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Cien Saude Colet ; 28(2): 585-598, 2023 Feb.
Artículo en Portugués | MEDLINE | ID: mdl-36651409


The article analyzes aspects of the structuring of the health care network in the regions of the State of Mato Grosso, and the narrative about them, by institutional actors representing management, service providers and society. It is based on research on governance and regionalization of the SUS in this state, with a quantitative and qualitative approach, the empirical basis of which included secondary data, institutional documents and interviews with key actors representing management, service providers and society. In this research, the focus was on coverage of the Family Health Strategy; availability of health services; workforce; expenses on health. Between 2010 and 2018, despite the improvement of several indicators examined: the supply and distribution of services and professionals reveal regional inequalities; there are financial limitations and a lack of services and professionals. The Health Care Network (HCN) is not structured as regulated, but rather as each region - and its municipalities - interprets and adapts it, according to its installed capacity. The PHC network has promoted advances, but it has not been able to be effective and resolute in terms of health needs, not providing care properly nor coordinating the HCN.

O artigo objetiva analisar aspectos da estruturação da rede de atenção à saúde nas regiões do estado de Mato Grosso e a narrativa sobre eles, de atores institucionais representantes da gestão, da prestação de serviços e da sociedade. Tem por base a pesquisa sobre governança e regionalização do SUS neste estado, de abordagem quantitativa e qualitativa, cuja base empírica contemplou dados secundários, documentos institucionais e entrevistas com atores-chave, estes representando a gestão, a prestação de serviços e a sociedade. Os aspectos da estrutura deste recorte focam: cobertura da ESF; disponibilidade de estabelecimentos/serviços de saúde; força de trabalho; despesas com saúde. Entre 2010 e 2018, em que pese a melhoria de vários indicadores explorados: a oferta e a distribuição de serviços e de profissionais evidenciam desigualdades regionais; há limitações financeiras, insuficiência de serviços e de profissionais. A Rede de Atenção à Saúde não está estruturada como regulamentada e sim como cada região - e seus municípios - a entendem e a adaptam, conforme sua capacidade instalada. A APS promoveu avanços, porém não tem conseguido ser efetiva e resolutiva frente às necessidades de saúde, não coordenando adequadamente o cuidado e tampouco orientando a RAS.

Atención a la Salud , Humanos , Brasil , Ciudades , Atención a la Salud/organización & administración , Fuerza Laboral en Salud
J Glob Health ; 13: 04005, 2023 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-36655879


Background: A growing global shortage of health workers is limiting access to health care, especially in resource-limited countries. Family participation in hospital care could enhance care while tackling health worker shortages. With the same resources, it might deliver additional and more personalised care. This review assessed the effect and safety of family participation interventions in the care of hospitalised adults in resource-limited settings and, ultimately, if it is a viable strategy to tackle health worker shortages. Methods: For this systematic review, Medline, Embase, CINAHL and the Global Health Library were searched from inception till April 7, 2022. Clinical studies were included if they described a family participation intervention for hospitalised adults, were performed in a low- or middle-income country and reported on a patient-related outcome. Data were collected on patient, family, staff and health service-related outcomes. Risk of bias was assessed with the ROB2 and ROBINS-I tool. Results: From 4444 studies, six were included for narrative synthesis, with a total of 1794 participants. Four studies were performed in Asia and two in Africa; all were published between 2017 and 2022. In-hospital family participation interventions aimed at medication administration and adherence, delirium prevention, and palliative cancer care were successful in significantly improving patient outcomes. Involving family in post-stroke rehabilitation interventions showed no significant effect on mortality and long-term disability. Few data were reported on participating family members' outcomes or hospital staffing issues. None of the included studies showed harm from family participation. Conclusions: The limited data suggest that family participation can be effective and safe in specific contexts. However, more research is needed to determine the effect of family participation and justify further implementation. Family participation research for enhancing care while tackling health worker shortages should be a collaborative priority of researchers, health care professionals, funding agencies and policymakers. Registration: PROSPERO registration No. CRD42020205878.

Atención a la Salud , Familia , Personal de Hospital , Adulto , Humanos , Atención a la Salud/organización & administración , Hospitales , Países en Desarrollo , Personal de Hospital/provisión & distribución
BMC Health Serv Res ; 23(1): 57, 2023 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-36658517


INTRODUCTION: An Integrated Community treatment of Childhood disease (ICCM)- focused intervention involving a large number of Patent and proprietary medicine vendors (PPMVs) was conducted by Society for Family Health Nigeria to improve management of childhood, malaria, pneumonia and diarrhea with an intervention approach focused on knowledge and skill improvement. The intervention was conducted in Kaduna and Ebonyi state; recruited and trained 15 interpersonal communication agents (IPCAs) who were saddled with the responsibility to sensitize and mobilize caregivers with children within the age bracket of 2 months to 5 years to our mapped PPMVs within the communities, on the account of Malaria, Diarrhea, and Pneumonia; while the IPCAs in return monitor the quality-of-service delivery. Following the intervention, the Society for Family health conducted a study to demonstrate the effectiveness of interventions such as ICCM training, supervision and linkage to quality ICCM commodities, among PPMVs to achieve high levels of knowledge and performance in diagnosing and treating common childhood illnesses. METHODS: Longitudinal research (before and after study) was adopted for the study. From the 387 PPMVs recruited and trained by SFH, 165 PPMVs were systematically selected to participate in the study, before and after the implementation of the intervention. Using SPSS version 22, data from the observation and completed questionnaires were analyzed and a chi-square test was used to examine the associations between the categorical information collected prior and after the intervention. The analysis was conducted at 5% level of significance. RESULTS: More than 50 % of the study participants were females (56.4%) and majority were either Junior community extension workers (35%) or Senior community extension worker (27%). About 21.8% trained PPMVs could not appropriately treat malaria in the first quarter of the intervention, however, there was a significant decrease to 1.8% in second quarter in the number of those that cannot appropriately diagnose and treat malaria. There was also a decrease in the number of those who could not treat cough and fast breathing from 47(28.5%) to 14(8.5%) in the second quarter and for diarrhea from 33.3% in the first quarter to 2.4% in the second quarter. CONCLUSION: The study revealed a significant improvement in the quality of treatment provided by the trained PPMVs across the three disease areas. PPMVs in hard-to-reach areas should be trained and supported to continuously provide quality services to change the indices of under-5 mortality in Nigeria.

Malaria , Neumonía , Niño , Femenino , Humanos , Masculino , Manejo de Caso , Medicamentos sin Prescripción , Nigeria , Malaria/diagnóstico , Malaria/tratamiento farmacológico , Diarrea/tratamiento farmacológico , Neumonía/terapia , Agentes Comunitarios de Salud , Servicios de Salud Comunitaria
BMC Health Serv Res ; 23(1): 70, 2023 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-36690961


BACKGROUND: Basic emergency management in urban and rural areas is a critical challenge, which can affect the pre-hospital mortality rate. Therefore, Non-hospital Healthcare Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The main aim of the study was to develop and validate an toolbar for NHHCs' preparedness to provide initial emergency care. METHODS: This study was designed based on a sequential exploratory mixed- method in two phases, in each of which there are three steps. In the phase I, the literature systematic review and qualitative methods (Focus Group Discussions (FGDs) and Semi-Structured Interviews (SSIs)) were applied to identify the domains and items. In the phase II, content validity, feasibility, and reliability of the toolbar were performed. Content validity was assessed using a modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the toolbar was randomly assessed through its implementation in 10 centers in Tabriz. Reliability was randomly assessed in a pilot on 30 centers. Reliability was assessed by measuring internal consistency, test-retest reliability, and inter-rater agreement. The main statistical methods for assessing reliability include Cronbach's alpha, Intra-class Correlation Coefficient, and Kendal's Tau-b. All the statistical analyses were performed using Stata 14. RESULTS: In the phase I, primary version of the toolbar containing 134 items related to assessing the preparedness of NHHCs was generated. In the phase II, item reduction was applied and the final version of the toolbar was developed containing 126 items, respectively. These items were classified in 9 domains which include: "Environmental Infrastructures of Centers", "Protocols, Guidelines and Policies", "Medical Supplies and Equipment", "Emergency Medicines", "Human Resources", "Clinical Interventions", "Maintenance of equipment", "Medicine Storage Capability", and "Management Process". The toolbar had acceptable validity and reliability. CONCLUSIONS: This study provided a standard and valid toolbar that can be used to assess the preparedness of NHHCs to deliver initial emergency care.

Servicios Médicos de Urgencia , Administración de los Servicios de Salud , Humanos , Reproducibilidad de los Resultados , Tratamiento de Urgencia , Encuestas y Cuestionarios , Atención a la Salud , Psicometría
Accid Anal Prev ; 182: 106965, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36634400


Real-time vehicle safety prediction is critical in roadway safety management as drivers or vehicles can be altered beforehand to take corresponding evasive actions and avoid possible collisions. This study proposes a physics-informed multi-step real-time conflict-based vehicle safety prediction model to enhance roadway safety. Physics insights (i.e., traffic shockwave properties) are combined with data-driven features extracted from deep-learning techniques to improve prediction accuracy. A time series of future vehicle safety indicators are predicted such that vehicles/drivers have enough time to take precautions. The safety indicator at each time stamp is a continuous value that the sign reflects the presence of conflict risks, and the absolute value indicates the conflict risk level to advise different magnitudes of evasive actions. A customized loss function is developed for the proposed prediction model to give more attention to risky events, which are the focus of safety management. The prediction superiority of the proposed model is proven through numerical experiments by comparing it with three benchmarks constructed based on the literature. Further, sensitivity analysis on key model parameters is carried out to advise parameter selections in developing real-world conflict-based vehicle safety prediction applications.

Accidentes de Tránsito , Planificación Ambiental , Humanos , Accidentes de Tránsito/prevención & control , Administración de la Seguridad , Factores de Tiempo , Seguridad
Hydrogeol J ; : 1-6, 2023 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-36687384


Groundwater's role in maintaining the well-being of the planet is increasingly acknowledged. Only recently has society recognised groundwater as a key component of the water cycle. To improve public understanding and the proper use of groundwater, the hydrogeological community must expand its efforts in groundwater assessment, management, and communication. The International Association of Hydrogeologists (IAH) intends to help achieve the United Nation's water-related Sustainable Development Goals (SDGs) by the adoption of innovative hydrogeological strategies. This essay introduces a topical collection that encapsulates IAH's 2022 'Year for Groundwater'.

Le rôle des eaux souterraines dans le maintien du bien-être de la planète est de plus en plus reconnu. Ce n'est que récemment que la société a reconnu les eaux souterraines comme un élément clé du cycle de l'eau. Pour améliorer la compréhension du public et l'utilisation appropriée des eaux souterraines, la communauté hydrogéologique doit étendre ses efforts en matière d'évaluation, de gestion des eaux souterraines et de communication à leur sujet. L'Association Internationale des Hydrogéologues (AIH) entend contribuer à la réalisation des objectifs du développement durable (ODDs) des Nations unies liés à l'eau par l'adoption de stratégies hydrogéologiques innovantes. Cet essai présente une collection thématique qui résume l''Année pour les eaux souterraines' 2022 de l'AIH.

El papel de las aguas subterráneas para mantener el bienestar del planeta está cada vez más reconocido. Sólo recientemente la sociedad ha reconocido que las aguas subterráneas son un componente clave del ciclo del agua. Para mejorar la comprensión pública y el uso adecuado de las aguas subterráneas, la comunidad hidrogeológica debe aumentar sus esfuerzos en materia de evaluación, gestión y comunicación de las aguas subterráneas. La Asociación Internacional de Hidrogeólogos (AIH) pretende contribuir a la concreción de los Objetivos de Desarrollo Sostenible (ODS) de las Naciones Unidas relacionados con el agua mediante la adopción de estrategias hidrogeológicas innovadoras. Este artículo presenta una colección temática que engloba el 2022 como 'Año Internacional para las Aguas Subterráneas' de la AIH.

O papel das águas subterrâneas na manutenção do bem-estar do planeta é cada vez mais reconhecido. Só recentemente a sociedade reconheceu as águas subterrâneas como um componente chave do ciclo da água. Para melhorar a compreensão pública e o uso adequado das águas subterrâneas, a comunidade hidrogeológica deve expandir seus esforços na avaliação, gestão e comunicação das águas subterrâneas. A Associação Internacional de Hidrogeólogos (AIH) pretende ajudar a alcançar os Objetivos de Desenvolvimento Sustentável (ODS) das Nações Unidas relacionados à água por meio da adoção de estratégias hidrogeológicas inovadoras. Este ensaio apresenta uma coleção tópica que encapsula o 'Ano para as Águas Subterrâneas' de 2022 da AIH.

J Health Organ Manag ; ahead-of-print(ahead-of-print)2023 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-36659868


PURPOSE: The authors review the literature on information behavior, an autonomous body of work developed mainly in library studies and compare it with work on knowledge mobilization. The aim is to explore how information behavior can contribute to understanding knowledge mobilization in healthcare management. DESIGN/METHODOLOGY/APPROACH: The authors conducted a narrative review using an exploratory, nonkeyword "double-sided systematic snowball" method. This is especially useful in the situation when the two traditions targeted are broad and relies on distinct vocabulary. FINDINGS: The authors find that the two bodies of work have followed similar trajectories and arrived at similar conclusions, with a linear view supplemented first by a social approach and then by a sensitivity to practice. Lessons from the field of information behavior can be used to avoid duplication of effort, repeating the same errors and reinventing the wheel among knowledge translation scholars. This includes, for example, focusing on sources of information or ignoring the mundane activities in which managers and policymakers are involved. ORIGINALITY/VALUE: The study is the first known attempt to build bridges between the field of information behavior and the study of knowledge mobilization. The study, moreover, foregrounds the need to address knowledge mobilization in context-sensitive and social rather than technical terms, focusing on the mundane work performed by a variety of human and nonhuman agents.

Administración de los Servicios de Salud , Humanos , Conocimiento , Práctica Clínica Basada en la Evidencia , Almacenamiento y Recuperación de la Información
JAMA ; 329(4): 325-335, 2023 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-36692555


Importance: Health systems play a central role in the delivery of health care, but relatively little is known about these organizations and their performance. Objective: To (1) identify and describe health systems in the United States; (2) assess differences between physicians and hospitals in and outside of health systems; and (3) compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. Evidence Review: Health systems were defined as groups of commonly owned or managed entities that included at least 1 general acute care hospital, 10 primary care physicians, and 50 total physicians located within a single hospital referral region. They were identified using Centers for Medicare & Medicaid Services administrative data, Internal Revenue Service filings, Medicare and commercial claims, and other data. Health systems were categorized as academic, public, large for-profit, large nonprofit, or other private systems. Quality of preventive care, chronic disease management, patient experience, low-value care, mortality, hospital readmissions, and spending were assessed for Medicare beneficiaries attributed to system and nonsystem physicians. Prices for physician and hospital services and total spending were assessed in 2018 commercial claims data. Outcomes were adjusted for patient characteristics and geographic area. Findings: A total of 580 health systems were identified and varied greatly in size. Systems accounted for 40% of physicians and 84% of general acute care hospital beds and delivered primary care to 41% of traditional Medicare beneficiaries. Academic and large nonprofit systems accounted for a majority of system physicians (80%) and system hospital beds (64%). System hospitals were larger than nonsystem hospitals (67% vs 23% with >100 beds), as were system physician practices (74% vs 12% with >100 physicians). Performance on measures of preventive care, clinical quality, and patient experience was modestly higher for health system physicians and hospitals than for nonsystem physicians and hospitals. Prices paid to health system physicians and hospitals were significantly higher than prices paid to nonsystem physicians and hospitals (12%-26% higher for physician services, 31% for hospital services). Adjusting for practice size attenuated health systems differences on quality measures, but price differences for small and medium practices remained large. Conclusions and Relevance: In 2018, health system physicians and hospitals delivered a large portion of medical services. Performance on clinical quality and patient experience measures was marginally better in systems but spending and prices were substantially higher. This was especially true for small practices. Small quality differentials combined with large price differentials suggests that health systems have not, on average, realized their potential for better care at equal or lower cost.

Atención a la Salud , Administración Hospitalaria , Calidad de la Atención de Salud , Anciano , Humanos , Atención a la Salud/economía , Atención a la Salud/organización & administración , Atención a la Salud/normas , Atención a la Salud/estadística & datos numéricos , Programas de Gobierno , Hospitales/clasificación , Hospitales/normas , Hospitales/estadística & datos numéricos , Medicare/economía , Medicare/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Estados Unidos/epidemiología , Administración Hospitalaria/economía , Administración Hospitalaria/normas , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/organización & administración , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos
Waste Manag ; 157: 269-278, 2023 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-36580882


The problem of waste generation has grown because of the need to extract natural resources, obtain materials, and consume energy to meet current societal needs. Many studies have been conducted worldwide in favor of technological solutions for the valorization of industrial waste (IW) but few discussed relevant data for effective recovery. In this study, a case study of ceramic shell waste (CSW) was performed using, for the first time, a waste valorization system based on the classification, potentiality, quantity/viability, and applicability criteria (CPQvA) in a specific region (Brazil). CPQvA is a multicriteria decision-making system that acts as a guide to help managers and researchers connect the potential of IW with the feasibility of its application in a product or another process. Using the proposed systematic criteria, it was possible to demonstrate similarities and differences in waste applications. Thirteen possible products made from CSW were analyzed based on all the parameters of CPQvA. Ceramic filters and refractory aggregates were the most viable products. Creating public policies that encourage the use of waste as a raw material could make the precision casting industry process cleaner and the economy more circular.

Cerámica , Administración de Residuos , Residuos Industriales , Política Pública , Brasil
Soc Sci Res ; 109: 102777, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36470630


The International Monetary Fund (IMF) is (in)famous for its structural adjustment programs, which provide fresh credit for borrowing governments in exchange for market-liberalizing policy reforms. While studies have documented a causal relationship between structural adjustment and political instability, scholarly understanding of the mechanisms underlying this relationship remain perfunctory. The received wisdom is that IMF policy conditions generate material hardship which then drives political instability. We advance an additional pathway-that instability is also prompted by alienation effects related to the foreign imposition of policies. Drawing on a sample of up to 168 countries between 1980 and 2014, we test for the presence of both mechanisms. Our results suggest that there are alienation effects, indicated by a persistent protest-inducing impact of IMF program participation when controlling for market-liberalizing conditions, and especially when programs are concluded by left-wing governments and non-repeat borrowers. We also find evidence of hardship effects, indicated by a positive relationship between the intensity of fiscal austerity required and the number of protests. Our findings have important implications for the relationship between structural adjustment, contentious politics, and the role of international organizations in domestic policy reform.

Países en Desarrollo , Administración Financiera , Humanos , Gobierno , Política Pública , Política
Front Public Health ; 10: 1018060, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36466448


Background: The emergence of the COVID-19 has disrupted the health and socioeconomic sectors, particularly in resource-poor settings such as Guinea. Like many sub-Saharan countries, Guinea is facing shortcomings related to its fragile health system and is further affected by the passage of the Ebola virus disease. The pandemic has worsened the socio-economic situation of the poorest people, leading to their exclusion from health care. To promote access to care for the most vulnerable populations, a system was set up to provide care for these people who are victims of health marginalization to promote their access to care. This study aimed to analyze access to health services by vulnerable populations during the COVID-19 pandemic in Guinea through the establishment of a health indigent fund (HIF). Methods: This was a qualitative study to assess the project implementation process. A total of 73 in-depth individual interviews were conducted with beneficiaries, health workers, community health workers and members of the HIF management committee, and a few informal observations and conversions were also conducted in the project intervention areas. The data collected were transcribed and coded using the deductive and inductive approaches with the Nvivo software before applying the thematic analysis. Results: A total of 1,987 indigents were identified, of which 1,005 were cared for and 64 referred to all 38 intervention health facilities within the framework of the HIF. All participants appreciated the project's social action to promote access to equitable and quality health care for this population excluded from health care services. In addition, the project has generated waves of compassion and solidarity toward these "destitute" people whose main barrier to accessing health care remains extreme poverty. A state of poverty that leads some to sell their assets (food or animal reserves) or to go into debt to ensure access to care for their children, considered the most at risk. Conclusion: The HIF can be seen as an honest attempt to provide better access to health care for the most vulnerable groups. Some challenges need to be addressed including the current system of acquiring funds before the attempt can be considered scalable.

COVID-19 , Administración Financiera , Animales , Humanos , COVID-19/epidemiología , Pandemias , Guinea/epidemiología , Pobreza , Agentes Comunitarios de Salud , Continuidad de la Atención al Paciente
Rev. med. cine ; 18(4): 347-355, dic. 2022. tab, ilus
Artículo en Español | IBECS | ID: ibc-213917


Este artículo presenta un análisis sobre la película Yo, Daniel Blake / I, Daniel Blake (2016) de Ken Loach, filme que nos pone en la posición de una persona con una enfermedad crónica degenerativa, mostrándonos el punto de vista de un paciente y su vivencia fuera de los muros del hospital, dentro de un sistema de salud europeo burocratizado y estandarizado que no cubre las necesidades individuales de los enfermos. Se consideran distintos aspectos de interés en este análisis, útiles para la formación universitaria en medicina humana, como lo son; la amenaza que puede significar que el sistema de salud se enfoque en la eficiencia y eficacia de la gestión por encima del bienestar del paciente y la comprensión de relevancia del contexto individual, familiar y comunitario del mismo, evidenciando que el ejercicio y desarrollo de la medicina integral es indispensable para una apropiada atención a los pacientes. (AU)

This article presents an analysis of the film I, Daniel Blake (2016) by de Ken Loach, a film that puts us in the position of a person with a chronic degenerative disease, showing us the point of view of a patient and his experience outside the walls of the hospital, within a bureaucratized and standardized European health system that does not cover the individual needs of patients. Different aspects of interest are considered in this analysis, useful for university training in human medicine, as they are; the threat that the health system may mean focusing on the efficiency and effectiveness of management over the well-being of the patient and the understanding of the relevance of the individual, family and community context, evidencing that the exercise and development of integral medicine is essential for proper patient care. (AU)

Humanos , Películas Cinematográficas , Sistemas de Salud , Enfermedad Crónica , Muerte Súbita Cardíaca , Salud Pública , Medicina en las Artes
BMJ Glob Health ; 7(12)2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36517112


A combination of public health campaigns and routine primary healthcare services are used in many countries to maximise the number of people reached with interventions to prevent, control, eliminate or eradicate diseases. Health campaigns have historically been organised within vertical (disease-specific) programmes, which are often funded, planned and implemented independently from one another and from routinely offered primary healthcare services. Global health agencies have voiced support for enhancing campaign effectiveness, including campaign efficiency and equity, through collaboration among vertical programmes. However, limited guidance is available to country-level campaign planners and implementers about how to effectively integrate campaigns. Planning is critical to the implementation of effective health campaigns, including those related to neglected tropical diseases, malaria, vitamin A supplementation and vaccine-preventable diseases, including polio, measles and meningitis. However, promising approaches to planning integrated health campaigns have not been sufficiently documented. This manuscript highlights promising practices for the collaborative planning of integrated health campaigns that emerged from the experiences of eight project teams working in three WHO regions. Adoption of the promising practices described in this paper could lead to enhanced collaboration among campaign stakeholders, increased agreement about the need for and anticipated benefits of campaign integration, and enhanced understanding of effective planning of integrated health campaigns.

Conducta Cooperativa , Planificación en Salud , Promoción de la Salud , Humanos , Salud Global , Promoción de la Salud/organización & administración , Estudios de Casos Organizacionales , Planificación en Salud/organización & administración
Respir Res ; 23(1): 361, 2022 Dec 19.
Artículo en Inglés | MEDLINE | ID: mdl-36529734


Respiratory self-care places considerable demands on patients with chronic airways disease (AD), as they must obtain, understand and apply information required to follow their complex treatment plans. If clinical and lifestyle information overwhelms patients' HL capacities, it reduces their ability to self-manage. This review outlines important societal, individual, and healthcare system factors that influence disease management and outcomes among patients with asthma and chronic obstructive pulmonary disease (COPD)-the two most common ADs. For this review, we undertook a comprehensive literature search, conducted reference list searches from prior HL-related publications, and added insights from international researchers and scientists with an interest in HL. We identified methodological limitations in currently available HL measurement tools in respiratory care. We also summarized the issues contributing to low HL and system-level cultural incompetency that continue to be under-recognized in AD management and contribute to suboptimal patient outcomes. Given that impaired HL is not commonly recognized as an important factor in AD care, we propose a three-level patient-centered model (strategies) designed to integrate HL considerations, with the goal of enabling health systems to enhance service delivery to meet the needs of all AD patients.

Asma , Alfabetización en Salud , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Asma/diagnóstico , Asma/epidemiología , Asma/terapia , Manejo de la Enfermedad , Atención a la Salud
BMC Health Serv Res ; 22(1): 1585, 2022 Dec 26.
Artículo en Inglés | MEDLINE | ID: mdl-36572882


BACKGROUND: Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in social needs case management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex interventions benefit patients inhibits effective translation to new settings. The CommunityConnect social needs case management program in Contra Costa County, California recently demonstrated an ability to reduce inpatient hospital admissions by 11% in a randomized study. We sought to characterize the mechanisms through which the Community Connect social needs case management program was effective in helping patients access needed medical and social services and avoid hospitalization. An in-depth understanding of how this intervention worked can support effective replication elsewhere. METHODS: Using a case study design, we conducted semi-structured, qualitative interviews with case managers (n = 30) and patients enrolled in social needs case management (n = 31), along with field observations of patient visits (n = 31). Two researchers coded all interview transcripts and observation fieldnotes. Analysis focused on program elements identified by patients and staff as important to effectiveness. RESULTS: Our analyses uncovered three primary mechanisms through which case management impacted patient access to needed medical and social services: [1] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [2] System mediation work to navigate systems, coordinate resources, and communicate information and [3] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. CONCLUSIONS: These findings highlight that the system mediation tasks which are the focus of many social needs assistance interventions offered by health care systems may be necessary but insufficient. Psychosocial support and direct assistance with social needs, enabled by a relationship-focused program, may also be necessary for effectiveness.

Manejo de Caso , Servicio Social , Humanos , Investigación Cualitativa , Atención a la Salud , Hospitales
Cad Saude Publica ; 38(11): e00228721, 2022.
Artículo en Portugués | MEDLINE | ID: mdl-36541966


Primary health care requires work processes guided by collaborative inter-professional action to respond to health care needs. The Expanded Family Health and Basic Healthcare Center (NASF-AB) acts as an important device to expand the possibilities of care in this scenario. This study aims to describe the process of constructing a theoretical-logical model and judgment matrix to evaluate the effectiveness of the NASF-AB. Evaluative study, with a descriptive-qualitative approach using documentary research, in which 11 documents regulating the work process of NASF-AB were selected to support the theoretical-logical model. For the elaboration of the judgment matrix to evaluate the effectiveness of NASF-AB, we considered the fundamental concepts and expected competencies, with the definition of indicators and criteria for a staggered evaluation, which allows classifying the NASF-AB as effective, potentially effective, low effectiveness, and non-effective. Both the structuring of the model and the application of the matrix and its graphic expression are instruments that support the ideal functioning of the NASF-AB, being able to guide decision-making in the management and work process, in the care and pedagogical dimensions. The products of this investigation constitute theoretical and methodological devices to support the evaluation of the effectiveness of NASF-AB and to identify the weaknesses and potencies of its performance.

A atenção básica requer processos de trabalho orientados pelo agir interprofissional colaborativo para responder às necessidades de saúde. O Núcleo Ampliado de Saúde da Família e Atenção Básica (NASF-AB) atua como importante dispositivo para ampliar as possibilidades de cuidado nesse cenário. Objetiva-se descrever o processo de construção de um modelo teórico-lógico e matriz de julgamento para avaliação da efetividade do NASF-AB. Foi realizado um estudo avaliativo, de abordagem descritivo-qualitativa com uso de pesquisa documental, em que foram selecionados 11 documentos regulamentadores do processo de trabalho do NASF-AB para subsidiar o modelo teórico-lógico. Na elaboração da matriz de julgamento para avaliação da efetividade do NASF-AB, consideraram-se os conceitos fundamentais e as competências esperadas, com a definição de indicadores e critérios para uma avaliação escalonar, a qual permite classificar o NASF-AB em efetivo, potencialmente efetivo, com baixa efetividade e não efetivo. Tanto a estruturação do modelo quanto a aplicação da matriz e sua expressão gráfica são instrumentos que subsidiam o funcionamento ideal do NASF-AB, sendo capazes de orientar a tomada de decisão na gestão e no processo de trabalho, nas dimensões assistencial e pedagógica. Os produtos desta investigação se constituem em dispositivos teórico-metodológicos para subsidiar a avaliação da efetividade do NASF-AB e permitir identificar insuficiências e potências de sua atuação.

La atención primaria requiere procesos de trabajo guiados por la acción colaborativa interprofesional para satisfacer las necesidades de salud. El Núcleo Ampliado de Salud Familiar y Atención Básica (NASF-AB) actúa como un importante dispositivo para ampliar las posibilidades de atención en este escenario. El objetivo es describir el proceso de construcción de un modelo teórico-lógico y una matriz de evaluación de la eficacia del NASF-AB. Estudio evaluativo de abordaje descriptivo-cualitativo con uso de investigación documental, en el que se seleccionaron 11 documentos reguladores del proceso de trabajo del NASF-AB para subsidiar el modelo teórico-lógico. Para la elaboración de la matriz de evaluación para la evaluación de la eficacia del NASF-AB, se consideraron los conceptos fundamentales y las competencias esperadas, con la definición de indicadores y criterios para una evaluación escalonada que permite clasificar el NASF-AB en eficaz, potencialmente eficaz, poco eficaz y no eficaz. Tanto la estructuración del modelo como la aplicación de la matriz y su expresión gráfica son instrumentos que subsidian el funcionamiento ideal del NASF-AB, pudiendo orientar la toma de decisiones en la gestión y en el proceso de trabajo, en las dimensiones asistencial y pedagógica. Los resultados de esta investigación se constituyen en dispositivos teórico-metodológicos para subsidiar la evaluación de la eficacia del NASF-AB y permitir la identificación de insuficiencias y potencialidades de su actuación.

Salud de la Familia , Juicio , Humanos , Brasil , Atención a la Salud
Medwave ; 22(11): e2618, 2022 Dec 06.
Artículo en Inglés, Español | MEDLINE | ID: mdl-36583651


The management of beds within healthcare centers is essential for meeting the health needs of the population. Currently, in Chile there are few computer tools that streamline the functions performed by the Bed Management Units of healthcare centers. The objective of this article is to describe the implementation of a bed management computer system in three hospitals of medium (Modular-La Serena) and high complexity (San José del Carmen-Copiapó y San Juan de Dios-La Serena) of the Chilean public health network. The process used the Framework of dissemination and implementation, which allowed for a consistent flow of bed management, namely: request, allocation of bed, transfer, hospitalization and patient discharge. Likewise, the relevant actors and the minimum variables for the adequate process were identified. The implementation of the system was carried out in stages of validation and configuration of the platform in each healthcare center, user training and follow-up of the start-up. To date, the three hospitals have an operational computer system for managing hospital beds, reporting no difficulties in its use. The next challenge is to carry out a comprehensive evaluation of the impact of the platform, using the indicators agreed upon with the clinical/administrative teams of the health centers.

La gestión de camas al interior de los centros asistenciales es fundamental para la atención de las necesidades de salud de la población. Actualmente, en Chile se cuenta con escasas herramientas informáticas que agilicen las funciones que realizan las unidades de gestión de camas de los centros asistenciales. El objetivo del presente artículo es describir la implementación de un sistema informático de gestión de camas en tres hospitales de mediana (Modular en La Serena) y alta complejidad (San José del Carmen en Copiapó y San Juan de Dios en La Serena) de la red pública de salud de Chile. El proceso utilizó el de diseminación e implementación, lo que permitió contar con un flujo coherente de gestión de camas, a saber: solicitud, asignación de cama, traslado, hospitalización y egreso de paciente. Asimismo, se identificaron los actores relevantes y las variables mínimas para el adecuado proceso. La implementación del sistema se llevó a cabo en etapas de validación y configuración de la plataforma en cada centro asistencial, capacitaciones a los usuarios y acompañamiento de la puesta en marcha. A la fecha, los tres hospitales cuentan operativamente con el sistema informático de gestión de camas hospitalarias, no reportando dificultades en su uso. El próximo desafío es efectuar una evaluación integral del impacto de la plataforma, utilizando los indicadores acordados con los equipos clínicos/administrativos de los centros de salud.

Hospitalización , Hospitales , Humanos , Salud Pública , Chile