Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.548
Filtrar
1.
PLoS One ; 15(8): e0236965, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810140

RESUMO

BACKGROUND: Despite decades of implementation of maternal health care programs, the uptake of antenatal care services based on the recommended gestational age continues to be below the national and regional targets. Thus, this study aimed to assess the prevalence and factors related to the completion of four antenatal care visits among mothers who gave birth 6 months preceding the study. METHOD: We conducted a community-based cross-sectional study using both quantitative and qualitative approaches. The quantitative component included administering a pre-tested structured questionnaire to 466 mothers who gave birth 6 months preceding the study using a simple random sampling technique from respective Tabias. The quantitative result was analyzed using SPSS version 22. Bivariate and multivariate analysis was done to determine the association between independent and dependent variables. Variables were declared as statistically significant at P ≤ 0.05 in multivariable logistic regression model. The qualitative interview data were collected from eight mothers and four key informants recruited through purposive sampling method. RESULTS: The overall prevalence of completion of four ANC visits based on the recommended time schedule was 9.9% (95% CI, 7.1-12.4). However, 63.9% of the participants attended four visits or more regardless of the recommended time schedule. Being member of community health insurance (AOR 2.140, 95% CI, 1.032-4.436), walking on foot less than or equal one hour to reach the health facility (AOR 3.921, 95% CI, 1.915-8.031), having workload at home (AOR 0.369, 95% CI, 0.182-0.751), and husband supported during antenatal care (AOR 2.561, 95% CI, 1.252-5.240) were independently associated with the completion of four ANC visits based on the recommended time schedule in multivariable analysis. CONCLUSION: The completion of four ANC contacts based on the recommended time schedule remains low in rural areas of Northern Ethiopia. Being a member of community health insurance, distance to the health facility, workload, and male involvement were associated with the completion of four ANC visits based on the recommended time schedule. The existing health system should consider improving the recommended ANC visits by integrating Community based interventions.


Assuntos
Cuidado Pré-Natal/métodos , Adolescente , Adulto , Serviços de Saúde Comunitária/estatística & dados numéricos , Estudos Transversais , Etiópia , Feminino , Humanos , Serviços de Saúde Materna/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multivariada , Cooperação do Paciente/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
2.
PLoS One ; 15(7): e0235264, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658921

RESUMO

OBJECTIVE: To identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya. METHODS: In a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018-2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively. RESULTS: Seventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women's decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment. CONCLUSION: Patient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.


Assuntos
Crioterapia/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/terapia , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Crioterapia/economia , Detecção Precoce de Câncer/economia , Feminino , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/economia , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Quênia/epidemiologia , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Estudos Observacionais como Assunto , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Educação de Pacientes como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
4.
BMC Public Health ; 20(1): 1034, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600440

RESUMO

BACKGROUND: A recent community-based disease management (CBDM) pilot study reported a 20.5% prevalence of hypertension and a 0.5 and 3.6% prevalence of stroke and coronary heart disease (CHD), respectively, in an elderly population (mean age 65 years) in the Xin Jiang autonomous region of China. The CBDM was initiated in 2013 as an essential public health service; however, the potential long-term impact of CBDM on cardiovascular (CV: CHD and stroke) events is unknown. The objective of the study was to understand the long-term impact of CBDM interventions on CV risk factors using disease-model simulation based on a single-arm experimental study. METHODS: A discrete event simulation was developed to evaluate the impact of CBDM on the long-term CV risk among patients with hypertension, in China's Xin Jiang autonomous region. The model generated pairs of identical patients; one receives CBDM and one does not (control group). Their clinical courses were simulated based on time to CV events (CHD and strokes), which are estimated using published risk equations. The impact of CBDM was incorporated as improvement in systolic blood pressure (SBP) based on observations from the CBDM study. The simulation estimated the number of CV events over patients' lifetimes. RESULTS: During a 2-year follow up, the CBDM led to an average reduction of 8.73 mmHg in SBP from baseline, and a 42% reduction in smoking. The discrete event simulation showed that, in the control group, the model estimated incidence rates of 276, 1789, and 616 per 100,000 individuals for lifetime CHD, stroke, and CV-related death, respectively. The impact of CBDM on SBP translated into reductions of 8, 28, and 23% in CHD, stroke, and CV-related deaths, respectively. Taking into account CBDM's reduction of both SBP and smoking, deaths from CHD, stroke, and CV-related deaths were reduced by 12, 30, and 26%, respectively. CONCLUSIONS: The implementation of CBDM in China's Xinjiang autonomous region is expected to significantly reduce incidences of CHD, strokes, and CV-related deaths.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Serviços de Saúde Comunitária/estatística & dados numéricos , Doença das Coronárias/complicações , Hipertensão/complicações , Acidente Vascular Cerebral/complicações , Idoso , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , China/epidemiologia , Simulação por Computador , Doença das Coronárias/epidemiologia , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Risco , Comportamento de Redução do Risco , Acidente Vascular Cerebral/epidemiologia
5.
BMC Public Health ; 20(1): 852, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493280

RESUMO

BACKGROUND: Social connectedness is an important predictor of health outcomes and plays a large role in the physical and mental health of an individual and a community. The presence of a functioning health clinic with a community health worker program may indirectly improve health outcomes by increasing the social connectedness of the community in addition to providing direct patient care. This study examines the social connectedness of the inhabitants of three Mexican towns within the catchment area of a healthcare Non-Government Organization (NGO) through a qualitative analysis. METHODS: Willing participants were videotaped answering open-ended questions about their community and use of healthcare resources. Interviews were then coded for relevant themes and analyzed for content relating to social connectedness, social isolation, and health. RESULTS: Respondents reported that having a functioning community clinic had improved their lives significantly through direct provision of care and by reducing the financial burden of travel to seek medical care elsewhere. Respondents from each town differed slightly in their primary means of social support. One town relied more heavily on organized groups (i.e., religious groups) for their support system. Social isolation was reported most frequently by housewives who felt isolated in the home and by respondents that had to deal with personal illness. Respondents that self-identified as Community Health Workers (CHWs) in their respective communities acknowledged that their roles bestowed physical and psychological health benefits upon themselves and their families. CONCLUSIONS: Overall, a long-term health intervention may directly impact the relative social isolation and social connectedness of a community's inhabitants. The social connectedness of the community is an important quality that must be considered when evaluating and planning health interventions.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , População Rural/estatística & dados numéricos , Comportamento Social , Apoio Social , Adulto , Integração Comunitária/psicologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Organizações , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Isolamento Social
6.
Int J Equity Health ; 19(1): 62, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381090

RESUMO

BACKGROUND: Hearing loss is a prevalent but neglected disease, especially in low- or middle-income countries. The role of Community Health Workers (CHWs) to deliver primary ear and hearing care has been explored in several studies from a technical standpoint, but understanding perceptions, barriers, and enablers of such an approach from the perspective of CHWs themselves through a health equity lens has been less well documented. METHODS: This qualitative study used photovoice to explore the views and experiences of CHWs in the Seeta Nazigo Parish of Mukono District in the delivery of ear and hearing care in the community. CHWs were trained in ear and hearing care, and provided with digital cameras to capture photographs related to their work in the community over the following 3 months. Individual interviews regarding the photographs were held at the end of each month, in addition to one focus group discussion. A community workshop was convened at the end of the study to display the photos. Thematic analysis of photographs was conducted using Braune and Clarkes six-step framework. We also used the data to explore potential roles for key stakeholders in primary ear and hearing care, and how photovoice may facilitate their engagement. RESULTS: 13 CHWs participated in the study. Several themes were generated from analysis. CHWs perceived a high burden of ear and hearing disorders in their community and recognised the role they could play in tackling that burden. Potential barriers identified included a lack of equipment, training, and supervision of CHWs; logistical, financial, or psychological barriers to community participation; and the widespread use of traditional medicine. CHWs identified roles for the government and NGO bodies to enable and support delivery of ear and hearing care in the community. The community workshop was a useful method to engage key stakeholders in this topic. CONCLUSIONS: Photovoice is a powerful method to capture issues affecting CHWs. Here it was used to identify a number of perceptions, barriers and enablers to the delivery of ear and hearing care. Our results may inform future strategy in the field of ear and hearing care, and the potential use of photovoice to enact sociocultural change.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Agentes Comunitários de Saúde/psicologia , Otopatias/terapia , Equidade em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Transtornos da Audição/terapia , Adulto , Agentes Comunitários de Saúde/estatística & dados numéricos , Otopatias/epidemiologia , Feminino , Grupos Focais , Transtornos da Audição/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Uganda/epidemiologia
7.
Rev Saude Publica ; 54: 38, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32267372

RESUMO

OBJECTIVE: To describe the implementation status of the Community-Based Rehabilitation in Chile. METHODS: Quantitative, transversal and descriptive study. The scope was constituted by the 66 community-based rehabilitation centers in the Chilean Metropolitan Region that implemented Community-Based Rehabilitation until December 2016. The sampling was based on a census method, so all the community centers were contacted. A self-administered questionnaire designed based on the Community-Based Rehabilitation matrix defined by the World Health Organization was applied. The questionnaire was answered on-line by the coordinators of the strategy in their respective centers. The data analysis was performed using descriptive statistics. RESULTS: A heterogeneous level of implementation of Community-Based Rehabilitation was identified, specifically in terms of the components of the matrix described by the World Health Organization. The most implemented component was Health; the Social, Livelihood and Empowerment components were moderately implemented; and the Education component was the least implemented. CONCLUSION: The implementation of Community-Based Rehabilitation is mainly based on the Health component. The level implementation of the other components of the matrix needs to be increased, as well as interdisciplinary and intersectoral strategies to achieve greater social inclusion of people with disabilities.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Participação da Comunidade/estatística & dados numéricos , Pessoas com Deficiência/reabilitação , Atenção Primária à Saúde/estatística & dados numéricos , Reabilitação/organização & administração , Atitude Frente a Saúde , Chile , Serviços de Saúde Comunitária/organização & administração , Estudos Transversais , Pessoas com Deficiência/estatística & dados numéricos , Educação em Saúde , Acesso aos Serviços de Saúde , Humanos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
8.
J Glob Health ; 10(1): 010807, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32257170

RESUMO

Background: The concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants' utilization of the essential public health services and its underlying factors on account of change of residence, and social support. Methods: Data came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants. Results: Approximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants' utilization of essential public health services. Conclusions: The utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde , Seguro Saúde/estatística & dados numéricos , Migrantes , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Emprego , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Características de Residência , População Rural , Apoio Social , População Urbana
9.
BMC Health Serv Res ; 20(1): 313, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293429

RESUMO

BACKGROUND: Since 2009, the Chinese government has been reforming the healthcare system and has committed to reinforcing increased use of primary care. To date, however, the Chinese healthcare system is still heavily reliant on hospital-based specialty care. Studies consistently show an association between primary care and improved health outcomes, and the same association is also found among the disadvantaged population. Due to the "hukou" system, interprovincial migrants in the urban districts are put in a weak position and become the disadvantaged. Therefore, the aim of this study is to investigate whether greater supply and utilization of primary care was associated with reduced child mortality among the entire population and the interprovincial migrants in urban districts of Guangdong province, China. METHODS: An ecological study was conducted using a 3-year panel data with repeated measurements within urban districts in Guangdong province from 2014 to 2016, with 178 observations in total. Multilevel linear mixed effects models were applied to explore the associations. RESULTS: Higher visit proportion to primary care was associated with reductions in the infant mortality rate and the under-five mortality rate in both the entire population and the interprovincial migrants (p < 0.05) in the full models. The association between visit proportion to primary care and reduced neonatal mortality rate was significant among the entire population (p < 0.05) while it was insignificant among the interprovincial migrants (p > 0.05). CONCLUSIONS: Our ecological study based in urban districts of Guangdong province found consistent associations between higher visit proportion to primary care and improvements in child health among the entire population and the interprovincial migrants, suggesting that China should continue to strengthen and develop the primary care system. The findings from China adds to the previously reported evidence on the association between primary care and improved health, especially that of the disadvantaged.


Assuntos
Saúde da Criança/estatística & dados numéricos , Serviços de Saúde Comunitária/provisão & distribução , Serviços de Saúde Comunitária/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Mortalidade da Criança/tendências , Pré-Escolar , China/epidemiologia , Conjuntos de Dados como Assunto , Assistência à Saúde/organização & administração , Hospitais , Humanos , Lactente , Mortalidade Infantil/tendências , Migrantes/estatística & dados numéricos , População Urbana/estatística & dados numéricos
10.
Artigo em Inglês | MEDLINE | ID: mdl-32150946

RESUMO

BACKGROUND: Long-term care (LTC) needs for the elderly have become increasingly crucial policy concerns in rapidly aging Asia, especially in China, the most populous nation. However, very few studies have examined the cohort differences in terms of their existing and expected utilization of LTC services, above all urban-rural differences. This study aims to evaluate the differences of LTC current status and needs between urban-rural areas and age groups, and to identify influencing factors causing the different LTC needs. METHODS: The data come from the Chinese Longitudinal Health Longevity Survey in 2014. A total of 7192 home-based elderly aged ≥65 years by multistage sampling were enrolled. The Andersen Model was applied to categorize the influential factors into three components including predisposing, enabling and needs. Multivariate logistic regression analysis was used to analyze the influential factors of the three levels of LTC needs. RESULTS: A total of 6909 valid sample sizes were included in this study. The overall LTC needs of the elderly showed a rapidly increasing trend among which older people had the highest needs for bathing (27.29%) and toileting (15.8%). It was also demonstrated the aged cohort between urban and rural exerted an impact on all aspects of LTC status and needs to varying degrees (p < 0.05). Compared with urban areas, the LTC needs for the elderly in rural areas was more vigorous, but the supply was seriously inadequate. The elderly who were older, living in rural areas, unmarried, non-farming, with low income, in poor health and having less autonomy had higher anticipated needs for LTC services (OR > 1, p < 0.01). Compared with the young-old in rural areas, the young-old in urban areas were prone to live alone (OR = 1.61, p < 0.01). The elderly who were older, living in rural areas, farming, with low income, lonely and depressed had higher anticipated needs for community-based services (1 < OR < 1.69, p < 0.05). CONCLUSIONS: The aged cohort in urban-rural distinction were facing an increasing need for immediate care due to the inadequate support being provided, especially among rural elderly. The oldest elderly in rural areas had higher LTC needs, and different levels of needs were affected by age, economic level, family support, health status and other related effects. This study provides evidence-based recommendation for further improving the construction and development of the LTC system in China.


Assuntos
Serviços de Saúde Comunitária , Assistência de Longa Duração , Idoso , Idoso de 80 Anos ou mais , Ásia , China , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Qualidade de Vida , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
11.
PLoS One ; 15(1): e0226597, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32005036

RESUMO

PURPOSE: To evaluate whether the early identification of patients who may benefit from palliative care impacts on the use of palliative, community and acute-based care services. METHODS: Between 2014 and 2017, physicians from eight sites were encouraged to systematically identify patients who were likely to die within one year and would were thought to benefit from early palliative care. Patients in the INTEGRATE Intervention Group were 1:1 matched to controls selected from provincial healthcare administrative data using propensity score-matching. The use of palliative care, community-based care services (home care, physician home visit, and outpatient opioid use) and acute care (emergency department, hospitalization) was each evaluated within one year after the date of identification. The hazard ratio (HR) in the Intervention Group was calculated for each outcome. RESULTS: Of the 1,185 patients in the Intervention Group, 951 (80.3%) used palliative care services during follow-up, compared to 739 (62.4%) among 1,185 patients in the Control Group [HR of 1.69 (95% CI 1.56 to 1.82)]. The Intervention Group also had higher proportions of patients who used home care [81.4% vs. 55.2%; HR 2.07 (95% CI 1.89 to 2.27)], had physician home visits [35.5% vs. 23.7%; HR 1.63 (95% CI 1.46 to 1.92)] or had increased outpatient opioid use [64.3% vs. 52.1%); HR 1.43 (95% CI 1.30 to 1.57]. The Intervention Group was also more likely to have a hospitalization that was not primarily focused on palliative care (1.42 (95% CI 1.28 to 1.58)) and an unplanned emergency department visit for non-palliative care purpose (1.47 (95% CI 1.32 to 1.64)). CONCLUSION: Physicians actively identifying patients who would benefit from palliative care resulted in increased use of palliative and community-based care services, but also increased use of acute care services.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Equipe de Assistência ao Paciente/normas , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida
12.
Healthc Q ; 22(4): 10-12, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32073385

RESUMO

Federal, provincial and territorial governments endorsed agreements in August of 2017 to focus on the shared health priorities of home, community, mental health and addictions care (Government of Canada 2017). The related $11 billion federal investment over a 10-year period aims to improve access for Canadians to effective and appropriate services in these areas (Government of Canada 2019).


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Idoso , Canadá , Criança , Serviços de Saúde Comunitária/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/mortalidade
13.
Healthc (Amst) ; 8(1): 100387, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32001247

RESUMO

With U.S. healthcare expenditures leading and social service spending trailing other developed nations, patients, caregivers, and employers are insisting on improved value in health and healthcare for communities. Yet, health systems struggle to understand how to best invest existing funding or savings to reach these goals. We share the experience of Los Angeles County's health system that has invested in housing through their Housing for Health Program (HFH) to address the needs of high cost populations within communities. The approach rested on four key program strategies including having partnerships with various housing facilities, a whole person approach with broad community-based resources, a local footprint in community health services, and a robust jail and prison transitions program. HFH also relied on three key implementation strategies including having dynamic funding sources, stakeholder alignment, and continuous improvement. This case report describes these program and implementation strategies plus challenges and lessons learned navigating homeless individuals through the regulations of various funding contracts, maintaining service provider capacity, maintaining local culture in implementation, and persistent gaps in affordable housing availability. Future policies can incentivize similar efforts and infrastructure to transfer healthcare dollars into public services to improve housing and value for communities.


Assuntos
Serviços de Saúde Comunitária/métodos , Habitação/estatística & dados numéricos , Investimentos em Saúde/tendências , Adolescente , Adulto , Idoso , Serviços de Saúde Comunitária/normas , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Governo Local , Los Angeles , Masculino , Pessoa de Meia-Idade , Saúde Pública
14.
Public Health ; 180: 136-140, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31901574

RESUMO

OBJECTIVES: To investigate patient demographics and venue type preferences within community settings associated with re-attendance for chlamydia testing. STUDY DESIGN: Data used for this analysis were obtained from the English National Chlamydia Screening Programme (NCSP) which focuses on prevention, control and treatment of chlamydia in sexually active under-25 year olds. A greater understanding of how young adults attend services helps to inform commissioners regarding where to focus resources within community settings. METHODS: Data from the Chlamydia surveillance system (CTAD) were used to count patient attendances at non-specialist sexual health services (SHSs) among 15-24-year-olds and monitor re-attendance for chlamydia testing within and between community services between 6 and 18 months of their first visit. RESULTS: From January 2013 to December 2016, 866,847 young people underwent 1,041,245 tests for chlamydia. Re-attendance for chlamydia testing was 20.1% (174,398/866,847). Re-attendance rate was 28.5% after a positive test and 19.5% after a negative test. For re-attenders, 64.2% used the same venue type for both visits. General practice (GP) and sexual and reproductive health services (SRH) were the most commonly re-attended services (31.0% and 30.6% respectively). CONCLUSIONS: Only one in five re-attended for chlamydia testing. Re-attendance was associated with having a positive result, accessibility and convenience. Patients are likely to return for testing to services they know. This should be considered by commissioners implementing new re-attendance guidance based on the NCSP.


Assuntos
Infecções por Chlamydia/prevenção & controle , Serviços de Saúde Comunitária/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Infecções por Chlamydia/epidemiologia , Inglaterra/epidemiologia , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Programas Nacionais de Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adulto Jovem
15.
Aust J Rural Health ; 28(1): 60-66, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31970843

RESUMO

PROBLEM: In the Katherine region, Northern Territory, barriers to eye care for Aboriginal and Torres Strait Islander people include unclear eye care referral processes, challenges coordinating patient eye care between various providers, complex socioeconomic determinants and a lengthy outpatient ophthalmology waiting list. DESIGN: Mixed methods participatory approach using a regional needs analysis, clinical file audit and stakeholder survey, to develop, implement and monitor quality improvement strategies. SETTING: Collaboration with Aboriginal Community Controlled Health Services and regional eye care stakeholders in the Katherine region. KEY MEASURES FOR IMPROVEMENT: Clinical audit data captured frequency and rates of primary eye checks, ophthalmology referrals and spectacle prescriptions. A survey was developed and applied to assess stakeholder perspectives of regional eye care systems. STRATEGY FOR CHANGE: Quality improvement strategies informed by regional data (clinical audits and survey) included increasing service delivery to match eye care needs, primary eye care training for Aboriginal Community Controlled Health Services staff, updating Aboriginal Community Controlled Health Services primary care templates and forming a regional eye care coalition group. EFFECTS OF CHANGE: Post-implementation, rates and frequency of recorded optometry examinations, number of spectacles prescribed and rates of annual dilated fundus examinations for patients with diabetes increased. There was a decrease in the number of patients with diabetes who had never had an eye examination. Eye care stakeholders perceived a marked improvement in the effectiveness of the regional eye care system. LESSONS LEARNT: Our findings highlight the importance of engaging services and stakeholders to ensure a systems approach that is evidence-informed, contextually appropriate and reflects commitment to improved eye health outcomes.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/métodos , Serviços de Saúde do Indígena/organização & administração , Grupo com Ancestrais Oceânicos/educação , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Optometria/educação , Melhoria de Qualidade/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Serviços de Saúde do Indígena/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Northern Territory , Melhoria de Qualidade/estatística & dados numéricos , Inquéritos e Questionários
16.
AIDS Behav ; 24(2): 387-394, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30863977

RESUMO

In Australia, HIV testing services have become increasingly available in non-traditional settings such as peer-led, community-based services to expand access and increase uptake of HIV testing among gay and bisexual men (GBM). This study aimed to compare the socio-demographic and behavioural characteristics of GBM whose last HIV test was conducted at a community-based service to GBM whose last test was at a traditional clinical setting. We analysed behavioural surveillance data collected from 5988 participants in seven states and territories in the period 2016-2017. We found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings, particularly in terms of sexual practice and risk of HIV. However, non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study points to the successful establishment of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV.


Assuntos
Bissexualidade , Serviços de Saúde Comunitária/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Vigilância da População/métodos , Adulto , Austrália/epidemiologia , Bissexualidade/estatística & dados numéricos , Estudos Transversais , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Grupo Associado , Testes Sorológicos , Comportamento Sexual
17.
Assist Inferm Ric ; 38(4): 174-182, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31834302

RESUMO

. Paediatric patients who access the Emergency Department for non-urgent visits and use of community services. INTRODUCTION: Overcrowding in emergency departments, often due to the high number of patients who access for non-urgent visits, leads to serious problems concerning also the quality of care. AIM: To investigate if and how parents who access a second level Emergency Department for non-urgent pediatric visits use community services. METHODS: From 11 July to 16 September 2018 a 40-item paper and pencil questionnaire was administered to parents of children aged 0 to 6 years who received a non-urgent code for access to the Emergency Department. RESULTS: Parents of 83 patients (males=62.7%, mean age=2 years±1.77) were enrolled. Most of them accessed the emergency departments because of their child's fever (n=31, 21.8%), for symptoms occurred more than 24 hours before (n=51, 61.4%). Most participants reported to consult sometimes/always the family pediatrician (n=72, 86.8%) but to hardly ever/never use the other health services available in the community. Parents need to receive more education regarding the management on the most typical symptoms in children, such as fever and skin rashes, or some minor frequent treatments. CONCLUSIONS: Parents who access the Emergency Department for non-urgent visits rarely use or know the community health services, which could help them in managing their child's health conditions.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Inquéritos e Questionários
18.
BMC Health Serv Res ; 19(1): 888, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31771580

RESUMO

BACKGROUND: Healthcare workers, in the hospital and in community clinics, are frequently exposed to verbal and physical abuse that can lead to frustration and despair. This study's objectives were to evaluate trends in violence towards hospital and community doctors in the Negev region of Israel and to compare them to the results of a previous 2005 study. METHODS: A convenience sample of doctors in the hospital and in the community completed anonymous questionnaires on previous exposure to work place violence and their attitudes to it. The data were collected in 2017. RESULTS: One hundred forty-five doctors participated in the study, of who 63 were hospital doctors and 82 were community doctors. Fifty nine percent of the doctors reported that they experienced at least one incident of verbal abuse over the previous year and 9% were exposed to physical abuse, compared to 56 and 9%, respectively, in the previous study. More hospital doctors (58.7%) were exposed to verbal abuse on the part of family members than community doctors (35.8%) (P = 0.007). The most common reason for a violent outbreak was long waiting times, followed by dissatisfaction with treatment, both consistent with the findings in the previous study. Seventy one percent said that violence was a major problem for doctors. The majority (73.9%) had not participated in a workshop or other training for preventing workplace violence or coping with it, an improvement over the 83% who reported not receiving any training in the previous study. CONCLUSIONS: Workplace violence is a major issue, which affects hospital and community physicians alike. There is a rise in the number of doctors who have undergone training in this area, although the majority have yet to receive formal training.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Médicos/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos , Adulto , Idoso , Atitude do Pessoal de Saúde , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Inquéritos e Questionários
19.
BMC Public Health ; 19(1): 1542, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752801

RESUMO

BACKGROUND: Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS: Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS: 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION: Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus/prevenção & controle , Hipertensão/prevenção & controle , Atenção Primária à Saúde/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Reprod Health ; 16(1): 157, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675974

RESUMO

BACKGROUND: Despite efforts to achieve the Millennium Development Goals, the maternal mortality ratio in the Democratic Republic of Congo was 693 per 100,000 in 2015-the 6th highest in the world and higher than the average (547 per 100,000) in sub-Saharan Africa. Antenatal care (ANC) service is a cost-effective intervention for reducing the maternal mortality ratio in low-income countries. This study aimed to identify the intervention effect of the maternal and child health care (MCH) project on the use of four or more (4+) ANC services. METHODS: The MCH project was implemented using the three delays model in Kenge city by the Ministry of Public Health (MoPH) of the DRC with technical assistance from Korea International Cooperation Agency (KOICA) and the Yonsei Global Health Center from 2014 to 2017. Furthermore, Boko city was selected as the control group. A baseline and an endline survey were conducted in order to evaluate the effectiveness of this project. We interviewed 602 and 719 participants in Kenge, and 150 and 614 participants in Boko in the baseline and endline surveys, respectively. We interviewed married reproductive-aged women (19-45 years old) in both cities annually. The study instruments were developed based on the UNICEF Multiple Indicator Cluster Surveys. This study used the homogeneity test and the binary logistic regression difference-in-differences method of analysis. RESULTS: The odds of reproductive-aged women's 4+ ANC service utilization at the intervention site increased 2.280 times from the baseline (OR: 2.280, 95% CI: 1.332-3.902, p = .003) as compared to the control site. CONCLUSIONS: This study showed that the KOICA MCH project effectively increased the 4+ ANC utilization by reproductive-aged women in Kenge. As the 4+ ANC services are expected to reduce maternal deaths, this project might have contributed to reducing maternal mortality in Kenge. In the future, we expect these findings to inform MCH policies of the MoPH in the DRC.


Assuntos
Saúde da Criança/normas , Serviços de Saúde Comunitária/estatística & dados numéricos , Parto Obstétrico/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mortalidade Materna , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Cuidado Pré-Natal/normas , Adolescente , Adulto , Estudos de Casos e Controles , Parto Obstétrico/estatística & dados numéricos , República Democrática do Congo , Feminino , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Pobreza , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA