RESUMO
Pregnant women from disadvantaged, vulnerable or excluded groups are more likely to have poorer maternal and neonatal outcomes. In Bradford, a three-year pilot project is targeting pregnant women in some of the poorest areas to improve the health of mothers and babies.
Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/métodos , Pobreza , Feminino , Deficiência de Ácido Fólico , Humanos , Saúde das Minorias/economia , Mães/psicologia , Projetos Piloto , Gravidez , Abandono do Hábito de Fumar , Reino UnidoRESUMO
OBJECTIVES: Comorbid psychiatric illness has been identified as a major driver of health care costs. The colocation of psychiatrists in primary care practices has been proposed as a model to improve mental health and medical care as well as a model to reduce health care costs. METHODS: Financial models were developed to determine the sustainability of colocation. RESULTS: We found that the population studied had substantial psychiatric and medical burdens, and multiple practice logistical issues were identified. CONCLUSION: The providers found the experience highly rewarding and colocation was financially sustainable under certain conditions. The colocation model was effective in identifying and treating psychiatric comorbidities.
Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Medicaid/economia , Pessoas Mentalmente Doentes/estatística & dados numéricos , Ambulatório Hospitalar/economia , Atenção Primária à Saúde/economia , Psiquiatria/economia , Comorbidade , Controle de Custos/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , Custos de Cuidados de Saúde/normas , Custos de Cuidados de Saúde/tendências , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/normas , Humanos , Masculino , Medicaid/legislação & jurisprudência , Medicaid/tendências , Pessoa de Meia-Idade , Saúde das Minorias/economia , Saúde das Minorias/estatística & dados numéricos , Cidade de Nova Iorque , Estudos de Casos Organizacionais , Ambulatório Hospitalar/organização & administração , Áreas de Pobreza , Atenção Primária à Saúde/organização & administração , Psiquiatria/tendências , Estados Unidos , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/organização & administração , Recursos HumanosRESUMO
BACKGROUND: Heart disease disproportionately affects Native Hawaiians and other Pacific people. In response, researchers proposed and communities endorsed, developing a cardiac rehabilitation (CR) program based on the hula, a Native Hawaiian dance form. The utilization of cultural practices in health interventions can improve outcomes and increase enrollment and retention, but requires sensitivity and understanding. OBJECTIVE: This paper provides the conceptual framework and methods used for integration of multiple communities' perspectives to inform the design of a hula-based CR intervention. METHODS: Specific strategies and processes were established to ensure the equity of scientific-clinical and patient- cultural knowledge and perspectives. Multiple methods were used and a flow diagram defined steps for the intervention development. RESULTS: Patient and cultural consultations provided information about the multidimensional benefits of hula and its use in a CR intervention. Clinical and scientific consultations provided specific guidelines for exercise prescription and patient monitoring. Integrating findings from all consultations identified important direction and requirements. CONCLUSIONS: Community-based participatory research (CBPR) principles guided a complex collaboration of multiple communities; although time consuming, inclusive consultations provided valuable information and relationships.