Search

Abstract Background Although falls are common and can cause serious injury to older adults, many health care facilities do not have falls prevention resources available. Falls prevention resources can reduce injury and mortality rates. Using the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) model, a falls risk clinic was implemented in a rural Indian Health Service (IHS) facility. Methods A Fall Risk Questionnaire was created and implemented into the Provider’s Electronic Health Records system interface to streamline provider screening and referral of patients who may be at risk for falls to a group falls risk reduction class. Results Participants exhibited average improvements in the Timed Up and Go (6.8 s) (P = 0.0001), Five-Time Sit-to-Stand (5.1 s) (P = 0.0002), and Functional Reach (3.6 inches) (P = 1.0) tests as compared to their own baseline. Results were analyzed via paired t test. 71% of participants advanced out of an “increased risk for falls” category in at least one outcome measure. Of the participants to complete the clinic, all were successfully contacted and three (18%) reported one or more falls at the 90-day mark, of which one (6%) required a visit to the Emergency Department but did not require hospital admission. Conclusions In regards to reducing falls in the community, per the CDC STEADI model, an integrated approach is best. All clinicians can play a part in reducing elder falls.

Abstract Background Globally, naturopathic practitioners offer services in 98 countries, reaching every world region and providing care to diverse populations for a range of acute and chronic health conditions. Community clinics provide free or low-cost healthcare services and play a key role in providing necessary primary healthcare for underprivileged or marginalized populations. However, the reach and impact of naturopathic community clinics (NCCs) has not yet been examined. The aim of this study was to identify the characteristics of NCCs around the world, determine the types of services they offer and provide insight into the populations being served. Methods Two online cross-sectional surveys were administered using purposive and snowball sampling. A 6-item screening survey was administered first to identify clinics and institutions who fit the criteria for NCC services, followed by a 40-item follow-up survey. Descriptive analysis was conducted using frequencies and means. Results The screening survey returned a total of 37 responses from six world regions. Of those respondents who indicated involvement in NCCs, 74% went on to complete the follow-up survey. The majority of the responding NCCs were located in North America (50%), followed by Western Pacific (17%), Europe (10%), Asia (13%), Latin America (7%) and Africa (3%). The vast majority (71%) of the NCCs that have been in operation for more than 10 years are located in North America, while 43% of the NCCs that have been operational less than 5 years are in the Western Pacific Region. 80% of the responding NCCs were affiliated with a naturopathic school. The majority of respondents (76%) mentioned that they aim to serve underserved and/or marginalized populations, with 34% indicating that their target population is low-income families, 21% focusing on serving immigrants and refugees, 21% on serving people experiencing homelessness, 14% on serving Indigenous peoples, 14% on serving those with specific gender differences, 10% on serving seniors and 10% on serving drug users. Conclusion The naturopathic profession offers free or significantly low-cost naturopathic services through community clinics around the world. The findings of this survey provide insight into the important role of the naturopathic profession in primary health care and provide rationale for exploring this topic in greater detail.

Abstract Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention. Results Post CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs. Conclusion CSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers’ accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.

Abstract Background Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Methods A pilot study conducted between January’2018-December’2018 explored feasibility and acceptability of CSC using a thematic framework. The tool was implemented in purposively selected three CCs in Chakaria and one CC in Teknaf sub-district of Bangladesh. Qualitative data from 20 Key-Informant Interviews and four Focus Group Discussions with service users, healthcare providers, and government personnel, document reviews and meeting observations were used in analysis. Results The study showed that participants were enthusiastic and willing to take part in the CSC intervention. They perceived CSC to be useful in raising awareness about health in the community and facilitating structured monitoring of CC services. The process facilitated building stronger community ownership, enhancing accountability and stakeholder engagement. The participants identified issues around service provision, set SMART (specific, measurable, attainable, relevant and time-bound) targets and indicators on supplies, operations, logistics, environment, and patient satisfaction through CSC. However, some systematic and operational challenges of implementation were identified including time and resource constraint, understanding and facilitation of CSC, provider-user conflict, political influence, and lack of central level monitoring. Conclusion The findings suggest that CSC is a feasible and acceptable tool to engage community and healthcare providers in monitoring and managing health facilities. For countries with health systems faced with challenges around accountability, quality and coverage, CSC has the potential to improve community level health-service delivery. The findings are intended to inform program implementers, donors and other stakeholders about context, mechanisms, outcomes and challenges of CSC implementation in Bangladesh and other developing countries. However, proper contextualization, institutional capacity building and policy integration will be critical in establishing effectiveness of CSC at scale.