Chris O Ifediora - Academia.edu (original) (raw)

Papers by Chris O Ifediora

Objectives: The use of escorts (chauffeurs and chaperones) while on duty in after-hours-house-cal... more Objectives: The use of escorts (chauffeurs and chaperones) while on duty in after-hours-house-call (AHHC) is one key protective option available to doctors in the service and has been linked to low burnout and increased satisfaction in AHHC. This study aims to explore the patterns of engagement of escorts in Australian AHHC. Method: A questionnaire-based, electronic survey of all 300 doctors involved in AHHC through the National Home Doctor Service (NHDS), Australia’s largest providers of the service. Results: A total of 168 valid responses (56.0%) were received. 60.8% of the doctors engaged escorts. Of the doctors that engage chauffeurs, three-quarters do so “all or most times”, while only one-quarter engage chaperones to the same degree of frequency. Hiring escorts is very popular among Brisbane (91.7%) and Sydney-based (88.2%) practitioners, but is unpopular in the City of Gold Coast (26.1%). There were moderate patronages in Adelaide (52.9%) and Melbourne (46.4%). Compared to fe...

Family Practice

Background/Objective. Headaches present commonly in general practice, and doctors face uncertaint... more Background/Objective. Headaches present commonly in general practice, and doctors face uncertainties and pressures in dealing with them. This study identifies key characteristics of headaches investigated through head imaging, in the hope of strengthening existing guidelines. Method. A 7-year retrospective analysis of head imaging scans ordered for investigating headaches among patients aged ≥18 in an Australian general practice setting. Results. A total of 109 of the 517 (21.1%) patients required head imaging, although 14 (2.7%) of these had repeat scans. Three-quarters were females, and most of the headaches were recurrent (56.9%), severe (62.4%) or had associated red flags (78.0%). Computed tomography (CT) and magnetic resonance imaging (MRI) were the only scans adopted (4:1 and 1:1 for first and repeat scans, respectively). Twelve (11.0%) scans had findings likely to explain the headaches after the initial scans, with no difference in findings between diagnoses from CTs and MRIs (P = 0.41). Repeat scans offered no additional benefits, and roughly one in three patients were referred to third-party carers (mostly neurologists). Females had more recurrent headaches (OR = 2.63; CI = 1.09-6.35; P = 0.03). Patients with psycho-morbidities were less likely to have scan findings that explained their headaches (OR = 0.22; CI = 0.06-0.88; P = 0.03), and, though not quite significant, were also more likely to undergo imaging (OR = 1.47; CI 0.96-2.27; P = 0.08). Conclusion. Significant intracranial findings were uncommon following imaging for headaches, and MRIs offer no advantages over CTs. Repeating head scans within 5 years offers no clear benefits. Psycho-morbidities should be considered when deciding the imaging needs, given the lesser chance of findings. Larger studies will help validate these findings.

BMC Public Health

Background: The negative impact of cervical and breast cancers in low and lower-middle income cou... more Background: The negative impact of cervical and breast cancers in low and lower-middle income countries are worsening, and, along with other non-communicable diseases, occur disproportionately in these resource-limited economies. Most preventive approaches to these cancers require government funding, but few countries with the most at-risk population can afford government-sponsored universal vaccination, screening, diagnostic and treatment programmes, which, along with socioeconomic issues, contribute to the poor outcomes in these mostly developing countries. An urgent need exists, therefore, to find an effective, affordable, cost-effective, culturally-acceptable and sustainable way of reducing these cancers. This paper advocates a rethinking in the current preventive campaigns. Main body: Using evidence provided by recently-published papers, a case is made for enlightenment campaigns to primarily target teenagers (boys and girls) in high schools of developing countries. Inclusions into the schools' academic curricula are the recommended approach, given that both cancers take hold on populations within that age bracket. This approach, if adopted, may be the only accessible, affordable and realistic approach that gives millions of women in low and lower-middle income countries the chance at survival. Empowering them early instils the selfawareness and confidence necessary for young adults to take charge of their own health. The acquired knowledge, in turn, helps them adopt positive attitudes and preventive behaviours that will, ultimately, prolong their lives. Conclusion: The recommended approach offers governments and concerned stakeholders an evidence-based option that allows them to deliver cost-effective and sustainable life-saving interventions, while hoping to get around the bottlenecks that limit the large scale implementation of other effective but capital-intensive strategies.

Journal of Medical Education and Curricular Development

Background: Online education options increasingly complement traditional face-to-face (F2F) appro... more Background: Online education options increasingly complement traditional face-to-face (F2F) approaches. Few studies have compared both formats on doctors, and little evidence exists to prove that the online approach is universally effective. This gap needs to be addressed to ensure that the quality of education and health care delivery is not compromised. Methods: A quantitative survey targeting 881 doctors that required online and F2F teaching sessions offers identical contents over a 12-month period. The surveyed doctors work in the Australian after-hours house-call (AHHC) industry, and the teachings were parts of their continuing professional development activities. Results: In all, 89 responses were received; 10 (11.2%) participated exclusively online, while 23 (25.8%) did so by F2F; 52 (58.4%) engaged through both modalities. No statistical differences existed based on sex, specialty, and post-graduate fellowship status, as well as on the perceptions with teaching structure, co...

Journal of Evaluation in Clinical Practice

Background: With limited government-sponsored breast screening programmes in developing countries... more Background: With limited government-sponsored breast screening programmes in developing countries, breast awareness remains the only realistic survival hope for millions. Poor levels of knowledge and preventive practices remain in these countries, and early enlightenments to empower teenage high school girls have been advocated recently. This study evaluates ways to ensure sustainability for such an approach. Method: A six-month longitudinal, interventional study of 432 female high school female students in Southeastern Nigeria, The efficacies of a video-assisted face-to-face intervention, as well as the the use of printed handouts, were evaluated. Results: A total of 317 (73.4%) and 301 (69.7%) valid responses were received from the pre-intervention (16.8±1.5 years) and post-intervention (17.2±1.6 years) surveys respectively. Logistics regression revealed that participants who were "engaged" with the campaigns, either through symposium attendance, or by reading handouts, showed significant improvements on most aspects of knowledge regarding the cancer's early symptoms and risk factors, as well as breast self-examination (BSE). However, the monthly practice of BSE was not significantly increased (Attendees: OR=1.44, P=0.18; Handoutreaders: OR=1.52; P=0.17) Also, when "engagement" to the respective empowerment activities was disregarded, a chi-squared analysis comparing the pre-intervention and post-intervention groups, showed significant improvements on specific knowledge regarding risk factors and early symptoms of breast cancer, as well as BSE techniques and regular monthly practice: χ 2 (1, N=596) = 46.703, p<0.001. Across multiple parameters, the impact of exclusive face-to-face participation was not different to that from the reading of handouts. Conclusion: Face-to-face and handout were both effective and of similar impact. However, sustained impact on monthly BSE is doubtful. To surmount this, strategies to ensure ongoing engagements are vital. Perhaps adjusting existing high school curricula to allow repeated yearly teachings on breast cancer and BSE, along with in-builtin evaluation systems like examinations and quizzes, are ways of ensuring engagement.

BMC family practice, Jan 13, 2016

No previous study had ever looked at Burnout among medical practitioners involved in after-hours ... more No previous study had ever looked at Burnout among medical practitioners involved in after-hours house calls (AHHC) in Australia. The growing popularity of AHHC and the high number of overseas-trained doctors involved in it make this a subject of both local and international significance. This study aims to assess the levels of burnout among Australian-based doctors involved in the service. This is a quantitative, questionnaire-based survey of all the 300 doctors engaged in AHHC through the National Home Doctor Service (NHDS), Australia's largest home doctor-visit service providers. The study looked at experiences of the participants over the 12-months period from October 2013 to September 2014. The main outcome measure was the 22-item Maslach Burnout Inventory (MBI). Results were presented as Means and Frequency Percentages. A total of 168 valid questionnaires out of 300 were returned, giving a 56.0 % response rate. The Total Maslach Mean Scores (MMS) obtained were 15.97 for Em...

Journal of evaluation in clinical practice, Apr 1, 2018

Minimizing the risks and distress arising from aggression in after-hours house call (AHHC) servic... more Minimizing the risks and distress arising from aggression in after-hours house call (AHHC) services will help improve service quality in the industry. Unfortunately, no national study has ever evaluated this in Australian AHHCs. Apart from reducing this gap, findings from this work will have global relevance given the rising popularity of the AHHC industry worldwide. A survey of all 300 doctors employed by the National Home Doctor Service, Australia's largest AHHC service provider. A validated electronic questionnaire was used to examine the doctors' experiences over a 12-month period. There were 168 valid responses (56% response rate). Aggression prevalence was 47.1%, and just over half (51.8%) of the cases came from the patients. "Verbal aggression" was the commonest (48.3%). Others are "threats" (26.6%), "vexatious complaints" (13.3%), "property damage" (4.2%), "physical violence" (4.2%), "sexual harassment" (2.8...

Family practice, Jul 23, 2018

Headaches present commonly in general practice, and doctors face uncertainties and pressures in d... more Headaches present commonly in general practice, and doctors face uncertainties and pressures in dealing with them. This study identifies key characteristics of headaches investigated through head imaging, in the hope of strengthening existing guidelines. A 7-year retrospective analysis of head imaging scans ordered for investigating headaches among patients aged ≥18 in an Australian general practice setting. A total of 109 of the 517 (21.1%) patients required head imaging, although 14 (2.7%) of these had repeat scans. Three-quarters were females, and most of the headaches were recurrent (56.9%), severe (62.4%) or had associated red flags (78.0%). Computed tomography (CT) and magnetic resonance imaging (MRI) were the only scans adopted (4:1 and 1:1 for first and repeat scans, respectively). Twelve (11.0%) scans had findings likely to explain the headaches after the initial scans, with no difference in findings between diagnoses from CTs and MRIs (P = 0.41). Repeat scans offered no ad...

European Journal for Person Centered Healthcare

Background: Multiple factors potentially influence doctors’ decisions regarding neuroimaging for ... more Background: Multiple factors potentially influence doctors’ decisions regarding neuroimaging for headaches in general practice and psycho-morbidities are one of such. Unfortunately, other non-clinical factors at play among psychological patients with headaches are poorly known and the need to identify these factors has become important in view of recent findings on the impact of psychological issues in managing headaches in primary care. The findings from this study are expected to help improve efficiency and confidence in managing headaches in this subset of patients.Method: This is a 7-year retrospective study exploring headache presentations of patients aged ≥18 in an Australian general practice setting from 1 January 2010 to 1 April 2017.Results: A total of 517 patients were identified, with an average age of 45.5 +/- 16.2 years (range of 18 to 94 years). Psycho-morbidities were reported among 190 (36.8%) patients. The female to male ratio was 72% to 28%. Most cases of headache...

Journal of evaluation in clinical practice, Jun 2, 2018

This study explores the postconsultation follow-up behaviours of patients who used the Australian... more This study explores the postconsultation follow-up behaviours of patients who used the Australian after-hours house-call (AHHC) medical services. These behaviours provide insights into the nature of the continuity of care (CoC) in the industry and are a measure quality in AHHC service delivery. Understanding the patterns of these CoCs and their predictors will enable stakeholders in the industry, both locally and globally, plan and implement higher quality services. This is a cross-sectional survey of all 10,838 patients who used AHHC during the last week of January 2016. A validated questionnaire was used, distributed through a mix of online and postal questionnaires. One thousand two hundred twenty-eight questionnaires were returned (11.3%). Had the AHHC not been available, 38.6% of respondents would have gone to their own general practitioners (GPs), 40.1% to an emergency department (ED), 15.9% to an office-based after-hours service, and 5.5% would have done nothing. After the AH...

PeerJ

Objectives The use of escorts (chauffeurs and chaperones) while on duty in after-hours-house-call... more Objectives The use of escorts (chauffeurs and chaperones) while on duty in after-hours-house-call (AHHC) is one key protective option available to doctors in the service, and has been linked to low burnout and increased satisfaction in AHHC. This study aims to explore the patterns of engagement of escorts in Australian AHHC. Method This is a questionnaire-based, electronic survey of all 300 doctors involved in AHHC through the National Home Doctor Service (NHDS), Australia’s largest providers of the service. The survey explored the doctor’s experiences over the 12-month period from October 2013 to September 2014. Results This survey received a total of 168 valid responses, giving a response rate of 56%. Nearly 61% of the doctors involved in AHHC engaged escorts (chauffeurs and chaperones). Of those doctors that engage chauffeurs, three-quarters do so “all or most times”, while only one-quarter engaged chaperones to the same degree of frequency. Hiring escorts is very popular among B...

Family Practice, 2016

Background. The Australian after-hours house-call (AHHC) services has grown rapidly in the past f... more Background. The Australian after-hours house-call (AHHC) services has grown rapidly in the past few years. Even though recent studies have looked at aspects of the service as it concerns the medical personnel involved, no national study has explored patient satisfaction with the service. Objective. This study aims to assess patient satisfaction with Australian AHHC services and its predictors, with the hope of improving quality and patient outcomes. The findings might also have international relevance, given the developing nature of the AHHC in most countries. Methods. A cross-sectional survey of all 10 838 patients known to have patronized the AHHC service in Australia over a 1-week period. The main outcome measure was the Patient Satisfaction Questionnaire 18 (PSQ-18). Results. A total of 1228 questionnaires were returned. General Satisfaction (GS) level was found to be 85.2% (mean 4.16/5).

Family Practice, 2015

Background. Despite the growing popularity of after-hours house calls (AHHCs) in Australia, no pr... more Background. Despite the growing popularity of after-hours house calls (AHHCs) in Australia, no previous study had ever looked at satisfaction among the involved practitioners. The high number of overseas-trained doctors in Australia makes this a subject of international significance. Objective. To determine the levels of satisfaction and its significant associations among doctors in AHHCs. Methods. Design, setting and participants: A quantitative, questionnaire-based survey of all 300 doctors engaged in AHHCs through the National Home Doctor Service (NHDS), Australia's largest home-visit doctor service provider. Main outcome measure: Satisfaction was assessed using the modified, 10-item Warr-Cook-Wall tool. Results. A total of 168 valid responses (56.0% response rate) were received. Mean satisfaction scores for each of the 10 items ranged from 3.02 to 3.86, indicating 'moderate' to 'very satisfied' levels. Overall satisfaction was 85.9%, mostly related to 'freedom of work and independence', 'amount of responsibility' and 'income'. Doctors in existing legal unions are more satisfied than the single, separated or widowed ones on the 'amount of responsibility' [odds ratio (OR) = 6.50, P = 0.02, confidence interval (CI): 1.33-31.72], while those engaged for <24 hours/week are less satisfied on 'income' than full-time ones (OR = 0.30, P = 0.01, CI: 0.13-0.71). The 'adoption of protective measures', being 'aged >40', being 'male' and 'working in Brisbane, Adelaide or the Gold Coast' are other doctor variables associated with increased satisfaction. Conclusions. Satisfaction levels among AHHC GPs in Australia are comparable to the levels seen among their colleagues in regular-hour jobs, but there is still room for improvement.

BMC Family Practice, 2016

Background: No previous study had ever looked at Burnout among medical practitioners involved in ... more Background: No previous study had ever looked at Burnout among medical practitioners involved in after-hours house calls (AHHC) in Australia. The growing popularity of AHHC and the high number of overseas-trained doctors involved in it make this a subject of both local and international significance. This study aims to assess the levels of burnout among Australian-based doctors involved in the service. Methods: This is a quantitative, questionnaire-based survey of all the 300 doctors engaged in AHHC through the National Home Doctor Service (NHDS), Australia's largest home doctor-visit service providers. The study looked at experiences of the participants over the 12-months period from October 2013 to September 2014. The main outcome measure was the 22-item Maslach Burnout Inventory (MBI). Results were presented as Means and Frequency Percentages. Results: A total of 168 valid questionnaires out of 300 were returned, giving a 56.0 % response rate. The Total Maslach Mean Scores (MMS) obtained were 15.97 for Emotional Exhaustion (EE), 3.15 for Depersonalization (DP) and 40.39 for Personal Accomplishment (PA), signifying low-level burnouts in all three dimensions of the MBI. This pattern was equally reflected when the Frequency Percentages were analyzed. With this approach, a majority (56.8 %) of the responses were low-level burnout on the EE dimension, while 23.4 and 19.8 % respectively reported medium and high level burnouts. On the DP dimension, 87.6, 6.3 and 6.1 % of the responses were low, moderate and high level burnouts respectively, while the PA dimension recorded 86.4, 9.6 and 4.0 % respectively. Given that on the MBI scale, perceived personal accomplishment has an inverse relationship with burnout, the low-level MMS finding on the PA dimension therefore indicate a commensurate high perception of personal accomplishments. Conclusions: Burnout levels are low while perceived achievements are high among doctors involved in after-hours house calls in Australia. The survey recommends that future studies be designed to explore the real reasons behind these findings.

Southern Medical Journal

Data from questionnaires completed by 419 10th-grade girls were analyzed as part of a school heal... more Data from questionnaires completed by 419 10th-grade girls were analyzed as part of a school health education program. The questionnaire was designed to collect knowledge of, attitudes toward, and experiences with cancer and cancer prevention. Data were collected from randomly selected health classes preceding a presentation on breast and cervical cancer prevention. Results showed that the girls were pessimistic about chances of surviving cancer and did not differentiate survival by type or site of the cancer. Although there was considerable confusion about its purpose, 27.6% reported having had a Papanicolaou smear within the past year and 79.2% correctly identified the Pap smear as a test for cancer.

Southern Medical Journal, 1990

Family Practice, 2017

Objectives. This paper explores, from the patients' perspective, the likely impact of the Austral... more Objectives. This paper explores, from the patients' perspective, the likely impact of the Australian after-hours house-call (AHHC) medical services on emergency department (ED) presentations. This has become imperative given the significant cost difference between patient presentations to either the AHHC or ED and their practical implications for health care funding. Design, setting and participants. A cross-sectional, self-reported survey of all 10 838 patients in Australia known to have patronized AHHC services over the last week of January 2016. Main outcome measure. The study used a validated, self-completion questionnaire, dispatched through a mixture of online and postal methods. Results. A total of 1228 questionnaires were returned, of which 1211 included all relevant sections of the survey (11.2% response rate). Four hundred and eighty-six patients (40.1%) indicated that they would have gone to the ED on the same day or night of their illness had the AHHC not been available, with the elderly (≥65) and children (<16) accounting for nearly two-thirds of these (64.6%). Following their AHHC consultations, 103 (8.5%) patients eventually attended the ED, meaning that the service prevented 383 patients from attending the ED, a decrease of 78.8%. Stratification based on location showed that this impact was seen across all states and territories in Australia where AHHC services exist, ranging from a reduction of 73.9% in Western Australia to 85.0% in Tasmania. Similarly, the impact cuts across all patient demographics, including age ranges, gender and social divides. Conclusions. Based on our respondents' reports, AHHC services appear to be associated with a reduction in ED visits in Australia, with the impact cutting across all regions and patient demographics.

Family Practice, 2018

Given the dearth of government-sponsored programmes, preventive lifestyles and practices are the ... more Given the dearth of government-sponsored programmes, preventive lifestyles and practices are the realistic hopes for millions of women in developing countries against cervical cancer. Early interventions for teenage high school girls have been advocated recently, but evidence-base for sustainable activities at this demographic is lacking. This article reduces this gap by determining the impact of two cervical cancer education techniques. Method. This is a 6-month interventional cohort study of 432 female high school students in South-eastern Nigeria. Results. A total of 317 (73.4%) and 301 (69.7%) valid responses were received from the preintervention (16.8 ± 1.5 years) and post-intervention (17.2 ± 1.6 years) surveys, respectively. About 213 (70.8%) were fully engaged with the interventions. Logistic regression revealed that participants who were ‘engaged’ with the interventions, either through symposium attendance or by reading of the printed handouts, showed significant improvements across multiple cervical cancer parameters regarding knowledge on ‘pap smears’ (analysed with four items), ‘HPV vaccine’ (two items) and ‘risk factors’ (two items). Improvements in Knowledge of ‘early symptoms’ were not improved, with ‘post-coital bleeding’ [odds ratio (OR) = 0.95; P = 0.87] and ‘being asymptomatic’ (OR = 0.69; P = 0.32) remaining statistically similar between the engaged and the unengaged. If ‘engagement’ with either intervention was disregarded, a chi-square analysis identified no significant improvement in knowledge on any parameter. Conclusion. Ensuring ‘engagement’ with intervention campaigns is vital to achieving effective and sustainable cervical cancer knowledge. Engagement may be achieved by repeating the education activities across all the years/classes that make up high school in each developing country, along with formal examinations at each level.
Key words: Cervical cancer, high school, intervention, knowledge, secondary school, teenage women.