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2.
Aust N Z J Public Health ; 43(6): 538-543, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31667912

RESUMEN

OBJECTIVE: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. METHODS: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. RESULTS: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. CONCLUSION: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs' role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/organización & administración , Grupo de Ascendencia Oceánica/psicología , Atención Primaria de Salud/organización & administración , Prisioneros , Prestación de Atención de Salud/métodos , Femenino , Humanos , Masculino , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Atención Primaria de Salud/métodos , Prisioneros/psicología , Prisioneros/estadística & datos numéricos , Investigación Cualitativa , Apoyo Social
3.
Nurs Clin North Am ; 54(4): 457-471, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31703773

RESUMEN

Depression management in primary care settings is the norm, in the United States and globally. As incidence and prevalence of depression continue to mount, there are innovative models of treatment, newer understandings, more open philosophies, and evidence-informed treatments that may address this troubling public health issue. This article attempts to succinctly examine the evidence in identifying and treating this in the United States in an expedient, evidence-informed manner to assist those in need of have care that is patient centered, of high quality, affordable, and readily accessible across the lifespan.


Asunto(s)
Depresión/diagnóstico , Depresión/terapia , Atención Dirigida al Paciente , Atención Primaria de Salud/organización & administración , Humanos , Telemedicina , Estados Unidos
4.
Nurs Clin North Am ; 54(4): 473-493, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31703774

RESUMEN

Although anxiety disorders are extremely prevalent in primary care settings, barriers such as a lack of knowledge, time constraints, and lack of common presentation can lead to misdiagnosis and ineffective treatment. Optimal treatment of anxiety disorders includes both pharmacologic and behavioral interventions. The purpose of this article is to assist primary care providers in quick identification of anxiety disorders so that proper treatment can be initiated and appropriate referrals can be made.


Asunto(s)
Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Atención Primaria de Salud/organización & administración , Trastornos de Ansiedad/tratamiento farmacológico , Humanos , Prevalencia , Encuestas y Cuestionarios
5.
Pan Afr Med J ; 33: 209, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692730

RESUMEN

Introduction: management of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) within primary health care (PHC) facilities involve nursing students as part of them integrating theory to practice. Clinical learning for nursing students requires adequate support from the Nursing Education Institution (NEI) and nursing professionals. Given the dearth of literature regarding clinical support for nursing students in the management of TB/HIV in PHC setting, this study is aimed at exploring and describing nursing students' experiences regarding clinical support. Methods: a phenomenological design was used to explore and describe the experiences of nursing students using an individual, unstructured, in-depth interview. Audio-taped interviews were transcribed verbatim and analysed using Atlas TI software. Results: themes derived from the study were factors inhibiting clinical support which incorporated shortage of professional nurses (PNs), lack of accompaniment, fear of managing TB/HIV patients and negative attitudes of PNs; outcomes of poor clinical support included inability to integrate TB/HIV theory to practice and lack of confidence among nursing students; nursing students' desired outcomes through clinical support included becoming a competent TB/HIV nurse and the ability to integrate TB/HIV theory to practice; and strategies to strengthen and promote clinical support in TB/HIV management through strengthened occupational health and safety learning, provision of knowledge regarding post-exposure prophylaxis and infection control, and appointed clinical PN for students in each facility. Conclusion: the development of policies for clinical support, increasing supervision, appointment of clinical preceptors and accompanists in facilities where nursing students are placed would promote clinical learning within the NEI and the production of competent and confident nurses.


Asunto(s)
Infecciones por VIH/enfermería , Atención Primaria de Salud/organización & administración , Estudiantes de Enfermería/estadística & datos numéricos , Tuberculosis/enfermería , Adulto , Competencia Clínica , Femenino , Humanos , Entrevistas como Asunto , Masculino , Adulto Joven
6.
Rev Saude Publica ; 53: 98, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31778397

RESUMEN

OBJECTIVES: To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS: A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool - child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS: Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS: Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants' health care.


Asunto(s)
Servicios de Salud del Niño/provisión & distribución , Servicios de Salud del Niño/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Brasil , Estudios Transversales , Salud de la Familia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Garantía de la Calidad de Atención de Salud , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios
7.
Pan Afr Med J ; 34: 10, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762879

RESUMEN

Introduction: There is an increasing commitment in the African Region towards diabetes care, following acknowledgement that it is an important public health issue which needs to be addressed in order to improve population health. We conducted a situational analysis of diabetes care in Guinea Bissau in order to identify the main issues faced in the management of the disease in this country. Methods: The study design was qualitative and data collection was done using semi directive interviews and focus groups with participants involved in primary diabetes care and management in Guinea Bissau (health care professionals, non-governmental organization staff, traditional healers) and patients. The data was analyzed using the five-phase approach of the thematic analysis framework. Results: The major themes identified included: the lack of specialists and properly trained healthcare personnel; no standardized care protocol for diagnosis, treatment, follow up and proper management for diabetic patients; resources poor primary health care settings; no validated epidemiological dataset on prevalence and the lack of awareness about diabetes (in general population and also in medical staff). Conclusion: This first situational analysis can serve as a baseline to develop an action plan to address the main issues identified.


Asunto(s)
Diabetes Mellitus/terapia , Personal de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Adulto , Niño , Diabetes Mellitus/diagnóstico , Grupos Focales , Guinea Bissau , Humanos , Entrevistas como Asunto
8.
BMC Health Serv Res ; 19(1): 785, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31675956

RESUMEN

BACKGROUND: There is increasing interest in and demands for partnerships between academia and healthcare practices. Few empirical studies have described the influence of such partnerships from a practice perspective. The purpose of this study was to evaluate the impact of a reform launched to increase integration between primary care and academia and to identify potential reasons for why the observed impact occurred in three areas targeted by the reform: research, student education, and continued professional development. METHODS: The study was conducted in Stockholm County, the largest healthcare region in Sweden, at the introduction of a partnership between primary care and academia, including eight coordinating centres and approximately 500 surrounding primary care units. A programme theory-based qualitative approach to evaluation was used, building on document analysis, and in-depth interviews with the centre managers (n = 6) and coordinators (n = 8) conducted 42-66 months after the initiation of the reform. RESULTS: The analysis showed that the reform had some impact on all three areas targeted by the reform: research, student education, and continued professional development. The input that contributed most extensively to the impact was the establishment of facilitating roles. Most changes occurred at the coordinating centres and primarily in the area of student education. The effect on student education was primarily due to having prior experience in this area and perceptions of timely benefits of students to care practice. CONCLUSIONS: Partnerships between primary care and academia hold the potential of practice impact. To increase integration between primary care and academia, the components of the integration must be understandable and relevant for primary care practitioners, and importantly, compliant with delivery of primary care.


Asunto(s)
Reforma de la Atención de Salud/organización & administración , Relaciones Interinstitucionales , Atención Primaria de Salud/organización & administración , Universidades/organización & administración , Humanos , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Suecia
9.
BMC Health Serv Res ; 19(1): 753, 2019 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-31653211

RESUMEN

BACKGROUND: The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. METHODS: Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. RESULTS: 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. CONCLUSIONS: Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.


Asunto(s)
Técnicos Medios en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Médicos de Atención Primaria/psicología , Atención Primaria de Salud/organización & administración , Traducción , Adulto , Técnicos Medios en Salud/economía , Niño , Estudios Transversales , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Médicos de Atención Primaria/estadística & datos numéricos , Encuestas y Cuestionarios , Suiza
10.
Afr Health Sci ; 19(2): 1841-1848, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31656466

RESUMEN

Background: Maternal, fetal and neonatal mortality are 10 to 100 fold higher in many low-income compared to high-income countries. Reasons for these discrepancies include limited antenatal care and delivery outside health facilities. Objectives: The study aimed at conducting a baseline survey to assess the current levels of maternal health indicators in six counties in Western Kenya. Methods: This was a cross sectional study conducted targeting women residing in Uasin-Gishu, ElgeyoMarakwet, TransNzoia, Bungoma, Busia and Kakamega counties who had given birth five years prior to the interview. Socio-demographic and maternal indicators were collected using forms adopted from KDHS 2009. Interviews were conducted in the homesteads between December 2015 and June 2016. Results: A total of 6257 women participated in the study, median age 27 years IQR 23-32. Majority of the women had post-primary level of education, were married and 40% were members of an income-generating activity. 56.8% were using modern family planning method, 49% attended WHO recommended four plus antenatal clinic visits and only 20% attended in the first trimester. Majority, 85% had their most recent delivery in a health facility. Conclusion: Findings suggest that women are not attending recommended four plus antenatal clinic visits and even those that attend are few are during the first trimester.


Asunto(s)
Salud Materna , Centros de Salud Materno-Infantil/organización & administración , Servicios de Salud Materno-Infantil/normas , Cooperación del Paciente , Atención Prenatal/estadística & datos numéricos , Atención Primaria de Salud/métodos , Adulto , Niño , Centros Comunitarios de Salud/organización & administración , Conducta Anticonceptiva , Estudios Transversales , Femenino , Humanos , Kenia , Mortalidad Materna , Embarazo , Atención Primaria de Salud/organización & administración , Factores Socioeconómicos
11.
BMC Health Serv Res ; 19(1): 764, 2019 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-31660954

RESUMEN

BACKGROUND: Globally, health inequities persist with effects on whole populations and the most profound effects on populations marginalized by poverty, discrimination and other forms of disadvantage. In the current neoliberal political-economic context, health inequities are produced and sustained by the inequitable distribution of social determinants of health and structural inequities such as discrimination and institutional racism. Even in the context of healthcare organizations with an explicit commitment to health equity, multiple intersecting discourses, such as ongoing efficiency discourses, and culturalist and racialized discourses, are in constant interaction with healthcare practices at the point of care and the organizational level, limiting providers' and organizations' capacities to address structural inequities. Attention to discourses that sustain inequities in health care is required to mitigate health inequities and related power differentials. In this paper, we present findings from a critical analysis of the relations among multiple discourses and healthcare practices within four Canadian primary health care clinics that have an explicit commitment to health equity. METHODS: Informed by critical theoretical perspectives and critical discourse analysis principles, we conducted an analysis of 31 in-depth interviews with clinic staff members. The analysis focused on the relations among discourses and healthcare practices, the ways in which competing discourses influence, reinforce, and challenge current practices, and how understanding these dynamics can be enlisted to promote health equity. RESULTS: We articulate the findings through three interrelated themes: equity-mandated organizations are positioned as the "other" in the health care system; discourses align with structures and policies to position equity at the margins of health care; staff and organizations navigate competing discourses through hybrid approaches to care. CONCLUSIONS: This study points to the ways in which multiple discourses interact with healthcare organizations' and providers' practices and highlights the importance of structural changes at the systemic level to foster health equity at the point of care.


Asunto(s)
Equidad en Salud/organización & administración , Atención Primaria de Salud/organización & administración , Canadá , Investigación sobre Servicios de Salud , Humanos
12.
Rev Lat Am Enfermagem ; 27: e3203, 2019.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-31664411

RESUMEN

OBJECTIVE: Evaluate the effect of interprofessional education on the climate of Primary Health Care teams and on the acquisition of knowledge about management of chronic non-communicable diseases. METHOD: Quasi-experimental study of interprofessional education intervention. Seventeen Primary Health Care teams (95 professionals) participated in the study, of which nine teams (50 professionals) composed the intervention group and eight teams (45 participants) composed the control group. The team climate inventory scale and a questionnaire on knowledge about management of chronic conditions in Primary Health Care were applied before and after intervention. Type I error was fixed as statistically significant (p<0.05). RESULTS: In the analysis of knowledge about management of chronic conditions, the teams that participated in the interprofessional education intervention presented higher mean post-intervention increase than the teams of the control group (p < 0.001). However, in the analysis of both groups, there was no significant variation in the teamwork climate scores (0.061). CONCLUSION: The short interprofessional education intervention carried out during team meetings resulted in improved apprehension of specific knowledge on chronic conditions. However, the short intervention presented no significant impacts on teamwork climate.


Asunto(s)
Enfermedad Crónica/terapia , Personal de Salud/educación , Prácticas Interdisciplinarias/organización & administración , Atención Primaria de Salud/organización & administración , Empleo , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Factores de Tiempo
13.
BMC Health Serv Res ; 19(1): 767, 2019 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-31665011

RESUMEN

BACKGROUND: Strong and effective workforce models are essential for improving comprehensive Indigenous primary healthcare service (PHC) provision to Indigenous peoples in Canada, Australia, New Zealand and the USA (CANZUS nations). This review systematically scoped the literature for studies that described or evaluated models and systems that support the sustainability, capacity or growth of the Indigenous PHC workforce to provide effective PHC provision. METHODS: Eleven databases, 10 websites and clearinghouses, and the reference lists of 5 review articles were searched for relevant studies from CANZUS nations published in English from 2000 to 2017. A process of thematic analysis was utilised to identify key conditions, strategies and outcomes of Indigenous PHC workforce development reported in the literature. RESULTS: Overall, 28 studies were found. Studies reported enabling conditions for workforce development as government funding and appropriate regulation, support and advocacy by professional organisations; community engagement; PHC leadership, supervision and support; and practitioner Indigeneity, motivation, power equality and wellbeing. Strategies focused on enhancing recruitment and retention; strengthening roles, capacity and teamwork; and improving supervision, mentoring and support. Only 12/28 studies were evaluations, and these studies were generally of weak quality. These studies reported impacts of improved workforce sustainability, workforce capacity, resourcing/growth and healthcare performance improvements. CONCLUSIONS: PHCs can strengthen their workforce models by bringing together healthcare providers to consider how these strategies and enabling conditions can be improved to meet the healthcare and health needs of the local community. Improvement is also needed in the quality of evidence relating to particular strategies to guide practice.


Asunto(s)
Servicios de Salud del Indígena/organización & administración , Fuerza Laboral en Salud/organización & administración , Atención Primaria de Salud/organización & administración , Australia , Canadá , Investigación sobre Servicios de Salud , Humanos , Nueva Zelanda , Estados Unidos
14.
BMC Health Serv Res ; 19(1): 687, 2019 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-31601199

RESUMEN

BACKGROUND: Social inequities are widening globally, contributing to growing health and health care inequities. Health inequities are unjust differences in health and well-being between and within groups of people caused by socially structured, and thus avoidable, marginalizing conditions such as poverty and systemic racism. In Canada, such conditions disproportionately affect Indigenous persons, racialized newcomers, those with mental health and substance use issues, and those experiencing interpersonal violence. Despite calls to enhance equity in health care to contribute to improving population health, few studies examine how to achieve equity at the point of care, and the impacts of doing so. Many people facing marginalizing conditions experience inadequate and inequitable treatment in emergency departments (EDs), which makes people less likely to access care, paradoxically resulting in reliance on EDs through delays to care and repeat visits, interfering with effective care delivery and increasing human and financial costs. EDs are key settings with potential for mitigating the impacts of structural conditions and barriers to care linked to health inequities. METHODS: EQUIP is an organizational intervention to promote equity. Building on promising research in primary health care, we are adapting EQUIP to emergency departments, and testing its impact at three geographically and demographically diverse EDs in one Canadian province. A mixed methods multisite design will examine changes in key outcomes including: a) a longitudinal analysis of change over time based on structured assessments of patients and staff, b) an interrupted time series design of administrative data (i.e., staff sick leave, patients who leave without care being completed), c) a process evaluation to assess how the intervention was implemented and the contextual features of the environment and process that are influential for successful implementation, and d) a cost-benefit analysis. DISCUSSION: This project will generate both process- and outcome-based evidence to improve the provision of equity-oriented health care in emergency departments, particularly targeting groups known to be at greatest risk for experiencing the negative impacts of health and health care inequities. The main deliverable is a health equity-enhancing framework, including implementable, measurable interventions, tested, refined and relevant to diverse EDs. TRIAL REGISTRATION: Clinical Trials.gov # NCT03369678 (registration date November 18, 2017).


Asunto(s)
Prestación de Atención de Salud/normas , Servicio de Urgencia en Hospital/normas , Equidad en Salud/organización & administración , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Colombia Británica , Protocolos Clínicos , Servicio de Urgencia en Hospital/organización & administración , Humanos , Indios Norteamericanos/estadística & datos numéricos , Análisis de Series de Tiempo Interrumpido , Servicios de Salud Mental/normas , Servicios de Salud Mental/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Racismo/estadística & datos numéricos , Trastornos Relacionados con Sustancias/rehabilitación , Violencia/estadística & datos numéricos
15.
BMC Health Serv Res ; 19(1): 709, 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31623609

RESUMEN

BACKGROUND: With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. METHODS: A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. RESULTS: Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. CONCLUSIONS: The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.


Asunto(s)
Demencia/terapia , Accesibilidad a los Servicios de Salud , Atención Primaria de Salud/organización & administración , Servicios de Salud Rural/organización & administración , Femenino , Grupos Focales , Humanos , Estudios Longitudinales , Masculino , Investigación Cualitativa , Saskatchewan
17.
BMC Health Serv Res ; 19(1): 675, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533696

RESUMEN

BACKGROUND: The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. Following a successful trial in the North Eastern part of the country, CHPS was adopted as Ghana's flagship programme for achieving the Universal Health Coverage. Recent empirical evidence suggests, however, that scale-up of CHPS has not necessarily replicated the successes of the pilot study. This study examines the community's perspective of the performance of CHPS and how the scale up could potentially align with the original experimental study. METHOD: Applying a qualitative research methodology, this study analysed transcripts from 20 focus group discussions (FGDs) in four functional CHPS zones in separate districts of the Northern and Volta Regions of Ghana to understand the community's assessment of CHPS. The study employed the thematic analysis to explore the content of the CHPS service provision, delivery and how community members feel about the service. In addition, ordinary least regression model was applied in interpreting 126 scores consigned to CHPS by the study respondents. RESULTS: Two broad areas of consensus were observed: general favourable and general unfavourable thematic areas. Favourable themes were informed by approval, appreciation, hard work and recognition of excellent services. The unfavourable thematic area was informed by rudeness, extortion, inappropriate and unprofessional behaviour, lack of basic equipment and disappointments. The findings show that mothers of children under the age of five, adolescent girls without children, and community leaders generally expressed favourable perceptions of CHPS while fathers of children under the age of five and adolescent boys without children had unfavourable expressions about the CHPS program. A narrow focus on maternal and child health explains the demographic divide on the perception of CHPS. The study revealed wide disparities in actual CHPS deliverables and community expectations. CONCLUSIONS: A communication gap between health care providers and community members explains the high and unrealistic expectations of CHPS. Efforts to improve program acceptability and impact should address the need for more general outreach to social networks and men rather than a sole focus on facility-based maternal and child health care.


Asunto(s)
Atención Primaria de Salud/organización & administración , Servicios de Salud Rural/organización & administración , Adolescente , Adulto , Niño , Padre/estadística & datos numéricos , Femenino , Ghana , Personal de Salud , Humanos , Masculino , Madres/estadística & datos numéricos , Proyectos Piloto , Cobertura Universal del Seguro de Salud/organización & administración
18.
BMC Health Serv Res ; 19(1): 670, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533710

RESUMEN

BACKGROUND: Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran. METHODS: Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson's policy triangle model incorporating the stages heuristic model was used to guide data analysis. RESULTS: The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development - a gap that occurred because politicians were in a great haste to fulfil a campaign promise. CONCLUSIONS: Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives.


Asunto(s)
Reforma de la Atención de Salud/organización & administración , Planificación en Salud/organización & administración , Política de Salud , Formulación de Políticas , Atención Primaria de Salud/organización & administración , Programas de Gobierno , Humanos , Irán , Programas Nacionales de Salud/organización & administración , Política , Cobertura Universal del Seguro de Salud/organización & administración
19.
Orv Hetil ; 160(39): 1542-1553, 2019 Sep.
Artículo en Húngaro | MEDLINE | ID: mdl-31544494

RESUMEN

Introduction: The indicator-based performance monitoring and pay-for-performance system for Hungarian primary care was established in 2009, covering the whole country. It is based on a stable legal system and well operating information technology. Although, the health insurance system is able to facilitate the performance improvement only by the financing for general medical practices, the many times modified present system does not take into consideration (apart from the geographical location of practices) factors which determine the performance but cannot be influenced by general practitioners. Aim: The study aimed at renewing the indicator set and evaluation methodology in order to enable the monitoring to evaluate the performance of general medical practices independent of their structural characteristics. Method: Each adult care specific primary care performance indicator from June 2016 covering the whole country has been investigated. Indicators adjusted for structural practice characteristics (age and gender of patients; relative education of people provided; settlement type and county of the practice) have been computed. The difference between adjusted indicators and national reference values has been evaluated by statistical testing. Appropriateness of the present monitoring and financing system has been investigated by comparing the practice level presently applied and adjusted indicators to outline the opportunities to develop the present system. Results: The present monitoring allocates 34.46% of pay-for-performance resources for improving the performance of practices. The majority of resources supports the conservation of performance. Furthermore, the present system is not able to identify each practice with better than reference performance, withholding amount corresponding to 8.83% of pay-for-performance resources. If this financing were restricted to practices with significantly better than reference performance, the maximum of the financing a month in a practice would increase from 176 042 HUF (551 EURO) to 406 604 HUF (1274 EURO). Conclusion: Completing the performance monitoring system operated at present by the National Health Insurance Fund of Hungary with indicators adjusted for structural characteristics of the general medical practices, the resource allocation effectiveness could be improved. Orv Hetil. 2019; 160(39): 1542-1553.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud , Reembolso de Incentivo , Rendimiento Laboral , Adulto , Humanos , Hungría , Seguro de Salud , Médicos de Familia , Asignación de Recursos
20.
Am J Occup Ther ; 73(5): 7305185020p1-7305185020p12, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31484021

RESUMEN

IMPORTANCE: Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy's feasibility and efficacy in primary care settings. OBJECTIVE: To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign® (LR)-occupational therapy (LR-OT) diabetes management intervention in a primary care clinic. DESIGN: Patients were randomized to be offered LR-OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods. SETTING: Safety-net primary care clinic. PARTICIPANTS: Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18-75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%. INTERVENTION: Eight 1-hr individual sessions of LR-OT focused on diabetes management. OUTCOMES AND MEASURES: Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR-OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations. RESULTS: Seventy-three patients were offered LR-OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation. CONCLUSIONS AND RELEVANCE: LR-OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care. WHAT THIS ARTICLE ADDS: This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy's effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.


Asunto(s)
Diabetes Mellitus , Hemoglobina A Glucada/metabolismo , Terapia Ocupacional , Adolescente , Adulto , Anciano , Humanos , Estilo de Vida , Persona de Mediana Edad , Atención Primaria de Salud/organización & administración , Adulto Joven
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