42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.568 Adequate... definitions and accounting, statistics, and reporting practices that are widely accepted in the health care... 42 Public Health 3 2010-10-01 2010-10-01 false Adequate financial records, statistical data, and...

42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.568 Adequate... definitions and accounting, statistics, and reporting practices that are widely accepted in the health care... 42 Public Health 3 2011-10-01 2011-10-01 false Adequate financial records, statistical data, and...

Just health care (II): Is equality too much?

PubMed

Fleck, L M

1989-12-01

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence. Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a 'non-ideal' mode, a framework in which philosophers have done little.

Health Literacy: Critical Opportunities for Social Work Leadership in Health Care and Research

ERIC Educational Resources Information Center

Liechty, Janet M.

2011-01-01

One-third of U. S. adults do not have adequate health literacy to manage their health care needs; and low health literacy is a major concern due to its association with poor health outcomes, high health care costs, and health communication problems. Low health literacy is a potential driver of health disparities, and its alleviation is central to…

Health care worker perspectives of their motivation to reduce health care-associated infections.

PubMed

McClung, Laura; Obasi, Chidi; Knobloch, Mary Jo; Safdar, Nasia

2017-10-01

Health care-associated infections (HAIs) are largely preventable, but are associated with considerable health care burden. Given the significant cost of HAIs, many health care institutions have implemented bundled interventions to reduce HAIs. These complex behavioral interventions require considerable effort; however, individual behaviors and motivations crucial to successful and sustained implementation have not been adequately assessed. We evaluated health care worker motivations to reduce HAIs. This was a phenomenologic qualitative study of health care workers in different roles within a university hospital, recruited via a snowball strategy. Using constructs from the Consolidated Framework for Implementation Research model, face-to-face semi-structured interviews were used to explore perceptions of health care worker motivation to follow protocols on HAI prevention. Across all types of health care workers interviewed, patient safety and improvement in clinical outcomes were the major motivators to reducing HAIs. Other important motivators included collaborative environment that valued individual input, transparency and feedback at both organizational and individual levels, leadership involvement, and refresher trainings and workshops. We did not find policy, regulatory considerations, or financial penalties to be important motivators. Health care workers perceived patient safety and clinical outcomes as the primary motivators to reduce HAI. Leadership engagement and data-driven interventions with frequent performance feedback were also identified as important facilitators of HAI prevention. Published by Elsevier Inc.

Systemic racism and U.S. health care.

PubMed

Feagin, Joe; Bennefield, Zinobia

2014-02-01

This article draws upon a major social science theoretical approach-systemic racism theory-to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing-with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources-and to adequate health care and health outcomes. Dealing justly with continuing racial "disparities" in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Costs and coverage. Pressures toward health care reform.

PubMed Central

Lee, P R; Soffel, D; Luft, H S

1992-01-01

Signs of discontent with the health care system are growing. Calls for health care reform are largely motivated by the continued increase in health care costs and the large number of people without adequate health insurance. For the past 20 years, health care spending has risen at rates higher than the gross national product. As many as 35 million people are without health insurance. As proposals for health care reform are developed, it is useful to understand the roots of the cost problem. Causes of spiraling health care costs include "market failure" in the health care market, expansion in technology, excessive administrative costs, unnecessary care and defensive medicine, increased patient complexity, excess capacity within the health care system, and low productivity. Attempts to control costs, by the federal government for the Medicare program and then by the private sector, have to date been mostly unsuccessful. New proposals for health care reform are proliferating, and important changes in the health care system are likely. PMID:1441510

Health needs and nursing care.

PubMed

Petersen, Cristina Buischi; Lima, Regina Aparecida Garcia de; Boemer, Magali Roseira; Rocha, Semiramis Melani Melo

2016-01-01

to present the concept of needs according to different approaches to discuss the possibility of health care that incorporates a broader view of human vulnerabilities in health services. the arguments are founded on nursing theorists who worked on the construction of frameworks relevant to care, based on needs and on philosophers who show the possibility of identifying the vulnerabilities of human beings, defending art as a therapeutic instrument that can promote health care. although care can acquire a new dimension with the introduction of art, according to certain perspectives, philosophical studies on ethics and aesthetics should be resumed to identify human vulnerabilities that can in fact be compensated by sensible understanding of the outer world. To incorporate art in nursing care requires studies from theorists to be recovered, deepening concepts and working on empirical investigations for their adequate use.

Prediction of Adequate Prenatal Care Utilization Based on the Extended Parallel Process Model

PubMed Central

Hajian, Sepideh; Imani, Fatemeh; Riazi, Hedyeh; Salmani, Fatemeh

2017-01-01

ABSTRACT Background: Pregnancy complications are one of the major public health concerns. One of the main causes of preventable complications is the absence of or inadequate provision of prenatal care. The present study was conducted to investigate whether Extended Parallel Process Model’s constructs can predict the utilization of prenatal care services. Methods: The present longitudinal prospective study was conducted on 192 pregnant women selected through the multi-stage sampling of health facilities in Qeshm, Hormozgan province, from April to June 2015. Participants were followed up from the first half of pregnancy until their childbirth to assess adequate or inadequate/non-utilization of prenatal care services. Data were collected using the structured Risk Behavior Diagnosis Scale. The analysis of the data was carried out in SPSS-22 using one-way ANOVA, linear regression and logistic regression analysis. The level of significance was set at 0.05. Results: Totally, 178 pregnant women with a mean age of 25.31±5.42 completed the study. Perceived self-efficacy (OR=25.23; P<0.001) and perceived susceptibility (OR=0.048; P<0.001) were two predictors of the intention to utilize prenatal care. Husband’s occupation in the labor market (OR=0.43; P=0.02), unwanted pregnancy (OR=0.352; P<0.001), and the need to care for the minors or elderly at home (OR=0.35; P=0.045) were associated with lower odds of receiving prenatal care. Conclusion: The model showed that when perceived efficacy of the prenatal care services overcame the perceived threat, the likelihood of prenatal care usage will increase. This study identified some modifiable factors associated with prenatal care usage by women, providing key targets for appropriate clinical interventions. PMID:29043280

Quality of care along the cancer continuum: does receiving adequate lymph node evaluation for colon cancer lead to comprehensive postsurgical care?

PubMed

Parsons, Helen M; Tuttle, Todd M; Kuntz, Karen M; Begun, James W; McGovern, Patricia M; Virnig, Beth A

2012-09-01

Among surgically treated patients with colon cancer, lower long-term mortality has been demonstrated in those with 12 or more lymph nodes evaluated. We examined whether patients receiving adequate lymph node evaluation were also more likely to receive comprehensive postsurgical care, leading to lower mortality. We used the 1992 to 2007 Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify surgically treated American Joint Committee on Cancer (AJCC) stage III colon cancer patients. We used chi-square analyses and logistic regression to evaluate the association between adequate (≥12) lymph node evaluation and receipt of postsurgical care (adjuvant chemotherapy, surveillance colonoscopy, CT scans, and CEA testing) and Cox proportional hazards regression to evaluate 10-year all-cause mortality, adjusting for postsurgical care. Among 17,906 surgically treated stage III colon cancer patients, adequate (≥12) lymph node evaluation was not associated with receiving comprehensive postsurgical care after adjustment for patient and tumor characteristics (p > 0.05 for all). Initially, adequate lymph node evaluation was associated with lower all-cause mortality (hazard ratio [HR] 0.88; 95% CI [0.85 to 0.91]), but among 3-year survivors, the impact of adequate lymph node evaluation on lower mortality was diminished (HR 0.94; 95% CI [0.88 to 1.01]). However, receiving comprehensive postsurgical care was associated with continued lower mortality in 3-year survivors. Adequate lymph node evaluation for colon cancer was associated with lower mortality among all patients. However, among 3-year survivors, the association between lymph node evaluation and lower hazard of death was no longer significant, while postsurgical care remained strongly associated with lower long-term mortality, indicating that postsurgical care may partially explain the relationship between lymph node evaluation and mortality. Copyright © 2012 American College of Surgeons. Published

Financial Burden of Health Care Expenditures: Turkey

PubMed Central

Sulku, S Nur; Bernard, D Minbay

2012-01-01

In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to “The Health Transformation Programme”. Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to health care and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of health care expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on health care. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the health care reform in terms of providing financial protection. PMID:23113149

Health Literacy and Access to Care

PubMed Central

Janke, Alex

2016-01-01

Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forego needed care or to report difficulty finding a provider, even after controlling for other factors including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after controlling for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way. PMID:27043757

Integrating the 3Ds—Social Determinants, Health Disparities, and Health-Care Workforce Diversity

PubMed Central

Pierre, Geraldine

2014-01-01

The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce. PMID:24385659

Integrating the 3Ds--social determinants, health disparities, and health-care workforce diversity.

PubMed

LaVeist, Thomas A; Pierre, Geraldine

2014-01-01

The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce.

[Medical care unit -- a suitable instrument for ambulatory patient-adequate care and performance-related remuneration].

PubMed

Rudolph, P; Isensee, D; Gerlach, E; Gross, H

2013-02-01

The question of whether a medical care unit is an appropriate tool for outpatient care has been discussed for a long time. Our aim is to investigate whether the MCU is an effective instrument for outpatient care and adequate performance-related remuneration. This retro- and prospective overview of the work included statements on legal foundations for medical care units, for reimbursement of services in medical care units, the development of medical care centres in Germany and a listing of the specific advantages and disadvantages of an MCU. This article focuses on the generally applicable facts and complements them with examples from general, visceral and vascular surgery. The main quantitative data on medical centre statistics come from different publications of the National Association of Statutory Health Insurance for Physicians. From a legal point of view the instrument MCU allows the participating of ambulatory and stationary care in the framework of medical care contracts. This has been especially extended for stationary applications, including the spectrum of possibilities that can contribute under certain circumstances for the provision of medical care in underdeveloped regions. Freelancers can benefit primarily from financial risk and minimising bureaucratic routine. The remuneration for services performed in the MCU is analogous to that of other ambulatory care providers. Basically, there are no disadvantages, but a greater design freedom and opportunities for the generation of aggregates are visible. The number of MCU in Germany has quadrupled in the last five years, indicating an establishment of an outpatient care landscape. MCU offers from the patient's perspective, providers and policy specific advantages and disadvantages. Indeed the benefits outweigh the disadvantages, but this is not yet verified by qualitative studies. The question of the appropriateness of medical care units as outpatient care instrumentation must be considered differentially

Wealth and antenatal care use: implications for maternal health care utilisation in Ghana

PubMed Central

2012-01-01

The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the

Wealth and antenatal care use: implications for maternal health care utilisation in Ghana.

PubMed

Arthur, Eric

2012-08-06

The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the

Characterizing the Mental Health Care of U.S. Cambodian Refugees.

PubMed

Wong, Eunice C; Marshall, Grant N; Schell, Terry L; Berthold, S Megan; Hambarsoomians, Katrin

2015-09-01

This study examined U.S. Cambodian refugees' utilization of mental health services across provider types, levels of minimally adequate care, and mode of communication with providers. Face-to-face household interviews about mental health service use in the past 12 months were conducted as part of a study of a probability sample of Cambodian refugees. The analytic sample was restricted to the 227 respondents who met past 12-month criteria for posttraumatic stress disorder (PTSD) or major depressive disorder or both. Analyses were weighted to account for complex sampling design effects and for attrition. Fifty-two percent of Cambodian refugees who met diagnostic criteria obtained mental health services in the past 12 months. Of those who obtained care, 75% visited a psychiatrist and 56% a general medical provider. Only 7% had obtained care from other mental health specialty providers. Virtually all respondents who had seen a psychiatrist (100%) or a general medical doctor (97%) had been prescribed a psychotropic medication. Forty-five percent had received minimally adequate care. Most relied on interpreters to communicate with providers. Cambodian refugees' rates of mental health service utilization and minimally adequate care were comparable to those of individuals in the general U.S. Cambodian refugees obtained care almost entirely from psychiatrists and general medical doctors, and nearly all were receiving pharmacotherapy; these findings differ from rates seen in a nationally representative sample. Given this pattern of utilization, and the persistently high levels of PTSD and depression found among Cambodian refugees, treatment improvements may require identification of creative approaches to delivering more evidence-based psychotherapy.

Health Care Provider Perspectives on Informal Supporters’ Involvement in HIV Care

PubMed Central

Mosack, Katie E.; Wendorf, Angela R.

2014-01-01

Positive social support has been associated with medication adherence and slowed disease progression among people living with HIV. The nature of support within the medical context itself has not been adequately investigated, however. The purpose of our study was to describe HIV health care providers’ perspectives on informal supporter-oriented health care and whether and how the involvement of patients’ adult informal supporters in health care and health care decision making is helpful or beneficial. We conducted in-depth qualitative interviews with 11 HIV specialists between March and September, 2005. Using directed qualitative content analysis, we first describe the frequency and course of others’ involvement and the type of support provided. We then situate these findings within the context of role theory and consider the meaning they have in terms of the negotiated relationships among and between patients, providers, and informal supporters. Finally, we provide research and clinical recommendations based on these findings that are designed to improve patient care. PMID:21709129

42 CFR 413.24 - Adequate cost data and cost finding.

Code of Federal Regulations, 2013 CFR

2013-10-01

... familiar with the laws and regulations regarding the provision of health care services, and that the... 42 Public Health 2 2013-10-01 2013-10-01 false Adequate cost data and cost finding. 413.24 Section 413.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

42 CFR 413.24 - Adequate cost data and cost finding.

Code of Federal Regulations, 2012 CFR

2012-10-01

... familiar with the laws and regulations regarding the provision of health care services, and that the... 42 Public Health 2 2012-10-01 2012-10-01 false Adequate cost data and cost finding. 413.24 Section 413.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

Health Literacy and Communication Quality in Health Care Organizations

PubMed Central

Wynia, Matthew K.; Osborn, Chandra Y.

2011-01-01

The relationship between limited health literacy and poor health may be due to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and health care organization type, patients with limited health literacy were 28–79% less likely than those with adequate health literacy to report their health care organization “always” provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in health care organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers. PMID:20845197

Health literacy and communication quality in health care organizations.

PubMed

Wynia, Matthew K; Osborn, Chandra Y

2010-01-01

The relationship between limited health literacy and poor health may be due, in part, to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and health care organization type, patients with limited health literacy were 28% to 79% less likely than those with adequate health literacy to report their health care organization "always" provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in health care organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers.

42 CFR 413.24 - Adequate cost data and cost finding.

Code of Federal Regulations, 2014 CFR

2014-10-01

... provision of health care services, and that the services identified in this cost report were provided in... 42 Public Health 2 2014-10-01 2014-10-01 false Adequate cost data and cost finding. 413.24 Section 413.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

Health literacy and health care spending and utilization in a consumer-driven health plan.

PubMed

Hardie, Nancy A; Kyanko, Kelly; Busch, Susan; Losasso, Anthony T; Levin, Regina A

2011-01-01

We examined health literacy and health care spending and utilization by linking responses of three health literacy questions to 2006 claims data of enrollees new to consumer-driven health plans (n = 4,130). Better health literacy on all four health literacy measures (three item responses and their sum) was associated with lower total health care spending, specifically, lower emergency department and inpatient admission spending (p < .05). Similarly, fewer inpatient admissions and emergency department visits were associated with higher adequate health literacy scores and better self-reports of the ability to read and learn about medical conditions (p-value <.05). Members with lower health literacy scores appear to use services more appropriate for advanced health conditions, although office visit rates were similar across the range of health literacy scores.

Interpersonal relations between health care workers and young clients: barriers to accessing sexual and reproductive health care.

PubMed

Alli, Farzana; Maharaj, Pranitha; Vawda, Mohammed Yacoob

2013-02-01

Interpersonal relations between health care providers and young clients have long being cited as an important element for improving client up take of services, satisfaction and overall health outcomes. In an era of HIV and AIDS this forms a critical determinant to young people accessing sexual and reproductive health care. This study explores to what extent interpersonal relations form a barrier to young peoples access to and satisfaction of health services. The study draws on data from 200 client exit interviews and four in-depth interviews conducted with university students and university health care staff in Kwazulu-Natal, South Africa. While young people are aware of the importance of utilising STI, HIV and family planning services they experienced barriers in their relationship with providers. This served as a deterrent to their use of the health facility. Adequate training in interpersonal relations for youth-friendly service provision is essential in helping overcome communication problems and enabling providers to interact with young clients at a more personal level.

42 CFR 438.207 - Assurances of adequate capacity and services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... enrollment in its service area in accordance with the State's standards for access to care under this subpart... 42 Public Health 4 2014-10-01 2014-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

42 CFR 438.207 - Assurances of adequate capacity and services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... enrollment in its service area in accordance with the State's standards for access to care under this subpart... 42 Public Health 4 2011-10-01 2011-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

42 CFR 438.207 - Assurances of adequate capacity and services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... enrollment in its service area in accordance with the State's standards for access to care under this subpart... 42 Public Health 4 2012-10-01 2012-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

PubMed

Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

2018-04-23

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

The health care Titanic: women and children first?

PubMed

Holland, S; Peterson, K

1993-01-01

The plight of people who lack access to health care has captured national attention and led to a number of proposals to remedy the problem. The authors look at three types of proposals being advanced--"pro-competition" plans, "pay-or-play" plans, and a national health care system--and find that they fail to address adequately the pressing needs of two groups of the poor: women of childbearing age and elderly women.

Medical Education and Research: The Foundations of Quality Health Care

PubMed Central

Mustard, J. F.; Laidlaw, J. C.; Godden, J. O.

1966-01-01

In May 1964 the Royal Commission on Health Services declared that “health research is essential to health progress”. However, since that time the means of providing adequate health care have received far less attention than have methods of payment for physicians' services. Because medical education and research is the source from which all other health benefits flow, urgent attention must be paid to the adequate support of teacher-scientists, as set forth in the Woods, Gordon (Gundy) report. It is the numbers and quality of these men and women, more than any other factor, that will determine the shape of medical science and, hence, medical practice in Canada in the future. Expensive as it is, Canadian medicine and Canadian medical scientists must have generous support if medical care in this country is to be of high quality. PMID:5908724

Reflections on curative health care in Nicaragua.

PubMed Central

Slater, R G

1989-01-01

Improved health care in Nicaragua is a major priority of the Sandinista revolution; it has been pursued by major reforms of the national health care system, something few developing countries have attempted. In addition to its internationally recognized advances in public health, considerable progress has been made in health care delivery by expanding curative medical services through training more personnel and building more facilities to fulfill a commitment to free universal health coverage. The very uneven quality of medical care is the leading problem facing curative medicine now. Underlying factors include the difficulty of adequately training the greatly increased number of new physicians. Misdiagnosis and mismanagement continue to be major problems. The curative medical system is not well coordinated with the preventive sector. Recent innovations include initiation of a "medicina integral" residency, similar to family practice. Despite its inadequacies and the handicaps of war and poverty, the Nicaraguan curative medical system has made important progress. PMID:2705603

Physician Migration, Education, and Health Care

ERIC Educational Resources Information Center

Norcini, John J.; Mazmanian, Paul E.

2005-01-01

Physician migration is a complex and multifaceted phenomenon that is intimately intertwined with medical education. Imbalances in the production of physicians lead to workforce shortages and surpluses that compromise the ability to deliver adequate and equitable health care to large parts of the world's population. In this overview, we address a…

Health Care Access and Utilization after the 2010 Pakistan Floods.

PubMed

Jacquet, Gabrielle A; Kirsch, Thomas; Durrani, Aqsa; Sauer, Lauren; Doocy, Shannon

2016-10-01

Introduction The 2010 floods submerged more than one-fifth of Pakistan's land area and affected more than 20 million people. Over 1.6 million homes were damaged or destroyed and 2,946 direct injuries and 1,985 deaths were reported. Infrastructure damage was widespread, including critical disruptions to the power and transportation networks. Hypothesis Damage and loss of critical infrastructure will affect the population's ability to seek and access adequate health care for years to come. This study sought to evaluate factors associated with access to health care in the aftermath of the 2010 Pakistan floods. A population-proportional, randomized cluster-sampling survey method with 80 clusters of 20 (1,600) households of the flood-affected population was used. Heads of households were surveyed approximately six months after flood onset. Multivariate analysis was used to determine significance. A total of 77.8% of households reported needing health services within the first month after the floods. Household characteristics, including rural residence location, large household size, and lower pre- and post-flood income, were significantly associated (P<.05) with inadequate access to health care after the disaster. Households with inadequate access to health care were more likely to have a death or injury in the household. Significantly higher odds of inadequate access to health care were observed in rural populations (adjusted OR 4.26; 95% CI, 1.89-9.61). Adequate health care access after the 2010 Pakistani floods was associated with urban residence location, suggesting that locating health care providers in rural areas may be difficult. Access to health services also was associated with post-flood income level, suggesting health resources are not readily available to households suffering great income losses. Jacquet GA , Kirsch T , Durrani A , Sauer L , Doocy S . Health care access and utilization after the 2010 Pakistan floods. Prehosp Disaster Med. 2016;31(5):485-491.

The political economy of health care for elderly blacks.

PubMed

Wallace, S P

1990-01-01

The author analyzes the influences of race and class on the life chances of blacks by focusing on the health care of black elderly. Theories based on cultural, class, and racial forces are explained in the context of how each would be used to analyze the health care of older blacks. The lower health and socioeconomic statuses of older blacks compared with older whites are documented. The author argues that cultural factors are unable to explain those differences adequately, and that class factors such as the profit orientation of the medical care system, and race factors such as residential segregation and racial discrimination in the medical care system, both contribute to the disparities in medical care. Since proposals for a U.S. national health insurance or national health service fail to include race-conscious measures, the proposals will fail to eliminate existing racial disparities in the health and health care of the elderly.

Human rights dimensions of food, health and care in children's homes in Kampala, Uganda - a qualitative study.

PubMed

Vogt, Line Erikstad; Rukooko, Byaruhanga; Iversen, Per Ole; Eide, Wenche Barth

2016-03-18

More than 14 % of Ugandan children are orphaned and many live in children's homes. Ugandan authorities have targeted adolescent girls as a priority group for nutrition interventions as safeguarding nutritional health before pregnancy can reduce the chance of passing on malnutrition to the offspring and thus future generations. Ugandan authorities have obligations under international human rights law to progressively realise the rights to adequate food, health and care for all Ugandan children. Two objectives guided this study in children's homes: (a) To examine female adolescent residents' experiences, attitudes and views regarding: (i) eating patterns and food, (ii) health conditions, and (iii) care practices; and (b) to consider if the conditions in the homes comply with human rights standards and principles for the promotion of the rights to adequate food, health and care. A human rights-based approach guided the planning and conduct of this study. Five children's homes in Kampala were included where focus group discussions were held with girls aged 12-14 and 15-17 years. These discussions were analysed through a phenomenological approach. The conditions of food, health and care as experienced by the girls, were compared with international standards for the realisation of the human rights to adequate food, health and care. Food, health and care conditions varied greatly across the five homes. In some of these the girls consumed only one meal per day and had no access to clean drinking water, soap, toilet paper and sanitary napkins. The realisation of the right to adequate food for the girls was not met in three homes, the realisation of the right to health was not met in two homes, and the realisation of the right to care was not met in one home. In three of the selected children's homes human rights standards for food, health or care were not met. Care in the children's homes was an important contributing factor for whether standards for the rights to adequate

Issues in Health Care of Middle Eastern Patients

PubMed Central

Lipson, Juliene G.; Meleis, Afaf I.

1983-01-01

Relationships between Middle Eastern patients and Western health care professionals are often troubled by mutual misunderstanding of culturally influenced values and communication styles. Although Middle Easterners vary ethnically, they do share a core of common values and behavior that include the importance of affiliation and family, time and space orientations, interactional style and attitudes toward health and illness. Problems in providing health care involve obtaining adequate information, “demanding behavior” by a patient's family, conflicting beliefs about planning ahead and differing patterns of communicating grave diagnoses or “bad news.” There are guidelines that will provide an understanding of the cultural characteristics of Middle Easterners and, therefore, will improve rather than impede their health care. A personal approach and continuity of care by the same health care professional help to bridge the gap between Middle Eastern cultures and Western medical culture. In addition, periodic use of cultural interpreters helps ameliorate the intensity of some cultural issues. PMID:6364575

[The public health care system and rehabilitation actions in Brazil].

PubMed

Ribeiro, Carla Trevisan Martins; Ribeiro, Marcia Gonçalves; Araújo, Alexandra Prufer; Mello, Lívia Rodrigues; Rubim, Luciana da Cruz; Ferreira, Joyce Espírito Santo

2010-07-01

To produce a historical account of rehabilitation actions in the context of the Brazilian Unified Health Care System (SUS). Search of SciELO, LILACS, and MEDLINE databases for literature published between 1980 and 2009. The following Portuguese search terms were used: Sistema Unico de Saúde, reabilitação, políticas de saúde, assistência médica, história. The English terms "rehabilitation" and "public health" were also used. Federal laws and Ministry of Health manuals available at the city of Rio de Janeiro Coordinating Office for Rehabilitation Programs, Fundação Instituto Oswaldo Cruz library, and in BIREME database were also surveyed. Only a small number of publications were recovered (four books, three Health Ministry manuals, four articles published in Brazil, one master's thesis, and one doctoral dissertation). Nevertheless, analysis of these materials revealed that since many municipalities are still incapable of ensuring the right to universal and comprehensive health care, rehabilitation actions are often carried out in a precarious manner, unsupported by an adequate and comprehensive policy. On the other hand, there have been real improvements in terms of expanding care to the population with special needs. There still are factors hindering the achievement of optimal results in the care to people with special needs. The challenge of action planning must be undertaken especially by municipal governments to ensure an adequate supply of services and thus equity of access and comprehensive health care.

[Primary care in maternal-child health].

PubMed

Pedreira Massa, J L

1986-07-01

The theoretical and methodological elements of primary health care (PHC) include a philosophy of work and an epistemological focus toward the processes of health and illness, as well as a practical medical anthropological knowledge of the culture-specific aspects of disease. The work methodology of PHC requires care of the individual as a bio-psycho-socio-affective being integrated into a particular environment; none of the aspects of being should be neglected or given priority. Care should also be integrated in the sense of providing preventive health care as well as curative and rehabilitative services, in all phases from training of health personnel to record keeping. The primary health care team is multidisciplinary in constitution and interdisciplinary in function. PHC assumes that health care will be accessible to users and that continuity of care will be provided. The need for community participation in all phases of health care has been reiterated in several international health declarations. A well-functioning PHC system will require new types of pre- and postgraduate health education in a changing social and professional system and continuing education under adequate supervision for health workers. Research capability for identifying community health problems, a rigorous evaluation system, and epidemiologic surveillance are also needed. All of these elements are applicable to the field of maternal and child health as well as to PHC. The most appropriate place to intervene in order to correct existing imbalances in access to health care for mothers and children is in the PHC system. Examples of areas that should be stressed include vaccinations, nutrition, psychomotor development, early diagnosis and treatment for handicapped children, prevention of childhood accidents, school health and absenteeism, all aspects of health education, adoption and alternatives to abandonment of children, alcoholism and addiction, adolescent pregnancy and family planning

Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning

PubMed Central

McPhaul, Kathleen; Phillips, Sally; Gershon, Robyn; Lipscomb, Jane

2009-01-01

The home health care sector is a critical element in a pandemic influenza emergency response. Roughly 85% of the 1.5 million workers delivering in-home care to 7.6 million clients are low-wage paraprofessionals, mostly women, and disproportionately members of racial and ethnic minorities. Home health care workers' ability and willingness to respond during a pandemic depends on appropriate communication, training, and adequate protections, including influenza vaccination and respiratory protection. Preparedness planning should also include support for child care and transportation and help home health care workers protect their income and access to health care. We summarize findings from a national stakeholder meeting, which highlighted the need to integrate home health care employers, workers, community advocates, and labor unions into the planning process. PMID:19461108

Community-orientated primary health care. The responsibility of the team for the health of the total population.

PubMed

Epstein, L; Eshed, H

1988-02-20

Community-orientated primary health care (COPHC) is presented as a framework for the delivery of primary health care based on the epidemiologically assessed needs of the population. It requires that the health team and the responsible agencies or institutions take upon themselves responsibility for the provision of care in relation to these measured needs of all those persons entitled to the service. This epidemiological diagnosis of community health conditions will include both the measurement of the distribution of health and disease states in the community as well as the possible causes for this distribution--this is in order to plan possible intervention adequately. It is concluded that COPHC is to the advantage of the community, the health team and the health care system.

[The pregnant employee in anaesthesia and intensive care - An evidence-based approach to designing adequate workplaces].

PubMed

Röher, Katharina; Göpfert, Matthias S

2015-07-01

In the light of a rising percentage of women among employees in anaesthesia and intensive care designing adequate workplaces for pregnant employees plays an increasingly important role. Here it is necessary to align the varied interests of the pregnant employee, fellow employees and the employer, where the legal requirements of the Maternity Protection Act ("Mutterschutzgesetz") form the statutory framework. This review describes how adequate workplaces for pregnant employees in anaesthesia and intensive care can be established considering the scientific evidence on the subject. © Georg Thieme Verlag Stuttgart · New York.

The impact of health and health insurance literacy on access to care for Hispanic/Latino communities.

PubMed

Edward, Jean; Morris, Sarah; Mataoui, Fatma; Granberry, Phillip; Williams, Mark V; Torres, Idali

2018-05-01

The aim of this study was to assess the impact of health literacy (HL) and health insurance literacy (HIL) on health insurance status and access to health care services for Spanish-speaking communities living in Massachusetts. A total of 139 surveys (descriptive, knowledge-based HIL questions, and Short Assessment of Health Literacy in Spanish) and 30 semi-structured interviews were collected and analyzed using chi-square, Mann-Whitney U test, and logistic regression analysis. The majority of participants had inadequate HL (56%) and HIL (93%). There were differences in HL scores (t = 4.1; p < .0001) between the insured (M = 12.3, SD = 5.7) and uninsured (M = 7.9, SD = 6.7) and differences (t = 1.9; p = .05) between those with adequate HIL (M = 14.3, SD = 4.3) and inadequate HIL (M = 10.2, SD = 6.6). Participants who were uninsured (MW U = 37.6; p < .0001) and who had inadequate HL (MW U = 5.2; p = .02) were more likely to have never accessed health care in the U.S. Participants who had never accessed health care were 93% less likely to be insured and those with adequate HL were three times more likely to be insured. Health literacy and HIL are closely associated with insurance status and access to health care for Spanish-speaking communities, indicating the need for further research and enhanced public health efforts to improve knowledge and awareness around navigating health care systems. © 2018 Wiley Periodicals, Inc.

Practical Guidelines for Health Care Management in Secondary School Athletics.

ERIC Educational Resources Information Center

Laire, Dean E.

1981-01-01

Offers advice to schools that need to provide adequate health care for student athletes without benefit of a certified athletic trainer. Covers written policy concerning athletic trauma, maintenance of playing fields, medical records and consent forms, and equipment needed for injury prevention and care. Includes samples of forms and procedures.…

Patient classification in home health care: are we ready?

PubMed

Cox, C L; Wood, J E; Montgomery, A C; Smith, P C

1990-09-01

This longitudinal descriptive study retrospectively profiled the acutely ill patient in home health care and explored the utility of using patient record data in predicting agency resource use and patient outcome. The findings suggest that those variables traditionally relied on for reimbursement qualification and as components of patient-classification schemes may not be wholly adequate to explain resource use and patient outcome in the home health setting. Professional nursing judgment of the patient's prognosis was found to be the most sensitive variable predicting outcome. Selected diagnoses and self-care capacity of the patient were the major predictors of resource use. Suggestions are offered for further studies that may move public health nursing more quickly toward the development of consistent and accurate home health care case mix measures.

Point-of-Care Ultrasound: A Trend in Health Care.

PubMed

Buerger, Anita M; Clark, Kevin R

2017-11-01

To discuss the current and growing use of point-of-care (POC) ultrasound in the management and care of patients. Several electronic research databases were searched to find articles that emphasized the use of POC ultrasound by health care providers who manage and treat critically ill or injured patients. Thirty-five relevant peer-reviewed journal articles were selected for this literature review. Common themes identified in the literature included the use of POC ultrasound in emergency medicine, military medicine, and remote care; comparison of POC ultrasound to other medical imaging modalities; investigation of the education and training required for nonimaging health care professionals who perform POC ultrasound in their practices; and discussion of the financial implications and limitations of POC ultrasound. POC ultrasound provides clinicians with real-time information to better manage and treat critically ill or injured patients in emergency medicine, military medicine, and remote care. In addition to providing immediate bedside diagnostic information, use of POC ultrasound has increased because of concerns regarding radiation protection. Finally, the expansion of POC ultrasound to other specialty areas requires nonimaging health care professionals to perform bedside ultrasound examinations and interpret the resulting images. Because POC ultrasound is user-dependent, adequate training is essential for all who perform and interpret the examinations. Research involving POC ultrasound will continue as innovations and confidence in ultrasound applications advance. Future research should continue to examine the broad use of POC ultrasound in patient care and management. ©2017 American Society of Radiologic Technologists.

Predictors of health literacy and numeracy concordance among adolescent with special health care needs and their parents

PubMed Central

Chisolm, Deena J; Sarkar, Madhurima; Kelleher, Kelly J.; Sanders, Lee M.

2015-01-01

Background Parent and teen health literacies (HL) are employed as teens with chronic illnesses transition to health self-management and the adult health system. This study explores the relationships between parent and teen HL. Methods Teens ages 12-18 with chronic conditions and their parents, sampled from a pediatric Medicaid ACO, completed an interview assessing HL and self-reported competence with written and numeric health information. Rates of teen and parent HL, degree of concordance, and relationship between concordance and teen-reported competence with health materials were measured. Results Half (52%) of teens had adequate HL. 62% of teens reported competence with written health materials and 69% with numeric information. Correlation between parent and teen HL was modest but significant (phi=0.13; p=0.03). 47% of parent-teen dyads were concordant for adequate HL while 10% were concordant inadequate. Adequate teen HL was associated with parental adequate HL and parental education. Discordance was associated with self-reported competence with written material and numeric material. Conclusion Over half of parent-teen dyads had at least one member with less than adequate health literacy and parent-teen HL concordance were associated with teen perception of health literacy. These findings support the consideration of both independent and dyad HL levels in adolescent care. PMID:26513030

Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

PubMed Central

Lake, James; Turner, Mason Spain

2017-01-01

Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. PMID:28898197

Role of Primary Health Care in Ensuring Access to Medicines

PubMed Central

Sambala, Evanson Z; Sapsed, Susan; Mkandawire, Mercy L

2010-01-01

To examine ways of ensuring access to health services within the framework of primary health care (PHC), since the goal of PHC to make universal health care available to all people has become increasingly neglected amid emerging themes of globalization, trade, and foreign policy. From a public health point of view, we argue that the premise of PHC can unlock barriers to health care services and contribute greatly to determining collective health through the promotion of universal basic health services. PHC has the most sophisticated and organized infrastructure, theories, and political principles, with which it can deal adequately with the issues of inequity, inequality, and social injustice which emerge from negative economic externalities and neo-liberal economic policies. Addressing these issues, especially the complex social and political influences that restrict access to medicines, may require the integration of different health initiatives into PHC. Based on current systems, PHC remains the only conventional health delivery service that can deal with resilient public health problems adequately. However, to strengthen its ability to do so, we propose the revitalization of PHC to incorporate scholarship that promotes human rights, partnerships, research and development, advocacy, and national drug policies. The concept of PHC can improve access; however, this will require the urgent interplay among theoretical, practical, political, and sociological influences arising from the economic, social, and political determinants of ill health in an era of globalization. PMID:20564760

Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments.

PubMed

Keuroghlian, Alex S; Ard, Kevin L; Makadon, Harvey J

2017-02-01

Lesbian, gay, bisexual and transgender (LGBT) people face pervasive health disparities and barriers to high-quality care. Adequate LGBT sexual health education for emerging health professionals is currently lacking. Clinical training programs and healthcare organisations are well poised to start addressing these disparities and affirming LGBT patients through curricula designed to cultivate core competencies in LBGT health as well as health care environments that welcome, include and protect LGBT patients, students and staff. Health education programs can emphasise mastery of basic LGBT concepts and terminology, as well as openness towards and acceptance of LGBT people. Core concepts, language and positive attitudes can be instilled alongside clinical skill in delivering inclusive sexual health care, through novel educational strategies and paradigms for clinical implementation. Caring for the health needs of LGBT patients also involves the creation of health care settings that affirm LGBT communities in a manner that is responsive to culturally specific needs, sensitivities and challenges that vary across the globe.

The Need for Cultural Competency in Health Care.

PubMed

Abrishami, Doris

2018-05-01

To highlight the importance of cultural competency education in health care and in the medical imaging industry. A comprehensive search of the Education Resource Information Center and MEDLINE databases was conducted to acquire full-text and peer-reviewed articles relating to cultural competency training in health care. A total of 1008 academic journal articles and 3 books were identified for this literature review. Search criteria was narrowed to peer-reviewed articles published between 2000 and 2016, resulting in 24 articles. A majority of the research studies addressed cultural competency education in allied health professions, as well as psychology and athletic training. Recent research studies pertaining to the cultural competence of imaging professionals were not found. Research shows that the behaviors of health care providers can contribute to health disparities. National standards have been established to promote patient-centered care that reduces or eliminates health disparities in the U.S. Lectures and training sessions help professionals maintain these standards, but they might not be adequate. Health care workers need to interact and work with diverse patient populations to increase their empathy and become culturally competent. A patient-centered care approach that responds to patients' unique needs and reduces health disparities among diverse patient populations can be achieved by training culturally competent health care professionals. More research is needed to determine the nature of cultural competency education taught in radiography programs. ©2018 American Society of Radiologic Technologists.

Opportunities for Palliative Care in Public Health.

PubMed

De Lima, Liliana; Pastrana, Tania

2016-01-01

In May 2014, the World Health Assembly, of the World Health Organization (WHO), unanimously adopted a palliative care (PC) resolution, which outlines clear recommendations to the United Nations member states, such as including PC in national health policies and in the undergraduate curricula for health care professionals, and highlights the critical need for countries to ensure that there is an adequate supply of essential PC medicines, especially those needed to alleviate pain. This resolution also carries great challenges: Every year over 20 million patients (of which 6% are children) need PC at the end of life (EOL). However, in 2011, approximately three million patients received PC, and only one in ten people in need is currently receiving it. We describe this public health situation and systems failure, the history and evolution of PC, and the components of the WHO public health model. We propose a role for public health for PC integration in community settings to advance PC and relieve suffering in the world.

Health care workforce crisis in Australia: too few or too disabled?

PubMed

Scott, Ian A

2009-06-15

A key challenge for the Australian health care system is ensuring that the numbers, distribution and skill set of the health care workforce are adequate to meet the emerging health needs of an ageing population with increasingly high expectations of health care. Professional and government responses have given priority to increasing the overall numbers of practising clinicians by investment in additional training places. Another approach is to enhance productivity of the existing workforce by activating strategies of professional enablement that remove constraints imposed on clinicians by inefficient work practices and inappropriate training programs, maladaptive organisational attributes, misdirected financial and non-financial incentives, and adverse sociopolitical influences.

[A historical and conceptual model for Primary Health Care: challenges for the organization of primary care and the Family Health Strategy in large Brazilian cities].

PubMed

Conill, Eleonor Minho

2008-01-01

This paper focuses on the experience with Primary Health Care as a strategy for reorganizing the health care model, based on reforms in this direction and their implementation in the Brazilian case. The article identifies a shift in the discourse concerning health sector reforms, with a return to emphasis on primary care and integration of services. The Brazilian context demands reflection on the possibilities for synergy between this strategy and other social policies and the factors needed to ensure adequate performance. Evaluation research has suggested that primary care activities are slightly superior as compared to traditional health care units, despite persistent difficulties in access, physical infrastructure, team formation, management, and organization of the network. These difficulties correlate with a low level of public financing, persistent segmentation of the system, and weak integration of primary care services with other levels of care. From the technical perspective, a reasonable target is to guarantee the strategy's continuity with the necessary adjustments, conditioned by the dynamics of the health care technical models involved in the dispute.

Using Multitheory Model of Health Behavior Change to Predict Adequate Sleep Behavior.

PubMed

Knowlden, Adam P; Sharma, Manoj; Nahar, Vinayak K

The purpose of this article was to use the multitheory model of health behavior change in predicting adequate sleep behavior in college students. A valid and reliable survey was administered in a cross-sectional design (n = 151). For initiation of adequate sleep behavior, the construct of behavioral confidence (P < .001) was found to be significant and accounted for 24.4% of the variance. For sustenance of adequate sleep behavior, changes in social environment (P < .02), emotional transformation (P < .001), and practice for change (P < .001) were significant and accounted for 34.2% of the variance.

Job satisfaction among health care workers in Serbia.

PubMed

Korac, Vesna; Vasic, Milena; Krstic, Maja; Markovic, Roberta

2010-01-01

According to literature review there seems to be a general agreement that job satisfaction among doctors is declining. This study's objective was to identify job satisfaction levels and their causes among health care workers, employed at the public health institutions. A job satisfaction survey of health care workers was therefore carried out in 197 public health centers in the Republic of Serbia, 157 primary health care centers and 40 general hospitals, in 2008. A satisfaction questionnaire, containing 24 items was used to investigate job satisfaction. Respondents (23.259), working in primary health care, indicated an average job satisfaction level of 3.08 +/- 0.67 on a 5-point scale. Respondents (11.302), working in general hospitals, indicated a lower average job satisfaction level of 2.96 +/- 0.63. The reported level of satisfaction was the highest for their opportunities to use their abilities, cooperation with colleagues and fellow workers, and freedom to choose their own methods of work. Doctors, working in primary health care centers, reported higher level of job satisfaction than hospital doctors. Overall, job satisfaction of doctors and nurses is relatively low. Increased pay rate and more adequate equipment, as well as possibilities for education and career improvement, would enhance their job satisfaction.

[Family Health Teams in Ontario: Ideas for Germany from a Canadian Primary Care Model].

PubMed

Ulrich, Lisa-R; Pham, Thuy-Nga Tia; Gerlach, Ferdinand M; Erler, Antje

2017-07-11

The German healthcare system is struggling with fragmentation of care in the face of an increasing shortage of general practitioners and allied health professionals, and the time-demanding healthcare needs of an aging, multimorbid patient population. Innovative interprofessional, intersectoral models of care are required to ensure adequate access to primary care across a variety of rural and urban settings into the foreseeable future. A team approach to care of the complex multimorbid patient population appears particularly suitable in attracting and retaining the next generation of healthcare professionals, including general practitioners. In 2014, the German Advisory Council on the Assessment of Developments in the Health Care System highlighted the importance of regional, integrated care with community-based primary care centres at its core, providing comprehensive, population-based, patient-centred primary care with adequate access to general practitioners for a given geographical area. Such centres exist already in Ontario, Canada; within Family Health Teams (FHT), family physicians work hand-in-hand with pharmacists, nurses, nurse practitioners, social workers, and other allied health professionals. In this article, the Canadian model of FHT will be introduced and we will discuss which components could be adapted to suit the German primary care system. © Georg Thieme Verlag KG Stuttgart · New York.

Considering organizational factors in addressing health care disparities: two case examples.

PubMed

Griffith, Derek M; Yonas, Michael; Mason, Mondi; Havens, Betsy E

2010-05-01

Policy makers and practitioners have yet to successfully understand and eliminate persistent racial differences in health care quality. Interventions to address these racial health care disparities have largely focused on increasing cultural awareness and sensitivity, promoting culturally competent care, and increasing providers' adherence to evidence-based guidelines. Although these strategies have improved some proximal factors associated with service provision, they have not had a strong impact on racial health care disparities. Interventions to date have had limited impact on racial differences in health care quality, in part, because they have not adequately considered or addressed organizational and institutional factors. In this article, we describe an emerging intervention strategy to reduce health care disparities called dismantling (undoing) racism and how it has been adapted to a rural public health department and an urban medical system. These examples illustrate the importance of adapting interventions to the organizational and institutional context and have important implications for practitioners and policy makers.

[Control of health care by the economist?].

PubMed

Henke, K D

2000-12-01

Although the health care system has to deal with huge financial problems one cannot neglect that this labour-intensive service branch creates the most jobs with social security obligations. Corrective strategies will have to increase the orientation of health care to patients' needs which requires better information and more decision-making autonomy for the insured people as well as a maximising of efficiency. Competition needs to be strengthened in order to improve quality and reduce costs. This requires more contractual freedom for insurance funds and a dismantling of the current monopolistic structures. Finally, adequate remuneration schedules and patients' individual responsibility play a major role to meet the future challenges in the European internal market.

Adequately Addressing Pediatric Obesity: Challenges Faced by Primary Care Providers.

PubMed

Shreve, Marilou; Scott, Allison; Vowell Johnson, Kelly

2017-07-01

To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity. All providers reported lack of time as a barrier to providing the care needed for obese children. Cultural barriers of both the provider and client were identified as factors, which negatively affect the care and treatment of obese children. Primary care providers continue to experience challenges when addressing pediatric obesity. In this study, a lack of adequate time to address obesity was identified as the most significant current barrier and may likely be tied to physician resources. Although reimbursement for obesity is increasing, the level of reimbursement does not support the time or the resources needed to treat patients. Many providers reported their patients' cultural view of obesity influenced how they counsel their patients. Increasing providers' knowledge concerning differences in how weight is viewed or valued may assist them in the assessment and care of obese pediatric patients. The challenges identified in previous research continue to limit providers when addressing obesity. Although progress has been made regarding knowledge of guidelines, continuing effort is needed to tackle the remaining challenges. This will allow for earlier identification and intervention, resulting in improved outcomes in pediatric obesity.

Reproductive health care for asylum-seeking women - a challenge for health professionals.

PubMed

Kurth, Elisabeth; Jaeger, Fabienne N; Zemp, Elisabeth; Tschudin, Sibil; Bischoff, Alexander

2010-11-01

access to adequate contraception, and to provide psychological care for this vulnerable group of patients. Care for asylum seekers may be emotionally very challenging for health professionals.

What Explains Divorced Women’s Poorer Health?: The Mediating Role of Health Insurance and Access to Health Care in a Rural Iowan Sample*

PubMed Central

Lavelle, Bridget; Lorenz, Frederick O.; Wickrama, K. A. S.

2012-01-01

The economic restructuring in rural areas in recent decades has been accompanied by rising marital instability. To examine the implications of the increase in divorce for the health of rural women, we examine how marital status predicts adequacy of health insurance coverage and health care access, and whether these factors help to account for the documented association between divorce and later illness. Analyzing longitudinal data from a cohort of over 400 married and recently divorced rural Iowan women, we decompose the total effect of divorce on physical illness a decade later using structural equation modeling. Divorced women are less likely to report adequate health insurance in the years following divorce, inhibiting their access to medical care and threatening their physical health. Full-time employment acts as a buffer against insurance loss for divorced women. The growth of marital instability in rural areas has had significant ramifications for women’s health; the decline of adequate health insurance coverage following divorce explains a component of the association between divorced status and poorer long-term health outcomes. PMID:23457418

Flat medicine? Exploring trends in the globalization of health care.

PubMed

Crone, Robert K

2008-02-01

Trailing nearly every other industry, health care is finally globalizing. Highly trained and experienced expatriate health care professionals are returning to their home countries from training in the West or are staying home to work in newly developed corporate health care delivery systems that can compete quite favorably with less-than-perfect providers in Europe and North America. In turn, these health care systems are attracting patients from around the world who are interested in exploring high-quality, lower-cost health care alternatives. Much of this activity is occurring in the emerging economies of the Middle East, South and Southeast Asia, and beyond. Three Harvard Medical International collaborations--in Dubai, Turkey, and India--highlight these trends and demonstrate the potential for new models of global health care, as well as potential ramifications for patients and providers in the established economies of the West, including the United States. Although globalization is not a cure-all solution to achieving universal access to health care, it is not only a significant first step for patients in these emerging economies, but may also present alternative solutions for those patients in wealthier nations who nonetheless lack adequate health care coverage. The increase in health care quality and competitiveness around the globe is important, but these improvements will need to be matched by the development of comprehensive payer solutions, to benefit as many people as possible.

“Whatever My Mother Wants”: Barriers to Adequate Pain Management

PubMed Central

Yennurajalingam, Sriram; Bruera, Eduardo

2013-01-01

Abstract Opioids are the preferred medications to treat cancer pain; however, several barriers to cancer pain management exist, including those related to the patient, health care provider, and family caregiver. We describe one such situation in which a family member prevents the patient from receiving adequate pain management at the end of life despite interdepartmental and interdisciplinary efforts. This case highlights the importance of understanding and addressing fears regarding opioid use and implementing an integrated approach including oncologists and palliative care physicians, along with early referrals to palliative care. PMID:22946542

Who pays for health care in Ghana?

PubMed Central

2011-01-01

Background Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Methods Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Results Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. Conclusion For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues

Who pays for health care in Ghana?

PubMed

Akazili, James; Gyapong, John; McIntyre, Diane

2011-06-27

Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National

Assessing Racial/Ethnic Disparities in Treatment across Episodes of Mental Health Care

PubMed Central

Cook, Benjamin Lê; Zuvekas, Samuel H; Carson, Nicholas; Wayne, Geoffrey Ferris; Vesper, Andrew; McGuire, Thomas G

2014-01-01

ObjectiveTo investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment. Study DesignWe analyzed whites, blacks, and Latinos with probable mental illness from Panels 9–13 of the Medical Expenditure Panel Survey, assessing disparities at the beginning, middle, and end of episodes of care (initiation, adequate care, having an episode with only psychotropic drug fills, intensity of care, the mixture of primary care provider (PCP) and specialist visits, use of acute psychiatric care, and termination). FindingsCompared with whites, blacks and Latinos had less initiation and adequacy of care. Black and Latino episodes were shorter and had fewer psychotropic drug fills. Black episodes had a greater proportion of specialist visits and Latino episodes had a greater proportion of PCP visits. Blacks were more likely to have an episode with acute psychiatric care. ConclusionsDisparities in adequate care were driven by initiation disparities, reinforcing the need for policies that improve access. Many episodes were characterized only by psychotropic drug fills, suggesting inadequate medication guidance. Blacks’ higher rate of specialist use contradicts previous studies and deserves future investigation. Blacks’ greater acute mental health care use raises concerns over monitoring of their treatment. PMID:23855750

The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

PubMed

Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

2018-05-01

Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

Principal-agent problems in health care systems: an international perspective.

PubMed

Smith, P C; Stepan, A; Valdmanis, V; Verheyen, P

1997-07-01

A central feature of all health care systems is the flow of finances from the population, via a variety of agencies, to the providers of health care. Each transfer of funds within the system involves a principal-agent problem, in the sense that a principal is entrusting funds to an agent with the intention that some desired aspect of health care delivery can be secured. This paper examines within the context of a principal-agent model three key elements of the health care system: the raising of finance, the transfer of funds to hospitals, and spending by hospitals. At each of these stages there is a danger that the objectives of society for the health care system are lost. In order to illustrate the issues involved, five mature systems of health care are examined: Austria, Germany, the United Kingdom, the Netherlands and the United States of America. The paper concludes that three aspects of the flow of funds are crucial to securing adequate control: the means of controlling patient entry to hospitals; the mechanism for remunerating hospitals for additional patients; and the control of physicians by hospital management.

When populism takes over the delivery of health care: Venezuela.

PubMed

Daryanani, Sunil

2017-01-01

Adequate and modern health care is not available in Venezuela at this moment. A humanitarian crisis of post war dimensions is currently rampant and afflicting all Venezuelans alike. The delivery and availability of cancer care is severely limited and inadequate. No funding is available as populist measures, mismanagement, pillaging, corruption, lack of forethought and expertise have brought the country into severe economic collapse and political turmoil.

School-Based Health Centers in an Era of Health Care Reform: Building on History

PubMed Central

Keeton, Victoria; Soleimanpour, Samira; Brindis, Claire D.

2013-01-01

School-based health centers (SBHCs) provide a variety of health care services to youth in a convenient and accessible environment. Over the past 40 years, the growth of SBHCs evolved from various public health needs to the development of a specific collaborative model of care that is sensitive to the unique needs of children and youth, as well as to vulnerable populations facing significant barriers to access. The SBHC model of health care comprises of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care and mental health clinicians. Research has demonstrated the SBHCs’ impacts on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths’ academic performance. Although evaluation of the SBHC model of care has been complicated, results have thus far demonstrated increased access to care, improved health and education outcomes, and high levels of satisfaction. Despite their proven success, SBHCs have consistently faced challenges in securing adequate funding for operations and developing effective financial systems for billing and reimbursement. Implementation of health care reform (The Patient Protection and Affordable Care Act [P.L. 111-148]) will profoundly affect the health care access and outcomes of children and youth, particularly vulnerable populations. The inclusion of funding for SBHCs in this legislation is momentous, as there continues to be increased demand and limited funding for affordable services. To better understand how this model of care has and could further help promote the health of our nation’s youth, a review is presented of the history and growth of SBHCs and the literature demonstrating their impacts. It may not be feasible for SBHCs to be established in every school campus in the country. However, the lessons

[Health policies and politicized health? An analysis of sexual and reproductive health policies in Peru from the perspective of medical ethics, quality of care, and human rights].

PubMed

Miranda, J Jaime; Yamin, Alicia Ely

2008-01-01

Health professionals view medical ethics as a discipline that provides the basis for more adequate patient care. In recent years the concepts of quality of care and human rights - with their attending discourses - have joined the concept of medical ethics among the paradigms to consider in care for humans both at the individual and health policy levels. The current study seeks to analyze such paradigms, based on a case study of sexual and reproductive health policies in Peru in the last 10 years.

Leveraging community-based financing for women's nonmaternal health care: experiences of rural Indian women.

PubMed

Gopalan, Saji S; Durairaj, Varatharajan

2015-03-01

Given the increasing need for mainstreaming household financing for women's nonmaternal health care and evidences on community-based financing's contribution to women's health care in general, this study explored their scope for nonmaternal health care in Orissa. A qualitative assessment conducted focus group discussions with rural women who met the eligibility criteria. Community-based financing provided financial access and risk protection for women's nonmaternal health care during the previous 1 year, though not adequately. Schemes covering outpatient care (or mild illnesses) provided relatively more financial access. The major determinants of their restricted financial access were limited sum assured, noncomprehensive coverage of services, exclusion of elderly women, and the lower priority households gave to nonmaternal health care. Community-based financing requires relevant structural changes along with demand-side behavioral modifications to ensure optimal attention to women's nonmaternal health care. © 2012 APJPH.

Primary health care in India.

PubMed

Deodhar, N S

1982-03-01

relative neglect of development of health manpower for nursing, environmental engineering, and other technical and paramedical personnel. Community involvement and participation were at a minimum if they existed at all. The basic concern about primary health care for all continued unabated however. To realize the goal of health care for all, 3 programs will have to be pursued simultaneously during the next 2 decades: integrated overall development including family planning; improvement in nutrition, environment, and health education; and the provision of adequate health care services for all, particularly the poor and underprivileged. It is necessary to redefine the roles of the central and state governments in view of the large power powers delegated to local bodies at the district level and below. Voluntary agencies will have to function within the overall plan/aid down by the state.

The health care home model: primary health care meeting public health goals.

PubMed

Grant, Roy; Greene, Danielle

2012-06-01

In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.

Mapping the literature of health care management.

PubMed

Taylor, Mary K; Gebremichael, Meseret D; Wagner, Catherine E

2007-04-01

The research provides an overview of the health care management literature and the indexing coverage of core journal literature. Citations from five source journals for the years 2002 through 2004 were studied using the protocols of the Mapping the Literature of Allied Health Project and Mapping the Literature of Nursing Project. The productivity of cited journals was analyzed by applying Bradford's Law of Scattering. Journals were the most frequently cited format, followed by books. Only 3.2% of the cited journal titles from all 5 source journals generated two-thirds of the cited titles. When only the health care management practitioner-oriented source journals were considered, two-thirds of the output of cited journal titles came from 10.8% of the titles. Science Citation Index and PubMed provided the best overall coverage of the titles cited by all 5 source journals, while the cited titles from the 2 practitioner-oriented journals were covered most completely by Social Sciences Citation Index and Business Source Complete. Health care management is a multidisciplinary field. Librarians must consider the needs of their users and assist them by providing the necessary materials and combination of indexes to access this field adequately.

When populism takes over the delivery of health care: Venezuela

PubMed Central

Daryanani, Sunil

2017-01-01

Adequate and modern health care is not available in Venezuela at this moment. A humanitarian crisis of post war dimensions is currently rampant and afflicting all Venezuelans alike. The delivery and availability of cancer care is severely limited and inadequate. No funding is available as populist measures, mismanagement, pillaging, corruption, lack of forethought and expertise have brought the country into severe economic collapse and political turmoil. PMID:29225695

Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs.

PubMed

Feldman, Heidi M; Buysse, Christina A; Hubner, Lauren M; Huffman, Lynne C; Loe, Irene M

2015-04-01

The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.

[Evaluation of women's health care programs in the main institutions of the Mexican health system].

PubMed

Enciso, Graciela Freyermuth; Navarro, Sergio Meneses; Martínez, Martín Romero

2015-01-01

The aim of this study was to analyze the institutional capacity for provision of women's health care services in Mexico in accordance with prevailing regulations. A probabilistic national sample of health care institutions was used to compare performance rates according to services packages based on analysis of variance. No package showed outstanding performance. Adequate performance was seen in referral and counter-referral centers for uterine cervical cancer, childbirth care, breast cancer diagnosis, family planning counseling, and training in sexual and reproductive health. The lowest performance was seen in the prevention of uterine cervical cancer, obstetric urgencies, family and sexual violence, and promotion of family planning. All the institutions showed low performance in the prevention of breast cancer, promotion of family planning, and management of family and gender violence. The Ministry of Health's leadership needs to be strengthened in order to overcome resistance for the institutions to adhere to the prevailing regulations.

Adequate sleep among adolescents is positively associated with health status and health-related behaviors.

PubMed

Chen, Mei-Yen; Wang, Edward K; Jeng, Yi-Jong

2006-03-08

Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6-8 hours per night regularly) is a critical factor in adolescent health and health-related behaviors. The present study was based on a health promotion project previously conducted on adolescents in Tao-Yuan County, Taiwan. The aim was to examine the relationship between AS during schooldays and excessive body weight, frequency of visiting doctors and health-related behaviors among Taiwanese adolescents. A cross-sectional study design, categorical and multivariate data analyses were used. The hypotheses investigated were: high frequency of AS is positively associated with lack of obesity and less frequent visits to doctors; and high frequency AS is positively associated with health-related behavior. A total of 656 boys (53.2%) and girls (46.8%), ranging in age from 13-18 years were studied between January and June 2004. Three hundred and fifty seven subjects (54%) reported that they slept less than the suggested 6-8 hours on schooldays. A significant negative association was found between low sleep and of the following health-related behaviors: (1) life appreciation; (2) taking responsibility for health; (3) adopting healthy diet; (4) effective stress management; (5) regular exercise; and (6) total AHP score. High frequency AS was associated with low frequencies of obesity after potential confounding factors were controlled. Junior high school adolescents reported significantly higher frequencies of AS than high school participants. Gender, family structure, home location and frequency of television watching or computer use were not significantly associated with AS. These findings support the proposition that AS is associated with good health status and high-frequency adoption of health-related behavior. Furthermore, these findings suggest that inadequate sleep may be a screening indicator for an unhealthy lifestyle and

Health care for undocumented immigrants in Texas: past, present, and future.

PubMed

Kuruvilla, Rohit; Raghavan, Rajeev

2014-07-01

Providing health care to the 1.6 million undocumented immigrants in Texas is an existing challenge. Despite continued growth of this vulnerable population, legislation between 1986 and 2013 has made it more difficult for states to provide adequate and cost-effective care. As this population ages and develops chronic illnesses, Texas physicians, health care administrators, and legislators will be facing a major challenge. New legislation, such as the Affordable Care Act and immigration reform, does not address or attempt to solve the issue of providing health care to this population. One example of inadequate care and poor resource allocation is the experience of undocumented immigrants with end-stage renal disease (ESRD). In Texas, these immigrants depend on safety net hospital systems for dialysis treatments. Often, treatments are provided only when their conditions become an emergency, typically at a higher cost, with worse outcomes. This article reviews the legislation regarding health care for undocumented immigrants, particularly those with chronic illnesses such as ESRD, and details specific challenges facing Texas physicians in the future.

Adequate supervision for children and adolescents.

PubMed

Anderst, James; Moffatt, Mary

2014-11-01

Primary care providers (PCPs) have the opportunity to improve child health and well-being by addressing supervision issues before an injury or exposure has occurred and/or after an injury or exposure has occurred. Appropriate anticipatory guidance on supervision at well-child visits can improve supervision of children, and may prevent future harm. Adequate supervision varies based on the child's development and maturity, and the risks in the child's environment. Consideration should be given to issues as wide ranging as swimming pools, falls, dating violence, and social media. By considering the likelihood of harm and the severity of the potential harm, caregivers may provide adequate supervision by minimizing risks to the child while still allowing the child to take "small" risks as needed for healthy development. Caregivers should initially focus on direct (visual, auditory, and proximity) supervision of the young child. Gradually, supervision needs to be adjusted as the child develops, emphasizing a safe environment and safe social interactions, with graduated independence. PCPs may foster adequate supervision by providing concrete guidance to caregivers. In addition to preventing injury, supervision includes fostering a safe, stable, and nurturing relationship with every child. PCPs should be familiar with age/developmentally based supervision risks, adequate supervision based on those risks, characteristics of neglectful supervision based on age/development, and ways to encourage appropriate supervision throughout childhood. Copyright 2014, SLACK Incorporated.

[Perspectives in the development of health care in Czechoslovakia].

PubMed

Zácek, A

1989-08-01

The finding that the health status of the population is shaped in particular by social and cultural conditions is accepted not only by health workers but also by political and executive authorities of the State. For the further development health care of the people is of revolutionary importance. If society will find adequate political will to take the appropriate measures, we may expect radical changes in all spheres of national economy, social life, science and culture. The basic demand is that health workers must acquire new sociomedical thinking which supplements and at the same time replaces the out-dated biomedical pattern. Structural changes will pertain in particular to mechanisms and organizational measures which will ensure the implementation of the health policy beyond the framework of the health services. In the system of health services we may anticipate that the centre of gravity in health care will shift from the traditional hospital to out-patient facilities with emphasis on the newly conceived function of primary health care. Training of health workers will have to be modified to the effect that graduates will be better prepared to meet actual needs of health care focused on prevention, economy, effectiveness and quality. It will be necessary to create favourable conditions for the development of socio-ecological, epidemiological and operational research. The democratization of health care will call for greater interest and initiative on the part of the public as regards collective and individual health. Our partial health projects should be re-arranged into a single comprehensive nation-wide programme which will include all spheres of health care in the sense of the WHO programme in its modification for Europe.

Indigence and access to health care in sub-Saharan Africa.

PubMed

Stierle, F; Kaddar, M; Tchicaya, A; Schmidt-Ehry, B

1999-01-01

Access to health care services for the poor and indigent is hampered by current policies of health care financing in sub-Saharan Africa. This paper reviews the issue as it is discussed in the international literature. No real strategies seem to exist for covering the health care of the indigent. Frequently, definitions of poverty and indigence are imprecise, the assessment of indigence is difficult for conceptual and technical reasons, and, therefore, the actual extent of indigence in Africa is not well known. Explicit policies rarely exist, and systematic evaluation of experiences is scarce. Results in terms of adequately identifying the indigent, and of mechanisms to improve indigents' access to health care, are rather deceiving. Policies to reduce poverty, and improve indigents' access to health care, seem to pursue strategies of depoliticizing the issue of social injustice and inequities. The problem is treated in a 'technical' manner, identifying and implementing 'operational' measures of social assistance. This approach, however, cannot resolve the problem of social exclusion, and, consequently, the problem of excluding large parts of African populations from modern health care. Therefore, this approach has to be integrated into a more 'political' approach which is interested in the process of impoverishment, and which addresses the macro-economic and social causes of poverty and inequity.

Expert perspectives on Western European prison health services: do ageing prisoners receive equivalent care?

PubMed

Bretschneider, Wiebke; Elger, Bernice Simone

2014-09-01

Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison.

Nursing Workload and the Changing Health Care Environment: A Review of the Literature

ERIC Educational Resources Information Center

Neill, Denise

2011-01-01

Changes in the health care environment have impacted nursing workload, quality of care, and patient safety. Traditional nursing workload measures do not guarantee efficiency, nor do they adequately capture the complexity of nursing workload. Review of the literature indicates nurses perceive the quality of their work has diminished. Research has…

Comparison of patients' and health care professionals' attitudes towards advance directives.

PubMed Central

Blondeau, D; Valois, P; Keyserlingk, E W; Hébert, M; Lavoie, M

1998-01-01

OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. PMID:9800589

The neglected health care needs of street youth.

PubMed Central

Sherman, D J

1992-01-01

Juveniles who live on the street are often the victims of physical and sexual abuse and family chaos. They have a multitude of health problems such as malnutrition, respiratory infections, sexually transmitted diseases, including human immunodeficiency virus, mental illness, and substance abuse. Health care, if available, is generally fragmented and often not relevant to their needs. Their high-risk existence leads to individual morbidity and has a negative effect on the health of the community. Presently, there is limited research on the health status and health care needs of street youth who are difficult to track and quantify. The findings of a project undertaken by Region IX of the Public Health Service in 1989 to provide technical assistance to three primary care clinics serving street youth in San Francisco are reviewed. Data were collected on demographics, overall health status, sex-related medical problems, mental health, and substance abuse and compared with another group of adolescents in the general population. Street youth were found to have a greater number of problems--both physical and psychological--than the general adolescent population. High-risk behaviors, such as drug abuse and failure to use condoms during sex, make this population especially vulnerable to sexually transmitted diseases, including human immunodeficiency virus. The potential impact on public health is enormous. Adequate access to health services needs to be addressed legislatively. PMID:1641440

Adolescents' Right to Participate: Opportunities and Challenges for Health Care Professionals.

PubMed

Todres, Jonathan; Diaz, Angela

Health care professionals and patients are partners in health care delivery, and this partnership is critical in the treatment of adolescents. International children's rights law establishes that all children have a right to participate in decisions that affect their lives. Fulfillment of that right is as critical in health care settings as any other area of children's lives. In this article we examine the right to participate under international children's rights law, its relevance to health care settings, and how health care professionals can foster adolescents' participation to fulfill children's rights and improve health care outcomes. The Convention on the Rights of the Child establishes a legal mandate-where ratified-that adolescents have the right to express their views in health care settings and that such views must be given due consideration. In many health care settings, adolescents are not adequately consulted or have limited opportunities to express their views. A review of research finds that both processes and outcomes can improve when youth participation is cultivated. Health care providers and organizations have numerous opportunities to cultivate adolescent's participation rights and in doing so improve health care delivery and outcomes. Health care providers and organizations should further develop structures and processes to ensure opportunities for children and adolescents to be heard on matters relevant to their health care and health status. Creating opportunities for adolescents to realize their right to participate means engaging youth at every stage in the process, beginning with the design of such opportunities. It also means addressing all aspects of health care, from the built environment to patient-provider communication to follow-up services, so that the entire process fosters an environment conductive to meaningful participation by adolescents. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All

Business continuity and pandemic preparedness: US health care versus non-health care agencies.

PubMed

Rebmann, Terri; Wang, Jing; Swick, Zachary; Reddick, David; delRosario, John Leon

2013-04-01

Only limited data are available on US business continuity activities related to biologic events. A questionnaire was administered to human resource professionals during May-July 2011 to assess business continuity related to biologic events, incentives businesses are providing to maximize worker surge capacity, and seasonal influenza vaccination policy. Linear regressions were used to describe factors associated with higher business continuity and pandemic preparedness scores. The χ(2) and Fisher exact tests compared health care versus non-health care businesses on preparedness indicators. Possible business continuity and pandemic preparedness scores ranged from 0.5 to 27 and 0 to 15, with average resulting scores among participants at 13.2 and 7.3, respectively. Determinants of business continuity and pandemic preparedness were (1) business size (larger businesses were more prepared), (2) type of business (health care more prepared), (3) having human resource professional as company disaster planning committee member, and (4) risk perception of a pandemic in the next year. Most businesses (63.3%, n = 298) encourage staff influenza vaccination; 2.1% (n = 10) mandate it. Only 10% of businesses (11.0%, n = 52) provide employee incentives, and fewer than half (41.0%, n = 193) stockpile personal protective equipment. Despite the recent H1N1 pandemic, many US businesses lack adequate pandemic plans. It is critical that businesses of all sizes and types become better prepared for a biologic event. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized controlled clinical trial.

PubMed

Obreli-Neto, Paulo Roque; Marusic, Srecko; Guidoni, Camilo Molino; Baldoni, André de Oliveira; Renovato, Rogério Dias; Pilger, Diogo; Cuman, Roberto Kenji Nakamura; Pereira, Leonardo Régis Leira

2015-01-01

Most diabetic and hypertensive patients, principally the elderly, do not achieve adequate disease control and consume 5%-15% of annual health care budgets. Previous studies verified that pharmaceutical care is useful for achieving adequate disease control in diabetes and hypertension. To evaluate the economic cost and the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of pharmaceutical care in the management of diabetes and hypertension in elderly patients in a primary public health care system in a developing country. A 36-month randomized controlled clinical trial was performed with 200 patients who were divided into a control group (n = 100) and an intervention group (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultations). The intervention group received the usual care plus a pharmaceutical care intervention. The intervention and control groups were compared with regard to the direct costs of health services (i.e., general practitioner, specialist, nurse, and pharmacist appointments; emergency room visits; and drug therapy costs) and the ICER per QALY. These evaluations used the health system perspective. No statistically significant difference was found between the intervention and control groups in total direct health care costs ($281.97 ± $49.73 per patient vs. $212.28 ± $43.49 per patient, respectively; P = 0.089); pharmaceutical care added incremental costs of $69.60 (± $7.90) per patient. The ICER per QALY was $53.50 (95% CI = $51.60-$54.00; monetary amounts are given in U.S. dollars). Every clinical parameter evaluated improved for the pharmaceutical care group, whereas these clinical parameters remained unchanged in the usual care group. The difference in differences (DID) tests indicated that for each clinical parameter, the patients in the intervention group improved more from pre to post than the control group (P < 0.001). While pharmaceutical

Measuring Quality of Care in Community Mental Health: Validation of Concordant Clinician and Client Quality-of-Care Scales.

PubMed

Luther, Lauren; Fukui, Sadaaki; Garabrant, Jennifer M; Rollins, Angela L; Morse, Gary; Henry, Nancy; Shimp, Dawn; Gearhart, Timothy; Salyers, Michelle P

2018-04-12

Measuring quality of care can transform care, but few tools exist to measure quality from the client's perspective. The aim of this study was to create concordant clinician and client self-report quality-of-care scales in a sample of community mental health clinicians (n = 189) and clients (n = 469). The client scale had three distinct factors (Person-Centered Care, Negative Staff Interactions, and Inattentive Care), while the clinician scale had two: Person-Centered Care and Discordant Care. Both versions demonstrated adequate internal consistency and validity with measures related to satisfaction and the therapeutic relationship. These measures are promising, brief quality assessment tools.

Transgender Health Care for Nurses: An Innovative Approach to Diversifying Nursing Curricula to Address Health Inequities.

PubMed

McDowell, Alex; Bower, Kelly M

2016-08-01

Transgender people experience high rates of discrimination in health care settings, which is linked to decreases in physical and mental wellness. By increasing the number of nurses who are trained to deliver high-quality care to transgender patients, health inequities associated with provider discrimination can be mitigated. At present, baccalaureate nursing curricula do not adequately prepare nurses to care for transgender people, which is a shortcoming that has been attributed to limited teaching time and lack of guidance regarding new topics. We developed transgender health content for students in a baccalaureate nursing program and used a student-faculty partnership model to integrate new content into the curriculum. We incorporated new transgender health content into five required courses over three semesters. We mitigated common barriers to developing and integrating new, diversity-related topics into a baccalaureate nursing curriculum. Added transgender health content was well received by students and faculty. [J Nurs Educ. 2016;55(8):476-479.]. Copyright 2016, SLACK Incorporated.

Is mental heal care in women's prisons adequate?

PubMed

Sims, Joyce

Some individuals and groups, find it difficult to seek healthcare, including prisoners. This group is recognised as needing input but are often difficult to engage, yet failure to meet their needs can be devastating for the health of individuals and have wider implications on society. This qualitative study explored the perceptions of female prisoners who had not yet consulted the mental health team. I aimed to find out what support these women seek out while in prison, what difficulties they encountered in getting psychological help and whether they avoided statutory mental health services. Participants revealed during semistructured interviews that continuing to have a caring role for their families encouraged them to feel more positive and supported. Support from family members, specialist prison officers and the multi-faith centre staff team was also highly regarded. Some of the participants reported experiencing problems self-referring to prison mental health services, for example when transferred to a new prison. They identified the prison application system and inreach administrative failings as weaknesses, alongside other variables. I found that prisoners did not avoid mental health services and often once settled in the prison, they reconsidered their need for statutory support.

The NASA role in major areas of human concern: Health care

NASA Technical Reports Server (NTRS)

Freeman, J. E.; Kottenstette, J. P.; Rusnak, J. J.

1973-01-01

Benefits derived from the civilian aeronautics and space effort are discussed in a statement whose focus is on the developments in health care which can be traced to specific NASA program elements. A summary is provided for each case where NASA has been involved in expanding the biomedical technical base, as well as where NASA has been directly instrumental in providing solutions in maintaining adequate health, and correcting health problems when they occur.

A Health Collaborative Network Focus on Self-care Processes in Personal Assistant Practice

NASA Astrophysics Data System (ADS)

de La Fuente, Ma Victoria; Ros, Lorenzo

Public health is oriented to the management of an adequate health atmosphere which acts directly on health, as well as health education work and the supervision of environmental health threats. The work presented in this paper aims to reduce inequality, and give disabled people the tools to be integrated more effectively, reducing social exclusion, removing obstacles and barriers, and facilitating mobility and the use of technology. The work is planned to design a special healthcare collaborative network as the best solution for addressing the needs of the disabled self-care and health care community through the creation and implementation of an interconnected, electronic information infrastructure and adoption of open data standards.

Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta.

PubMed

Winn, Anika; Hetherington, Erin; Tough, Suzanne

2018-06-26

Female refugees can be a vulnerable population, often having suffered through traumatic events that pose risks to their health, especially during pregnancy. Pregnancy can be an entry point into the health care system, providing health care professionals the opportunity to gain women's trust, connect refugees with resources, and optimize the health of mother and child. Policies surrounding the provision and funding of health care services to refugees can impact access to and quality of care. The aim of our study was to understand the experiences of health care professionals caring for pregnant refugee women in Calgary, AB, taking into consideration recent contextual changes to the refugee landscape in Canada. We conducted ten semi-structured interviews with health care professionals who provided regular care for pregnant refugee women at a refugee health clinic and major hospital in Calgary, Alberta. Interviews were recorded, transcribed, and analyzed using an interpretive description methodology. Health care providers described several barriers when caring for pregnant refugees, including language barriers, difficulty navigating the health care system, and cultural barriers such as managing traditional gender dynamics, only wanting a female provider and differences in medical practices. Providers managed these barriers through strategies including using a team-based approach to care, coordinating the patient's care with other services, and addressing both the medical and social needs of the patient. The federal funding cuts added additional challenges, as many refugees were left without adequate health coverage and the system was complicated to understand. Health care providers developed creative strategies to maximize coverage for their patients including paying out of pocket or relying on donations to care for uninsured refugees. Finally, the recent Syrian refugee influx has increased the demand on service providers and further strained already limited resources

Mapping the literature of health care management

PubMed Central

Taylor, Mary K.; Gebremichael, Meseret D.; Wagner, Catherine E.

2007-01-01

Objectives: The research provides an overview of the health care management literature and the indexing coverage of core journal literature. Method: Citations from five source journals for the years 2002 through 2004 were studied using the protocols of the Mapping the Literature of Allied Health Project and Mapping the Literature of Nursing Project. The productivity of cited journals was analyzed by applying Bradford's Law of Scattering. Results: Journals were the most frequently cited format, followed by books. Only 3.2% of the cited journal titles from all 5 source journals generated two-thirds of the cited titles. When only the health care management practitioner–oriented source journals were considered, two-thirds of the output of cited journal titles came from 10.8% of the titles. Science Citation Index and PubMed provided the best overall coverage of the titles cited by all 5 source journals, while the cited titles from the 2 practitioner-oriented journals were covered most completely by Social Sciences Citation Index and Business Source Complete. Conclusions: Health care management is a multidisciplinary field. Librarians must consider the needs of their users and assist them by providing the necessary materials and combination of indexes to access this field adequately. PMID:17443238

Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs

PubMed Central

Buysse, Christina A.; Hubner, Lauren M.; Huffman, Lynne C.; Loe, Irene M.

2015-01-01

ABSTRACT: The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN. PMID:25793891

Needs for mental health care and service provision in single homeless people.

PubMed

Salize, H J; Horst, A; Dillmann-Lange, C; Killmann, U; Stern, G; Wolf, I; Henn, F; Rössler, W

2001-04-01

Specific problems in sampling methodology, case-finding strategies and a standardised needs assessment in mentally ill homeless people have contributed to their being neglected as a mental health care clientele. We assessed a representative sample of homeless people (n=102) in the highly industrialised city of Mannheim (Germany) regarding their prevalence of mental disorders (using the SCID) and their needs for mental health care (using the NCA). We found high prevalences, with 68.6% of all assessed homeless persons having a current mental disorder. Thus, needs for mental health care were very common, with unmet needs predominating in all problem areas, which was supported by a very weak service utilization. Thus, even in a region with a comprehensive community mental health care network, like the study area, mentally ill homeless people are widely under-provided. Results suggest that the traditional shelter system for homeless people carries most of the mental health care burden for their clientele and must be supported by adequate interventions from community-based mental health care services. A closer connection of both sectors and a better co-ordination of the care offers seems to be a prerequisite for helping to reduce unmet mental health care needs in this specific high-risk group.

Social Networks in Improvement of Health Care

PubMed Central

Masic, Izet; Sivic, Suad; Toromanovic, Selim; Borojevic, Tea; Pandza, Haris

2012-01-01

, procedures, etc., which gives a special emphasis on public health aspects of information, especially in the field of medicine and health care. The authors of this paper discuss the role and practical importance of social networks in improving the health and solving of health problems without the physical entrance into the health care system. Social networks have their advantages and disadvantages, benefits and costs, especially when it comes to information which within the network set unprofessional people from unreliable sources, without an adequate selection. The ethical aspect of the norms in this segment is still not adequately regulated, so any sanctions for the unauthorized and malicious use of social networks in private and other purposes in order to obtain personal gain at the expense of individuals or groups (sick or healthy, owners of certain businesses and companies, health organizations and pharmaceutical manufacturers, etc.), for which there is still no global or European codes and standards of conduct. Cyber crime is now one of the mostly present types of crime in modern times, as evidenced by numerous scandals that are happening both globally and locally. PMID:23922516

Evaluation of health literacy among Spanish-speaking primary care patients along the US--Mexico border.

PubMed

Penaranda, Eribeth; Diaz, Marco; Noriega, Oscar; Shokar, Navkiran

2012-07-01

Health literacy (HL) is a measure of the communication skills that are needed by an individual to effectively navigate the healthcare system. Hispanic adults have lower average levels of HL than any other racial/ethnic group; however, the prevalence of adequate HL among Hispanics along the US-Mexico border is unknown. We performed a cross-sectional survey of 200 adult primary care patients who attended four low-income community clinics along the US-Mexico border. Patients were included in the study if they were self-described Hispanics whose first language was Spanish or bilingual patients who reported that they were primarily Spanish speakers. Adequate HL was defined as having a score of ≥38 on the Short Assessment of Health Literacy for Spanish Adults-50. Three patients (1.5%) had inadequate HL. Because of the high proportion of patients having adequate HL, we found no statistical differences between patients with adequate HL versus inadequate HL by age, sex, educational attainment, health coverage, or self-reported health status; however, all three patients with inadequate HL were found to be 60 years old or older and had less than a high school education. The results of HL assessment varied according to the tool and setting used in measuring Spanish-speaking Hispanics. In certain clinical scenarios, current tools may underestimate the actual prevalence of adequate HL. Further development and assessment of HL tools appropriate for Spanish-speaking Hispanics is needed as a first step in developing interventions to limit disparities in health care among all Americans.

Challenges in the new prospective payment system: action steps for social work in home health care.

PubMed

Lee, Ji Seon; Rock, Barry D

2005-02-01

The Balanced Budget Act of 1997 changed the reimbursement rules for Medicare home health benefits from a fee-for-service system to a prospective payment system (PPS). As with Medicare's hospital reimbursement system, home health agencies have to provide appropriate and adequate care for a flat rate reimbursement for each patient. As a result coordination and collaboration among all members of the home health care team (that is, nurses, social workers, physical therapist, occupational therapist, speech therapist, and home health aides) is critical to provide home care for frail and chronically ill populations. The authors provide background on the PPS, home health care, and social work roles in home health care and propose policy and research action steps for the social work profession.

The opinions of Turkish mental health nurses on physical health care for individuals with mental illness: A qualitative study.

PubMed

Çelik Ince, S; Partlak Günüşen, N; Serçe, Ö

2018-05-01

Individuals with mental illness have significantly higher mortality and morbidity than the general population due to physical illnesses. Mental health nurses play a key role in providing care for common physical problems and protecting and promoting healthy lifestyles. Little is known from previous studies in the international literature about the attitudes, behaviours and thoughts of mental health nurses on providing physical health care. Mental health nurses mostly focus on the existing physical health problems of individuals with mental illness. However, mental health nurses do not include practices of disease prevention and physical health promotion for individuals with mental illness. The desire to see positive changes in individuals with mental illness, receiving positive feedback, feeling useful and happy, and feeling satisfied with their profession motivate mental health nurses in terms of providing physical health care. The knowledge and skill required of mental health nurses to provide physical health care need to be increased. Institutions should employ expert nurses who are able to guide mental health nurses to provide physical health care. It is important to provide adequate physical infrastructure and human resources to provide better physical health care in mental health services. Background Mental health nurses play an important role in improving the physical health of individuals with mental illnesses. However, there are limited studies of their attitudes and practices about physical health. Therefore, there is a need for qualitative studies to clarify the issue. The aim of this study was to determine mental health nurses' opinions about physical health care for individuals with mental illness. This study was carried out in Turkey. A qualitative descriptive approach was taken in the study. The sample consisted of twelve mental health nurses selected by purposeful sampling. In-depth interviews were conducted using a semi-structured interview format

[Economics of health care in Mali].

PubMed

Coulibaly, S O; Keita, M

1996-01-01

From the results obtained regarding the financing of health care in Mali, we emphasize two important points. First, there is a lack of criteria for the distribution of finding in the health care sector, resulting in a waste of resources. Secondly, there is an absence of adequate pharmaceutical policies. The field studies led in 1987 provided the following observations. The rate of occupation of the beds is very low. Also, the numerous new investments are not yet put into service because of the lack of necessary equipment of qualified personnel. In addition, this does not consider the excessive investments occurring in certain localities where neither the rate of frequentation nor the economic conditions will ever allow the use of the capacity created. Among the possible solutions for the crisis of health care funding in Mali, the following should be priority: first, to fight against the complete lack of organization of the activities at the health care centers; secondly, to fight against the waste and misappropriation of money resulting from the behavior of the medical and paramedical personnel: and thirdly, to clarify the management of the resources coming from the charges for each service. The pharmaceutical policies adopted and implemented in recent years Largely contributed to, first, the creation of competition between essential generic medications and nongeneric medications that can be replaced, and then, the destruction of the public network of drug distribution. These conditions considerably limited the distribution of essential medications; yet, this is the only manner of reducing the pharmaceutical expenses and accordingly, allowing more funding for other medical services. As the distribution network is disorganized, the only alternative for the population to obtain the medications at the lowest price was to create centers of purchasing and distribution and to multiply the number of retailers of essential medications. Extensive work has been conducted in

Barriers of delivering oral health care to older people experienced by dentists: a systematic literature review.

PubMed

Bots-VantSpijker, Pieternella C; Vanobbergen, Jacques N O; Schols, Jos M G A; Schaub, Rob M H; Bots, Casper P; de Baat, Cees

2014-04-01

To identify barriers of delivering oral health care to older people experienced by dentists. A comprehensive literature search was carried out for studies published in the period January 1990-December 2011, using free text and MESH term search strategies for PubMed (Medline), EMBASE and CINAHL. The initial search identified 236 potentially relevant publications: PubMed (Medline; n = 127), EMBASE (n = 108) and CINAHL (n = 1). After screening of titles and abstracts, 14 publications were revealed as relevant for further review. Seven articles, focusing on dentists delivering oral health care to older people in care homes, were suitable for this review, and seven articles did not meet the previously determined quality criteria. One of these articles also focused on barriers experienced by dentists working in their own practice and delivering oral health care to community-dwelling older people. The most common barriers of delivering oral health care to older people were identified respectively as: the lack of adequate equipment in a care home and no area for treatment available (n = 4) and the lack of adequate reimbursement for working in a care home (n = 5). In addition, the inadequate training and experience in delivering oral health care to older care home residents (n = 2) were mentioned. Four publications indicated the loss of time from private practice as a barrier to deliver oral health care in a care home. We suggest that additional research should be initiated to investigate more in detail the barriers dentists experience in delivering oral health care to older people in their own dental practices. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Program to Improve Access to Health Care Among Mexican Immigrants in Rural Colorado

ERIC Educational Resources Information Center

Diaz-Perez, Maria de Jesus; Farley, Tillman; Cabanis, Clara Martin

2004-01-01

Migration to the United States from Mexico is increasing every year. Mexican immigrants tend to be poor, uninsured, monolingual Spanish speakers without adequate access to appropriate medical care. As a further barrier, many are also undocumented. This article describes a program developed to improve access to health care among Mexican immigrants…

What does 'access to health care' mean?

PubMed

Gulliford, Martin; Figueroa-Munoz, Jose; Morgan, Myfanwy; Hughes, David; Gibson, Barry; Beech, Roger; Hudson, Meryl

2002-07-01

Facilitating access is concerned with helping people to command appropriate health care resources in order to preserve or improve their health. Access is a complex concept and at least four aspects require evaluation. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society. Equity of access may be measured in terms of the availability, utilisation or outcomes of services. Both horizontal and vertical dimensions of equity require consideration. Copyright The Royal Society of Medicine Press Ltd 2002.

Brazilian immigrants' oral health literacy and participation in oral health care in Canada.

PubMed

Calvasina, Paola; Lawrence, Herenia P; Hoffman-Goetz, Laurie; Norman, Cameron D

2016-02-15

Inadequate functional health literacy is a common problem in immigrant populations. The aim of this study was to investigate the association between oral (dental) health literacy (OHL) and participation in oral health care among Brazilian immigrants in Toronto, Ontario, Canada. The study used a cross-sectional design and a convenience sample of 101 Brazilian immigrants selected through the snowball sampling technique. Data were analyzed using descriptive statistics and logistic regression modeling. Most of the sample had adequate OHL (83.1 %). Inadequate/marginal OHL was associated with not visiting a dentist in the preceding year (OR = 3.61; p = 0.04), not having a dentist as the primary source of dental information (OR = 5.55; p < 0.01), and not participating in shared dental treatment decision making (OR = 1.06; p = 0.05; OHL as a continuous variable) in multivariate logistic regressions controlling for covariates. A low average annual family income was associated with two indicators of poor participation in oral health care (i.e., not having visited a dentist in the previous year, and not having a dentist as regular source of dental information). Limited OHL was linked to lower participation in the oral health care system and with barriers to using dental services among a sample of Brazilian immigrants. More effective knowledge transfer will be required to help specific groups of immigrants to better navigate the Canadian dental care system.

Consumer participation and organizational development in health care: a systematic review.

PubMed

Tempfer, Clemens B; Nowak, Peter

2011-07-01

To provide an overview of published data on user participation in Health Care. Active and passive involvement of consumers into agendas associated with Health Care is still an exception. Data on the success of user participation projects in various areas of Health Care are lacking. Systematic literature review using public databases. We identified 467 studies including five systematic reviews describing various participation projects, among them workshops, citizens' panels, focus groups, citizens' juries, and consultation meetings. A general trend favoring a specific method was not observed. The categorization of evaluable studies according to Health Care area (n = 331) yielded the following results: general medicine/preventive medicine (n = 5), internal medicine/oncology (n = 132), obstetrics and gynecology (n = 2), surgery (n = 1), neurology/psychiatry (n = 2), social medicine (n = 16), health worker training (n = 38), and research agenda setting (n = 135). Predefined qualitative parameters were extracted from 69/467 (15%) studies. Sixty one of 69 studies (88%) were retrospective analyses without control groups and without outcome assessment. Six studies had outcome assessment, three judged the outcome as successful, two as negative, and one multi-project study reported 'very successful' project assessments in 24% of the projects. In 18 studies, the level of consumer participation was described as 'informed' in 2/18, 'advisory' in 14/18, and 'decision-making' in 2/18. The following factors associated with project success were identified: adequate financing, partnerships with well institutionalized consumer organizations, advanced project logistics, small-scale projects, and adequate internal and external communication. Most consumer participation projects were performed in research agenda setting, internal medicine/oncology, and health worker training. Various methods have been used in the projects, the level of consumer participation was low, and the success

Feasibility of implementing oral health guidelines in residential care settings: views of nursing staff and residential care workers.

PubMed

Hilton, Shaylee; Sheppard, Justine Joan; Hemsley, Bronwyn

2016-05-01

To determine the views of nurses and on the feasibility of implementing current evidence-based guidelines for oral care, examining barriers and facilitators to implementation. This mixed-methods study involved an online survey of 35 nurses and residential care workers, verified and expanded upon by one focus group of six residential care workers. Results reflected that nurses and residential care workers (a) have little or no training in recommended oral care techniques, and (b) lack access to the equipment and professional supports needed to provide adequate oral care. Basic oral care might be performed less than once per day in some settings and patients with problematic behaviours, dysphagia, or sensitivities associated with poor oral health might be less likely to receive oral care. While lack of time was highlighted as a barrier in the survey findings, focus group members considered that time should not be a barrier to prioritising oral care practices on a daily basis in residential care settings. There are several important discrepancies between the recommendations made in evidence-based guidelines for oral care and the implementation of such practices in residential care settings. Nursing and residential care staff considered adequate oral care to be feasible if access, funding and training barriers are removed and facilitators enhanced. Copyright © 2015 Elsevier Inc. All rights reserved.

Health care reform 2010: a fresh view on tort reform.

PubMed

Stimson, C J; Dmochowski, Roger; Penson, David F

2010-11-01

We reviewed the state of medical malpractice tort reform in the context of a new political climate and the current debate over comprehensive health care reform. Specifically we asked whether medical malpractice tort reform is necessary, and evaluated the strengths and weaknesses of contemporary reform proposals. The medical, legal and public policy literature related to medical malpractice tort reform was reviewed and synthesized. We include a primer for understanding the current structure of medical malpractice law, identify the goals of the current system and analyze whether these goals are presently being met. Finally, we describe and evaluate the strengths and weaknesses of the current reform proposals including caps on damages, safe harbors and health care courts. Medical malpractice tort law is designed to improve health care quality and appropriately compensate patients for medical malpractice injuries, but is failing on both fronts. Of the 3 proposed remedies, caps on damages do little to advance the quality and compensatory goals, while safe harbors and health care courts represent important advancements in tort reform. Tort reform should be included in the current health policy debate because the current medical malpractice system is not adequately achieving the basic goals of tort law. While safe harbors and health care courts both represent reasonable remedies, health care courts may be preferred because they do not rely on jury determination in the absence of strong medical evidence. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Factors associated with adequate weekly reporting for disease surveillance data among health facilities in Nairobi County, Kenya, 2013.

PubMed

Mwatondo, Athman Juma; Ng'ang'a, Zipporah; Maina, Caroline; Makayotto, Lyndah; Mwangi, Moses; Njeru, Ian; Arvelo, Wences

2016-01-01

Kenya adopted the Integrated Disease Surveillance and Response (IDSR) strategy in 1998 to strengthen disease surveillance and epidemic response. However, the goal of weekly surveillance reporting among health facilities has not been achieved. We conducted a cross-sectional study to determine the prevalence of adequate reporting and factors associated with IDSR reporting among health facilities in one Kenyan County. Health facilities (public and private) were enrolled using stratified random sampling from 348 facilities prioritized for routine surveillance reporting. Adequately-reporting facilities were defined as those which submitted >10 weekly reports during a twelve-week period and a poor reporting facilities were those which submitted <10 weekly reports. Multivariate logistic regression with backward selection was used to identify risk factors associated with adequate reporting. From September 2 through November 30, 2013, we enrolled 175 health facilities; 130(74%) were private and 45(26%) were public. Of the 175 health facilities, 77 (44%) facilities classified as adequate reporting and 98 (56%) were reporting poorly. Multivariate analysis identified three factors to be independently associated with weekly adequate reporting: having weekly reporting forms at visit (AOR19, 95% CI: 6-65], having posters showing IDSR functions (AOR8, 95% CI: 2-12) and having a designated surveillance focal person (AOR7, 95% CI: 2-20). The majority of health facilities in Nairobi County were reporting poorly to IDSR and we recommend that the Ministry of Health provide all health facilities in Nairobi County with weekly reporting tools and offer specific trainings on IDSR which will help designate a focal surveillance person.

Factors associated with adequate weekly reporting for disease surveillance data among health facilities in Nairobi County, Kenya, 2013

PubMed Central

Mwatondo, Athman Juma; Ng'ang'a, Zipporah; Maina, Caroline; Makayotto, Lyndah; Mwangi, Moses; Njeru, Ian; Arvelo, Wences

2016-01-01

Introduction Kenya adopted the Integrated Disease Surveillance and Response (IDSR) strategy in 1998 to strengthen disease surveillance and epidemic response. However, the goal of weekly surveillance reporting among health facilities has not been achieved. We conducted a cross-sectional study to determine the prevalence of adequate reporting and factors associated with IDSR reporting among health facilities in one Kenyan County. Methods Health facilities (public and private) were enrolled using stratified random sampling from 348 facilities prioritized for routine surveillance reporting. Adequately-reporting facilities were defined as those which submitted >10 weekly reports during a twelve-week period and a poor reporting facilities were those which submitted <10 weekly reports. Multivariate logistic regression with backward selection was used to identify risk factors associated with adequate reporting. Results From September 2 through November 30, 2013, we enrolled 175 health facilities; 130(74%) were private and 45(26%) were public. Of the 175 health facilities, 77 (44%) facilities classified as adequate reporting and 98 (56%) were reporting poorly. Multivariate analysis identified three factors to be independently associated with weekly adequate reporting: having weekly reporting forms at visit (AOR19, 95% CI: 6-65], having posters showing IDSR functions (AOR8, 95% CI: 2-12) and having a designated surveillance focal person (AOR7, 95% CI: 2-20). Conclusion The majority of health facilities in Nairobi County were reporting poorly to IDSR and we recommend that the Ministry of Health provide all health facilities in Nairobi County with weekly reporting tools and offer specific trainings on IDSR which will help designate a focal surveillance person. PMID:27303581

Health care reform and people with disabilities.

PubMed

Batavia, A I

1993-01-01

As a group, people with disabilities or chronic conditions experience higher-than-average health care costs and have difficulty gaining access to affordable private health insurance coverage. While the Americans with Disabilities Act will enhance access by prohibiting differential treatment without sound actuarial justification, it will not guarantee equal access for people in impairment groups with high utilization rates. Health care reform is needed to subsidize the coverage of such individuals. Such subsidization can be achieved under either a casualty insurance model, in which premiums based on expected costs are subsidized directly, or a social insurance model, in which low-cost enrollees cross-subsidize high-cost enrollees. Cost containment provisions that focus on the provider, such as global budgeting and managed competition, will adversely affect disabled people if providers do not have adequate incentives to meet these people's needs. Provisions focusing on the consumer, such as cost sharing, case management, and benefit reductions, will adversely affect disabled people if they unduly limit needed services or impose a disproportionate financial burden on disabled people.

In search of the quickest way to disseminate health care innovations.

PubMed

Schrijvers, Guus; Oudendijk, Nico; de Vries, Pety

2003-10-14

Innovations in health care are slowly disseminated in The Netherlands and elsewhere. That's why the researchers defined their research question: What is the quickest way of disseminating health care innovations? The design was a comparative, qualitative case study. The researchers invited a group of 52 authors to describe their 21 health care innovations. All case descriptions were published in a book of 261 pages. Six types of innovations were distinguished. Most innovations simultaneously improved quality from the patient's point of view (18 out of 21 cases), professional pride (18/21) and speed of introduction (16/21). Clinical outcomes were better or comparable in 13 of the 21 cases. Brainstorm sessions took place with the innovators and the 22 experts on the quickest way to disseminate the innovations more widely in The Netherlands. These sessions looked for the critical success factors for the dissemination of the 21 projects and identified nine. The following factors were identified: 1. A clear distribution of responsibilities between professionals within the innovation (20/21). 2. Enough educational programs about the innovations for the professionals (18/21). 3. Adequate ICT support for the running of the innovations (15/21). 4. Suitable publicity for the innovations (12/21). 5. An adequate payment system for innovative care providers (7/21). 6. The right size of catchment's area for the innovations (6/21). 7. Enough professional freedom to adopt the innovation (5/21). 8. Fast managerial and public decision-making about the adoption of the innovation (3/21). 9. The embedding of the innovations in quality management assurance policy (1/21). The results of the study had some influence on the political health agenda in The Netherlands, leading to greater emphasis on innovations and quality of care.

Public health and primary care: struggling to "win friends and influence people".

PubMed

Mayes, Rick; McKenna, Sean

2011-01-01

Why are the goals of public health and primary care less politically popular and financially supported than those of curative medicine? A major part of the answer to this question lies in the fact that humans often worry wrongly by assessing risk poorly. This reality is a significant obstacle to the adequate promotion of and investment in public health, primary care, and prevention. Also, public health's tendency to infringe on personal privacy-as well as to call for difficult behavioral change-often sparks intense controversy and interest group opposition that discourage broader political support. Finally, in contrast to curative medicine, both the cost-benefit structure of public health (costs now, benefits later) and the way in which the profession operates make it largely invisible to and, thus, underappreciated by the general public. When curative medicine works well, most everybody notices. When public health and primary care work well, virtually nobody notices.

Physical health care for people with mental illness: training needs for nurses.

PubMed

Happell, Brenda; Platania-Phung, Chris; Scott, David

2013-04-01

People diagnosed with serious mental illness have higher rates of physical morbidity and decreased longevity, yet these people are not adequately served by health care systems. Nurses may provide improved physical health support to consumers with serious mental illness but this is partly dependent on nurses having necessary skills and interest in training opportunities for this component of their work. This survey investigated Australian nurses' interest in training across areas of physical health care including lifestyle factors, cardiovascular disease, and identifying health risks. A nation-wide online survey of nurse members of the Australian College of Mental Health Nurses. The survey included an adapted version of a sub-section of the Physical Health Attitudes Scale. Participants were asked to indicate their interest in various aspects of physical health care training. Most (91.6%) participants viewed educating nurses in physical health care as of moderate or significant value in improving the physical health of people with serious mental illness. Interest in training in all areas of physical health care was over 60% across the health care settings investigated (e.g. public, private, primary care). Forty-two percent sought training in all nine areas of physical health care, from supporting people with diabetes, to assisting consumers with sexually-related and lifestyle issues. The findings suggest that nurses in mental health services in Australia acknowledge the importance of training to improve physical health care of consumers with serious mental illness. Training programs and learning opportunities for nurses are necessary to reduce inequalities in health of people with serious mental illness. Copyright © 2013. Published by Elsevier Ltd.

[Audit of management of arterial hypertension in primary health care in Sousse].

PubMed

Ben Abdelaziz, Ahmed; Ben Othman, Aicha; Mandhouj, Olfa; Gaha, Rafika; Bouabid, Zouhour; Ghannem, Hassen

2006-03-01

A medical audit has been carried out on a representative sample of 456 hypertensive patients followed in the health care facilities of Sousse during 2002, to evaluate the quality of management of hypertension in primary health care. The study yielded the following results: the patients selected for a first line follow-up did not represent more than 79% of the studied population. The minimal recommended balance was achieved in 8% of cases only. Adequate drug therapy was prescribed in 64% of cases. 59% of patients were considered compliant. Controls of blood pressure was achieved in 5,5% of patients. The quality of management of hypertension in primary health care was considered satis factory in 28,7% of patents with a significant difference between urban and rural areas (24,9% versus 40,5%). These results indicate that increased attention should be paid by the national program of Struggle against the Chronic Diseases to the quality of management of hypertension in primary health care institutions.

Incorporating human rights into reproductive health care provider education programs in Nicaragua and El Salvador.

PubMed

Reyes, H Luz McNaughton; Zuniga, Karen Padilla; Billings, Deborah L; Blandon, Marta Maria

2013-07-01

Health care providers play a central role in the promotion and protection of human rights in patient care. Consequently, the World Medical Association, among others, has called on medical and nursing schools to incorporate human rights education into their training programs. This report describes the efforts of one Central American nongovernmental organization to include human rights - related content into reproductive health care provider training programs in Nicaragua and El Salvador. Baseline findings suggest that health care providers are not being adequately prepared to fulfill their duty to protect and promote human rights in patient care. Medical and nursing school administrators, faculty, and students recognize the need to strengthen training in this area and are enthusiastic about incorporating human rights content into their education programs. Evaluation findings suggest that exposure to educational materials and methodologies that emphasize the relationship between human rights and reproductive health may lead to changes in health care provider attitudes and behaviors that help promote and safeguard human rights in patient care.

Health literacy in the urgent care setting: What factors impact consumer comprehension of health information?

PubMed

Alberti, Traci L; Morris, Nancy J

2017-05-01

An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly. To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk. As part of a larger cross-sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors. A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p < .001), less education (p < .001), and lower income (p = .006). Limited health literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self-management is essential to optimize outcomes for UC patients. ©2017 American Association of Nurse Practitioners.

Suicidal ideations, plans and attempts in primary care: cross-sectional study of consultants at primary health care system in Morocco.

PubMed

Oneib, Bouchra; Sabir, Maria; Otheman, Yassine; Abda, Naima; Ouanass, Abderrazzak

2016-01-01

The aim of the study is to estimate the prevalence of suicidal ideation among Moroccan consultants in primary health care system. We conducted a cross sectional survey in three health care centers in two cities of Morocco to estimate the prevalence of suicidal ideation, plan and suicide attempts among 396 consultants in the primary health care system, using the Mini International neuropsychiatric interview. Patients were 18 years and older, without known psychiatric or chronic somatic disease. Statistical analysis was performed by the SPSS 13.0 software. The prevalence of suicidal ideation was 5.3%, and 2.7% of the patients planned their suicide and 1.2% tried to commit suicide. The multivariate analysis did not demonstrate significant association. Suicidal ideation, plan and suicide attempts are prevalent in primary health care patients, but they are still under diagnosed. An adequate training of physicians and the establishment of education programs is essential to reduce the rate of suicide.

The quality of health care in prison: results of a year's programme of semistructured inspections.

PubMed Central

Reed, J.; Lyne, M.

1997-01-01

OBJECTIVES: To assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales. DESIGN: Inspections based on a set of "expectations" derived mainly from existing healthcare quality standards published by the prison service and existing ethical guidelines; questionnaire survey of prisoners. SUBJECTS: 19 prisons in England and Wales, 1996-7. MAIN OUTCOME MEASURES: Appraisals of needs assessment and the commissioning and delivery of health care against the inspectorate's expectations. RESULTS: The quality of health care varied greatly. A few prisons provided health care broadly equivalent to NHS care, but in many the health care was of low quality, some doctors were not adequately trained to do the work they faced, and some care failed to meet proper ethical standards. Little professional support was available to healthcare staff. CONCLUSIONS: The current policy for improving health care in prisons is not likely to achieve its objectives and is potentially wasteful. The prison service needs to recognise that expertise in the commissioning and delivery of health care is overwhelming based in the NHS. The current review of the provision of health care in prisons offers an opportunity to ensure that prisoners are not excluded from high quality health care. PMID:9418090

Measurement and analysis of inequality of opportunity in access of maternal and child health care in Togo.

PubMed

Sanoussi, Yacobou

2017-12-04

Access to maternal and child health care in low- and middle-income countries such as Togo is characterized by significant inequalities. Most studies in the Togolese context have examined the total inequality of health and the determinants of individuals' health. Few empirical studies in Togo have focused on inequalities of opportunity in maternal and child health. To fill this gap, we estimated changes in inequality of opportunity in access to maternal and child health services between 1998 and 2013 using data from Togo Demographic and Health Surveys (DHS). We computed the Human Opportunity Index (HOI)-a measure of how individual, household, and geographic characteristics like sex and place of residence can affect individuals' access to services or goods that should be universal-using five indicators of access to healthcare and one composite indicator of access to adequate care for children. The five indicators of access were: birth in a public or private health facility; whether the child had received any vaccinations; access to prenatal care; prenatal care given by qualified staff; and having at least four antenatal visits. We then examined differences across the two years. Between 1998 and 2013, inequality of opportunities decreased for four out of six indicators. However, inequalities increased in access to antenatal care provided by qualified staff (5.9% to 12.5%) and access to adequate care (27.7% to 28.6%). Although inequality of opportunities reduced between 1998 and 2013 for some of the key maternal and child health indicators, the average coverage and access rates underscore the need for sustained efforts to ensure equitable access to primary health care for mothers and children.

Knowledge, attitude, and practice towards blood donation among health care providers in hospitals at Bahir Dar City, Ethiopia.

PubMed

Abera, Bayeh; Mohammed, Beyan; Betela, Wendmagegn; Yimam, Reshid; Oljira, Adam; Ahmed, Merhab; Tsega, Wubet; Mulu, Wondemagegn; Yizengaw, Endalew

2017-06-01

Like other sub-Saharan Africa, in Ethiopia there is a shortage of adequate and safe blood supplies. Health care providers are potential resource and promoter of voluntary blood donation. This study was conducted to determine the knowledge, attitude and practice towards blood donation among health care providers in Bahir Dar City, Ethiopia. Paper based questionnaire was distributed to 276 health care providers from May 01 to June 30, 2016. Overall, 42.8% had donated blood at least once. Of these, males accounted for 60%. The median age of blood donors was 26 years. Voluntary-unpaid donation was 21.2%. Overall, 75.5% health care providers were knowledgeable. The levels of knowledge were significantly different among different disciplines (One-way ANOVA; F=69.7; P=0.004). Males were more knowledgeable than females (P<0.05). The overall favorable attitude was 78.6%. Previous practice of blood donation determined the odds of favorable attitude to be a future regular voluntary-unpaid blood donor (OR: 5.7, 95% CI: 3.2-10.4). Majority of health care providers had adequate knowledge and favorable attitude. However, voluntary-unpaid donation practice (21.1%) was lower compared to 100% target of voluntary-unpaid donation. There should be motivation packages to enhance voluntary-unpaid blood donation among health care professionals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Policy approach to nutrition and physical activity education in health care professional training1234

PubMed Central

Loy, Lisel; Zatz, Laura Y

2014-01-01

Nutrition and physical activity are key risk factors for a host of today's most prevalent and costly chronic conditions, such as obesity and diabetes; yet, health care providers are not adequately trained to educate patients on the components of a healthy lifestyle. The purpose of this article is to underscore the need for improved nutrition and physical activity training among health care professionals and to explore opportunities for how policy can help support a shift in training. We first identify key barriers to sufficient training in nutrition and physical activity. Then, we provide an overview of how recent changes in the government and institutional policy environment are supporting a shift toward prevention in our health care system and creating an even greater need for improved training of health care professionals in nutrition and physical activity. Last, we outline recommendations for additional policy changes that could drive enhanced training for health care professionals and recommend future directions in research. PMID:24646822

Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers.

PubMed

Odusola, Aina O; Stronks, Karien; Hendriks, Marleen E; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A

2016-01-01

Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider-insurer relationships; automated administration systems; and tailoring guidelines/patient education. By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

Impact of health care adversity on providers: Lessons learned from a staff support program.

PubMed

Trent, Maxine; Waldo, Kimberly; Wehbe-Janek, Hania; Williams, Daniel; Hegefeld, Wendy; Havens, Lisa

2016-08-01

Health care providers often experience traumatic events and adversity that can have negative emotional impacts on the profession and on patients. These impacts are typically multifaceted and can result from many different events, such as unanticipated outcomes, licensing board complaints, claims, and litigation. Because health care providers are exposed to diverse situations, they require adequate and timely support, imperative for provider resilience and patient safety. This study evaluated the success of an institution's second victim health care support program and best practices in responding to these traumatic experiences effectively. Twenty faculty and medical residents who utilized the support program at a large hospital system located in Central Texas from 2001 to 2012 participated in 1 of 6 focus groups. Qualitative data were collected from these groups to describe program requirements for the adequate delivery of health care adversity support and necessary program improvements. Responses were first transcribed verbatim. Each research team member analyzed data using a thematic framework approach. This approach helped to characterize traumatic experiences and to design a support system. The results revealed that (1) provider experiences are traumatic, (2) it is necessary to communicate an adverse event in a confidential and timely manner, preferably with a peer, (3) preemptive education regarding risk management and the legal process is helpful, and (4) there is a need for further support of the specific experience of a board complaint. Focus group data indicated the complexity of the emotional impact of traumatic experiences. Specific program components are needed to create best practices for providers affected by health care adversity, including support when providers face board complaints. The program's unique combination of support and education allowed us to expand upon leading national health care adversity programs. © 2016 American Society for

Consumer-directed health care: implications for health care organizations and managers.

PubMed

Guo, Kristina L

2010-01-01

This article uses a pyramid model to illustrate the key components of consumer-directed health care. Consumer-directed health care is considered the essential strategy needed to lower health care costs and is valuable for making significant strides in health care reform. Consumer-directed health care presents new challenges and opportunities for all health care stakeholders and their managers. The viability of the health system depends on the success of managers to respond rapidly and with precision to changes in the system; thus, new and modified roles of managers are necessary to successfully sustain consumerism efforts to control costs while maintaining access and quality.

Health system support for childbirth care in Southern Tanzania: results from a health facility census

PubMed Central

2013-01-01

Background Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Results Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2–3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Conclusions Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries

Reforming the health care system: implications for health care marketers.

PubMed

Petrochuk, M A; Javalgi, R G

1996-01-01

Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

A New Foundation for the Delivery and Financing of American Health Care.

PubMed

Saultz, John W; Jones, Samuel M; McDaniel, Susan H; Bagley, Bruce; McCormally, Terence; Marker, Jason E; Weida, Jane A; Green, Larry A

2015-09-01

For the past decade, primary care practices across America have worked to implement a practice model called the Patient-Centered Medical Home (PCMH) to revitalize practice, better support clinicians and patients, improve efficiency, and facilitate growth in primary care capacity. In spite of substantial progress, this work has not been matched by sufficient change in the payment system to allow these goals to be accomplished. Nevertheless, improving the quality and availability of primary care remains essential to achieving the goals of the Triple Aim (better health care, better population health, and containment of health care costs). For this to occur, the PCMH model of care must be further refined, and the payment system for primary care must be completely restructured. The need for these changes is urgent. In October 2014, the discipline of family medicine announced a comprehensive strategic plan called Family Medicine for America's Health (FMAHealth). FMAHealth proposes to expand the PCMH care model by fully integrating our nation's behavioral/mental health, public health, and primary care systems to create a new foundation for American health care. Accomplishing these ambitious goals will require a broad coalition of private and public interests across the health care disciplines as well as patients, communities, government, and businesses. These changes require additional infrastructure that existing financing systems do not adequately support, so comprehensive payment reform is essential for large-scale dissemination and sustainability of this model. The new payment model must reward value rather than volume of service and must provide a secure financial foundation for practices designed to care for patients and communities at affordable costs.

Rhetoric vs. reality: employer views on consumer-driven health care.

PubMed

Trude, Sally; Conwell, Leslie

2004-07-01

Because of rising premiums, employers are investigating new health insurance approaches that maintain workers' broad choice of providers while raising awareness of health care costs through increased patient financial responsibility. Employers' knowledge of new health plan products, including consumer-driven health plans and tiered-provider networks, has grown considerably in recent years, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visit to 12 nationally representative communities. But employers are concerned that consumer-driven health plans would take considerable effort to implement without much cost savings. They also are skeptical that tiered-provider networks can adequately capture both cost and quality information in a way that is understandable to patients.

Evaluation of health literacy status among patients in a tertiary care hospital in coastal karnataka, India.

PubMed

U P, Rathnakar; Belman, Madhuri; Kamath, Ashwin; B, Unnikrishnan; Shenoy K, Ashok; A L, Udupa

2013-11-01

People with limited health literacy are more likely to make medication errors, and they have less health knowledge, worse health status, more hospitalizations, and higher healthcare costs than people with adequate literacy. The objective of this study is to assess the health literacy status among patients who are able to read and understand English attending a tertiary care hospital by using Rapid Estimate of Adult Literacy in Medicine [REALM] technique and to compare the health literacy levels to educational status and other baseline characteristics. A widely used word recognition method [REALM] was used to assess the HL status of 200 patients attending a tertiary care hospital in Southern India. The number of correctly pronounced words was used to assign a grade-equivalent reading level. Scores 0 to 44 indicate reading skills at or below the 6th grade level, scores from 45 to 60 represent skills at the 7th or 8th grade level, and scores above 60 indicate skills at the high-school level or higher. HL status was found below adequate level in more than 50% of the patients. Younger age group showed better HL scores compared to those aged more than 25 years. General education level or the medium of education does not truly reflect HL levels as brought out in the study. Even those with postgraduate qualification had poor HL skills. The study was carried out to find out the HL levels among patients attending a tertiary care hospital. It was assumed that the general education levels may not reflect true HL status. In view of the results of this study it can be concluded that patient's HL skills should not be taken for granted and adequate attention should be paid in educating and briefing patients whenever patients are required to interpret and understand health care related documents.

Private health care.

PubMed

Uplekar, M W

2000-09-01

During the last decade there has been considerable international mobilisation around shrinking the role of States in health care. The World Bank reports that, in many low and middle-income countries, private sources of finance comprise the largest share of total national health expenditures. Private sector health care is ubiquitous, reaches throughout the population, preferred by the people and is significant from both economic as well as health perspective. Resources are limited, governments are weak, and a new approach is needed. This paper provides a broad overview and raises key issues with regard to private health care. The focus is on provision of health care by private medical providers. On the background of the world's common health problems and interventions available to tackle them, the place of private health care in the overall context is first discussed. The concept of privatisation within the various forms of health care systems is then explained. The paper then describes the genesis and key elements of rapidly enhancing role of the private sector in health care and points to the paucity of literature from low and middle-income countries. Common concerns about private health care are outlined. Two illustrative examples--tuberculosis, the top infectious killer among the poor and coronary heart disease, the top non-infectious killer among the rich--are presented to understand the current and possible role of private sector in provision of health care. Highlighting the need to distinguish between health care as a public good or a market commodity, the paper leaves it to the reader to draw conclusions.

The performance of mHealth in cancer supportive care: a research agenda.

PubMed

Nasi, Greta; Cucciniello, Maria; Guerrazzi, Claudia

2015-02-13

Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Further research should start by stating and explaining what is meant

[Perceptions of primary care physicians in Madrid on the austerity measures in the health care system].

PubMed

Heras-Mosteiro, Julio; Otero-García, Laura; Sanz-Barbero, Belén; Aranaz-Andrés, Jesús María

2016-01-01

To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Herpes labialis and Nigerian dental health care providers: knowledge, attitudes, behaviors, and refusal to treat.

PubMed

Azodo, Clement Chinedu; Umoh, Agnes O

2015-09-15

The few existing studies on herpes labialis among health care workers have been predominantly among non-dental health care workers. The purpose of this study was to determine Nigerian dental health care providers' knowledge of, attitudes toward, preventive behaviors for, and refusal to treat patients with herpes labialis. This cross-sectional study was conducted among final-year dental students at the University of Benin, dental house officers, and residents at the University of Benin Teaching Hospital, Benin City, Nigeria. Data collection was via a self-administered questionnaire. Bivariate statistics and logistic regression were used to relate the dependent and independent variables. Of the 120 questionnaires distributed, 110 were completed and returned, giving a 91.7% retrieval rate. However, 15 of the returned questionnaires were discarded because they were improperly completed, leaving a total of 95 questionnaires for final analysis in this study. The majority of participants were over 28 years old (54.7%), male (67.4%), unmarried (66.3%), and postgraduate dental health care providers (51.6%). Less than half (43.2%) of participants demonstrated adequate overall knowledge of herpes labialis. About one-tenth (10.5%) and more than three-quarters (87.4%) of participants reported a positive attitude and performance of adequate preventive behaviors, respectively. A total of 16.8% of participants reported a high tendency to refuse treatment to patients with herpes labialis. Although not statistically significant, young, unmarried, male undergraduate participants reported a greater likelihood to refuse treatment to herpes labialis patients. We found a statistically significant positive correlation between attitude and refusal to treat patients with herpes labialis. However, marital status and the attitude of participants toward these patients emerged as the determinants for refusal to treat patients with herpes labialis. Data from this study revealed a high level of

Mental health care for youth with rheumatologic diseases - bridging the gap.

PubMed

Davis, Alaina M; Rubinstein, Tamar B; Rodriguez, Martha; Knight, Andrea M

2017-12-28

Youth with rheumatologic diseases have a high prevalence of comorbid mental health disorders. Individuals with comorbid mental health disorders are at increased risk for adverse outcomes related to mental health as well as their underlying rheumatologic disease. Early identification and treatment of mental health disorders has been shown to improve outcomes, but current systems of care fall short in providing adequate mental health services to those in need. Pediatric rheumatologists are uniquely positioned to provide mental health screening and intervention for youth with rheumatologic diseases due to the frequency of patient encounters and ongoing therapeutic relationship with patients and families. However, additional training is likely required for pediatric rheumatologists to provide effective mental health care, and focusing efforts on providing trainees with mental health education is key to building competency. Potential opportunities for improved mental health education include development of clinical guidelines regarding mental health screening and management within pediatric rheumatology settings and incorporation of mental health didactics, workshops, and interdisciplinary clinic experiences into pediatric rheumatology fellowship curricula. Additional steps include mental health education for patients and families and focus on system change, targeting integration of medical and mental health care. Research is needed to better define the scope of the problem, determine effective strategies for equipping pediatric rheumatologists with skills in mental health intervention, and develop and implement sustainable systems for delivery of optimal mental health care to youth with rheumatologic diseases.

Health Care Waste Management Practice in Health Care Institutions of Nepal.

PubMed

Joshi, H D; Acharya, T; Ayer, R; Dhakal, P; Karki, K B; Dhimal, M

2017-01-01

Medical waste is considered as a major public health hazard. In a developing country like Nepal, there is much concern about the management practice of medical waste. This study aimed to assess Health Care Waste Management practice among Health Care Institutions in Nepal. A cross sectional study was carried out between July 2012 to June 2013 in 62 different Health Care Institutions, selected from stratified proportionate random sampling technique from all administrative regions of Nepal. A structured questionnaire and observation checklist were used for data collection. The waste generation rate is found significantly correlated with bed capacity, patient flow rate and annual budget spent in the hospital. It is found significantly higher in Teaching hospital than other Health Care Institutions of Nepal. An average of 3.3 kg/day/patient of medical waste (2.0 kg/day/patient non-hazardous and 1.0 kg/day/patient hazardous waste) was generated during the study period. Further, it was found that most of the Health care wastes were not disinfected before transportation to waste disposal sites. Very limited number of Health Care Institutions had conducted Environmental Assessment. Similarly, some of the Health Care Institutions had not followed Health care waste management guideline 2009 of Nepal Government. We found poor compliance of medical waste management practice as per existing legislation of Government of Nepal. Hence, additional effort is needed for improvement of Health care waste management practice at Health Care Institutions of Nepal.

The personal health record paradox: health care professionals' perspectives and the information ecology of personal health record systems in organizational and clinical settings.

PubMed

Nazi, Kim M

2013-04-04

Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals' accounts and analysis of organizational

The Personal Health Record Paradox: Health Care Professionals’ Perspectives and the Information Ecology of Personal Health Record Systems in Organizational and Clinical Settings

PubMed Central

2013-01-01

Background Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. Objective The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. Methods In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Results Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals�

Developments in health care in Nicaragua.

PubMed

Halperin, D C; Garfield, R

1982-08-05

The 4 year war that resulted in the overthrow of Nicaragua's Somoza dictatorship cost 50,000 lives. In 1972 an earthquake killed 20,000 with 10,000 injured. Under Somoza health conditions had been worse than in neighboring countries with 35% of the urban and 95% of the rural population lacking access to potable water and only about 10% of the population receiving adequate medical care. 1/3 of the people contracted malaria at least once in their lives and 46-83% of the children were malnourished. Life expectancy at the time of the revolution was 52.9 years, infant mortality was between 120-140/1000. Since July 1979, however, about 70% of the people have regular medical care and health care education campaigns are widespread. Public health programs have administered vaccinations to thousands of children and literacy programs have incorporated elementary health principles into their curricula. However, despite these efforts malaria continued to rise from 4.4 people/1000 in 1978 to 9.4/1000 in 1980. After an antimalarial drug campaign in 1981, a 98% decline was noted in new cases of malaria. Poliomyelitis and tuberculosis prevention campaigns are likewise effective and oral rehydration centers have been set up to combat infant diarrhea. Having recently experienced a baby boom, a campaign to disseminate family planning information is being planned. Technical and professional health training has been expanded as well with a second medical school opening in Managua in 1981 along with growth in the amount of nursing school students. International aid has been crucial in health care with more than 24 countries sending medical supplies and personnel. Lack of equipment and facilities is holding back medical advances and there is a dilemma concerning physicians' time spent at public versus their private practices. Drugs remain the largest health import for the country even though their pharmaceutical manufacturers have increased production. 5 new hospitals are being built with

Health Care Spending: Changes in the Perceptions of the Australian Public.

PubMed

Robertson, Jane; Newby, David A; Walkom, Emily J

2016-01-01

Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers. To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs. Two computer-assisted telephone interviews were conducted in 2006 (533 respondents) and 2015 (1318 respondents) and results compared. More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1) with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53). The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35) and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86) as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76). They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50). Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

Work stress of primary care physicians in the US, UK and German health care systems.

PubMed

Siegrist, Johannes; Shackelton, Rebecca; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

2010-07-01

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. Copyright 2010 Elsevier Ltd. All rights reserved.

Work stress of primary care physicians in the US, UK and German health care systems

PubMed Central

Siegrist, Johannes; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

2010-01-01

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005–2007. Results demonstrate country-specific differences in work stress- with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. PMID:20494505

Health care reform and care at the behavioral health--primary care interface.

PubMed

Druss, Benjamin G; Mauer, Barbara J

2010-11-01

The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.

Influence of workplace culture on nursing-sensitive nurse outcomes in municipal primary health care.

PubMed

Hahtela, Nina; Paavilainen, Eija; McCormack, Brendan; Slater, Paul; Helminen, Mika; Suominen, Tarja

2015-10-01

To explore the influence of workplace culture on sickness absences, overtime work and occupational injuries in municipal primary health care. The need to improve nursing sensitive outcomes has been highlighted. Therefore, an adequate understanding of the influence of workplace culture on nursing-sensitive nurse outcomes is essential for nurse managers to meet the requirements of improving nursing outcomes. A cross-sectional survey design was used to incorporating the data from 21 inpatient acute care units of nine organisations at the Finnish municipal primary health care system from 2011 to 2012. Findings emphasise in particular the importance of the practice environment as being an interpretative factor for nurses' absences owing to sickness, overtime work and occupational injuries. To ensure favourable nursing sensitive outcomes it is essential that there is a shared interest in the unit to invest in the creation of a supportive practice environment. Outcome improvements require a special focus on issues related to nursing management, adequate staffing and resources and intention to leave. © 2014 John Wiley & Sons Ltd.

What Makes Health Care Special?: An Argument for Health Care Insurance.

PubMed

Horne, L Chad

2017-01-01

While citizens in a liberal democracy are generally expected to see to their basic needs out of their own income shares, health care is treated differently. Most rich liberal democracies provide their citizens with health care or health care insurance in kind. Is this "special" treatment justified? The predominant liberal account of justice in health care holds that the moral importance of health justifies treating health care as special in this way. I reject this approach and offer an alternative account. Health needs are not more important than other basic needs, but they are more unpredictable. I argue that citizens are owed access to insurance against health risks to provide stability in their future expectations and thus to protect their capacities for self-determination.

Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

PubMed Central

Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A.

2016-01-01

Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Results Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA. PMID:26880152

Towards achievement of universal health care in India by 2020: a call to action.

PubMed

Reddy, K Srinath; Patel, Vikram; Jha, Prabhat; Paul, Vinod K; Kumar, A K Shiva; Dandona, Lalit

2011-02-26

To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the out-of-pocket expenditure on health care through a well regulated integration of the private sector within the national health-care system. Dialogue and consensus building among the stakeholders in the government, civil society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In our call to action, we propose that India must achieve health care for all by 2020. Copyright © 2011 Elsevier Ltd. All rights reserved.

Towards achievement of universal health care in India by 2020: a call to action

PubMed Central

Reddy, K Srinath; Patel, Vikram; Jha, Prabhat; Paul, Vinod K; Shiva Kumar, A K; Dandona, Lalit

2016-01-01

To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the out-of-pocket expenditure on health care through a well regulated integration of the private sector within the national health-care system. Dialogue and consensus building among the stakeholders in the government, civil society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In our call to action, we propose that India must achieve health care for all by 2020. PMID:21227489

When Health Systems Are Barriers to Health Care: Challenges Faced by Uninsured Mexican Kidney Patients

PubMed Central

Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J.

2013-01-01

Background Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. Methods The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. Results In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Conclusions Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an

When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

PubMed

Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J

2013-01-01

Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

Shift work and burnout among health care workers.

PubMed

Wisetborisut, A; Angkurawaranon, C; Jiraporncharoen, W; Uaphanthasath, R; Wiwatanadate, P

2014-06-01

Burnout, defined as a syndrome derived from prolonged exposure to stressors at work, is often seen in health care workers. Shift work is considered one of the occupational risks for burnout in health care workers. To identify and describe the association between shift work and burnout among health care workers. A cross-sectional study of health care workers in Chiang Mai University Hospital, Thailand. Data were collected via an online self-answered questionnaire and included details of shift work and burnout. Burnout was measured by the Maslach Burnout Inventory (MBI). Two thousand seven hundred and seventy two health care workers participated, a 52% response rate. Burnout was found more frequently among shift workers than those who did not work shifts (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI]: 1.0-1.9). Among shift workers, over 10 years of being a shift worker was associated with increasing burnout (aOR 1.7, 95% CI: 1.2-2.6) and having 6-8 sleeping hours per day was associated with having less burnout (aOR 0.7, 95% CI: 0.5-0.9). Nurses who had at least 8 days off per month had lower odds of burnout compared with those with fewer than 8 days off (aOR 0.6, 95% CI: 0.5-0.8). Shift work was associated with burnout in this sample. Increased years of work as a shift worker were associated with more frequent burnout. Adequate sleeping hours and days off were found to be possible protective factors. Policies on shift work should take into account the potential of such work for contributing towards increasing burnout. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A qualitative study of health care providers' perceptions and experiences of working together to care for children with medical complexity (CMC).

PubMed

Altman, Lisa; Zurynski, Yvonne; Breen, Christie; Hoffmann, Tim; Woolfenden, Susan

2018-01-31

Children with medical complexity (CMC) have a wide range of long term health problems and disabilities that have an adverse impact on their quality of life. They have high levels of family identified health care needs and health care utilisation. There is no Australian literature on the experiences of health care providers working in the Australian tertiary, secondary and primary health care system, whilst managing CMC. This information is essential to inform the design of integrated health care systems for these children. We address this knowledge gap by exploring the perceptions and experiences of health care providers on the provision of health care for CMC aged 0 to 18 years. A qualitative research study was undertaken. Stakeholder forums, group and individual in depth interviews were undertaken using a semi-structured interview guide. The stakeholder forums were audio recorded and transcribed verbatim. Field notes of the stakeholder forums, group and individual interviews were taken. Inductive thematic analysis was undertaken to identify key themes. One hundred and three providers took part in the stakeholder forums and interviews across 3 local health districts, a tertiary paediatric hospital network, and primary health care organisations. Providers expressed concern regarding family capacity to negotiate the system, which was impacted by the medical complexity of the children and psychosocial complexity of their families. Lack of health care provider capacity in terms of their skills, time and availability to manage CMC was also a key problem. These issues occurred within a health system that had impaired capacity in terms of fragmentation of care and limited communication among health care providers. When designing integrated care models for CMC, it is essential to understand and address the challenges experienced by their health care providers. This requires adequate training of providers, additional resources and time for coordination of care, improved

A comparison of health behaviors of women in centering pregnancy and traditional prenatal care.

PubMed

Shakespear, Kaylynn; Waite, Phillip J; Gast, Julie

2010-03-01

Researchers sought to determine the difference in health behaviors between women who receive prenatal care via the Centering Pregnancy approach and those involved in traditional prenatal care. Using a cross-sectional design, adult pregnant women (n = 125) were surveyed from at least 28 weeks gestation to delivery. The sample was comprised of primarily white low income women. Using multiple linear regression it was determined that women in Centering Pregnancy had significantly lower index health behavior scores compared with the traditional care group showing that those in Centering Pregnancy reported engaging in fewer health promoting behaviors. Furthermore, no differences were observed for smoking or weight gain behaviors between groups. Additionally, those in Centering Pregnancy reported a lower perceived value of prenatal care. The results of this study suggest that Centering Pregnancy is not adequately aiding its patients in adopting healthy behaviors during pregnancy.

Health Care Access among Latinos: Implications for Social and Health Care Reforms

ERIC Educational Resources Information Center

Perez-Escamilla, Rafael

2010-01-01

According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…

Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam

PubMed Central

2010-01-01

Background High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make

Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam.

PubMed

Graner, Sophie; Mogren, Ingrid; Duong, Le Q; Krantz, Gunilla; Klingberg-Allvin, Marie

2010-10-14

High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their

Stakeholders' perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms.

PubMed

Van Durme, Thérèse; Macq, Jean; Anthierens, Sibyl; Symons, Linda; Schmitz, Olivier; Paulus, Dominique; Van den Heede, Koen; Remmen, Roy

2014-04-18

Adequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders' perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium. Four focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care. Informants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today's health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines. Our study's methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire other countries faced with the challenge of

A framework for current public mental health care practice in South Africa.

PubMed

Janse Van Rensburg, A B

2007-11-01

One of the main aims of the new Mental Health Care Act, Act No. 17 of 2002 (MHCA) is to promote the human rights of people with mental disabilities in South Africa. However, the upholding of these rights seems to be subject to the availability of resources. Chapter 2 of the MHCA clarifies the responsibility of the State to provide infrastructure and systems. Chapters 5, 6 and 7 of the Act define and regulate the different categories of mental health care users, clarify the procedures around these categories and spell out mental health practitioners' roles and responsibilities in this regard. Also according to the National Health Act No. 61 of 2003, the State remains the key role player in mental health care provision, being responsible for adequate mental health infrastructure and resource allocation. Due to "limited resources" practitioners however often work in environments where staff ratios may be fractional of what should be expected and in units of which the physical structure and security is totally inadequate. The interface between professional responsibility of clinical workers versus the inadequacy of clinical interventions resulting from infrastructure and staffing constraints needs to be defined. This paper considered recent legislation currently relevant to mental health care practice in order to delineate the legal, ethical and labour framework in which public sector mental health practitioners operate as state employees. These included the Mental Health Care Act, No.17 of 2002; the National Health Act, No. 61 of 2003 and the proposed Traditional Health Practitioners Act, No. 35 of 2004. Formal legal review of and advice on this legislation as it pertains to public sector mental health practitioners as state employees, is necessary and should form the basis of the principles and standards for care endorsed by organized mental health care practitioner groups such as the South African Society of Psychiatrists (SASOP).

Motivators and barriers to mammography screening uptake by female health-care workers in primary health-care centres: a cross-sectional study.

PubMed

Nazzal, Zaher; Sholi, Hisham; Sholi, Suha B; Sholi, Mohammad B; Lahaseh, Rawya

2018-02-21

Mammography screening is an effective tool for early detection and management of breast cancer. Female health-care workers' awareness of breast cancer screening is important because their beliefs and behaviours could influence other women. The aim of this study was to assess mammography screening uptake by female health-care workers at primary health-care centres and to identify the primary motivators and barriers that affect uptake. This cross-sectional study included all governmental primary health-care centres in the West Bank. Governorates were grouped into three regions as follows: north West Bank (Nablus, Jenin, Tulkarm, Tubas, Qalqiliya, and Salfit), middle West Bank (Jerusalem, Jericho, and Ramallah), and south West Bank (Hebron, and Bethlehem). The study population included all female health-care workers older than 40 years. Those who performed mammography for a suspected mass or other breast abnormalities were excluded. A self-administered questionnaire was used to collect data on demographic characteristics, knowledge about mammography screening, the extent and regularity of mammography screening, and motivators and barriers influencing their mammography screening uptake. The rate of mammography screening uptake was calculated. χ 2 test and t tests were used to assess screening motivators and barriers. The study was approved by the Institutional Review Board of the An-Najah National University. Participation was voluntary, and written consent was obtained from each participant. 299 female health-care workers completed a self-administered questionnaire. The mean age of the participants was 46 years (SD 4·7). 284 (95%) women had adequate knowledge about breast cancer and mammography screening, and 149 (50%) women reported having had at least one mammogram. 62 (21%) women had had regular scheduled mammograms. The most frequent reported motivators were the perceived benefit that early detection of breast cancer is important for its management (269 [90

[PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

PubMed

Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V

2014-01-01

The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular

Health Care in the United States [and] Health Care Issues: A Lesson Plan.

ERIC Educational Resources Information Center

Lewis, John; Dempsey, Joanne R.

1984-01-01

An article on American health care which focuses on health care costs and benefits is combined with a lesson plan on health care issues to enable students to consider both issues of cost effectiveness and morality in decisions about the allocation of health care. The article covers the history of interest in health care, the reasons for the…

Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care.

PubMed

Deutsch, Stephanie Anne; Fortin, Kristine

2015-10-01

Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed. Copyright © 2015 Mosby, Inc. All rights reserved.

The Performance of mHealth in Cancer Supportive Care: A Research Agenda

PubMed Central

2015-01-01

Background Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. Objective This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. Methods We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Results Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Conclusions Further research

Ethical dilemmas concerning decision-making within health care leadership: a systematic literature review.

PubMed

Zydziūnaite, Vilma; Suominen, Tarja; Astedt-Kurki, Päivi; Lepaite, Daiva

2010-01-01

The objective was to describe the research methods and research focuses on ethical dilemmas concerning decision-making within health care leadership. The search was conducted on Medline and PubMed databases (1998-2008). The systematic review included 21 selected articles. The ethical dilemmas concerning decision-making within health care leadership are related to three levels: institutional (particular organization), political and local interface (local governmental structure), and national (professional expertise and system). The terms that are used as adequate to the term of "ethical dilemma" are the following: "continuous balancing," "result of resource allocation," "gap between professional obligations and possibilities," "ethically controversial situation," "concern about interactions," "ethical difficulty," "outcome of medical choices," "concern about society access to health care resources," "ethically difficult/challenging situation," "(the consequence of) ethical concern/ethical issue." In qualitative studies, a semi-structured interview and qualitative content analysis are the most commonly applied methods; in quantitative studies, questionnaire surveys are employed. In the research literature, there is a lack of specification according to professional qualification of health care professionals concerning ethical dilemmas by decision-making within health care management/administration. The research on ethical dilemmas in health care leadership, management, and administration should integrate data about levels at which ethical dilemmas occur and investigate ethical dilemmas as complex phenomena because those are attached to decision-making and specific nuances of health care management/administration. In this article, the presented scientific problem requires extensive scientific discussions and research on ethical dilemmas concerning decision-making within health care leadership at various levels.

Inequalities in public health care delivery in Zambia

PubMed Central

2014-01-01

Background Access to adequate health services that is of acceptable quality is important in the move towards universal health coverage. However, previous studies have revealed inequities in health care utilisation in the favour of the rich. Further, those with the greatest need for health services are not getting a fair share. In Zambia, though equity in access is extolled in government documents, there is evidence suggesting that those needing health services are not receiving their fair share. This study seeks therefore, to assess if socioeconomic related inequalities/inequities in public health service utilisation in Zambia still persist. Methods The 2010 nationally representative Zambia Living Conditions and Monitoring Survey data are used. Inequality is assessed using concentration curves and concentrations indices while inequity is assessed using a horizontal equity index: an index of inequity across socioeconomic status groups, based on standardizing health service utilisation for health care need. Public health services considered include public health post visits, public clinic visits, public hospital visits and total public facility visits. Results There is evidence of pro-poor inequality in public primary health care utilisation but a pro-rich inequality in hospital visits. The concentration indices for public health post visits and public clinic visits are −0.28 and −0.09 respectively while that of public hospitals is 0.06. After controlling for need, the pro-poor distribution is maintained at primary facilities and with a pro-rich distribution at hospitals. The horizontal equity indices for health post and clinic are estimated at −0.23 and −0.04 respectively while that of public hospitals is estimated at 0.11. A pro-rich inequity is observed when all the public facilities are combined (horizontal equity index = 0.01) though statistically insignificant. Conclusion The results of the paper point to areas of focus in ensuring equitable access

Evaluation of Health Literacy Status Among Patients in a Tertiary Care Hospital in Coastal Karnataka, India

PubMed Central

U.P, Rathnakar; Belman, Madhuri; Kamath, Ashwin; B, Unnikrishnan; Shenoy K, Ashok; A.L, Udupa

2013-01-01

Introduction: People with limited health literacy are more likely to make medication errors, and they have less health knowledge, worse health status, more hospitalizations, and higher healthcare costs than people with adequate literacy. The objective of this study is to assess the health literacy status among patients who are able to read and understand English attending a tertiary care hospital by using Rapid Estimate of Adult Literacy in Medicine [REALM] technique and to compare the health literacy levels to educational status and other baseline characteristics. Material and Methods: A widely used word recognition method [REALM] was used to assess the HL status of 200 patients attending a tertiary care hospital in Southern India. The number of correctly pronounced words was used to assign a grade-equivalent reading level. Scores 0 to 44 indicate reading skills at or below the 6th grade level, scores from 45 to 60 represent skills at the 7th or 8th grade level, and scores above 60 indicate skills at the high-school level or higher. Results: HL status was found below adequate level in more than 50% of the patients. Younger age group showed better HL scores compared to those aged more than 25 years. General education level or the medium of education does not truly reflect HL levels as brought out in the study. Even those with postgraduate qualification had poor HL skills. Conclusion: The study was carried out to find out the HL levels among patients attending a tertiary care hospital. It was assumed that the general education levels may not reflect true HL status. In view of the results of this study it can be concluded that patient’s HL skills should not be taken for granted and adequate attention should be paid in educating and briefing patients whenever patients are required to interpret and understand health care related documents. PMID:24392398

The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care

PubMed Central

Cueto, Marcos

2004-01-01

I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations’ political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America. PMID:15514221

Implementing Routine Health Literacy Assessment in Hospital and Primary Care Patients

PubMed Central

Cawthon, Courtney; Mion, Lorraine C.; Willens, David E.; Roumie, Christianne L.; Kripalani, Sunil

2014-01-01

Background Patients with inadequate health literacy often have poorer health outcomes and increased utilization and costs, compared to those with adequate health literacy skills. The Institute of Medicine has recommended that health literacy assessment be incorporated into health care information systems, which would facilitate large-scale studies of the effects of health literacy, as well as evaluation of system interventions to improve care by addressing health literacy. As part of the Health Literacy Screening (HEALS) study, a brief health literacy screen (BHLS) was incorporated into the electronic health record (EHR) at a large academic medical center. Methods Changes were implemented to the nursing intake documentation across all adult hospital units, the emergency department, and three primary care practices. The change involved replacing previous education screening items with the BHLS. Implementation was based on a quality improvement framework, with a focus on acceptability, adoption, appropriateness, feasibility, fidelity and sustainability. Support was gained from nursing leadership, education and training was provided, a documentation change was rolled out, feedback was obtained, and uptake of the new health literacy screening items was monitored. Results Between November 2010 and April 2012, there were 55,611 adult inpatient admissions, and from November 2010 to September 2011, 23,186 adult patients made 39,595 clinic visits to the three primary care practices. The completion (uptake) rate in the hospital for November 2010 through April 2012 was 91.8%. For outpatient clinics, the completion rate between November 2010 and October 2011 was 66.6%. Conclusions Although challenges exist, it is feasible to incorporate health literacy screening into clinical assessment and EHR documentation. Next steps are to evaluate the association of health literacy with processes and outcomes of care across inpatient and outpatient populations. PMID:24716329

Unveiling factors that contribute to functional aging among health care shiftworkers in São Paulo, Brazil.

PubMed

Fischer, Frida Marina; Bellusci, Silvia M; Teixeira, Liliane R; Borges, Flávio N S; Ferreira, Regiane M; Gonçalves, Mariana B L; Martins, Samantha E; Christoffolete, Marcelo A

2002-01-01

The aims of this study were to evaluate aging factors associated with work stressors, work ability, and the quality of living conditions, among health care personnel. A cross-sectional study was conducted among 176 health care shiftworkers. Two health survey questionnaires (Tuomi et al., 1997, Scandinavian Journal of Work, Environment and Health, 17(Suppl 1), 67-74; and Tepas, 1996, unpublished instrument) were completed and ergonomic work analyses (Rohmert & Landau, 1983, A new technique for job analysis, London and New York: Taylor & Francis) were carried out at the emergency wards. Main concerns about exposure at the workplace were changes in equipment and technology, transportation, and changes in employer policies. Main concerns about off-the-job conditions were personal safety, increases in the cost of living, food safety, and water and air quality. 81.7% scored adequate (> 36.5 points) in the Work Ability Index, and considered themselves having adequate current work ability to cope with physical, mental, and social demands. The most frequently reported diseases were musculoskeletal disorders and minor emotional problems.

Nurses' foot care activities in home health care.

PubMed

Stolt, Minna; Suhonen, Riitta; Puukka, Pauli; Viitanen, Matti; Voutilainen, Päivi; Leino-Kilpi, Helena

2013-01-01

This study described the basic foot care activities performed by nurses and factors associated with these in the home care of older people. Data were collected from nurses (n=322) working in nine public home care agencies in Finland using the Nurses' Foot Care Activities Questionnaire (NFAQ). Data were analyzed statistically using descriptive statistics and multivariate liner models. Although some of the basic foot care activities of nurses reported using were outdated, the majority of foot care activities were consistent with recommendations in foot care literature. Longer working experience, referring patients with foot problems to a podiatrist and physiotherapist, and patient education in wart and nail care were associated with a high score for adequate foot care activities. Continuing education should focus on updating basic foot care activities and increasing the use of evidence-based foot care methods. Also, geriatric nursing research should focus in intervention research to improve the use of evidence-based basic foot care activities. Copyright © 2013 Mosby, Inc. All rights reserved.

Measuring school health center impact on access to and quality of primary care.

PubMed

Gibson, Erica J; Santelli, John S; Minguez, Mara; Lord, Alyssa; Schuyler, Ashley C

2013-12-01

School health centers (SHC) that provide comprehensive health care may improve access and quality of care for students; however, published impact data are limited. We evaluated access and quality of health services at an urban high school with a SHC compared with a school without a SHC, using a quasiexperimental research design. Data were collected at the beginning of the school year, using a paper and pencil classroom questionnaire (n = 2,076 students). We measured SHC impact in several ways including grade by school interaction terms. Students at the SHC school were more likely to report having a regular healthcare provider, awareness of confidential services, support for health services in their school, and willingness to utilize those services. Students in the SHC school reported higher quality of care as measured by: respect for their health concerns, adequate time with the healthcare provider, understandable provider communications, and greater provider discussion at their last visit on topics such as sexual activity, birth control, emotions, future plans, diet, and exercise. Users of the SHC were also more likely to report higher quality of care, compared with either nonusers or students in the comparison school. Access to comprehensive health services via a SHC led to improved access to health care and improved quality of care. Impact was measureable on a school-wide basis but was greater among SHC users. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

"A constant struggle to receive mental health care": health care professionals' acquired experience of barriers to mental health care services in Rwanda.

PubMed

Rugema, Lawrence; Krantz, Gunilla; Mogren, Ingrid; Ntaganira, Joseph; Persson, Margareta

2015-12-16

In Rwanda, many people are still mentally affected by the consequences of the genocide and yet mental health care facilities are scarce. While available literature explains the prevalence and consequences of mental disorders, there is lack of knowledge from low-income countries on health care seeking behavior due to common mental disorders. Therefore, this study sought to explore health care professionals' acquired experiences of barriers and facilitators that people with common mental disorders face when seeking mental health care services in Rwanda. A qualitative approach was applied and data was collected from six focus group discussions (FGDs) conducted in October 2012, including a total of 43 health care professionals, men and women in different health professions. The FGDs were performed at health facilities at different care levels. Data was analyzed using manifest and latent content analysis. The emerging theme "A constant struggle to receive mental health care for mental disorders" embraced a number of barriers and few facilitators at individual, family, community and structural levels that people faced when seeking mental health care services. Identified barriers people needed to overcome were: Poverty and lack of family support, Fear of stigmatization, Poor community awareness of mental disorders, Societal beliefs in traditional healers and prayers, Scarce resources in mental health care and Gender imbalance in care seeking behavior. The few facilitators to receive mental health care were: Collaboration between authorities and organizations in mental health and having a Family with awareness of mental disorders and health insurance. From a public health perspective, this study revealed important findings of the numerous barriers and the few facilitating factors available to people seeking health for mental disorders. Having a supportive family with awareness of mental disorders who also were equipped with a health insurance was perceived as vital for

Long-Term Outcome of Bodily Distress Syndrome in Primary Care: A Follow-Up Study on Health Care Costs, Work Disability, and Self-Rated Health.

PubMed

Rask, Mette Trollund; Ørnbøl, Eva; Rosendal, Marianne; Fink, Per

2017-04-01

The upcoming International Classification of Diseases, 11th Revision for primary care use suggests inclusion of a new diagnostic construct, bodily (di)stress syndrome (BDS), for individuals with medically unexplained symptoms. We aimed to explore the long-term outcome of BDS in health care costs, work disability, and self-rated health. Consecutive patients consulting their family physician for a new health problem were screened for physical and mental symptoms by questionnaires (n = 1785). A stratified subsample was examined with a standardized diagnostic interview (n = 701). Patients with single-organ BDS (n = 124) and multiorgan BDS (n = 35), and a reference group with a family physician-verified medical condition (n = 880) were included. All included patients completed a questionnaire at 3, 12, and 24 months of follow-up. Register data on health care costs and work disability were obtained after 2 and 10 years of follow-up, respectively. Patients with BDS displayed poorer self-rated health and higher illness worry at index consultation and throughout follow-up than the reference group (p ≤ .001). The annual health care costs were higher in the BDS groups (2270 USD and 4066 USD) than in the reference group (1392 USD) (achieved significance level (ASL) ≤ 0.001). Both BDS groups had higher risk of sick leave during the first 2 years of follow-up (RRsingle-organ BDS = 3.0; 95% confidence interval [CI] = 1.8-5.0; RRmultiorgan BDS = 3.4; 95% CI = 1.5-7.5) and substantially higher risk of newly awarded disability pension than the reference group (HRsingle-organ BDS = 4.9; 95% CI = 2.8-8.4; HRmultiorgan BDS = 8.7; 95% CI = 3.7-20.7). Patients with BDS have poor long-term outcome of health care costs, work disability, and subjective suffering. These findings stress the need for adequate recognition and management of BDS.

Appraisal of primary health care services in Federal Capital Territory, Abuja, Nigeria: how committed are the health workers?

PubMed Central

Obembe, Taiwo Akinyode; Osungbade, Kayode Omoniyi; Ibrahim, Christianah

2017-01-01

Introduction The primary health care model was declared as the appropriate strategy for ensuring health-for-all. However up till date, very few studies have assessed the services provided by primary health centres in terms of its basic components. This study aimed to appraise health services provided and to estimate the commitment of the health workers in selected primary health care centres within Abuja Nigeria. Methods A cross sectional study was utilized to obtain information from 642 health workers across 6 area councils of the Federal Capital Territory, Nigeria. Data collection was performed using pre-tested, structured, interviewer-administered questionnaires and data were analyzed at 95% level of significance using SPSS version 17.0. Results Our study participants were largely females (58.6%), Christians (63.2%) and aged 30-39 years (40.0%). Health services offered in centres were adequate in all components of PHC except for mental health (23.7%) and care of the elderly (43.0%). Conduct of home visits was least practiced by health workers (83.8%) compared to the use of patient appointments (96.4%) and conducting staff outreach activities (94.9%). Commitment was three times more likely when service was related to health promotion and education (OR = 2.52; CI = 1.23-5.18); nutrition education (OR = 3.13; CI = 1.13-8.68). Conclusion Health workers in primary health centres of the federal capital territory still provide sub-optimal services with respect to mental health and care of elderly. Concerted efforts and unrelenting political will to strengthen mental and geriatric health components are recommended. PMID:29541284

Rural Health Networks and Care Coordination: Health Care Innovation in Frontier Communities to Improve Patient Outcomes and Reduce Health Care Costs

PubMed Central

Conway, Pat; Favet, Heidi; Hall, Laurie; Uhrich, Jenny; Palcher, Jeanette; Olimb, Sarah; Tesch, Nathan; York-Jesme, Margaret; Bianco, Joe

2017-01-01

Rural residents’ health is challenged by high health care costs, chronic diseases, and policy decisions affecting rural health care. This single-case, embedded design study, guided by community-based participatory research principles and using mixed methods, describes outcomes of implementation of a community care team (CCT) and care coordination to improve outcomes of patients living in a frontier community. Seventeen organizations and 165 adults identified as potential care coordination candidates constituted the target populations. Following CCT development, collaboration and cohesion increased among organizations. Patients who participated in care coordination reported similar physical and lower emotional health quality of life than national counterparts; emergency department use decreased following care coordination. Key components identified as successful in urban settings seem applicable in rural settings, with emphasis on the key role of team facilitators; need for intense care coordination for people with complex health needs, especially behavioral health needs; and access to specialty care through technology. PMID:27818417

Implementation of tuberculosis infection prevention and control in Mozambican health care facilities.

PubMed

Brouwer, M; Coelho, E; das Dores Mosse, C; van Leth, F

2015-01-01

District and urban health care facilities in three provinces (Manica, Sofala, Tete) in central Mozambique. To assess the level of implementation of selected tuberculosis infection prevention and control (TB-IPC) measures. In a cross-sectional study of TB-IPC implementation in 29 health care facilities, we assessed TB clinics, laboratories, out-patient departments and medical and TB wards. Assessment included selected managerial, administrative and environmental measures and the availability and use of respiratory protective equipment (N95 respirators). Guidelines for diagnosis and treatment of (presumptive) TB patients were not present in all facilities. Staff instructed patients on sputum collection in 91%, but only 4% observed it. Using a pragmatic '20% rule', 52% of the rooms assessed had adequate ventilation. Potentially, this could be increased to 76%. Three quarters of the health care workers had N95 respirators. Only 36% knew how to use it correctly. Implementation of TB-IPC measures showed wide variations within health care facilities. Relatively simple measures to improve TB-IPC include the availability of guidelines, opening doors and windows to improve ventilation, and training and support on correct N95 respirator use. However, even relatively simple measures are challenging to implement, and require careful attention in and evaluation of the implementation process.

[On the issues of private-public partnership in health care: the case of organization of optometric service)].

PubMed

2011-01-01

The article deals with the issue of private-public partnership in health care. It is demonstrated that in many countries health care system condition is characterized by increase of problems in organization, financing and provision of medical sanitary care. The exponent up growth of aggregate costs of health care, medical services financing occurs. The system of public and municipal health care has no adequate resources to efficiently function without interaction with private organizations. The reason is that most of the suppliers of medical services are not public or municipal belonging. It is necessary to provide inter-financing of curative preventive care at the expense of funds of public and private economic sectors within a framework of full-scale implementation health care the mechanisms of private-public partnership. The studies in this field are to be organized on the example of organizational specificity of optometric service which is positioned concurrently in public and private sectors. This approach makes it possible to reveal feasible ways of implementation of the private-public partnership institution to enhance quality and accessibility of medical care to population in the conditions of concurrent model of health care and globalization challenges.

Human resources for mental health care: current situation and strategies for action.

PubMed

Kakuma, Ritsuko; Minas, Harry; van Ginneken, Nadja; Dal Poz, Mario R; Desiraju, Keshav; Morris, Jodi E; Saxena, Shekhar; Scheffler, Richard M

2011-11-05

A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

Health care informatics.

PubMed

Siau, Keng

2003-03-01

The health care industry is currently experiencing a fundamental change. Health care organizations are reorganizing their processes to reduce costs, be more competitive, and provide better and more personalized customer care. This new business strategy requires health care organizations to implement new technologies, such as Internet applications, enterprise systems, and mobile technologies in order to achieve their desired business changes. This article offers a conceptual model for implementing new information systems, integrating internal data, and linking suppliers and patients.

[Evaluation of primary health care activities at the Albert Schweitzer hospital in Lambarene, Gabon].

PubMed

Diallo, M; Ninteretse, B

2007-06-01

In 1999 the Albert Schweitzer Hospital in Lambrene, Gabon set up a community health care service that provides immunization campaigns and mother/child health care and manages 9 village health care centers in a district with a population of approximately 64000 inhabitants. An evaluation conducted in April 2006 showed that collection of a consultation charge (15 euros) could cover the basic costs of operating these centers and purchasing necessary medicines. Three of the four centers evaluated demonstrated good quality indicators including properly kept records, posting of information bulletins for patients, appropriate referrals, and good relations with village authorities. At the center that performed poorly, the nurse apparently received no pay or lodging. Analysis of data about pediatric activity showed that diagnosis of diarrhea, malnutrition and anemia has fallen while hospitalization for tuberculosis and urinary schistomiasis is now being recorded. At the same time, village health centers are increasingly concerned with problems related to management and prevention of AIDS, malaria and urinary schistomiasis. This service shows that with good supervision it is possible to improve the quality of primary health care with partial but adequate recovery of costs and that basic health care workers are able to provide overall management for complicated patients, facilitate the work of reference hospital, and report new health problems.

Oral health status and need for oral care of care-dependent indwelling elderly: from admission to death.

PubMed

Hoeksema, Arie R; Peters, Lilian L; Raghoebar, Gerry M; Meijer, Henny J A; Vissink, Arjan; Visser, Anita

2017-09-01

The objective of this study is to assess oral health and oral status of elderly patients newly admitted to a nursing home from admission until death. Oral health, oral status, need for dental care, cooperation with dental treatment, and given dental care were assessed by two geriatric dentists in all new long-stay patients (n = 725) admitted to a nursing home between January 2009 and December 2013. All patients were followed from admission until death or until they left the nursing home. At admission, dementia patients were significantly older than somatic patients; median [IQR] ages were, respectively, 85 [79-89] and 81 [76-87] (p = 0.001). In addition, edentulous patients were significantly older than patients with remaining teeth, 83 [79-89] versus 80 [74-86] (p = 0.001) years. Thirty percent of the admitted patients died within 12 months after admission. A small minority (20%) of the patients had their own teeth. In this group, poor oral hygiene (72%), caries (70%), and broken teeth (62%) were frequently observed. Edentulous patients were significantly more cooperative with treatment than patients with remaining teeth (64 versus 27%). Finally, significantly less professional dental care was given to edentulous patients when compared to patients with remaining teeth (median 90 [IQR 60-180] versus 165 [75-375] min). When compared to edentulous elderly patients, patients with remaining teeth were younger at admittance, were more often non-cooperative, and had a poorer oral health and higher need for dental care. It is important that health care workers ensure adequate oral health and dental care to frail elderly, especially for elderly with remaining teeth.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

PubMed

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

[Quality of health care for diabetic and hypertensive patients in primary care settings servicing Mexican Seguro Popular].

PubMed

Ortiz-Domínguez, Maki E; Garrido-Latorre, Francisco; Orozco, Ricardo; Pineda-Pérez, Dayana; Rodríguez-Salgado, Marlenne

2011-01-01

To assess health care quality provided to type-2 diabetic and hypertensive patients in primary care settings from the Mexican Ministry of Health and to evaluate whether accredited clinics providing services to the Mexican Seguro Popular performed better in terms of metabolic control of those patients compared to the non-accredited. Cross-sectional study performed on 2008. Previous year clinical measures were obtained from 5 444 diabetic and 5 827 hypertensive patient's clinical records. Adequate metabolic control (glucose <110 mg/dl for diabetes and blood pressure <140/90 mmHg for hypertension) associated factors were assessed by multiple-multilevel logistic regression methods. Patients attending accredited clinics were more likely to be controlled, however, metabolic control was not constant over time of accreditation. Additional efforts are required to monitor accredited clinics' performance in order to maintain both metabolic control and clinical assessment of patients.

The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: The opening minds scale for Health Care Providers (OMS-HC)

PubMed Central

2012-01-01

Background Research on the attitudes of health care providers towards people with mental illness has repeatedly shown that they may be stigmatizing. Many scales used to measure attitudes towards people with mental illness that exist today are not adequate because they do not have items that relate specifically to the role of the health care provider. Methods We developed and tested a new scale called the Opening Minds Scale for Health Care Providers (OMS-HC). After item-pool generation, stakeholder consultations and content validation, focus groups were held with 64 health care providers/trainees and six people with lived experience of mental illness to develop the scale. The OMS-HC was then tested with 787 health care providers/trainees across Canada to determine its psychometric properties. Results The initial testing OMS-HC scale showed good internal consistency, Cronbach’s alpha = 0.82 and satisfactory test-retest reliability, intraclass correlation = 0.66 (95% CI 0.54 to 0.75). The OMC-HC was only weakly correlated with social desirability, indicating that the social desirability bias was not likely to be a major determinant of OMS-HC scores. A factor analysis favoured a two-factor structure which accounted for 45% of the variance using 12 of the 20 items tested. Conclusions The OMS–HC provides a good starting point for further validation as well as a tool that could be used in the evaluation of programs aimed at reducing mental illness related stigma by health care providers. The OMS-HC incorporates various dimensions of stigma with a modest number of items that can be used with busy health care providers. PMID:22694771

The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: the Opening Minds Scale for Health Care Providers (OMS-HC).

PubMed

Kassam, Aliya; Papish, Andriyka; Modgill, Geeta; Patten, Scott

2012-06-13

Research on the attitudes of health care providers towards people with mental illness has repeatedly shown that they may be stigmatizing. Many scales used to measure attitudes towards people with mental illness that exist today are not adequate because they do not have items that relate specifically to the role of the health care provider. We developed and tested a new scale called the Opening Minds Scale for Health Care Providers (OMS-HC). After item-pool generation, stakeholder consultations and content validation, focus groups were held with 64 health care providers/trainees and six people with lived experience of mental illness to develop the scale. The OMS-HC was then tested with 787 health care providers/trainees across Canada to determine its psychometric properties. The initial testing OMS-HC scale showed good internal consistency, Cronbach's alpha = 0.82 and satisfactory test-retest reliability, intraclass correlation = 0.66 (95% CI 0.54 to 0.75). The OMC-HC was only weakly correlated with social desirability, indicating that the social desirability bias was not likely to be a major determinant of OMS-HC scores. A factor analysis favoured a two-factor structure which accounted for 45% of the variance using 12 of the 20 items tested. The OMS-HC provides a good starting point for further validation as well as a tool that could be used in the evaluation of programs aimed at reducing mental illness related stigma by health care providers. The OMS-HC incorporates various dimensions of stigma with a modest number of items that can be used with busy health care providers.

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse

PubMed Central

Lindblad, Monica; Möller, Ulrika

2017-01-01

Abstract Introduction Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. Aim To describe patients' experiences of health care provided by an APN in primary health care. Methods An inductive, descriptive qualitative approach with qualitative open‐ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. Results The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. Conclusion The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. PMID:29071766

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse.

PubMed

Eriksson, Irene; Lindblad, Monica; Möller, Ulrika; Gillsjö, Catharina

2018-02-01

Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. To describe patients' experiences of health care provided by an APN in primary health care. An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. © 2017 The Authors. International Journal of Nursing Practice Published by John Wiley & Sons Australia, Ltd.

Oral Health Care Delivery Within the Accountable Care Organization.

PubMed

Blue, Christine; Riggs, Sheila

2016-06-01

The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

Health Care Delivery.

ERIC Educational Resources Information Center

Starfield, Barbara

1987-01-01

The article reviews emerging health care delivery options for handicapped children. Cost structures, quality of care, and future prospects are considered for Health Maintenance Organizations, Preferred Provider Organizations, Tax Supported Direct Service Programs, Hospital-Based Services, and Ambulatory Care Organizations. (Author/DB)

Health Care Indicators

PubMed Central

Donham, Carolyn S.; Sensenig, Arthur L.

1994-01-01

This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data. PMID:10142373

[Nurse-led in Primary Health Care setting: a well-timed and promising organizational innovation].

PubMed

Torres-Ricarte, Marc; Crusat-Abelló, Ernest; Peñuelas-Rodríguez, Silvia; Zabaleta-del-Olmo, Edurne

2015-01-01

At present, the severe economic crisis along with the increasing prevalence of chronic diseases is leading to different countries to consider updating their Primary Health Care (PHC) services in order to make them more efficient and reduce health inequalities. To that end, various initiatives are being carried out, such as the provision of Nurse-led services and interventions. The purpose of this article is to present the available knowledge, controversies and opportunities for Nurse-led initiatives in the setting of PHC. Nurse- led interventions or health services in PHC have proven to be equal or more effective than usual care in disease prevention, the routine follow-up of patients with chronic conditions, and first contact care for people with minor illness. However, as there are only a few health economic evaluation studies published their efficiency is still potential. In conclusion, the Nurse-led care could be an innovative organizational initiative with the potential to provide an adequate response to the contemporary health needs of the population, as well as an opportunity for the nursing profession and for PHC and health systems in general. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Degree of patient satisfaction with health care performance assesed by marketing surveys.

PubMed

Druguş, Daniela; Azoicăi, Doina

2015-01-01

Marketing surveys of the health system collect useful information to develop effective management strategies. The research aim consisted in measuring patient satisfaction with health care quality. The qualitative research was based on an online SurveyMonkey open-ended questionnaire. The analysis of patient satisfaction/dissatisfaction with healthcare professionals was performed in 1838 patients. Correlation analysis allowed the identification of some determinants associated with patient satisfaction. The variable most commonly associated with satisfaction was "I got adequate information about procedures/treatment" according to 32.2% of respondents. The patients who were dissatisfied most commonly complained that they were "Not adequately informed about maneuvers and treatment", reported by 40.0% of respondents. This study provides a basis for building an original model for determining the variables of an efficient healthcare system which to ensure a high degree of patient satisfaction.

The HIV/AIDS epidemic in Indonesia: does primary health care as a prevention and intervention strategy work?

PubMed

Ibrahim, Kusman; Songwathana, Praneed; Boonyasopun, Umaporn; Francis, Karen

2010-04-01

The continuing increase in the number of people living with HIV/AIDS (PLWHA) in Indonesia is impacting on society. Various policies and strategies have been adopted and implemented to tackle this epidemic including primary health-care (PHC) initiatives. This paper describes the current HIV/AIDS epidemic in Indonesia and highlights a range of prevention and intervention initiatives introduced to limit the spread and impact of this disease factors, such as the characteristics of high-risk groups, the decentralization policy in the health sector, and the lack of skilled human resources and supplies in health centres have been identified as influencing access to health-care services among high-risk groups. Revitalization of a PHC approach coupled with adequate fiscal, infrastructure and human resources if addressed will increase of PLWHA and other risk groups to health care.

Statement on gender-affirmative approach to care from the pediatric endocrine society special interest group on transgender health.

PubMed

Lopez, Ximena; Marinkovic, Maja; Eimicke, Toni; Rosenthal, Stephen M; Olshan, Jerrold S

2017-08-01

The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth. Transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. The Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender nonconforming/transgender youth, as well as adequate mental health and medical care. This document provides a summary of relevant definitions, information and current literature on which the medical management and affirmative approach to care of transgender youth are based.

Medical education in an era of health-care reform.

PubMed

Cohen, Jordan J

2011-01-01

Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. In facing up this challenge, however, today's educators not only must equip students to deal effectively with the rapidly changing paradigms in health care and medical practice, they also must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education. Their success in addressing these dual imperatives will determine whether the educational transformations currently underway will have as momentous an effect on the public's health as did those stimulated by Flexner a century ago.

An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

PubMed

Dwinnells, Ronald; Misik, Lauren

2017-10-01

Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

[Primary Health Care in the coordination of health care networks: an integrative review].

PubMed

Rodrigues, Ludmila Barbosa Bandeira; Silva, Patricia Costa Dos Santos; Peruhype, Rarianne Carvalho; Palha, Pedro Fredemir; Popolin, Marcela Paschoal; Crispim, Juliane de Almeida; Pinto, Ione Carvalho; Monroe, Aline Aparecida; Arcêncio, Ricardo Alexandre

2014-02-01

Health systems organized in health care networks and coordinated by Primary Health Care can contribute to an improvement in clinical quality with a positive impact on health outcomes and user satisfaction (by improving access and resolubility) and a reduction in the costs of local health systems. Thus, the scope of this paper is to analyze the scientific output about the evidence, potential, challenges and prospects of Primary Health Care in the coordination of Health Care Networks. To achieve this, the integrative review method was selected covering the period between 2000 and 2011. The databases selected were Medline (Medical Literature Analysis and Retrieval System online), Lilacs (Latin American Literature in Health Sciences) and SciELO (Scientific Electronic Library Online). Eighteen articles fulfilled the selection criteria. It was seen that the potential impacts of primary care services supersede the inherent weaknesses. However, the results revealed the need for research with a higher level of classification of the scientific evidence about the role of Primary Healh Care in the coordination of Health Care Networks.

The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment

PubMed Central

2011-01-01

In a rapidly changing world of health care information access and patients’ rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities. PMID:21164096

Stakeholders’ perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms

PubMed Central

2014-01-01

Background Adequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders’ perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium. Methods Four focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care. Results Informants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today’s health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines. Conclusion Our study’s methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire

Simulation studies of a wide area health care network.

PubMed Central

McDaniel, J. G.

1994-01-01

There is an increasing number of efforts to install wide area health care networks. Some of these networks are being built to support several applications over a wide user base consisting primarily of medical practices, hospitals, pharmacies, medical laboratories, payors, and suppliers. Although on-line, multi-media telecommunication is desirable for some purposes such as cardiac monitoring, store-and-forward messaging is adequate for many common, high-volume applications. Laboratory test results and payment claims, for example, can be distributed using electronic messaging networks. Several network prototypes have been constructed to determine the technical problems and to assess the effectiveness of electronic messaging in wide area health care networks. Our project, Health Link, developed prototype software that was able to use the public switched telephone network to exchange messages automatically, reliably and securely. The network could be configured to accommodate the many different traffic patterns and cost constraints of its users. Discrete event simulations were performed on several network models. Canonical star and mesh networks, that were composed of nodes operating at steady state under equal loads, were modeled. Both topologies were found to support the throughput of a generic wide area health care network. The mean message delivery time of the mesh network was found to be less than that of the star network. Further simulations were conducted for a realistic large-scale health care network consisting of 1,553 doctors, 26 hospitals, four medical labs, one provincial lab and one insurer. Two network topologies were investigated: one using predominantly peer-to-peer communication, the other using client-server communication.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7949966

Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: results from a survey into hospital choice.

PubMed

Lako, Christiaan J; Rosenau, Pauline

2009-03-01

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician's opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician's advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient's confidence in physician referral and advice.

Social and cultural dimensions of hygiene in Cambodian health care facilities

PubMed Central

2011-01-01

Background The frequency of bloodborne pathogen healthcare-associated infections is thought to be high in developing Southeast Asian Countries. The underlying social-cultural logics contributing to the risks of transmission are rarely studied. This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings. Methods We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors) and with patients who attended the study health facilities. Results Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipements. In addition, many other factors were identified to influence and distort hygiene practices which include (1) informal and formal social rapports in hospitals, (2) major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff. Conclusion Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting. PMID:21294927

Fair relationships and policies to support family day care educators' mental health: a qualitative study.

PubMed

Corr, Lara; Davis, Elise; Cook, Kay; Waters, Elizabeth; LaMontagne, Anthony D

2014-11-25

High quality child care is a population health investment that relies on the capacity of providers. The mental health and wellbeing of child care educators is fundamental to care quality and turnover, yet sector views on the relationship between working conditions and mental health and wellbeing are scarce. This paper examines child care educators' and sector key informants' perspectives on how working in family day care influences educator's mental health and wellbeing. Semi-structured telephone interviews were conducted with Australian family day care educators (n = 16) and key informants (n = 18) comprised of representatives from family day care schemes, government and other relevant organisations regarding the relationship between working conditions and educator mental health. Thematic analysis referenced the assumptions and concepts of critical inquiry and used social exchange theory. Educators and key informants reported that educators' mental health was affected by the quality of their relationships with government, family day care schemes, and the parents and children using their services. These social relationships created and contributed to working conditions that were believed to promote or diminish educators' mental health. High quality relationships featured fair exchanges of educator work for key resources of social support and respect; adequate income; professional services; and information. Crucially, how exchanges influenced educator wellbeing was largely contingent on government policies that reflect the values and inequities present in society. Making policies and relationships between educators, government and family day care schemes fairer would contribute strongly to the protection and promotion of educator mental health and wellbeing, and in turn contribute to workforce stability and care quality.

WHO/INRUD patient care and facility-specific drug use indicators at primary health care centres in Eastern province, Saudi Arabia.

PubMed

El Mahalli, A A; Akl, O A M; Al-Dawood, S F; Al-Nehab, A A; Al-Kubaish, H A; Al-Saeed, S; Elkahky, A A A; Salem, A M A A

2012-11-01

This study aimed to measure the performance of primary health care centres in Eastern province, Saudi Arabia, using the WHO/International Network of Rational Use of Drugs patient care and facility-specific drug use indicators. In a cross-sectional study, 10 health centres were selected using systematic random sampling. A total of 300 patients were interviewed while visiting the centre from January to March 2011 and 10 pharmacists from the same centres were interviewed. Average consultation time was 7.3 min (optimal > or = 30 min), percentage of drugs adequately labelled was 10% (optimal 100%) and patient's knowledge of correct dosage was 79.3% (optimal 100%). The percentage of key drugs in stock was only 59.2% (optimal 100%). An overall index of rational facility-specific drug use was calculated and applied to rank the health centres for benchmarking.

Redeeming Hollow Promises: The Case for Mandatory Spending on Health Care for American Indians and Alaska Natives

PubMed Central

Westmoreland, Timothy M.; Watson, Kathryn R.

2006-01-01

The reliance on discretionary spending for American Indian/ Alaska Native health care has produced a system that is insufficient and unreliable and is associated with ongoing health disparities. Moreover, the gap between mandatory spending on a Medicare beneficiary and discretionary spending on an American Indian/Alaska Native beneficiary has grown dramatically, thus compounding the problem. The budget classification for American Indian/Alaska Native health services should be changed, and health care delivery to this population should be designated as mandatory spending. If a correct structure is in place, mandatory spending is more likely to provide adequate funding that keeps pace with changes in costs and need. PMID:16507732

Using Online Health Communities to Deliver Patient-Centered Care to People With Chronic Conditions

PubMed Central

2013-01-01

Background Our health care system faces major threats as the number of people with multiple chronic conditions rises dramatically. Objective To study the use of Online Health Communities (OHCs) as a tool to facilitate high-quality and affordable health care for future generations. Methods OHCs are Internet-based platforms that unite either a group of patients, a group of professionals, or a mixture of both. Members interact using modern communication technologies such as blogs, chats, forums, and wikis. We illustrate the use of OHCs for ParkinsonNet, a professional network for Parkinson disease whose participants—both patients and professionals—use various types of OHCs to deliver patient-centered care. Results We discuss several potential applications in clinical practice. First, due to rapid advances in medical knowledge, many health professionals lack sufficient expertise to address the complex health care needs of chronic patients. OHCs can be used to share experiences, exchange knowledge, and increase disease-specific expertise. Second, current health care delivery is fragmented, as many patients acquire relationships with multiple professionals and institutions. OHCs can bridge geographical distances and enable interdisciplinary collaboration across institutions and traditional echelons. Third, chronic patients lack adequate tools to self-manage their disease. OHCs can be used to actively engage and empower patients in their health care process and to tailor care to their individual needs. Personal health communities of individual patients offer unique opportunities to store all medical information in one central place, while allowing transparent communication across all members of each patient’s health care team. Conclusions OHCs are a powerful tool to address some of the challenges chronic care faces today. OHCs help to facilitate communication among professionals and patients and support coordination of care across traditional echelons, which does

Care for the Health Care Provider.

PubMed

Kunin, Sharon Brown; Kanze, David Mitchell

2016-03-01

Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning. Copyright © 2016 Elsevier Inc. All rights reserved.

Health Care in China.

PubMed

Younger, David S

2016-11-01

China has recently emerged as an important global partner. However, like other developing nations, China has experienced dramatic demographic and epidemiologic changes in the past few decades. Population discontent with the health care system has led to major reforms. China's distinctive health care system, including its unique history, vast infrastructure, the speed of health reform, and economic capacity to make important advances in health care, nonetheless, has incomplete insurance coverage for urban and rural dwellers, uneven access, mixed quality of health care, increasing costs, and risk of catastrophic health expenditures. Copyright © 2016 Elsevier Inc. All rights reserved.

Management Knowledge and Skills Required in the Health Care System of the Federation Bosnia and Herzegovina

PubMed Central

Slipicevic, Osman; Masic, Izet

2012-01-01

Extremely complex health care organizations, by their structure and organization, operate in a constantly changing business environment, and such situation implies and requires complex and demanding health management. Therefore, in order to manage health organizations in a competent manner, health managers must possess various managerial skills and be familiar with problems in health care. Research, identification, analysis, and assessment of health management education and training needs are basic preconditions for the development and implementation of adequate programs to meet those needs. Along with other specific activities, this research helped to determine the nature, profile, and level of top-priority needs for education. The need for knowledge of certain areas in health management, as well as the need for mastering concrete managerial competencies has been recognized as top-priorities requiring additional improvement and upgrading. PMID:23922519

Barriers to primary care responsiveness to poverty as a risk factor for health.

PubMed

Bloch, Gary; Rozmovits, Linda; Giambrone, Broden

2011-06-29

Poverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage. One to one interviews were conducted with twelve experts on poverty and health in primary care in Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent themes. This study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study's findings point to a number of areas front line primary care providers could target to address their patients' poverty. These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect adequate data about patients' social circumstances, and to the development of inappropriate care plans. Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can take to address patients' poverty. While this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported existence of significant barriers to addressing income as a health issue within primary care, the findings point to the possibility of front line primary care providers taking direct steps to address the health risks posed by poverty. The consistent

Behavioral Health's Integration Within a Care Network and Health Care Utilization.

PubMed

McClellan, Chandler; Flottemesch, Thomas J; Ali, Mir M; Jones, Jenna; Mutter, Ryan; Hohlbauch, Andriana; Whalen, Daniel; Nordstrom, Nils

2018-05-30

Examine how behavioral health (BH) integration affects health care costs, emergency department (ED) visits, and inpatient admissions. Truven Health MarketScan Research Databases. Social network analysis identified "care communities" (providers sharing a high number of patients) and measured BH integration in terms of how connected, or central, BH providers were to other providers in their community. Multivariable generalized linear models adjusting for age, sex, number of prescriptions, and Charlson comorbidity score were used to estimate the relationship between the centrality of BH providers and health care utilization of BH patients. Used outpatient, inpatient, and pharmacy claims data from six Medicaid plans from 2011 to 2013 to identify study outcomes, comorbidities, providers, and health care encounters. Behavioral health centrality ranged from 0 (no BH providers) to 0.49. Relative to communities at the median BH centrality (0.06), in 2012, BH patients in communities at the 75th percentile of BH centrality (0.31) had 0.2 fewer admissions, 2.1 fewer all-cause ED visits, and accrued $1,947 fewer costs, on average. Increased behavioral centrality was significantly associated with a reduced number of ED visits, less frequent inpatient admissions, and lower overall health care costs. © Health Research and Educational Trust.

Health Care Services

Science.gov Websites

State Employees Health Care Services DHSS State of Alaska Home Divisions and Agencies Alaska Pioneer Homes Behavioral Health Office of Children's Services Office of the Commissioner Office of Substance Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice

Health and Functioning of Families of Children With Special Health Care Needs Cared for in Home Care, Long-term Care, and Medical Day Care Settings.

PubMed

Caicedo, Carmen

2015-06-01

To examine and compare child and parent or guardian physical and mental health outcomes in families with children with special health care needs who have medically complex technology-dependent needs in home care, long-term care (LTC), and medical day care (MDC) settings. The number of children requiring medically complex technology-dependent care has grown exponentially. In this study, options for their care are home care, LTC, or MDC. Comparison of child and parent/guardian health outcomes is unknown. Using repeated measures data were collected from 84 dyads (parent/guardian, medically complex technology-dependent child) for 5 months using Pediatric Quality of Life Inventory Generic Core Module 4.0 and Family Impact Module Data analysis: χ(2), RM-ANCOVA. There were no significant differences in overall physical health, mental health, and functioning of children by care setting. Most severely disabled children were in home care; moderately disabled in MDC; children in vegetative state LTC; however, parents perceived children's health across care setting as good to excellent. Parents/guardians from home care reported the poorest physical health including being tired during the day, too tired to do the things they like to do, feeling physically weak, or feeling sick and had cognitive difficulties, difficulties with worry, communication, and daily activities. Parents/guardians from LTC reported the best physical health with time and energy for a social life and employment. Trends in health care policy indicate a movement away from LTC care to care in the family home where data indicate these parents/guardians are already mentally and functionally challenged.

The ethics of everyday practice in primary medical care: responding to social health inequities

PubMed Central

2010-01-01

Background Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities. Results Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either. Conclusion This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision. PMID:20438627

Digital health care--the convergence of health care and the Internet.

PubMed

Frank, S R

2000-04-01

The author believes that interactive media (the Internet and the World Wide Web) and associated applications used to access those media (portals, browsers, specialized Web-based applications) will result in a substantial, positive, and measurable impact on medical care faster than any previous information technology or communications tool. Acknowledging the dynamic environment, the author classifies "pure" digital health care companies into three business service areas: content, connectivity, and commerce. Companies offering these services are attempting to tap into a host of different markets within the health care industry including providers, payers, pharmaceutical and medical products companies, employers, distributors, and consumers. As the fastest growing medium in history, and given the unique nature of health care information and the tremendous demand for content among industry professionals and consumers, the Internet offers a more robust and targeted direct marketing opportunity than traditional media. From the medical consumer's standpoint (i.e., the patient) the author sees the Internet as performing five critical functions: (1) Disseminate information, (2) Aid informed decision making, (3) Promote health, (4) Provide a means for information exchange and support--the community concept, and (5) Increase self-care and manage demand for health services, lowering direct medical costs. The author firmly submits the Web will provide overall benefits to the health care economy as health information consumers manage their own health problems that might not directly benefit from an encounter with a health professional. Marrying the Internet to other interactive technologies, including voice recognition systems and telephone-based triage lines among others, holds the promise of reducing unnecessary medical services.

Ohio study shows that insurance coverage is critical for children with special health care needs as they transition to adulthood.

PubMed

Goudie, Anthony; Carle, Adam C

2011-12-01

Nearly 30 percent of young adults with special health care needs in Ohio lack health insurance, compared to 5 percent of the state's children with special health care needs. As children with such needs become too old for Medicaid or insurance through their parents' employer, they face great challenges in obtaining insurance. Lack of insurance is highly predictive of unmet needs, which in turn are predictive of costly hospital-based encounters. Young adults with special health care needs who are uninsured are more than twice as likely as their peers with insurance to forgo filling prescriptions and getting care and to have problems getting care. Even after insurance status is accounted for, young adults with special health care needs are more likely than children with such needs to not fill prescriptions because of cost and to delay or forgo needed care. This study demonstrates that continuous and adequate health insurance is vital to the continued well-being of children with special health care needs as they transition to young adulthood.

Mental health care roles of non-medical primary health and social care services.

PubMed

Mitchell, Penny

2009-02-01

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Cancer care management through a mobile phone health approach: key considerations.

PubMed

Mohammadzadeh, Niloofar; Safdari, Reza; Rahimi, Azin

2013-01-01

Greater use of mobile phone devices seems inevitable because the health industry and cancer care are facing challenges such as resource constraints, rising care costs, the need for immediate access to healthcare data of types such as audio video texts for early detection and treatment of patients and increasing remote aids in telemedicine. Physicians, in order to study the causes of cancer, detect cancer earlier, act in prevention measures, determine the effectiveness of treatment and specify the reasons for the treatment ineffectiveness, need to access accurate, comprehensive and timely cancer data. Mobile devices provide opportunities and can play an important role in consulting, diagnosis, treatment, and quick access to health information. There easy carriage make them perfect tools for healthcare providers in cancer care management. Key factors in cancer care management systems through a mobile phone health approach must be considered such as human resources, confidentiality and privacy, legal and ethical issues, appropriate ICT and provider infrastructure and costs in general aspects and interoperability, human relationships, types of mobile devices and telecommunication related points in specific aspects. The successful implementation of mobile-based systems in cancer care management will constantly face many challenges. Hence, in applying mobile cancer care, involvement of users and considering their needs in all phases of project, providing adequate bandwidth, preparation of standard tools that provide maximum mobility and flexibility for users, decreasing obstacles to interrupt network communications, and using suitable communication protocols are essential. It is obvious that identifying and reducing barriers and strengthening the positive points will have a significant role in appropriate planning and promoting the achievements of mobile cancer care systems. The aim of this article is to explain key points which should be considered in designing

Operations management in health care.

PubMed

Henderson, M D

1995-01-01

Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.

Petroleum and Health Care: Evaluating and Managing Health Care's Vulnerability to Petroleum Supply Shifts

PubMed Central

Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica

2011-01-01

Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. PMID:21778473

An intervention to improve mental health care for conflict-affected forced migrants in low-resource primary care settings: a WHO MhGAP-based pilot study in Sri Lanka (COM-GAP study)

PubMed Central

2013-01-01

Background Inadequacy in mental health care in low and middle income countries has been an important contributor to the rising global burden of disease. The treatment gap is salient in resource-poor settings, especially when providing care for conflict-affected forced migrant populations. Primary care is often the only available service option for the majority of forced migrants, and integration of mental health into primary care is a difficult task. The proposed pilot study aims to explore the feasibility of integrating mental health care into primary care by providing training to primary care practitioners serving displaced populations, in order to improve identification, treatment, and referral of patients with common mental disorders via the World Health Organization Mental Health Gap Action Programme (mhGAP). Methods/Design This pilot randomized controlled trial will recruit 86 primary care practitioners (PCP) serving in the Puttalam and Mannar districts of Sri Lanka (with displaced and returning conflict-affected populations). The intervention arm will receive a structured training program based on the mhGAP intervention guide. Primary outcomes will be rates of correct identification, adequate management based on set criteria, and correct referrals of common mental disorders. A qualitative study exploring the attitudes, views, and perspectives of PCP on integrating mental health and primary care will be nested within the pilot study. An economic evaluation will be carried out by gathering service utilization information. Discussion In post-conflict Sri Lanka, an important need exists to provide adequate mental health care to conflict-affected internally displaced persons who are returning to their areas of origin after prolonged displacement. The proposed study will act as a local demonstration project, exploring the feasibility of formulating a larger-scale intervention study in the future, and is envisaged to provide information on engaging PCP, and data on

An intervention to improve mental health care for conflict-affected forced migrants in low-resource primary care settings: a WHO MhGAP-based pilot study in Sri Lanka (COM-GAP study).

PubMed

Siriwardhana, Chesmal; Adikari, Anushka; Van Bortel, Tine; McCrone, Paul; Sumathipala, Athula

2013-12-09

Inadequacy in mental health care in low and middle income countries has been an important contributor to the rising global burden of disease. The treatment gap is salient in resource-poor settings, especially when providing care for conflict-affected forced migrant populations. Primary care is often the only available service option for the majority of forced migrants, and integration of mental health into primary care is a difficult task. The proposed pilot study aims to explore the feasibility of integrating mental health care into primary care by providing training to primary care practitioners serving displaced populations, in order to improve identification, treatment, and referral of patients with common mental disorders via the World Health Organization Mental Health Gap Action Programme (mhGAP). This pilot randomized controlled trial will recruit 86 primary care practitioners (PCP) serving in the Puttalam and Mannar districts of Sri Lanka (with displaced and returning conflict-affected populations). The intervention arm will receive a structured training program based on the mhGAP intervention guide. Primary outcomes will be rates of correct identification, adequate management based on set criteria, and correct referrals of common mental disorders. A qualitative study exploring the attitudes, views, and perspectives of PCP on integrating mental health and primary care will be nested within the pilot study. An economic evaluation will be carried out by gathering service utilization information. In post-conflict Sri Lanka, an important need exists to provide adequate mental health care to conflict-affected internally displaced persons who are returning to their areas of origin after prolonged displacement. The proposed study will act as a local demonstration project, exploring the feasibility of formulating a larger-scale intervention study in the future, and is envisaged to provide information on engaging PCP, and data on training and evaluation including

Building consensus on key priorities for rural health care in South Africa using the Delphi technique.

PubMed

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-24

South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

Mental health care treatment initiation when mental health services are incorporated into primary care practice.

PubMed

Kessler, Rodger

2012-01-01

Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice. Referral data were drawn from 2 convenience samples of patients referred by primary care physicians for collaborative mental health treatment at Fletcher Allen Health Care in Vermont. The first sample consisted of 93 consecutively scheduled referrals in a family medicine office (sample A) between January 2006 and December 2007. The second sample consisted of 215 consecutive scheduled referrals at an internal medicine office (sample B) between January 2009 and December 2009. Referral data identified age, sex, and presenting mental health/medical problem. In sample A, 95.5% of those patients scheduling appointments began behavioral health treatment; in sample B this percentage was 82%. In sample B, 69% of all patients initially referred for mental health care both scheduled and initiated treatment. When referred to a mental health clinician who provides on-site access as part of a primary care mental health collaborative care model, a high percentage of patients referred scheduled care. Furthermore, of those who scheduled care, a high percentage of patients attend the scheduled appointment. Findings persist despite differences in practice type, populations, locations, and time frames of data collection. That the

Across the health-social care divide: elderly people as active users of health care and social care.

PubMed

Roberts, K

2001-03-01

Several ways in which elderly people may assume an active role when using welfare services are discussed here. Selected findings are presented from a study that explored the experience and behaviour of elderly people on discharge from inpatient care with regard to criteria indicating user influence or control (namely participation, representation, access, choice, information and redress). Data were collected via semistructured interviews with service users (n = 30) soon after their return home from hospital. A number of differences were revealed between health care and social care in relation to users being provided with opportunities to assume an active role and in being willing and able to assume an active role. These differences were manifest in elderly service users accessing services, seeking information, exercising choice and acting independently of service providers. It appeared paradoxical that contact points were more easily defined with regard to health care yet users were more likely to exercise choice and act independently in securing social care. It is suggested that social care needs and appropriate service delivery are more easily recognised than making the link between perceived health care needs and appropriate services. In addition, it appeared that informal and private providers are more widely available and accessible for social care. If comprehensive continuing care is to be provided, incorporating both health and social care elements, greater uniformity appears to be required across the welfare sector. Lessons for social care provision from the delivery of health care suggest the clear definition of contact points to facilitate service use. Making health care more accessible, however, does not appear to be easily attainable due to the monopoly provision of health care and the lack of direct purchasing power by potential users.

Primary Health Care: care coordinator in regionalized networks?

PubMed Central

de Almeida, Patty Fidelis; dos Santos, Adriano Maia

2016-01-01

RESUMO OBJECTIVE To analyze the breadth of care coordination by Primary Health Care in three health regions. METHODS This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. RESULTS Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. CONCLUSIONS Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. PMID:28099663

Relationship-centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care.

PubMed

Wyer, Peter C; Alves Silva, Suzana; Post, Stephen G; Quinlan, Patricia

2014-12-01

Contemporary health care is increasing in complexity and lacks a unifying understanding of epistemology, methodology and goals. Lack of conceptual consistency in concepts such as 'patient-centred care' (PCC) typifies system-wide discordance. We contrast the fragmented descriptions of PCC and related tools to its own origins in the writings of Balint and to a subsequent construct, relationship-centred care (RCC). We identify the explicit and elaborated connection between RCC and a defined epistemological foundation as a distinguishing feature of the construct and we demonstrate that this makes possible the recognition of alignments between RCC and independently developed constructs. Among these, we emphasize Schon's reflective practice, Nonaka's theory of organizational knowledge creation and the research methodology of realist synthesis. We highlight the relational principles common to these domains and to their common epistemologies and illustrate unsatisfying consequences of adherence to less adequate epistemological frameworks such as positivism. We offer RCC not as an 'antidote' to the dilemmas identified at the outset but as an example that illuminates the value and importance of explicit identification of the premises and assumptions underlying approaches to improvement of the health care system. We stress the potential value of identifying epistemological affinities across otherwise disparate fields and disciplines. © 2014 John Wiley & Sons, Ltd.

The relationship between employment and health and health care among working-age adults with and without disabilities in the United States.

PubMed

Reichard, Amanda; Stransky, Michelle; Brucker, Debra; Houtenville, Andrew

2018-05-20

To better understand the relationship between employment and health and health care for people with disabilities in the United States (US). We pooled US Medical Expenditure Panel Survey (2004-2010) data to examine health status, and access to health care among working-age adults, comparing people with physical disabilities or multiple disabilities to people without disabilities, based on their employment status. Logistic regression and least squares regression were conducted, controlling for sociodemographics, health insurance (when not the outcome), multiple chronic conditions, and need for assistance. Employment was inversely related to access to care, insurance, and obesity. Yet, people with disabilities employed in the past year reported better general and mental health than their peers with the same disabilities who were not employed. Those who were employed were more likely to have delayed/forgone necessary care, across disability groups. Part-time employment, especially for people with multiple limitations, was associated with better health and health care outcomes than full-time employment. Findings highlight the importance of addressing employment-related causes of delayed or foregone receipt of necessary care (e.g., flex-time for attending appointments) that exist for all workers, especially those with physical or multiple disabilities. Implications for rehabilitation These findings demonstrate that rehabilitation professionals who are seeking to support employment for persons with physical limitations need to ensure that overall health concerns are adequately addressed, both for those seeking employment and for those who are currently employed. Assisting clients in prioritizing health equally with employment can ensure that both areas receive sufficient attention. Engaging with employers to develop innovative practices to improve health, health behaviors and access to care for employees with disabilities can decrease turnover, increase productivity, and

Long-Term Outcome of Bodily Distress Syndrome in Primary Care: A Follow-Up Study on Health Care Costs, Work Disability, and Self-Rated Health

PubMed Central

Rask, Mette Trollund; Ørnbøl, Eva; Rosendal, Marianne; Fink, Per

2017-01-01

ABSTRACT Objective The upcoming International Classification of Diseases, 11th Revision for primary care use suggests inclusion of a new diagnostic construct, bodily (di)stress syndrome (BDS), for individuals with medically unexplained symptoms. We aimed to explore the long-term outcome of BDS in health care costs, work disability, and self-rated health. Methods Consecutive patients consulting their family physician for a new health problem were screened for physical and mental symptoms by questionnaires (n = 1785). A stratified subsample was examined with a standardized diagnostic interview (n = 701). Patients with single-organ BDS (n = 124) and multiorgan BDS (n = 35), and a reference group with a family physician–verified medical condition (n = 880) were included. All included patients completed a questionnaire at 3, 12, and 24 months of follow-up. Register data on health care costs and work disability were obtained after 2 and 10 years of follow-up, respectively. Results Patients with BDS displayed poorer self-rated health and higher illness worry at index consultation and throughout follow-up than the reference group (p ≤ .001). The annual health care costs were higher in the BDS groups (2270 USD and 4066 USD) than in the reference group (1392 USD) (achieved significance level (ASL) ≤ 0.001). Both BDS groups had higher risk of sick leave during the first 2 years of follow-up (RRsingle-organ BDS = 3.0; 95% confidence interval [CI] = 1.8–5.0; RRmultiorgan BDS = 3.4; 95% CI = 1.5–7.5) and substantially higher risk of newly awarded disability pension than the reference group (HRsingle-organ BDS = 4.9; 95% CI = 2.8–8.4; HRmultiorgan BDS = 8.7; 95% CI = 3.7–20.7). Conclusions Patients with BDS have poor long-term outcome of health care costs, work disability, and subjective suffering. These findings stress the need for adequate recognition and management of BDS. PMID:27768649

Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.

PubMed

Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J

This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.

Health care in Brazil.

PubMed Central

Haines, A

1993-01-01

Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor. Images p503-a p504-a p505-a PMID:8448465

[Family health and infant palliative care: listening the relatives of technology dependent children].

PubMed

Rabello, Claudia Azevedo Ferreira Guimarães; Rodrigues, Paulo Henrique de Almeida

2010-10-01

This study discusses the creation of a new child palliative care program based on the Family Health Program, considering the level of care at home and yielding to family requests. Eighteen members of nine families of technology dependent children (TDC) who were hospital patients in the Instituto Fernandes Figueira (IFF) participated on the study. From those four were being assisted by its palliative care program Programa de Assistência Domiciliar Interdisciplinar (PADI); three were inpatients waiting for inclusion in the program, and finally two inpatients already included in PADI. PADI was chosen because it is the only child palliative care program in Brazil. The results are positive in regards to the connection established between the families and the health care team, the reception of the children, the explanation to the family concerning the disease, and the functional dynamics between the PADI and the IFF. As negative points, difficulties arose as a result of the implementation of the program, from its continuity to the worsening or illness of the entire family. In conclusion, although the PADI is the IFF's way of discharging patients, the domiciliary care provided by the Family Health Program, well articulated with the healthcare system, would be ideal for being the adequate assistance for it.

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 32 2013-07-01 2013-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 32 2012-07-01 2012-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 31 2011-07-01 2011-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

Vacation health care

MedlinePlus

... page: //medlineplus.gov/ency/article/001937.htm Vacation health care To use the sharing features on this page, ... and help you avoid problems. Talk to your health care provider or visit a travel clinic 4 to ...

Equity in health care.

PubMed

La Rosa-Salas, Virginia; Tricas-Sauras, Sandra

2008-01-01

It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which this health care equity paper is based are fundamental human rights. The main aim is to ensure the implementation of these essential rights by those carrying out public duties. Viewed from this angle, equity in health care means equality: equality in access to services and treatment, and equality in the quality of care provided. As a result, this paper attempts to address both human dignity and efficiency through the context of equity to reconcile them in the middle ground.

Seeking mental health care from private health practitioners among individuals with alcohol dependence/abuse; results from a study in the French general population.

PubMed

Constant, Aymery; Sherlaw, William; Kovess-Masfety, Viviane

2017-03-01

Better knowledge of the factors that have an impact on pathways to mental health care may contribute greatly to organizing optimum health-care delivery. However, surveillance systems concerning alcohol problems in the French general population are suboptimal. The objectives of this study were to investigate: 1) the prevalence of mental health-care seeking in individuals with alcohol abuse/dependence in France, 2) which category of medical practitioner was consulted, and 3) psychological and socio-environmental factors associated with mental health-care seeking. A total sample of 22,138 individuals was interviewed in a telephone survey. Individual data on alcohol dependence/abuse and other mental health disorders were collected using the Composite International Diagnosis Interview - short form. Mental health-care seeking was assessed, together with data on living conditions, deprivation, and self-reported drinking problems. Only respondents meeting criteria for alcohol dependence/abuse were included in analyses. Less than half of the 722 respondents with alcohol abuse/dependence had sought mental health care in the preceding 12 months, of whom 90.5% consulted their general practitioner (GP) (56.1%), or both a general practitioner and a psychiatrist (34.4%). Mental health-care seeking was associated with female sex, previous alcohol discussion with a doctor, and the presence of psychiatric comorbidities arising in the preceding 12 months. Living environment, socio-economic status, or self-reported drinking problems had no influence. A minority of people with alcohol abuse/dependence sought mental health care, mainly in relation to psychiatric comorbidities. In addition, most people consulting a GP were not referred to a psychiatrist. However, social deprivation and living in rural areas did not hinder mental health-care seeking among respondents. Adequate protocols to treat alcohol disorders could be implemented among private health-care providers to improve

Characteristics of Indigenous primary health care service delivery models: a systematic scoping review.

PubMed

Harfield, Stephen G; Davy, Carol; McArthur, Alexa; Munn, Zachary; Brown, Alex; Brown, Ngiare

2018-01-25

Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified - accessible health services, community

Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.

PubMed

Bao, Yuhua; Casalino, Lawrence P; Pincus, Harold Alan

2013-01-01

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.

The Obama health care plan: what it means for mental health care of older adults.

PubMed

Sorrell, Jeanne M

2009-01-01

Health care was an important issue for both the Obama and McCain election campaigns. Now that Barack Obama is poised to serve as the 44th President of the United States, many health care providers are focused on what Obama's administration will mean for new health care initiatives. This article focuses specifically on aspects of the Obama and Biden health care plan that affects mental health care for older adults.

Health Workforce: Ensuring Adequate Supply and Distribution Remains Challenging. Testimony before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives.

ERIC Educational Resources Information Center

Heinrich, Janet

The General Accounting Office's (GAO's) director of health care-public health issues testified before Congress regarding growing concerns about the adequacy of the health care work force and lessons learned from the experience of the National Health Service Corps (NHSC) in addressing the maldistribution of health care professionals. The following…

The spectrum of ethical issues in a Learning Health Care System: a systematic qualitative review.

PubMed

McLennan, Stuart; Kahrass, Hannes; Wieschowski, Susanne; Strech, Daniel; Langhof, Holger

2018-04-01

To determine systematically the spectrum of ethical issues that is raised for stakeholders in a 'Learning Health Care System' (LHCS). The systematic review was conducted in PubMed and Google Books between the years 2007 and 2015. The literature search retrieved 1258 publications. Each publication was independently screened by two reviewers for eligibility for inclusion. Ethical issues were defined as arising when a relevant normative principle is not adequately considered or two principles come into conflict. A total of 65 publications were included in the final analysis and were analysed using an adapted version of qualitative content analysis. A coding frame was developed inductively from the data, only the highest-level categories were generated deductively for a life-cycle perspective. A total of 67 distinct ethical issues could be categorized under different phases of the LHCS life-cycle. An overarching theme that was repeatedly raised was the conflict between the current regulatory system and learning health care. The implementation of a LHCS can help realize the ethical imperative to continuously improve the quality of health care. However, the implementation of a LHCS can also raise a number of important ethical issues itself. This review highlights the importance for health care leaders and policy makers to balance the need to protect and respect individual participants involved in learning health care activities with the social value of improving health care.

Phases of capitalism, welfare states, medical dominance, and health care in Ontario.

PubMed

Coburn, D

1999-01-01

There has been a lacuna in previous studies of medicine and health care of concepts or structures relating changes in health care with their contextualizing social structures. That is, there is a need to more adequately account for health care and social structure in terms of dynamic rather than static concepts. This article reports the application of a general schema outlining the transformation of capitalism through the phases of entrepreneurial, monopoly, and global capitalism, first presented by Ross and Trachte, to help understand both the changing role of medicine in Canada and the historical trajectory of the development of health insurance. These related events are shown to be partly reflective of the transformed class dynamic involved in a changing capitalist mode of production. The recent history of challenges to medicare in Canada as well as evidence of the declining power of medicine are both related directly and indirectly to the increased power of business and the decline in the relative autonomy of the state accompanying globalization. The application of the phases of capitalism sequence does roughly fit the Canadian instance although some modifications will be required to account for the specifics of the Canadian case. The schema also helps resolve two previously competing class arguments about the rise of health insurance in Canada.

Prenatal health care beyond the obstetrics service: Utilization and predictors of unscheduled care

PubMed Central

Magriples, Urania; Kershaw, Trace S.; Rising, Sharon Schindler; Massey, Zohar; Ickovics, Jeannette R.

2008-01-01

OBJECTIVE The objective of the study was to describe the patient characteristics of prenatal care utilization within and outside of routine obstetric care, and the clinical and psychosocial factors that predict care utilization. STUDY DESIGN Four hundred twenty pregnant women enrolled in a randomized controlled trial receiving prenatal care in a university-affiliated clinic. All hospital encounters were obtained by review of computerized databases. The Kotelchuck index (KI) was computed, and the characteristics of inadequate, adequate, or excessive prenatal care were described. Demographic and psychosocial predictors of unscheduled visits were evaluated. RESULTS A total of 50.5% of women were adequate users by KI, with 19% being inadequate. An average of 5 additional unscheduled encounters occurred (standard deviation 4.2; range, 0−26). Almost 75% of participants made an unscheduled obstetric visit, with 38% making 2 or more unscheduled visits. Overweight/obese, younger women, high symptom distress, and excessive and inadequate prenatal users were more likely to utilize the labor floor before delivery. CONCLUSION Unscheduled care is common during pregnancy. PMID:18166312

Antenatal and obstetric care in Afghanistan--a qualitative study among health care receivers and health care providers.

PubMed

Rahmani, Zuhal; Brekke, Mette

2013-05-06

Despite attempts from the government to improve ante- and perinatal care, Afghanistan has once again been labeled "the worst country in which to be a mom" in Save the Children's World's Mothers' Report. This study investigated how pregnant women and health care providers experience the existing antenatal and obstetric health care situation in Afghanistan. Data were obtained through one-to-one semi-structured interviews of 27 individuals, including 12 women who were pregnant or had recently given birth, seven doctors, five midwives, and three traditional birth attendants. The interviews were carried out in Kabul and the village of Ramak in Ghazni Province. Interviews were taped, transcribed, and analyzed according to the principles of Giorgi's phenomenological analysis. Antenatal care was reported to be underused, even when available. Several obstacles were identified, including a lack of knowledge regarding the importance of antenatal care among the women and their families, financial difficulties, and transportation problems. The women also reported significant dissatisfaction with the attitudes and behavior of health personnel, which included instances of verbal and physical abuse. According to the health professionals, poor working conditions, low salaries, and high stress levels contributed to this matter. Personal contacts inside the hospital were considered necessary for receiving high quality care, and bribery was customary. Despite these serious concerns, the women expressed gratitude for having even limited access to health care, especially treatment provided by a female doctor. Health professionals were proud of their work and enjoyed the opportunity to help their community. This study identified several obstacles which must be addressed to improve reproductive health in Afghanistan. There was limited understanding of the importance of antenatal care and a lack of family support. Financial and transportation problems led to underuse of available care

Determinants of choosing public or private health care among patients with sexually transmitted infections in Uganda.

PubMed

Nuwaha, Fred

2006-07-01

To identify variables that distinguish patients with sexually transmitted infections (STIs) who seek care in public or private health units. To recommend measures for improved care of patients with STIs. Patients with STIs were interviewed at public (n = 101) or private health units (n = 124). Information was collected on attitudinal, normative, and self-efficacy beliefs; STI symptoms; health-seeking behavior; sociodemographic characteristics, and on partner referral. Choosing private health units is favored by age >25 years, favorable beliefs towards private health units (e.g., they cure or prevent STIs and give adequate drug doses); unfavorable beliefs towards public health units (such as they make STIs chronic and have corrupt staff); not being influenced by sexual partner(s) in choice of treatment site, being likely to chose a treatment site if sexual partners were not treated free, and being likely to choose a treatment site if not recommend by a friend. This 9-variable model correctly classified 214 (95%) of the 225 patients (model chi squared = 192, 9 degrees of freedom, P <0.001). Psychosocial variables markedly influence choice of health care provider. Improving quality of care will enhance STI management and help to modify the unfavorable psychosocial beliefs.

Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

PubMed Central

Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

2012-01-01

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486

The Photo Essay: A Visual Research Method for Educating Obstetricians and Other Health Care Professionals

ERIC Educational Resources Information Center

Quinn, Gwendolyn P.; Albrecht, Terrance L.; Mahan, Charles; Bell-Ellison, Bethany A.; Akintobi, Tabia Henry; Reynolds, Beth; Jeffers, Delores

2006-01-01

When it comes to issues related to low-income women seeking early, adequate, or continuous prenatal care, the public health and medical communities continue to tell women to take responsibility for their actions. Rarely are messages aimed at providers. To help physicians see how factors in their offices and clinics can affect service utilization,…

Misalignment between Medicare Policies and Depression Care in Home Health Care: Home health provider perspectives

PubMed Central

Bao, Yuhua; Eggman, Ashley; Richardson, Joshua; Bruce, Martha

2013-01-01

Objective Depression affects one in four older adults receiving home health care. Medicare policies are influential in shaping home health practice. This study aims to identify Medicare policy areas that are aligned or misaligned with depression care quality improvement in home health care. Methods Qualitative study based on semi-structured interviews with nurses and administrators from five home health agencies in five states (n=20). Digitally recorded interviews were transcribed and analyzed using the grounded theory method. A multi-disciplinary team iteratively developed a codebook from interview data to identify themes. Results Several important Medicare policies are largely misaligned with depression care quality improvement in home health care: Medicare eligibility requirements for patients to remain homebound and to demonstrate a need for skilled care restrict nurses’ abilities to follow up with depressed patients for sufficient length of time; the lack of explicit recognition of nursing time and quality of care in the home health Prospective Payment System (PPS) provides misaligned incentives for depression care; incorporation of a two-item depression screening tool in Medicare-mandated comprehensive patient assessment raised clinician awareness of depression; however, inclusion of the tool at Start-of-Care only but not any other follow-up points limits its potential in assisting nurses with depression care management; under-development of clinical decision support for depression care in vendor-developed electronic health records constitutes an important barrier to depression quality improvement in home health care. Conclusions Several influential Medicare policies and regulations for home health practice may be misaligned with evidence-based depression care for home health patients. PMID:24632686

[Parameter of evidence-based medicine in health care economics].

PubMed

Wasem, J; Siebert, U

1999-08-01

In the view of scarcity of resources, economic evaluations in health care, in which not only effects but also costs related to a medical intervention are examined and a incremental cost-outcome-ratio is build, are an important supplement to the program of evidence based medicine. Outcomes of a medical intervention can be measured by clinical effectiveness, quality-adjusted life years, and monetary evaluation of benefits. As far as costs are concerned, direct medical costs, direct non-medical costs and indirect costs have to be considered in an economic evaluation. Data can be used from primary studies or secondary analysis; metaanalysis for synthesizing of data may be adequate. For calculation of incremental cost-benefit-ratios, models of decision analysis (decision tree models, Markov-models) often are necessary. Methodological and ethical limits for application of the results of economic evaluation in resource allocation decision in health care have to be regarded: Economic evaluations and the calculation of cost-outcome-rations should only support decision making but cannot replace it.

Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.

PubMed

Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W

2015-01-01

(1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.

How health plans promote health IT to improve behavioral health care.

PubMed

Quinn, Amity E; Reif, Sharon; Evans, Brooke; Creedon, Timothy B; Stewart, Maureen T; Garnick, Deborah W; Horgan, Constance M

2016-12-01

Given the large numbers of providers and enrollees with which they interact, health plans can encourage the use of health information technology (IT) to advance behavioral health care. The manner and extent to which commercial health plans promote health IT to improve behavioral health care is unknown. This study aims to address that gap. Cross-sectional study. Data are from a nationally representative survey of commercial health plans regarding administrative and clinical dimensions of behavioral health services in 2010. Data are weighted to be representative of commercial managed care products in the United States (n = 8427; 88% response rate). Approaches within the domains of provider support, access to care, and assessment and treatment were investigated as examples of how health plans can promote health IT to improve behavioral health care delivery. Health plans were using health IT approaches in each domain. About a quarter of products offered financial support for electronic health records, but technical assistance was rare. Primary care providers could bill for e-mail contact with patients for behavioral health in about a quarter of products. Few products offered member-provider e-mail, and none offered online appointment scheduling. However, online referral systems and online provider directories were common, and nearly all offered an online self-assessment tool; most offered online counseling and online personalized responses to questions or problems. In 2010, commercial health plans encouraged the use of health IT strategies for behavioral health care. Health plans have an important role to play for increasing health IT as a tool for behavioral health care.

Committee opinion no. 515: Health care for urban American Indian and Alaska Native women.

PubMed

2012-01-01

Sixty percent of American Indian and Alaska Native women live in metropolitan areas. Most are not eligible for health care provided by the federal Indian Health Service (IHS). The IHS partly funds 34 Urban Indian Health Organizations, which vary in size and services. Some are small informational and referral sites that are limited even in the scope of outpatient services provided. Compared with other urban populations, urban American Indian and Alaska Native women have higher rates of teenaged pregnancy, late or no prenatal care, and alcohol and tobacco use in pregnancy. Their infants have higher rates of preterm birth, mortality, and sudden infant death syndrome than infants in the general population. Barriers to care experienced by American Indian and Alaska Native women should be addressed. The American College of Obstetricians and Gynecologists encourages Fellows to be aware of the risk profile of their urban American Indian and Alaska Native patients and understand that they often are not eligible for IHS coverage and may need assistance in gaining access to other forms of coverage. The American College of Obstetricians and Gynecologists also recommends that Fellows encourage their federal legislators to support adequate funding for the Indian Health Care Improvement Act, permanently authorized as part of the Patient Protection and Affordable Care Act.

Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review.

PubMed

Gotovac, Sandra; Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret

2018-04-01

The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families.

Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review

PubMed Central

Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret

2018-01-01

Introduction The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. Methods A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Results Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Discussion Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Conclusion Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families. PMID:29662521

[A Maternal Health Care System Based on Mobile Health Care].

PubMed

Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

2016-02-01

Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

The health care learning organization.

PubMed

Hult, G T; Lukas, B A; Hult, A M

1996-01-01

To many health care executives, emphasis on marketing strategy has become a means of survival in the threatening new environment of cost attainment, intense competition, and prospective payment. This paper develops a positive model of the health care organization based on organizational learning theory and the concept of the health care offering. It is proposed that the typical health care organization represents the prototype of the learning organization. Thus, commitment to a shared vision is proposed to be an integral part of the health care organization and its diagnosis, treatment, and delivery of the health care offering, which is based on the exchange relationship, including its communicative environment. Based on the model, strategic marketing implications are discussed.

Is home health care a substitute for hospital care?

PubMed

Lichtenberg, Frank R

2012-01-01

A previous study used aggregate (region-level) data to investigate whether home health care serves as a substitute for inpatient hospital care and concluded that "there is no evidence that services provided at home replace hospital services." However, that study was based on a cross-section of regions observed at a single point of time and did not control for unobserved regional heterogeneity. In this article, state-level employment data are used to reexamine whether home health care serves as a substitute for inpatient hospital care. This analysis is based on longitudinal (panel) data--observations on states in two time periods--which enable the reduction or elimination of biases that arise from use of cross-sectional data. This study finds that states that had higher home health care employment growth during the period 1998-2008 tended to have lower hospital employment growth, controlling for changes in population. Moreover, states that had higher home health care payroll growth tended to have lower hospital payroll growth. The estimates indicate that the reduction in hospital payroll associated with a $1,000 increase in home health payroll is not less than $1,542, and may be as high as $2,315. This study does not find a significant relationship between growth in utilization of home health care and growth in utilization of nursing and residential care facilities. An important reason why home health care may serve as a substitute for hospital care is that the availability of home health care may allow patients to be discharged from the hospital earlier. Hospital discharge data from the Healthcare Cost and Utilization Project are used to test the hypothesis that use of home health care reduces the length of hospital stays. Major Diagnostic Categories with larger increases in the fraction of patients discharged to home health care tended to have larger declines in mean length of stay (LOS). Between 1998 and 2008, mean LOS declined by 4.1%, from 4.78 to 4.59 days

Health care in China.

PubMed

Brown, M S; Burns, C E; Hellings, P J

1984-05-01

Maternal-child nurses are part of a growing number of Americans who have had the opportunity to visit China. An increased understanding of the history and of the health care practices of the Chinese people lends itself to an examination of American values and health practices. The insight developed may aid us as we seek to understand our own health care practices for women and children and to plan for the future in health care.

Multiculturalism, Medicine and Health Part I: Multicultural Health Care

PubMed Central

Masi, R.

1988-01-01

Culturally sensitive health care is not a matter of simple formulas or prescriptions that provide a single definitive answer: rather, it requires understanding of the principles on which health care is based and the manner in which culture may influence those principles. This series of six articles will examine influences that ethnic and cultural background may have on health and health care. Part I outlines the development, importance and relevance of multicultural health care. The author stresses the importance of understanding community needs, cultures and beliefs; the active interest and participation of the patient in his or her own health care; the importance of a good physician-patient relationship; and the benefit of an open-minded approach by physicians and other health-care workers to the delivery of health-care services. PMID:21253247

Cost of health care utilization among homeless frequent emergency department users.

PubMed

Mitchell, Matthew S; León, Casey L K; Byrne, Thomas H; Lin, Wen-Chieh; Bharel, Monica

2017-05-01

Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Building consensus on key priorities for rural health care in South Africa using the Delphi technique

PubMed Central

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-01

Background South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. Methods The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Results Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Conclusion Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential. PMID:23364081

American Health Care Association

MedlinePlus

... Louis, Qualifications Required: Bachelor’s degree in business, marketing, health care administration or a related field Current Nursing Home ... Director of Assisted Living and Personal Care | Pennsylvania Health Care Association (PHCA) US - PA - Harrisburg, Qualifications: Preferred candidates ...

Model for the evaluation of drug-dispensing services in primary health care

PubMed Central

Sartor, Vanessa de Bona; de Freitas, Sergio Fernando Torres

2014-01-01

OBJECTIVE To develop a model for evaluating the efficacy of drug-dispensing service in primary health care. METHODS An efficacy criterion was adopted to determine the level of achievement of the service objectives. The evaluation model was developed on the basis of a literature search and discussions with experts. The applicability test of the model was conducted in 15 primary health care units in the city of Florianópolis, state of Santa Catarina, in 2010, and data were recorded in structured and pretested questionnaires. RESULTS The model developed was evaluated using five dimensions of analysis for analysis. The model was suitable for evaluating service efficacy and helped to identify the critical points of each service dimension. CONCLUSIONS Adaptations to the data collection technique may be required to adjust for the reality and needs of each situation. The evaluation of the drug-dispensing service should promote adequate access to medications supplied through the public health system. PMID:25372174

Health care employee perceptions of patient-centered care.

PubMed

Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L

2015-03-01

Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.

Environmental Health: Health Care Reform's Missing Pieces.

ERIC Educational Resources Information Center

Fadope, Cece Modupe; And Others

1994-01-01

A series of articles that examine environmental health and discuss health care reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for health care professionals who want to address…

Haitian vodou as a health care system: between magic, religion, and medicine.

PubMed

Vonarx, Nicolas

2011-01-01

Haitian vodou has been considered an African-American religion organized around a pantheon, sanctuaries, priests, fraternities, and rituals honoring the spirits (lwa), the dead, and the ancestors. This construction of vodou, which is predominant in the literature, is based on a substantive approach to religion. It obscures the close connections between vodou and illness and does not adequately reveal how vodou is used in the daily lives of Haitians. By adopting a microsocial perspective on vodou and focusing on the knowledge and practices of vodou practitioners, the importance of vodou's therapeutic dimension becomes clear. Indeed, I am compelled to conclude that vodou is a health care system. Grounded in 16 months' research in the Haitian countryside and using a definition of health care systems identified in the medical anthropology literature, this new way of approaching vodou situates its religious and magical dimensions within its role as a health care system. This article deals with these different aspects, addressing the criteria that make vodou a health care system. In particular, I explore the practitioners who are recognized as healers and consulted as such; the sites where practitioners meet with the sick and treat them; the vodou theories on illness; and the curative, preventive, and care-giving practices based on those theories. This approach helps us to better understand how medicine, religion, and magic are linked in Haitian vodou and leads us back to debates about the construction of vodou, which are apparently well known in the scientific literature. All of this leads us to reflect on Western approaches to healing and caring.

Controversies in faith and health care.

PubMed

Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon

2015-10-31

Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Metrics for Radiologists in the Era of Value-based Health Care Delivery.

PubMed

Sarwar, Ammar; Boland, Giles; Monks, Annamarie; Kruskal, Jonathan B

2015-01-01

Accelerated by the Patient Protection and Affordable Care Act of 2010, health care delivery in the United States is poised to move from a model that rewards the volume of services provided to one that rewards the value provided by such services. Radiology department operations are currently managed by an array of metrics that assess various departmental missions, but many of these metrics do not measure value. Regulators and other stakeholders also influence what metrics are used to assess medical imaging. Metrics such as the Physician Quality Reporting System are increasingly being linked to financial penalties. In addition, metrics assessing radiology's contribution to cost or outcomes are currently lacking. In fact, radiology is widely viewed as a contributor to health care costs without an adequate understanding of its contribution to downstream cost savings or improvement in patient outcomes. The new value-based system of health care delivery and reimbursement will measure a provider's contribution to reducing costs and improving patient outcomes with the intention of making reimbursement commensurate with adherence to these metrics. The authors describe existing metrics and their application to the practice of radiology, discuss the so-called value equation, and suggest possible metrics that will be useful for demonstrating the value of radiologists' services to their patients. (©)RSNA, 2015.

Public Health System-Delivered Mental Health Preventive Care Links to Significant Reduction of Health Care Costs.

PubMed

Chen, Jie; Novak, Priscilla; Goldman, Howard

2018-04-23

The objective was to estimate the association between health care expenditures and implementation of preventive mental health programs by local health departments (LHDs). Multilevel nationally representative data sets were linked to test the hypothesis that LHDs' provision of preventive mental health programs was associated with cost savings. A generalized linear model with log link and gamma distribution and state-fixed effects was used to estimate the association between LHDs' mental illness prevention services and total health care expenditures per person per year for adults aged 18 years and older. The main outcome measure was the annual total health care expenditure per person. The findings indicated that LHD provision of population-based prevention of mental illness was associated with an $824 reduction (95% confidence interval: -$1,562.94 to -$85.42, P < 0.05) in annual health care costs per person, after controlling for individual, LHD, community, and state characteristics. LHDs can play a critical role in establishing an integrated health care model. Their impact, however, has often been underestimated or neglected. Results showed that a small investment in LHDs may yield substantial cost savings at the societal level. The findings of this research are critical to inform policy decisions for the expansion of the Public Health 3.0 infrastructure.

Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions.

PubMed

Pons-Vigués, Mariona; Berenguera, Anna; Coma-Auli, Núria; Pombo-Ramos, Haizea; March, Sebastià; Asensio-Martínez, Angela; Moreno-Peral, Patricia; Mora-Simón, Sara; Martínez-Andrés, Maria; Pujol-Ribera, Enriqueta

2017-06-13

Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having

Marketing women's health care.

PubMed

Triolo, P K

1987-11-01

Women's health care is a growing component of the health care business. Developing women's health services can offer hospitals and clinics the opportunity to generate greater revenue and gain the competitive edge. The nurse executive plays a critical role in the development of marketable women's health services.