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PubMed2002

Social work services in home health care: challenges for the new prospective payment system era.

The implementation of the Prospective Payment System (PPS) provides a unique opportunity for social workers to be better integrated into home health care. To do so, it is important for social workers to define their roles and eliminate any barriers to providing social workers services, which may improve patient outcomes. Two focus groups with home health nurses (n = 10) and social workers (n = 8) were conducted in a large urban home health agency to define social work roles and identify barriers to providing social work services. This paper categorizes the barriers to providing social work services into informational, systems/organizational, and inter-professional barriers and presents possible solutions to these barriers as home health agencies strive to provide care under PPS.

Adult↗
PubMed2003

Family caregivers' perceptions of barriers to and supports of participation in their children's out-of-home treatment.

OBJECTIVE: Although the importance of family caregivers' involvement in their children's mental health treatment is increasingly recognized, factors that influence caregivers' participation are not clearly understood. This study examined the views of family caregivers whose children received out-of-home treatment to determine the amount and types of family caregivers' participation in their children's treatment, the caregivers' perceptions of barriers and supports to participation, and the relationship of barriers and supports to caregivers' participation and satisfaction with care. METHODS: As part of a national survey, a subsample of 102 family caregivers from 31 states whose children were in a residential treatment center, psychiatric unit, or group home answered a questionnaire that included questions about their participation in their children's treatment and about barriers and supports to their participation. RESULTS: Family caregivers identified as barriers concrete factors such as cost of transportation and distance from service providers as well as more intangible factors such as lack of communication between staff members of different programs and negative attitudes of staff members. CONCLUSIONS: Programs seeking to create a more supportive environment for family caregivers' involvement in out-of-home care will need to seek out family members' perceptions of their experience with their children's treatment and their views about factors that would help increase their participation.

Attitude↗
PubMed2006

How language barriers impact patient care: a commentary.

The population of the United States population is growing more diverse at a rapid rate through the 21st century. Health care providers are interacting more frequently with patients of diverse ethnic affiliations where health beliefs, languages, and life experiences may differ greatly from their own. According to Timmins (2002), "...the U.S. health care system is largely geared toward serving English speakers." This is because language is the most common barrier in any health care setting and has been found to be a risk factor with adverse outcomes. Health care providers and patient communication are positively correlated with improved health outcome. Health outcomes include medication regimen, preventive testing, and patient satisfaction.

Communication Barriers↗
PubMed1999

Inherited cancer and the primary care physician. Barriers and strategies.

Difficulties faced by primary care physicians as they increase their responsibility for the diagnosis of inherited cancer risk include issues of cognitive strategy, the context of care, and cultural and institutional factors. Charateristics common to many genetic disorders--such as rarity, variability, implications for relatives, and temporal pattern--render our usual cognitive strategies less effective. Constraints of managed care, care teams, and high turnover of panels create a particularly difficult context for the care of people at risk for inherited cancer. Echoes of the eugenics movement, the implications of expanding genetic knowledge, and concerns about discrimination all complicate collaborative clinical decision making. Eight strategies are suggested to cope with these barriers to diagnosis. Primary care physicians also face challenges managing patients identified as at increased risk for inherited cancer. These include confidentiality, coordination and communication. Concerns for protecting the patient's confidentiality can inadvertently leave primary care physicians with partial information. Coordination is complicated when multiple organ systems and individuals are at risk, and knowledgable specialty centers may be distant. Communication requires sensitivity and skill in translating complex concepts from molecular biology and statistics into lay terms. Seven strategies are suggested to help with management.

Adult↗
PubMed2000

Barriers to, and facilitators of, research utilization among nurses in Northern Ireland.

It is clear from the nursing literature that there are a number of factors which can impede or facilitate the use of research in practice. It is important that these are identified and addressed, both at local and national levels, if evidence-based practice is to become a reality. This study surveyed nurses' perceptions of barriers to, and facilitators of, research utilization. The Barriers Scale was administered to a convenience sample of 2600 nurses in 23 hospitals in Northern Ireland. The number of completed questionnaires was 1368 (52.6%). The results show that the top barrier was 'The nurse does not feel she/he has enough authority to change patient procedures' followed by 'statistical analyses are not understandable'. Seven out of the top 10 barriers were related to 'setting'. The implications of these and other findings are discussed.

Communication Barriers↗
PubMed1996

Breast cancer screening practices among Cambodian women in Houston, Texas.

BACKGROUND: Faced with Western medicine and a health care system that is unfamiliar, Cambodian women experience barriers to breast cancer prevention activities and thus are seldom reached through current breast cancer education and prevention activities. This study examined the knowledge, attitudes, and practices of breast cancer screening among Cambodian women in Houston, Texas. METHODS: Two hundred sixteen Cambodian women aged 18 years or older were surveyed by telephone. RESULTS: Logistic regression analysis identified five variables as significant predictors of ever having had a clinical breast examination: perceived barriers to clinical breast examination, income, written-language acculturation, knowledge about clinical breast examination recommendations, and education in the United States. Education and knowledge of mammography were found to be important predictors of mammography. Language acculturation variables were not associated with ever having had mammography. CONCLUSIONS: The rate of breast cancer screening among Cambodian women in Houston is lower than that for all women in the United States. These results underscore the importance of developing culturally and linguistically appropriate breast cancer prevention activities for Cambodian women, who face cultural and language barriers to traditional services.

Acculturation↗
PubMed1998

Planned and reported implementation of clinical practice guidelines.

The aim of this project was to compare the intentions with reported action of Health Trusts in Scotland to prioritise and implement published SIGN clinical guidelines. All health Trusts in Scotland were asked about plans for implementation, and resurveyed 15-18 months later for confirmation. Specific guideline implementation groups led by medical doctors were the most common implementation structure. Implementation usually consisted of baseline audit, development of a local version, and reaudit. In one case a successful link between acute and primary care through an area level GP audit facilitator was thought to increase implementation. More research is required to: find out what influences the ability of an organisation to implement guidelines; identify particular facilitating factors or barriers; and on factors influencing the ability of a health organisation to implement guidelines.

Communication Barriers↗
PubMedDate not supplied

Pharmacy-related health disparities experienced by non-english-speaking patients: impact of pharmaceutical care.

OBJECTIVES: To identify the availability of foreign language services in pharmacies near a medical clinic serving a large immigrant population and determine whether the type of observed drug therapy problems differed between English- and non-English-speaking patients at this clinic. SETTING: A community health care center in a diverse neighborhood of Minneapolis, Minnesota. PARTICIPANTS: 40 pharmacies near the clinic and in the surrounding Minneapolis-St. Paul area known to provide services to patients in languages in addition to English and 91 clinic patients, including 38 for whom English was not their primary language, seen for full pharmaceutical care assessments. INTERVENTIONS: Comprehensive drug therapy assessments were conducted for English- and non-English-speaking patients (with assistance from interpreters) in a primary care setting secondary to physician referral. Patient-specific data and the results of the pharmacist's assessment were recorded in a patient management database. MAIN OUTCOME MEASURES: Language services provided by area pharmacies, frequency of drug therapy problems in English- and non-English-speaking patients, and the status of patient's medication conditions before and after provision of pharmaceutical care. RESULTS: Of the six primary languages other than English (Vietnamese, Hmong, Laotian, Somali, Spanish, and Cambodian) spoken by clinic patients, written or verbal information was available for five languages in one or more area pharmacies. The clinic pharmacist completed comprehensive assessments for 91 patients via 230 patient encounters, identifying 186 drug therapy problems. Problems related to adherence were significantly more prevalent in non-English-speaking patients compared with English-speaking patients (31% versus 12%). In all 91 patients, the percentage achieving desired drug therapy outcomes improved by 24% after a pharmacist joined the team of clinic providers. CONCLUSION: Despite the availability of clinic-based interpreters and foreign language services in pharmacies, adherence-related problems are significantly more common in non-English-speaking patients. Pharmacists committed to providing pharmaceutical care must consider the impact of language barriers when working to optimize drug therapy outcomes.

Adult↗
PubMed1980

Marketing principles and the future of preventive health care.

Whether preventive programs are advanced as complementary to therapy or as partial substitutes to lower costs, public resistance makes the cost effectiveness of these programs questionable. "Marketing" may be helpful in differentiating among the nature of products, services, and ideas of prevention, on the one hand, and heterogeneous consumer needs, attitudes, and responsibilities on the other. Making policy for marketing will involve new strategies and use of leverage: the "message' is not the only medium.

Attitude to Health↗
PubMed2005

School of nursing sponsorship of a school-based health center: challenges and barriers.

School-based health centers (SBHCs) are a growing phenomenon in the United States and appear to be an ideal fit for school of nursing (SON) sponsorship. However, nationally only about 6% of existing SBHCs are sponsored by either an SON or a school of medicine. Sponsorship of health care in schools is consistent with the mission of university-based SONs, but also presents many challenges. Despite these challenges, the authors believe that the benefit to nursing students, faculty, and the profession far outweigh constraints. This article describes the many benefits that can occur when SONs create and maintain a SBHC in their own community. Extensive practical suggestions for how to overcome the barriers that constrain university faculty from developing service-oriented programs in the community are also emphasized.

Adolescent↗
PubMed1997

Transaction costs economics as a conceptual framework for the analysis of barriers to the diffusion of telemedicine.

Telemedecine has been talked about for more than 20 years, without it entering daily use with any success. Based on transaction costs economics, the present analysis of the exchange relationships between health care producers highlights certain characteristics of the current technical and legislative context, which leads to transaction costs. It also demonstrates that the introduction of telemedicine shifts the costs associated with agents' opportunism from patients to health-care producers themselves. All these costs may be considered nowadays to thwart the use of telemedicine. It is argued here that the Public Authorities and professionals of health care could act upon telemedicine in two fields: (1) intervention in the institutional environment aims notably at better defining the property rights of telemedicine, and so constitutes an unavoidable means of encouraging health-care producers to invest in new technology; and (2) implementation of organisational forms and mechanisms susceptible to regulating such telemedical relationships between health care producers-given the present institutional environment-constitutes an essential means for overcoming the immediate barriers blocking the diffusion of telemedicine.

Communication Barriers↗
PubMed1999

Barriers to informed consent.

OBJECTIVES: To provide oncology nurses with a review of barriers that may limit the ability of adults to provide informed consent. DATA SOURCES: Published articles, research studies, and review articles pertaining to informed consent and clinical research. CONCLUSIONS: Patient-centered barriers to informed consent (such as age, education, and illness) and process-centered barriers (such as content and readability of the consent form, timing of discussion, and amount of time allotted to the process) can affect an individual's ability to provide substantial informed consent. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must be aware and knowledgeable of the various barriers to informed consent to minimize these barriers and to improve and facilitate the informed consent process.

Clinical Trials as Topic↗
PubMed2002

Interprofessionalism and ethics: consensus or clash of cultures?

The ethical arguments which underpin the call for interdisciplinary collaboration are analysed. In particular, the concept of 'teamwork' is considered as well as the organisational, professional, personal and cultural obstacles that constitute the barriers to the effective development of interdisciplinary relationships.

Australia↗
PubMed1992

Pitfalls in communication with Hispanic and African-American patients: do translators help or harm?

The Martin Luther King County General Hospital, Los Angeles, California, provides services for an equal number of Hispanics (most are recent immigrants from Mexico) and African Americans who have lived in the community since before the Watts riot in 1965. The hospital is staffed by a large percentage of foreign-trained doctors and other personnel who speak some English, but suffer from a lack of understanding of the Hispanic as well as the African-American patients. Very few trained interpreters are provided for the Spanish-speaking population, and no interpreters are provided for African Americans. A 100-question survey on common African-American expressions was conducted in the Department of Family Medicine, as well as an opinion poll to determine if adequate understanding existed between patients and providers. The data revealed that native African-American providers understood significantly more African-American expressions than foreign, white, and Hispanic providers. The opinion poll also revealed inadequate translation of medical complaints from patients through interpreters. In addition, the poll found that diagnoses and instructions were not adequately related to the patients. Furthermore, it was felt that trained interpreters should be provided for all patients who presented communication problems.

Black or African American↗
PubMed2005

The informed consent process in a cross-cultural setting: is the process achieving the intended result?

This report is based on the experiences of Navajo interpreters working in a diabetes clinical trial and describes the problems encountered in translating the standard research consent across cultural and linguistic barriers. The interpreters and a Navajo language consultant developed a translation of the standard consent form, maintaining the sequence of information and exactly translating English words and phrases. After four months of using the translated consent, the interpreters met with the language expert and a diabetes expert to review their experiences in presenting the translation in the initial phases of recruitment. Their experiences suggest that the consent process often leads to embarrassment, confusion, and misperceptions that promoted mistrust. The formal processes that have been mandated to protect human subjects may create barriers to research in cross-cultural settings and may discourage participation unless sufficient attention is given to ensuring that both translations and cross-cultural communications are effective.

Adult↗