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1.
Rev. enferm. UERJ ; 28: e45918, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1117684

RESUMEN

Objetivo: analisar a compreensão de estudantes de graduação em enfermagem sobre as Redes de Atenção à Saúde. Método: estudo descritivo e exploratório, qualitativo, realizado com 27 estudantes em Enfermagem de uma universidade federal do sul do Brasil, por meio de entrevistas semiestruturadas realizadas entre agosto e setembro de 2018. Resultados: foi evidenciado o conhecimento dos estudantes em relação ao conceito e objetivo das Redes de Atenção à Saúde, a identificação de fragilidades na comunicação e a falta de conhecimento do usuário como obstáculos na efetivação das mesmas, a dificuldade em ver a atuação do enfermeiro dentro dos variados serviços das redes e a percepção sobre a fragmentação do processo de formação. Conclusão: o estudo contribui para a discussão sobre a inclusão dos estudantes nas Redes de Atenção à Saúde, com intuito de superar as exigências educacionais que buscam favorecer a efetivação do Sistema Único de Saúde e das Redes de Atenção à Saúde.


Objective: to examine undergraduate nursing students' understanding of Health Care Networks (HCNs). Method: in this exploratory, qualitative descriptive study, semi-structured interviews were conducted with 27 Nursing students at a federal University in southern Brazil between August and September 2018. Results: the interviews revealed that the students' knowledge related to the HCNs' concept and purpose, beyond the communication weaknesses and users' lack knowledge as obstacles to effective HCNs, the difficulty in seeing nurses' roles in the various network services, and perceived fragmentation in the training process. Conclusion: the study contributed to discussion of inclusion of students in HCRs, with a view to meeting the educational requirements designed to favor implementation of the national health system (SUS) and the HCNs.


Objetivo: analizar la comprensión de los estudiantes de enfermería de pregrado sobre las redes de atención de la salud (HCN). Método: en este estudio exploratorio, cualitativo descriptivo, se realizaron entrevistas semiestructuradas a 27 estudiantes de Enfermería de una Universidad federal del sur de Brasil entre agosto y septiembre de 2018. Resultados: las entrevistas revelaron que los conocimientos de los estudiantes relacionados con el concepto y propósito, más allá de las debilidades de comunicación y la falta de conocimiento de los usuarios como obstáculos para una HCN eficaz, la dificultad para ver el rol de las enfermeras en los distintos servicios de la red y la fragmentación percibida en el proceso de formación. Conclusión: el estudio contribuyó a la discusión de la inclusión de los estudiantes en las HCR, con miras a cumplir con los requisitos educativos diseñados para favorecer la implementación del Sistema Nacional de Salud (SUS) y las HCN.


Asunto(s)
Humanos , Masculino , Femenino , Atención Primaria de Salud/organización & administración , Estudiantes de Enfermería , Sistema Único de Salud/organización & administración , Prestación de Atención de Salud/organización & administración , Comprensión , Brasil , Rol de la Enfermera , Investigación Cualitativa , Educación de Postgrado en Enfermería
2.
Rev Saude Publica ; 54: 102, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33146296

RESUMEN

OBJECTIVE: To present the methodological approach used in a research that analyzed the use and performance of specialized health care, from primary care access, in four major Brazilian cities: Fortaleza (CE), Campinas (SP), São Paulo (SP) and Porto Alegre (RS). METHODS: Presentation and discussion of the quantitative-qualitative components of the proposed research strategy. RESULTS: Four tracing conditions were studied: systemic arterial hypertension, high-risk pregnancy, breast cancer and severe mental disorder. For each health condition, indicators were constructed based on health information systems data, pointing out frequencies, temporal trends and local differences. This initial contextualization was enriched with a descriptive-qualitative study of the performance of each municipal health service network. Next, a cross-sectional study was conducted through a survey of 7,053 users of specialized services for each health condition. Finally, in-depth interviews were conducted with key actors to complement selected operational aspects of each municipality's network. The results of all these data sources were triangulated, allowing us to explore the variability of SUS implementations in different regional scenarios. CONCLUSIONS: The multifaceted analytical model presented allows us to understand relevant aspects of the Unified Health System performance, paying attention to the singularities, heterogeneities and inequalities that characterize its implementation in Brazil and emphasizing the performance of local networks for the addressed health conditions.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Brasil , Ciudades , Estudios Transversales , Accesibilidad a los Servicios de Salud , Humanos , Factores Socioeconómicos
3.
4.
Recurso Educacional Abierto en Portugués | CVSP - Regional | ID: oer-3911

RESUMEN

Protocolos de classificação de risco Organização do acesso a rede Fluxos das portas de entrada Cuidados em serviços de saúde


Asunto(s)
Gestión de Riesgos , Pandemias/prevención & control , Protocolos Clínicos , Gravedad del Paciente , Atención Primaria de Salud/organización & administración
5.
Recurso Educacional Abierto en Portugués | CVSP - Regional | ID: oer-3912

RESUMEN

Triagem diagnóstico Orientação e prescrição de fármacos Monitoramento epidemiológico Encaminhamento para unidade de referencia.


Asunto(s)
Pandemias/prevención & control , Protocolos Clínicos , Atención Primaria de Salud/organización & administración , Aislamiento Social , Cuarentena/organización & administración
7.
Recurso Educacional Abierto en Portugués | CVSP - Regional | ID: oer-3915
9.
Can Fam Physician ; 66(10): 745-747, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33077454
10.
Med Clin North Am ; 104(6): 919-938, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33099452

RESUMEN

The burden of cancer in the United States is substantial, providing important opportunity and obligation for primary care clinicians to promote cancer prevention and early detection. Without a system of organized screening to support reminders and follow-up of cancer screening, primary care clinicians face challenges in addressing risk assessment, informed/shared decision making, reminders for screening, and tracking adherence to screening recommendations. Tools exist for collecting information about family history, tracking screening adherence, and reminding patients when they are due for screening, and strategies exist for making cancer prevention and early detection an office policy and delegating roles and responsibilities to office staff.


Asunto(s)
Detección Precoz del Cáncer , Neoplasias/prevención & control , Atención Primaria de Salud/organización & administración , Humanos , Neoplasias/mortalidad , Estados Unidos
11.
J Nurs Adm ; 50(11): 565-570, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33074956

RESUMEN

OBJECTIVE: The aim of this study was to analyze perceptions and experiences of clinicians implementing the patient-centered medical home (PCMH). BACKGROUND: The PCMH model focuses on several important concepts, including team-based care management as well as care coordination and continuity among providers and across settings of care. METHODS: A qualitative analysis of data collected in 2016 from primary care personnel through a national survey was conducted. RESULTS: Four themes were found consistent with care management and care coordination: the importance of teamwork and optimized team member roles, need for adequate prioritization of care management and care coordination, need to refine tools and resources supporting care management and care coordination, and challenges with managing and coordinating care with and across complex systems. CONCLUSIONS: Successful implementation requires adequate support for teamwork and ensuring team members can work according to their clinical competency. Nurses practicing in expanded roles need clear role guidelines and adequate time to function in these roles.


Asunto(s)
Continuidad de la Atención al Paciente , Atención Dirigida al Paciente , Atención Primaria de Salud/organización & administración , Competencia Clínica , Humanos , Modelos Organizacionales , Grupo de Atención al Paciente , Investigación Cualitativa
13.
BMC Fam Pract ; 21(1): 208, 2020 10 10.
Artículo en Inglés | MEDLINE | ID: mdl-33038926

RESUMEN

BACKGROUND: To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care. METHODS: Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator's percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change. RESULTS: We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of - 2.69% (95%CI - 3.17% to - 2.23%) in March and - 3.41% (95%CI - 3.82% to - 3.01%) in April; and the control of blood pressure with a reduction of - 2.13% (95%CI - 2.34% to - 1.9%) and - 2.59% (95%CI - 2.8% to - 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of - 2.86% (95%CI - 3.33% to - 2.39%) and - 4.13% (95%CI - 4.55% to - 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome. CONCLUSIONS: The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Atención Primaria de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud , Cuarentena/estadística & datos numéricos , Adulto , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Sistema de Registros , Estudios Retrospectivos , España
14.
Isr J Health Policy Res ; 9(1): 53, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33081834

RESUMEN

BACKGROUND: Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era. METHODS: A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed. RESULTS: One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation. CONCLUSIONS: The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.


Asunto(s)
Actitud del Personal de Salud , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Pediatras/psicología , Neumonía Viral/prevención & control , Atención Primaria de Salud/organización & administración , Telemedicina/tendencias , Adulto , Anciano , Niño , Infecciones por Coronavirus/epidemiología , Femenino , Predicción , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Pediatras/estadística & datos numéricos , Neumonía Viral/epidemiología , Política Pública , Cuarentena
15.
J Prim Care Community Health ; 11: 2150132720965080, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33084496

RESUMEN

Hospitals and health systems suffer an over-reliance on elective surgeries to remain profitable. As a result, systems report record losses, while demand for emergency room, hospital, and intensive care beds have surged. Studies have admitted that many surgeries are unnecessary, and physician leaders admit that profit plays a role in driving such needless cost and risk. Most diseases are better managed with medications and lifestyle changes. But it pays more to replace a knee than to prevent that replacement. We must bring surgical and medical value closer in-line. Communities of color are suffering disproportionately from coronavirus. The social determinants of health that lead to higher concentrations of hypertension and diabetes can be mitigated by investment in primary care. Such investment has been proven to decrease cost and increase quality of life. However, the United States spends 50% less on primary care, than other developed countries. While showing promise, telehealth is not a panacea. It relies on continued reimbursement parity, and there remains a digital divide. Any meaningful fix will draw the ire from those who profit from such a profligate system. If we want to improve quality, access and equity, while avoiding unnecessary hospitalizations, risky surgeries, and runaway costs, we must invest in primary care.


Asunto(s)
Infecciones por Coronavirus/etnología , Neumonía Viral/etnología , Medicina Preventiva , Atención Primaria de Salud/economía , Atención Primaria de Salud/organización & administración , Procedimientos Quirúrgicos Electivos/economía , Accesibilidad a los Servicios de Salud , Disparidades en el Estado de Salud , Humanos , Área sin Atención Médica , Pandemias , Determinantes Sociales de la Salud/etnología , Estados Unidos/epidemiología
16.
N Z Med J ; 133(1523): 29-40, 2020 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-33032301

RESUMEN

AIM: The aim of the survey was to describe the demographics, distribution, clinical settings and employment arrangements of the New Zealand nurse practitioner workforce in primary healthcare settings; and organisational factors limiting their practice. METHOD: An online survey was developed and sent to all NPs in mid-2019. RESULTS: The survey was completed by 160 nurse practitioners who worked in settings broadly defined as primary healthcare (response rate 71.4%). In addition to clinical work, nurse practitioners engaged in teaching and clinical supervision; leadership and management; policy development; locum work; and research; but 14% continued to do at least some work as a registered nurse. One hundred and fifty-one respondents were working clinically and 48% of these worked in more than one clinical setting. General practice-type settings (39%), of which over 40% were very low-cost access practices, and aged residential care (19%) were most commonly identified as the main clinical setting. Others included long-term conditions; mental health and addiction; sexual health/family planning; whanau ora; child/youth health; and various community nursing service roles. Seventy-three percent of nurse practitioners earned less than $120,000 per annum for full-time work; and 60% had $2,000 or less available for professional development. Three quarters had worked in the same setting for at least two years, and 60% intended to stay a further three years. Fourteen percent worked rurally. Employment models, models of care, and access to diagnostics, particularly radiology, were most limiting to their practice. CONCLUSION: The nurse practitioner workforce offers stability and flexibility in working across multiple clinical settings in primary healthcare. They provide the potential solution to the general practitioner workforce shortage by improving access to primary healthcare and reducing health inequalities. As authorised prescribers able to enrol patients, receive capitation payments and claim general medical services, it is timely to facilitate the expansion of the nurse practitioner workforce in New Zealand.


Asunto(s)
Enfermeras Practicantes/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Recursos Humanos/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Encuestas y Cuestionarios
17.
J Prim Care Community Health ; 11: 2150132720966409, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33063617

RESUMEN

COVID-19 supportive quarantine care in the community is managed by primary care practices. There is no current guidance on how a primary care practice with high volumes of patients screened for COVID-19 can re-configure itself to become responsive to the pandemic. We examined Learning Health System guidance from the National Academies of Science, Engineering and Medicine and adapted it to our primary care practice to create an efficient, effective, adaptive response to the COVID-19 pandemic. We suggest evaluating this response in the future for effectiveness and efficiency.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Medicina Familiar y Comunitaria/organización & administración , Aprendizaje del Sistema de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Atención Primaria de Salud/organización & administración , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Estados Unidos/epidemiología
18.
J Prim Care Community Health ; 11: 2150132720967514, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33089729

RESUMEN

INTRODUCTION: Predominantly, studies on COVID-19 report quantitative data that often miss the social implications and other determinants of health. The objective of this study was to explore the experiences and perceptions of health care workers (HCWs) in primary health care in the management of COVID-19 with respect to medical response experiences, socio-cultural and religious reforms, psychological impressions, and lessons learned. METHODS: This was a qualitative study using an empirical phenomenological approach. Six focus group discussions were conducted across various stakeholders working frontline in the management of COVID-19 (managerial, public health/field/community and primary care health centers). They participated in semi-structured, in-depth group discussions from 11th to 20th May 2020. All discussions were audio-recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS: Forty participants were involved in this study. Three themes emerged related to the medical response experiences, including the rapid re-structuring of the PHC services, use of technology and challenges of working on COVID-19. Perceptions on the socio-cultural and religious reforms included changes in social and religious norms, and anticipated gaps in accessing health care among the vulnerable groups (elderly, expatriates, and individuals with low economic status). Perceptions on psychological disturbances were themed as consequences of social distancing, management of dead bodies, exhaustion among the health care workers, and risk of exposure. Finally, lessons learned were centered around building on the existing epidemiological and public health capacities, improving access to health care and overcoming resistance to change. Most participants labelled their experience in COVID-19 as an "experience of wisdom" in which learning was a continuous process. CONCLUSION: This qualitative study amongst primary HCWs revealed certain aspects of response to COVID-19 in Muscat, Oman. Results has unfolded various aspects of COVID-19. The situation was perceived by primary HCWs as a new experience that challenged the primary health care; enforced the utilization of public health/epidemiological skills, and linked to unfavorable socio-religious and psychological events.


Asunto(s)
Infecciones por Coronavirus/terapia , Personal de Salud/psicología , Pandemias , Neumonía Viral/terapia , Atención Primaria de Salud/organización & administración , Adulto , Anciano , Infecciones por Coronavirus/epidemiología , Femenino , Grupos Focales , Personal de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Omán/epidemiología , Neumonía Viral/epidemiología , Investigación Cualitativa
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