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6.
Am J Public Health ; 110(10): 1472-1475, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816543

RESUMO

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.


Assuntos
Redes Comunitárias/tendências , Tempestades Ciclônicas , Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde , Assistência à Saúde/estatística & dados numéricos , Desastres , Financiamento Governamental/economia , Humanos , Louisiana , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências
7.
PLoS One ; 15(8): e0236169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745081

RESUMO

In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Desenvolvimento Sustentável , Cobertura Universal do Seguro de Saúde/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Academias de Ginástica/organização & administração , Academias de Ginástica/estatística & dados numéricos , Reforma dos Serviços de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Índia , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
8.
Rev Saude Publica ; 54: 74, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32725099

RESUMO

OBJECTIVE To analyze the recommendations of international organizations based on the Washington Consensus on health system reforms of selected countries in Latin America and the Caribbean in the 1980s and 1990s and to investigate the effects of the competitive market logic on public action in the health system. METHODS Comparative analysis of the characteristics of health system reforms conducted in the 1980s and 1990s, still seen in Brazil, Argentina, Chile, Colombia, Mexico and Peru. Data were collected by documental analysis and literature review. The systems were described based on the characteristics of: co-payment, privatization mechanisms, decentralization, fragmentation of the system, integration of funding sources and coverage of the population (universal or segmented). RESULTS The reforms were implemented differently, worsening inequalities in health service delivery systems. Changes related to the neoliberal idea of transforming public action in the direction of private logic point to the predominance of competition rules and the reduction in economic costs in all countries analyzed, contrary to the logic of universal health systems. CONCLUSION The reduction in economic costs, the fragmentation of systems and inequalities in the provision of health services, among others, may mean other future costs resulting from low protection to the population's health. A striking and multidimensional counter-reform is essential to make health a right of all again, in a solidarity system that can lead to the reduction in inequalities and a more democratic society.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Política , Humanos , América Latina
10.
J Orthop Surg Res ; 15(1): 279, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703305

RESUMO

BACKGROUND: According to the required reorganization of all hospital activities, the recent COVID-19 pandemic had dramatic consequences on the orthopedic world. We think that informing the orthopedic community about the strategy that we adopted both in our hospital and in our Department of Orthopedics could be useful, particularly for those who are facing the pandemic later than Italy. METHODS: Changes were done in our hospital by medical direction to reallocate resources to COVID-19 patients. In the Orthopedic Department, a decrease in the number of beds and surgical activity was stabilized. Since March 13, it has been avoided to perform elective surgery, and since March 16, non-urgent outpatient consultations were abolished. This activity reduction was associated with careful evaluation of staff and patients: extensive periodical swab testing of all healthcare staff and swab testing of all surgical patients were applied. RESULTS: These restrictions determined an overall reduction of all our surgical activities of 30% compared to 2019. We also had a reduction in outpatient clinic activities and admissions to the orthopedic emergency unit. Extensive swab testing has proven successful: of more than 160 people tested in our building, only three COVID-19 positives were found, and of over more than 200 surgical procedures, only two positive patients were found. CONCLUSIONS: Extensive swab test of all people (even if asymptomatic) and proactive tracing and quarantining of potential COVID-19 positive patients may diminish the virus spread.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ortopedia/organização & administração , Pneumonia Viral/epidemiologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Emergências , Reforma dos Serviços de Saúde/organização & administração , Hospitalização , Humanos , Controle de Infecções/organização & administração , Itália/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Centro Cirúrgico Hospitalar/organização & administração
11.
Eur J Cardiothorac Surg ; 58(2): 319-327, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32584978

RESUMO

OBJECTIVES: During the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic, Northern Italy had to completely reorganize its hospital activity. In Lombardy, the hub-and-spoke system was introduced to guarantee emergency and urgent cardiovascular surgery, whereas most hospitals were dedicated to patients with coronavirus disease 2019 (COVID-19). The aim of this study was to analyse the results of the hub-and-spoke organization system. METHODS: Centro Cardiologico Monzino (Monzino) became one of the four hubs for cardiovascular surgery, with a total of eight spokes. SARS-CoV-2 screening became mandatory for all patients. New flow charts were designed to allow separated pathways based on infection status. A reorganization of spaces guaranteed COVID-19-free and COVID-19-dedicated areas. Patients were also classified into groups according to their pathological and clinical status: emergency, urgent and non-deferrable (ND). RESULTS: A total of 70 patients were referred to the Monzino hub-and-spoke network. We performed 41 operations, 28 (68.3%) of which were emergency/urgent and 13 of which were ND. The screening allowed the identification of COVID-19 (three patients, 7.3%) and non-COVID-19 patients (38 patients, 92.7%). The newly designed and shared protocols guaranteed that the cardiac patients would be divided into emergency, urgent and ND groups. The involvement of the telematic management heart team allowed constant updates and clinical discussions. CONCLUSIONS: The hub-and-spoke organization system efficiently safeguards access to heart and vascular surgical services for patients who require ND, urgent and emergency treatment. Further reorganization will be needed at the end of this pandemic when elective cases will again be scheduled, with a daily increase in the number of operations.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Cirurgia Torácica/organização & administração , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Emergências , Reforma dos Serviços de Saúde/organização & administração , Prioridades em Saúde , Humanos , Controle de Infecções/organização & administração , Colaboração Intersetorial , Itália/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Centro Cirúrgico Hospitalar/organização & administração , Procedimentos Cirúrgicos Torácicos/normas
12.
Int J Health Serv ; 50(4): 396-407, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32515260

RESUMO

While the COVID-19 pandemic presents every nation with challenges, the United States' underfunded public health infrastructure, fragmented medical care system, and inadequate social protections impose particular impediments to mitigating and managing the outbreak. Years of inadequate funding of the nation's federal, state, and local public health agencies, together with mismanagement by the Trump administration, hampered the early response to the epidemic. Meanwhile, barriers to care faced by uninsured and underinsured individuals in the United States could deter COVID-19 care and hamper containment efforts, and lead to adverse medical and financial outcomes for infected individuals and their families, particularly those from disadvantaged groups. While the United States has a relatively generous supply of Intensive Care Unit beds and most other health care infrastructure, such medical resources are often unevenly distributed or deployed, leaving some areas ill-prepared for a severe respiratory epidemic. These deficiencies and shortfalls have stimulated a debate about policy solutions. Recent legislation, for instance, expanded coverage for testing for COVID-19 for the uninsured and underinsured, and additional reforms have been proposed. However comprehensive health care reform - for example, via national health insurance - is needed to provide full protection to American families during the COVID-19 outbreak and in its aftermath.


Assuntos
Infecções por Coronavirus/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Administração em Saúde Pública/economia , Betacoronavirus , Técnicas de Laboratório Clínico , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/diagnóstico , Reforma dos Serviços de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/provisão & distribução , Pessoas sem Cobertura de Seguro de Saúde , Pandemias , Estados Unidos/epidemiologia
14.
N C Med J ; 81(3): 191-194, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32366630

RESUMO

North Carolina has received national attention for its approach to health care payment and delivery reform. Importantly, payment reform alone is not enough to drive systematic changes in care delivery. We highlight the importance of progress in four complementary areas to achieve system-wide payment and care reform.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Humanos , North Carolina
15.
BMC Public Health ; 20(1): 507, 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299399

RESUMO

BACKGROUND: Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care - public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes. METHODS: Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims. RESULTS: Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building. CONCLUSIONS: Primary care and public health collaborations can strengthen community-based primary health care while addressing the Quadruple Aims with an emphasis on reducing health inequities but requires attention to collaboration barriers and enablers.


Assuntos
Fortalecimento Institucional/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Saúde Pública/métodos , Atitude do Pessoal de Saúde , Canadá , Comportamento Cooperativo , Assistência à Saúde/organização & administração , Humanos , Estudos de Casos Organizacionais
16.
Ciênc. Saúde Colet ; 25(4): 1205-1214, abr. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1089530

RESUMO

Resumen La residencia de medicina familiar y comunitaria comenzó en Uruguay en el año 1997. A través de un proceso autogestionado, las primeras generaciones se moldearon en una formación que integraba en ellos el conocimiento y la experiencia hospitalarios junto con la praxis territorial en un servicio de salud de base comunitaria con población de referencia. El reconocimiento académico de la especialidad y la instalación de los ámbitos institucionales para su gestión fueron conquistas paralelas a ese proceso en la primera década. La segunda década estuvo marcada por la expansión territorial de la estructura docente-asistencial, la descentralización de la universidad y la participación activa de la medicina familiar y comunitaria en la reforma de la salud y la agenda de derechos. La tercera década de la especialidad se presenta en su inicio como crisis dada por la caída sostenida en la aspiración a la residencia. Desde una aproximación inicial a las explicaciones, se reflexiona sobre la posibilidad de estar frente a una crisis más profunda y la necesidad de encontrar las claves de una medicina del siglo XXI que permita alcanzar los principios de Alma Ata, siempre vigentes.


Abstract The Family and Community Medicine Residency started in Uruguay in 1997. Through a self-managed process, the first generations were molded into training that integrated hospital knowledge and experience with territorial praxis in a community-based health service with a population of reference. The academic recognition of the specialty and the installation of the institutional areas for its management were achievements parallel to that process in the first decade. The second decade was marked by the territorial teaching-assistance expansion in the country, university decentralization and the active participation of Family and Community Medicine in the Health Reform, and the country's rights agenda. The third decade of the specialty begins with a crisis triggered by the sustained decline in the aspiration for residency. An initial approach to explanations reflects on the possibility of facing a more profound crisis and the need to find the keys to a 21st century Medicine that allows us to achieve the principles of Alma-Ata that are still current.


Assuntos
Humanos , História do Século XX , História do Século XXI , Desenvolvimento de Pessoal/história , Internato e Residência/história , Uruguai , Cazaquistão , Reforma dos Serviços de Saúde/história , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/organização & administração , Medicina Comunitária/educação , Medicina Comunitária/história , Medicina Comunitária/tendências , Congressos como Assunto/normas , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/história , Medicina de Família e Comunidade/tendências , Internato e Residência/tendências
17.
Ciênc. Saúde Colet ; 25(4): 1197-1204, abr. 2020. graf
Artigo em Português | LILACS | ID: biblio-1089520

RESUMO

Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.


Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.


Assuntos
Humanos , Atenção Primária à Saúde/história , Reforma dos Serviços de Saúde/história , Congressos como Assunto/história , Medicina de Família e Comunidade/história , Portugal , Atenção Primária à Saúde/organização & administração , Especialização/história , Brasil , Saúde Global , Cazaquistão , Reforma dos Serviços de Saúde/organização & administração , Centros Comunitários de Saúde/história , Centros Comunitários de Saúde/legislação & jurisprudência , Centros Comunitários de Saúde/organização & administração , Congressos como Assunto/organização & administração , Academias e Institutos/história , Academias e Institutos/organização & administração , Europa (Continente) , Medicina de Família e Comunidade/organização & administração , Programas Nacionais de Saúde/história , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração
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