Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la médecine rurale : le journal officiel de la Société de médecine rurale du Canada
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Epidural steroid injections (ESIs) are a safe and accessible therapy for chronic low back pain, one of the most common and challenging chronic conditions seen in primary care. However, the indications for and effectiveness of ESI remain controversial. In rural settings with limited public transportation infrastructure, such a mobility-limiting condition can have even more negative effects on quality of life and function. Furthermore, diagnostic and specialist services are often limited. A paucity of safe, effective and accessible treatments leads to heavy reliance on oral analgesics, especially opioids, which have well-known complications. ⋯ Some patients with neurologic compromise from LDH or LSS have improvement in symptoms after ESI. A prospective study is underway to more rigorously assess the effectiveness of this treatment.
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Barriers to patient care in southwestern Ontario rural emergency departments: physician perceptions.
We sought to determine the perceptions of physicians staffing rural emergency departments (EDs) in southwestern Ontario with respect to factors affecting patient care in the domains of physical resources, available support and education. ⋯ Our survey results reveal that physicians practising emergency medicine in southwestern Ontario perceive crowding as the greatest barrier to providing patient care. Conversely, the survey identified that rural ED physicians perceive information sharing within the hospital, the availability of emergent laboratory studies and access to medications within the ED as having a strongly positive impact on patient care. Interestingly, our findings suggest that physicians in rural EDs view their access to education as adequate, as responses were either positive or neutral in regard to access to training and ability to maintain relevant skills.