed in their town or within a 48 km (30 mile) radius. Analyses from 335 respondents (34.4%) representative of rural hospital CEOs in the USA are presented. RESULTS: Primary care shortages based on survey responses were very similar to the pattern for all rural areas in the USA (49% vs 52%, respectively). The location of respondents according to ZIP code rurality status was similar to all rural areas in the USA (moderately rural, 29.3% vs 27.6%, respectively), and 69.1% were located in highly rural ZIP codes (vs 72.4% of highly rural ZIP codes for all USA). Physician shortages were reported by 75.4% of the rural CEOs, and 70.3% indicated shortages of two or more primary care specialties. The most frequently reported shortage was family medicine (FM, 58.3%) followed by general internal medicine (IM, 53.1%). Other reported shortages were: psychiatry (46.6%); general surgery (39.9%); neurology (36.4%); pediatrics (PEDS, 36.2%); cardiology (35%); and obstetrics-gynecology (34.4%). The three most commonly needed allied health professions were registered nurses (73.5%), physical therapists (61.2%) and pharmacists (51%). The percentage of CEOs reporting shortages of two or more primary care specialties (FM, IM or PEDS) was 70.3% nationally, with no statistically significant regional variation (p = .394), while higher for the New England through Virginia region (83.9%) than for all other regions. The CEOs reported the highest specialty care shortages for psychiatry (46.6%) followed by general surgery (39.9%), neurology (36.4%), cardiology (35.0%) and obstetrics-gynecology (34.4%). Major specialty shortages varied among regions and only for neurology and cardiology were regional differences statistically significant (p < .05). Marked variation between need for healthcare professionals were reported ranging from approximately 73% for registered nurses (RNs) to 16% for health educators. Reporting of need for RNs in rural areas was nearly 74% nationally and 35% reported a need for nurse practitioners. Differences for both RNs and nurse practitioners were not statistically significant among regions. Nationally, approximately 30% of CEOs reported a shortage of licensed practical nurses, which differed significantly among regions (p = .006). There was variation in physical therapist shortages among regions (p = .001), with 61.2% of CEOs reporting shortages nationally. Regional variation pattern was observed for pharmacists (p = .004) with approximately 50% of rural CEOs reporting a need for pharmacists nationally. The association between CEOs' reported shortages of two or more primary care doctors and their indication of the need for other health professionals was statistically significant for nurse practitioners, physician assistants, pharmacists, and dentists. The recruitment and retention attributes deemed to be of greatest importance were: (1) healthcare is a major part of the local economy; (2) community is a good place for family; (3) doctors are well-respected and supported; and (4) people in the community are friendly and supportive of each other. These were remarkably similar across 6 US geographic regions. CONCLUSIONS: Similarities in shortages and attributes influencing recruitment across regions suggest that major policy and program interventions are needed to develop a rural health professions workforce that will enable the benefits of recent US health reform insurance coverage to be realized. Substantial and targeted programs to increase rural healthcare professionals are needed.


Assuntos
Atenção Primária à Saúde , Serviços de Saúde Rural , Pesquisas sobre Atenção à Saúde , Humanos , Área Carente de Assistência Médica , Avaliação das Necessidades , Seleção de Pessoal/métodos , Especialização/estatística & dados numéricos , Estados Unidos , Recursos Humanos
15.
J Rural Health ; 25(2): 135-40, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19785578

RESUMO

CONTEXT: Past research has documented rural physician and health care professional shortages. PURPOSE: Rural hospital chief executive officers' (CEOs') reported shortages of health professionals and perceptions about recruiting and retention are compared in Illinois and Arkansas. METHODS: A survey, previously developed and sent to 28 CEOs in Illinois, was mailed to 110 CEOs in Arkansas. Only responses from rural CEOs are presented (Arkansas n = 39 and Illinois n = 22). FINDINGS: Physician shortages were reported by 51 CEOs (83.6%). Most reported physician shortages in Arkansas were for family medicine, internal medicine, cardiology, obstetrics-gynecology, general surgery, and psychiatry. Most reported physician shortages in Illinois were for family medicine, obstetrics-gynecology, orthopedic surgery, internal medicine, cardiology, and general surgery. Additionally, registered nurses and pharmacists were the top 2 allied health professions shortages. Multivariate analysis (factor and discriminant analyses) examined community attributes associated with ease of recruiting physicians. Six factors were identified and assessed as to their importance in influencing ease of recruitment, with the state included in the model. Three factors were identified as discriminating whether or not physician recruitment was easy: community supportive for family, community cooperates and perceives a good future, and community attractiveness. CONCLUSIONS: Similarities in shortages and attributes influencing recruitment in both states suggest that efforts and policies in health professions workforce development can be generalized between regions. This study further reinforces some important known issues concerning retention and recruitment, such as the importance of identifying providers whose preferences are matched to the characteristics and lifestyle of a given area.


Assuntos
Serviços de Saúde Rural , Arkansas , Hospitais Rurais , Illinois , Área Carente de Assistência Médica , Seleção de Pessoal , Médicos/provisão & distribuição , População Rural , Recursos Humanos
16.
Acad Med ; 83(10): 952-61, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18820528

RESUMO

This article presents the characteristics and results of the Rural Medical Education (RMED) Program which addresses medical workforce needs focused on reducing rural health disparities. The program is comprehensive in implementing a system of recruitment of candidates from rural backgrounds, offering a rural-focused curriculum, and instituting evaluative components to track outcomes. Distinctive program features include a Recruitment and Retention Committee of rural community members; special rural-focused topics and events during the first three years of undergraduate medical education; and a required fourth-year, 16-week rural preceptorship through which students work with primary care physicians and conduct community-oriented primary care projects. Since 1993, 216 students have matriculated. More than three quarters of candidates interviewed received offers into the program (overall acceptance rate of 75%). Comparisons between RMED and all other students on composite MCAT scores and United States Medical Licensing Examination (USMLE) Part 1 scores show a slightly lower MCAT average for RMED students, but USMLE scores are equal to those of non-RMED students. To date, 159 students have graduated, with 76% entering primary care residencies; 103 are currently in practice, with 64.4% in primary care practice in small towns and/or rural communities. RMED Program outcomes compare favorably with those of other rural medical education programs. RMED can serve as a model at many levels, including recruitment, collaboration, curriculum, and retention. Future challenges for program development and disparity reduction include recruiting students from the growing number of rural minority populations, expanding the number of program slots, and integrating the program with other health professions to address the needs of rural populations.


Assuntos
Educação de Graduação em Medicina , Necessidades e Demandas de Serviços de Saúde , Médicos de Família/educação , Atenção Primária à Saúde , Área de Atuação Profissional , Serviços de Saúde Rural/provisão & distribuição , Adulto , Currículo , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Internato e Residência/organização & administração , Masculino , Avaliação das Necessidades , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Saúde da População Rural , Estudantes de Medicina , Estados Unidos
17.
J Rural Health ; 22(1): 59-62, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16441337

RESUMO

BACKGROUND: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals. PURPOSE: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process. METHODS: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention. FINDINGS: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities. CONCLUSIONS: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention.


Assuntos
Atitude do Pessoal de Saúde , Diretores de Hospitais/psicologia , Hospitais Rurais , Seleção de Pessoal , Hospitais Rurais/organização & administração , Humanos , Illinois , Lealdade ao Trabalho , Área de Atuação Profissional , Inquéritos e Questionários , Recursos Humanos
18.
Dis Manag ; 6(3): 143-58, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14570383

RESUMO

To credibly state that a disease management (DM) program "caused" a specific outcome it is required that metrics observed in the DM population be compared with metrics that would have been expected in the absence of a DM intervention. That requirement can be very difficult to achieve, and epidemiologists and others have developed guiding principles of causality by which credible estimates of DM impact can be made. This paper introduces those key principles. First, DM program metrics must be compared with metrics from a "reference population." This population should be "equivalent" to the DM intervention population on all factors that could independently impact the outcome. In addition, the metrics used in both groups should use the same defining criteria (ie, they must be "comparable" to each other). The degree to which these populations fulfill the "equivalent" assumption and metrics fulfill the "comparability" assumption should be stated. Second, when "equivalence" or "comparability" is not achieved, the DM managers should acknowledge this fact and, where possible, "control" for those factors that may impact the outcome(s). Finally, it is highly unlikely that one study will provide definitive proof of any specific DM program value for all time; thus, we strongly recommend that studies be ongoing, at multiple points in time, and at multiple sites, and, when observational study designs are employed, that more than one type of study design be utilized. Methodologically sophisticated studies that follow these "principles of causality" will greatly enhance the reputation of the important and growing efforts in DM.


Assuntos
Gerenciamento Clínico , Pesquisa sobre Serviços de Saúde/métodos , Programas de Assistência Gerenciada/normas , Avaliação de Resultados em Cuidados de Saúde/métodos , Viés , Causalidade , Fatores de Confusão Epidemiológicos , Projetos de Pesquisa Epidemiológica , Humanos , Metronidazol , Modelos Teóricos , Seleção de Pacientes , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Estados Unidos
19.
Womens Health Issues ; 12(2): 96-102, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-11879762

RESUMO

This study assessed the health status and behavior of college-educated and non-college-educated African American women and European American women in Ohio. Analyses focused on health services utilization, health status, and life style/health behaviors from the 1998 Ohio Family Health Survey. College-educated African American women used more preventive health services and had better health status than non-college-educated African American women. Even so, college-educated African American women still had higher body mass index values, lower health status, and higher percent currently smoking than college-educated European American women. We conclude that college-educated African American women may face unique barriers to implementing all types of health-promoting behaviors available consequent to their higher education. Partnerships with respected community institutions, such as churches, may help these women develop good health practices in their entire community as well as in themselves.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Escolaridade , Comportamentos Relacionados com a Saúde/etnologia , Nível de Saúde , Serviços Preventivos de Saúde/estatística & dados numéricos , Assunção de Riscos , População Branca/estatística & dados numéricos , Saúde da Mulher , Adulto , Planejamento em Saúde Comunitária/organização & administração , Relações Comunidade-Instituição/normas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Ohio , Inquéritos e Questionários
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