Archna Gupta - Academia.edu (original) (raw)
Papers by Archna Gupta
Australian Journal of General Practice
Canadian Family Physician Medecin De Famille Canadien, Feb 1, 2012
F1000Research, 2016
IntroductionHealth sector management is increasingly complex as new health technologies, treatmen... more IntroductionHealth sector management is increasingly complex as new health technologies, treatments, and innovative service delivery strategies are developed. Many of these innovations are implemented prematurely, or fail to be implemented at scale, resulting in substantial wasted resources. MethodsA scoping review was conducted to identify articles that described the scale up process conceptually or that described an instance in which a healthcare innovation was scaled up. We define scale up as the expansion and extension of delivery or access to an innovation for all end users in a jurisdiction who will benefit from it.ResultsSixty nine articles were eligible for review. Frequently described stages in the innovation process and contextual issues that influence progress through each stage were mapped. 16 stages were identified: 12 deliberation and 4 action stages. Included papers suggest that innovations progress through stages of maturity and the uptake of innovation depends on t...
BMC medicine, Jan 18, 2016
Pragmatic randomized trials aim to examine the effects of interventions in the full spectrum of p... more Pragmatic randomized trials aim to examine the effects of interventions in the full spectrum of patients seen by clinicians who receive routine care. Such trials should be employed in parallel with efforts to implement many interventions which appear promising but where evidence of effectiveness is limited. We illustrate this need taking the case of essential interventions to reduce inpatient neonatal mortality in low and middle income countries (LMIC) but suggest the arguments are applicable in most clinical areas. A set of basic interventions have been defined, based on available evidence, that could substantially reduce early neonatal deaths if successfully implemented at scale within district and sub-district hospitals in LMIC. However, we illustrate that there remain many gaps in the evidence available to guide delivery of many inpatient neonatal interventions, that existing evidence is often from high income settings and that it frequently indicates uncertainty in the magnitud...
Healthcare policy = Politiques de sante, 2015
To investigate the cost-effectiveness of in-hospital obstetrical care by obstetricians (OBs), fam... more To investigate the cost-effectiveness of in-hospital obstetrical care by obstetricians (OBs), family physicians (FPs) and midwives (MWs) for delivery of low-risk obstetrical patients. Cost-effectiveness analysis from the Ministry of Health perspective using a retrospective cohort study. The time horizon was from hospital admission of a low-risk pregnant patient to the discharge of the mother and infant. Costing data included human resource, intervention and hospital case-mix costs. Interventions measured were induction or augmentation of labour with oxytocin, epidural use, forceps or vacuum delivery and caesarean section. The outcome measured was avoidance of transfer to a neonatal intensive care unit (NICU). Model results were tested using various types of sensitivity analyses. The mean maternal age by provider groups was 29.7 for OBs, 29.8 for FPs and 31.2 for MWs - a statistically higher mean for the MW group. The MW deliveries had lower costs and better outcomes than FPs and OBs...
Canadian family physician Médecin de famille canadien, 2015
Canadian family physician Médecin de famille canadien, 2013
This study evaluates the self-perceived awareness of the new CanMEDS-Family Medicine (CanMEDS-FM)... more This study evaluates the self-perceived awareness of the new CanMEDS-Family Medicine (CanMEDS-FM) roles by family medicine residents. A 22-question online survey. Canadian family medicine residency programs. All residents enrolled in a Canadian family medicine residency as of September 2010 received the survey between May and June 2011. A total of 568 residents participated. Survey respondents indicated their awareness of, their exposure to, and the perceived importance of the CanMEDS-FM roles. The survey response rate was 25.1%. In total, 88.9% (463 of 521) of family medicine residents were aware of the CanMEDS-FM roles; there was no statistically significant difference in awareness between first- and second-year residents. Family medicine expert and communicator were most frequently chosen as the most important CanMEDS-FM roles, while manager and scholar were selected the least often. Overall, 76.4% of family medicine residents thought that their core family medicine teaching was ...
Canadian family physician Médecin de famille canadien, 2013
To examine Canadian family medicine residents' perspectives surrounding teaching opportunitie... more To examine Canadian family medicine residents' perspectives surrounding teaching opportunities and mentorship in teaching. A 16-question online survey. Canadian family medicine residency programs. Between May and June 2011, all first- and second-year family medicine residents registered in 1 of the 17 Canadian residency programs as of September 2010 were invited to participate. A total of 568 of 2266 residents responded. Demographic characteristics, teaching opportunities during residency, and resident perceptions about teaching. A total of 77.7% of family medicine residents indicated that they were either interested or highly interested in teaching as part of their future careers, and 78.9% of family medicine residents had had opportunities to teach in various settings. However, only 60.1% of respondents were aware of programs within residency intended to support residents as teachers, and 33.0% of residents had been observed during teaching encounters. It appears that most Can...
Canadian family physician Médecin de famille canadien, 2012
Canadian family physician Médecin de famille canadien, 2010
Council of the Section of Residents (2 representatives per family medicine program and 1 third-ye... more Council of the Section of Residents (2 representatives per family medicine program and 1 third-year resident representative) Figure 1. Organizational structure of the Section of Residents, CFPC
Thrombosis Research, 2007
Family Practice, 2012
Objective. To understand how women affected by intimate partner violence (IPV), felt their family... more Objective. To understand how women affected by intimate partner violence (IPV), felt their family physicians cared for them and to identify where gaps in care exist. Methods. Interviews were conducted with ten women (mean age 50 years and minimum to maximum ages of 40-73 years). Content analysis was used to identify common themes. Results. Women acknowledged a lack of insight into their abusive relationships given a lack of physical violence, preconceptions about IPV or presumed reasons their abusers had for violence. After identifying abuse, most shared feelings of fear, preventing them from disclosure. They feared being judged, not believed and consequences from their abuser. Perceptions' about their family physician's role prevented disclosure particularly misconceptions regarding physician's interest and time to discuss non-medical issues. After disclosure, women valued their family physicians listening, following up, providing validation and advocacy. All women experienced isolation secondary to the abuser, the family practice clinic, the physician and/or the 'system' itself. Conclusions. Women were not aware of family doctors' interest in issues aside from physical health. They appreciated a confidential and non-threatening environment and valued followup and advocacy on their behalf. They expressed frustration with open access scheduling and multiple providers. To improve care, family physicians should educate patients about their role, provide safe environments for disclosure and offer follow-up and support. Recommended system changes include measures to ensure continuity of care and easy booking of appointments. Finally, family physicians should recognize that there is a need to follow these patients long term as the effects of IPV are long lasting.
Australian Journal of General Practice
Canadian Family Physician Medecin De Famille Canadien, Feb 1, 2012
F1000Research, 2016
IntroductionHealth sector management is increasingly complex as new health technologies, treatmen... more IntroductionHealth sector management is increasingly complex as new health technologies, treatments, and innovative service delivery strategies are developed. Many of these innovations are implemented prematurely, or fail to be implemented at scale, resulting in substantial wasted resources. MethodsA scoping review was conducted to identify articles that described the scale up process conceptually or that described an instance in which a healthcare innovation was scaled up. We define scale up as the expansion and extension of delivery or access to an innovation for all end users in a jurisdiction who will benefit from it.ResultsSixty nine articles were eligible for review. Frequently described stages in the innovation process and contextual issues that influence progress through each stage were mapped. 16 stages were identified: 12 deliberation and 4 action stages. Included papers suggest that innovations progress through stages of maturity and the uptake of innovation depends on t...
BMC medicine, Jan 18, 2016
Pragmatic randomized trials aim to examine the effects of interventions in the full spectrum of p... more Pragmatic randomized trials aim to examine the effects of interventions in the full spectrum of patients seen by clinicians who receive routine care. Such trials should be employed in parallel with efforts to implement many interventions which appear promising but where evidence of effectiveness is limited. We illustrate this need taking the case of essential interventions to reduce inpatient neonatal mortality in low and middle income countries (LMIC) but suggest the arguments are applicable in most clinical areas. A set of basic interventions have been defined, based on available evidence, that could substantially reduce early neonatal deaths if successfully implemented at scale within district and sub-district hospitals in LMIC. However, we illustrate that there remain many gaps in the evidence available to guide delivery of many inpatient neonatal interventions, that existing evidence is often from high income settings and that it frequently indicates uncertainty in the magnitud...
Healthcare policy = Politiques de sante, 2015
To investigate the cost-effectiveness of in-hospital obstetrical care by obstetricians (OBs), fam... more To investigate the cost-effectiveness of in-hospital obstetrical care by obstetricians (OBs), family physicians (FPs) and midwives (MWs) for delivery of low-risk obstetrical patients. Cost-effectiveness analysis from the Ministry of Health perspective using a retrospective cohort study. The time horizon was from hospital admission of a low-risk pregnant patient to the discharge of the mother and infant. Costing data included human resource, intervention and hospital case-mix costs. Interventions measured were induction or augmentation of labour with oxytocin, epidural use, forceps or vacuum delivery and caesarean section. The outcome measured was avoidance of transfer to a neonatal intensive care unit (NICU). Model results were tested using various types of sensitivity analyses. The mean maternal age by provider groups was 29.7 for OBs, 29.8 for FPs and 31.2 for MWs - a statistically higher mean for the MW group. The MW deliveries had lower costs and better outcomes than FPs and OBs...
Canadian family physician Médecin de famille canadien, 2015
Canadian family physician Médecin de famille canadien, 2013
This study evaluates the self-perceived awareness of the new CanMEDS-Family Medicine (CanMEDS-FM)... more This study evaluates the self-perceived awareness of the new CanMEDS-Family Medicine (CanMEDS-FM) roles by family medicine residents. A 22-question online survey. Canadian family medicine residency programs. All residents enrolled in a Canadian family medicine residency as of September 2010 received the survey between May and June 2011. A total of 568 residents participated. Survey respondents indicated their awareness of, their exposure to, and the perceived importance of the CanMEDS-FM roles. The survey response rate was 25.1%. In total, 88.9% (463 of 521) of family medicine residents were aware of the CanMEDS-FM roles; there was no statistically significant difference in awareness between first- and second-year residents. Family medicine expert and communicator were most frequently chosen as the most important CanMEDS-FM roles, while manager and scholar were selected the least often. Overall, 76.4% of family medicine residents thought that their core family medicine teaching was ...
Canadian family physician Médecin de famille canadien, 2013
To examine Canadian family medicine residents' perspectives surrounding teaching opportunitie... more To examine Canadian family medicine residents' perspectives surrounding teaching opportunities and mentorship in teaching. A 16-question online survey. Canadian family medicine residency programs. Between May and June 2011, all first- and second-year family medicine residents registered in 1 of the 17 Canadian residency programs as of September 2010 were invited to participate. A total of 568 of 2266 residents responded. Demographic characteristics, teaching opportunities during residency, and resident perceptions about teaching. A total of 77.7% of family medicine residents indicated that they were either interested or highly interested in teaching as part of their future careers, and 78.9% of family medicine residents had had opportunities to teach in various settings. However, only 60.1% of respondents were aware of programs within residency intended to support residents as teachers, and 33.0% of residents had been observed during teaching encounters. It appears that most Can...
Canadian family physician Médecin de famille canadien, 2012
Canadian family physician Médecin de famille canadien, 2010
Council of the Section of Residents (2 representatives per family medicine program and 1 third-ye... more Council of the Section of Residents (2 representatives per family medicine program and 1 third-year resident representative) Figure 1. Organizational structure of the Section of Residents, CFPC
Thrombosis Research, 2007
Family Practice, 2012
Objective. To understand how women affected by intimate partner violence (IPV), felt their family... more Objective. To understand how women affected by intimate partner violence (IPV), felt their family physicians cared for them and to identify where gaps in care exist. Methods. Interviews were conducted with ten women (mean age 50 years and minimum to maximum ages of 40-73 years). Content analysis was used to identify common themes. Results. Women acknowledged a lack of insight into their abusive relationships given a lack of physical violence, preconceptions about IPV or presumed reasons their abusers had for violence. After identifying abuse, most shared feelings of fear, preventing them from disclosure. They feared being judged, not believed and consequences from their abuser. Perceptions' about their family physician's role prevented disclosure particularly misconceptions regarding physician's interest and time to discuss non-medical issues. After disclosure, women valued their family physicians listening, following up, providing validation and advocacy. All women experienced isolation secondary to the abuser, the family practice clinic, the physician and/or the 'system' itself. Conclusions. Women were not aware of family doctors' interest in issues aside from physical health. They appreciated a confidential and non-threatening environment and valued followup and advocacy on their behalf. They expressed frustration with open access scheduling and multiple providers. To improve care, family physicians should educate patients about their role, provide safe environments for disclosure and offer follow-up and support. Recommended system changes include measures to ensure continuity of care and easy booking of appointments. Finally, family physicians should recognize that there is a need to follow these patients long term as the effects of IPV are long lasting.