Louanne Keenan

Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum.

OBJECTIVE Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. METHOD Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi. Participants were interviewed using open-ended, semi-structured questions. Content analysis was used when exploring transcribed data. RESULTS Three major themes - systems, software, and social considerations - emerged from content analysis, with sustainability concerns prevailing. Although participants reported many systems (e.g., power, network, Internet, hardware, interoperability) and software (e.g., data integrity, confidentiality, function) challenges, social factors (e.g., identity management, training, use incentives) appeared the most important impediments to sustainability. DISCUSSION These findings are consistent with what others have reported, especially the importance of practical barriers to EMR deployments in resource-constrained settings. Other findings contribute unique insights about social determinants of EMR impact in slum settings, including the challenge of multiple-identity management and development of meaningful incentives to staff compliance. CONCLUSIONS This study exposes front-line experiences with opportunities and shortcomings of EMR implementations in urban slum primary care clinics. Although the promise is great, there are a number of unique system, software and social challenges that EMR advocates should address before expecting sustainable EMR use in resource-constrained settings.

Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review.

BackgroundThe intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa.MethodsA state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis.ResultsFrom an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts.DiscussionThis review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers.ConclusionThe future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

The Impact of Homelessness and Incarceration on Women's Health.

Female inmates have multiple challenges during incarceration and as they transition into the community including: barriers to accessing health care within correctional facilities, poor transitional preparation preceding release, and inadequate continuity of health care after release. This qualitative study explored the health-seeking experiences and the health and housing needs of female inmates. Four focus groups were conducted in a remand facility in Canada. Women described poor health at entry to the correctional system and viewed incarceration as a means to access health care services. Transition back into the community represented a crossroad that was dependent on the stability of housing status. These findings support gender-sensitive health and housing programs to reduce addictions, recidivism, and poor health among this vulnerable population.

Conceptual understanding of social capital in a First Nations community: a social determinant of oral health in children

Objective The purpose of the study was: (a) to better understand the concept of social capital and its potential role in oral health of children in a First Nations community and (b) to identify the strengths and resources in terms of social capital and a health promotion model that the community has at its disposal to address its oral health issues. Methods In this qualitative case study, participants were purposively selected in a First Nations community: Seven individual interviews and two focus groups involving 18 parents/care givers were selected. Putnams concept of social capital guided all the interviews. The interviews were recorded and transcribed verbatim. Thematic analysis was employed using the NVivo software. Results The community was close-knit and seemed to have strong moral fibre, which encouraged members to help each other. A strong bonding social capital was also found among the members, especially inside the clans (families). A need for improvement in bridging social capital that would help the community to reach external resources was observed. While members of the community were actively involved in religious rituals and cultural ceremonies, more efforts seemed to be required to recruit volunteers for other events or programs. Active engagement of community members in any program requires that members be given a voice as well as some ownership of the process. Mobilizing or building communitys social capital can play a role when planning future interventions. Conclusion A better understanding of social capital may enhance the communitys investment and efforts by reinforcing healthy oral behaviours and improving access to external resources. With more dynamic collaboration, it may be possible to create more sustainable community-based oral health promotion programs.Objective The purpose of the study was: (a) to better understand the concept of social capital and its potential role in oral health of children in a First Nations community and (b) to identify the strengths and resources in terms of social capital and a health promotion model that the community has at its disposal to address its oral health issues. Methods In this qualitative case study, participants were purposively selected in a First Nations community: Seven individual interviews and two focus groups involving 18 parents/care givers were selected. Putnams concept of social capital guided all the interviews. The interviews were recorded and transcribed verbatim. Thematic analysis was employed using the NVivo software. Results The community was close-knit and seemed to have strong moral fibre, which encouraged members to help each other. A strong bonding social capital was also found among the members, especially inside the clans (families). A need for improvement in bridging social capital that would help the community to reach external resources was observed. While members of the community were actively involved in religious rituals and cultural ceremonies, more efforts seemed to be required to recruit volunteers for other events or programs. Active engagement of community members in any program requires that members be given a voice as well as some ownership of the process. Mobilizing or building communitys social capital can play a role when planning future interventions. Conclusion A better understanding of social capital may enhance the communitys investment and efforts by reinforcing healthy oral behaviours and improving access to external resources. With more dynamic collaboration, it may be possible to create more sustainable community-based oral health promotion programs.

Women in orthodontics and work-family balance: challenges and strategies.

The number of women entering the orthodontic profession over the past few decades has increased dramatically. A review of the literature revealed the lack of research on achieving a work-family balance among female dentists and dental specialists. Work-family balance has been researched more extensively in the field of medicine; however, despite some critical differences, parallels between these 2 professions exist. This study identified issues that Canadian female orthodontists face and strategies they use to achieve a work-family balance. A phenomenological qualitative study was used to analyze the results of semi-structured telephone interviews of a purposive sample of 13 Canadian female orthodontists. The results strongly support the role-conflict theory about the competing pressures of maternal and professional roles. Female orthodontists described their challenges and strategies to minimize role conflict in their attempt to achieve a work-family balance. The women defined balance as having success and satisfaction in both their family life and professional life. They identified specific challenges of achieving a work-family balance that are unique to orthodontic practice and strategies for adapting to their maternal and professional roles. Achieving a work-family balance is of paramount importance to female orthodontists, and the results of this study may be applied to other specialties in dentistry.

Addressing Women’s Unmet Health Care Needs in a Canadian Remand Center: Catalyst for Improved Health?

Incarcerated women have a disproportionate burden of infectious and chronic disease, substance disorders, and mental illness. This study explored incarcerated women’s health and whether a Women’s Health Clinic improved care within this vulnerable population. Retrospective chart reviews and focus groups were conducted. Poor access to care in the community due to competing social needs was described. Barriers to care during incarceration included lack of comprehensive gender-specific services, mistrust of providers, and fragmentation. Of 109 women, high rates of mental illness, partner violence, substance use, sexually transmitted infection (STI), and irregular Pap testing were observed. Pap (15% to 54%, p < .001) and STI (17% to 89%, p < .001) testing rates increased. Fragmentation of care remained at transition points, and further work is needed to improve continuity within corrections and the community.

WORK PATTERN DIFFERENCES BETWEEN MALE AND FEMALE ORTHODONTISTS IN CANADA.

OBJECTIVE To examine sex-specific differences in the demographics and work patterns of Canadian orthodontists. METHODS Questionnaires were mailed and emailed to a random sample of 384 orthodontists: 289 men and 95 women. Questions regarding work patterns and personal demographics were created and results were compared by sex. RESULTS The response rate was 53.9%. The demographics and work patterns for male and female orthodontists were similar for most variables. Women were found to be 6 years younger; have 6 fewer years of work experience; expect to retire earlier; be more often married to a professional in full-time employment; and be more likely to take a leave of absence during their career than their male colleagues. Age significantly affected the number of hours worked per week and number of phase II starts per year; both variables increased with increasing age until approximately 50 years, after which they decreased with age. Having children did not significantly affect any of the analyzed variables. CONCLUSIONS As the practice of female orthodontists was not found to be substantially different from that of men, it is not possible to speculate whether the increasing number of women specializing in orthodontics will provoke a significant change in the profession. As this is the first survey of its kind in Canada, these results may be used as a reference for future comparisons to determine work patterns and trends in the orthodontic workforce.