This study aimed to identify publicly reported access characteristics for episodic primary care in BC and provided a clinic-level comparison between walk-in clinics and UPCCs.

Walk-in clinics are non-hospital-based primary care facilities that are designed to operate without appointments and provide increased healthcare access with extended hours. Urgent and Primary Care Centres (UPCCs) were introduced to British Columbia (BC) in 2018 as an additional primary care resource that provided urgent, but not emergent care during extended hours.

This cross-sectional study used publicly available data from all walk-in clinics and UPCCs in BC. A structured data collection form was used to record access characteristics from clinic websites, including business hours, weekend availability, attachment to a longitudinal family practice, and provision of virtual services.

In total, 268 clinics were included in the analysis (243 walk-in clinics, 25 UPCCs). Of those, 225 walk-in clinics (92.6%) and two UPCCs (8.0%) were attached to a longitudinal family practice. Only 153 (63%) walk-in clinics offered weekend services, compared to 24 (96%) of UPCCs. Walk-in clinics offered the majority (8,968.6/ 78.4%) of their service hours between 08:00 and 17:00, Monday to Friday. UPCCs offered the majority (889.3/ 53.7%) of their service hours after 17:00.

Most walk-in clinics were associated with a longitudinal family practice and provided the majority of clinic services during typical business hours. More research that includes patient characteristics and care outcomes, analyzed at the clinic level, may be useful to support the optimization of episodic primary healthcare delivery.

In Cambodia, little is known about the state of ear and hearing care, or the roles providers or key stakeholders play in delivering services.

This was an exploratory study using semi-structured qualitative interviews and a questionnaire addressed to key stakeholders to explore their perceptions and experiences in providing services to people suffering from ear disease or hearing loss in Cambodia.

Several challenges were described including a lack of hearing services to meet the demand, especially outside Phnom Penh in primary care and aural rehabilitation. Supply-side challenges include a shortage of trained professionals, facilities and resources, poor co-ordination between providers, unclear referral pathways, and long wait times.

Now is an opportune time to build on the positive trend in providing integrated care for non-communicable diseases in Cambodia, through the integration of effective ear and hearing care into primary care and strengthening the package of activities delivered at government facilities.

Chronic suppurative otitis media is a major global disease disproportionately affecting low- and middle-income countries, but few studies have explored access to care for those with ear and hearing disorders.

In a tertiary hospital in Cambodia providing specialist ear services, a mixed method study was undertaken. This study had three arms: (1) quantitative analysis of patients undergoing ear surgery, (2) a questionnaire survey and (3) semi-structured in-depth interviews.

Patients presented with advanced middle-ear disease and associated hearing loss at rates that are amongst the highest per capita levels globally. Patients reported several structural, financial and socio-cultural barriers to treatment. This study showed a significant burden of ear disease in Cambodia, which reflects a delay in receiving timely and effective treatment.

This study highlights the opportunity to integrate effective ear and hearing care into primary care service provision, strengthening the package of activities delivered at government facilities.

Fear of contracting coronavirus disease 2019 may be the latest addition to the barriers to clinic attendance. This study aimed to examine the impact of coronavirus disease 2019 and other variables on non-attendance rate at an out-patient clinic.

Clinic attendance at the Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, New Zealand, was assessed. For each appointment, the impact of coronavirus disease 2019 and other variables on non-attendance rate were analysed.

In total, 1963 appointments were scheduled, with 194 non-attendances (9.9 per cent). Patients who had their appointments confirmed beforehand were 10.0 times more likely to attend their appointment. Sex, socioeconomic status, ethnicity and age were found to impact non-attendance rate.

In New Zealand, coronavirus disease 2019 does not appear to be a barrier to out-patient clinic appointment attendance. The patient's age, sex, ethnicity, socioeconomic status and prior appointment confirmation were found to influence clinic attendance.

Our objective was to explore the difficulties experienced by transgender people in accessing primary health-care services and their expectations towards primary care providers to improve their health-care access.

Because transgender people are exposed to many discriminations, their health-care access is particularly poor. Guidelines recommend greater involvement of primary care providers in the processes because of the accessibility feature of primary care services.

A qualitative study using semi-directed interviews was conducted among 27 transgender people (February 2018 – August 2018). These voluntary participants were recruited through different means: local trans or LGBTI (lesbian, gay, bisexual, trans, and/or intersex) associations, primary care providers, and social networks. The data analysis was based on reflexive thematic analysis in an inductive approach.

Difficulties in accessing health-care occurred at all the levels of the primary health-care system: primary care providers – transgender people interaction, access to the primary care team facility (starting with the secretariat), access to secondary care specialists, and continuity of care. Transgender people report ill-adapted health-care services as a result of gender-based identification in health-care settings. Their main expectation was depsychiatrization and self-determination. They supported mixed health network comprising primary care providers and transgender people with a coordinating role for the general practitioner. These expectations should be priorities to consider in our primary health-care system to improve access to health-care for transgender people.

Telemedicine uses information and communication technologies to provide services in the field where the distance is a critical factor. The aim of the present study is to describe the experience of a synchronous telemedicine between two hospitals in Spain and Angola.

This is a retrospective observational study of all synchronous telemedicine sessions conducted between the Hospital Nossa Senhora da Paz in Angola and the Vall d'Hebron University Hospital in Spain from January 2011 to December 2014.

Seventy-two cases were discussed in the telemedicine sessions. The average age of patients was 18.02 (SD 13.75) years and mostly women (54.38 percent). Reasons to discuss the cases were 46.47 percent doubts in the diagnosis and therapeutic management, 15.47 percent were purely formative cases, and only 8.45 percent treatment doubt. At the time of presentation, 29 percent of the patients were already diagnosed, 95 percent of whom with infectious disease diagnostic, and from the undiagnosed patients 36 percent presented a febrile syndrome.

This study shows the viability of synchronous telemedicine between European and African countries without an excessively sophisticated technology.

The 2010 floods submerged more than one-fifth of Pakistan’s land area and affected more than 20 million people. Over 1.6 million homes were damaged or destroyed and 2,946 direct injuries and 1,985 deaths were reported. Infrastructure damage was widespread, including critical disruptions to the power and transportation networks.

Damage and loss of critical infrastructure will affect the population’s ability to seek and access adequate health care for years to come. This study sought to evaluate factors associated with access to health care in the aftermath of the 2010 Pakistan floods.

A population-proportional, randomized cluster-sampling survey method with 80 clusters of 20 (1,600) households of the flood-affected population was used. Heads of households were surveyed approximately six months after flood onset. Multivariate analysis was used to determine significance.

A total of 77.8% of households reported needing health services within the first month after the floods. Household characteristics, including rural residence location, large household size, and lower pre- and post-flood income, were significantly associated (P<.05) with inadequate access to health care after the disaster. Households with inadequate access to health care were more likely to have a death or injury in the household. Significantly higher odds of inadequate access to health care were observed in rural populations (adjusted OR 4.26; 95% CI, 1.89-9.61).

Adequate health care access after the 2010 Pakistani floods was associated with urban residence location, suggesting that locating health care providers in rural areas may be difficult. Access to health services also was associated with post-flood income level, suggesting health resources are not readily available to households suffering great income losses.

JacquetGA, KirschT, DurraniA, SauerL, DoocyS. Health Care Access and Utilization after the 2010 Pakistan Floods. Prehosp Disaster Med. 2016;31(5):485–491.

Symptoms of sleep-disordered breathing in children, such as frequent snoring, apnoea and choking, may lead to health problems if untreated. The caregiver's level of awareness of these symptoms has been poorly studied. This study aimed to study healthcare provider contact related to sleep-disordered breathing symptoms in a population of children aged 0–11 years.

A total of 1320 children were randomly selected from a national database that included all children living in Sweden. Caregivers answered a questionnaire about sleep-disordered breathing symptoms during the last month and healthcare provider contact related to these symptoms.

A total of 754 answers were received. The prevalence of sleep-disordered breathing symptoms was 4.8 per cent. Of this subgroup, 69 per cent had not been in contact with a healthcare provider regarding their symptoms.

This study shows that sleep-disordered breathing in children is underestimated and that there is a need to increase caregiver and healthcare provider awareness of sleep-disordered breathing in children.

Low socioeconomic status (SES) is associated with adverse health outcomes. Possible explanations include differences in health status, access to health care, and care provided by clinicians. We sought to determine whether SES is associated with computed tomography (CT) use in the emergency department (ED).

A retrospective cohort study of all Ontario ED patients (April 1, 2009, to March 31, 2010) using administrative databases was conducted, and patients were stratified into SES quintiles based on median neighbourhood income. Using multivariate logistical regression, CT scan use within SES quintiles was compared for all patients and subgroups based on chief complaints: headache, abdominal pain, and complex abdominal pain (age ≥ 65 years, high acuity, and admittance to hospital).

We analyzed 4,551,101 patient visits, of which 52% were female. Overall, 8.2% underwent CT scanning. In adjusted analyses, the lowest SES patients were less likely to undergo CT scanning overall and in all clinical subgroups, except for complex abdominal pain. Compared to the lowest SES quintile, the adjusted odds ratios of CT scanning in the highest SES quintile were 1.08 (95% CI 1.07–1.09), 1.28 (95%CI 1.22–1.34), and 1.24 (95% CI 1.21–1.27) for all patients, headache pain patients, and abdominal pain patients, respectively. For patients presenting with complex abdominal pain, no significant difference in CT use was observed.

Lowest SES ED patients were less likely to receive CT scans overall and in headache and abdominal pain subgroups. No difference was seen among complex abdominal pain patients, suggesting that as clinical indications for the test become more clearcut, use across SES quintiles differs less.

To identify the level of consensus among a group of Canadian emergency department (ED) experts on the importance of a set of indicators to document ED overcrowding.

A 2-round Delphi survey was conducted from February 2005 to April 2005, with a multi-disciplinary group of 38 Canadian experts in various aspects of ED operations who rated the relevance of 36 measures and ranked their relative importance as indicators of ED overcrowding.

The response rates for the first and second rounds were 84% and 87%, respectively. The most important indicator identified by the experts was the percentage of the ED occupied by in-patients (mean on a 7-point Likert-type scale 6.53, standard deviation [SD] 0.80). The other 9 indicators, in order of the importance attributed, were the total number of ED patients (mean 6.35, SD 0.75), the total time in the ED (mean 6.16, SD 1.04), the percentage of time that the ED was at or above capacity (mean 6.16, SD 1.08), the overall bed occupancy (mean 6.19, SD 0.93), the time from bed request to bed assignment (mean 6.06, SD 1.08), the time from triage to care (mean 5.84, SD 1.08) the physician satisfaction (mean 5.84, SD 1.22), the time from bed availability to ward transfer (mean 5.53, SD 1.72) and the number of staffed acute care beds (mean 5.53, SD 1.57).

Ten clinically important measures were prioritized by the participants as relevant indicators of ED overcrowding. Indicators derived from consensus techniques have face validity, but their metric properties must be tested to ensure their effectiveness for identifying ED overcrowding in different settings.