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2.
BMC Health Serv Res ; 18(1): 390, 2018 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-29855292

RESUMO

BACKGROUND: Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. METHODS: Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. RESULTS: Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women's experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level. CONCLUSIONS: These study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Serviços de Planejamento Familiar/provisão & distribução , Aborto Induzido/estatística & dados numéricos , Adulto , Serviços de Saúde Comunitária/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepcionais/provisão & distribução , Aconselhamento , Assistência à Saúde/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Grupos Focais , Programas Governamentais/provisão & distribução , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Assistência Médica , Gravidez , Pesquisa Qualitativa , Zâmbia
4.
Home Health Care Serv Q ; 37(1): 41-59, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29319423

RESUMO

This article provides an overview of Medicaid home- and community-based services (HCBS) for older adults and individuals with physical disabilities by describing eligibility criteria, availability, and types of services. All 50 state Medicaid programs provide supplementary HCBS in addition to mandatory services. The amount, type, and eligibility for HCBS varied widely between states. Variation in service provision and eligibility rules has led to a patchwork of services from state to state, with the same person eligible for services in one state but not another.


Assuntos
Serviços de Saúde Comunitária/normas , Pessoas com Deficiência/psicologia , Acesso aos Serviços de Saúde/normas , Serviços de Saúde Comunitária/provisão & distribução , Assistência à Saúde/economia , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Definição da Elegibilidade/métodos , Humanos , Assistência de Longa Duração/estatística & dados numéricos , Medicaid/organização & administração , Medicaid/estatística & dados numéricos , Governo Estadual , Estados Unidos
5.
Glob Public Health ; 13(11): 1713-1724, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29376472

RESUMO

This article examines the social patterning of health, economic uncertainty, hegemonic masculinity, and vulnerability among men who live and work in a low-income sex work community in Kampala, Uganda. This problematises the notion that vulnerable communities are homogenous, in demographics, economic status, and risk. This article draws on ethnographic data collected in 2016, including semi-structured interviews and participant observation. This article uses a stratified risk framework to describe the central finding of this study, which is that men's experience in Kataba is characterised by a struggle to fulfil the provider role that constitutes a core aspect of their socially ascribed gender role. In a context of economic scarcity, men's lives are fraught with strain and this intersects with other forms of risk. Finally, by focusing on community vulnerability rather than individual risk, this work contributes to theories of gender and sex work, and informs HIV/AIDS praxis.


Assuntos
Infecções por HIV/epidemiologia , Masculinidade , Trabalho Sexual , Classe Social , Adulto , Idoso , Serviços de Saúde Comunitária/provisão & distribução , Infecções por HIV/prevenção & controle , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pesquisa Qualitativa , Medição de Risco , Uganda/epidemiologia , Adulto Jovem
6.
PLoS Negl Trop Dis ; 11(11): e0005966, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29155826

RESUMO

INTRODUCTION: The CDTI model is known to have enhanced community participation in planning and resource mobilization toward the control of onchocerciasis. These effects were expected to translate into better individual acceptance of the intervention and hence high Treatment Coverage, leading to a sustainable community-led strategy and reduction in the disease burden. A survey revealed that after 10-12 rounds of treatment, prevalence of onchocerciasis was still high in three drainage basins of South West Cameroon and transmission was going on. METHODS: We designed a three (3)-year retrospective (2012, 2013 and 2014), descriptive cross-sectional study to explore the roles of operational challenges in the failure of CDTI to control the disease as expected. We administered 83 semi-structured questionnaires and conducted 12 in-depth interviews with Chiefs of Bureau Health, Chiefs of Centers, CDDs and Community Heads. Descriptive statistics was used to explore indicators of performance which were supported with views from in-depth interviews. RESULTS: We found that community participation was weak; communities were not deciding time and mode of distributions. Only 6 (15.0%) of 40 Community Drug Distributors reported they were selected at general community meetings as required. The health service was not able to meet and discuss Community-Directed Treatment with Ivermectin activities with individual communities partly due to transportation challenges; this was mostly done through letters. Funding was reported to be inadequate and not timely. Funds were not available to conduct Community-Self Monitoring after the 2014 Mass Drug Administration. There was inadequate health staff at the frontline health facility levels, and some Chiefs of Center reported that Community-Directed Treatment with Ivermectin work was too much for them. The mean operational Community Drug Distributor-population ratio was 1 Community Drug Distributor per 317 populations (range: 194-464, expected is 1:250). Community Drug Distributor attrition rate was 14% (2012), 11% (2013) and 12% (2014) of total Community Drug Distributors trained in the region. Lack of incentive for Community Drug Distributor was primary reason for Community Drug Distributor attrition. Number of Community Drug Distributors trained together by health area ranged from 14 to 127 (mean ± SD = 51 ±32) with duration of training ranging from 4-7 hours (mean ± SD = 5.05 ± 1.09). The trainings were conducted at the health centers. Community Drug Distributors always conducted census during the past three distributions (Mean ± SD = 2.85 ± 0.58). Community-Self Monitoring was facing challenge. Several of the community heads, Chiefs of Bureau Health and Chiefs of Center agreed that Community-Self Monitoring was not being carried out effectively due to lack of incentives for monitors in the communities. CONCLUSION: Inadequate human resource, funding issues and transportation challenges during distribution periods reduced the ability of the health service to thoroughly sensitize communities and supervise CDTI activities. This resulted in weak community understanding, acceptance and participation in the process. CDTI in our study area did not achieve sustainable community-led campaign and this may have led to the reduced impact on Onchocerciasis.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Filaricidas/provisão & distribução , Ivermectina/provisão & distribução , Oncocercose/tratamento farmacológico , Camarões , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/organização & administração , Estudos Transversais , Feminino , Filaricidas/uso terapêutico , Humanos , Ivermectina/uso terapêutico , Masculino , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Inquéritos e Questionários
9.
Prev Chronic Dis ; 14: E51, 2017 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-28662760

RESUMO

INTRODUCTION: Diabetes Prevention Programs (DPPs) have shown that healthy eating and moderate physical activity are effective ways of delaying and preventing type 2 diabetes in people with impaired glucose tolerance. We assessed willingness to pay for DPPs from the perspective of potential recipients and the cost of providing these programs from the perspective of community health centers and local health departments in North Carolina. METHODS: We used contingent valuation to determine how much potential recipients would be willing to pay to participate in DPPs under 3 different models: delivered by registered professionals (traditional model), by community health workers, or online. By using information on the minimum reimbursement rate at which public health agencies would be prepared to provide the 3 models, we estimated the marginal costs per person of supplying the programs. Matching supply and demand, we estimated the degree of cost sharing between recipients and providers. RESULTS: Potential program recipients (n = 99) were willing to pay more for programs led by registered professionals than by community health workers, and they preferred face-to-face contact to an online format. Socioeconomic status (measured by education and employment) and age played the biggest roles in determining willingness to pay. Leaders of public health agencies (n = 27) reported up to a 40% difference in the cost of providing the DPP, depending on the delivery model. CONCLUSION: By using willingness to pay to understand demand for DPPs and computing the provider's marginal cost of providing these services, we can estimate cost sharing and market coverage of these services and thus compare the viability of alternate approaches to scaling up and sustaining DPPs with available resources.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/prevenção & controle , Estudos de Viabilidade , Adulto , Centros Comunitários de Saúde/economia , Estudos Transversais , Coleta de Dados , Pesquisas sobre Serviços de Saúde , Ocupações em Saúde , Política de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , North Carolina , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários
10.
Healthc (Amst) ; 5(4): 174-182, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28065558

RESUMO

BACKGROUND: Community Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period. METHODS: We pooled six years of data from the Medical Expenditure Panel Survey (2008-2013) and linked it to geographic data on CHCs from Health Resources and Services Administration's Health Center Program Uniform Data System. We also link other community characteristics from the Area Health Resource File and the Dartmouth Institute's data files. The associations between CHC availability and our access measures are estimated with logistic regression models stratified by insurance status. RESULTS: The availability of CHC services was positively associated with both measures of access among those with no insurance coverage. Additionally, it was positively associated with having a usual source of care among those with Medicaid and private insurance. These findings persist after controlling for key individual- and community-level characteristics. CONCLUSIONS: Our findings suggest that an enhanced CHC program could be an important resource for supporting the efficacy of expanded Medicaid coverage under the Affordable Care Act and, ultimately, improving access to quality primary care for underserved Americans.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/tendências , Centros Comunitários de Saúde/provisão & distribução , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Inquéritos e Questionários
11.
J Aging Health ; 29(7): 1160-1181, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-27333911

RESUMO

OBJECTIVE: This study analyzes the links between planning, the built environment, and availability of health-related community services across U.S. urban and rural communities. METHOD: We analyze the first national survey of health-related community services for seniors (2010 Maturing of America), covering 1,459 U.S. cities and counties. We tested the influence of morbidity (diabetes and obesity), city management, socioeconomic characteristics, planning and the built environment, metro status, and government finance. RESULTS: Community health-related services are more common in places that plan for and involve seniors in planning processes. Places with higher need and government capacity also show higher levels. Service levels in rural communities are not lower after controlling for other population characteristics. Morbidity measures (diabetes and obesity) do not explain differences in service availability. DISCUSSION: Policies promoting planning for aging and elder involvement in the planning process have the greatest impact on the level of community health-related services for seniors.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Acesso aos Serviços de Saúde , Idoso , Bases de Dados Factuais , Pesquisas sobre Serviços de Saúde , Humanos , População Rural , Inquéritos e Questionários , Estados Unidos
12.
R I Med J (2013) ; 99(10): 57-60, 2016 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-27706282

RESUMO

"The goal of community health teams is to develop and implement care models that integrate clinical and community health promotion and preventive services for patients." -Association of State and Territorial Health Officials (ASTHO)1 Eleven community health teams (CHTs) operate in various geographies within Rhode Island. Physicians and payers refer their highest-risk patients to CHTs that serve as community extenders. Community health workers and others work to link referred individuals to primary care and work to address the other determinants affecting their health, such as safe housing. Since much of health is driven by factors outside of the healthcare setting, CHTs compliment the work of physicians within the office environment. Transforming practices and addressing both the physical and behavioral needs of patients simultaneously is key to CHT success. This article attempts to quantify the expanding need for CHTs within Rhode Island and describes ways in which CHTs as a practice transformation resource may be leveraged by providers. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].


Assuntos
Serviços de Saúde Comunitária/normas , Agentes Comunitários de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente/normas , Adulto , Criança , Serviços de Saúde Comunitária/provisão & distribução , Humanos , Saúde Pública , Encaminhamento e Consulta , Rhode Island
13.
Midwifery ; 41: 89-95, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27571773

RESUMO

BACKGROUND: maternity waiting homes (MWHs) are residential dwellings located near health facilities where women in the late stages of pregnancy stay to await childbirth and receive immediate postpartum services. These shelters help overcome distance and transportation barriers that prevent women from receiving timely skilled obstetric care. OBJECTIVE: the purpose of this study was to explore Zambian stakeholders' beliefs regarding the acceptability, feasibility, and sustainability of maternity waiting homes (MWHs) to inform a model for rural Zambia. DESIGN: a qualitative design using a semi-structured interview guide for data collection was used. SETTING: two rural districts in the Eastern province of Zambia. PARTICIPANTS: individual interviews were conducted with community leaders (n=46). Focus groups were held with Safe Motherhood Action Groups, husbands, and women of childbearing age in two rural districts in Zambia (n=500). MEASURES: latent content analysis was used to analyze the data. FINDINGS: participants were overwhelmingly in support of MWHs as a way to improve access to facility-based childbirth and address the barrier of distance. Data suggest that participants can describe features of high quality care, and the type of care they expect from a MWH. Stakeholders acknowledged the need to contribute to the maintenance of the MWH, and that community involvement was crucial to MWH sustainability. KEY CONCLUSIONS: access to facility childbirth remains particularly challenging in rural Zambia and delays in seeking care exist. Maternity waiting homes offer a feasible and acceptable intervention to reduce delays in seeking care, thereby holding the potential to improve maternal outcomes. IMPLICATIONS FOR PRACTICE: this study joins a growing literature on the acceptability, feasibility, and sustainability of MWHs. It is believed that MWHs, by addressing the distance and transportation barriers, will increase the use of skilled birth attendants, thereby reducing maternal and neonatal morbidity and mortality in rural, low resource areas of Zambia. We recommend that any initiative, such as MWHs, seeking to increase facility-based births with a skilled birth attendant also concurrently addresses any local deficiencies in quality of care.


Assuntos
Serviços de Saúde Materna/provisão & distribução , Instituições Residenciais/provisão & distribução , Adulto , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/provisão & distribução , Feminino , Grupos Focais , Acesso aos Serviços de Saúde/normas , Humanos , Masculino , Serviços de Saúde Materna/normas , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/métodos , Pesquisa Qualitativa , População Rural , Zâmbia
14.
Farm. comunitarios (Internet) ; 8(2): 16-23, jun. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-154159

RESUMO

En abril de 2013, la Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC) presentó su propuesta sobre servicios profesionales farmacéuticos (SPF) cuyo fin es cubrir las necesidades relacionadas tanto con la atención de los pacientes que utilizan medicamentos, como con la salud pública. Esta propuesta ofrece un planteamiento sobre la implantación y desarrollo de los SPF con el objetivo de impulsar su prestación por las farmacias comunitarias en los próximos años. De acuerdo con dicha propuesta todos los SPF que constituyen el catálogo de servicios contarán con un documento de especificaciones. El objeto de este documento de especificaciones es definir y caracterizar el servicio de medición y control de la presión arterial con un doble objeto: • Ayudar al farmacéutico comunitario y a sus representantes en el ofrecimiento, prestación, difusión, financiación y concertación de este servicio. • Servir de guía a los farmacéuticos comunitarios que desean implantar este servicio en la farmacia o elaborar un procedimiento normalizado de trabajo para su realización. Este documento se complementa con la Guía de actuación para el farmacéutico comunitario en pacientes con HTA y riesgo cardiovascular (RCV). Documento de consenso GIAF-UGR, SEFAC y SEH-LELHA y con el programa impacHta: formación de SEFAC y SEH-LELHA en hipertensión y riesgo vascular (AU)


In April 2013, the Spanish Family and Community Pharmacy Society (Sociedad Española de Farmacia Familiar y Comunitaria - SEFAC) issued a proposal for professional pharmacy services, with an aim to cover both the needs relating to care for patients on medication and to public health. This proposal put forward an approach for the implementation and development of professional pharmacy services with an aim to roll out this service in community pharmacies in the next few years. In accordance with this proposal, all professional pharmacy services that offer these services will be supported by a specifications document. The purpose of this specifications document is to define and characterize the arterial pressure measurement and testing service with two aims: • To help community pharmacists and their representatives in the offer, provision, promotion, financing and arrangement of this service. • To serve as a guide for community pharmacists who want to implement this service in the pharmacy or to provide a standardized working procedure to do so. This document is accompanied by the procedural guide for community pharmacists for patients with arterial hypertension and cardiovascular risk (Guía de actuación para el farmacéutico comunitario en pacientes con HTA y riesgo cardiovascular (RCV)). Consensus document of GIAF-UGR, SEFAC and SEH-LELHA and the impacHta program: SEFAC and SEH-LELHA training in hypertension and vascular risk (AU)


Assuntos
Humanos , Masculino , Feminino , Pressão Arterial , Anormalidades Cardiovasculares/metabolismo , Anormalidades Cardiovasculares/prevenção & controle , Farmácias/provisão & distribução , Espanha , Pessoal de Saúde/educação , Serviços de Saúde Comunitária/métodos , Certificado de Necessidades/normas , Pressão Arterial/fisiologia , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/diagnóstico , Farmácias/classificação , Espanha/etnologia , Pessoal de Saúde/classificação , Serviços de Saúde Comunitária/provisão & distribução , Certificado de Necessidades/classificação
15.
Bull World Health Organ ; 94(3): 222-7, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26966334

RESUMO

PROBLEM: In China, human immunodeficiency virus (HIV) care provided by community-based organizations and the public sector are not well integrated. APPROACH: A community-based organization and experts from the Guangzhou Center for Disease Control and Prevention developed internet-based services for men who have sex with men, in Guangzhou, China. The internet services were linked to clinical services offering HIV testing and care. LOCAL SETTING: The expanding HIV epidemic among men who have sex with men is a public health problem in China. HIV control and prevention measures are implemented primarily through the public system. Only a limited number of community organizations are involved in providing HIV services. RELEVANT CHANGES: The programme integrated community and public sector HIV services including health education, online HIV risk assessment, on-site HIV counselling and testing, partner notification, psychosocial care and support, counting of CD4+ T-lymphocytes and treatment guidance. LESSONS LEARNT: The internet can facilitate HIV prevention among a subset of men who have sex with men by enhancing awareness, service uptake, retention in care and adherence to treatment. Collaboration between the public sector and the community group promoted acceptance by the target population. Task sharing by community groups can increase access of this high-risk group to available HIV-related services.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Infecções por HIV , Acesso aos Serviços de Saúde , Homossexualidade Masculina , China/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Disseminação de Informação , Internet , Masculino , Parcerias Público-Privadas
16.
BJU Int ; 118(2): 327-34, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26917016

RESUMO

OBJECTIVES: To conduct an audit of patients presenting with long-term urinary catheter (LTC)-associated problems to our Emergency Department (ED) and to assess the availability of community nursing support for their LTC. We also estimated the cost implication to the health service and the potential solutions to this issue, as although catheter care is provided by community nurses, LTC problems are common presentations to the ED and are often significant burdens to the services. PATIENTS AND METHODS: A study was carried out of all patients presenting to the ED with a urinary catheter problem, specifically studying LTCs and the reason for presentation, district nurses' involvement, and the intervention received. RESULTS: In all, 78 patients with a urinary catheter problem presented to the ED over a 69-day period, of whom 59 (68%) had a LTC. In all, 33 patients (42%) attended during normal working hours between 0900 and 1700 h. The mean (range) age was 74 (42-93) years and the duration the LTC had been in situ was 11 (1-120) months. The most common reasons for attendance were blocked catheter (37 patients, 47%) and catheter-bypass (18, 23%). Only 28 patients (36%) were known to district nursing services, and 14% were referred by a district nurse. Most of the remaining patients self-referred to the ED. No patient had any documented contact with their general practitioner. In addition, 64 patients (82%) had their catheter issues addressed adequately by ED nurses or doctors, without any urology involvement. CONCLUSIONS: The high morbidity of LTCs causes a considerable demand on ED services, and has heavy cost implications to the health system. Most patients had minimal community nurse support, and their catheter problems were easily dealt with by ED nurses and doctors.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Serviço Hospitalar de Emergência/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Cateterismo Urinário/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
17.
N Z Med J ; 129(1430): 29-38, 2016 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-26914420

RESUMO

AIM: To investigate the contribution to cancer care and prevention by Maori health provider organisations (MHPs) in Aotearoa/New Zealand. METHODS: A nationwide postal survey of all MHPs (n=253) was undertaken in 2011. The response rate was 55%. RESULTS: We found that MHPs are delivering a wide range of programmes including cancer prevention services focussed on health promotion, advocacy, information and support. MHPs identified financial hardship, transport difficulties, and lack of information as the greatest barriers to cancer care. Culturally safe care by mainstream providers would improve cancer service provision overall. The importance of trust and long-term relationships, with a focus on families rather than individual-based care, was highlighted. CONCLUSION: These findings could lead to substantial improvements in quality of life for Maori cancer patients. This is the first study to show how indigenous health providers contribute to cancer care and prevention in Aotearoa/New Zealand.


Assuntos
Serviços de Saúde Comunitária , Promoção da Saúde , Serviços de Saúde do Indígena , Neoplasias/diagnóstico , Neoplasias/terapia , Grupo com Ancestrais Oceânicos , Serviços de Saúde Comunitária/provisão & distribução , Detecção Precoce de Câncer , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena/provisão & distribução , Humanos , Neoplasias/prevenção & controle , Nova Zelândia , Cuidados Paliativos , Aceitação pelo Paciente de Cuidados de Saúde , Defesa do Paciente , Educação de Pacientes como Assunto , Inquéritos e Questionários , Transportes
18.
J Am Geriatr Soc ; 64(2): 425-31, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26825429

RESUMO

Falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through exercise. Public health authorities and healthcare professionals endorse the use of evidence-based, exercise-focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practice, including lack of evidence of the transferability of efficacy trial results to clinical and community settings, insufficient local expertise to roll out community exercise programs, and inadequate infrastructure to integrate evidence-based programs into clinical and community practice. The practical solutions highlighted in this article can be used to address these evidence-to-practice challenges. Falls and their associated healthcare costs can be reduced by better integrating research on exercise intervention into clinical practice and community programs.


Assuntos
Acidentes por Quedas/prevenção & controle , Exercício Físico , Idoso , Pesquisa Biomédica , Serviços de Saúde Comunitária/provisão & distribução , Medicina Baseada em Evidências , Humanos , Vida Independente , Disseminação de Informação , Comunicação Interdisciplinar , Guias de Prática Clínica como Assunto , Projetos de Pesquisa
19.
Health Policy Plan ; 31(5): 656-66, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26608585

RESUMO

BACKGROUND: In 2010, Ethiopia began scaling up the integrated community case management (iCCM) of childhood illness strategy throughout the country allowing health extension workers (HEWs) to treat children in rural health posts. After 2 years of iCCM scale up, utilization of HEWs remains low. Little is known about factors related to the use of health services in this setting. This research aimed to elicit perceptions and experiences of caregivers to better understand reasons for low utilization of iCCM services. METHODS: A rapid ethnographic assessment was conducted in eight rural health post catchment areas in two zones: Jimma and West Hararghe. In total, 16 focus group discussions and 78 in-depth interviews were completed with mothers, fathers, HEWs and community health volunteers. RESULTS: In spite of the HEW being a core component of iCCM, we found that the lack of availability of HEWs at the health post was one of the most common barriers to the utilization of iCCM services mentioned by caregivers. Financial and geographic challenges continue to influence caregiver decisions despite extension of free child health services in communities. Acceptability of HEWs was often low due to a perceived lack of sensitivity of HEWs and concerns about medicines given at the health post. Social networks acted both to facilitate and hinder use of HEWs. Many mothers stated a preference for using the health post, but some were unable to do so due to objections or alternative care-seeking preferences of gatekeepers, often mothers-in-law and husbands. CONCLUSION: Caregivers in Ethiopia face many challenges in using HEWs at the health post, potentially resulting in low demand for iCCM services. Efforts to minimize barriers to care seeking and to improve demand should be incorporated into the iCCM strategy in order to achieve reductions in child mortality and promote equity in access and child health outcomes.


Assuntos
Cuidadores/psicologia , Administração de Caso/estatística & dados numéricos , Serviços de Saúde da Criança/provisão & distribução , Serviços de Saúde Comunitária/estatística & dados numéricos , Agentes Comunitários de Saúde/provisão & distribução , Antropologia Cultural , Pré-Escolar , Serviços de Saúde Comunitária/provisão & distribução , Agentes Comunitários de Saúde/psicologia , Etiópia , Grupos Focais , Humanos , Lactente , Pesquisa Qualitativa
20.
Am J Public Health ; 106(2): 271-2, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26691131

RESUMO

I have described a decision support tool that may facilitate local decisions regarding the provision and billing of clinical services. I created a 2 by 2 matrix of health professional shortage and Medicaid expansion availability as of July 2015. I found that health departments in 93% of US counties may still need to provide clinical services despite the institution of the Affordable Care Act. Local context and market conditions should guide health departments' decision to act as safety net providers.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Técnicas de Apoio para a Decisão , Acesso aos Serviços de Saúde/economia , Patient Protection and Affordable Care Act , Provedores de Redes de Segurança/economia , Humanos , Governo Local , Medicaid/economia , Estados Unidos
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