Canadian Journal of Rural Medicine最新文献

{"title":"Lessons learned from the COVID-19 pandemic: The importance of physician leadership in responding to rural community ecosystem disruptions.","authors":"Alexandra Bland, Anna de Waal, Stefan Grzybowski","doi":"10.4103/cjrm.cjrm_27_23","DOIUrl":"10.4103/cjrm.cjrm_27_23","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic presented an unprecedented challenge for rural family physicians. The lessons learned over the course of 2 years have potential to help guide responses to future ecosystem disruption. This qualitative study aims to explore the leadership experiences of rural Canadian family physicians during the COVID-19 pandemic as both local care providers and community health leaders and to identify potential supports and barriers to physician leadership.</p><p><strong>Methods: </strong>Semi-structured, virtual, qualitative interviews were completed with participants from rural communities in Canada from December 2021 to February 2022 inclusive. Participant recruitment involved identifying seed contacts and conducting snowball sampling. Participants were asked about their experiences during the COVID-19 pandemic, including the role of physician leadership in building community resilience. Data collection was completed on theoretical saturation. Data were thematically analysed using NVivo 12.</p><p><strong>Results: </strong>Sixty-four participants took part from 22 rural communities in 4 provinces. Four key factors were identified that supported physician leadership towards rural resilience during ecosystem disruption: (1) continuity of care, (2) team-based care models, (3) physician well-being and (4) openness to innovative care models.</p><p><strong>Conclusion: </strong>Healthcare policy and practice transformation should prioritise developing opportunities to strengthen physician leadership, particularly in rural areas that will be adversely affected by ecosystem disruption.</p><p><strong>Introduction: </strong>La pandémie de COVID-19 a représenté un défi sans précédent pour les médecins de famille en milieu rural. Les leçons tirées au cours des deux années écoulées peuvent aider à orienter les réponses aux futures perturbations de l'écosystème. Cette étude qualitative vise à explorer les expériences de leadership des médecins de famille ruraux canadiens pendant la pandémie de COVID-19, en tant que prestataires de soins locaux et chefs de file de la santé communautaire, et à identifier les soutiens et les obstacles potentiels au leadership des médecins.</p><p><strong>Mthodes: </strong>Des entretiens qualitatifs virtuels semi-structurés ont été réalisés avec des participants issus de communautés rurales du Canada entre décembre 2021 et février 2022 inclus. Le recrutement des participants a consisté à identifier des contacts de base et à procéder à un échantillonnage boule de neige. Les participants ont été interrogés sur leurs expériences durant la pandémie de COVID-19, notamment sur le rôle du leadership des médecins dans le renforcement de la résilience des communautés. La collecte des données s'est achevée après saturation théorique. Les données ont été analysées thématiquement à l'aide de NVivo 12.</p><p><strong>Rsultats: </strong>Soixante-quatre participants provenant de 22 communautés rurales de qu","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informal peer support for rural doctors.","authors":"Tandi Wilkinson, Rola Ajjawi, Shireen Mansouri","doi":"10.4103/cjrm.cjrm_16_23","DOIUrl":"10.4103/cjrm.cjrm_16_23","url":null,"abstract":"<p><strong>Introduction: </strong>Practising medicine exposes physicians to emotionally difficult situations, which can be devastating, and for which they might be unprepared. Informal peer support has been recognised as helpful, although this phenomenon is understudied. Hence, it is important to develop a better understanding of the features of helpful informal peer support from the experiences of physicians who have successfully moved through such difficult events. This could lead to new and potentially more effective ways to support struggling physicians.</p><p><strong>Methods: </strong>Rural Canadian generalist physicians were interviewed. Using a hermeneutic phenomenological approach, data analysis was oriented towards understanding features of helpful informal peer support and the meanings that participants derived from the experience.</p><p><strong>Results: </strong>Eleven rural generalist physicians took part. Peer support prompted the processing of difficult emotional experiences, which initially seemed insurmountable and career-ending. Participants overcame feelings of emotional distress after even brief encounters of informal peer support. Most participants described the support they received as vitally important. After the peer support encounter, practitioners no longer thought of leaving medical practice and felt more able to handle such difficulties moving forward.</p><p><strong>Conclusions: </strong>Informal peer support enabled recipients to move through an emotionally difficult experience. Empathy, shared vulnerability and connection were the part of the peer support encounter. In addition, the support offered benefits which are known to help physicians not only process emotionally difficult events but also to acquire 'post-traumatic growth'. Practitioners, healthcare leaders and medical educators all have roles to play in enabling the conditions for informal peer support to flourish.</p><p><strong>Introduction: </strong>La pratique de la médecine expose les médecins à des situations émotionnellement difficiles, qui peuvent être dévastatrices, et auxquelles ils ne sont pas préparés. Le soutien informel par les pairs a été reconnu comme utile, même si ce phénomène est peu étudié. Il est donc important de mieux comprendre les caractéristiques du soutien informel par les pairs à partir des expériences de médecins qui ont réussi à traverser des événements aussi difficiles. Cela pourrait conduire à de nouvelles façons, potentiellement plus efficaces, de soutenir les médecins en difficulté.</p><p><strong>Mthodes: </strong>Onze médecins généralistes canadiens ruraux ont été interrogés. En utilisant une approche phénoménologique herméneutique, l'analyse des données a été orientée vers la compréhension des caractéristiques du soutien informel utile par les pairs et des significations que les participants ont tirées de l'expérience.</p><p><strong>Rsultats: </strong>Le soutien des pairs a incité à vivre des expériences émotionnelles diffici","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversité.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_29_24","DOIUrl":"10.4103/cjrm.cjrm_29_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Pan-Canadian licensure: Potential impact on the rural physician workforce.","authors":"","doi":"10.4103/cjrm.cjrm_31_24","DOIUrl":"10.4103/cjrm.cjrm_31_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversity.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_13_24","DOIUrl":"10.4103/cjrm.cjrm_13_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversité.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_29_24","DOIUrl":"10.4103/cjrm.cjrm_29_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does proximity to a fertility centre increase the chance of achieving pregnancy in Northeastern Ontario?","authors":"Ashley R Wallace, Karen Splinter","doi":"10.4103/cjrm.cjrm_20_23","DOIUrl":"10.4103/cjrm.cjrm_20_23","url":null,"abstract":"<p><strong>Introduction: </strong>Northern Ontario has a population of approximately 800,000 people distributed over 806,707 km2. Before 2018, the only fertility treatment centre in Northern Ontario was located in Thunder Bay; many patients travelled south for care. In 2018, the Northeastern Ontario Women's Health Network (NEOWHN) opened in Sudbury, providing fertility treatments to people living in Northeastern Ontario. The goal of this study was to determine if proximity to this new fertility centre increases one's chance of achieving pregnancy when undergoing fertility treatment. Secondary outcomes included the quantity and types of fertility investigations and treatments completed by patients.</p><p><strong>Materials and methods: </strong>A retrospective chart review was performed for all patients seeking fertility treatment at NEOWHN between January 2019 and December 2020. Traveling >100 km to access healthcare was considered to be a clinically significant determinant of health.</p><p><strong>Results: </strong>Seven hundred and 5 patients were seen in consultation for fertility services at NEOWHN during the study period. One hundred eighty-one of 478 (37.9%) patients living <100 km from NEOWHN achieved pregnancy compared to 39 of 227 (17.2%) patients living >100 km from NEOWHN (P < 0.01).</p><p><strong>Conclusion: </strong>Living in proximity (<100 km) to NEOWHN increased the likelihood that individuals in Northeastern Ontario would seek fertility services and would achieve pregnancy. Financial constraints and inaccessibility likely play a role in this, but further studies are needed to explain this difference.</p><p><strong>Introduction: </strong>Le Nord de l'Ontario compte une population d'environ 800,000 personnes réparties sur 806,707 km2. Avant 2018, le seul centre de traitement de la fertilité du Nord de l'Ontario était situé à Thunder Bay; de nombreux patients SE rendaient dans le sud pour recevoir des soins. En 2018, le Northeastern Ontario Women's Health Network (NEOWHN-le Réseau de santé des femmes du Nord-Est de l'Ontario) a ouvert ses portes à Sudbury, offrant des traitements de fertilité aux personnes vivant dans le Nord-Est de l'Ontario. L'objectif de cette étude était de déterminer si la proximité de ce nouveau centre de fertilité augmente les chances d'obtenir une grossesse lors d'un traitement de fertilité. Les résultats secondaires comprenaient la quantité et les types d'examens et de traitements de fertilité effectués par les patients.</p><p><strong>Mthodes: </strong>Une étude rétrospective des dossiers a été réalisée pour tous les patients cherchant un traitement de fertilité au NEOWHN entre janvier 2019 et décembre 2020. Le fait de voyager >100 km pour accéder aux soins de santé a été considéré comme un déterminant de la santé cliniquement significatif.</p><p><strong>Rsultats: </strong>Seven hundred and 5 patients ont été vus en consultation pour des services de fertilité au NEOWHN pendant la période d'étude. One hundred","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In situ clinical education of frontline healthcare providers in under-resourced areas: A rapid review.","authors":"Michael Seabrooke, Adrienne Seabrooke","doi":"10.4103/cjrm.cjrm_95_22","DOIUrl":"10.4103/cjrm.cjrm_95_22","url":null,"abstract":"<p><strong>Abstract: </strong>Rural communities are geographically isolated from large urban areas, affecting access to definitive care, specialists and other health services that only service urban areas. Rural decision-makers are often faced with numerous challenges regarding the availability, capacity, sustainability and performance of health systems in rural and remote areas. We evaluated the current body of literature on educational initiatives being used in under-resourced areas to increase the knowledge or skills of healthcare workers. This rapid review followed the methods laid out by the Cochrane Rapid Reviews Methods Group and included published articles from any of three databases that described and evaluated an educational intervention, in which healthcare workers were the learners and which took place in an under-resourced area. Papers were excluded if they were deemed to be too resource intensive, were an opinion or concept paper or took place in an urban area. Results were synthesised descriptively. Ten studies were identified that contained information on educational initiatives in a variety of countries. The healthcare workers targeted in the studies varied from physicians, nurses and midwives to community health workers and students. The quality of studies also varied and included randomised control trials, systematic reviews and both prospective and retrospective studies. Initiatives involving simulation or point-of-care ultrasound were most common and showed the most benefit to a learner's knowledge and skill development. A limited body of literature exists on educational initiatives for healthcare workers in under-resourced areas. While simulation and hands-on learning showed positive results, the opportunity remains for a low-cost, high-yield educational initiative tailored to the unique needs of healthcare workers in under-resourced areas.Les communautés rurales sont géographiquement isolées des grandes zones urbaines, ce qui affecte l'accès à des soins définitifs, à des spécialistes et à d'autres services de santé qui ne desservent que les zones urbaines. Les décideurs ruraux sont souvent confrontés à de nombreux défis concernant la disponibilité, la capacité, la durabilité et la performance des systèmes de santé dans les zones rurales et éloignées. Nous avons évalué l'ensemble de la littérature actuelle sur les initiatives éducatives utilisées dans les zones sous-dotées pour améliorer les connaissances ou les compétences des travailleuses et travailleurs de la santé. Cette examen rapide a suivi les méthodes définies par le Cochrane Rapid Reviews Methods Group et a inclus des articles publiés dans l'une des trois bases de données qui décrivaient et évaluaient une intervention éducative dans laquelle les travailleuses et travailleurs de la santé étaient les apprenants et qui SE déroulait dans une zone manquant de ressources. Des articles jugés trop gourmands en ressources, des opinions, des documents conceptuels ou en lien ","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pan-Canadian licensure: Potential impact on the rural physician workforce.","authors":"Carmela Bosco, Louise Sweatman, Kyle Sue","doi":"10.4103/cjrm.cjrm_19_23","DOIUrl":"10.4103/cjrm.cjrm_19_23","url":null,"abstract":"<p><strong>Abstract: </strong>Proposals to establish pan-Canadian licensure for physicians have broad support amongst medical groups to address physician shortages in underserved rural communities. The concept has also elicited concern from some stakeholders that its implementation could exacerbate rural physician workforce shortages by prompting an exodus of rural physicians to urban centres. An environmental scan of reports from key medical groups published within the past 10 years was conducted to determine factors influencing rural physician practice patterns. Data from membership surveys of the Society of Rural Physicians of Canada and the Canadian Medical Association - conducted in fall 2022 - were reviewed to determine whether licensure is a factor in rural physicians' decisions to leave or stay in practice in rural Canada. Factors contributing to physicians' decisions to leave rural practice identified in the environmental scan included lack of infrastructure support, inability to find locum coverage, inadequate support for team-based care and effects of high workloads on wellness. A common theme found in responses to the membership surveys was the recognition of licensing restrictions as barriers preventing rural physicians from practising in multiple provinces or territories. Survey respondents also voiced strong support for national licensure implementation. Pan-Canadian licensure holds promise as a strategy to enhance the recruitment and retention of physicians in rural communities. It could also provide physicians flexibility to work in multiple jurisdictions to address the health workforce needs of underserved communities.Les propositions visant à établir un permis d'exercice pancanadien pour les médecins bénéficient d'un large soutien de la part des groupes médicaux afin de remédier aux pénuries de médecins dans les communautés rurales mal desservies. Ce concept a également suscité des inquiétudes de la part de certaines parties prenantes qui craignent que sa mise en oeuvre n'aggrave les pénuries de médecins en milieu rural en provoquant l'exode de ces derniers vers les centres urbains. Une analyse environnementale des rapports des principaux groupes médicaux publiés au cours des dix dernières années a été effectuée pour déterminer les facteurs influençant les modes de pratique des médecins ruraux. Les données des enquêtes sur les membres de la Société de la médecine rurale du Canada et de l'Association médicale canadienne-menées à l'automne 2022-ont été examinées pour déterminer si le permis d'exercice est un facteur dans la décision des médecins ruraux de quitter ou de rester en pratique dans les régions rurales du Canada. Les facteurs contribuant à la décision des médecins de quitter la pratique rurale, identifiés dans l'analyse de l'environnement, comprenaient le manque de soutien en matière d'infrastructure, l'incapacité à trouver une couverture de suppléance, le soutien inadéquat des soins en équipe et les effets des charges ","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sécurité alimentaire.","authors":"Sarah Lespérance","doi":"10.4103/cjrm.cjrm_7_24","DOIUrl":"10.4103/cjrm.cjrm_7_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}