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1.
J Public Health (Oxf) ; 39(2): 387-394, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-27247121

RESUMO

Background: Tuberculosis (TB) is the second leading cause of death worldwide due to a single infectious agent. Rates of active TB in places of prescribed detention (PPD), which include Prisons, Young Offender Institutions and Immigration Removal Centres, are high compared with the general population. PPD therefore present an opportunity to develop targeted health programmes for TB control. This audit aims to assess current service provisions and identify barriers to achieving best practice standards in PPD across London. Methods: Twelve healthcare teams within PPD commissioned by NHS England (London Region) were included in the audit. Services were evaluated against the National Institute for Health and Care Excellence standards for TB best practice. Results: None of the health providers with a digital X-ray machine were conducting active case finding in new prisoners and no health providers routinely conduct Latent TB infection testing and preventative treatment. Barriers to implementing standards include the lack of staff skills and staff skills mix, structural and technical barriers, and demands of custodial and health services. Conclusions: This audit restates the importance of national public health TB strategies to consider healthcare provisions across PPD.


Assuntos
Antituberculosos/uso terapêutico , Atenção à Saúde/estatística & dados numéricos , Emigração e Imigração/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Prisioneiros/estatística & dados numéricos , Prisões/estatística & dados numéricos , Tuberculose/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade
2.
BMC Health Serv Res ; 16: 489, 2016 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-27633653

RESUMO

BACKGROUND: The English health system experienced a large-scale reorganisation in April 2013. A national tri-partite delivery framework involving the Department of Health, NHS England and Public Health England was agreed and a new local operational model applied. Evidence about how health system re-organisations affect constituent public health programmes is sparse and focused on low and middle income countries. We conducted an in-depth analysis of how the English immunisation programme adapted to the April 2013 health system reorganisation, and what facilitated or hindered the delivery of immunisation services in this context. METHODS: A qualitative case study methodology involving interviews and observations at national and local level was applied. Three sites were selected to represent different localities, varying levels of immunisation coverage and a range of changes in governance. Study participants included 19 national decision-makers and 56 local implementers. Two rounds of interviews and observations (immunisation board/committee meetings) occurred between December 2014 and June 2015, and September and December 2015. Interviews were audio recorded and transcribed verbatim and written accounts of observed events compiled. Data was imported into NVIVO 10 and analysed thematically. RESULTS: The new immunisation programme in the new health system was described as fragmented, and significant effort was expended to regroup. National tripartite arrangements required joint working and accountability; a shift from the simpler hierarchical pre-reform structure, typical of many public health programmes. New local inter-organisational arrangements resulted in ambiguity about organisational responsibilities and hindered data-sharing. Whilst making immunisation managers responsible for larger areas supported equitable resource distribution and strengthened service commissioning, it also reduced their ability to apply clinical expertise, support and evaluate immunisation providers' performance. Partnership working helped staff adapt, but the complexity of the health system hindered the development of consistent approaches for training and service evaluation. CONCLUSION: The April 2013 health system reorganisation in England resulted in significant fragmentation in the way the immunisation programme was delivered. Some of this was a temporary by-product of organisational change, other more persistent challenges were intrinsic to the complex architecture of the new health system. Partnership working helped immunisation leaders and implementers reconnect and now the challenge is to assess how inter-agency collaboration can be strengthened.


Assuntos
Atenção à Saúde/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Programas de Imunização/organização & administração , Medicina Estatal/organização & administração , Comportamento Cooperativo , Atenção à Saúde/normas , Inglaterra , Programas Governamentais , Humanos , Programas de Imunização/normas , Relações Interinstitucionais , Inovação Organizacional , Avaliação de Programas e Projetos de Saúde , Saúde Pública/normas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Medicina Estatal/normas
3.
BMJ Open ; 6(2): e009739, 2016 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-26883237

RESUMO

OBJECTIVE: To evaluate the effectiveness and cost of the pan-London pharmacy initiative, a programme that allows administration of seasonal influenza vaccination to eligible patients at pharmacies. DESIGN: We analysed 2013-2015 data on vaccination uptake in pharmacies via the Sonar reporting system, and the total vaccination uptake via 2011-2015 ImmForm general practitioner (GP) reporting system data. We conducted an online survey of London pharmacists who participate in the programme to assess time use data, vaccine choice, investment costs and opinions about the programme. We conducted an online survey of London GPs to assess vaccine choice of vaccine and opinions about the pharmacy vaccine delivery programme. SETTING: All London boroughs. PARTICIPANTS: London-based GPs, and pharmacies that currently offer seasonal flu vaccination. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Comparison of annual vaccine uptake in London across risk groups from years before pharmacy vaccination introduction to after pharmacy vaccination introduction. Completeness of vaccine uptake reporting data. Cost to the National Health Service (NHS) of flu vaccine delivery at pharmacies with that at GPs. Cost to pharmacists of flu delivery. Opinions of pharmacists and GPs regarding the flu vaccine pharmacy initiative. RESULTS: No significant change in the uptake of seasonal vaccination in any of the risk groups as a result of the pharmacy initiative. While on average a pharmacy-administered flu vaccine dose costs the NHS up to £2.35 less than a dose administered at a GP, a comparison of the 2 recording systems suggests there is substantial loss of data. CONCLUSIONS: Flu vaccine delivery through pharmacies shows potential for improving convenience for vaccine recipients. However, there is no evidence that vaccination uptake increases and the use of 2 separate recording systems leads to time-consuming data entry and missing vaccine record data.


Assuntos
Programas de Imunização/estatística & dados numéricos , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Farmácias/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Análise Custo-Benefício , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Programas de Imunização/organização & administração , Vacinas contra Influenza/economia , Londres , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Vacinação/economia
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