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1.
BMC Health Serv Res ; 19(1): 515, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337391

RESUMO

BACKGROUND: Many international health policies recognise the World Health Organization's (2008) vision that communities should be involved in shaping primary healthcare services. However, researchers continue to debate definitions, models, and operational challenges to community participation. Furthermore, there has been no use of implementation theory to study how community participation is introduced and embedded in primary healthcare in order to generate insights and transferrable lessons for making this so. Using Normalisation Process Theory (NPT) as a conceptual framework, this qualitative study was designed to explore the levers and barriers to the implementation of community participation in primary healthcare as a routine way of working. METHODS: We conducted two qualitative studies based on a national Initiative designed to support community participation in primary care in Ireland. We had a combined multi-stakeholder purposeful sample (n = 72), utilising documentary evidence (study 1), semi-structured interviews (studies 1 and 2) and focus groups (study 2). Data generation and analysis were informed by Participatory Learning and Action (PLA) Research Methodology and NPT. RESULTS: For many stakeholders, community participation in primary healthcare was a new way of working. Stakeholders did not always have a clear, shared understanding of the aims, objectives and benefits of this way of working and getting involved in a specific project sometimes provided this clarity. Drivers/champions, and strong working partnerships, were considered integral to its initiation and implementation. Participants emphasised the benefits of funding, organisational support, training and networking to enact relevant activities. Health-promoting activities and healthcare consultation/information events were generally successful, but community representation on interdisciplinary Primary Care Teams proved more challenging. Overall, participants were broadly positive about the impacts of community participation, but were concerned about the scope to sustain the work without the 'protected' space and resources that the national Initiative afforded. CONCLUSIONS: Despite the success of specific activities undertaken as part of a community process in Irish primary healthcare, the likelihood of this becoming a routine way of working in Ireland is low. Analysing the learning from this process using NPT provides theoretically informed recommendations that are transferrable to other settings and can be used to prospectively design and formatively evaluate community participation processes.


Assuntos
Participação da Comunidade , Atenção Primária à Saúde , Desenvolvimento de Programas/métodos , Grupos Focais , Política de Saúde , Humanos , Irlanda , Modelos Teóricos , Pesquisa Qualitativa , Encaminhamento e Consulta
2.
Int J Evid Based Healthc ; 17 Suppl 1: S68-S71, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283587

RESUMO

In 2016, the Belgian Minister for Social Affairs and Public Health decided to set up a central governance structure for evidence-based practice (EBP). The underlying model, consisting of six EBP life cycle cells (prioritization, development, validation, dissemination, implementation and evaluation) and a bipolar governance layer was developed in 2017. Based on the characteristics of the Belgian EBP landscape, a network administrative organization was chosen to coordinate and facilitate the operational processes in the EBP life cycle and act as intermediate between the two forces: stakeholders and funders/policy makers. Scientific processes remain the responsibility of the EBP experts in the cells. As organizational change can result in resistance, building trust and consensus is a very important success factor for the setup of the network. The process is now in an advanced stage and in 2019 the EBP governance structure will be operationalized.


Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Bélgica , Guias como Assunto/normas , Humanos , Inovação Organizacional , Desenvolvimento de Programas/métodos
3.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31160512

RESUMO

OBJECTIVES: To develop a nationwide, evidence-based framework to support prenatal counseling in extreme prematurity, focusing on organization, decision-making, content, and style aspects. METHODS: A nationwide multicenter RAND-modified Delphi method study was performed between November 2016 and December 2017 in the Netherlands. Firstly, recommendations were extracted from literature and previous studies. Secondly, an expert panel (n = 21) with experienced parents, obstetricians, and neonatologists rated the recommendations on importance for inclusion in the framework. Thirdly, ratings were discussed in a consensus meeting. The final set of recommendations was approved and transformed into a framework. RESULTS: A total of 101 recommendations on organization, decision-making, content, and style were included in the framework, including tools to support personalization. The most important recommendations regarding organization were to have both parents involved in the counseling with both the neonatologist and obstetrician. The shared decision-making model was recommended for deciding between active support and comfort care. Main recommendations regarding content of conversation were explanation of treatment options, information on survival, risk of permanent consequences, impossibility to predict an individual course, possibility for multiple future decision moments, and a discussion on parental values and standards. It was considered important to avoid jargon, check understanding, and provide a summary. The expert panel, patient organization, and national professional associations (gynecology and pediatrics) approved the framework. CONCLUSIONS: A nationwide, evidence-based framework for prenatal counseling in extreme prematurity was developed. It contains recommendations and tools for personalization in the domains of organization, decision-making, content, and style of prenatal counseling.


Assuntos
Aconselhamento/normas , Pessoal de Saúde/normas , Lactente Extremamente Prematuro , Doenças do Prematuro/diagnóstico , Cuidado Pré-Natal/normas , Desenvolvimento de Programas/normas , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/métodos , Aconselhamento/métodos , Técnica Delfos , Feminino , Humanos , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Países Baixos/epidemiologia , Gravidez , Cuidado Pré-Natal/métodos , Desenvolvimento de Programas/métodos , Inquéritos e Questionários
4.
Nurs Womens Health ; 23(3): 224-233, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31077639

RESUMO

OBJECTIVE: To design and implement group prenatal care (GPC) for Somali women and to evaluate participants' satisfaction, knowledge, and care engagement. DESIGN: Quality improvement project. SETTING/LOCAL PROBLEM: A federally qualified health center in an urban Midwestern setting, which serves a largely East African immigrant and refugee population. PARTICIPANTS: Pregnant Somali women at more than 20 weeks gestation receiving prenatal care at the project site. Many participants were non-English speaking. INTERVENTION/MEASUREMENTS: While honoring the 13 essential elements of CenteringPregnancy, the model was adapted to the East African population at the project site and offered to all eligible women receiving individual prenatal care at the clinic. Women attended biweekly sessions, including individual assessment and education, exposure to integrative health therapies, and group discussion. Pre- and postintervention data were collected in surveys and in-depth interviews from March through August 2017. RESULTS: Seventeen Somali women attended a median of two sessions (range = 1-7). Self-reported results for knowledge of safe exercise in pregnancy (p = .02), exclusive breastfeeding (p = .04), what happens in the hospital (p = .02), and stress management (p = .03) increased after GPC participation. Ninety-three percent of women preferred GPC to individual care. CONCLUSION: When adapted to meet the needs of Somali women, GPC has the potential to improve care satisfaction, increase knowledge, and reduce stress during pregnancy and the postpartum period. This model may interest women and care providers in similar community health care settings.


Assuntos
Instituições de Assistência Ambulatorial/tendências , Cuidado Pré-Natal/métodos , Desenvolvimento de Programas/métodos , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Emigrantes e Imigrantes/psicologia , Feminino , Humanos , Meio-Oeste dos Estados Unidos , Áreas de Pobreza , Gravidez , Melhoria de Qualidade , Somália/etnologia , Inquéritos e Questionários
5.
Nurs Womens Health ; 23(3): 253-264, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31059674

RESUMO

Choosing Wisely is a national health care improvement campaign promoting conversations between women and their health care professionals about selecting high-value health care practices. It disseminates lists of recommendations and downloadable educational materials from professional societies on its website. In November 2018, we searched for and categorized Choosing Wisely recommendations pertinent to women's health care. Of 78 recommendations, 28 (36%) were related to perinatal care, 22 (28%) were related to gynecologic care, and 28 (36%) were related to women's health and general care. Twelve recommendations (17.6%) were related to antenatal care, 10 (14.7%) to intrapartum and postpartum care, and 10 (14.7%) to cervical cancer screening. These free resources can help frame the shared decision-making process in clinical practice.


Assuntos
Tomada de Decisões , Melhoria de Qualidade/tendências , Serviços de Saúde da Mulher/normas , Feminino , Humanos , Gravidez , Desenvolvimento de Programas/métodos , Qualidade da Assistência à Saúde/normas , Serviços de Saúde da Mulher/tendências
8.
Clinics (Sao Paulo) ; 74: e435, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994702

RESUMO

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.


Assuntos
Cistostomia/educação , Avaliação Educacional , Modelos Anatômicos , Desenvolvimento de Programas/métodos , Treinamento por Simulação/métodos , Análise Custo-Benefício , Cistostomia/instrumentação , Cistostomia/métodos , Educação de Graduação em Medicina/métodos , Feminino , Humanos , Masculino , Paracentese/educação , Paracentese/instrumentação , Paracentese/métodos , Estudos Prospectivos , Distribuição Aleatória , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Gravação em Vídeo/métodos
9.
World J Surg ; 43(7): 1628-1635, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31004208

RESUMO

BACKGROUND: Mozambique has had no policy-driven trauma system and no hospital-based trauma registries, and injury was not a public health priority. In other low-income countries, trauma system implementation and trauma registries have helped to reduce mortality from injury by up to 35%. In 2014, we introduced a trauma registry in four hospitals in Maputo serving 18,000 patients yearly. The project has since expanded nationally. This study summarizes the challenges, results, and lessons learned from this large national undertaking. METHODS: Between October 2014-September 2015, we implemented a trauma registry at four hospitals in Maputo. In October 2015, the project began to be expanded nationally. Physicians and allied health professionals at each hospital were trained to implement the registry, and each identified and trained data collectors. We conducted semi-structured interviews with the key stakeholders of this project to identify the challenges, results, and creative solutions implemented for the success of this project. RESULTS: Most participants identified the importance of having a trauma registry and its usefulness in identifying gaps in trauma care. The registry identified that less than 5% of injured patients arrived by ambulance, which served as evidence for the need for a prehospital system, which the Ministry of Health had already begun implementing. Participants also highlighted how the registry has allowed for a structured clinical approach to patients, ensuring that severely injured patients are identified early. Challenges reported included the high rates of missing data, the difficulty in establishing a streamlined flow of trauma patients within each hospital, and the bureaucratic challenges faced when attempting to improve capacity for trauma care at each hospital by introducing a trauma bay and new technologies. Participants identified the need to improve data completeness, to disseminate the results of the project nationally and internationally, to improve inter-divisional cooperation, and to continue educating health providers on the importance of registries. Participants also identified political instabilities in the region as a potential source of challenge in expanding the project nationally; they also identified the lack of uniform resource allocation and low personnel in many areas, especially rural, as a major burden that would need to be overcome. CONCLUSION: Introduction of a trauma registry system in Mozambique is feasible and necessary. Initial findings provide insight into the nature of traumas seen in Maputo hospitals, but also underscore future challenges, especially in minimizing missing data, utilizing data to develop evidence-based trauma prevention policies, and ensuring the sustainability of these efforts by ensuring continued governmental support, education, and resource allocation. Many of these measures are being undertaken.


Assuntos
Desenvolvimento de Programas/métodos , Vigilância em Saúde Pública/métodos , Sistema de Registros , Ferimentos e Lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Coleta de Dados/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia , Adulto Jovem
10.
Worldviews Evid Based Nurs ; 16(2): 142-150, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30861333

RESUMO

BACKGROUND: Diabetes is a major health concern in the United States. Poor quality diabetes care leads to negative outcomes affecting patients and healthcare systems. Research shows evidence-based clinical practice guidelines from the American Diabetes Association, Standards of Medical Care in Diabetes-2017, have improved outcomes in management of diabetes. AIMS: The aim of this improvement project was to improve diabetes care and outcomes in a primary care clinic serving a Hispanic community in Miami-Dade, Florida. Specific objectives of the project were to improve primary care provider attitudes and knowledge of American Diabetes Association guidelines and outcomes in patients with diabetes. METHODS: This two-phase quality improvement project used a pre- and post-test study design. In Phase I, the Diabetes Attitude Survey was administered to determine primary care provider attitudes and knowledge of guidelines. Based on survey results, a 2-hr educational intervention was developed to inform providers regarding the American Diabetes Association clinical practice guidelines. In Phase II, data were collected for 19 clinical quality diabetes outcome measures from agency reports. Guidelines were implemented into practice, and intervention effectiveness was evaluated. RESULTS: Statistical analysis (paired-sample t-test) revealed postintervention improvement in provider knowledge and attitudes, and patient outcomes. Findings suggest the intervention led to improvements in the quality of diabetes care in this Hispanic clinic. LINKING EVIDENCE TO ACTION: Project success supports the importance of evidence-based clinical practice guideline use to achieve better diabetes outcomes. Implementation of the American Diabetes Association Standards of Medical Care in Diabetes to improve patient outcomes is strongly recommended. It is equally important that clinical agencies educate and update primary care providers to achieve best practice and best patient diabetes outcomes. Other healthcare professionals can use this project design to provide culturally competent care to patients with diabetes.


Assuntos
Diabetes Mellitus/terapia , Guias como Assunto , Desenvolvimento de Programas/métodos , Hispano-Americanos/psicologia , Humanos , Atenção Primária à Saúde/métodos , Saúde Pública/métodos , Saúde Pública/tendências , Melhoria de Qualidade , Estados Unidos
11.
Int J Gynaecol Obstet ; 144 Suppl 1: 7-12, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30815866

RESUMO

The Expanding Maternal and Neonatal Survival (EMAS) program was implemented from September 2011 to March 2017 to support the Indonesian Ministry of Health to improve the quality of emergency obstetric and newborn care, increase the efficiency and effectiveness of emergency referrals, and increase accountability through local government and civic engagement. EMAS worked in over 400 public and private referral hospitals and community health centers (puskesmas) in six provinces where over 50% of all maternal deaths were occurring. Mentoring was the main method used to improve performance at facilities and within referral systems. The use of data for prospective assessment of indicators of improved quality of care and referral efficiency was strengthened. Case reviews were used to examine contextual factors contributing to maternal deaths in EMAS-target hospitals and external evaluations were used in retrospective assessments of effectiveness of approaches. The vision of sustainability was infused into EMAS approaches from the outset. Collaboration and advocacy with district health offices in EMAS-supported districts enabled self-funding of selected interventions within 23 of 30 EMAS districts and 35 non-EMAS districts. Articles in this Supplement describe outcomes and impact of EMAS approaches over the term of the program.


Assuntos
Mortalidade Infantil , Mortalidade Materna , Desenvolvimento de Programas/métodos , Melhoria de Qualidade/organização & administração , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Recém-Nascido , Serviços de Saúde Materno-Infantil/legislação & jurisprudência , Serviços de Saúde Materno-Infantil/normas , Gravidez , Estudos Prospectivos , Encaminhamento e Consulta/normas , Estudos Retrospectivos
13.
Worldviews Evid Based Nurs ; 16(1): 4-11, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30714308

RESUMO

BACKGROUND: In 2006, our healthcare system created a hospital Evidence-based Practice Center (EPC) to support the local delivery of high-quality, safe and high value patient care. Since then, the importance of healthcare staff work life has also been highlighted, and together these four elements form the Quadruple Aim framework. Synergistic to this Aim, the Magnet® program promotes and recognizes organizational nursing excellence. OBJECTIVE: To examine the EPC's work to inform nursing policy and practice in support of the goals of the Quadruple Aim framework and Magnet® designation. METHODS: Methods used included the following: (1) descriptive analysis of the hospital EPC's database of rapid reviews; and (2) administration of a 40-item electronic questionnaire to nurses who requested an EPC review during fiscal years (FY) 2015 and 2016. RESULTS: Of 308 rapid reviews completed in the EPC's first 10 years, 59 (19%) addressed nursing topics. The proportion of reviews relevant to nursing increased from 5% (2/39) in the center's first 2 years to 44% (25/60) in FY 2015-2016. The majority of nursing reviews (39/59) examined processes of care. Of 23 nurses eligible to participate in the survey, 21 responded (91%). Nurses with administrative or managerial responsibilities requested 70% of reviews; clinical nurse specialists and bedside nurses requested 17% and 9%, respectively. Reviews were used to support clinical program development (48%), provide clinical guidance (33%), update nursing policies or procedures (24%) and develop training and curricula (24%). Nurses were satisfied with the hospital EPC reviews (mean; 4.7/5), and 95% indicated they were likely to request a future review. LINKING EVIDENCE TO ACTION: A dedicated hospital EPC in partnership with nursing offers a unique mechanism for promoting a culture of evidence-based practice. Nurses at all organizational levels use the services of a hospital EPC to inform nursing policy and practice and are highly satisfied with the process, supporting the Quadruple Aim and Magnet® designation.


Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Prática Clínica Baseada em Evidências/normas , Política de Saúde/tendências , Hospitais/tendências , Humanos , Pennsylvania , Desenvolvimento de Programas/métodos , Desenvolvimento de Programas/normas , Inquéritos e Questionários
14.
Hosp Top ; 97(2): 39-45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30755105

RESUMO

The most common form of ownership of medical establishments worldwide is a nonprofit organization. In contrast, the number of nonprofit medical institutions in Georgia is very scarce, while private profit organizations hold about 90% of the medical market. The goal of the research is to study the factors that affect the development of nonprofit hospitals in Georgia. Since there are very few nonprofit medial institutions in Georgia, we hypothesize that there is not enough motivation for functioning of such institutions. For the purposes of this research, six in-depth interviews were conducted with managers and experts of nonprofit organizations. As the research demonstrated, there is no sufficient motivation for functioning of the nonprofit form of medical organizations. Although the Tax Code provides tax benefits, they exist only in a token way and do not support the development of nonprofit medical organizations. It is necessary to improve the tax benefits provided for nonprofit hospitals in the Tax Code and share the world experience in order to increase number of nonprofit organizations in Georgia. It is recommended for Government to give more support to nonprofit organizations, in order to increase their functioning efficiency and bring incentive for development of new nonprofit medical institutions.


Assuntos
Hospitais , Organizações sem Fins Lucrativos/economia , Desenvolvimento de Programas/métodos , República da Geórgia , Humanos , Entrevistas como Assunto/métodos , Organizações sem Fins Lucrativos/tendências , Pesquisa Qualitativa , Impostos/legislação & jurisprudência , Impostos/estatística & dados numéricos
15.
Congenit Heart Dis ; 14(1): 90-94, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811791

RESUMO

OBJECTIVES: Patent ductus arteriosus (PDA) is a common finding in preterm infants. A hemodynamically significant PDA may require intervention for closure. This article aims to describe a transcatheter PDA closure (TCPC) program for preterm infants and the components of a comprehensive outpatient follow-up strategy. SETTING: A multidisciplinary team approach including neonatology, cardiology, anesthesiology, medical transport team, pulmonology, cardiac surgery, neurodevelopmental specialist, nutrition, speech therapy, social work, research collaborators, and other health care specialists is integral to the dedicated care and promotion of wellness of extremely low birth weight (ELBW) infants. PATIENTS: To date, we have performed TCPC on 134 ELBW infants weighing <2 kg at the time of the procedure, 54 of whom were <1 kg with the smallest weighing 640 g with a median gestation age of 25 weeks (range 23-27 weeks). INTERVENTIONS: A comprehensive follow-up strategy with the creation of the Memphis PDA Clinic was implemented. OUTCOME MEASURES: Respiratory support, tolerance of enteral feeds, growth, and neurodevelopmental progress are indicators of favorable outcomes. RESULTS: TCPC has benefited ELBW infants with faster weaning off the ventilator, increase in enteral feedings, and somatic growth with the overall shortening of the hospital length of stay. The Memphis PDA Clinic has ensured optimal postdischarge follow-up to improve long-term outcomes. CONCLUSIONS: TCPC is a safe and effective alternative to manage ELBW infants with a hemodynamically significant PDA. Comprehensive follow-up after discharge provided in a multispecialty clinic developed specifically for this unique population has been successful in improving outcomes.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Recém-Nascido de Baixo Peso , Guias de Prática Clínica como Assunto , Desenvolvimento de Programas/métodos , Humanos , Recém-Nascido
16.
Violence Against Women ; 25(1): 29-55, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30803428

RESUMO

Effective prevention of intimate partner violence (IPV) among adolescents and young adults is a key strategy for reducing rates of gender-based violence (GBV). Numerous initiatives have been developed and evaluated over the past 25 years. There is emerging evidence about effective strategies for universal prevention of dating violence in high school settings and effective bystander interventions on university and college campuses. In addition, there have been some effective practices identified for specific groups of youth who are vulnerable to victimization (either based on past experiences of exposure to domestic violence or previous dating victimization). At the same time, though our evidence about school and college-based interventions has grown, there are significant gaps in our knowledge of effective prevention among marginalized groups. For example, there is a lack of evidence-based strategies for preventing IPV among Indigenous youth; lesbian, gay, bisexual, transgender, questioning+ [LGBTQ+] youth; and young women with disabilities, even though these groups are at elevated risk for experiencing violence. Our review of the current state of evidence for effective GBV prevention among adolescents and young adults suggests significant gaps. Our analysis of these gaps highlights the need to think more broadly about what constitutes evidence. We identify some strategies and a call to action for moving the field forward and provide examples from our work with vulnerable youth in a variety of settings.


Assuntos
Violência de Gênero/psicologia , Avaliação de Programas e Projetos de Saúde/tendências , Adolescente , Criança , Vítimas de Crime/psicologia , Feminino , Violência de Gênero/prevenção & controle , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Masculino , Ontário , Desenvolvimento de Programas/métodos , Desenvolvimento de Programas/normas , Avaliação de Programas e Projetos de Saúde/métodos , Adulto Jovem
17.
Fam Community Health ; 42(2): 104-108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768474

RESUMO

Trauma-informed care has emerged as an important model to address the pervasiveness of traumatic experiences across the life cycle and their association with significant adverse medical and psychiatric consequences. To achieve health equity, in which all people have the opportunity for health, it is crucial for physicians to become comfortable with a neurobiopsychosocial understanding of trauma and how to provide optimal trauma-informed care. Given the pervasiveness of trauma exposure, and its impact on individual and community health, this paradigm shift in adult health care delivery systems requires physician engagement at every stage of development and implementation.


Assuntos
Equidade em Saúde/normas , Política de Saúde/tendências , Desenvolvimento de Programas/métodos , Saúde Pública/normas , Humanos
18.
Glob Health Action ; 12(1): 1570646, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30773102

RESUMO

BACKGROUND: The SAFE strategy (surgery for trichiasis, antibiotics for active infection, facial cleanliness and environmental improvement) is the World Health Organization (WHO) recommended guideline for the elimination of blindness by trachoma by the year 2020. OBJECTIVE: While evaluations on the implementation of the SAFE strategy have been done, systematic reviews on the factors that have shaped implementation are lacking. This review sought to identify these factors. METHODS: We searched PUBMED, Google Scholar, CINAHL and Cochrane Collaboration to identify studies that had implemented SAFE interventions. The Consolidated Framework for Implementation Research (CFIR) guided development of the data extraction guide and data analysis. RESULTS: One hundred and thirty-seven studies were identified and only 10 papers fulfilled the eligibility criteria. Characteristics of the innovation - such as adaptation of the SAFE interventions to suit the setting and observability of positive health outcomes from pilots - increased local adoption. Characteristics of outer setting - which included strong multisectoral collaboration - were found to enhance implementation through the provision of resources necessary for programme activities. When community needs and resources were unaccounted for there was poor compatibility with local settings. Characteristics of the inner setting - such as poor staffing, high labour turnovers and lack of ongoing training - affected health workers' implementation behaviour. Implementation climate within provider organisations was shaped by availability of resources. Characteristics of individuals - which included low knowledge levels - affected the acceptability of SAFE programmes; however, early adopters could be used as change agents. Finally, the use of engagement strategies tailored towards promoting community participation and stakeholder involvement during the implementation process facilitated adoption process. CONCLUSION: We found CFIR to be a robust framework capable of identifying different implementation determinants in low resource settings. However, there is a need for more research on the organisational, provider and implementation process related factors for trachoma as most studies focused on the outer setting.


Assuntos
Promoção da Saúde , Desenvolvimento de Programas/métodos , Tracoma , Cegueira/etiologia , Cegueira/prevenção & controle , Assistência à Saúde , Metas , Pessoal de Saúde , Humanos , Pesquisa , Tracoma/complicações , Organização Mundial da Saúde
19.
Public Health Nurs ; 36(3): 388-400, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30723954

RESUMO

OBJECTIVE: To evaluate the effectiveness of an education program for mid-level Japanese public health nurses (PHNs) to improve their competencies in program planning, which will fulfill community health needs. DESIGN: Randomized control trial. SAMPLE: During 2017, 103 PHNs with 5-20 years of PHN work experience in Japan were enrolled and randomly allocated to the intervention (n = 51) or control group (n = 52). MEASUREMENTS: The primary outcome measured competency in program planning based on Competency Measurement of Creativity for PHNs (CMC), knowledge, and skills regarding program planning. INTERVENTION: Six web-based learning modules followed by two face-to-face group sessions. RESULTS: The PHN participants averaged about 12 years of experience. In the intervention group, 25 PHNs completed all modules (49.0%). Post intervention, there were no statistically significant differences among any between-group CMC scores. However, the intervention group's CMC 3 score was significantly higher than that of the control group of ≥12 years of experience. Total knowledge and skill scores also improved significantly in the intervention group compared with the control group. CONCLUSIONS: The results suggest that PHNs with ≥12 years of experience are a suitable target of this educational program, and should play a key role in program planning.


Assuntos
Enfermeiras de Saúde Pública/educação , Desenvolvimento de Programas/métodos , Enfermagem em Saúde Pública/educação , Adulto , Feminino , Humanos , Japão , Masculino
20.
BMC Musculoskelet Disord ; 20(1): 85, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777049

RESUMO

BACKGROUND: Reassuring patient education and exercise therapy are widely recommended interventions for back pain in clinical guidelines. However, many patients are offered non-guideline endorsed options, and strategies for effective implementation of guideline-based care have not yet been developed. This protocol outlines the evaluation of a strategy for nationwide implementation of standardised patient education and exercise therapy for people with persistent or recurrent back pain in a hybrid implementation-effectiveness design. The strategy and the evaluation were planned using the framework of the Behaviour Change Wheel. METHODS: The main activity of the implementation strategy is a two-days course for physiotherapists and chiropractors in delivering patient education and exercise therapy that is aimed at supporting patient self-management. This comes with ready-to-use patient education materials and exercise programs. The clinical intervention is a group-based program consisting of two sessions of patient education and 8 weeks of supervised exercises. The program uses a cognitive-behavioural approach and the aim of the exercise component is to restore the patient's ability and confidence to move freely. The implementation process is evaluated in a dynamic process monitoring the penetration, adoption and fidelity of the clinical intervention. The clinical intervention and potential effect mechanisms will be evaluated at the patient-level using measures of knowledge, skills, beliefs, performance, self-efficacy and success in self-management. The education of clinicians will be evaluated via clinician-level outcomes, including the Pain Attitudes and Beliefs Scale, the Practitioner Confidence Scale, and the Determinants of Implementation Behaviour Questionnaire. Effects at a national level will be investigated via data from national registries of health care utilisation and sick-leave. DISCUSSION: This implementation-effectiveness study is designed to evaluate the process of implementing an evidence-based intervention for back pain. It will inform the development of strategies for implementing evidence-based care for musculoskeletal pain conditions, it will enhance the understanding of mechanisms for developing patient self-management skills, and it will demonstrate the outcomes that are achievable in everyday clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT03570463 . Registered 27 June 2018.


Assuntos
Dor nas Costas/terapia , Terapia por Exercício/métodos , Educação de Pacientes como Assunto/métodos , Desenvolvimento de Programas/métodos , Autogestão/métodos , Dor nas Costas/epidemiologia , Dinamarca/epidemiologia , Terapia por Exercício/psicologia , Humanos , Manipulação Quiroprática/métodos , Fisioterapeutas , Autogestão/psicologia , Resultado do Tratamento
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