Tuberculosis care services in Armenia: What has changed since the 2014 reform?

INTRODUCTION: In efforts to reach the 2020 Tuberculosis targets, the WHO advocates for an outpatient, people-centered model of TB care. To this end, the TB care system in Armenia underwent structural and financing reforms in 2014. Financing mechanism for inpatient TB facilities was changed from a fee per bed/day to a mixed type of financing that includes fixed and variable costs eliminating incentives for unnecessary and extended hospitalizations. Unfortunately, outpatient facilities continue to be financed through per-capita mechanism, resulting in high number of referrals and draining resources. This study aimed to assess the implementation of these reforms within the Armenian TB care system. METHODOLOGY: This was a retrospective cross-sectional study using nationwide programme data and survey data collected from healthcare facilities. RESULTS: In 2017 a total of 901 TB patients were registered in outpatient facilities. Only 7.6% of total TB cases were diagnosed in outpatient facilities and 30.9% of the presumptive TB cases were referred to inpatient facilities. The number of hospitalizations was reduced by 76% from 2013 to 2017. The average duration of stay reduced as well from 55+ days to 37 days. However, the proportion of smear negative TB patients remains high among all hospitalized patients (63.8%). CONCLUSIONS: Overall, the reform has been successful, however unnecessary hospitalizations persist. Our results indicate there a need to go upstream for a structural and financial reform of the outpatient sector to complete Armenia's TB healthcare reform and improve both patient outcomes and efficient use of system resources.

Providing primary care using an interprofessional collaborative practice model: What clinicians have learned.

This article details a nurse-led, interprofessional collaborative practice (IPCP) model that was developed to provide primary care to a medically indigent population in Birmingham, Alabama. Funding to develop and implement this project came from a federal Nurse Education, Practice, Quality and Retention award to the University of Alabama at Birmingham (UAB) School of Nursing, with additional support coming from the UAB Hospital and Health System. The clinic is housed within a local community-based, non-profit organization and all services, including supplies and pharmaceuticals, are provided free of charge to this vulnerable population. The IPCP model that was developed includes three primary care teams and incorporates faculty clinicians from a variety of disciplines, including nursing, medicine, optometry, nutrition, mental health, social work and informatics. Evaluation of the project has included annual structured interviews of project personnel, a variety of survey instruments completed electronically at various intervals, and assessments by students as well as patients experiencing team-based care. The focus of this article is the qualitative data collected from structured interviews of clinician faculty annually over the three years of the funded project. The learning, understanding and growth that have taken place by the experienced clinicians from multiple disciplines regarding IPCP are detailed.

The Preparedness and Emergency Response Learning Centers: advancing standardized evaluation of public health preparedness and response trainings.

INTRODUCTION: The Centers for Disease Control and Prevention funded Preparedness and Emergency Response Learning Centers (PERLCs) across the United States. The PERLCs provide training to state, local, and tribal public health organizations to meet workforce development needs in the areas of public health preparedness and response, specialized training, education, and consultation. METHODS/ACTIVITY: Using Donald Kirkpatrick's training evaluation model, the PERLC network established 4 evaluation working groups that developed evaluation criteria to address each level of the model. The purpose of the working groups was to inform and promote center-level and program-level evaluation across the PERLC network; identify common training evaluation methods and measures; and share materials, resources, and lessons learned with state, local, and tribal public health organizations for potential replication. RESULTS/OUTCOMES: The evaluation of education and training, irrespective of its modality (eg, in-person, online, webinars, seminars, symposia) can be accomplished using Kirkpatrick's 4-level taxonomy. DISCUSSION: The 4 levels aim to measure the following aspects of training programs: (1) trainees' reaction; (2) knowledge acquired, skills improved, or attitudes changed; (3) behavior changed; and (4) results or impact. To successfully evaluate emergency preparedness training, drills and exercises, it is necessary to understand the fundamental tenets of each level and how to apply each to measure training outcomes. LESSONS LEARNED/NEXT STEPS: The PERLC evaluators have adopted the basic schema of Kirkpatrick's 4-level model and applied its structure to a wide variety of preparedness and emergency response training and related activities. The PERLC evaluation working groups successfully developed and tested survey methods and instruments for each of the 4 levels of Kirkpatrick's training evaluation model. Each can be used for replication by state, local, and tribal public health professionals.

A geospatial mixed methods approach to assessing campus safety.

BACKGROUND: While there is no panacea for alleviating campus safety concerns, safety experts agree that one of the key components to an effective campus security plan is monitoring the environment. Despite previous attempts to measure campus safety, quantifying perceptions of fear, safety, and risk remains a challenging issue. Since perceptions of safety and incidents of crime do not necessarily mirror one another, both were utilized in this investigation. PURPOSE: The purpose of this article is to describe an innovative, mixed methods approach for assessing campus safety at a large, urban campus in the southeast region of the United States. METHOD: A concurrent triangulation design was implemented to allow investigators the opportunity to collect qualitative and quantitative data simultaneously and integrate results in the interpretation phase. Data were collected from four distinct sources of information. RESULTS: Student focus groups yielded data regarding perceptions of risk, and kernel density analysis was used to identify "hot spots" of campus crime incidents. CONCLUSION: While in many cases perceived risk and actual crime incidents were associated, incidents of hot spots of each type occurred independently with such frequency that an overall correlation of the two was not significant. Accordingly, while no significant correlation between perceived risk and crime incidents was confirmed statistically, the geospatial integration of these data suggested three types of safety conditions. Further, the combination of focus group data and spatial analyses provided a more comprehensive and, therefore, more complete understanding of the multifaceted issues related to campus safety.

Emergency preparedness training of tribal community health representatives.

This study describes the development and evaluation of online Public Health Emergency Preparedness (PHEP) training adapted to the learning styles and needs of tribal Community Health Representatives (CHRs). Working through a university-tribal community college partnership, the Arizona Center for Public Health Preparedness at the University of Arizona and Diné College of the Navajo Nation delivered a blended online and face-to-face public health preparedness certificate program based on core public health emergency preparedness competencies. This program was carefully adapted to meet the environmental and learning needs of the tribal CHRs. The certificate program was subsequently evaluated via a scenario-based decision-making methodology. Significant improvements in five of six competency areas were documented by comparison of pre- and post-certificate training testing. Based on statistical support for this pedagogical approach the cultural adaptations utilized in delivery of the certificate program appear to be effective for PHEP American Indian education.

Expanding the public health emergency preparedness competency set to meet specialized local and evolving national needs: a needs assessment and training approach.

This article presents an approach to competency development created at the South Central Center for Public Health Preparedness to expand and refine existing competency sets for public health emergency responders. The technique uses course content generated by subject matter experts to validate and expand existing national competency sets. New competencies based on local needs were identified that provide coverage of subject matter appropriate to local public health emergency responders beyond the focus of existing national competency sets.

The south central center for public health preparedness training system model: a comprehensive approach.

The South Central Center for Public Health Preparedness (SCCPHP) is a collaboration among the schools of public health at Tulane University and the University of Alabama at Birmingham and the state health departments in Alabama, Arkansas, Louisiana, and Mississippi. The SCCPHP provides competency-based training via distant delivery methods to prepare public health workers to plan for and rapidly respond to public health threats and emergency events. This article presents the training system model used by the SCCPHP to assess, design, develop, implement, and evaluate training that is both competency driven and practice based. The SCCPHP training system model ensures a standardized process is used across public health occupations and geographic regions, while allowing for tailoring of the content to meet the specific training needs of the workforce in the respective state and local health departments. Further, the SCCPHP training system model provides evidence of the reciprocal nature between research and practice needed to advance the area of emergency preparedness training and workforce development initiatives in public health.