Doctoral Dissertation Research: Short-Term Health Care Providers and Network Structure

佛罗里达大学博士生Jessica-Jean Casler将在Clarence C.Gravlee博士的指导下，探索旨在改善患者和提供者之间关系的项目如何塑造医疗保健获取和提供网络。这项研究将重点放在短期保健提供者(STHP)的作用上。短期保健提供者(如医学院学生队)在许多低收入国家补充地方和州立保健服务。然而，即使有了这些额外的提供者，无法获得适当的医疗保健在很大程度上继续影响着穷人。低收入国家的短期保健提供者每年涌入表明，保健系统可能正在结构上发生变化，患者和提供者使用保健服务的方式也随之发生变化。这项研究将通过审查：(1)患者和提供者如何使用短期医疗保健提供者(STHP)，(2)提供者的非正式结构，及时为这一全球问题做出贡献。网络类似于患者网络，以及(3)STHP在患者中的作用？医疗保健网络。为了实现这些目标，CoPI将在尼加拉瓜马塔加尔巴招募30户代表该市社会经济、家庭和地理多样性的家庭参与这项研究。之所以选择这个地点，是因为在STHP旅行期间参观它的美国医学生非常集中。研究人员卡斯勒女士将在八个月的时间里每两个月访问一次家庭，对参与者进行深入的人种学访谈，并记录他们最近使用卫生保健服务的情况。CoP将绘制地图并采访所有当地医疗保健提供者(如社区所确定的)，收集有关他们如何将患者转介到系统内不同的医疗保健提供者的信息。利用这些信息，合作伙伴将能够为患者和提供者创建网络使用模式，确定网络之间的任何相似之处，并确定STHP在尼加拉瓜-S城市医疗保健系统中的作用。这项研究很重要，因为它将有助于医学人类学和发展人类学的理论发展，因为它将绘制患者和提供者在当地较大的卫生保健网络中对卫生保健提供者的使用情况。这项研究专门探讨了较新加入穷人保健系统的性传播疾病，并将有助于对保健系统进行跨学科的社会科学研究。调查结果还将表明，城市医疗保健系统如何更有效地利用和组织通常构成它们的提供者。该项目还支持对一名研究生的培训。

University of Florida doctoral student Jessica-Jean Casler, supervised by Dr. Clarence C. Gravlee, will explore how networks of health care access and delivery are shaped by programs designed to improve the relationship between patient and provider. The research will focus on the role of short-term health care providers (STHPs). Short-term health care providers (such as medical school student brigades) supplement local and state health care services in many lower-income countries. Even with these additional providers however; the inability to access adequate health care largely continues to affect the poor. Annual influxes of short-term health care providers in lower-income countries suggest that health care systems may be changing structurally and with them the ways that patients and providers use health care services. This study will provide a timely contribution to this global issue by examining: (1) how patients and providers use short-term health care providers (STHPs), (2) whether the informal structure of providers? networks resemble patient networks, and (3) the role of STHPs in patients? health care networks. To meet these goals, the Co-PI will recruit 30 households in Matagalpa, Nicaragua representative of the socioeconomic, familial, and geographic diversity in the city to participate in the study. The site itself is chosen because of the high concentration of American medical students that visit it during an STHP trip. Households will be visited bi-monthly over a period of eight months as Ms. Casler the researcher conducts in-depth ethnographic interviews with her participants and also records their most recent usage of health care services. The Co-PI will map and interview all local health care providers (as identified by the community), collecting information about how they refer patients to different health care providers within the system. Using this information the Co-PI will be able to create network usage patterns for both patients and providers, determining any similarities between the networks and identifying the role of STHPs in one of Nicaragua?s urban health care systems. This research is important because it will contribute to the development of theory in both medical anthropology and the anthropology of development by mapping patients' and providers' use of health care providers within larger health care networks in a local setting. This study specifically explores the relatively recent addition of STHPs to health care systems of the poor and will also contribute to interdisciplinary social science research on health care systems. Findings will also suggest how urban health care systems could more efficiently use and organize the providers that typically comprise them. The project also supports the training of a graduate student.