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2.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769199

RESUMO

OBJECTIVES: Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018. METHODS: This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes. RESULTS: Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening. CONCLUSIONS: Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.


Assuntos
Colaboração Intersetorial , Programas de Rastreamento/normas , Atenção Primária à Saúde/normas , Melhoria de Qualidade/normas , Inquéritos e Questionários , Pré-Escolar , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos
3.
Neurología (Barc., Ed. impr.) ; 35(6): 363-371, jul.-ago. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-188626

RESUMO

INTRODUCCIÓN: La infección por SARS-CoV-2 ha tenido un enorme impacto en los sistemas sanitarios. España, donde la cefalea constituye el motivo principal de consulta ambulatoria en Neurología, es uno de los países con más casos notificados. OBJETIVO: Conocer el impacto de la pandemia COVID-19 en las Unidades de Cefaleas en España y evaluar cómo imaginan el futuro de estas estructuras los neurólogos responsables. MÉTODOS: estudio transversal mediante encuesta online distribuida a los responsables de las Unidades, realizada durante la sexta semana del Estado de Alarma. RESULTADOS: La tasa de respuesta fue del 74%, con participación de centros de diferentes características y de todas las Comunidades Autónomas. El 95,8% describió limitaciones en la actividad presencial, un 60,4% mantuvo la consulta presencial preferente y el 45,8% los procedimientos urgentes. En el 91,7% de los centros la actividad presencial cancelada se sustituyó por consulta telefónica. El 95,8% de los encuestados afirmó que empleará material de protección personal en el futuro y el 86% pretende incorporar en mayor medida la telemedicina. La mayoría prevé un incremento en las listas de espera (93,8% en primeras visitas, 89,6% en revisiones y 89,4% en procedimientos) y una peor situación clínica de los pacientes, pero sólo un 15% cree que su estructura asistencial se verá debilitada. CONCLUSIONES: Como consecuencia de la pandemia, la actividad asistencial e investigadora en cefaleas se ha reducido de manera notable. Esto pone de manifiesto la necesidad de un incremento de la oferta de telemedicina en nuestros centros en un futuro cercano


INTRODUCTION:The COVID-19 pandemic has had a great impact on healthcare systems. Spain, where headache is the main reason for outpatient neurology consultation, is one of the countries with the most reported cases of the disease.Objectives.This study aimed to analyse the impact of the COVID-19 pandemic on headache units in Spain and to evaluate how neurologists see the future of these units. METHODS: We conducted a cross-sectional online survey of headache units during the sixth week of the state of alarm declared in Spain in response to the pandemic. RESULTS:The response rate was 74%, with the participation of centres with different characteristics and from all Autonomous Communities of Spain. Limitations in face-to-face activity were reported by 95.8% of centres, with preferential face-to-face consultation being maintained in 60.4%, and urgent procedures in 45.8%. In 91.7% of centres, the cancelled face-to-face activity was replaced by telephone consultation 95.8% of respondents stated that they woulduse personal protection equipment in the future, and 86% intendedto increase the use of telemedicine. The majority foresaw an increase in waiting lists (93.8% for initial consultations, 89.6% for follow-up, and 89.4% for procedures) and a worse clinical situation for patients, but only 15% believed that their healthcare structures would be negatively affected in the future.Conclusions.As a consequence of the pandemic, headache care and research activity has reduced considerably. This demonstrates the need for an increase in the availability of telemedicine in our centres in the near future


Assuntos
Humanos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/tendências , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Assistência Ambulatorial/normas , Assistência Ambulatorial/tendências , Cefaleia/terapia , Teleneurologia , Inquéritos e Questionários , Estudos Transversais
4.
Public Health Rep ; 135(1_suppl): 172S-181S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735191

RESUMO

OBJECTIVE: Targeted testing and treatment of persons with latent tuberculosis infection (LTBI) is a critical component of the US tuberculosis (TB) elimination strategy. In January 2016, the California Department of Public Health issued a tool and user guide for TB risk assessment (California tool) and guidance for LTBI testing, and in September 2016, the US Preventive Services Task Force (USPSTF) issued recommendations for LTBI testing in primary care settings. We estimated the epidemiologic effect of adherence to both recommendations in California. METHODS: We used an individual-based Markov micro-simulation model to estimate the number of cases of TB disease expected through 2026 with baseline LTBI strategies compared with implementation of the USPSTF or California tool guidance. We estimated the risk of LTBI by age and country of origin, the probability of being in a targeted population, and the probability of presenting for primary care based on available data. We assumed 100% adherence to testing guidance but imperfect adherence to treatment. RESULTS: Implementation of USPSTF and California tool guidance would result in nearly identical numbers of tests administered and cases of TB disease prevented. Perfect adherence to either recommendation would result in approximately 7000 cases of TB disease averted (40% reduction compared with baseline) by 2026. Almost all of this decline would be driven by a reduction in the number of cases among non-US-born persons. CONCLUSIONS: By focusing on the non-US-born population, adherence to LTBI testing strategies recommended by the USPSTF and the California tool could substantially reduce the burden of TB disease in California in the next decade.


Assuntos
Tuberculose Latente/diagnóstico , Atenção Primária à Saúde/organização & administração , Adulto , Fatores Etários , Antituberculosos/uso terapêutico , California , Emigrantes e Imigrantes , Fidelidade a Diretrizes , Humanos , Hospedeiro Imunocomprometido , Tuberculose Latente/tratamento farmacológico , Tuberculose Latente/etnologia , Cadeias de Markov , Programas de Rastreamento , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Instituições Residenciais , Medição de Risco , Tuberculose/etnologia
5.
PLoS One ; 15(7): e0236270, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735616

RESUMO

BACKGROUND: An integrated chronic disease management (ICDM) model was introduced by the National Department of Health in South Africa to tackle the dual burden of HIV/AIDS and non-communicable diseases. One of the aims of the ICDM model is to reduce HIV-related stigma. This paper describes the viewpoints of service users and providers on HIV stigma in an ICDM model in rural South Africa. MATERIALS AND METHODS: A content analysis of HIV stigmatisation in seven primary health care (PHC) facilities and their catchment communities was conducted in 2013 in the rural Agincourt sub-district, South Africa. Eight Focus Group Discussions were used to obtain data from 61 purposively selected participants who were 18 years and above. Seven In-Depth Interviews were conducted with the nurses-in-charge of the facilities. The transcripts were inductively analysed using MAXQDA 2018 qualitative software. RESULTS: The emerging themes were HIV stigma, HIV testing and reproductive health-related concerns. Both service providers and users perceived implementation of the ICDM model may have led to reduced HIV stigma in the facilities. On the other hand, service users and providers thought HIV stigma increased in the communities because community members thought that home-based carers visited the homes of People living with HIV. Service users thought that routine HIV testing, intended for pregnant women, was linked with unwanted pregnancies among adolescents who wanted to use contraceptives but refused to take an HIV test as a precondition for receiving contraceptives. CONCLUSIONS: Although the ICDM model was perceived to have contributed to reducing HIV stigma in the health facilities, it was linked with stigma in the communities. This has implications for practice in the community component of the ICDM model in the study setting and elsewhere in South Africa.


Assuntos
Doença Crônica/epidemiologia , Gerenciamento Clínico , Infecções por HIV/epidemiologia , HIV/isolamento & purificação , Atenção Primária à Saúde/normas , Doença Crônica/psicologia , Anticoncepção , Feminino , Grupos Focais/estatística & dados numéricos , HIV/patogenicidade , Infecções por HIV/psicologia , Infecções por HIV/terapia , Infecções por HIV/virologia , Humanos , Assistência de Longa Duração , Masculino , Programas de Rastreamento , Enfermeiras e Enfermeiros , Gravidez , População Rural , Estigma Social , África do Sul/epidemiologia
6.
PLoS One ; 15(8): e0237083, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780769

RESUMO

INTRODUCTION: Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia. METHODS: A cross-sectional analysis of 13 784 medical records from 20 selected public primary care clinics in Malaysia was performed for patients aged ≥30 years old who were diagnosed with hypertension and had at least one visit between 1st November 2016 and 30th June 2019. Multivariable logistic regression adjusted for complex survey design was used to determine the association between process of care and blood pressure (BP) control among the hypertensive patients. RESULTS: Approximately 50% of hypertensive patients were obese, 38.4% of age ≥65 years old, 71.2% had at least one comorbidity and approximately one-third were on antihypertensive monotherapy. Approximately two-third of the hypertensive patients with diabetic proteinuria were prescribed with the appropriate choice of antihypertensive agents. Approximately half of the patients received at least 70% of the target indicated care and 42.8% had adequately controlled BP. After adjusting for covariates, patients who received counseling on exercise were positively associated with adequate BP control. Conversely, patients who were prescribed with two or more antihypertensive agents were negatively associated with good BP control. CONCLUSIONS: These findings indicated that BP control was suboptimal and deficient in the process of care with consequent gaps in guidelines and actual clinical practices. This warrants a re-evaluation of the current strategies and approaches to improve the quality of hypertension management and ultimately to improve outcome.


Assuntos
Hospitais Públicos/normas , Hipertensão/terapia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Malásia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos
7.
Arq. ciências saúde UNIPAR ; 24(2): 117-123, maio-ago. 2020.
Artigo em Português | LILACS | ID: biblio-1116377

RESUMO

Este estudo trata-se de um relato de experiência sobre o processo de construção e desenvolvimento de um Seminário de Saúde do Trabalhador (SST), articulado pelos profissionais residentes do Programa de Pós-Graduação em Residência Multiprofissional em Atenção Básica/Saúde da Família da Universidade do Vale do Itajaí - UNIVALI, atuantes do Núcleo Ampliado a Saúde da Família (NASF) pertencente ao Sistema Único de Saúde (SUS) do município de Itapema-SC. O SST contou com o apoio e parceria dos setores de Vigilância Sanitária (VS) e Programa de Saúde do Trabalhador (PST) para a sua realização. Objetivou-se por meio deste estudo relatar a construção do SST e o fortalecimento da educação permanente de Itapema a partir da realização do seminário. Como resultado desta experiência, foi realizado o "2º Seminário de Saúde do trabalhador: uma visão ampliada", em comemoração à campanha "Abril Verde" do ano de 2018, contando com aproximadamente 200 participantes durante todo o evento, com direcionamento principal aos trabalhadores dos setores da educação (professores, orientadores educacionais, diretores) e saúde (profissionais da atenção básica, especializada e gestão) do município de Itapema. Com a realização do SST, foi possível diagnosticar as necessidades de saúde dos trabalhadores por meio de um levantamento do itinerário terapêutico, abrindo assim, a possibilidade de cuidado continuado para estes profissionais em seu âmbito de trabalho mediante do apoio institucional realizado pela equipe de residentes. Para alcançar esta produção de cuidado, é fundamental que ocorra o fortalecimento da educação permanente na saúde do trabalhador do município, sendo necessárias estratégias de apoio aos profissionais em seu cotidiano de trabalho, com objetivo de problematizar as necessidades relatadas e alcançar outras práticas de produção de saúde dos trabalhadores.


This study is a report on the experience regarding the process of construction and development of a Seminar on Occupational Health (SST) articulated by the residents of the Post-Graduation Program in Multi-professional Residency in Basic Care/Family Health of the University of the Itajaí Valley - UNIVALI, members of the Expanded Family Health Center (NASF) belonging to the Unified Health System (SUS) in the city of Itapema, in Santa Catarina. The SST had the support and partnership of the Health Surveillance (VS) and Occupational Health Program (PST) sectors for its implementation. The purpose of this study is to report on the construction of the SST and the strengthening of the permanent education of Itapema from the seminar. As a result of this experience, the "2nd Worker's Health Seminar: an expanded vision" was held in commemoration of the "Green April" campaign of 2018, with approximately 200 participants throughout the event, with the participation of teachers, educational counselors, directors and health professionals (basic care, specialized and management professionals) of the city of Itapema. With the SST, it was possible to diagnose the health needs of workers through a survey regarding the therapeutic itinerary and the opening of the possibility of support to those professionals in their work areas. In order to achieve this production of care, it is essential to strengthen the continuous education in the health of workers in Itapema; further strategies are needed to support professionals on their daily work in order to problematize the reported needs and reach other production practices for the health of workers.


Assuntos
Humanos , Masculino , Feminino , Adulto , Equipe de Assistência ao Paciente/classificação , Atenção Primária à Saúde/normas , Saúde do Trabalhador/educação , Congressos como Assunto/normas , Sistema Único de Saúde/organização & administração , Educação em Saúde/organização & administração , Pessoal de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Corpo Clínico Hospitalar/educação
9.
PLoS One ; 15(7): e0236019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667953

RESUMO

BACKGROUND: Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance. METHODS AND FINDINGS: Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. CONCLUSIONS: Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment.


Assuntos
Promoção da Saúde/normas , Informática Médica/normas , Assistência Centrada no Paciente/normas , Atenção Primária à Saúde/normas , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-32646063

RESUMO

BACKGROUND: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients' perceived quality of primary healthcare between rural and urban community health centers in Guangdong. METHODS: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients' primary care experiences. A t-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. RESULTS: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences. CONCLUSION: Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.


Assuntos
Centros Comunitários de Saúde/normas , Satisfação do Paciente , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adulto , China , Estudos Transversais , Feminino , Humanos , Masculino , Garantia da Qualidade dos Cuidados de Saúde , População Rural , Inquéritos e Questionários , População Urbana
11.
Palmas; [Secretaria de Estado da Saúde]; 20200000. 8 p.
Não convencional em Português | LILACS, Coleciona SUS, CONASS, SES-TO | ID: biblio-1120800

RESUMO

Orienta os serviços de Atenção Primária à Saúde (APS) ou Atenção Básica (AB), por meio da Estratégia Saúde da Família (ESF), no manejo e controle da infecção COVID-19. Indica os instrumentos de orientação clínica para os profissionais do Sistema Único de Saúde (SUS) a partir da transmissão do novo Coronavírus (COVID-19) no Tocantins.


It guides the Primary Health Care (PHC) or Basic Care (AB) services, through the Family Health Strategy (FHS), in the management and control of the COVID-19 infection. Indicates the instruments of clinical guidance for professionals of the Unified Health System (SUS) from the transmission of the new Coronavirus (COVID-19) in Tocantins.


Orienta a los servicios de Atención Primaria de Salud (APS) o Atención Básica (AB), a través de la Estrategia de Salud de la Familia (ESF), en el manejo y control de la infección por COVID-19. Indica los instrumentos de orientación clínica para profesionales del Sistema Único de Salud (SUS) a partir de la transmisión del nuevo Coronavirus (COVID-19) en Tocantins.


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/normas , Infecções por Coronavirus/prevenção & controle , Pandemias , Transporte de Pacientes/normas , Assistência Odontológica/normas , Cuidados de Enfermagem/normas
12.
Lancet ; 395(10239): 1802-1812, 2020 06 06.
Artigo em Inglês | MEDLINE | ID: covidwho-548644

RESUMO

China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.


Assuntos
Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , China , Continuidade da Assistência ao Paciente , Infecções por Coronavirus , Planos de Pagamento por Serviço Prestado , Humanos , Pandemias , Médicos de Atenção Primária/educação , Médicos de Atenção Primária/normas , Pneumonia Viral , Atenção Primária à Saúde/organização & administração
13.
PLoS One ; 15(6): e0234318, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530944

RESUMO

BACKGROUND: Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. METHODS: A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. RESULTS: This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (ß = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (ß = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (ß = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (ß = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (ß = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (ß = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (ß = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers' satisfaction (ß = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers' skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. CONCLUSIONS: There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers' level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers' work-related burnout.


Assuntos
Acesso aos Serviços de Saúde , Assistência Perinatal/normas , Qualidade da Assistência à Saúde , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Grupos Focais , Instalações de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Tocologia/normas , Tocologia/estatística & dados numéricos , Enfermagem Obstétrica/normas , Enfermagem Obstétrica/estatística & dados numéricos , Obstetrícia/normas , Obstetrícia/estatística & dados numéricos , Parto , Assistência Perinatal/estatística & dados numéricos , Período Pós-Parto , Gravidez , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
14.
PLoS One ; 15(6): e0234425, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542028

RESUMO

BACKGROUND: Amid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors. OBJECTIVE: We conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S. DESIGN: We invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems. PARTICIPANTS: Eighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated. APPROACH: Six qualitative panel discussions were conducted via teleconference with experts. Transcripts were coded using team-based qualitative content analysis to identify key challenges and recommendations in opioid risk mitigation. KEY RESULTS: Panelists provided insight into challenges across multiple levels of the U.S. health system, including the technical complexity of treating chronic pain, the fraught national climate around opioids, the need to integrate surveillance data across a fragmented U.S. health system, a lack of access to non-pharmacological options for chronic pain care, and difficulties in provider and patient communication. Participating experts identified recommendations for multi-level change efforts spanning policy, research, education, and the organization of healthcare delivery. CONCLUSIONS: Reducing opioid risk while ensuring safe and effective pain management, according to participating experts, is likely to require multi-level efforts spanning military, veteran, and civilian health systems. Efforts to implement risk mitigation strategies at the patient level should be accompanied by efforts to increase education for patients and providers, increase access to non-pharmacological pain care, and support use of existing clinical decision support, including state-level prescription drug monitoring programs.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/terapia , Manejo da Dor/métodos , Padrões de Prática Médica/organização & administração , Programas de Monitoramento de Prescrição de Medicamentos/organização & administração , Analgésicos Opioides/normas , Sistemas de Apoio a Decisões Clínicas/organização & administração , Prescrições de Medicamentos/normas , Feminino , Humanos , Colaboração Intersetorial , Masculino , Serviços de Saúde Militar/normas , Epidemia de Opioides , Educação de Pacientes como Assunto/organização & administração , Padrões de Prática Médica/normas , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Programas de Monitoramento de Prescrição de Medicamentos/normas , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Pesquisa Qualitativa , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/normas
15.
PLoS One ; 15(6): e0234577, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555696

RESUMO

The effects of hepatitis C virus (HCV), such as morbidity and mortality associated with cirrhosis and liver cancer, is a major public health issue in Australia. Highly effective treatment has recently been made available to all Australians living with HCV. A decision-analytic model was developed to evaluate the cost-effectiveness of the hepatology partnership, compared to usual care. A Markov model was chosen, as it is state-based and able to include recursive events, which accurately reflects the natural history of the chronic and repetitive nature of HCV. Cost-effectiveness of the new model of care is indicated by the incremental cost-effectiveness ratio (ICER), where the mean change to costs associated with the new model of care is divided by the mean change in quality adjusted life-years (QALYs). Ten thousand iterations of the model were run, with the majority (73%) of ICERs representing cost-savings. In comparison to usual care, the intervention improves health outcomes (22.38 QALYs gained) and reduces costs by $42,122 per patient. When compared to usual care, a partnership approach to management of HCV is cost-effective and good value for money, even when key model parameters are changed in scenario analyses. Reduction in costs is driven by improved efficiency of the new model of care, where more patients are treated in a timely manner, away from the expensive tertiary setting. From an economic perspective, a reduction in hospital-based care is a positive outcome and represents a good investment for decision-makers who wish to maximise health gain per dollar spent.


Assuntos
Análise Custo-Benefício , Hepatite C Crônica/tratamento farmacológico , Administração dos Cuidados ao Paciente/economia , Atenção Primária à Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , Adulto , Austrália , Gerenciamento Clínico , Feminino , Hepacivirus , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Atenção Primária à Saúde/normas
16.
Musculoskelet Sci Pract ; 48: 102179, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32560875

RESUMO

Safety netting is a recognised General Practitioner (GP) diagnostic strategy often used in the face of uncertainty to help ensure that a patient with unresolved or worsening symptoms knows when and how to access further advice. It is an important way of reducing clinical risk. In the context of the COVID-19 pandemic and the rapid move to mainly remote consultations within the musculoskeletal field, safety netting is an important strategy to embed within all consultations. Only those presenting with potentially serious conditions are offered face to face consultations. Screening for Red Flags and any indication of a serious cause of symptoms is always first line in any consultation, however, clinical presentations are not always black and white with patients falling into a clear diagnostic category. With patients minds more focussed on COVID-19 symptoms this can be problematic. With the additional ramifications of public health social restrictions, onward management can be a conundrum. Many people with risk factors of serious pathology are also as a consequence, vulnerable to contracting COVID-19. In situations of uncertain clinical presentations, to avoid unnecessary social contact, safety netting can help to monitor symptoms over time until the clinical context becomes more certain. Embedding safety netting within physiotherapy best practice could be a silver lining in this pandemic black cloud.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Segurança do Paciente/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Humanos , Pandemias , Pesquisa Qualitativa
17.
Med Care ; 58(7): 643-650, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32520838

RESUMO

BACKGROUND: Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management. OBJECTIVE: To assess how PCP communication with their care team relates to patients' health. RESEARCH DESIGN: Longitudinal study of how 3 aspects of PCP-care team communication-participation, time spent listening, and uninterrupted speaking length-relate to disease management of patients with hypertension or diabetes, and the effect of these team communication behaviors on PCP-patient communication as a pathway by which this relationship might exist. We used multilevel regression models. SUBJECTS: Twenty-seven PCPs and 98 team members, and 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites. MEASURES: Primary data on communication collected using sociometric sensors worn by PCPs and team members, patient-PCP communication data collected with surveys, and patient health, PCP and patient characteristics extracted from electronic records. RESULTS: PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. PCP participation, listening, and length of uninterrupted speaking time were associated with significantly higher odds that their patients had controlled hypertension and diabetes and improvements in disease control over time. PCP-patient communication mediates this relationship. CONCLUSIONS: PCP-team communication is associated with patient health management. How team members speak with one another may be as important as the content of their communication.


Assuntos
Gerenciamento Clínico , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/normas , Atenção Primária à Saúde/métodos , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários
18.
Lancet ; 395(10239): 1802-1812, 2020 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-32505251

RESUMO

China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.


Assuntos
Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , China , Continuidade da Assistência ao Paciente , Infecções por Coronavirus , Planos de Pagamento por Serviço Prestado , Humanos , Pandemias , Médicos de Atenção Primária/educação , Médicos de Atenção Primária/normas , Pneumonia Viral , Atenção Primária à Saúde/organização & administração
19.
Health Qual Life Outcomes ; 18(1): 193, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32563246

RESUMO

BACKGROUND: Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region. METHODS: The HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My™). The SASC10-My™ was then tested on 175 post-stroke patients who were recruited at ten public primary care healthcentres across Peninsular Malaysia, in a trial-within a trial study. RESULTS: One item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My™ had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My™ was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My™ score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge. CONCLUSIONS: The SASC10-My™ questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes. TRIAL REGISTRATION: No.: ACTRN12616001322426 (Registration Date: 21st September 2016.


Assuntos
Assistência Ambulatorial/normas , Cuidadores/psicologia , Serviços de Assistência Domiciliar/normas , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Reabilitação do Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Satisfação Pessoal , Psicometria , Qualidade de Vida/psicologia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Sobreviventes/psicologia , Traduções
20.
Braz Oral Res ; 34: e047, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-263241

RESUMO

The emergence of severe acute respiratory coronavirus 2 (SARS-CoV-2) and its association with severe pneumonia and deaths has exposed gaps in the health systems of several countries worldwide. Although the necessary focus has been to care for hospitalized patients, the strengthening of Primary Health Care (PHC) actions is necessary. PHC is the gateway to the health system in several countries, including Brazil and it plays a role in preventing, protecting, promoting, and treating individuals and communities. Brazil, like other countries, has faced the SARS-CoV-2 pandemic. As Brazil has a universal and decentralized health system, in which PHC has been the model of health re-organizing the health system; here we reflected the importance of strengthening PHC in Brazil in the times of coronavirus disease 2019 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Necessidades e Demandas de Serviços de Saúde/normas , Programas Nacionais de Saúde/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/normas , Brasil , Necessidades e Demandas de Serviços de Saúde/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração
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