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3.
J Prev Med Public Health ; 52(3): 200-204, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31163956

RESUMO

On September 12, 2018, President Jae-In Moon announced the Comprehensive Plan for Lifelong Care for People with Developmental Disabilities, with representatives from the associated government branches (Ministry of Health and Welfare, Ministry of Education, and Ministry of Employment and Labor) in attendance. The goals of this plan are to provide health, medical, rehabilitative, special education, and social welfare services according to the life-stages of the affected individuals; to reduce parental pressure; to promote social interventions; and to enhance community-level participation in order to create a 'welfare society in harmony.' However, in order for the plan to succeed, additional efforts must be made in the following areas. First, an epidemiological survey is needed to understand the scale, prevalence, and incidence of developmental disabilities and to establish an evidence base to support policy development. Second, accurate definitions of developmental disabilities must be established in order to avoid policy discrimination based on impairment type and age. Third, personal evaluations to assess disabled individuals' unmet needs and customized service designs to deliver those needs are required. Fourth, the plan must fulfill the goals of accessibility and fairness that the government intends to provide. Fifth, the government should consider an integrated financial support system and to propose a detailed plan for monetary distributions. Finally, an integrated system that links health, medical, employment, educational, and welfare services must be constructed.


Assuntos
Planejamento em Saúde Comunitária/métodos , Deficiências do Desenvolvimento/terapia , Programas Governamentais/tendências , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Planejamento em Saúde Comunitária/tendências , Deficiências do Desenvolvimento/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Inquéritos e Questionários
5.
J Public Health Manag Pract ; 25(3): 262-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29889180

RESUMO

OBJECTIVE: The Continuum of Care (CoC) process-a nationwide system of regional collaborative planning networks addressing homelessness-is the chief administrative method utilized by the US Department of Housing and Urban Development to prevent and reduce homelessness in the United States. The objective of this study is to provide a benchmark comprehensive picture of the structure and practices of CoC networks, as well as information about which of those factors are associated with lower service gaps, a key goal of the initiative. DESIGN: A national survey of the complete population of CoCs in the United States was conducted in 2014 (n = 312, 75% response rate). This survey is the first to gather information on all available CoC networks. Ordinary least squares (OLS) regression was used to determine the relationship between internal networking, advocacy frequency, government investment, and degree of service gaps for CoCs of different sizes. SETTING: United States. PARTICIPANTS: Lead contacts for CoCs (n = 312) that responded to the 2014 survey. MAIN OUTCOME MEASURE: Severity of regional service gaps for people who are homeless. RESULTS: Descriptive statistics show that CoCs vary considerably in regard to size, leadership, membership, and other organizational characteristics. Several independent variables were associated with reduced regional service gaps: networking for small CoCs (ß = -.39, P < .05) and local government support for midsized CoCs (ß = -.10, P < .05). For large CoCs, local government support was again significantly associated with lower service gaps, but there was also a significant interaction effect between advocacy and networking (ß = .04, P < .05). CONCLUSIONS: To reduce service gaps and better serve the homeless, CoCs should consider taking steps to improve networking, particularly when advocacy is out of reach, and cultivate local government investment and support.


Assuntos
Planejamento em Saúde Comunitária/métodos , Comportamento Cooperativo , Pessoas em Situação de Rua/estatística & dados numéricos , Adulto , Planejamento em Saúde Comunitária/normas , Planejamento em Saúde Comunitária/tendências , Assistência à Saúde/métodos , Assistência à Saúde/normas , Feminino , Habitação/normas , Habitação/estatística & dados numéricos , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , Defesa do Paciente , Inquéritos e Questionários , Estados Unidos
6.
Acad Med ; 94(4): 501-506, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30520810

RESUMO

To address gaps in U.S. health care outcomes, medical education is evolving to incorporate new competencies, as well as to align with care delivery transformation and prepare systems-ready providers. These new health systems science (HSS) competencies-including value-based care, quality improvement, social determinants of health, population health, informatics, and systems thinking-require formal education and role modeling in both classroom and clinical settings. This is challenging because few faculty had formal training in how to practice or teach these concepts. Thus, these new competencies require both expanding current educators' skills and a new cohort of educators, especially interprofessional clinicians. Additionally, because interprofessional teams are the foundation of many clinical learning environments, medical schools are developing innovative experiential activities that include interprofessional clinicians as teachers. This combination of a relative "expertise vacuum" within the current cohort of medical educators and expanding need for workplace learning opportunities requires a reimagining of medical school teachers. Based on experiences implementing HSS curricula at two U.S. medical schools (Penn State College of Medicine and University of California, San Francisco, School of Medicine, starting in 2013), this Perspective explores the need for new educator competencies and the implications for medical education, including the need to identify and integrate "new" educators into the education mission, develop faculty educators' knowledge and skills in HSS, and acknowledge and reward new and emerging educators. These efforts have the potential to better align the clinical and education missions of academic health centers and cultivate the next generation of physician leaders.


Assuntos
Planejamento em Saúde Comunitária/métodos , Papel Profissional , Planejamento em Saúde Comunitária/tendências , Educação Médica/métodos , Educação Médica/tendências , Docentes de Medicina/educação , Docentes de Medicina/tendências , Humanos , Competência Profissional/normas , Melhoria de Qualidade , São Francisco , Estados Unidos
7.
Acad Med ; 94(4): 544-549, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30570498

RESUMO

PROBLEM: In 2017, there were 25.4 million refugees worldwide, of whom 33,400 were resettled in the United States. In fiscal year 2016, 20,455 individuals were granted permanent asylum status in the United Sates. Both in the United States and overseas, refugees/asylees face significant disparities in accessing needed medical, mental health, and social support. APPROACH: The Refugee Health Partnership (RHP) was developed by Johns Hopkins University School of Medicine students and colleagues at a local refugee resettlement agency in 2011. The program pairs teams of preclinical medical students with recently resettled refugees/asylees who have special health care needs. After receiving training, students conducted monthly home visits and accompanied patients to appointments to assist them in navigating the health care system over one year. Students participated in monthly reflection exercises to process experiences and attended monthly seminars facilitated by expert faculty and guests. OUTCOMES: From 2012 to 2016, the RHP served 20 refugee families and engaged 60 students across four cohorts. Refugee participant retention was 20/22 (90.9%), and student retention was 57/60 (95.0%). In surveys completed at the end of their programs, students reported improvement in all measures, including understanding of different patient perspectives as well as comfort in communicating with patients across cultures and language barriers. NEXT STEPS: The authors plan to integrate more objective measures of students' progress into the evaluations. They are scaling this model up both locally and beyond and plan to gather data from refugee/asylee participants to more accurately assess how they benefit from the program.


Assuntos
Currículo/tendências , Parcerias Público-Privadas , Refugiados/estatística & dados numéricos , Estudantes de Medicina/psicologia , Planejamento em Saúde Comunitária/métodos , Planejamento em Saúde Comunitária/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Área Carente de Assistência Médica , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
8.
Gac. sanit. (Barc., Ed. impr.) ; 32(6): 539-546, nov.-dic. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-174287

RESUMO

Objective: This research explores the role of social capital in urban citizens’ initiatives in the Netherlands, by using in-depth interviews. Method: Social capital was operationalized as shared norms and values, connectedness, trust and reciprocity. Results: The findings show that initiatives form around a shared idea or ambition (shared norms and values). An existing network of relationships (connectedness) is needed for an idea to emerge and take form. Connectedness can also increase as a result of an initiative. Some level of trust between people needs to be present from the start of the initiative. For the initiative to persist, strong in-group connections seem important, as well as a good balance between investments and returns. This reciprocity is mainly about intangible assets, such as energy and friendship. Conclusion: This study concludes that social capital within citizens’ initiatives is both a prerequisite for the formation of initiatives and a result of the existence of initiatives


Objetivo: Explorar, mediante la realización de entrevistas en profundidad, el papel del capital social en las iniciativas de los ciudadanos de zonas urbanas de los Países Bajos. Método: Se conceptualizó el capital social como normas y valores compartidos, conectividad, confianza y reciprocidad. Resultados: Las iniciativas se forman alrededor de una idea o ambición compartida (normas y valores compartidos). Es necesaria la existencia de una red de relaciones previa (conectividad) para que una idea surja y tome forma. La conectividad también puede incrementarse como resultado de la iniciativa. Desde el inicio de la iniciativa debe estar presente un nivel mínimo de confianza entre las personas. Para que la iniciativa persista, parecen importantes las conexiones fuertes dentro del grupo, así como un buen equilibrio entre los esfuerzos y los beneficios obtenidos. Esta reciprocidad se refiere principalmente a bienes inmateriales, como la energía y la amistad. Conclusión: Este estudio concluye que el papel del capital social en las iniciativas de los ciudadanos de zonas urbanas es tanto un requisito para la aparición de iniciativas como el resultado de la existencia de algunas iniciativas


Assuntos
Humanos , Capital Social , Pesquisa Participativa Baseada na Comunidade , Planejamento Social , Planejamento em Saúde Comunitária/tendências , Países Baixos/epidemiologia , Participação da Comunidade , População Urbana/tendências , Entrevistas como Assunto
10.
Intern Med J ; 47(12): 1405-1411, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28742280

RESUMO

BACKGROUND: Epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) is a subgroup of oncogene addicted lung cancer that predicts response to tyrosine kinase inhibitors (TKI). However, there is variability in response and survival outcomes in patients with EGFR mutation treated with TKI. AIM: To describe clinical characteristics, treatment patterns and factors influencing outcomes in patients with EGFR-mutated NSCLC in South Western Sydney Local Health District. METHODS: Retrospective review of patients with EGFR-mutated NSCLC diagnosed between January 2010 and June 2016. RESULTS: A total of 85 EGFR-mutated NSCLC patients was identified; 80 (94%) received first-line treatment with EGFR-TKI. The median follow-up was 10.7 months with a median duration of treatment of 9 months. On disease progression (n = 44), 37% had best supportive care only, 30% received chemotherapy, 23% participated in clinical trials, 7% continued on a first generation EGFR-TKI and 3% received afatinib. Overall response rate to first-line EGFR-TKI was 66%. Median progression-free survival (PFS) was 10.7 months (range 2.7-55.9 months) and median overall survival (OS) was 23 months (range 0.4-35.8 months). Multivariate Cox regression analysis showed that patients with lower disease burden (<4 sites) had longer PFS (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.18-0.72, P = 0.004) but not OS. Good performance status predicts longer OS (HR 0.33, CI 0.14-0.77, P = 0.01). Lower (<5) pre-treatment neutrophil-to-lymphocyte ratio (NLR) was associated with better PFS (HR 0.40, 95% CI 0.18-0.87, P = 0.02) and OS (HR 0.43, 95% CI 0.19-0.94, P = 0.04). There were no survival differences when patients were stratified by age, baseline albumin level and types of EGFR mutation. CONCLUSION: Results from this community-based cohort confirm known prognostic factors in patients with EGFR-mutated NSCLC receiving TKI and suggest the negative influence of a heightened host systemic inflammatory response on patient outcomes.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/genética , Receptores ErbB/genética , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/genética , Mutação/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/terapia , Planejamento em Saúde Comunitária/métodos , Planejamento em Saúde Comunitária/tendências , Progressão da Doença , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
11.
Mil Med Res ; 4(1): 32, 2017 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-29502517

RESUMO

Hospital-acquired infections (HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, we characterized how strategy and technology could be mobilized to improve the effectiveness of infection prevention and control in hospitals during the outbreaks of Ebola, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) in Asia and West Africa. Published literature on the hospital-borne outbreaks of SARS, Ebola, and MERS in Asia and West Africa was comprehensively reviewed. The results showed that healthcare systems and hospital management in affected healthcare facilities had poor strategies and inadequate technologies and human resources for the prevention and control of HAIs, which led to increased morbidity, mortality, and unnecessary costs. We recommend that governments worldwide enforce disaster risk management, even when no outbreaks are imminent. Quarantine and ventilation functions should be taken into consideration in architectural design of hospitals and healthcare facilities. We also recommend that health authorities invest in training healthcare workers for disease outbreak response, as their preparedness is essential to reducing disaster risk.


Assuntos
Planejamento em Saúde Comunitária/métodos , Assistência à Saúde/tendências , Doença Iatrogênica/prevenção & controle , Controle de Infecções/normas , África Ocidental/epidemiologia , Ásia/epidemiologia , Planejamento em Saúde Comunitária/tendências , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/epidemiologia , Assistência à Saúde/métodos , Países em Desenvolvimento/estatística & dados numéricos , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/etiologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Doença Iatrogênica/epidemiologia , Controle de Infecções/métodos , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/etiologia , Síndrome Respiratória Aguda Grave/prevenção & controle
12.
Am J Health Syst Pharm ; 73(23): 1956-1966, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-27864203

RESUMO

PURPOSE: The development and implementation of a multidisciplinary pharmacogenomics clinic within the framework of an established community-based medical genetics program are described. SUMMARY: Pharmacogenomics is an important component of precision medicine that holds considerable promise for pharmacotherapy optimization. As part of the development of a health system-wide integrated pharmacogenomics program, in early 2015 Northshore University Health-System established a pharmacogenomics clinic run by a multidisciplinary team including a medical geneticist, a pharmacist, a nurse practitioner, and genetic counselors. The team identified five key program elements: (1) a billable-service provider, (2) a process for documentation of relevant medication and family histories, (3) personnel with the knowledge required to interpret pharmacogenomic results, (4) personnel to discuss risks, benefits, and limitations of pharmacogenomic testing, and (5) a mechanism for reporting results. The most important program component is expert interpretation of genetic test results to provide clinically useful information; pharmacists are well positioned to provide that expertise. At the Northshore University HealthSystem pharmacogenomics clinic, patient encounters typically entail two one-hour visits and follow a standardized workflow. At the first visit, pharmacogenomics-focused medication and family histories are obtained, risks and benefits of genetic testing are explained, and a test sample is collected; at the second visit, test results are provided along with evidence-based pharmacotherapy recommendations. CONCLUSION: A multidisciplinary clinic providing genotyping and related services can facilitate the integration of pharmacogenomics into clinical care and meet the needs of early adopters of precision medicine.


Assuntos
Planejamento em Saúde Comunitária/tendências , Serviços Comunitários de Farmácia/tendências , Equipe de Assistência ao Paciente/tendências , Farmacogenética/tendências , Papel Profissional , Planejamento em Saúde Comunitária/métodos , Testes Genéticos/métodos , Testes Genéticos/tendências , Humanos , Farmacogenética/métodos , Medicina de Precisão/métodos , Medicina de Precisão/tendências
13.
Soc Sci Med ; 157: 96-102, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27077704

RESUMO

Much research aimed at developing measures for normative criteria to guide the assessment of healthcare resource allocation decisions has focused on health maximization, equity concerns and more recently approaches based on health capabilities. However, a widely embraced idea is that health resources should be allocated to meet health needs. Little attention has been given to the principle of need which is often mentioned as an alternative independent criteria that could be used to guide healthcare evaluations. This paper develops a model and indicator of need satisfaction that aggregates the health needs of a population in a particular time period into a single measure that weights individual health needs by the severity of their ill health. The paper provides a first step towards formalizing the principle of need as a measurable objective for healthcare policy and we discuss some challenges for future research, including incorporating the duration of time into need-based health evaluations.


Assuntos
Planejamento em Saúde Comunitária/métodos , Política de Saúde/tendências , Prioridades em Saúde/tendências , Determinação de Necessidades de Cuidados de Saúde/tendências , Planejamento em Saúde Comunitária/tendências , Humanos , Pesos e Medidas
14.
Am J Health Syst Pharm ; 73(7): 463-7, 2016 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-27001988

RESUMO

PURPOSE: An initiative to optimize the treatment of malignant hyperthermia in surgical patients through a dantrolene product conversion program is described. SUMMARY: A large health system's formulary evaluation of a new dantrolene sodium product indicated that despite a higher cost per treatment course, the product could offer key advantages over older formulations of dantrolene in terms of preparation and administration time, product content, and storage requirements. A work group, consisting of pharmacy personnel, an anesthesiologist, a nurse anesthetist, and a representative of the health system's group purchasing organization, determined that a switch to the new dantrolene product would offer both patient care benefits and process benefits. With the approval of the health system's pharmacy and therapeutics committee, the new product was added to the formulary as the preferred dosage form of dantrolene, and existing dantrolene product stock was converted to the new formulation. Key implementation steps included (1) concurrent replacement of dantrolene stock on all "malignant hyperthermia carts" across the 15-hospital health system, (2) development of educational materials to raise awareness of the conversion and revised product preparation procedures, (3) anesthesiology provider and pharmacy staff education, (4) revision of dantrolene listings in each hospital's computerized prescriber-order-entry system, and (5) redistribution of returned dantrolene product stock. The dantrolene product conversion occurred over a four-month period. CONCLUSION: A multifacility health system was successful in converting an existing stock of dantrolene to a newly available formulation.


Assuntos
Planejamento em Saúde Comunitária/métodos , Dantroleno/administração & dosagem , Composição de Medicamentos/métodos , Hipertermia Maligna/tratamento farmacológico , Relaxantes Musculares Centrais/administração & dosagem , Serviço de Farmácia Hospitalar/métodos , Planejamento em Saúde Comunitária/tendências , Composição de Medicamentos/tendências , Humanos , Hipertermia Maligna/diagnóstico , Serviço de Farmácia Hospitalar/tendências
15.
Am J Occup Ther ; 70(1): 7001090010p1-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26709420

RESUMO

Occupational therapy practitioners play an important role in improving the health of populations through the development of occupational therapy interventions at the population level and through advocacy to address occupational participation and the multiple determinants of health. This article defines and explores population health as a concept and describes the appropriateness of occupational therapy practice in population health. Support of population health practice as evidenced in the official documents of the American Occupational Therapy Association and the relevance of population health for occupational therapy as a profession are reviewed. Recommendations and directions for the future are included related to celebration of the achievements of occupational therapy practitioners in the area of population health, changes to the Occupational Therapy Practice Framework and educational accreditation standards, and the importance of supporting, recognizing, rewarding, and valuing occupational therapy practitioners who assume roles in which direct care is not their primary function.


Assuntos
Planejamento em Saúde Comunitária/organização & administração , Terapia Ocupacional , Atenção Primária à Saúde/organização & administração , Planejamento em Saúde Comunitária/tendências , Humanos , Atenção Primária à Saúde/tendências
16.
Obes Rev ; 16(6): 454-72, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25824957

RESUMO

The implementation of intersectoral community approaches targeting childhood obesity (IACO) is considered challenging. To help overcome these challenges, an overview of the evidence to date is needed. We searched four databases to identify papers that reported on the determinants of successful implementation of IACOs, resulting in the inclusion of 25 studies. We appraised study quality with the Crowe Critical Appraisal Tool and the Quality Framework; reported implementation outcome indicators were reviewed via narrative synthesis. Quality of included studies varied. The most frequently reported indicators of implementation success were fidelity and coverage. Determinants related to the social-political context and the organization were most often cited as influencing implementation, in particular, 'collaboration between community partners', 'the availability of (human) resources' and 'time available for implementation'. The association between determinants and implementation variability was never explicated. We conclude that although some insights into the effective implementation of IACOs are present, more research is needed. Emphasis should be placed on elucidating the relationship between determinants and implementation success. Research should further focus on developing a 'golden standard' for evaluating and reporting on implementation research. These actions will improve the comparison of study outcomes and may constitute the cumulative development of knowledge about the conditions for designing evidence-based implementation strategies.


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Planejamento em Saúde Comunitária , Serviços de Saúde Comunitária , Medicina Baseada em Evidências , Implementação de Plano de Saúde , Promoção da Saúde/métodos , Obesidade Pediátrica/prevenção & controle , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Criança , Pré-Escolar , Planejamento em Saúde Comunitária/tendências , Serviços de Saúde Comunitária/tendências , Implementação de Plano de Saúde/tendências , Promoção da Saúde/tendências , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Atividade Motora , Política Nutricional
17.
Am J Health Syst Pharm ; 72(2): 133-42, 2015 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-25550137

RESUMO

PURPOSE: Pharmacists' satisfaction with a computerized prescriber order-entry (CPOE) system and the impact of CPOE on pharmacy workflows and order verification were investigated. SUMMARY: A mixed-method study was conducted to evaluate the implementation of a CPOE system in three hospitals of a large Michigan-based health system and early user experience with the system. Surveys of pharmacists before (n = 54) and after (n = 42) CPOE implementation indicated that they held generally positive expectations about CPOE prior to and during system implementation and continued to hold positive views about CPOE after several months of system use. In interviews and focus group discussions, pharmacists reported a number of important CPOE benefits, but they also cited challenges related to CPOE provider alerts, uncertainty about medication timing, and the need to support providers by serving as informal CPOE system trainers. Direct observation of pharmacists before and after CPOE implementation indicated decreases in both the rate of order clarification events (from 0.89 to 0.35 per hour, p < 0.001) and the average time spent per hour clarifying orders (from 4.75 to 2.11 minutes, p = 0.008). CONCLUSION: Several months after CPOE implementation, pharmacists indicated that several aspects of their workload had improved, including the process of medication order clarification, their ability to prioritize work, and their ability to move around within the hospital to respond to demand. However, pharmacists also noted that order ambiguity still existed and that the system needed to be optimized to gain efficiencies and increase clarity.


Assuntos
Planejamento em Saúde Comunitária/tendências , Sistemas de Registro de Ordens Médicas/tendências , Sistemas de Medicação no Hospital/tendências , Farmacêuticos/tendências , Farmácia/tendências , Sistemas de Informação em Farmácia Clínica/tendências , Planejamento em Saúde Comunitária/métodos , Coleta de Dados/métodos , Coleta de Dados/tendências , Humanos , Michigan , Farmácia/métodos
18.
J Public Health Manag Pract ; 21(6): 546-55, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26785397

RESUMO

Public health HIV prevention efforts have begun to focus on addressing social and structural factors contributing to HIV risk, such as unstable housing, unemployment, and access to health care. With a limited body of evidence-based structural interventions for HIV, communities tasked with developing structural changes need a defined process to clarify their purpose and goals. This article describes the adaptations made to a coalition development model with the purpose of improving the start-up phase for a second group of coalitions. Modifications focused on preparing coalitions to more efficiently apply structural change concepts to their strategic planning activities, create more objectives that met study goals, and enhance coalition procedures such as building distributed coalition leadership to better support the mobilization process. We report on primary modifications to the process, findings for the coalitions, and recommendations for public health practitioners who are seeking to start a similar coalition.


Assuntos
Planejamento em Saúde Comunitária/métodos , Infecções por HIV/prevenção & controle , Coalizão em Cuidados de Saúde/tendências , Fatores Socioeconômicos , Estudos de Coortes , Planejamento em Saúde Comunitária/tendências , Comportamento Cooperativo , Humanos , Liderança , Desenvolvimento de Programas/métodos
19.
J Nurs Manag ; 23(4): 459-67, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-23895504

RESUMO

AIM: To establish the extent to which professional role identity shapes community nurses' reactions before the implementation of a policy that sought to introduce a generic role. BACKGROUND: Many countries seek to alter community nurse roles to address changes in population health and health workforce. We know little about the influences that might shape nurses' reaction to these policies before their implementation and our theoretical understanding is poorly developed at this point in the policy-making cycle. METHOD: Self completed cross-sectional survey of 703 community nurses before the introduction of a generic Community Health Nurse role in Scotland. RESULT: The minority (33%) supported the new role. The professional role identity of those who were supportive differed significantly from those who did not support the policy or were uncertain of it. CONCLUSION: It is possible that the new policy acted to increase the value of the professional role identity of those who were supportive and conversely devalued the professional role identity of those who were unsupportive or uncertain of it. IMPLICATIONS: Professional role identity should be considered by policy makers in any country seeking to introduce policies that aim to radically change the role of community nurses and that this is acknowledged at an early stage in the policy-making cycle.


Assuntos
Política de Saúde/tendências , Papel do Profissional de Enfermagem/psicologia , Enfermeiras e Enfermeiros/psicologia , Planejamento em Saúde Comunitária/normas , Planejamento em Saúde Comunitária/tendências , Estudos Transversais , Humanos , Liderança , Papel Profissional/psicologia , Escócia
20.
Health Aff (Millwood) ; 33(6): 1058-66, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24889956

RESUMO

In the past decade, "big push" global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program's implementation, its ownership by national ministries of health, and its effects on health systems. The project's impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large "dose" of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President's Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control.


Assuntos
Planejamento em Saúde Comunitária/organização & administração , Planejamento em Saúde Comunitária/tendências , Países em Desenvolvimento , Planos de Sistemas de Saúde/organização & administração , Planos de Sistemas de Saúde/tendências , Mortalidade Materna/etnologia , Mortalidade Materna/tendências , Pobreza/etnologia , Planejamento em Saúde Comunitária/economia , Análise Custo-Benefício/tendências , Países em Desenvolvimento/economia , Feminino , Previsões , Saúde Global , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Recém-Nascido , Pobreza/economia , Gravidez , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/tendências , Uganda , Zâmbia
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