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1.
Soc Work Public Health ; 39(2): 141-155, 2024 Feb 17.
Article in English | MEDLINE | ID: mdl-38445907

ABSTRACT

Research shows that U.S. Latinas are at risk for high rates of postpartum depression (PPD) but have low rates of treatment compared to non-Hispanic White mothers. This study examined the feasibility of a multi-site home-visiting intervention (PST4PPD) conducted by bilingual community health workers (CHW) among low-income Latina mothers. A one-group, pre/posttest design and paired sample's t-test were used to measure changes in depressive symptoms and self-efficacy for participants (n = 76) across five sites. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were used to assess depression; the New General Self-Efficacy Scale and the Maternal Efficacy Questionnaire measured general self-efficacy and parenting self-efficacy. Depression scores decreased significantly from pretest to posttest. Participants' general self-efficacy, maternal self-efficacy, and PPD knowledge increased. With a 76% completion rate, demonstrable improvements were seen in participants' depression and self-efficacy. Implications for addressing modifiable factors such as self-efficacy and stress management are discussed.


Subject(s)
Depression, Postpartum , Female , Humans , Depression, Postpartum/therapy , Depression, Postpartum/diagnosis , House Calls , Mothers , Hispanic or Latino , Self Efficacy
2.
Health Policy Plan ; 39(4): 344-354, 2024 Apr 10.
Article in English | MEDLINE | ID: mdl-38491997

ABSTRACT

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.


Subject(s)
Child Development , Maternal Health Services , Pregnancy , Child , Female , Humans , Child, Preschool , Infant , Brazil , Cohort Studies , Prenatal Care , House Calls
4.
Aten. prim. (Barc., Ed. impr.) ; 56(3): [102809], Mar. 2024. tab
Article in Spanish | IBECS | ID: ibc-230997

ABSTRACT

Objetivo: Identificar fortalezas, obstáculos, cambios en el entorno y capacidades de los equipos y unidades de apoyo en atención primaria, con el objetivo de proporcionar atención de alta calidad en un área de salud integrada. Diseño: Estudio de métodos mixtos basado en la matriz DAFO y el análisis CAME. Emplazamiento: Atención primaria, Comunidad Valenciana. Participantes: En total han participado 271 profesionales de los diferentes colectivos y representantes de asociaciones de pacientes, 99 en la fase de captura de ideas, 154 en la fase de elaboración de la matriz DAFO y 18 en la fase de elaboración del análisis CAME. Intervenciones: Se condujo un análisis DAFO-CAME a partir del cual se establecieron líneas de acción. La captura de información se realizó mediante grupos nominales, la fase de consenso integrando al conjunto de profesionales mediante Delphi y conferencia de consenso. Mediciones principales: Priorización de propuestas para mantener las fortalezas, afrontar las amenazas, explotar las oportunidades, corregir las debilidades en el marco de un plan de acción de un área de salud integrada. Resultados: Se propusieron un total de 82 ideas diferentes (20 fortalezas, 40 debilidades, 4 amenazas, 12 oportunidades y 6 amenazas-oportunidades). Este análisis condujo a un plan estratégico con 7 líneas y 33 acciones/intervenciones priorizadas. Conclusiones: Atención integrada buscando fórmulas colaborativas entre niveles asistenciales, redefinición de roles, soluciones digitales, capacitación del personal y mejoras en equipamientos y procesos de soporte, junto a medidas para afrontar el envejecimiento de la población y las necesidades de centros sociosanitarios constituyen los retos sobre los que actuar.(AU)


Objective: To identify strengths, obstacles, changes in the environment, and capabilities of primary care teams and support units, with the aim of providing high-quality care in an integrated healthcare area. Design: Mixed methods study based on the SWOT matrix and CAME analysis. Location: Primary care, Valencian community. Participants: A total of 271 professionals from different collectives and patient association representatives participated. 99 in the idea generation phase, 154 in the SWOT matrix development phase, and 18 in the CAME analysis development phase. Interventions: A SWOT-CAME analysis was conducted, from which action lines were established. Information capture was carried out through nominal groups, and the consensus phase involved integrating all professionals through Delphi and consensus conference techniques. Main measurements: Prioritization of proposals to maintain strengths, address threats, exploit opportunities, and correct weaknesses within the framework of an integrated healthcare area action plan. Results: A total of 82 different ideas were proposed (20 strengths; 40 weaknesses; 4 threats; 12 opportunities; 6 threats-opportunities), which, once prioritized, were translated into 7 lines and 33 prioritized actions/interventions (CAME analysis). Conclusions: Integrated care, seeking collaborative approaches between care levels, redefining roles, digital solutions, staff training, and improvements in equipment and support processes, along with measures to address the aging population and the needs of socio-sanitary centers, constitute the challenges to be addressed.(AU)


Subject(s)
Humans , Male , Female , Primary Health Care/organization & administration , Primary Health Care/trends , Quality of Health Care , Patient Care , House Calls , Spain , Health Management , Health Systems
5.
Ann N Y Acad Sci ; 1533(1): 99-144, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38354095

ABSTRACT

This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.


Subject(s)
Child Development , Parenting , Child , Humans , Parenting/psychology , House Calls
6.
Rev Bras Epidemiol ; 27: e240007, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-38422231

ABSTRACT

OBJECTIVE: To analyze characteristics of the home visit (HV) in Brazil, 2012 and 2017. METHODS: Ecological study, with panel data whose units of analysis were the Primary Health Care teams in Brazil, participants of the 1st and 3rd cycles of the Program to Improve Access and Quality of Primary Care of the Unified Health System. Descriptive, inferential and spatial analyzes (alpha=5%) were performed. RESULTS: There was an increase in the proportion of teams that carried out home visits at a frequency defined based on risk and vulnerability analysis and actively searched for people with respiratory symptoms and women with delayed and altered cytopathological examination. In the heat maps, the Northeast, Southeast and South regions had a higher concentration of teams that carried out the HV and carried out an active search. CONCLUSION: The maintenance and qualification of HVs must be a priority in Brazil, since there are few countries in the world with such capillarity of health services, reaching the homes of millions of people.


Subject(s)
House Calls , Quality of Health Care , Humans , Female , Brazil
7.
J Laparoendosc Adv Surg Tech A ; 34(4): 318-322, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38301124

ABSTRACT

Background: It has been shown that surgical residents who took few or no in-house calls during medical school felt less prepared for the residency. In this study, our objective was to assess the impact of in-house calls carried out by medical students on their perceptions of medical training, including the influence on specialty choice. Methods: The students were asked to complete an anonymized questionnaire at the first and last day of their general surgery clerkship. Students were asked regarding importance for medical training and education, preparation for the internship, learning opportunities, skills acquisition; negative effects, including fatigue, negative effect over medical training, personal life, and physical and mental health derangements; and the student's perception of the residents' in-house calls and parameters affecting specialty selection: difficulty of the residency, prestige, and future career opportunities. Results: A total of 42 medical students responded to 84 questionnaires. There was a significant difference in the importance of calls among male students before the beginning of the clerkships compared with the end of the clerkship (4.53 versus 4.21, P = .034). At the end of general surgery clerkship, students indicated that the calls less impaired studying during the clerkship (2.5 versus 2.21, P < .05) compared with the beginning of the clerkship. Female students ranked the calls as less demanding at the end of the clerkship (2.53 versus 2.12, P < .05). The impact of the residency difficulty on the selection of their future specialty was rated higher by the students at the end of the clerkship compared with their expectations at the beginning (3.13 versus 2.85, P = .033). Conclusions: In conclusion, our study demonstrates that in-house calls performed by medical students during their general surgery clerkships have a significant influence on their perceptions of medical training and choice of specialty. The study also highlights the importance of gender differences in the students' perception of the importance and impact of calls on their well-being.


Subject(s)
Students, Medical , Humans , Male , Female , Students, Medical/psychology , House Calls , Learning , Educational Status , Forecasting , Surveys and Questionnaires
8.
J Gen Intern Med ; 39(Suppl 1): 36-43, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38227169

ABSTRACT

BACKGROUND: In response to the aging population, the Department of Veterans Affairs (VA) seeks to expand access to evidence-based practices which support community-dwelling older persons such as the Geriatric Resources for Assessment and Care of Elders (GRACE) program. GRACE is a multidisciplinary care model which provides home-based geriatric evaluation and management for older Veterans residing within a 20-mile drive radius from the hospital. We sought to expand the geographic reach of VA-GRACE by developing a hybrid-virtual home visit (TeleGRACE). OBJECTIVES: The objectives were to: (1) describe challenges encountered and solutions implemented during the iterative, pre-implementation program development process; and (2) illustrate potential successes of the program with two case examples. DESIGN: Quality improvement project with longitudinal qualitative data collection. PROGRAM DESCRIPTION: The hybrid-virtual home visit involved a telehealth technician travelling to patients' homes and connecting virtually to VA-GRACE team members who participated remotely. APPROACH & PARTICIPANTS: We collected multiple data streams throughout program development: TeleGRACE staff periodic reflections, fieldnotes, and team meeting notes; and VA-GRACE team member interviews. KEY RESULTS: The five program domains that required attention and problem-solving were: telehealth connectivity and equipment, virtual physical examination, protocols and procedures, staff training, and team integration. For each domain, we describe several challenges and solutions. An example from the virtual physical examination domain: several iterations were required to identify the combination of telehealth stethoscope with dedicated headphones that allowed remote nurse practitioners to hear heart and lung sounds. The two cases illustrate how this hybrid-virtual home visit model provided care for patients who would not otherwise have received timely healthcare services. CONCLUSIONS: These results provide a blueprint to translate an in-person home-based geriatrics program into a hybrid-virtual model and support the feasibility of using hybrid-virtual home visits to expand access to comprehensive geriatric evaluation and ongoing care for high-risk, community-dwelling older persons who reside geographically distant from the primary VA facility.


Subject(s)
Telemedicine , Veterans , Humans , Aged , Aged, 80 and over , House Calls , Program Evaluation , Program Development
9.
HIV Res Clin Pract ; 25(1): 2300923, 2024 Dec 31.
Article in English | MEDLINE | ID: mdl-38251822

ABSTRACT

The PROMISE study assessed revisions designed to facilitate implementation of an HIV care coordination program (CCP) addressing gaps in care and treatment engagement among people living with HIV in New York City (NYC). Through latent class analysis (LCA) of a discrete choice experiment (DCE), we explored heterogeneity of provider preferences regarding CCP features. From January-March 2020, 152 NYC CCP providers completed a DCE with 3-4 levels on each of 4 program attributes: 1) Help with Adherence to Antiretroviral Therapy (ART), 2) Help with Primary Care Appointments, 3) Help with Issues Other than Primary Care, and 4) Where Program Visits Happen. We used LCA to assess patterns of preference, and choice simulation to estimate providers' endorsement of hypothetical CCPs. LCA identified three subgroups. The two larger subgroups (n = 133) endorsed more intensive individual program features, including directly observed therapy, home visits, and appointment reminders with accompaniment of clients to their appointments. The smallest subgroup (n = 19) endorsed medication reminders only, appointment reminders without accompaniment, and meeting at the program location rather than clients' homes. Choice simulation analysis affirmed the highest degree of endorsement (62%) for hypothetical programs combining the intensive features described above. Results indicated providers' preference for intensive program features and also reinforced the need for flexible service delivery options. Provider perspectives on service delivery approaches can inform program adjustments for successful long-term implementation, which in turn can improve patient outcomes.


Subject(s)
Directly Observed Therapy , House Calls , Humans , Latent Class Analysis , Computer Simulation , New York City
10.
Child Care Health Dev ; 50(1): e13226, 2024 01.
Article in English | MEDLINE | ID: mdl-38265138

ABSTRACT

BACKGROUND: The early development of left-behind children requires great concern and improvement. Yet, current interventions for left-behind children are mainly focussed on children older than 3. This study aims to assess the effectiveness of a home visiting programme on family responsive care and early development of rural left-behind children and examine whether family responsive care mediates the effects of intervention on child development. METHODS: A quasi-experimental study design was utilized in this study. A stratified clustered sampling was employed to choose villages in programme towns into intervention group. A control village was matched with every intervention village. All of the left-behind children and their caregivers meeting the inclusion criteria in the chosen villages were enrolled in the survey. The outcomes included child development, caregiver's early stimulation, parent-child communication, and learning materials. Baseline assessments were conducted in 2018, and endline assessments were conducted in 2020. RESULTS: In the endline survey, we enrolled 608 children with 258 in the intervention group and 350 in the control group. Left-behind children in the intervention group were less likely to have development delay compared with the control group (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.36, 0.96). Migrant parents of children in the intervention group showed higher proportion of expressing emotional support to their children when communicating (OR = 1.69, 95% CI: 1.05, 2.72). Children who received home visits more than once per 2 months had lower level of suspected development delay than children in the control group (OR = 0.34, 95% CI: 0.18, 0.68). Caregiver's early stimulation and migrant parents' emotional support to left-behind children mediated the intervention dose and left-behind children's development. CONCLUSION: Caregiver's early stimulation mediates the intervention and child's development. The findings suggest a promising future for scaling similar early childhood development interventions for left-behind children in rural settings.


Subject(s)
House Calls , Research Design , Humans , Child, Preschool , Child Development , China , Communication
11.
JAMA Netw Open ; 7(1): e2351752, 2024 Jan 02.
Article in English | MEDLINE | ID: mdl-38236602

ABSTRACT

Importance: Individuals with low income may have heightened rates of obesity and hypertension. Objective: To determine whether prenatal and infancy home visitation by nurses reduces maternal and offspring obesity and hypertension. Design, Setting, and Participants: This randomized clinical trial of prenatal and infancy nurse home visitation in a public health care system in Memphis, Tennessee, enrolled 742 women with no previous live births and at least 2 sociodemographic risk factors (unmarried, <12 years of education, unemployed) from June 1, 1990, through August 31, 1991. At registration during pregnancy, 727 mothers (98%) were unmarried, and 631 (85%) lived below the federal poverty level. At offspring ages 12 and 18 years, maternal and offspring obesity and hypertension were assessed by staff masked to treatment. The data analysis was performed from July 1, 2021, to October 31, 2023. Interventions: Women assigned to the control group received free transportation for prenatal care and child developmental screening and referral at child ages 6, 12, and 24 months. Women assigned to nurse visitation received transportation and screening plus prenatal and infant and toddler nurse home visits. Main Outcomes and Measures: Obesity and hypertension among mothers and their offspring at child ages 12 and 18 years, although not hypothesized in the original trial design, were analyzed using post-double selection lasso method. Results: Of the 742 participants randomized (mean [SD] age, 18.1 [3.2] years), interviews were completed with 594 mothers and 578 offspring at child age 12 years and 618 mothers and 629 offspring at child age 18 years. Obesity was assessed for 576 offspring at age 12 years and 605 at age 18 years and for 563 and 598 mothers at child ages 12 and 18 years, respectively. Blood pressure was assessed for 568 offspring aged 12 years and 596 aged 18 years and 507 and 592 mothers at child ages 12 and 18 years, respectively. There were no overall treatment-control differences in offspring obesity or hypertension at ages 12 and 18 years combined, although nurse-visited female offspring, compared with controls, had a lower prevalence of obesity (adjusted relative risk [ARR], 0.449; 95% CI, 0.234-0.858; P = .003) and severe obesity (ARR, 0.185; 95% CI, 0.046-0.748; P < .001). There were reductions at ages 12 and 18 years combined for stage 1 and stage 2 hypertension for nurse-visited vs control group mothers, with differences limited to mothers of females (stage 1: ARR, 0.613 [95% CI, 0.440-0.855; P = .001]; stage 2: ARR, 0.217 [95% CI, 0.081-0.582; P < .001]). For both obesity and hypertension outcomes, there was no intervention effect among male offspring or the mothers of males. Self-reported maternal health aligned with program effects on hypertension. Conclusions and Relevance: In this clinical trial follow-up at offspring ages 12 and 18, nurse-visited female offspring had lower rates of obesity and mothers of females had lower rates of hypertension than control-group counterparts. These findings suggest that risks for chronic disease among mothers of females and their female offspring who live in extreme poverty may be prevented with prenatal and infant and toddler home visitations by nurses. Trial Registration: ClinicalTrials.gov Identifier: NCT00708695.


Subject(s)
House Calls , Hypertension , Obesity , Adolescent , Child , Female , Humans , Infant , Male , Pregnancy , Follow-Up Studies , Hypertension/epidemiology , Hypertension/prevention & control , Obesity/epidemiology , Obesity/prevention & control , Outcome Assessment, Health Care , Poverty
12.
Rev Esc Enferm USP ; 57: e20230209, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-38194515

ABSTRACT

OBJECTIVE: To report the structures of the experience of nurse's home visits to premature and low birth weight newborns. METHOD: This is a descriptive study of the experience report type, structured on the experience of the nurse authors in the development of 48 home visits in a city in the state of São Paulo and its microregion between August 2020 and 2021 with eight mothers of premature and low weight newborns. RESULTS: The guiding documents "Home visit for families with preterm and low birth weight newborns" and "Strategy of guiding questions for home visits" were created and used to promote open narratives from parental caregivers about caring for at-risk newborns, creating a relational space aimed at joint construction. CONCLUSION: The documents used have favored home visits, helping nurses to establish professional bonds and build relational space through dialogue when conducting their activities in the home environment.


Subject(s)
House Calls , Premature Birth , Infant, Newborn , Humans , Female , Brazil , Mothers , Parents
13.
Prim Health Care Res Dev ; 24: e73, 2024 Jan 09.
Article in English | MEDLINE | ID: mdl-38193504

ABSTRACT

AIM: To identify what type of recommendations were recorded in older adults' health records by health professionals during preventive home visits. BACKGROUND: To promote health and prevent ill health, health professionals can give support and recommendations to older adults. The preventive home visit for older adults is one example of an intervention where health professionals such as nurses, social workers, and assistant nurses can give recommendations. By exploring what recommendations are recorded and within what areas, we can also gain knowledge about areas where provision of recommendations seems lacking. This knowledge would provide health professionals with guidance in their counseling with the older adult. METHODS: Records from preventive home visits (n = 596; mean age 78.71) were qualitatively and quantitatively analyzed. FINDINGS: The most frequently recorded recommendations were related to physical or mental illness, falls, and then nutrition. The results showed that recommendations could be sorted into ten sub-categories related to physical or mental illness, falls, nutrition, physical activity, preparation for the future, social participation, finances, getting help from others, municipal services, and security at home. These ten sub-categories were classified into the International Classification of Functioning, Disability, and Health categories body functions & structure (including one sub-category), activity (including four sub-categories), participation (including three sub-categories), and environmental factors (including two sub-categories). From the results, we could conclude that the major focus was on risk prevention and less focus was on health promotion. Thus, the visitor's recommendations most likely mirror the older adult's explicit needs 'here and now' to a great extent. However, health visitors also need to focus on intrinsic capacities to promote health. Besides recommendations relating to the person's intrinsic capacities, environmental aspects should be focused upon, to improve healthy aging.


Subject(s)
Healthy Aging , Humans , Aged , Health Promotion , Health Personnel , Exercise , House Calls
14.
Cad Saude Publica ; 40(1): e00081323, 2024.
Article in Portuguese | MEDLINE | ID: mdl-38198386

ABSTRACT

The replacement of the Primary Care Information System (SIAB, 1998-2015), as of January 2016, by the new Health Information System for Primary Care (SISAB) determined new forms of collecting, processing, and using information, with a possible impact on the records of activities carried out in primary health care in Brazil. This study aimed to evaluate the implementation impact of the new information system on records of physicians' and nurses' patient care and home visits of community health workers (CHW) in Brazil from 2007 to 2019. To this end, a Bayesian structural time-series model approach was used, based on a diffuse state-space regression. From 2016 to 2019, 463.47 million physician care, 210.61 million nursing care, and 1.28 billion CHW visits were recorded. Following the trend recorded before the implementation, 598.86 million, 430.46 million, and 1.5 billion physician and nursing appointments and CHW visits would be expected, respectively. In relative terms, there was a decrease of 25% in physician care, 51% in nursing care, and 15% in CHW visits when compared to the value expected by the Bayesian method. The negative impact on the records of patient care and home visits identified in this study, whether due to difficulties in adapting to the new system or a reduction in improper records, must be investigated so that the challenge of improving the primary care information system can be understood and overcome in a planned way.


A substituição do Sistema de Informação da Atenção Básica (SIAB, 1998-2015), a partir de janeiro de 2016, pelo novo Sistema de Informação em Saúde para a Atenção Básica (SISAB) determinou novas formas de coleta, processamento e uso das informações, com possível impacto nos registros das atividades desenvolvidas na atenção primária à saúde no Brasil. O objetivo deste estudo foi avaliar o impacto da implantação do novo sistema de informação sobre registros de atendimentos de médicos e enfermeiros, e de visitas domiciliares de agentes comunitários de saúde (ACS) brasileiros entre 2007 e 2019. Para tal, utilizou-se uma abordagem bayesiana de modelo estrutural para séries temporais, com base em uma regressão difusa de espaço-estado. Ao longo do período de 2016 a 2019, foram registrados 463,47 milhões de atendimentos médicos, 210,61 milhões de atendimentos de enfermagem e 1,28 bilhão de visitas de ACS. Seguindo a tendência registrada antes da implantação, seriam esperados 598,86 milhões, 430,46 milhões e 1,5 bilhão de atendimentos de médicos, enfermeiros e visitas de ACS, respectivamente. Em termos relativos, houve um decréscimo de 25% nos atendimentos médicos, 51% nos atendimentos de enfermagem e 15% nas visitas de ACS quando comparado com o valor esperado pelo método bayesiano. O impacto negativo no registro de atendimentos e de visitas domiciliares identificado neste estudo, seja por dificuldade de adaptação ao novo sistema, seja por diminuição de registros indevidos, merece ser alvo de investigação para que se possa, de forma planejada, compreender e superar o desafio da melhoria do sistema de informação da atenção primária.


La sustitución del Sistema de Información de la Atención Básica (SIAB, 1998-2015), desde enero de 2016, por el nuevo Sistema de Información en Salud para la Atención Básica (SISAB) estableció nuevas maneras para recolectar, procesar y utilizar las informaciones, con posibles impactos en los registros de las actividades desarrolladas en la atención primaria de salud en Brasil. El objetivo de este estudio fue evaluar el impacto de la implantación del nuevo sistema de información sobre los registros de atención de médicos y enfermeros y de visitas domiciliarias de agentes comunitarios de salud (ACS) en Brasil entre 2007 y 2019. Para eso, se utilizó un enfoque bayesiano de modelo estructural para series temporales basadas en una regresión difusa de espacio de estado. Entre los años 2016 y 2019, se registraron 463,47 millones de consultas médicas, 210,61 millones de consultas de enfermería y 1,28 mil millones de visitas de ACS. Siguiendo la tendencia registrada antes de la implantación, se esperarían 598,86 millones, 430,46 millones y 1,5 mil millones de consultas médicas y de enfermería y visitas de ACS respectivamente. En términos relativos, hubo una disminución del 25% en las consultas médicas, del 51% en las consultas de enfermería y del 15% en las visitas de ACS en comparación con el valor esperado por el método bayesiano. El impacto negativo en el registro de consultas y visitas domiciliarias identificado en este estudio, ya sea por dificultades en la adaptación al nuevo sistema o por la disminución de los registros indebidos, merece ser objeto de investigación para que se pueda, de manera planificada, comprender y superar el desafío continuo de mejorar el sistema de información de la atención primaria.


Subject(s)
Health Information Systems , Humans , Brazil , House Calls , Bayes Theorem , Patient Care
15.
Matern Child Health J ; 28(2): 333-343, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37989933

ABSTRACT

BACKGROUND: Evidence-based home visiting programs are designed to improve maternal child health. Nurse-Family Partnership (NFP) is a model evidence-based home visiting program, shown to improve pregnancy outcomes, child development, and economic self-sufficiency for first-time mothers and their families experiencing social and economic adversities, enrolling them early in pregnancy. Recently, NFP has expanded its services to multiparous women (previous live births) and enrolling women past 28 weeks gestation (late registrants) in selected agencies in Florida since 2021. OBJECTIVE: To study the process and impacts of expanding NFP to expanded populations (multiparous and/or late registrants), we convened a diverse Advisory Committee to guide the NFP expansion evaluation in Florida. METHODS: This study employed a modified e-Delphi method with three rounds of data collection, to engage diverse partners to identify process and impact outcomes for the NFP expansion evaluation. RESULTS: Child maltreatment was identified as the highest priority outcome. Process outcomes included program reach, client enrollment, and client engagement, while impact outcomes included maternal physical health, maternal mental health and substance use, birth outcomes, and breastfeeding practices. The Advisory Committee further identified potential data sources to measure these outcomes. CONCLUSIONS FOR PRACTICE: Identifying and selecting key process and impact outcomes using a community-engaged process is necessary to ensure equal buy-in from all partners and to inform rigorous program evaluation. This study showed that using methods such as e-Delphi is feasible and effective for achieving thoughtful and rigorous decision-making, even in times of uncertainty like the COVID-19 pandemic.


Subject(s)
Child Abuse , Family Health , Pregnancy , Child , Humans , Female , Delphi Technique , Pandemics , Mothers , House Calls
16.
Matern Child Health J ; 28(1): 19-23, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38010588

ABSTRACT

BACKGROUND: A joint statement from two federal agencies in the United States calls for coordination and collaboration between programs serving families of infants and toddlers who are at risk or developmentally delayed or disabled U.S. Department of Education and U.S. Department of Health and Human Services. Policy guidance: Joint statement on collaboration and coordination of the MIECHV and IDEA Part C programs. (2017). Individuals with Disabilities Education Act. ED/HHS Joint Guidance Document: Collaboration and Coordination of the Maternal, Infant, and Early Childhood Home Visiting Program and the Individuals with Disabilities Education Act Part C Programs. Young Native American children living on tribal lands in this country are currently eligible for two federal programs associated with these agencies which overlap in mission and implementation. PURPOSE: This paper outlines potential strategies for creating a more seamless system of services for tribal families involving more centralized intake processes and procedures, cross training of staff to work across programs, and adopting more unifying approaches to program implementation. CONCLUSION: A streamlined system of services will result in interventions that better support family and child outcomes while reducing duplication of services, consolidating the limited number of qualified professionals available to provide services, and increasing convenience and cultural attunement of services to Native American families currently participating in both programs.


Subject(s)
Child Health Services , Indians, North American , Maternal Health Services , Infant , Pregnancy , Female , Child , United States , Humans , Child, Preschool , American Indian or Alaska Native , House Calls
17.
J Appl Gerontol ; 43(3): 287-292, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38018418

ABSTRACT

Annual Wellness Visits (AWV) promote preventive care for older adults, yet uptake remains low. To increase AWVs, a Medicare Advantage (MA) plan in Puerto Rico contracted a medical group to provide home-based AWVs during the last quarter of 2020. Using data from 464 visits, we conducted descriptive and multivariable analysis to profile patient characteristics and identify predictors of mental health referrals. We found that 87% of patients had multiple chronic conditions, 75% were taking more than 5 medications, and the odds of a mental health referral were higher for those who also had a nutrition-related condition (AOR = 5.05, CI95: 1.76-11.88), diabetes (AOR = 3.34, CI95: 1.18-7.58), or an additional reported uncontrolled health issue (AOR = 28.18, CI95: 8.96-70.59). This strategy helped one MA plan reach high-need patients, but coordination of follow-up care is needed to ensure patients receive recommended services.


Subject(s)
COVID-19 , Medicare Part C , Aged , Humans , Mental Health , Pandemics , Puerto Rico , Referral and Consultation , United States , House Calls
18.
J Interprof Care ; 38(2): 234-244, 2024.
Article in English | MEDLINE | ID: mdl-37855719

ABSTRACT

Interprofessional care coordination within evidence-based prevention programs like Nurse-Family Partnership® (NFP) is necessary to meet family needs and maximize program impact. This study aimed to describe the coordination of families' care in the NFP home visiting context. We used an adapted grounded theory approach and purposively sampled seven NFP sites. We conducted telephone interviews with 95 participants: 51 NFP staff (54%), 39 healthcare providers (41%), and 5 social service providers (5%). All interviews were recorded, transcribed, validated, and analyzed in NVivo11. Many community providers in all sites described their knowledge of the characteristics of the NFP intervention, including the strength of its evidence to achieve outcomes. Care coordination was dynamic and changed over time based on client needs and staff willingness to work together. Effective care coordination in the NFP context from the provider perspective is driven by shared knowledge, integrated systems, mission alignment, and individual champions who value the program.


Subject(s)
Interprofessional Relations , Social Work , Female , Humans , Qualitative Research , Health Personnel , House Calls
19.
Health Econ ; 33(2): 197-203, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37919827

ABSTRACT

General practitioners' (GPs') income often relies on self-reported activities and performances. They can therefore 'game the system' to maximize their remuneration. We investigate whether Danish GPs game their travel fees for home visits. Combining administrative and geographical data, we measure the difference between GPs' traveled and billed distances. We exploit a rise in the fees for home visits. If there is a link between the rise in fees and upcoding, we interpret this finding as indicative of gaming behavior. We find that upcoding occurs slightly more often than downcoding (16% vs. 13% of visits) for visits that can be both upcoded and downcoded. Using linear probability models with GP fixed effects, we find that the fee rise is associated with a reduction in upcoding of 0.6% of home visits (2.8% for visits where upcoding is feasible) and no change in downcoding. Importantly, we find no statistically significant differences in the reduction in upcoding across distance bands despite large differences in their fee rises. We therefore conclude that there is no causal evidence of GPs gaming their fees.


Subject(s)
General Practitioners , Humans , House Calls , Income , Fees and Charges
20.
Prev Sci ; 25(1): 126-136, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37552380

ABSTRACT

The objective of this paper is to report on the effectiveness of a mental health addition to a national nurse-delivered home visiting program. The methods are as follows: analysis of pre/post-launch of the standard Mental Health Intervention and comparison of 356 teams randomized to standard versus enhanced implementation. Stepwise regression controlled for significant client characteristics that were related to relevant outcomes. These characteristics were used in generalized mixed effect models comparing pre/post implementation and intervention and control groups. Pre/post analysis showed that only clients with no elevated mental health screening scores or mental health diagnoses at enrollment showed a significant decrease in depressive symptoms. Clients enrolled with and without mental health needs at enrollment significantly decreased on anxiety scores while referrals to mental health care increased. Teams receiving enhanced implementation enrolled more clients with mental health needs and clients completed more well-child visits and use of safe sleep practices. By integrating mental health care into maternal, infant, and early childhood home visiting programs, a new equitable model of primary mental health care can reach populations in need. This example provides a new paradigm of accessible and equitable mental health care for the future that can be implemented in a variety of home visiting programs.


Subject(s)
Depression , Mental Health , Infant , Pregnancy , Female , Humans , Child, Preschool , Depression/prevention & control , Depression/psychology , Postnatal Care , Anxiety/prevention & control , Anxiety Disorders , House Calls
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