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3.
Aten. prim. (Barc., Ed. impr.) ; 51(10): 610-616, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185943

RESUMO

Objetivo: Comparar los resultados de los equipos de atención primaria en Cataluña en función de su modelo de gestión y evaluar el impacto de un modelo de gestión conocido como gestión por entidades de base asociativa (EBA). Diseño: Llevamos a cabo un análisis comparado multidimensional siguiendo una lógica cuasi-experimental a partir de comparar los centros gestionados a través del modelo EBA con otros centros gestionados por el sector público a través del Instituto Catalán de la Salud (ICS) o por el tercer sector a través de consorcios hospitalarios. Localización: Barcelona, Cataluña, España. Participantes: Tenemos en cuenta 368 observaciones (centros de atención primaria) y 18 parámetros medidos en 2015. Intervenciones: Distintos métodos de gestión. Mediciones principales: Comparación de indicadores de actividad, efectividad en el proceso asistencial y eficiencia antes y después de controlar por el indicador socioeconómico del área básica de salud y las características de la región sanitaria. Test de diferencias significativas en las medias de los indicadores según modelo de gestión una vez realizado el emparejamiento conforme a variables clave mediante la técnica Propensity Score Matching. Resultados: Diferencias significativas en el indicador de carga de trabajo por profesional médico de familia, en cinco indicadores de efectividad en el proceso asistencial y en el coste por usuario. Conclusiones: La diversificación del modelo de gestión a través del modelo EBA muestra resultados que se pueden interpretar a favor del mantenimiento o de la ampliación de la aplicación de este modelo de gestión. Si bien los centros gestionados a través del modelo EBA se han implantado en áreas de nivel socioeconómico medio o alto, sus resultados continúan siendo significativamente positivos una vez se controla por el nivel socioeconómico de su área


Goal: Compare the performance of primary health centers managed by the public sector (ICS), the third sector (Hospitals) or by small private organizations known as EBAs. Design: Multidimensional comparative analysis. We follow a quasi-experimental logic comparing primary health centers managed by EBAs with other centers managed by the public sector (ICS) o by the third sector (hospitals). Localization: Barcelona, Catalonia, Spain. Participants: We have 368 observations (primary health centers) and 18 indicators measured in 2015. Intervention: Different management models (public, third sector, private). Main measures: We compare activity measures, measures of effectiveness in the process of medical assistance, and efficiency. We compare before and after controlling for the socio-economic level corresponding to the basic health area and the characteristics of the population and health region. We conduct a test of significant differences between the indicators corresponding to centers managed differently, after a process of matching using key variables and Propensity Score Matching. Results: Significant differences in the measure of work load for family doctors, in five measures of effectiveness in the process of assistance and in the cost per user. Conclusions: The diversity in the management model through EBAs shows results that can be interpreted in favor of the maintenance or the expansion of this model of management. The majority of EBAs have been implanted in areas of a medium or high level, but their results are still significantly positive once the socio economic level of the area is controlled


Assuntos
Humanos , Pessoa de Meia-Idade , Administração Pública , Atenção Primária à Saúde/organização & administração , Modelos de Assistência à Saúde/organização & administração , Modernização do Setor Público , Espanha , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/normas
4.
Aust N Z J Public Health ; 43(6): 538-543, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667912

RESUMO

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.


Assuntos
Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde do Indígena/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Atenção Primária à Saúde/organização & administração , Prisioneiros , Assistência à Saúde/métodos , Feminino , Humanos , Masculino , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Pesquisa Qualitativa , Apoio Social
5.
Nurs Clin North Am ; 54(4): 457-471, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703773

RESUMO

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.


Assuntos
Depressão/diagnóstico , Depressão/terapia , Assistência Centrada no Paciente , Atenção Primária à Saúde/organização & administração , Humanos , Telemedicina , Estados Unidos
6.
Nurs Clin North Am ; 54(4): 473-493, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703774

RESUMO

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.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Atenção Primária à Saúde/organização & administração , Transtornos de Ansiedade/tratamento farmacológico , Humanos , Prevalência , Inquéritos e Questionários
7.
Pan Afr Med J ; 33: 209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692730

RESUMO

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.


Assuntos
Infecções por HIV/enfermagem , Atenção Primária à Saúde/organização & administração , Estudantes de Enfermagem/estatística & dados numéricos , Tuberculose/enfermagem , Adulto , Competência Clínica , Feminino , Humanos , Entrevistas como Assunto , Masculino , Adulto Jovem
8.
Rev Saude Publica ; 53: 98, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31778397

RESUMO

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.


Assuntos
Serviços de Saúde da Criança/provisão & distribução , Serviços de Saúde da Criança/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Brasil , Estudos Transversais , Saúde da Família , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
9.
Pan Afr Med J ; 34: 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762879

RESUMO

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.


Assuntos
Diabetes Mellitus/terapia , Pessoal de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Adulto , Criança , Diabetes Mellitus/diagnóstico , Grupos Focais , Guiné-Bissau , Humanos , Entrevistas como Assunto
10.
BMC Health Serv Res ; 19(1): 785, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675956

RESUMO

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.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Relações Interinstitucionais , Atenção Primária à Saúde/organização & administração , Universidades/organização & administração , Humanos , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Suécia
11.
BMC Health Serv Res ; 19(1): 753, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653211

RESUMO

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.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Tradução , Adulto , Pessoal Técnico de Saúde/economia , Criança , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Médicos de Atenção Primária/estatística & dados numéricos , Inquéritos e Questionários , Suíça
12.
Afr Health Sci ; 19(2): 1841-1848, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656466

RESUMO

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.


Assuntos
Saúde Materna , Centros de Saúde Materno-Infantil/organização & administração , Serviços de Saúde Materno-Infantil/normas , Cooperação do Paciente , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Adulto , Criança , Centros Comunitários de Saúde/organização & administração , Comportamento Contraceptivo , Estudos Transversais , Feminino , Humanos , Quênia , Mortalidade Materna , Gravidez , Atenção Primária à Saúde/organização & administração , Fatores Socioeconômicos
13.
BMC Health Serv Res ; 19(1): 764, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660954

RESUMO

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.


Assuntos
Equidade em Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Canadá , Pesquisa sobre Serviços de Saúde , Humanos
14.
Rev Lat Am Enfermagem ; 27: e3203, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31664411

RESUMO

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.


Assuntos
Doença Crônica/terapia , Pessoal de Saúde/educação , Práticas Interdisciplinares/organização & administração , Atenção Primária à Saúde/organização & administração , Emprego , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Fatores de Tempo
15.
BMC Health Serv Res ; 19(1): 767, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665011

RESUMO

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.


Assuntos
Serviços de Saúde do Indígena/organização & administração , Mão de Obra em Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Austrália , Canadá , Pesquisa sobre Serviços de Saúde , Humanos , Nova Zelândia , Estados Unidos
16.
BMC Health Serv Res ; 19(1): 687, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601199

RESUMO

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).


Assuntos
Assistência à Saúde/normas , Serviço Hospitalar de Emergência/normas , Equidade em Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Colúmbia Britânica , Protocolos Clínicos , Serviço Hospitalar de Emergência/organização & administração , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Análise de Séries Temporais Interrompida , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Racismo/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Violência/estatística & dados numéricos
17.
BMC Health Serv Res ; 19(1): 709, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623609

RESUMO

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.


Assuntos
Demência/terapia , Acesso aos Serviços de Saúde , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Feminino , Grupos Focais , Humanos , Estudos Longitudinais , Masculino , Pesquisa Qualitativa , Saskatchewan
19.
BMC Health Serv Res ; 19(1): 675, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533696

RESUMO

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.


Assuntos
Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Adolescente , Adulto , Criança , Pai/estatística & dados numéricos , Feminino , Gana , Pessoal de Saúde , Humanos , Masculino , Mães/estatística & dados numéricos , Projetos Piloto , Cobertura Universal do Seguro de Saúde/organização & administração
20.
BMC Health Serv Res ; 19(1): 670, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533710

RESUMO

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.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Planejamento em Saúde/organização & administração , Política de Saúde , Formulação de Políticas , Atenção Primária à Saúde/organização & administração , Programas Governamentais , Humanos , Irã (Geográfico) , Programas Nacionais de Saúde/organização & administração , Política , Cobertura Universal do Seguro de Saúde/organização & administração
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