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Interprofessional Health Camps to Improve Health Outcomes in Rural Areas of Himachal Pradesh-A Novel Intervention
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International Journal of Medical Research & Health Sciences (IJMRHS)
ISSN: 2319-5886 Indexed in: ESCI (Thomson Reuters)

Research - International Journal of Medical Research & Health Sciences ( 2021) Volume 10, Issue 3

Interprofessional Health Camps to Improve Health Outcomes in Rural Areas of Himachal Pradesh-A Novel Intervention

Manpreet Singh Nanda1*, Kiran Kumar Singhal2, Selvam Ramachandran3, Anand R4 and Ciraj Ali Mohammed5
 
1Department of ENT, Maharishi Markandeshwar Medical College and Hospital Solan, Himachal Pradesh, India
2Department of Medicine, Maharishi Markandeshwar Medical College and Hospital Solan, Himachal Pradesh, India
3Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
4Department of Respiratory Medicine, Kasturba Medical College Mangalore, Karnataka, India
5Department of Microbiology, Melaka Manipal Medical College, Manipal, Karnataka, India
 
*Corresponding Author:
Manpreet Singh Nanda, Department of ENT, Maharishi Markandeshwar Medical College and Hospital Solan, Himachal Pradesh, India, Email: [email protected]

Received: 23-Feb-2021 Accepted Date: Mar 23, 2021 ; Published: 30-Mar-2021

Abstract

Background: There is a lack of proper health care in rural Himachal Pradesh. Our hospital had been organizing medical camps where a team of doctors, nurses, and technicians attended the camp. There was no or minimal involvement of local panchayats, NGOs, and other professionals. Though patients attended the camp the number was less and very few patients visited the hospital for follow-up.

Objectives: To find out whether organizing these camps with interprofessional collaboration improves the camp outcomes and benefits the rural patients in terms of health outcomes.

Methods: These camps were held with interprofessional collaboration in the same villages where medical camps were held earlier. The interprofessional team was formed. During camp along with medical checkups, healthy living and hygiene were emphasized. Post camp follow-up was done and data compared with earlier only medical camps. Statistical data for quantitative analysis was mean, average, range, median, and percentage and for qualitative analysis, information was gathered from interviews and feedbacks. The improvement of health outcomes concerning certain chronic disorders was evaluated.

Results: A total of 18 camps were held and the mean of 571 patients attended which is higher than the mean of 426 patients who attended only medical camps. The percentage of referred patients attending the hospital was also higher. There was greater patient satisfaction. Regarding the disease outcomes, there was significant cure/control of some chronic disorders like Diabetes, Hypertension, Cataract, CSOM, and Allergies.

Conclusion: These camps are more effective in terms of the number of patients attending, percentage of referred patients visiting the hospital, and patient satisfaction. This collaboration benefits the rural population in terms of health outcomes.

Keywords

Feedback, Health camps, Interprofessional collaboration, Panchayats, Professionals, Rural areas

Introduction

There is a lack of proper health care in rural areas because of limited resources and lack of supplies in these areas because of poor road infrastructure and transportation [1]. This is also because of ignorance, poverty, and traditional beliefs among the rural population [2]. More ever in rural areas, mostly untrained and unskilled practitioners see the patients [3]. Most of the specialists prefer to operate in urban areas [4]. High transportation costs and long travel time also inhibit access to healthcare [5]. This problem becomes more evident in hilly terrain [6].

Himachal Pradesh being a hilly state, most of its rural areas fall in difficult terrain [7]. The lack of health care negatively affects the well-being of the rural population here. The idea of the health camps is to make quality healthcare accessible to the rural population. Our hospital has been organizing various health camps in these rural areas of Solan, Sirmour, and Shimla district. These were medical camps where a team of doctors, nurses, and technicians attended the camp. The pre-camp analysis of the problems faced in this area was never done, nor the villagers properly counseled. There was no or minimal involvement of local panchayats, NGOs, health workers, and other professionals. Though patients attended the camp the number was less, minimal post-camp follows up was available, and very few patients visited the hospital for follow-up.

Interprofessional collaboration for health camps means involving various professionals belonging to different professions to work together as a team for organizing these health camps. According to the literature available, interprofessional collaboration is required to improve the quality of health services [8]. So our study aimed to find out whether organizing these health camps with interprofessional collaboration improves the health outcomes and benefits the rural patients by:

• Studying the patient satisfaction as these Interprofessional (IP) camps

• Comparing the number of patients attending the IP camps with earlier held camps

• Comparing the number of referred patients attending the hospital in one week between IP camps and earlier held camps

• Evaluating the improvement in disease outcomes for certain chronic disorders like Diabetes, Hypertension, Chronic Suppurative Otitis Media (CSOM), Cataract and Allergies

Materials and Methods

This study was conducted in two phases. The study was approved by the Institutional Ethics Committee of our hospital. The first phase was from July 2018 to June 2019 where interprofessional collaborated health camps were conducted in rural areas of Solan, Sirmour, and Shimla district, and the second phase from July 2019 to October 2019 where disease outcomes of the camp patients were analyzed. Various professionals constituted the IP team for these IP camps and had their well-defined roles and responsibilities (Table 1).

Table 1 IP team members

IP Member Role
Specialist Doctors Treat the patients of their specialty at camp
Nursing staff Patient care and assist the doctors
Pharmacist Dispense medicines
Lab technicians Perform tests
Yoga specialists For teaching yoga exercises
Dietician For dietary advise
Public relation officer Camp publicity and feedback
Local health workers Health and hygiene awareness and publicity, patient contact and feedback
Village Sarpanch and panchayat members Publicity and villagers mobilization
Local-level administrative officer Permissions and arrangement
Local govt. health officer Permission and area disease profiling
NGO Camp organization and publicity
Media persons Camp publicity
Area drug controller For arranging medicines

The 1st phase was done between July 2018 and June 2019. These camps were held with interprofessional collaboration in the same villages where only medical camps were held earlier. The inclusion criteria were the villages where our hospital medical camps were held earlier. The exclusion criteria were the urban areas or those rural areas where no medical camps were organized earlier by our hospital. For each camp first, the location was finalized, the publication material was made ready and the interprofessional team including doctors, nurses, yoga specialists, dietician, lab technicians, pharmacist, health workers, panchayat members, government officers, media persons was formed (the earlier held medical camps had only specialist doctors, nursing staff, lab technicians and pharmacists as the camp team). Pre-camp meetings were held where the role and responsibility of each member were defined. Camps were held with the collaboration of all members and feedback taken by local health workers to reduce bias. During camp along with medical checkups, the focus was on teaching healthy living and hygiene through expert talks by health workers and on learning allied specialties like yoga and dietary advice by a dietician.

Post camp meeting was held where feedback was analyzed. The demographic and disease profile of the patients was recorded. Post camp analysis was done by comparing with earlier held camps by the number of patients attending the camp and number of such patients visiting the hospital in 1 week for identification of which they were issued a Camp Card with discount benefits. With the help of a feedback form, from a sample of patients attending the camp, patient satisfaction and approval ratings for the camp were obtained. The comparison with earlier held pure medical camps was also done. Statistical data for quantitative analysis was mean, average, range, median, and percentage, and for qualitative analysis was by information obtained from interviews and feedbacks.

In the 2nd phase from July 2019 to October 2019, the disease outcomes for common disorders were evaluated for the villagers who attend the IP camps from July 2019 to October 2019. This was done by the local health workers who kept track of the patients. The diseases evaluated were Diabetes, Hypertension, Cataract, CSOM, and Allergies. The version of software used for statistical analysis was windows 7 ultimate.

Results

18 interprofessional camps were held between July 2018 and June 2019. A mean of 571 patients has attended the camps which are significantly higher than a mean of 423 patients who attended only medical camps. Regarding the percentage of patients attending the hospital, the median of the interprofessional camp is 14% (range 11% to 17%) which is higher than earlier camps 8% (range 6% to 13%) (Table 2).

Table 2 Comparison between IP camps and earlier held pure medical camps

Location I P CAMPS PURE MEDICAL CAMPS
Date held Patients NPH Date held Patients NPH
Kotkhai 18-07-18 2505 351 07-04-18 1309 105
Rabon 24-07-18 357 43 04-03-18 246 22
Balag 16-09-18 488 74 26-11-17 334 23
Kuthar 23-09-18 284 45 07-01-18 186 14
Kunehar 30-09-18 228 25 05-03-17 93 6
Chambaghat 04-11-18 356 43 06-11-16 248 15
Chamkadi 25-11-18 285 45 26-03-17 224 18
Pattabarori 09-12-18 408 49 17-12-17 196 19
Arki 24-12-18 187 32 18-03-18 190 15
Mehendo Baag 24-02-19 355 56 17-06-18 282 28
Jaman Ki Sher 28-02-19 256 31 13-11-16 120 8
Darlaghat 09-03-19 410 62 16-10-16 290 40
Mamlig 24-03-19 350 53 17-09-17 210 25
Noradhar 31-03-19 418 71 30-05-18 340 41
Dadahu 07-04-19 374 51 19-03-17 336 36
Mandal 20-04-19 1350 139 05-08-17 1215 90
Pulvahal 26-05-19 1100 133 18-11-17 810 80
Kandaghat 02-06-19 586 80 12-11-17 205 15

Regarding patient satisfaction, more than 80% of patients were satisfied in each of the camps. Nearly 80% of patients found these camps to be better than earlier held pure medical camps (Table 3 and Table 4).

Table 3 Patient feedback-camp 1 to 9

Location Kotkhai Rabon Balag Kuthar Kunehar Chambaghat Chamkadi Pattabarori Arki
Sample size for feedback 100 30 40 30 30 30 30 40 30
Patient satisfaction Satisfied 80 27 36 25 27 24 28 31 29
Not satisfied 20 3 4 5 3 6 2 9 1
Rating Very Good 18 6 10 6 7 6 9 12 10
Good 46 16 15 12 10 10 9 7 9
OK 25 7 14 10 11 10 12 14 11
Bad 9 1 1 2 2 2 0 5 0
Very Bad 2 0 0 0 0 2 0 2 0
Better than previous camps Yes - - - - - - 21 23 22
No - - - - - - 0 6 0
Can't say - - - - - - 9 11 8

Table 4 Patient feedback-camp 10 to 18

Location Mehendo Baag Jaman Ki Ser Darlaghat Mamlig Noradhar Dadahu Mandal Pulvahal Kandaghat
Sample size for feedback 30 30 40 30 40 30 80 80 50
Patient satisfaction Satisfied 28 25 37 24 33 28 66 69 49
Not satisfied 2 5 3 6 7 2 14 11 1
Rating Very Good 12 5 12 6 10 11 17 19 18
Good 8 18 15 10 12 12 33 32 21
OK 9 4 13 12 15 5 22 24 10
Bad 0 2 0 2 2 2 6 5 1
Very Bad 1 1 0 0 1 0 2 0 0
Better than previous camps Yes 24 25 37 22 30 27 62 62 41
No 0 1 0 0 2 1 6 4 1
Can’t say 6 4 3 8 8 2 12 14 8

There was equal gender distribution among patients with the majority of patients in middle and younger age groups (Table 5).

Table 5 Age and sex distribution

Age group Males Females Total
<18 yrs 1646 1748 3394
18-40 yrs 1493 1615 3108
41-60 yrs 1125 1187 2312
>60 yrs 744 739 1483
Total 5008 5289 10297

Most of the patients had medical illness-including respiratory diseases (35%) followed by orthopedic complaints (32%), pediatric diseases (27%), and Eye problems (21%). Some of the patients even got checkups done in 2-3 departments as per their ailments (Figure 1).

medical-research-health-distribution-patients

Figure 1. Department wise distribution of patients

There was a significant improvement in health outcomes concerning all disorders evaluated particularly Cataract (63%), CSOM (44%), and Diabetes (41%) (Table 6).

Discussion

A total of 18 interprofessional camps have been organized in hilly rural areas in the last 1 year. There was excellent collaboration between various IP team members and there was a better understanding of each other’s working and this led to great mutual respect. The final beneficiary was the rural population who got better health care at their doorsteps. This led to improved health and sanitation in the rural area. The hospital facilities were utilized by the rural population in a better way. There was a significant improvement in disease outcomes for common disorders.

Health camps are short-term mobile interventions for a target community generally lasting for a day to a week [9]. The importance of health camps is more in difficult geographical conditions. Interprofessional collaboration is working together with professionals from different backgrounds to achieve a common goal. It helps to be more responsive to the needs of the service users [10]. According to the standard definition, Interprofessional collaboration is defined as “when multiple health workers from different professional backgrounds work together with patients, families, carers (caregivers), and communities to deliver the highest quality of care [11]. According to an expert panel report, interprofessional collaboration leads to improve quality in health care and patient safety [8]. According to Gajuryal, et al. involvement of local clubs and volunteers must be encouraged during such camps and it forms a bond of community participation and makes the camp more fruitful and harmonious [12]. Other studies by Hudson et al also show the benefits of interprofessional practice [13]. Other studies as one by Mwala, et al. have also shown health camps to be beneficial to the community and at the same time acceptable to them especially in personnel and financially starved areas [2]. In another study by MacDowell et al, the one-to-one interaction between various interprofessional workers leads to a better understanding of skills and functioning of each other’s profession which improves patient care especially in rural areas [3].

These camps helped in providing medical treatment to the rural population at their doorsteps. As many of these rural communities remain cut off from main cities because of difficult terrain, this led to the improved health status of these societies. These camps also led to collaborative interprofessional working. This in the future can fulfill the dream of integrated health care with a focus on the patient needs and will improve the overall health of society.

The challenges faced in the study were convinced all the IP members to be part of the camp team and working together on equal footing. This required a lot of effort which was possible because of pre-camp meetings. The limitations of the study were that these were general health checkup camps where analysis of only a few disorders as possible. The focus on more age-specific diseases and their outcomes could not be achieved. In the future, age-specific camps could be organized and the disease outcomes of other disorders would be evaluated.

Conclusion

The interprofessional camps are more effective in terms of the number of patients attending, percentage of referred patients visiting the hospital, and patient satisfaction. This collaboration benefits the rural population in terms of health outcomes. Furthermore, studies could be done in other parts of the country covering other major disorders as this collaboration if successful on a national scale can improve the health index of the nation.

Declarations

Acknowledgement

We are thankful to our institute-Maharishi Markandeshwar Medical College and Hospital Solan for its support and the various professionals who participated in the camps in a collaborative manner and also to the patients who attended the camps. We are also thankful to Manipal FAIMER institute (MFIILIPE) and FAIMER Philadelphia which gave us this project and provided guidance at every stage.

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

This research was part of the FAIMER fellowship of the corresponding author.

References

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