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Sample records for designing primary health

  1. Designing primary health care teams for developing countries.

    PubMed Central

    Reisman, A; Duran, L

    1983-01-01

    A time-honored industrial engineering technique, job evaluation, which was developed to set rates for manual labor, was used in the design of new teams for delivering primary health care in Latin America. The technique was used both in writing job descriptions for new allied health personnel and in designing the curriculums needed to train the personnel. PMID:6856744

  2. 76 FR 68198 - Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-03

    ... (54 FR 8735). The criteria for psychiatric HPSAs were expanded to mental health HPSAs on January 22, 1992 (57 FR 2473). Currently funded PHS Act programs use only the primary medical care, mental health... designated HPSAs and supersedes the HPSA lists published in the Federal Register on February 20, 2002 (67...

  3. 78 FR 38718 - Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ... criteria for correctional facility HPSAs were revised and published on March 2, 1989 (54 FR 8735). The criteria for psychiatric HPSAs were expanded to mental health HPSAs on January 22, 1992 (57 FR 2473... on June 29, 2012 (77 FR 38838). The lists also include automatic facility HPSAs, designated as...

  4. Designing a valid randomized pragmatic primary care implementation trial: the my own health report (MOHR) project

    PubMed Central

    2013-01-01

    Background There is a pressing need for greater attention to patient-centered health behavior and psychosocial issues in primary care, and for practical tools, study designs and results of clinical and policy relevance. Our goal is to design a scientifically rigorous and valid pragmatic trial to test whether primary care practices can systematically implement the collection of patient-reported information and provide patients needed advice, goal setting, and counseling in response. Methods This manuscript reports on the iterative design of the My Own Health Report (MOHR) study, a cluster randomized delayed intervention trial. Nine pairs of diverse primary care practices will be randomized to early or delayed intervention four months later. The intervention consists of fielding the MOHR assessment – addresses 10 domains of health behaviors and psychosocial issues – and subsequent provision of needed counseling and support for patients presenting for wellness or chronic care. As a pragmatic participatory trial, stakeholder groups including practice partners and patients have been engaged throughout the study design to account for local resources and characteristics. Participatory tasks include identifying MOHR assessment content, refining the study design, providing input on outcomes measures, and designing the implementation workflow. Study outcomes include the intervention reach (percent of patients offered and completing the MOHR assessment), effectiveness (patients reporting being asked about topics, setting change goals, and receiving assistance in early versus delayed intervention practices), contextual factors influencing outcomes, and intervention costs. Discussion The MOHR study shows how a participatory design can be used to promote the consistent collection and use of patient-reported health behavior and psychosocial assessments in a broad range of primary care settings. While pragmatic in nature, the study design will allow valid comparisons to answer

  5. Designing for Risk Assessment Systems for Patient Triage in Primary Health Care: A Literature Review

    PubMed Central

    Carvalho, Paulo Victor Rodrigues

    2016-01-01

    Background This literature review covers original journal papers published between 2011 and 2015. These papers review the current status of research on the application of human factors and ergonomics in risk assessment systems’ design to cope with the complexity, singularity, and danger in patient triage in primary health care. Objective This paper presents a systematic literature review that aims to identify, analyze, and interpret the application of available evidence from human factors and ergonomics to the design of tools, devices, and work processes to support risk assessment in the context of health care. Methods Electronic search was performed on 7 bibliographic databases of health sciences, engineering, and computer sciences disciplines. The quality and suitability of primary studies were evaluated, and selected papers were classified according to 4 classes of outcomes. Results A total of 1845 papers were retrieved by the initial search, culminating in 16 selected for data extraction after the application of inclusion and exclusion criteria and quality and suitability evaluation. Conclusions Results point out that the study of the implications of the lack of understanding about real work performance in designing for risk assessment in health care is very specific, little explored, and mostly focused on the development of tools. PMID:27528543

  6. Designing Excellence and Quality Model for Training Centers of Primary Health Care: A Delphi Method Study

    PubMed Central

    TABRIZI, Jafar-Sadegh; FARAHBAKHSH, Mostafa; SHAHGOLI, Javad; RAHBAR, Mohammad Reza; NAGHAVI-BEHZAD, Mohammad; AHADI, Hamid-Reza; AZAMI-AGHDASH, Saber

    2015-01-01

    Background: Excellence and quality models are comprehensive methods for improving the quality of healthcare. The aim of this study was to design excellence and quality model for training centers of primary health care using Delphi method. Methods: In this study, Delphi method was used. First, comprehensive information were collected using literature review. In extracted references, 39 models were identified from 34 countries and related sub-criteria and standards were extracted from 34 models (from primary 39 models). Then primary pattern including 8 criteria, 55 sub-criteria, and 236 standards was developed as a Delphi questionnaire and evaluated in four stages by 9 specialists of health care system in Tabriz and 50 specialists from all around the country. Results: Designed primary model (8 criteria, 55 sub-criteria, and 236 standards) were concluded with 8 criteria, 45 sub-criteria, and 192 standards after 4 stages of evaluations by specialists. Major criteria of the model are leadership, strategic and operational planning, resource management, information analysis, human resources management, process management, costumer results, and functional results, where the top score was assigned as 1000 by specialists. Functional results had the maximum score of 195 whereas planning had the minimum score of 60. Furthermore the most and the least sub-criteria was for leadership with 10 sub-criteria and strategic planning with 3 sub-criteria, respectively. Conclusion: The model that introduced in this research has been designed following 34 reference models of the world. This model could provide a proper frame for managers of health system in improving quality. PMID:26576350

  7. Prevalence of Work-Related Asthma in Primary Health Care: Study Rationale and Design

    PubMed Central

    Rabell-Santacana, Ventura; Panadès-Valls, Rafael; Vila-Rigat, Rosa; Hernandez-Huet, Enric; Sivecas-Maristany, Joan; Blanché-Prat, Xavier; Prieto, Gemma; Muñoz, Laura; Torán, Pere

    2015-01-01

    Background : Occupational Asthma (OA) is the most frequent origin of occupational respiratory diseases in industrialized countries and accounts for between 5% and 25% of asthmatic patients. The correct and early diagnosis of OA is of great preventive and socio-economic importance. However, few studies exist on OA’s prevalence in Catalonia and in Spain and those affected are mainly treated by the public health services and not by the occupational health services, which are private. Objective : To determine the prevalence of OA in patients diagnosed with asthma in the Primary Healthcare system and to evaluate the socio-economic impact of OA in the Primary Healthcare system. Methods/Design : We will carry out an observational, transversal and multi-center study in the Primary Healthcare Service in the Barcelona region (Catalonia, Spain), with 385 asthmatic workers aged between 16 and 64 who are currently working or have been working in the past. We will confirm the asthma diagnosis in each patient, and those meeting the inclusion criteria will be asked to answer a questionnaire that aims to link asthma to the patient’s past employment history. The resulting diagnosis will be of either occupational asthma, work-aggravated asthma or common asthma. We will also collect socio-demographic information about the patients, about their smoking status, their exposure outside of the workplace, their work situation at the onset of the symptoms, their employment history, their symptoms of asthma, their present and past medical asthma treatment, and, in order to estimate the economic impact in the Primary Healthcare system, where they have been attended to and treated. Prevalence will link OA or work-aggravated asthma to the total of patients participating in the study with a asthma diagnosis. Discussion : The results will show the prevalence of OA and work-aggravated asthma, and shall provide valuable information to set out and apply the necessary personal and technical

  8. Primary Health Care.

    ERIC Educational Resources Information Center

    Lauffer, Sandra, Ed.

    1979-01-01

    This report contains 13 articles and book/film reviews on various topics related to the diffusion of health care information in developing countries; beginning with two articles which define primary health care, and suggest principles related to the community, communication, and the health practitioner upon which primary health care should be…

  9. 77 FR 38838 - Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-29

    ... HPSAs were revised and published on March 2, 1989, in Federal Register (54 FR 8735). The criteria for psychiatric HPSAs were expanded to mental health HPSAs on January 22, 1992 (57 FR 2473). Currently-funded PHS... lists published in the Federal Register on November 3, 2011 (76 FR 68198). The lists include...

  10. Primary care and health reform.

    PubMed

    Calman, Neil S; Golub, Maxine; Shuman, Saskia

    2012-01-01

    Skyrocketing health care costs are burdening our people and our economy, yet health care indicators show how little we are achieving with the money we spend. Federal and state governments, along with public-health experts and policymakers, are proposing a host of new initiatives to find solutions. The Patient Protection and Affordable Care Act is designed to address both the quality and accessibility of health care, while reducing its cost. This article provides an overview of models supported by the Affordable Care Act that address one or more goals of the "Triple Aim": better health care for individuals, better health outcomes in the community, and lower health care costs. The models described below rely on the core principles of primary care: comprehensive, coordinated and continuous primary care; preventive care; and the sophisticated implementation of health information technology designed to promote communication between health care providers, enhance coordination of care, minimize duplication of services, and permit reporting on quality. These models will support better health care and reduced costs for people who access health care services but will not address health outcomes in the community at large. Health care professionals, working in concert with community-based organizations and advocates, must also address conditions that influence health in the broadest sense to truly improve the health of our communities and reduce health care costs. PMID:22976358

  11. Developing primary health care.

    PubMed Central

    Jarman, B; Cumberlege, J

    1987-01-01

    Primary health care is best provided by a primary health care team of general practitioners, community nurses, and other staff working together from good premises and looking after the population registered with the practice. It encourages personal and continuing care of patients and good communication among the members of the team. Efforts should be made to foster this model of primary care where possible and also to evaluate its effectiveness. Community services that are not provided by primary care teams should be organised on a defined geographical basis, and the boundaries of these services should coincide as much as possible. Such arrangements would facilitate effective community care and health promotion and can be organised to work well with primary care teams. The patient's right to freedom of choice of a doctor, however, should be retained, as it adds flexibility to the rigidity of fixed geographically based services. PMID:3119003

  12. Integrating Children's Mental Health into Primary Care.

    PubMed

    Wissow, Lawrence S; van Ginneken, Nadja; Chandna, Jaya; Rahman, Atif

    2016-02-01

    Children's mental health problems are among global health advocates' highest priorities. Nearly three-quarters of adult disorders have their onset or origins during childhood, becoming progressively harder to treat over time. Integrating mental health with primary care and other more widely available health services has the potential to increase treatment access during childhood, but requires re-design of currently-available evidence-based practices to fit the context of primary care and place a greater emphasis on promoting positive mental health. While some of this re-design has yet to be accomplished, several components are currently well-defined and show promise of effectiveness and practicality. PMID:26613691

  13. User-generated quality standards for youth mental health in primary care: a participatory research design using mixed methods

    PubMed Central

    Graham, Tanya; Rose, Diana; Murray, Joanna; Ashworth, Mark; Tylee, André

    2014-01-01

    Objectives To develop user-generated quality standards for young people with mental health problems in primary care using a participatory research model. Methods 50 young people aged 16–25 from community settings and primary care participated in focus groups and interviews about their views and experiences of seeking help for mental health problems in primary care, cofacilitated by young service users and repeated to ensure respondent validation. A second group of young people also aged 16–25 who had sought help for any mental health problem from primary care or secondary care within the last 5 years were trained as focus groups cofacilitators (n=12) developed the quality standards from the qualitative data and participated in four nominal groups (n=28). Results 46 quality standards were developed and ranked by young service users. Agreement was defined as 100% of scores within a two-point region. Group consensus existed for 16 quality standards representing the following aspects of primary care: better advertising and information (three); improved competence through mental health training and skill mix within the practice (two); alternatives to medication (three); improved referral protocol (three); and specific questions and reassurances (five). Alternatives to medication and specific questions and reassurances are aspects of quality which have not been previously reported. Conclusions We have demonstrated the feasibility of using participatory research methods in order to develop user-generated quality standards. The development of patient-generated quality standards may offer a more formal method of incorporating the views of service users into quality improvement initiatives. This method can be adapted for generating quality standards applicable to other patient groups. PMID:24920648

  14. Development of Dental Health Knowledge Tests for the Primary Grades.

    ERIC Educational Resources Information Center

    Kleinman, Susan P.

    1981-01-01

    A project was designed to provide evaluation materials for dental health education programs at the primary level. Reliable test instruments that assessed cognitive understanding of dental concepts by primary age children were designed. (JN)

  15. Phytotherapy in primary health care

    PubMed Central

    Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

    2014-01-01

    OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

  16. Phytotherapy in primary health care.

    PubMed

    Antonio, Gisele Damian; Tesser, Charles Dalcanele; Moretti-Pires, Rodrigo Otavio

    2014-06-01

    OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

  17. Children's Health in Primary Schools.

    ERIC Educational Resources Information Center

    Mayall, Berry; And Others

    Positing the relevance of well-being and social support to educational achievement, this book explores the status of children's health and its importance to the education of young children. A mail questionnaire survey of 1031 of approximately 20,000 Primary Education Schools in England and Wales in the fall of 1993 yielded 620 replies; a response…

  18. HEALTH WATCH: health promotion and disease prevention in primary care.

    PubMed

    Schmidt, R M

    1993-04-01

    HEALTH WATCH, a longitudinal prospective study of healthy aging, was designed to characterize a healthy population of 2,200 men and women, ages 20-80 years in 1970. Biochemical, hematological, and physiological tests are performed annually over three weekly visits, combined with a self-administered HEALTH WATCH questionnaire to measure health status and behaviors in seven areas (with over 1,330 variables). In 1988, the HEALTH WATCH study was modified to assess characteristics of an oldest old "productive aging" cohort in Kauai, Hawaii. Nutrition, physical activity, extended family, and spirituality were found to be major health determinants. During 1989 to 1991 a controlled intervention study (ten local primary care physicians and their patients, aged 65-89 years) was completed in the Sun Cities, Arizona. These studies provide evidence that primary care physicians can promote positive health outcomes in patients of any chronological age and baseline health status through active healthy aging interventions. PMID:8341160

  19. Education for primary health care.

    PubMed

    Smith, M; Drickey, R

    1985-07-01

    Postrevolutionary Nicaragua has developed a new health system in which primary health care is a central component. Great progress has been made in correcting the poor health conditions that existed prior to the revolution. As part of an interdisciplinary health team that emphasizes prevention and community service, physicians in the new system play a different role than they did previously. Training for health workers of all types has been expanded. However, scarce teaching and curricular resources have restrained progress in this area. The U.S. based Committee for Health Rights in Central America (CHRICA) has collaborated with the Nicaraguan Ministry of Health to organize two Colloquia on Health in Nicaragua in the past two years. These Colloquia brought together North American participants who provided current medical training and Nicaraguan participants who provided information about the new health system. The Colloquia, whose participants were eligible to receive CME credit from the UCSF School of Medicine, have led to continuing educational exchanges between health care personnel in the two countries. PMID:10272498

  20. Exposure of health workers in primary health care to glutaraldehyde

    PubMed Central

    2013-01-01

    Background In order to avoid proliferation of microorganisms, cleaning, disinfection and sterilisation in health centres is of utmost importance hence reducing exposure of workers to biological agents and of clients that attend these health centres to potential infections. One of the most commonly-used chemical is glutaraldehyde. The effects of its exposure are well known in the hospital setting; however there is very little information available with regards to the primary health care domain. Objective To determine and measure the exposure of health workers in Primary Health Care Centres. Environmental to glutaraldehyde and staff concentration will be measured and compared with regulated Occupational Exposure Limits. Methods/Design Observational, cross-sectional and multi-centre study. The study population will be composed of any health professionals in contact with the chemical substance that work in the Primary Health Care Centres in the areas of Barcelonès Nord, Maresme, and Barcelona city belonging to the Catalan Institute of Health. Data will be collected from 1) Glutaraldhyde consumption from the previous 4 years in the health centres under study. 2) Semi-structured interviews and key informants to gather information related to glutaraldehyde exposure. 3) Sampling of the substance in the processes considered to be high exposure. Discussion Although glutaraldehyde is extensively used in health centres, scientific literature only deals with certain occupational hazards in the hospital setting. This study attempts to take an in-depth look into the risk factors and environmental conditions that exist in the primary care workplace with exposure to glutaraldehyde. PMID:24180250

  1. Establishment of primary health care in Vietnam.

    PubMed Central

    Birt, C A

    1990-01-01

    Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary health care. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary health care development are described. PMID:2121182

  2. Primary prevention of childhood obesity through counselling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial

    PubMed Central

    2014-01-01

    Background Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. Methods/Design The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children’s body mass index and waist circumference at four years. Secondary outcomes are children’s and mothers’ eating habits (assessed by a food frequency questionnaire), and children’s and mothers’ physical activity (measured by accelerometer and a validated questionnaire), and mothers’ body mass index and waist circumference. Discussion The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control

  3. Primary care NPs: Leaders in population health.

    PubMed

    Swartwout, Kathryn D

    2016-08-18

    A 2012 Institute of Medicine report calls primary and public healthcare workers to action, tasking them with working together to improve population health outcomes. A Practical Playbook released in 2014 enables this public health/primary care integration. Primary care NPs are in an excellent position to lead the charge and make this integration happen. PMID:27434390

  4. Primary prevention protects public health.

    PubMed

    Tomatis, Lorenzo

    2002-12-01

    It is widely accepted that epidemiological data provide the only reliable evidence of a carcinogenic effect in humans, but epidemiology is unable to provide early warning of a cancer risk. The experimental approach to carcinogenicity can ascertain and predict potential cancer risks to humans in time for primary prevention to be successful. Unfortunately, only in rare instances were experimental data considered sufficiently convincing per se to stimulate the adoption of preventive measures. The experimental testing of environmental agents is the second line of defense against potential human carcinogens. The first line is the testing of synthesized agents, be these pesticides, medical drugs, or industrial chemical/physical agents, at the time of their development. We do not know, however, how many substances have been prevented from entering the environment because most tests are carried out by commercial or private laboratories and results are rarely released. A better understanding of the mechanisms underlying the sequence of events of the carcinogenesis process will eventually lead to a more accurate characterization and quantification of risks. However, the ways that mechanistic data have been used lately for evaluating evidence of carcinogenicity have not necessarily meant that the evaluations were more closely oriented toward public health. A tendency has surfaced to dismiss the relevance of long-term carcinogenicity studies. In the absence of absolute certainty, rarely if ever reached in biology, it is essential to adopt an attitude of responsible caution, in line with the principles of primary prevention, the only one that may prevent unlimited experimentation on the entire human species. PMID:12562637

  5. Association between Women Veterans’ Experiences with VA Outpatient Healthcare and Designation as a Women’s Health Provider in Primary Care Clinics

    PubMed Central

    Bastian, Lori A.; Trentalange, Mark; Murphy, Terrence E.; Brandt, Cynthia; Bean-Mayberry, Bevanne; Maisel, Natalya C.; Wright, Steven M.; Gaetano, Vera S.; Allore, Heather; Skanderson, Melissa; Reyes-Harvey, Evelyn; Yano, Elizabeth M.; Rose, Danielle; Haskell, Sally

    2016-01-01

    Background Women Veterans comprise a small percentage of VA healthcare users. Prior research on women Veterans’ experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women’s healthcare by designated women’s health providers (DWHPs). Little is known about the quality of healthcare delivered by DWHPs and women Veterans’ experience with care from these providers. Methods Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity (DAWC) that discerns between DWHPs versus non-DWHPs. Findings Of the 28,994 surveys mailed to women Veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n=1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (RR=1.02 95% CI=1.01−1.04) reported higher overall experiences with care compared to patients seen by non-DWHPs. Conclusions The main finding is that women Veterans’ overall experiences with outpatient healthcare are slightly better for those receiving care from DWHPs compared to those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women Veterans’ experiences. Our work provides support to increase access to DWHPs at VA primary care clinics. PMID:25442706

  6. Rainbows: a primary health care initiative for primary schools.

    PubMed

    Munns, Ailsa; Forde, Karen A; Krouzecky, Miriam; Shields, Linda

    2015-01-01

    Within the current Australian health system is the understanding of a need to change from the predominate biomedical model to incorporate a comprehensive primary health care centred approach, embracing the social contexts of health and wellbeing. Recent research investigated the benefits of the primary health care philosophy and strategies in relation to the Rainbows programme which addresses grief and loss in primary school aged students in Western Australia. A multidisciplinary collaboration between the Western Australian Departments of Health and Education enabled community school health nurse coordinators to train teacher facilitators in the implementation of Rainbows, enabling support for students and their parents. The results of this qualitative study indicate that all participants regard Rainbows as effective, with many perceived benefits to students and their families. PMID:26281402

  7. Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana’s Community-based Health Planning and Services (CHPS)

    PubMed Central

    2014-01-01

    Background Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana. Methods This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones. Results The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban

  8. Health Is Primary: Family Medicine for America’s Health

    PubMed Central

    Phillips, Robert L.; Pugno, Perry A.; Saultz, John W.; Tuggy, Michael L.; Borkan, Jeffrey M.; Hoekzema, Grant S.; DeVoe, Jennifer E.; Weida, Jane A.; Peterson, Lars E.; Hughes, Lauren S.; Kruse, Jerry E.; Puffer, James C.

    2014-01-01

    PURPOSE More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to “renew the specialty to meet the needs of people and society,” some of which bore important fruit. Family Medicine for America’s Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim). METHODS Family Medicine for America’s Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included. RESULTS The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of

  9. Primary Health Care Needs of Immigrants.

    ERIC Educational Resources Information Center

    Department of Health, Education, and Welfare, Washington, DC.

    This report constitutes the response by the Department of Health, Education, and Welfare (DHEW) to 1977 and 1978 Congressional directives to assess immigrants' access to health care and the impact of immigrants on public health services and resources. Areas covered in the report are: (1) the primary health care needs of immigrants, including…

  10. Primary Health Care and Narrative Medicine.

    PubMed

    Murphy, John W

    2015-01-01

    Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery. PMID:26222094

  11. Primary Health Care and Narrative Medicine

    PubMed Central

    Murphy, John W

    2015-01-01

    Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery. PMID:26222094

  12. Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care

    PubMed Central

    2011-01-01

    Background Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR) has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR) trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting. Methods A multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS) tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149) were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated) groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters) and chest x-rays (pneumonia iCPR only) between intervention and control providers. Discussion Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to

  13. Teaching Primary Health Care: An Interdisciplinary Approach.

    ERIC Educational Resources Information Center

    Bezzina, Paul; Keogh, Johann J.; Keogh, Mariana

    1998-01-01

    Nursing and radiology students (n=15) at the University of Malta who completed an interdisciplinary module on primary health care reported they found the theoretical material applicable to practice; the module enabled them to learn about their potential role in primary health care. (SK)

  14. Improving mental health through primary care.

    PubMed Central

    Dowrick, C

    1992-01-01

    The government white paper Health of the nation has highlighted mental health as a key issue for the next decade. Primary care is being encouraged to take a leading role in developing effective services for people with mental health problems. This paper reviews current research on key aspects of mental health in adults: the prevalence of mental health problems, improving detection and management of mental health problems, the role of counselling, and communication between primary and secondary care. Recommendations are made for initiatives in both research and service development. PMID:1457175

  15. Traveller health and primary care in Ireland: a consultative forum.

    PubMed

    Van Hout, Marie Claire

    2010-05-01

    Travellers in Ireland continue to experience health disparity, cultural fragmentation and a lack of visibility in health service provision. This paper reports on a pilot study exploring factors that affect Traveller health and the experiences of primary care services from the perspectives of key Traveller health stakeholders in Ireland. The study was designed as an initial consultative forum using a single focus group (n = 13) in order to yield specific recommendations for the development of a designated primary care service framework for Travellers. A thematic analysis of the narratives identified key areas of interest--emerging issues in Traveller health, recognition of Traveller culture and ethnic identity,Traveller uptake of primary care services, the role of the primary health care Traveller (PHCT) worker, and recommendations for a primary care service framework for Travellers in Ireland. The findings highlight the importance of consulting Traveller communities in the design of a primary care service framework within each local needs analysis. The promotion of Traveller advocacy, visible access and referral pathways can therefore be achieved, with PHCT workers acting as a 'bridge' between Travellers and the designated area primary care team. PMID:20503791

  16. Strengthening the delivery of asthma and chronic obstructive pulmonary disease care at primary health-care facilities: study design of a cluster randomized controlled trial in Pakistan

    PubMed Central

    Khan, Muhammad Amir; Ahmed, Maqsood; Anil, Shirin; Walley, John

    2015-01-01

    Background Respiratory diseases, namely asthma and chronic obstructive pulmonary disease (COPD), account for one-fourth of the patients at the primary health-care (PHC) facilities in Pakistan. Standard care practices to manage these diseases are necessary to reduce the morbidity and mortality rate associated with non-communicable diseases in developing countries. Objective To develop and measure the effectiveness of operational guidelines and implementation materials, with sound scientific evidence, for expanding lung health care, especially asthma and COPD through PHC facilities already strengthened for tuberculosis (TB) care in Pakistan. Design A cluster randomized controlled trial with two arms (intervention and control), with qualitative and costing study components, is being conducted in 34 clusters; 17 clusters per arm (428 asthma and 306 COPD patients), in three districts in Pakistan from October 2014 to December 2016. The intervention consists of enhanced case management of asthma and COPD patients through strengthening of PHC facilities. The main outcomes to be measured are asthma and COPD control among the registered cases at 6 months. Cluster- and individual-level analyses will be done according to intention to treat. Residual confounding will be addressed by multivariable logistic and linear regression models for asthma and COPD control, respectively. The trial is registered with ISRCTN registry (ISRCTN 17409338). Conclusions Currently, only about 20% of the estimated prevalent asthma and COPD cases are being identified and reported through the respective PHC network. Lung health care and prevention has not been effectively integrated into the core PHC package, although a very well-functioning TB program exists at the PHC level. Inclusion of these diseases in the already existent TB program is expected to increase detection rates and care for asthma and COPD. PMID:26578109

  17. The Participatory Imperative in Primary Health Care.

    ERIC Educational Resources Information Center

    Hollnsteiner, Mary Racelis

    1982-01-01

    This article presents the major issues, trends, interpretations, and difficulties facing Primary Health Care (PHC) personnel in taking the drastic steps required to reform the health care system. The author argues that PHC aims to enable people to take responsibility for their own health and further the redistribution of resources. (SSH)

  18. Primary health care nurse practitioners in Canada.

    PubMed

    DiCenso, Alba; Auffrey, Lucille; Bryant-Lukosius, Denise; Donald, Faith; Martin-Misener, Ruth; Matthews, Sue; Opsteen, Joanne

    2007-08-01

    Canada, like many countries, is in the midst of primary health care reform. A key priority is to improve access to primary health care, especially in remote communities and areas with physician shortages. As a result, there is an increased emphasis on the integration of primary health care nurse practitioners. As of March 2006, legislation exists in all provinces and two territories in Canada that allows nurse practitioners (NPs) to implement their expanded nursing role. In this paper, we will briefly review the historical development of the NP role in Canada and situate it in the international context; describe the NP role, supply of NPs in the country, and the settings in which they work; propose an NP practice model framework; summarize facilitators and barriers to NP role implementation in primary health care delivery; and outline strategies to address the barriers. PMID:18041990

  19. 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

  20. Setting standards for primary health services.

    PubMed

    Garner, P; Thomason, J

    1993-10-01

    Clear performance guidelines, appropriate resources, supportive supervision, and appropriate training are needed to help primary health workers to uphold high-quality care. The Ministry of Health in Papua New Guinea and authorities of provincial health divisions have developed minimum standards for all levels of the primary health service, which supervisors use to monitor the performance of workers. These levels are aidposts with 1 community health worker, aidposts with 2 community health workers, health subcenters, health centers, and urban clinics. The standards are part of the National Health Plan. They form the basis for developing a national quality assurance plan. These standards allow health workers to understand what they need to do and supervisors to know on what to focus. They also allow the monitoring of quality care and rational planning. They guard against inappropriate health infrastructure development in areas where local politicians are active in sectoral investments. Some examples of standards for the first level of primary health services are: An orderly or a community health worker at an aidpost provides basic care for a population of 500-1000 people. The community health worker provides outpatient care each working day from 8 to 1300 hours. He/she needs to be available to provide care of acute minor illnesses evenings from 18 to 2000 hours and on call for serious illness at all times. The community health worker follows up on mothers and children seen at the maternal and child health clinic. He/she promotes family planning and provides oral contraceptives an injections. Each aidpost must have an outpatient treatment area suitable for conducting child clinics and patient examinations: sink; water supply; pharmacy; and sterilizer. The community health worker's house must have a tin roof, an external tank, and a latrine. PMID:8273154

  1. The new Australian Primary Health Networks: how will they integrate public health and primary care?

    PubMed

    Booth, Mark; Hill, Graham; Moore, Michael J; Dalla, Danielle; Moore, Michael G; Messenger, Anne

    2016-01-01

    On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding. The two main objectives of the new PHNs, as stated on the Department of Health's website, are "increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time". Below are three viewpoints, commissioned for this primary health care themed issue of Public Health Research & Practice, from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney-based PHN. We asked the authors to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape. Our authors have pointed out the huge overlap between public health and primary care and looked at evidence showing the great benefits for health systems of collaboration between the two. Challenges ahead include a possible government focus on delivery of 'frontline' medical services, which may come at the expense of population health, and the complexity of dealing with all primary health care stakeholders, including health professionals, Local Health Districts, nongovernment organisations, research institutions and local communities. PMID:26863166

  2. [Evolution of primary health care in Spain].

    PubMed

    Martínez Riera, José Ramón

    2012-12-01

    Coinciding with the celebration of the 35th anniversary of the journal of nursing, invented in 1977, conducted a systematic review of all issues published (371) to identify items (222) and news (94) related to primary care health. Events are arranged temporarily and refer to accompanying the evolution of primary care model. The Analysis Shows the evolution of primary care, since its inception in 1978, has been reflected in the type of articles and the content of news published, be an excellent indicator of its development and contribution for the nurses. PMID:23390875

  3. Crossing the divide: primary care and mental health integration.

    PubMed

    Upshur, Carole C

    2005-03-01

    This paper describes the views of primary care providers about treating depression among adult Medicaid patients and their experiences with managed behavioral health care. It also shows the outcomes of an intervention project that provides a care manager to facilitate connections among PCPs, patients, and behavioral health providers. Despite widespread initiatives to improve depression management in primary care and to manage behavioral health services, it appears that links between the two systems and the use of evidence-based approaches to managing patients are rare. A pilot project to initiate practice redesign, the use of a care manager to assist in patient support, and compliance with both medical and behavioral health treatment has been shown to improve communication and results in positive patient outcomes. Managed behavioral health care can result in incentive structures that create gaps between primary care and behavioral health systems. This project illustrates an initiative co-sponsored by the Massachusetts behavioral health program designed to strengthen links between behavioral health and primary care, and increase rates and effectiveness of depression treatment. PMID:15844853

  4. Integrating Behavioral Health into Primary Care.

    PubMed

    McGough, Peter M; Bauer, Amy M; Collins, Laura; Dugdale, David C

    2016-04-01

    Depression is one of the more common diagnoses encountered in primary care, and primary care in turn provides the majority of care for patients with depression. Many approaches have been tried in efforts to improve the outcomes of depression management. This article outlines the partnership between the University of Washington (UW) Neighborhood Clinics and the UW Department of Psychiatry in implementing a collaborative care approach to integrating the management of anxiety and depression in the ambulatory primary care setting. This program was built on the chronic care model, which utilizes a team approach to caring for the patient. In addition to the patient and the primary care provider (PCP), the team included a medical social worker (MSW) as care manager and a psychiatrist as team consultant. The MSW would manage a registry of patients with depression at a clinic with several PCPs, contacting the patients on a regular basis to assess their status, and consulting with the psychiatrist on a weekly basis to discuss patients who were not achieving the goals of care. Any recommendation (eg, a change in medication dose or class) made by the psychiatrist was communicated to the PCP, who in turn would work with the patient on the new recommendation. This collaborative care approach resulted in a significant improvement in the number of patients who achieved care plan goals. The authors believe this is an effective method for health systems to integrate mental health services into primary care. (Population Health Management 2016;19:81-87). PMID:26348355

  5. Integrating Behavioral Health into Primary Care

    PubMed Central

    Bauer, Amy M.; Collins, Laura; Dugdale, David C.

    2016-01-01

    Abstract Depression is one of the more common diagnoses encountered in primary care, and primary care in turn provides the majority of care for patients with depression. Many approaches have been tried in efforts to improve the outcomes of depression management. This article outlines the partnership between the University of Washington (UW) Neighborhood Clinics and the UW Department of Psychiatry in implementing a collaborative care approach to integrating the management of anxiety and depression in the ambulatory primary care setting. This program was built on the chronic care model, which utilizes a team approach to caring for the patient. In addition to the patient and the primary care provider (PCP), the team included a medical social worker (MSW) as care manager and a psychiatrist as team consultant. The MSW would manage a registry of patients with depression at a clinic with several PCPs, contacting the patients on a regular basis to assess their status, and consulting with the psychiatrist on a weekly basis to discuss patients who were not achieving the goals of care. Any recommendation (eg, a change in medication dose or class) made by the psychiatrist was communicated to the PCP, who in turn would work with the patient on the new recommendation. This collaborative care approach resulted in a significant improvement in the number of patients who achieved care plan goals. The authors believe this is an effective method for health systems to integrate mental health services into primary care. (Population Health Management 2016;19:81–87) PMID:26348355

  6. Health Activities for Primary School Students.

    ERIC Educational Resources Information Center

    Peace Corps, Washington, DC. Information Collection and Exchange Div.

    This manual targets new and second-year Peace Corps volunteers, presenting health lessons and activities for primary school students in Thailand. Each section of the manual outlines basic technical information about the topic, contains several detailed lesson plans, and lists quick activities that can be carried out at schools. Songs and recipes…

  7. Managing Health and Safety in Primary Science

    ERIC Educational Resources Information Center

    Borrows, Peter

    2003-01-01

    Since science in primary schools is very safe, the coordinator's role in respect of health and safety can be a relatively modest one and integrated with other parts of the job. In this article, the author outlines the role of the science coordinator and sources of advice.

  8. Primary Principals' Leadership Styles, School Organizational Health and Workplace Bullying

    ERIC Educational Resources Information Center

    Cemaloglu, Necati

    2011-01-01

    Purpose: The purpose of this paper is to determine the relationships between leadership styles of primary school principals and organizational health and bullying. Design/methodology/approach: Two hypotheses were formulated in relation to the research. Three instruments were used--a multi-level questionnaire for measuring leadership, an…

  9. Integrating mental health into primary health care in Iraq

    PubMed Central

    2011-01-01

    The Ministry of Health in Iraq is undertaking a systematic programme to integrate mental health into primary care in order to increase population access to mental health care. This paper reports the evaluation of the delivery of a ten day interactive training programme to 20% of primary care centres across Iraq. The multistage evaluation included a pre- and post-test questionnaire to assess knowledge, attitudes and practice in health workers drawn from 143 health centres, a course evaluation questionnaire and, in a random sample of 41 clinics, direct observation of health workers skills and exit interviews of patients, comparing health workers who had received the training programme with those from the same clinics who had not received the training. Three hundred andseventeen health workersparticipated in the training, which achieved an improvement in test scores from 42.3% to 59%. Trained health workers were observed by research psychiatrists to have a higher level of excellent skills than the untrained health workers, and patient exit interviews also reported better skills in the trained rather than untrained health workers. The two week course has thus been able to achieve significant change, not only in knowledge, but also in subsequent demonstration of trained practitioners practical skills in the workplace. Furthermore, it has been possible to implement the course and the evaluation despite a complex conflict situation. PMID:22479291

  10. Primary Health Networks and Aboriginal and Torres Strait Islander health.

    PubMed

    Couzos, Sophia; Delaney-Thiele, Dea; Page, Priscilla

    2016-04-01

    The Australian Government has established that the health of Aboriginal and Torres Strait Islander peoples is a priority for the newly established 31 Primary Health Networks (PHNs). Efforts to reduce the high hospitalisation rates of Aboriginal people will require PHNs to build formal participatory structures with Aboriginal health organisations to support best practice service models. There are precedents as to how PHNs can build formal partnerships with Aboriginal community controlled health services (ACCHSs), establish an Aboriginal and Torres Strait Islander steering committee to guide strategic plan development, and work towards optimising comprehensive primary care. All health services within PHN boundaries can be supported to systematically and strategically improve their responsiveness to Aboriginal and Torres Strait Islander people by assessing systems of care, adopting best practice models, embedding quality assurance activity, and participating in performance reporting. PHNs can be guided to adopt an Aboriginal and Torres Strait Islander-specific quality improvement framework, agree to local performance measures, review specialist and other outreach services to better integrate with primary health care, enhance the cultural competence of services, and measure and respond to progress in reducing potentially preventable hospitalisations. Through collaborations and capacity building, PHNs can transition certain health services towards greater Aboriginal community control. These proposals may assist policy makers to develop organisational performance reporting on PHN efforts to close the gap in Aboriginal health disparity. PMID:27031397

  11. [Clinical bioethics for primary health care].

    PubMed

    González-de Paz, L

    2013-01-01

    The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health. PMID:23608158

  12. [The scientific entertainer in primary health care].

    PubMed

    Ortega-Calvo, Manuel; Santos, José Manuel; Lapetra, José

    2012-09-01

    The scientific method is capable of being applied in primary care. In this article we defend the role of the "scientific entertainer "as strategic and necessary in achieving this goal. The task has to include playful and light-hearted content. We explore some words in English that may help us to understand the concept of "scientific entertainer" from a semantic point of view (showman, master of ceremonies, entrepreneur, go-between) also in Spanish language (counsellor, mediator, methodologist) and finally in Latin and Greek (tripalium, negotium, chronos, kairos). We define the clinical, manager or research health-worker who is skilled in primary care as a "primarylogist". PMID:22018794

  13. Primary health care of the newborn baby.

    PubMed

    Bhakoo, O N; Kumar, R

    1990-01-01

    More than 50% of infant deaths in India occur during the neonatal period. High priority therefore needs to be given to improving the survival of newborns. A large number of neonatal deaths have their origin in the perinatal period and are mainly determined by the health and nutritional status of the mother, the quality of care during pregnancy and delivery, and the immediate care of the newborn at birth. Main causes of neonatal mortality are birth asphyxia, respiratory problems, and infections, especially tetanus. Most such deaths occur among low birthweight babies. Hypothermia, undernutrition, and mismanaged breast feeding may also indirectly contribute to neonatal mortality. Community-based studies have, however, demonstrated that most neonatal mortality can be affordably prevented through primary health care. Efforts are underway to expand the health care infrastructure, but the outreach of maternal and child health care remains unsatisfactory especially in rural areas. PMID:12319228

  14. Traditional health practitioners as primary health care workers.

    PubMed

    Hoff, W

    1997-01-01

    The author conducted a field study in 1993 to evaluate the effectiveness of four projects that were training traditional health practitioners (THPs) to provide primary health care (PHC) services in Ghana, Mexico, and Bangladesh. The study, funded by a grant from the World Health Organization, Division of Strengthening Health Services, concluded that incorporating trained THPs in PHC programmes can be cost effective in providing essential and culturally relevant health services to communities. The main objective of the study was to evaluate how effective the training projects were and to determine what impacts they might have upon the communities served. A qualitative field evaluation was performed using data collected from project documents, observations, and field interviews with a selection of health agency staff, THPs, and community members. A summary of results is presented from the four field studies. For details refer to the full report. PMID:9204727

  15. Migrant health care: creativity in primary care.

    PubMed

    Artemis, L

    1996-01-01

    Historically, migrant health care services have always been in a precarious position for funding. The government currently proposes major cuts in federally and state-funded programs for indigent and underserved populations, making this state of precariousness the rule, rather than the exception. The primary care practitioner, therefore, must provide quality, cost-effective care with minimal resources. Case studies illustrate how services can be provided using creativity and community resources. PMID:9447073

  16. Curriculum Design in Health Education

    ERIC Educational Resources Information Center

    Conceicao, Simone C. O.; Colby, Holly; Juhlmann, Anne; Johaningsmeir, Sarah

    2011-01-01

    While health care providers are knowledgeable of health conditions and of the information patients need to make appropriate health decisions and follow health providers' recommendations, they lack information about adult teaching and learning and appropriate curriculum design. Adult educators can contribute more sophisticated skills in program…

  17. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

    PubMed

    Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

  18. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

    PubMed Central

    Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

  19. Primary health care and the Midwest flood disaster.

    PubMed Central

    Axelrod, C; Killam, P P; Gaston, M H; Stinson, N

    1994-01-01

    The Midwest flood disaster of 1993 ravaged communities across a 9-State area. Homes were destroyed, roads closed, and services disrupted. Economic costs, including loss of revenue from farming and loss of jobs, are estimated at more than $1 billion. Even as people continue to rebuild their lives 1 year later, renewed flooding has occurred in some areas. A community-based primary health care system can be described as a system of services that (a) offers all members of a family continuous, comprehensive, quality health services throughout their lives; (b) includes case management and coordinated referrals to other related services when necessary; (c) is usually provided by family practitioners, general internists, general pediatricians, obstetricians-gynecologists, nurse practitioners, certified nurse midwives, and physician assistants; and (d) has community involvement in the development and management of the system to assure that it meets the changing needs and the diversity of the people it is designed to serve. This paper uses the floods to describe the impact of a disaster on primary health care services and primary health care systems. This includes changes in the demand for services (as evidenced by the frequency and type of patient visits) and the ability of the system to respond to these changes. The effect of a disaster on access to primary health care is discussed. PMID:7938379

  20. Design and Multi-Country Validation of Text Messages for an mHealth Intervention for Primary Prevention of Progression to Hypertension in Latin America

    PubMed Central

    Diez-Canseco, Francisco; Zavala-Loayza, J Alfredo; Beratarrechea, Andrea; Kanter, Rebecca; Ramirez-Zea, Manuel; Rubinstein, Adolfo; Martinez, Homero

    2015-01-01

    Background Mobile health (mHealth) has been posited to contribute to the reduction in health gaps and has shown fast and widespread growth in developing countries. This growth demands understanding of, and preparedness for, local cultural contexts. Objective To describe the design and validation of text messages (short message service, SMS) that will be used for an mHealth behavioral change intervention to prevent hypertension in three Latin American countries: Argentina, Guatemala, and Peru. Methods An initial set of 64 SMS text messages were designed to promote healthy lifestyles among individuals in different stages of behavior change, addressing four key domains: salt and sodium intake, fruit and vegetable intake, consumption of high fat and sugar foods, and physical activity. The 64 SMS text messages were organized into nine subsets for field validation. In each country 36 people were recruited, half of them being male. Of the participants, 4 per country evaluated each subset of SMS text messages, which contained between 6 and 8 SMS text messages regarding different key domains and stages of change. The understanding and appeal of each SMS text message was assessed using a 7-item questionnaire. The understanding and appeal ratings were used to reach a final set of 56 SMS text messages. Results Overall, each of the 64 SMS text messages received a total of 12 evaluations (4 per country). The majority of evaluations—742 out of a total of 767 (96.7%) valid responses—revealed an adequate understanding of the key idea contained in the SMS text message. On a scale from 1 to 10, the average appeal score was 8.7 points, with a range of 4 to 10 points. Based on their low scores, 8 SMS text messages per country were discarded. Once the final set of 56 SMS text messages was established, and based on feedback obtained in the field, wording and content of some SMS text messages were improved. Of the final set, 9, 8, and 16 of the SMS text messages were improved based on

  1. Multidisciplinary teamwork in US primary health care.

    PubMed

    Solheim, Karen; McElmurry, Beverly J; Kim, Mi Ja

    2007-08-01

    Primary health care (PHC) is a systems perspective for examining the provision of essential health care for all. A multidisciplinary collaborative approach to health care delivery is associated with effective delivery and care providers' enrichment. Yet data regarding multidisciplinary practice within PHC are limited. The purpose of this exploratory qualitative descriptive study was to better understand team-based PHC practice in the US. Aims included (a) describing nursing faculty involvement in PHC, (b) analyzing ways that multidisciplinary work was enacted, and (c) recommending strategies for multidisciplinary PHC practice. After institutional review board (IRB) protocol approval, data collection occurred by: (a) surveying faculty/staff in a Midwestern nursing college (N=94) about their PHC practice, and (b) interviewing a purposive sample of nursing faculty/staff identified with PHC (n=10) and their health professional collaborators (n=10). Survey results (28% return rate) were summarized, interview notes were transcribed, and a systematic process of content analysis applied. Study findings show team practice is valued because health issues are complex, requiring different types of expertise; and because teams foster comprehensive care and improved resource use. Mission, membership attributes, and leadership influence teamwork. Though PHC is not a common term, nurses and their collaborators readily associated their practice with a PHC ethos. PHC practice requires understanding community complexity and engaging with community, family, and individual viewpoints. Though supports exist for PHC in the US, participants identified discord between their view of population needs and the health care system. The following interpretations arise from this study: PHC does not explicitly frame health care activity in the US, though some practitioners are committed to its ethics; and, teamwork within PHC is associated with better health care and rewarding professional

  2. Reproductive health in India's primary health care system.

    PubMed

    Rao, M

    1997-01-01

    India's family planning program having reached a dead end, the government of India appointed an expert group to develop a new population policy for the country. While the group's report, submitted in May 1994, proclaimed a new orientation described as pro-poor, pro-nature, and pro-women, the recommendations of the report were criticized as not being serious about gender equity. The government of India, describing a new reproductive health care approach, envisions a paradigm shift in the family planning program strategy. Reproductive health is defined as a state in which people can reproduce and regulate their fertility, women are able to go through pregnancy and childbirth safely, the outcome of pregnancy is successful with regard to maternal and infant survival and well-being, and couples are able to have sexual relations free of the fear of pregnancy and of contracting disease. To further the discussion on the newly initiated reproductive health care approach, the faculty of the Center of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi, organized a workshop for November 4-5, 1996, on the place of reproductive health in India's primary health care. The workshop brought together public health persons, clinicians, and health and women's rights activists. The author outlines the content of papers presented at the workshop. PMID:9230606

  3. Primary battery design and safety guidelines handbook

    NASA Astrophysics Data System (ADS)

    Bragg, Bobby J.; Casey, John E.; Trout, J. Barry

    1994-12-01

    This handbook provides engineers and safety personnel with guidelines for the safe design or selection and use of primary batteries in spaceflight programs. Types of primary batteries described are silver oxide zinc alkaline, carbon-zinc, zinc-air alkaline, manganese dioxide-zionc alkaline, mercuric oxide-zinc alkaline, and lithium anode cells. Along with typical applications, the discussions of the individual battery types include electrochemistry, construction, capacities and configurations, and appropriate safety measures. A chapter on general battery safety covers hazard sources and controls applicable to all battery types. Guidelines are given for qualification and acceptance testing that should precede space applications. Permissible failure levels for NASA applications are discussed.

  4. Primary battery design and safety guidelines handbook

    NASA Technical Reports Server (NTRS)

    Bragg, Bobby J.; Casey, John E.; Trout, J. Barry

    1994-01-01

    This handbook provides engineers and safety personnel with guidelines for the safe design or selection and use of primary batteries in spaceflight programs. Types of primary batteries described are silver oxide zinc alkaline, carbon-zinc, zinc-air alkaline, manganese dioxide-zionc alkaline, mercuric oxide-zinc alkaline, and lithium anode cells. Along with typical applications, the discussions of the individual battery types include electrochemistry, construction, capacities and configurations, and appropriate safety measures. A chapter on general battery safety covers hazard sources and controls applicable to all battery types. Guidelines are given for qualification and acceptance testing that should precede space applications. Permissible failure levels for NASA applications are discussed.

  5. Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

    PubMed Central

    2013-01-01

    Background The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective. Methods A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework. Results Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care. Conclusion Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices

  6. Experience of Behvarzes (Iranian primary healthcare providers) from giving primary health services in health houses

    PubMed Central

    Keshvari, Mahrokh; Mohammadi, Eesa; Farajzadegan, Ziba; Zargham-Boroujeni, Ali

    2016-01-01

    Background: Primary healthcare (PHC) providers play a major role in provision of public health in rural areas in Iran. They are considered as the key elements of health development in rural population. There is limited research on clarification of their experiences from provision of health services in their working conditions. This study aimed to clarify the experience of PHC providers from working conditions in giving primary health services in health houses (district branches of rural health care centers). Materials and Methods: This is a content analysis qualitative study, conducted through personal and group interviews with 12 health workers working in health care centers in rural areas in Isfahan province, 2010. Sampling continued until data saturation. Data were analyzed through conventional content analysis and constant comparative method. Results: Data analysis led to extraction of 11 categories, and finally, four themes of “ignoring the rights,” “causing tension in working climate,” “pressure or overload of expectations beyond the power,” and “occupational worn out” were yielded from the categories. These themes reveal the concepts and nature of PHC providers’ experiences from giving health care at health houses as the first level of PHC centers. Conclusion: The results of the present study showed that the PHC providers work in a tense condition in health houses. Although they devote themselves to the health of society members, their own health is neglected. Policy makers and authorities should amend working conditions of PHC providers through modification of resources and making supportive and collaborative strategies to improve the quality of services and promote the health level of the service receivers. PMID:27512699

  7. Distributed information system architecture for Primary Health Care.

    PubMed

    Grammatikou, M; Stamatelopoulos, F; Maglaris, B

    2000-01-01

    We present a distributed architectural framework for Primary Health Care (PHC) Centres. Distribution is handled through the introduction of the Roaming Electronic Health Care Record (R-EHCR) and the use of local caching and incremental update of a global index. The proposed architecture is designed to accommodate a specific PHC workflow model. Finally, we discuss a pilot implementation in progress, which is based on CORBA and web-based user interfaces. However, the conceptual architecture is generic and open to other middleware approaches like the DHE or HL7. PMID:11187702

  8. The missing link – the role of primary care in global health

    PubMed Central

    Rao, Mala; Pilot, Eva

    2014-01-01

    This chapter provides an overview of the role of primary care in the context of global health. Universal health coverage is a key priority for WHO and its member states, and provision of accessible and safe primary care is recognised as essential to meet this important international policy goal. Nevertheless, more than three decades after Alma Ata, the provision of primary health care remains inadequate, indicating that primary care has not received the priority it deserves, in many parts of the world. This is despite the proven health benefits that result from access to comprehensive primary health care. We highlight some examples of good practice and discuss the relevance of primary care in the context of health equity and cost-effectiveness. Challenges that influence the success of primary care include the availability of a qualified workforce, financing and system design and quality assurance and patient safety. PMID:24560266

  9. Project Design Concept Primary Ventilation System

    SciTech Connect

    MCGREW, D.L.

    2000-10-02

    Tank Farm Restoration and Safe Operation (TFRSO), Project W-3 14 was established to provide upgrades that would improve the reliability and extend the system life of portions of the waste transfer, electrical, ventilation, instrumentation and control systems for the Hanford Site Tank Farms. An assessment of the tank farm system was conducted and the results are documented in system assessment reports. Based on the deficiencies identified in the tank farm system assessment reports, and additional requirements analysis performed in support of the River Protection Project (RPP), an approved scope for the TFRSO effort was developed and documented in the Upgrade Scope Summary Report (USSR), WHC-SD-W314-RPT-003, Rev. 4. The USSR establishes the need for the upgrades and identifies the specific equipment to be addressed by this project. This Project Design Concept (PDC) is in support of the Phase 2 upgrades and provides an overall description of the operations concept for the W-314 Primary Ventilation Systems. Actual specifications, test requirements, and procedures are not included in this PDC. The PDC is a ''living'' document, which will be updated throughout the design development process to provide a progressively more detailed description of the W-314 Primary Ventilation Systems design. The Phase 2 upgrades to the Primary Ventilation Systems shall ensure that the applicable current requirements are met for: Regulatory Compliance; Safety; Mission Requirements; Reliability; and Operational Requirements.

  10. Primary health services at district level in South Africa: a critique of the primary health care approach

    PubMed Central

    2012-01-01

    Background The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa’s progress and attempts at implementing primary health care, various factors still limit its success. Discussion Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied. There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation. Summary A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment. PMID:22748078

  11. Enhancing Primary Health Care Services for Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Melville, C. A.; Finlayson, J.; Cooper, S.-A.; Allan, L.; Robinson, N.; Burns, E.; Martin, G.; Morrison, J.

    2005-01-01

    Primary health care teams have an important part to play in addressing the health inequalities and high levels of unmet health needs experienced by people with intellectual disabilities (ID). Practice nurses have an expanding role within primary health care teams. However, no previous studies have measured their attitudes, knowledge, training…

  12. Community participation to design rural primary healthcare services

    PubMed Central

    2014-01-01

    Background This paper explores how community participation can be used in designing rural primary healthcare services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as useful in planning services and is understood as particularly relevant in rural settings, partly due to high social capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from top-down standard models to contextual plans arising from population health planning that incorporates community participation. This paper addresses an evidence gap about the outcomes of using community participation in (re)designing rural community health services. Methods Community-based participatory action research was applied in four Scottish case study communities in 2008–10. Data were collected from four workshops held in each community (total 16) and attended by community members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings and selections from workshops are presented. Results Community members identified consistent health priorities, including local practitioners, emergency triage, anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models to address health priorities. One community did not design a service model and another replicated the current model despite initial enthusiasm for innovation. Conclusions Communities differ in their receptiveness to engaging in innovative service design, but some will create new models that fit in a given budget. Design diversity indicates that context influences local healthcare planning, suggesting community participation impacts on design outcomes, but standard service models maybe useful as part of the evidence in community participation discussions

  13. Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

    PubMed Central

    Mukumbang, Ferdinand C.; van Belle, Sara; Marchal, Bruno; van Wyk, Brian

    2016-01-01

    Background The antiretroviral adherence club intervention was rolled out in primary health care facilities in the Western Cape province of South Africa to relieve clinic congestion, and improve retention in care, and treatment adherence in the face of growing patient loads. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory—the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not). Methods We adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective. Results We classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase. Conclusion The perspectives of the programme designers and managers provided an important step towards developing

  14. Epidemiology of primary health problems in Beirut.

    PubMed Central

    Armenian, H K; Halabi, S S; Khlat, M

    1989-01-01

    As a result of 12 years of civil war in Lebanon, it has been impossible to collect regular morbidity information at the primary level. This report is based on a case-control analysis of various health problems as identified from a population based health survey in Beirut in 1983-1984. Cases of headache, backpain and peptic ulcer, as identified from this survey of 2752 households, were matched for age, sex, and neighbourhood with controls from the same sample. Cases and controls were compared for the presence of various characteristics as collected in the household interview. Headaches were more prevalent in females and in the higher educational categories, and the odds ratio was 1.3 (95 per cent confidence interval 1.01-1.68) for the married compared to the non-married. In comparisons of backpain, the odds ratio for alcohol consumption was 2.40 (1.14-5.08), and for belonging to skilled and unskilled labour categories of occupation it was 2.33 (1.05-5.15) when the analysis was limited to the employed group only. Although the peptic ulcer cases were of lower educational background compared to their controls, no other findings were identified in this third case-control comparison. The methodological shortcomings of such studies and the various interpretations of the findings are presented in the discussion. PMID:2533238

  15. Primary care: can it solve employers' health care dilemma?

    PubMed

    Sepulveda, Martin-J; Bodenheimer, Thomas; Grundy, Paul

    2008-01-01

    Employers are beginning to recognize that investing in the primary care foundation of the health care system may help address their problems of rising health care costs and uneven quality. Primary care faces a crisis as a growing number of U.S. medical graduates are avoiding primary care careers because of relatively low reimbursement and an unsatisfying work life. Yet a strong primary care sector has been associated with reduced health care costs and improved quality. Through the Patient-Centered Primary Care Collaborative and other efforts, some large employers are engaged in initiatives to strengthen primary care. PMID:18180490

  16. Implementing Family Health Nursing in Tajikistan: from policy to practice in primary health care reform.

    PubMed

    Parfitt, Barbara Ann; Cornish, Flora

    2007-10-01

    The health systems of former Soviet Union countries are undergoing reform away from the highly centralised, resource-intensive, specialised and hierarchical Soviet system, towards a more generalist, efficient health service with greater focus on primary health care. Family Health Nursing is a new model designed by WHO Europe in which skilled generalist community nurses deliver primary health care to local communities. This paper presents a qualitative evaluation of the implementation of Family Health Nursing in Tajikistan. Using Stufflebeam's 'Context, Input, Process, and Product' model, the paper aims to evaluate the progress of this reform, and to understand the factors that help or hinder its implementation. A four-phase research design investigates the development of the Family Health Nurse role over time. In 5 rural areas, 6 focus groups and 18 interviews with Family Health Nurses, 4 observations of their practice, 7 interviews with families and 9 interviews with physicians were carried out. Data were analysed according to the components of Stufflebeam's model. Although the legacy of the Soviet health system did not set a precedent for a nurse who is capable of decision-making and who works in partnership with the physician, Family Health Nurses were successfully implementing new practices. Crucial to their ability to do so were the co-operation of physicians and families. Physicians were impressed by the nurses' development of knowledge, and families were impressed that the nurses could offer real solutions to their problems. However, failure to pay the nurses regular salaries had led to serious attrition of the workforce. We conclude that the success of the Family Health Nurse role in other countries will depend upon its position in relation to the historical health care system. PMID:17651876

  17. Primary Health Care in Canada: Systems in Motion

    PubMed Central

    Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

    2011-01-01

    Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. Methods: This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Findings: Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Conclusions: Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. PMID:21676023

  18. Primary health care and public health: foundations of universal health systems.

    PubMed

    White, Franklin

    2015-01-01

    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. PMID:25591411

  19. Primary Health Care Experiences in the Developing World: Lessons for Canada?

    PubMed Central

    Robinson, Sheila A.

    1990-01-01

    Primary health care, as practised in many developing countries, is a set of guidelines for designing health strategies that are both appropriate to the health needs of the population and to cultural and socio-economic contexts. Four aspects of primary health care experience in developing countries may be relevant to Canadian health care: the integration of health and development, participation of the community in problem identification and program planning, the role of the community-based worker, and the use of health information. Canadian physicians may draw on this experience to address present challenges in our health system: providing health services to marginal groups, viewing health in a broader perspective, the escalating costs of health services, and increasing community involvement in planning health services. PMID:21249109

  20. Metrics for assessing improvements in primary health care.

    PubMed

    Stange, Kurt C; Etz, Rebecca S; Gullett, Heidi; Sweeney, Sarah A; Miller, William L; Jaén, Carlos Roberto; Crabtree, Benjamin F; Nutting, Paul A; Glasgow, Russell E

    2014-01-01

    Metrics focus attention on what is important. Balanced metrics of primary health care inform purpose and aspiration as well as performance. Purpose in primary health care is about improving the health of people and populations in their community contexts. It is informed by metrics that include long-term, meaning- and relationship-focused perspectives. Aspirational uses of metrics inspire evolving insights and iterative improvement, using a collaborative, developmental perspective. Performance metrics assess the complex interactions among primary care tenets of accessibility, a whole-person focus, integration and coordination of care, and ongoing relationships with individuals, families, and communities; primary health care principles of inclusion and equity, a focus on people's needs, multilevel integration of health, collaborative policy dialogue, and stakeholder participation; basic and goal-directed health care, prioritization, development, and multilevel health outcomes. Environments that support reflection, development, and collaborative action are necessary for metrics to advance health and minimize unintended consequences. PMID:24641561

  1. Students' Knowledge of and Attitudes towards Primary Health Care.

    ERIC Educational Resources Information Center

    Chalmers, Karen I.; Luker, Karen A.; Bramadat, Ina J.

    1998-01-01

    A survey of 427 British nursing students found that all had been exposed to primary health care (PHC) concepts; most had positive attitudes about PHC; and differences in knowledge appeared among degree, health visitor, and district nursing students. (SK)

  2. Health Careers Education for Rural Primary Schoolchildren

    ERIC Educational Resources Information Center

    Gorton, Susan M.

    2011-01-01

    International and national studies have reported that health professionals who grew up in a rural area are more likely to return to work in a rural area than their urban raised counterparts. The chronic severe shortage of health professionals in rural and remote Australia has meant inequitable health care for rural and remote communities and a…

  3. StreetHealth - improving access to primary care.

    PubMed

    Hookey, Susan J

    2012-01-01

    Homeless, marginalised and other disadvantaged groups may be reluctant to access mainstream health services. StreetHealth, a mobile street-based after hours primary healthcare service, was developed to address the primary health care needs of disadvantaged groups in the western Melbourne region of Victoria. This article describes StreetHealth and reflects on strategies to improve access to primary care services in this population. Mainstream general practices may like to consider and adapt some of these strategies to better meet the needs of similar patients in their community. PMID:22276289

  4. Providing primary health care through integrated microfinance and health services in Latin America.

    PubMed

    Geissler, Kimberley H; Leatherman, Sheila

    2015-05-01

    The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic

  5. Health communication in primary health care -A case study of ICT development for health promotion

    PubMed Central

    2013-01-01

    Background Developing Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel. Methods A qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis. Results Health communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel. Conclusions Health communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health

  6. [Social inequalities in health and primary care. SESPAS Report 2012].

    PubMed

    Hernández-Aguado, Ildefonso; Santaolaya Cesteros, María; Campos Esteban, Pilar

    2012-03-01

    The health system is a social determinant of health. Although not the most important determinant of health, the health system's potential contribution to reducing social inequalities in health should not be underestimated. Due to its characteristics, primary health care is well placed to attain equity in health. To make progress in achieving this goal, the main measures to be considered are the removal of barriers to access to services, the provision of care proportionate to need, and engagement in intersectoral work. This article reviews the background and framework for action to tackle social inequalities in health and provides a summary of the primary health care actions that could help to reduce social inequalities in health and are mentioned in the most important national and international documents on health policy. We hope to stimulate debate, promote research in the field and encourage implementation. The proposals are grouped in the following five intervention lines: information systems; participation; training; intersectoral work; and reorientation of health care. Each intervention is ordered according to its targets (population and civil society; primary health team; health center and health area management; and health policy decision-makers). PMID:22321945

  7. Exercise-referral scheme to promote physical activity among hypertensive patients: design of a cluster randomized trial in the Primary Health Care Units of Mexico’s Social Security System

    PubMed Central

    2014-01-01

    Background Although the benefits of physical activity (PA) on to prevent and manage non-communicable diseases are well known, strategies to help increase the levels of PA among different populations are limited. Exercise-referral schemes have emerged as one effective approach to promote PA; however, there is uncertainty about the feasibility and effectiveness of these schemes in settings outside high-income countries. This study will examine the effectiveness of a scheme to refer hypertensive patients identified in Primary Health Care facilities (PHCU) of the Mexican social security institution to a group PA program offered in the same institution. Methods and design We will describe the methods of a cluster randomized trial study designed to evaluate the effectiveness of an exercise referral scheme to increasing physical activity in hypertensive patients compared to a non-referral scheme. Four PHCU were selected for the study; the PHCU will take part as the unit of randomization and sedentary hypertensive patients as the unit of assessment. 2 PHCU of control group (GC) will provide information to hypertensive patients about physical activity benefits and ways to increase it safely. 2 PHCU of intervention group (IG) will refer patients to sports facilities at the same institution, to follow a group-based PA program developed to increase the PA levels with a designed based on the Transtheoretical Model and Social Cognitive Theory. To evaluate the effects of the intervention as well as short-term maintenance of the intervention’s effects, PA will be assessed at baseline, at 24 and 32 weeks of follow-up. The main outcome will be the difference before and after intervention in the percentage of participants meeting recommended levels of PA between and within intervention and control groups. PA will be measured through self-report and with objective measure by accelerometer. Discussion This study will allow us to evaluate a multidisciplinary effort to link the primary

  8. Health Literacy in Primary Care Practice.

    PubMed

    Hersh, Lauren; Salzman, Brooke; Snyderman, Danielle

    2015-07-15

    Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension. Additionally, printed information should be written at or below a fifth- to sixth-grade reading level. Visual aids, graphs, or pictures can enhance patient understanding, as can more concrete presentation of numerical information. PMID:26176370

  9. Primary health care trading companies for sustainable development.

    PubMed

    Soeters, R; Nzala, S

    1994-01-01

    A programme of comprehensive primary health care in Zambia has been accompanied by the emergence of autonomous, non-profit trading and production companies that sell health-related goods to communities and health institutions and find markets for locally produced good. PMID:8141978

  10. Primary Health Care in Africa: Implications for Teacher Education.

    ERIC Educational Resources Information Center

    Tambo, Leke I.

    1991-01-01

    Delivery of primary health care (PHC) programs is critical to rural African health care. The paper explores the school's role in PHC delivery and indicates ways that professional health personnel and teacher educators can cooperate in preparing teachers with necessary knowledge and skills to participate meaningfully in PHC delivery. (SM)

  11. Status of Health Appraisal Services for Primary School Children in Edo State, Nigeria

    ERIC Educational Resources Information Center

    Ojugo, Augustine I.

    2005-01-01

    The purpose of this study was to determine the status of the health appraisal services provided for primary school children in Edo State, Nigeria. Using the cross-sectional survey design a total of 1506 primary school children were selected from across the state as the study participants. The analysis of data collected through a 14-item…

  12. Integration of mental health into primary care in Kenya.

    PubMed

    Jenkins, Rachel; Kiima, David; Njenga, Frank; Okonji, Marx; Kingora, James; Kathuku, Dammas; Lock, Sarah

    2010-06-01

    Integration of mental health into primary care is essential in Kenya, where there are only 75 psychiatrists for 38 million population, of whom 21 are in the universities and 28 in private practice. A partnership between the Ministry of Health, the Kenya Psychiatric Association and the World Health Organization (WHO) Collaborating Centre, Institute of Psychiatry, Kings College London was funded by Nuffield Foundation to train 3,000 of the 5,000 primary health care staff in the public health system across Kenya, using a sustainable general health system approach. The content of training was closely aligned to the generic tasks of the health workers. The training delivery was integrated into the normal national training delivery system, and accompanied by capacity building courses for district and provincial level staff to encourage the inclusion of mental health in the district and provincial annual operational plans, and to promote the coordination and supervision of mental health services in primary care by district psychiatric nurses and district public health nurses. The project trained 41 trainers, who have so far trained 1671 primary care staff, achieving a mean change in knowledge score of 42% to 77%. Qualitative observations of subsequent clinical practice have demonstrated improvements in assessment, diagnosis, management, record keeping, medicine supply, intersectoral liaison and public education. Around 200 supervisors (psychiatrists, psychiatric nurses and district public health nurses) have also been trained. The project experience may be useful for other countries also wishing to conduct similar sustainable training and supervision programmes. PMID:20671901

  13. Organisation of Prevention in Primary Health Care.

    ERIC Educational Resources Information Center

    Council of Europe, Strasbourg (France).

    This report examines the possiblities of increasing the amount of preventive work being carried out by primary care workers in European communities. Before making practical recommendations about promoting prevention, an analysis is presented of the main present day problems. These center on the environment (not only physical but also social and…

  14. Primary care in Cuba: a public health approach.

    PubMed

    Swanson, K A; Swanson, J M; Gill, A E; Walter, C

    1995-01-01

    Cuba's primary health care model is presented. Unlike ambulatory care services, which are but one component of primary care, Cuba's model is a comprehensive public health approach that meets the World Health Organization's definition of primary care. The history of the development of Cuba's model is presented, including an update on the innovative neighborhood/home clinics. Achievements in health outcomes as a result of Cuba's model and the consequences for women's health care are discussed. Examples are presented of the effects on health care delivery of the economic hardship that Cuba has experienced since 1991 as a result of the loss of 85% of its trade with the former Soviet Union and the intensified U.S. embargo. A critique of Cuba's model concludes the article. PMID:7649887

  15. Assessing health literacy in safety net primary care practices.

    PubMed

    McCune, Renée L; Lee, Hyunhwa; Pohl, Joanne M

    2016-02-01

    Health literacy is now recognized as a crucial element of patient safety. Measuring health literacy in busy primary care practices can be challenging. This article presents findings from a study in which a relatively recent tool, the Newest Vital Sign (NVS) was used in seven safety net primary care practices, five of which were nurse managed health centers. The NVS is a promising tool that could be used extensively in most primary care practices. Providers and staff felt the use of the NVS would be beneficial in identifying low health literacy patients. This study supported previous research on low health literacy as well as the predictors of health literacy. The study also confirmed the NVS as a tool that is efficient to administer while maintaining work flow. PMID:26856512

  16. 78 FR 69520 - Designation of the Primary Freight Network

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-19

    ... 6, 2013 (78 FR 8686), introduced the process for designation of the highway PFN, NFN, and CRFCs... Federal Highway Administration Designation of the Primary Freight Network AGENCY: Federal Highway... initial designation of the highway Primary Freight Network (PFN), which is established by the Secretary...

  17. Primary Health Care: Comparing Public Health Nursing Models in Ireland and Norway

    PubMed Central

    Leahy-Warren, Patricia; Day, Mary Rose

    2013-01-01

    Health of populations is determined by a multitude of contextual factors. Primary Health Care Reform endeavors to meet the broad health needs of populations and remains on international health agendas. Public health nurses are key professionals in the delivery of primary health care, and it is important for them to learn from global experiences. International collaboration is often facilitated by academic exchanges. As a result of one such exchange, an international PHN collaboration took place. The aim of this paper is to analyse the similarities and differences in public health nursing in Ireland and Norway within the context of primary care. PMID:23606956

  18. Engaging primary healthcare nurses in men's health education: A pilot study.

    PubMed

    Rizio, Taletha A; Thomas, Wendy J; O'Brien, Anthony Paul; Collins, Veronica; Holden, Carol A

    2016-03-01

    Many countries have identified a need for targeted men's health promotion within primary health care as part of broader men's health policy. Primary health care nurses are well placed to deliver such services but may lack the requisite skills. The aim of this study was to pilot the delivery phase of an education program and evaluate a train-the-trainer approach for delivering men's health education to primary health care nurses. The 8-h train-the-trainer workshop was designed to equip nurses to deliver men's health education workshops to peers. Surveys of facilitators (n = 18) and peer workshop participants (n = 98) evaluated their level of confidence in men's health and knowledge and skills in men's health promotion. After completing the train-the-trainer workshop, most facilitators expressed confidence (92%), and all indicated sufficient knowledge and access to resources to deliver a peer workshop. All agreed that the module was sufficiently flexible to suit their local setting. Following the peer education workshop, facilitators and workshop participants reported high levels of confidence and knowledge in men's health promotion. This pilot evaluation suggests train-the-trainer is an effective model to deliver men's health education across a range of settings, with a flexible approach to raising awareness and improving the skills of primary health care nurses in men's health promotion. PMID:26803801

  19. Primary Health Care Evaluation: the view of clients and professionals about the Family Health Strategy1

    PubMed Central

    da Silva, Simone Albino; Baitelo, Tamara Cristina; Fracolli, Lislaine Aparecida

    2015-01-01

    Objective: to evaluate the attributes of primary health care as for access; longitudinality; comprehensiveness; coordination; family counseling and community counseling in the Family Health Strategy, triangulating and comparing the views of stakeholders involved in the care process. Method: evaluative research with a quantitative approach and cross-sectional design. Data collected using the Primary Care Assessment Tool for interviews with 527 adult clients, 34 health professionals, and 330 parents of children up to two years old, related to 33 family health teams, in eleven municipalities. Analysis conducted in the Statistical Package for Social Sciences software, with a confidence interval of 95% and error of 0.1. Results: the three groups assessed the first contact access - accessibility with low scores. Professionals evaluated with a high score the other attributes. Clients assigned low score evaluations for the attributes: community counseling; family counseling; comprehensiveness - services rendered; comprehensiveness - available services. Conclusions: the quality of performance self-reported by the professionals of the Family Health Strategy is not perceived or valued by clients, and the actions and services may have been developed inappropriately or insufficiently to be apprehended by the experience of clients. PMID:26487150

  20. Interprofessional collaboration in primary health care

    PubMed Central

    Bond, John; Cartlidge, Ann M.; Gregson, Barbara A.; Barton, Andrew G.; Philips, Peter R.; Armitage, Paul; Brown, Anna M.; Reedy, Barry L.E.C.

    1987-01-01

    A study of interprofessional collaboration involving 148 general practitioner and district nurse pairs and 161 general practitioner and health visitor pairs was undertaken in 20 health districts throughout England in 1982-83. Data were collected using personal interviews and a prospective record of referrals and consultations. The ratings of collaboration recorded showed that only 27% of general practitioner-district nurse pairs and 11% of general practitioner-health visitor pairs were working in partial or full collaboration. Structural arrangements such as attachment, the number of general practitioners that community nurses work with, and working from the same building were found to be strongly associated with collaboration. ImagesFigure 2. PMID:3694572

  1. The health effects of decentralizing primary care in Brazil.

    PubMed

    Guanais, Frederico C; Macinko, James

    2009-01-01

    A renewed focus on primary health care could lead to improved health outcomes in developing countries. Moving more control to local authorities, or decentralization, is one approach to expanding primary care's reach. Proponents argue that it increases responsiveness to local needs and helps local resources reach those in need. Critics argue that it might increase fragmentation and disparities and provide opportunities for local economic and political gains that do not improve population health. We explore questions surrounding decentralization using the example of infant mortality in Brazil. Our study of two programs identified positive effects on health outcomes in the context of infant mortality. PMID:19597212

  2. Training managers for primary health care.

    PubMed

    Kekki, P

    1994-01-01

    The University of Helsinki has devised a powerful in-service training course for managers of health centres. By working together at the University and their own centres on setting objectives, analysing data and solving problems, the participants greatly enhance their management and teamwork skills. PMID:7945761

  3. The self-help component of primary health care.

    PubMed

    Robinson, D

    1980-10-01

    The target of "health for all by 2000," to be achieved through primary health care, is discussed. The author states that the goal entails reorganization of health care and community participation at the local level. Self-help groups are proposed as an effective and efficient vehicle for participation by the people in their own health care, and the strong points of such groups, including emotional and psychological support, and orientation toward action and progress, are described. Another major feature is that participants become their own health care personnel, achieving some expertise in the management of their particular illness or disability. Clubs for hypertensives, wherein participants learn to monitor and control their blood pressure, are used as an example of the self-help group. The author suggests that self-help could be a basic component of primary health care, and contribute to "health for all." PMID:7444489

  4. Providing Perinatal Mental Health Services in Pediatric Primary Care

    ERIC Educational Resources Information Center

    Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

    2009-01-01

    After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…

  5. Tuberculosis diagnosis: primary health care or emergency medical services?

    PubMed Central

    Andrade, Rubia Laine de Paula; Scatolin, Beatriz Estuque; Wysocki, Anneliese Domingues; Beraldo, Aline Ale; Monroe, Aline Aparecida; Scatena, Lúcia Marina; Villa, Tereza Cristina Scatena

    2013-01-01

    OBJECTIVE To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fisher's exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physician's responsibility. CONCLUSIONS Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control. PMID:24626553

  6. [Chronicity and primary care: the role of prison health].

    PubMed

    Morral-Parente, R

    2015-10-01

    The Prison Primary Health Care Teams in Catalonia have been integrated into the Catalan Health Institute. This integration shall facilitate¹ training and updating, while eliminating the existing differences between the health services belonging to prison institutions and those of the Catalan Health Service. It shall enable team work and coordination between Primary Health Care Teams in the community and the PHCTs in prisons within the same geographical area by sharing ongoing training, multi-sector work teams and territory-based relations, thereby facilitating continuance in care and complete and integrated treatment of chronicity. The existing information systems in Primary Health Care and the shared clinical history in Catalonia are key factors for this follow up process. Support tools for clinical decision making shall also be shared, which shall contribute towards an increase in quality and clinical safety. These tools include electronic clinical practice guides, therapeutic guides, prescription alert systems, etc. This shall be an opportunity for Prison Health Care Teams to engage in teaching and research, which in turn shall have an indirect effect on improvements in health care quality and the training of professionals in this sector. The critical factor for success is the fact that a unique chronicity health care model shall be shared, where measures for health promotion prevention can be taken, along with multi-sector monitoring of pathologies and with health care information shared between professionals and levels throughout the patient's life, both in and out of the prison environment. PMID:26191790

  7. Noise in Primary Schools: Implications for Design

    ERIC Educational Resources Information Center

    Lewis, P. T.

    1977-01-01

    An evaluation of various plan forms for primary schools analyzes school activities in terms of their acoustic characteristics. The acoustic properties of different teaching spaces and the extent to which these meet the needs of the various types of activity are discussed. (Author/MLF)

  8. The Australian experiment: how primary health care organizations supported the evolution of a primary health care system.

    PubMed

    Nicholson, Caroline; Jackson, Claire L; Marley, John E; Wells, Robert

    2012-03-01

    Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system. PMID:22403246

  9. Primary Mental Health Care in Disasters: Armero, Colombia.

    ERIC Educational Resources Information Center

    Lima, Bruno R.

    This paper focuses on the mental health consequences of the disaster in Armero, Colombia which resulted from a volcanic eruption and mudslide, and highlights the role of the primary care worker in delivering mental health care to disaster victims. Eight characteristics of disasters that are closely related to their psychopathogenetic potential…

  10. Primary health care in Turkey: a passing fashion?

    PubMed

    Tatar, M; Tatar, F

    1997-09-01

    The Alma-Ata Declaration has long been regarded as a watershed in the health policy arena. The global goal of the World Health Organization, 'Health for All by the Year 2000' through primary health care, has attracted many countries both in the developed and the developing world and commitments to this end have been made at every level. However, albeit this consensus on the paper, a common and explicit definition of the concept has not been reached yet. This paper aims at discussing various definitions of primary health care that emerged after the Declaration and also presenting a case study from Turkey, a country that advocates primary health care in her recent health policy reform attempts. After setting the conceptual framework for discussion the Turkish case is presented by using research carried out among Turkish policy-makers at different levels of the State apparatus. It has been concluded that application of primary health care principles as defined in the broad definition of the concept requires major changes or rather shake-ups in Turkey. These areas are outlined briefly at the end of the paper. PMID:10173403

  11. Assessing Health Literacy in Diverse Primary Care Settings

    ERIC Educational Resources Information Center

    McCune, Renee L.

    2010-01-01

    Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills.…

  12. Physical access to primary health care in Andean Bolivia.

    PubMed

    Perry, B; Gesler, W

    2000-05-01

    Limited physical access to primary health care is a major factor contributing to the poor health of populations in developing countries, particularly in mountain areas with rugged topography, harsh climates and extensive socioeconomic barriers. Assessing physical access to primary health care is an important exercise for health care planners and policy makers. The development of geographic information system (GIS) technology has greatly improved this assessment process in industrialized countries where digital cartographic data are widely available. In developing countries particularly in mountain areas, however, detailed cartographic data, even in hardcopy form, are nonexistent, inaccurate or severely lacking. This paper uses GIS technology to assess physical access to primary health care in a remote and impoverished region of Andean Bolivia. In addition, it proposes an alternative model of health personnel distribution to maximize physical accessibility. Methods involved extensive fieldwork in the region, utilizing GPS (global positioning system) technology in the development of the GIS and gathering other pertinent health data for the study. Satellite imagery also contributed to the development of the GIS and in the modeling process. The results indicate significant variation in physical access to primary health care across the three study sites. More importantly, this paper highlights the use of GIS technology as a powerful tool in improving physical accessibility in mountain areas of developing countries. PMID:10728839

  13. Proactive Learning in Primary Health Care: An Adult Education Model.

    ERIC Educational Resources Information Center

    Marsick, Victoria J.

    1988-01-01

    A two-week workshop was held by the United Nations Children Fund and the World Health Organization for planners of training in primary health care (PHC) to increase their ability to plan effectively for PHC training. The emphasis was on placing training within the national context and ensuring that people would be trained to meet national goals.…

  14. Implementing the role of the primary care mental health worker: a qualitative study

    PubMed Central

    England, Elizabeth; Lester, Helen

    2007-01-01

    Background Primary care mental health workers are a new role recently introduced into primary care in England to help manage patients with common mental health problems. Aim To explore the views of GPs, primary care teams and patients on the value and development of the new role of primary care mental health workers in practice. Design of study Qualitative study. Setting The Heart of Birmingham Primary Care Teaching Trust in the West Midlands, UK. Method Thirty-seven semi-structured interviews involving seven primary care mental health workers, 21 patients and 11 focus groups involving 38 members of primary care teams were held with six teams with a worker. Two teams asked for the worker to be removed. Six practice managers also took part in the study. Results A number of different approaches were used to implement this new role. Strategies that incorporated the views of primary care trust senior management, primary care teams and workers' views appeared most successful. Rapid access to a healthcare professional at times of stress and the befriending role of the worker were also highly valued. Workers felt that their role left them professionally isolated at times. A number of workers described tension around ownership of the role. Conclusion Primary care mental health workers appear to provide a range of skills valued by patients and the primary care teams and can increase patient access and choice in this area of health care. Successful implementation strategies highlighted in this study may be generalisable to other new roles in primary care. PMID:17359607

  15. How integrating primary care and public health could improve population health outcomes: a view from Liverpool, UK.

    PubMed

    Gosling, Rachael; Davies, Sandra M; Hussey, John A

    2016-01-01

    Although primary care is at the forefront of delivering healthcare to the population, its role in preventing poor health has varied throughout history. Faced with growing demand on healthcare services and a rise in noncommunicable diseases, some health systems are attempting to integrate healthcare delivery with broader population health and wellbeing interventions. Liverpool has a rich history of taking action to improve population health; this paper discusses a range of interventions that have taken place across the city. There is a renewed opportunity to systematise approaches to primary and secondary prevention, strengthened by the lead that general practitioners now have in commissioning health services and their accountability for improved population health outcomes through clinical commissioning groups. This is strongly articulated in the Healthy Liverpool program, a city-wide plan for health and care services. This paper suggests that four key enablers strengthen delivery of public health priorities through primary care: maximising opportunities to identify risk factors for preventable disease, fully exploiting the data collected in primary care to plan and design services, responding to community needs and assets through community engagement, and addressing wider determinants of health through strong partnerships. PMID:26863165

  16. Knowledge of Maternal and Newborn Care Among Primary Level Health Workers in Kapilvastu District of Nepal

    PubMed Central

    Acharya, D; Paudel, R; Gautam, K; Gautam, S; Upadhyaya, T

    2016-01-01

    Background: Higher maternal and neonatal deaths are common in low- and middle-income countries; due to less access to skilled help. Adequate knowledge and skills on maternal and newborn care (MNC) of community health workers can improve maternal and newborn health. Aims: To identify the knowledge of primary level health workers on some components of MNC. Subjects and Methods: Respondents were selected using simple random sampling method. For collecting the data, enumerators visited health institutions for 2 months from 1st October to 31st November 2012, and structured interview schedule was used to gather the information. A cross-sectional study was conducted in a total of one hundred and thirty-seven primary level health workers in Kapilvastu district, Nepal. The Chi-square test was employed to examine the association between the knowledge of health workers on MNC and designation and work experience. Data were analyzed using SPSS version 17. Results: In a total of 137 primary level health workers, more than half 53.2% (73/137) were senior auxiliary health workers/health assistant. Health workers having correct knowledge on contents of MNC were-registration 32.1% (44/137), major components of antenatal care 57.7% (79/137), danger signs of pregnancy 39.4% (54/137), five cleans 59.1% (81/137), postnatal health problems 54.0% (74/137), majority to health action to newborn care, newborn bath and meaning of exclusive breastfeeding. There was a statistical association between designation of health workers and above-mentioned components of MNC (P < 0.05). Conclusions: The differentials in the knowledge of MNC among primary level health suggest improving knowledge of the grass root level health workers with appropriate training and development programs. PMID:27144073

  17. Primary prevention in public health: an analysis of basic assumptions.

    PubMed

    Ratcliffe, J; Wallack, L

    1985-01-01

    The common definition of primary prevention is straightforward; but how it is transformed into a framework to guide action is based on personal and societal feelings and beliefs about the basis for social organization. This article focuses on the two contending primary prevention strategies of health promotion and health protection. The contention between the two strategies stems from a basic disagreement about disease causality in modern society. Health promotion is based on the "lifestyle" theory of disease causality, which sees individual health status linked ultimately to personal decisions about diet, stress, and drug habits. Primary prevention, from this perspective, entails persuading individuals to forgo their risk-taking, self-destructive behavior. Health protection, on the other hand, is based on the "social-structural" theory of disease causality. This theory sees the health status of populations linked ultimately to the unequal distribution of social resources, industrial pollution, occupational stress, and "anti-health promotion" marketing practices. Primary prevention, from this perspective, requires changing existing social and, particularly, economic policies and structures. In order to provide a basis for choosing between these contending strategies, the demonstrated (i.e., past) impact of each strategy on the health of the public is examined. Two conclusions are drawn. First, the health promotion strategy shows little potential for improving the public health, because it systematically ignores the risk-imposing, other-destructive behavior of influential actors (policy-makers and institutions) in society. And second, effective primary prevention efforts entail an "upstream" approach that results in far-reaching sociopolitical and economic change. PMID:20841269

  18. Humanization policy in primary health care: a systematic review

    PubMed Central

    Nora, Carlise Rigon Dalla; Junges, José Roque

    2013-01-01

    OBJECTIVE To analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy. METHODS A systematic review of the literature was carried out, followed by a meta-synthesis, using the following databases: BDENF (nursing database), BDTD (Brazilian digital library of theses and dissertations), CINAHL (Cumulative Index to nursing and allied health literature), LILACS (Latin American and Caribbean health care sciences literature), MedLine (International health care sciences literature), PAHO (Pan-American Health Care Organization Library) and SciELO (Scientific Electronic Library Online). The following descriptors were used: Humanization; Humanizing Health Care; Reception: Humanized care: Humanization in health care; Bonding; Family Health Care Program; Primary Care; Public Health and Sistema Único de Saúde (the Brazilian public health care system). Research articles, case studies, reports of experiences, dissertations, theses and chapters of books written in Portuguese, English or Spanish, published between 2003 and 2011, were included in the analysis. RESULTS Among the 4,127 publications found on the topic, 40 studies were evaluated and included in the analysis, producing three main categories: the first referring to the infrastructure and organization of the primary care service, made clear the dissatisfaction with the physical structure and equipment of the services and with the flow of attendance, which can facilitate or make difficult the access. The second, referring to the health work process, showed issues about the insufficient number of professionals, fragmentation of the work processes, the professional profile and responsibility. The third category, referring to the relational technologies, indicated the reception, bonding, listening, respect and dialog with the service users. CONCLUSIONS Although many practices were cited as humanizing they do not produce changes

  19. Providing primary health care with non-physicians.

    PubMed

    Chen, P C

    1984-04-01

    The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined. PMID:6497324

  20. Identifying Teachable Moments for Health Behavior Counseling in Primary Care

    PubMed Central

    Cohen, Deborah J.; Clark, Elizabeth C.; Lawson, Peter J.; Casucci, Brad; Flocke, Susan A.

    2015-01-01

    Objective Situations with potential to motivate positive change in unhealthy behavior have been called ‘teachable moments.’ Little is known about how they occur in the primary care setting. Methods Cross-sectional observational design. Audio-recordings collected during 811 physician-patient interactions for 28 physicians and their adult patients were analyzed using Conversation Analysis. Results Teachable moments were observed in 9.8% of the cases, and share three features: (1) the presence of a concern that is salient to the patient that is either obviously relevant to an unhealthy behavior, or through conversation comes to be seen as relevant; (2) a link that is made between the patient’s salient concern and a health behavior that attempts to motivate the patient toward change; and (3) a patient response indicating a willingness to discuss and commit to behavior change. Additionally, we describe phenomena related to, but not teachable moments, including teachable moment attempts, missed opportunities, and health behavior advice. Conclusions Success of the teachable moment rests on the physician’s ability to identify and explore the salience of patient concerns and recognize opportunities to link them with unhealthy behaviors. PMID:21183305

  1. Immunization: a key to primary health care.

    PubMed

    1983-01-01

    Focus of this discussion is on some of the problems enountered by national immunization programs and on the technology that is available now or that will be in the near future to help solve these problems. 4 basic aspects of immunization services are examined: the safety, effectiveness, and stability of vaccines; the cold chain, i.e., the transportation, storage, and handling of heat-sensitives vaccines from manufacturer to health worker in the field; vaccination equipment and sterilization for correct administration of immunization; and program management--schedules, records, training, resource allocation. The section devoted to vaccines focuses on immunization against 6 of (diphtheria, whooping cough, tetanus, measles, polio, and tuberculosis) against 6 of the major killers of children in developing countries: BCG, DPT (diphtheria-pertussis-tetanus), measles and poli vaccines, and tetanus toxiod. The bacillus of Calmette and Guerline (BCG) is considered a very safe vaccine. Questions about the effectiveness of BCG in preventing tuberculosis have been raised throughout its 60-year history. Different studies have produced conflicting results, some showing BCG to be highly effective and others showing no positive effect. Diphtheria toxioid, a very safe and relatively stable vaccine, is very effective in protecting against the development of diphtheria. Live attenuated measles virus vaccine is a safe, highly effective vaccine, but it requires careful handling and storage to prevent damage due to excessive heat or light exposure. The vaccine used for pertussis (whooping cough) is a saline suspension of killed Bordetella pertussis bacteria. The vaccine usually is administered as part of the triple DPT vaccine. Concerns about its safety have led to greatly reduced levels of use in some European countries in recent years. Its effectiveness also has been questioned. 2 types of polio vaccine are available: a live, attenuated vaccine given orally (Sabin) and a killed or

  2. Community Health Risk Assessment of Primary Aluminum Smelter Emissions

    PubMed Central

    Larivière, Claude

    2014-01-01

    Objective: Primary aluminum production is an industrial process with high potential health risk for workers. We consider in this article how to assess community health risks associated with primary aluminum smelter emissions. Methods: We reviewed the literature on health effects, community exposure data, and dose–response relationships of the principal hazardous agents emitted. Results: On the basis of representative measured community exposure levels, we were able to make rough estimates on health risks associated with specific agents and categorize these as none, low, medium, or high. Conclusions: It is possible to undertake a rough-estimate community Health Risk Assessment for individual smelters on the basis of information available in the epidemiological literature and local community exposure data. PMID:24806724

  3. The effect of problem-based learning in patient education after an event of CORONARY heart disease – a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study

    PubMed Central

    2012-01-01

    Background Even though there is convincing evidence that self-care, such as regular exercise and/or stopping smoking, alters the outcomes after an event of coronary heart disease (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention programmes are structurally and pedagogically applied using adult learning principles e.g. problem-based learning (PBL). Until now, most education programs for patients with CHD have not been based on such principles. The basic aim is to discover whether PBL provided in primary health care (PHC) has long-term effects on empowerment and self-care after an event of CHD. Methods/Design A randomised controlled study is planned for patients with CHD. The primary outcome is empowerment to reach self-care goals. Data collection will be performed at baseline at hospital and after one, three and five years in PHC using quantitative and qualitative methodologies involving questionnaires, medical assessments, interviews, diaries and observations. Randomisation of 165 patients will take place when they are stable in their cardiac condition and have optimised cardiac medication that has not substantially changed during the last month. All patients will receive conventional care from their general practitioner and other care providers. The intervention consists of a patient education program in PHC by trained district nurses (tutors) who will apply PBL to groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients in the control group will not attend a PBL group but will receive home-sent patient information on 11 occasions during the year. Discussion We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy and empowerment to achieve self-care goals significantly more than one year of standardised home-sent patient information. The assumption is that PBL will reduce cardiovascular events in the long-term and will also be cost-effective compared to

  4. The strategy, cost, and progress of primary health care.

    PubMed

    Boland, R G; Young, M E

    1982-01-01

    Since the 1978 Alma-Alta International Conference on Primary Health Care, investments in primary health care projects throughout the world have been increasing. However, with the exception of China, no national projects have demonstrated the ability to provide longterm comprehensive primary health care in conditions of chronic proverty with local resources. Programs in China, Cuba, and Tanzania have achieved primary health care coverage for 100% of their populations. These countries have in common strong governments that have been able to implement radical changes in the health system. Individual freedoms in these societies have been restricted in favor of improved health. Programs in Nigeria, India, and Afghanistan have been less successful, although some progress has been made in projects using external funds, inspite of a strong committment by the governments. Efforts to reorganize the health care system have lacked needed political strength. Currently, these systems have resulted in less than complete coverage, without the prospect of attaining acceptable levels of infant mortality, life expectancy and net population growth. Economic, political, and cultural costs may be high as for example, national security or traditional practices are traded to achieve primary health care with 100% coverage. WHO has devised a global strategy which, when translated into operational policies will need to address several unresolved issues. These include recognizing that the goal of comprehensive primary health care may not be justified given the lack of progress to date and that effective, selective primary health care focused on nutrition, immunization, control of endemic diseases, and health education may be a more realistic goal; and that a system of international social security may be an effective means of assuring that the poorest countries are able to provide care. In addition, questions concerning continued funding of programs that can never be locally funded, the role

  5. Two models on primary health care approach of Region VII.

    PubMed

    Ricana, C

    1981-01-01

    This article presents descriptions of 2 experiences with primary health care in Region VII of the Philippines: the Sudtonggan Human Resource Development Project and the Consolacion Integrated Baranguay Area Development Project. In the Sudtonggan project, a community assembly identified 3 priority activities--increased income, accessible schooling, and health services--and invited government agencies and private agencies such as the Institute of Cultural Affairs to assist. Government agencies delivered medical assistance, road improvements, school facility construction, and extension technical works, while private agencies extended capital loans and training grants, market development, and technical expertise. Today 3 locally based industries are operable in the community, and 20% of their income is targeted for support of social programs in the areas of health and education. A health clinic has been established, as well as a school and recreational facilities. In the 2nd experiment, the aranguay was divided into 3 development projects focusing on industrial development; residential, commercial, and institutional development; and agricultural development. Coalitions of agencies were formed to provide more comprehensive services in areas such as health and nutrition. Voluntary health workers, selected out of community assemblies, received training and assisted rural health midwives in baranguay health stations. These 2 experiences indicate that primary health care is most effective when it is based in a community that is cognizant of its needs and problems and has the resolve to protect the health of its members. PMID:12313221

  6. Effects of Training Programme on HIV/AIDS Prevention among Primary Health Care Workers in Oyo State, Nigeria

    ERIC Educational Resources Information Center

    Ajuwon, Ademola; Funmilayo, Fawole; Oladepo, Oladimeji; Osungbade, Kayode; Asuzu, Michael

    2008-01-01

    Purpose: The purpose of this paper is to train primary health care workers to be trainers and implementers of community-based AIDS prevention activities in Oyo State, Nigeria, by describing an evaluation of the project. Design/methodology/approach: A total of 148 primary health care workers recruited from the 33 local government areas (LGA) of the…

  7. Genetic competencies essential for health care professionals in primary care.

    PubMed

    Engstrom, Janet L; Sefton, Marlene G S; Matheson, Jolie Kim; Healy, Kristine M

    2005-01-01

    The completion of the sequencing of the human genome in 2003 signaled the onset of the genomic era in health care. The knowledge gleaned from the Human Genome Project has led to the understanding that every health problem has a genetic component and that clinicians should include the application of genetic information in all aspects of health care. This article describes the genetic competencies essential for all health care professionals in primary care. Health care professionals should augment their current practice by obtaining a multigenerational genetic family history for each patient, assessing all patients for potentially heritable conditions, providing referrals to genetic health professionals as needed, offering genetic testing when indicated, and considering an individual's genetic makeup in the selection of medications and treatments for that person. Finally, all health care professionals ought to be prepared to address the complex personal, cultural, theological, ethical, legal, and social issues associated with genetic testing and other genetic issues commonly encountered in clinical practice. PMID:15894994

  8. Health needs assessment in primary care: the evolution of a practical public health approach.

    PubMed

    Kilduff, A; McKeown, K; Crowther, A

    1998-05-01

    The purpose of the paper is to place health needs assessment in its primary care context. This is a dynamic context where changes in policies, staff roles and patient expectations have all to be considered. Given this complexity and the variations between practices, it is necessary to help primary health care teams (PHCTs) to understand their stage of development and how this will directly affect any health needs assessment. The technical and methodological aspects of health needs assessment have been explored and described by others, and that work will not be duplicated here. This paper reviews the health needs assessment (HNA) work of the Ribblesdale Total Purchasing Project (RTPP) and then sets this review against the political, organisational, professional and practical pressures that currently confront primary care. Out of this analysis emerges a diagnostic and development tool which links together, and emphasises the intimate relationships between, five stages of development needed for effective primary care-oriented health needs assessment work. The emphasis is on understanding the place of health needs assessment within the general processes and systems of the primary health care team. The paper concludes by suggesting ways in which public health practitioners and specialists might approach the task of supporting and influencing the evolution of the recently proposed Primary Care Groups and Primary Care Trusts. The overall intention of the article is to stimulate debate and action. PMID:9629025

  9. Revitalizing primary health care--another utopian goal?

    PubMed

    Marahatta, Sujan B

    2010-01-01

    The quest for greater efficiency, fairness and responsiveness to the expectation of the people that system serve have brought about three generations of health system reforms in the twentieth century. The first generation saw the founding of national health care systems and extension to middle income nations of social insurance systems in the 1940s and 1950s. By the late 1960s the rising costs of hospital based care, its usage by better off, inaccessibility by the poor and rural population of even the most basic services heralded second generation reforms promoting primary health care as a means of achieving the affordable universal coverage. It included the best public health strategy that is prevention and the highest ethical principle of public health that is equity. It was expected the best system for reaching households with essential and affordable care, and the best route towards universal coverage. The primary health care approach though adopted universally did not materialize its notion of translating ethos of Health for All by 2000. Overall, primary health care movement by the end of 20th century became lifeless. Since the Declaration of Alma-Ata, fundamental changes have occurred affecting health service delivery, such as economic development and financing approaches, globalization of trade and knowledge, and the shift to privatization. This is the time to develop a new vision, taking into consideration the many changes affecting global health and the strategic developments in health of recent years. With this recognition, the third generation of reforms now underway in many countries is driven by the idea of responding more to demand, assuring access for the poor and emphasizing financing rather than just provision within the public sector. The key concern is: how to translate ethos of revitalizing in the reality. Otherwise the revitalizing concept will turn into utopian goal so like HFA by 2000 strategy. PMID:22610741

  10. [Social constructionism in primary health care: an integrative review].

    PubMed

    Cadoná, Eliane; Scarparo, Helena

    2015-09-01

    This study sets out to analyze scientific articles in order to investigate how researchers in the area of Social Constructionism define "health" in Primary Health Care. An integrative review of the literature was conducted along with a decision to concentrate on those works with narrative experiences and research studies. The database researched was the Brazilian Virtual Health Library, with experiences in the scope of Primary Health Care. The effectiveness of this step resulted in 12 articles. Data were analyzed and discussed based on the perspectives of social constructionism, which generated two central themes. They were: citizenship exercises - promoting health in collective spaces; health practices - overcoming the dichotomies and absolute truths. This study revealed the relevance of the notion of shared responsibility on meanings of health contained in the texts analyzed. The researchers claim that it is possible to expand health practices into collective action to facilitate ongoing dialogue between health users and workers. However, the dominance of biomedical discourse is criticized by the researchers, because that paradigm still promotes practices of care focused on illness. PMID:26331504

  11. [Research and the recent evolution of primary health care].

    PubMed

    Palomo, L

    2002-01-01

    Primary care in Spain has undergone a burgeoning phase in the 80's, followed by a decade of stagnation in the 90's, with little creativity, a routinisation of tasks, and the set up of service port-folios and program-contracts. On the other hand, the recent changes in the orientation of the research promoted by the health administration, in favor of basic research, at the expense of health services research and clinical epidemiology, are in contrast with the importance of primary care as a natural setting for the management of many causal agents and risk factors for health. Despite such limitations, the culture of research has become present in many primary care centres and pharmacies, and primary care research is increasingly present in scientific journals. Nevertheless, it is necessary, also for the case of primary care, to manage research, in differentiated and specific ways, favoring priorization, evaluation and responsibility through flexible organisational formulas and information systems. This should include contracting procedures allowing for at least part-time research, as well as professional career models acknowledging research and teaching activities. Scientific and professional associations in primary care face the challenge of maintaning research projects, of increasing their presence among professionals, of formulating opinions regarding the problems of their sector, as well as of reinforcing their organizational and communication capabilities. PMID:11958755

  12. Health Services for Behavioral Problems in Pediatric Primary Care.

    PubMed

    Nasir, Arwa; Watanabe-Galloway, Shinobu; DiRenzo-Coffey, Gina

    2016-07-01

    The aim of this research was to explore primary care pediatricians' experiences in delivering behavioral health services in their own practices within the Nebraska context. An online survey was sent to the 154 primary care pediatricians who are members of the Nebraska chapter of the American Academy of Pediatrics. Questions explored their management of behavioral problems, attitudes, and perceived barriers to providing behavioral health services in their practices. Seventy pediatricians completed the survey (47%). The majority of pediatricians reported seeing substantial numbers of children with behavioral problems. Eighty-five percent believed that most emotional and behavioral complaints could be managed by the pediatrician. Eighty-eight percent believed that the parents would prefer to receive services for their children's behavioral problems in the primary care office. Most felt that their training in mental health issues was inadequate. Pediatricians in this survey feel that pediatric behavioral problems are best managed in the primary care office and perceive that parents also prefer this setting. Improving training in behavioral health in pediatrics is necessary to meet the delivery of much needed behavioral health care to children and families. PMID:25398258

  13. Sudan: national health programme and primary health care 1977/78-1983/84

    PubMed Central

    Idriss, A. A.; Lolik, P.; Khan, R. A.; Benyoussef, A.

    1976-01-01

    As a follow-up to the national health programming process developed in 1975 in Sudan, a primary health care programme for the whole country was formulated with assistance from WHO. In this article the methods used in the programming and formulation are described and discussed. These methods ensured an intersectoral approach on which technical, cultural, socioeconomic, financial, and political considerations were based. Areas in the field of health and rural development requiring government and community action during the period 1977/78-1983/84 are identified. Details on the strategies for population coverage of rural and nomadic communities with primary health care are given. Fundamental to these strategies is community participation in the development of primary health care within community development as a whole. The guiding principles of these strategies are their technical, political, social and financial feasibility. The social relevance of the primary health care programme for the community and the developmental sectors is emphasized. PMID:1086739

  14. Public health nurses' primary health care practice: strategies for fostering citizen participation.

    PubMed

    Aston, Megan; Meagher-Stewart, Donna; Edwards, Nancy; Young, Linda M

    2009-01-01

    Citizen participation is heralded as a critical element of community health programs that emphasize empowerment and health promotion strategies. Although there is a growing body of research on public health nurses' primary health care practice, few studies have described how public health nurses foster citizen participation. This article presents findings from an interpretive qualitative study of public health nurses' perceptions of their role in fostering citizen participation in an eastern Canadian province at a time of significant health care restructuring. The findings from this study clearly profile public health nurses as integral to the practice of fostering citizen participation. PMID:19177270

  15. Contributions of Physical Therapists to Primary Preventive Health Care.

    PubMed

    Nomura, Takuo

    2016-01-01

    The limitations of what physical therapists can differ from country to country. In Japan, physical therapists are national licensed health care professionals who can help patients improve or restore their mobility. Most Japanese physical therapists provide care for people in health care facilities, medical-welfare transitional facilities, and welfare facilities for the elderly. Currently, physical therapists are unable to sufficiently contribute to primary preventive health care in Japan. However, there are many health problems that physical therapists could help alleviate. For example, low back pain (LBP) more likely than any other condition prevents people from working; thus, making the establishment of effective measures to prevent and reduce LBP vital. An estimated 20,500,000 Japanese individuals have diabetes mellitus (DM) or are at a high risk of developing the disease. DM commonly accompanies stroke and/or heart disease, and is characterized by complications that result from chronic hyperglycemia. Evidence-based physical therapy is effective for the prevention and treatment of LBP and DM. The Japanese Physical Therapy Association established the Japanese Society of Physical Therapy (JSPT) in June 2013. The JSPT has 12 departmental societies and 10 sections. We believe that the JSPT will advance the study of the potential role of physical therapists in primary preventive health care. In the future, it is expected that Japanese physical therapists will contribute to primary preventive health care. PMID:27246148

  16. 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

  17. Clinical biopsychosocial practice and primary health care in Eastern Nigeria.

    PubMed

    Day, S B

    1985-01-01

    An account with case reports of the organization of medical education in the direction of a synthesis between divergent biological paradigms within sociological parameters (the biopsychosocial way), towards problem solving and solution finding in rural health in Cross River State, in the Rain Forest Belt of Tropical West Africa (Nigeria) is described. The objective of the biopsychosocial programme is to strengthen rural health through primary health care based on health education and health communications transfer strategies, implemented by medical students absolving their Community Health Clinical Clerkship. Informational messages and health education is transmitted in such a way as to be accepted by village communities, and to lead to community action within their own resources (Self-Health and Self-Help). Individual and Community Health is integrated with general practice medicine in the clinical biopsychosocial approach, which fulfils the WHO position of health as physical (BIO), mental (PSYCHO) and SOCIAL well being. Rural support activities are a part of biosocial development. It is believed that the biopsychosocial way has contributed to health improvement in this part of Nigeria. PMID:4095596

  18. Strengthening of primary health care: key to deliver inclusive health care.

    PubMed

    Yeravdekar, Rajiv; Yeravdekar, Vidya Rajiv; Tutakne, M A; Bhatia, Neeta P; Tambe, Murlidhar

    2013-01-01

    Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in 'Right to Life.' It is imperative to define 'essential health care,' which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of 'family physician' in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery. PMID:23873190

  19. The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting.

    PubMed

    Carey, Mariko; Noble, Natasha; Mansfield, Elise; Waller, Amy; Henskens, Frans; Sanson-Fisher, Rob

    2015-01-01

    Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world's morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward. PMID:26001983

  20. An alternative strategy in community health care: community-oriented primary health care.

    PubMed

    Kark, S L; Kark, E

    1983-08-01

    The need for alternative strategies in providing personal health services in the community is discussed in relation to Israel, which has a widespread network of community-based curative clinics and preventive family health centers. Community-oriented primary health care (C-OPHC) is the major alternative strategy, which has been developed and evaluated by the Hadassah Teaching and Research Health Center in Kiryat Hayovel, a neighborhood of Jerusalem. The case for adapting this C-OPHC approach throughout the country is presented in a review of existing primary health care services. PMID:6885360

  1. Access to Health Care for Hispanic Women: A Primary Health Care Perspective.

    ERIC Educational Resources Information Center

    Juarbe, Teresa C.

    1995-01-01

    Describes and analyzes from a primary health care perspective how sociopolitical and cultural issues are key factors that influence the health of Hispanic women and their ability to access health care. Looks at the implications for nursing practice, theory, and research and advocates social and political changes needed to improve the situation.…

  2. Evaluation of Health Educator Consults in Primary Care

    ERIC Educational Resources Information Center

    Maher, Stacia; Lopez, Patricia; McKee, M. Diane; Deen, Darwin; Fornari, Alice; Fletcher, Jason; Blank, Arthur

    2010-01-01

    Purpose: The paper aims to evaluate a primary care obesity prevention intervention, targeting low-income minority parents in the USA. The first objective is to describe the barriers to behavior change experienced by families. The second objective is to understand the types of strategies that were used by the health educator to empower families to…

  3. Primary health care in rural areas: an agenda for research.

    PubMed Central

    DeFriese, G H; Ricketts, T C

    1989-01-01

    The confluence of forces slowing the growth of the physician supply despite a continued shortage of primary care physicians, the encouragement of competitive medical practices that centralize resources in larger places, and the changing of the rural population's character to one of more dependence on medical care may bring on another "rural health crisis" in the decade ahead. PMID:2645252

  4. Primary prevention of type 2 diabetes: integrative public health and primary care opportunities, challenges and strategies

    PubMed Central

    Green, Lawrence W; Brancati, Frederick L; Albright, Ann

    2012-01-01

    Type 2 diabetes imposes a large and growing burden on the public’s health. This burden, combined with the growing evidence for primary prevention from randomized controlled trials of structured lifestyle programs leads to recommendations to include caloric reduction, increased physical activity and specific assistance to patients in problem solving to achieve modest weight loss as well as pharmacotherapy. These recommendations demand exploration of new ways to implement such primary prevention strategies through more integrated community organization, medical practice and policy. The US experience with control of tobacco use and high blood pressure offers valuable lessons for policy, such as taxation on products, and for practice in a variety of settings, such as coordination of referrals for lifestyle supports. We acknowledge also some notable exceptions to their generalizability. This paper presents possible actions proposed by an expert panel, summarized in Table 1 as recommendations for immediate action, strategic action and research. The collaboration of primary care and public health systems will be required to make many of these recommendations a reality. This paper also provides information on the progress made in recent years by the Division of Diabetes Translation at the US Centers for Disease Control and Prevention (CDC) to implement or facilitate such integration of primary care and public health for primary prevention. PMID:22399542

  5. Replicating Impact of a Primary School HIV Prevention Programme: Primary School Action for Better Health, Kenya

    ERIC Educational Resources Information Center

    Maticka-Tyndale, E.; Mungwete, R.; Jayeoba, O.

    2014-01-01

    School-based programmes to combat the spread of HIV have been demonstrated to be effective over the short-term when delivered on a small scale. The question addressed here is whether results obtained with small-scale delivery are replicable in large-scale roll-out. Primary School Action for Better Health (PSABH), a programme to train teachers to…

  6. Experience of Primary Care among Homeless Individuals with Mental Health Conditions

    PubMed Central

    Chrystal, Joya G.; Glover, Dawn L.; Young, Alexander S.; Whelan, Fiona; Austin, Erika L.; Johnson, Nancy K.; Pollio, David E.; Holt, Cheryl L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa A.; Daigle, Shanette G.; Steward, Jocelyn L.; Kertesz, Stefan G

    2015-01-01

    The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers. PMID:25659142

  7. Metals and Disease: A Global Primary Health Care Perspective

    PubMed Central

    Mamtani, Ravinder; Stern, Penny; Dawood, Ismail; Cheema, Sohaila

    2011-01-01

    Metals are an important and essential part of our daily lives. Their ubiquitous presence and use has not been without significant consequences. Both industrial and nonindustrial exposures to metals are characterized by a variety of acute and chronic ailments. Underreporting of illnesses related to occupational and environmental exposures to chemicals including metals is of concern and presents a serious challenge. Many primary care workers rarely consider occupational and environmental exposures to chemicals in their clinical evaluation. Their knowledge and training in the evaluation of health problems related to such exposures is inadequate. This paper presents documented research findings from various studies that have examined the relationship between metal exposures and their adverse health effects both in developing and developed countries. Further, it provides some guidance on essential elements of a basic occupational and environmental evaluation to health care workers in primary care situations. PMID:22007209

  8. Effects of a Psychological Intervention in a Primary Health Care Center for Caregivers of Dependent Relatives: A Randomized Trial

    ERIC Educational Resources Information Center

    Rodriguez-Sanchez, Emiliano; Patino-Alonso, Maria C.; Mora-Simon, Sara; Gomez-Marcos, Manuel A.; Perez-Penaranda, Anibal; Losada-Baltar, Andres; Garcia-Ortiz, Luis

    2013-01-01

    Purpose: To assess, in the context of Primary Health Care (PHC), the effect of a psychological intervention in mental health among caregivers (CGs) of dependent relatives. Design and Methods: Randomized multicenter, controlled clinical trial. The 125 CGs included in the trial were receiving health care in PHC. Inclusion criteria: Identifying…

  9. LUTE primary mirror materials and design study report

    NASA Technical Reports Server (NTRS)

    Ruthven, Greg

    1993-01-01

    The major objective of the Lunar Ultraviolet Telescope Experiment (LUTE) Primary Mirror Materials and Design Study is to investigate the feasibility of the LUTE telescope primary mirror. A systematic approach to accomplish this key goal was taken by first understanding the optical, thermal, and structural requirements and then deriving the critical primary mirror-level requirements for ground testing, launch, and lunar operations. After summarizing the results in those requirements which drove the selection of material and the design for the primary mirror are discussed. Most important of these are the optical design which was assumed to be the MSFC baseline (i.e. 3 mirror optical system), telescope wavefront error (WFE) allocations, the telescope weight budget, and the LUTE operational temperature ranges. Mechanical load levels, reflectance and microroughness issues, and options for the LUTE metering structure were discussed and an outline for the LUTE telescope sub-system design specification was initiated. The primary mirror analysis and results are presented. The six material substrate candidates are discussed and four distinct mirror geometries which are considered are shown. With these materials and configurations together with varying the location of the mirror support points, a total of 42 possible primary mirror designs resulted. The polishability of each substrate candidate was investigated and a usage history of 0.5 meter and larger precision cryogenic mirrors (the operational low end LUTE temperature of 60 K is the reason we feel a survey of cryogenic mirrors is appropriate) that were flown or tested are presented.

  10. Electronic health record functionality needed to better support primary care

    PubMed Central

    Krist, Alex H; Beasley, John W; Crosson, Jesse C; Kibbe, David C; Klinkman, Michael S; Lehmann, Christoph U; Fox, Chester H; Mitchell, Jason M; Mold, James W; Pace, Wilson D; Peterson, Kevin A; Phillips, Robert L; Post, Robert; Puro, Jon; Raddock, Michael; Simkus, Ray; Waldren, Steven E

    2014-01-01

    Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This article presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and meaningful use (MU) objectives to define EHR functionality. Current objectives remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden. While stage 3 MU's focus on outcomes is laudable, enhanced functionality is still needed, including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies. PMID:24431335

  11. Neighborhood health centers as providers of primary mental-health care.

    PubMed

    Borus, J F

    1976-07-15

    The 19 Boston neighborhood health centers with mental-health programs were studied to investigate the delivery of mental-health services as part of a primary health-care system. Staff-time utilization data show these programs focus on the provision of primary mental-health services to neighborhood residents and indirect consultative and collaborative services to general health staff to co-ordinate health care. Forty-eight per cent of referrals for mental-health services were patients first identified and referred by general health staff. Children constituted a disproportionately high percentage of the patients served (43 per cent), and 22 per cent of the services were outreach visits, primarily in patients' homes. Quantitative studies are necessary to confirm my qualititative findings that the conjoint health and mental-health delivery site at the neighborhood level increases the accessibility and psychologic acceptability of mental-health services and enhances case finding, successful referral, and co-ordination of primary health care. PMID:1272331

  12. [Primary health care and the millennium development goals].

    PubMed

    Faye, A; Bob, M; Fall, A; Fall, C

    2012-01-01

    Member countries of the World Health Organization (WHO) met in Alma Ata (8-12 September 1978) to define and advocate the implementation of primary health care (PHC) worldwide, above all, in developing countries, which had a real need to review their strategies for meeting the health needs of their populations. They did not suspect that 20 years later the vision they displayed would remain undeniably relevant. Here we examine the similarities and points of convergence of their declaration about PHC with the Millennium Development Goals that seek today to reduce poverty across the world. An exhaustive and analytic literature review was conducted to collect those similarities. Further analysis of the definitions, objectives, principles and recommendations of the Alma Ata Declaration and the Millennium Declaration reveals multiple dependencies and fundamental points of similarity between these two representations. Almost all states have pledged to achieve the eight MDG by 2015: to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability, and develop a global partnership for development. The Alma Ata conference defined primary health care as essential health care, based on practical methods and techniques that are both scientifically sound and socially acceptable, universally accessible to all individuals and all families of the community, through their full participation and at a cost that the community and countries can afford at all stages of their development in the spirit of self-reliance and self-determination. It is an integral part of economic and social development. The following principles are involved in the achievement of both primary health care and the MDG: social equity, community participation, and intersectorality. Public health is an essential condition of poverty

  13. Design of infrared astronomical satellite /IRAS/ primary mirror mounts

    NASA Technical Reports Server (NTRS)

    Schreibman, M.; Young, P.

    1980-01-01

    The design of an operational mount to rigidly secure the primary mirror to its baseplate without the introduction of figure error always proves to be a major task on diffraction limited optical systems. A summary of the design of the Infrared Astronomical Satellite (IRAS) primary mirror mount is given. The mirror was designed to be alligned and tested at room temperature and operated in a zero 'g' field at temperatures of 2K. To minimize overstressing, a stiffness requirement of greater than 150 Hz was required for cold launch and room temperature vibration acceptance testing. Additional isolation was required to minimize strains, introduced via the mounting base, due to thermal and mechanical distortions.

  14. Interprofessional student-run primary health care clinics

    PubMed Central

    Pammett, Robert; Landry, Eric; Jorgenson, Derek

    2015-01-01

    Introduction: Interprofessional student-run primary health care clinics have been a flagship model of health professional education in Canada for many years. The purpose of this study was to determine if there is support for implementing this educational model in the United Kingdom and to highlight the implications for pharmacy education in Scotland. Method: A cross-sectional postal survey of 3000 randomly selected citizens of Aberdeen city and shire, Scotland, aged 18 years and older. Results: Of the 824 questionnaires that were returned (response rate 27.5%), more than half of the respondents (62.4%; n = 514) would consider accessing health care from a student-led, walk-in service. The range of services they expect to see includes general health checks (60%; n = 494), help for sexually transmitted diseases (57.5%; n = 474), weight management (56.8%; n = 468), smoking cessation (54.4%; n = 448) and drug misuse services (47.2%; n = 387). Concerns raised pertained to student ability, suitability for children and accessibility. Many comments pertained to the improvement of the current system by offering after-hours care. Discussion: The positive response from the general public towards an interprofessional student-run primary health care clinic in Aberdeen suggests that this Canadian model of interdisciplinary health professional education would likely be a successful addition to the pharmacy curriculum in Scotland. PMID:26150889

  15. Risk Adjustment and Primary Health Care in Chile

    PubMed Central

    Vargas, Veronica; Wasem, Juergen

    2006-01-01

    Aim To offer a capitation formula with greater capacity for guiding resource spending on population with poorer health and lower socioeconomic status in the context of financing and equity in primary health care. Methods We collected two years of data on a sample of 10 000 individuals from a region in Chile, Valdivia and Temuco and evaluated three models to estimate utilization and expenditures per capita. The first model included age and sex; the second one included age, sex, and the presence of two key diagnoses; and the third model included age, sex, and the presence of seven key diagnoses. Regression results were evaluated by R2 and predictive ratios to select the best specifications. Results Per-capita expenditures by age and sex confirmed international trends, where children under five, women, and the elderly were the main users of primary health care services. Women sought health advice twice as much as men. Clear differences by socioeconomic status were observed for the indigent population aged ≥65 years who under-utilized primary health care services. From the three models, major improvement in the predictive power occurred from the demographic (adjusted R2, 9%) to the demographic plus two diagnoses model (adjusted R2, 27%). Improvements were modest when five other diagnoses were added (adjusted R2, 28%). Conclusion The current formula that uses municipality’s financial power and geographic location of health centers to adjust capitation payments provides little incentive to appropriate care for the indigent and people with chronic conditions. A capitation payment that adjusts for age, sex, and the presence of diabetes and hypertension will better guide resource allocation to those with poorer health and lower socioeconomic status. PMID:16758525

  16. In search of a perennial philosophy for behavioral health integration in primary care.

    PubMed

    Mauksch, Larry B; Fogarty, Colleen T

    2016-06-01

    The "perennial philosophy," a concept religious scholars have studied for centuries, represents a search for the values, themes, and constructs that transcend individual religions. Can we who develop and disseminate behavioral health integration in primary care step back from individual models to identify our perennial philosophy? If so, what are the components? What does the evidence tell us? What do we need to learn? Four case examples are presented which represent many patients seen by both of us-a family therapist and a family physician-over our combined 55 years of collaborative practice within integrated primary care settings. Can these patients be cared for in a primary care setting? Our experience provides a simple answer-yes. However, providing care for this range of patients requires variability in team configurations, frequency of visits, lengths of relationships, and interventional strategies. Is there a perennial philosophy of how to design and implement the integration of behavioral health in primary care? We think there should be. we highlight a recent publication from the Eugene S. Farley, Jr. Health Policy Center, entitled "Core Competencies For Behavioral Health Providers Working In Primary Care." The authors purposefully transcend models in delineating eight core competencies. Embedded within these competencies are common or perennial factors. These factors may guide our field going forward, helping us avoid "religious" divisions, seek to understand diverse designs, and embrace integration of models to meet the needs of the populations and teams we serve. (PsycINFO Database Record PMID:27270247

  17. Primary health care assessment tools: a literature review and metasynthesis.

    PubMed

    Fracolli, Lislaine Aparecida; Gomes, Maria Fernanda Pereira; Nabão, Fabiana Rodrigues Zequini; Santos, Mariana Souza; Cappellini, Verusca Kelly; de Almeida, Ana Cláudia Correa

    2014-12-01

    This study comprises a systematic review and metasynthesis of qualitative literature on national and international databases to identify the main tools used to assess Primary Health Care (PHC). A total of 3,048 results were returned for literature written in Portuguese, Spanish and English published between 1979 and 2013. Thirty-three articles/studies were selected after thorough reading and analysis. Eight of these studies addressed the use of one or more of the following validated PHC assessment tools: the WHO Primary Care Assessment Tool (PCET); the ADHD Questionnaire for Primary Care Providers (AQ-PCP); the General Practice Assessment Questionnaire (GPAQ), PACOTAPS (primary health care software); and the PCAT (Primary Care Assessment Tool). The study showed that the majority of these tools were used internationally. The PCAT and EUROPEP were used in Brazil and the most commonly used tool in this country was the PCAT. The results show that the use of research tools to assess PHC may assist in the creation of new proposals to improve family healthcare and that PCAT is the most adequate tool for this purpose. PMID:25388193

  18. Telemental health: responding to mandates for reform in primary healthcare.

    PubMed

    Myers, Kathleen M; Lieberman, Daniel

    2013-06-01

    Telemental health (TMH) has established a niche as a feasible, acceptable, and effective service model to improve the mental healthcare and outcomes for individuals who cannot access traditional mental health services. The Accountability Care Act has mandated reforms in the structure, functioning, and financing of primary care that provide an opportunity for TMH to move into the mainstream healthcare system. By partnering with the Integrated Behavioral Healthcare Model, TMH offers a spectrum of tools to unite primary care physicians and mental health specialist in a mind-body view of patients' healthcare needs and to activate patients in their own care. TMH tools include video-teleconferencing to telecommute mental health specialists to the primary care setting to collaborate with a team in caring for patients' mental healthcare needs and to provide direct services to patients who are not progressing optimally with this collaborative model. Asynchronous tools include online therapies that offer an efficient first step to treatment for selected disorders such as depression and anxiety. Patients activate themselves in their care through portals that provide access to their healthcare information and Web sites that offer on-demand information and communication with a healthcare team. These synchronous and asynchronous TMH tools may move the site of mental healthcare from the clinic to the home. The evolving role of social media in facilitating communication among patients or with their healthcare team deserves further consideration as a tool to activate patients and provide more personalized care. PMID:23611641

  19. Mental Health Services in Rural China: A Qualitative Study of Primary Health Care Providers

    PubMed Central

    Ma, Zhenyu; Huang, Hui; Chen, Qiang; Chen, Faqin; Abdullah, Abu S.; Nie, Guanghui; Feng, Qiming; Wei, Bo

    2015-01-01

    This study aimed to understand the challenges that primary health care providers faced in the process of delivering mental healthcare and assess their attitudes towards patients with mental health problems. In-depth interviews were conducted among 42 primary health care providers in two counties of Guangxi province, China. All interviews were audio-recorded and analyzed thematically. Primary health care providers in both counties faced the same difficulties: lack of professional knowledge, fear of patients' attack, more extra work, and less subsidies. However, most of primary health care providers (30/42) were still willing to do mental healthcare management. All the interviewees considered that communication skills with patients and their family members, proper attitude (without discrimination), and the professional knowledge of mental health are required. There are still several participants (15/42) who showed negative attitude toward mental disorders. Nearly all the respondents (39/42) emphasized the importance of increasing their income or subsidies by the government. This qualitative study provides insights into mental health services in rural communities of Guangxi and identified issues that could be considered in engaging primary health care providers in the management of mental disorders. PMID:26819947

  20. Sustainability in Primary Care and Mental Health Integration Projects in Veterans Health Administration

    PubMed Central

    Ford, James H.; Krahn, Dean; Oliver, Karen Anderson; Kirchner, JoAnn

    2015-01-01

    Objective To explore staff perceptions about sustainability, commitment to change, participation in change process, and information received about the change project within the Veterans Administration Primary Care and Mental Health Integration (PC-MHI) initiative and to examine differences from the Veterans Health Administration Mental Health Systems Redesign (MHSR) initiative. Data Sources Surveys of change team members involved in the Veterans Affairs PC-MHI and MHSR initiatives. Study Design One-way analysis of variance examined the relationship between commitment, participation and information, and sustainability. Differences in PC-MHI sustainability were explored by location and job classification. Staff sustainability perceptions were compared with MHSR results. Principal Findings Sustainability differed by staff discipline. Difference between MHSR and PC-MHI existed by job function and perceptions about the change benefits. Participation in the change process and information received about the change process were positively correlated with sustainability. Staff commitment to change was positively associated with staff perceptions about the benefits of change and staff attitudes toward change. Conclusions Sustainability is an important part of organizational change efforts. Change complexity seems to influence perception about sustainability and impacts staff perceptions about the benefits of change. These perceptions seem to be driven by the information received and opportunities to participate in the change process. Further research is needed to understand how information and participation influence sustainability and affect employee commitment to change. PMID:23011071

  1. Dynamic analysis and design of the SIRTF primary mirror mount

    NASA Technical Reports Server (NTRS)

    Richard, Ralph M.; Vukobratovich, Daniel; Pollard, L. Wayne

    1987-01-01

    The criteria and considerations for the design of the support system for the Space Infrared Telescope Facility (SIRTF) primary mirror are presented. A flexural-gimbal-baseplate design for the 0.5 m primary mirror was developed. Preliminary studies have indicated that this design may be further improved by replacing the flexures by a post-gimbal system wherein the gimbal design accomodates both the cryogenic cool down effects, the dynamic launch loads, and manufacturing tolerance effects. Additionally, a prestressed baseplate concept had evolved and was presented for the full scale 1.0 m mirror. However, preliminary design studies indicate that this concept will not be required, and the post-gimbal-baseplate design similar to the 0.5 m alternate support system will meet the cryogenic cool down, dynamic launch load criteria, and manufacturing tolerance effects.

  2. Prevalence of health promotion programs in primary health care units in Brazil

    PubMed Central

    Ramos, Luiz Roberto; Malta, Deborah Carvalho; Gomes, Grace Angélica de Oliveira; Bracco, Mário M; Florindo, Alex Antonio; Mielke, Gregore Iven; Parra, Diana C; Lobelo, Felipe; Simoes, Eduardo J; Hallal, Pedro Curi

    2014-01-01

    OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil. PMID:25372175

  3. Chronic disease, prevention policy, and the future of public health and primary care.

    PubMed

    Mayes, Rick; Armistead, Blair

    2013-11-01

    Globally, chronic disease and conditions such as diabetes, cardiovascular disease, depression and cancer are the leading causes of morbidity and mortality. Why, then, are public health efforts and programs aimed at preventing chronic disease so difficult to implement and maintain? Also, why is primary care--the key medical specialty for helping persons with chronic disease manage their illnesses--in decline? Public health suffers from its often being socially controversial, personally intrusive, irritating to many powerful corporate interests, and structurally designed to be largely invisible and, as a result, taken for granted. Primary care struggles from low reimbursements, relative to specialists, excessive paperwork and time demands that are unattractive to medical students. Our paper concludes with a discussion of why the need for more aggressive public health and redesigned primary care is great, will grow substantially in the near future, and yet will continue to struggle with funding and public popularity. PMID:23192570

  4. Design and Usability Testing of an mHealth Application for Midwives in Rural Ghana

    ERIC Educational Resources Information Center

    Velez, Olivia

    2011-01-01

    Midwives in Ghana provide the majority of rural primary and maternal healthcare services, but have limited access to data for decision making and knowledge work. Few mobile health (mHealth) applications have been designed for midwives. The study purpose was to design and test an mHealth application (mClinic) that can improve data access and reduce…

  5. Connecting Primary Health Care: A Comprehensive Pilot Study.

    PubMed

    Maghsoudloo, Mehran; Abolhassani, Farid; Lotfibakhshaiesh, Nasrin

    2016-07-01

    The collection of data within the primary health care facilities in Iran is essentially paper-based. It is focused on family's health, monitoring of non-infectious and infectious diseases. Clearly due to the paper-based nature of the tasks, timely decision making at most can be difficult if not impossible. As part of an on-going electronic health record implementation project at Tehran University of Medical Sciences, for the first time in the region, based on a comprehensive pilot project, four urban healthcare facilities are connected to their headquarters and beyond, covering all aspects of primary health care, for the last four years. Without delving into the technical aspects of its software engineering processes, the progress of the implementation is reported, selection of summarized data is presented, and experience gained thus far are discussed. Four years passed and if time is any important reason to go by, then it is safe to accept that the software architecture and electronic health record structural model implemented are robust and yet extensible. Aims and duration of a pilot study should be clearly defined prior to start and managed till its completion. Resistance to change and particularly to information technology, apart from its technical aspects, is also based on human factors. PMID:27424015

  6. Children's Mental Health as a Primary Care and Concern

    PubMed Central

    Tolan, Patrick H.; Dodge, Kenneth A.

    2009-01-01

    In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country. PMID:16173893

  7. Implementation of the principles of primary health care in a rural area of South Africa

    PubMed Central

    Schneider, Marguerite

    2014-01-01

    Background The philosophy of primary healthcare forms the basis of South Africa's health policy and provides guidance for healthcare service delivery in South Africa. Healthcare service provision in South Africa has shown improvement in the past five years. However, it is uncertain as to whether the changes have reached rural areas and if primary healthcare is implemented successfully in these areas. Objectives The aim of this article is to explore the extent to which the principles of primary healthcare are implemented in a remote, rural setting in South Africa. Method A descriptive, qualitative design was implemented. Data were collected through interviews and case studies with 36 purposively-sampled participants, then analysed through Interpretative Phenomenological Analysis. Results Findings indicated challenges with regard to client-centred care, provision of health promotion and rehabilitation, the way care was organised, the role of the doctor, health-worker attitudes, referral services and the management of complex conditions. Conclusion The principles of primary healthcare were not implemented successfully. The community was not involved in healthcare management, nor were users involved in their personal health management. The initiation of a community-health forum is recommended. Service providers, users and the community should identify and address the determinants of ill health in the community. Other recommendations include the training of service managers in the logistical management of ensuring a constant supply of drugs, using a Kombi-type vehicle to provide user transport for routine visits to secondary- and tertiary healthcare services and increasing the doctors’ hours. PMID:26245391

  8. [Social representations on aging by primary care health workers].

    PubMed

    Mendes, Cristina Katya Torres Teixeira; Alves, Maria do Socorro Costa Feitosa; Silva, Antonia Oliveira; Paredes, Maria Adelaide Silva; Rodrigues, Tatyanni Peixoto

    2012-09-01

    The objective of this study was to get to know the social representations on aging developed by primary care health workers. This is an exploratory study involving 204 primary health care workers, in the city of João Pessoa, in the state of Paraíba. For data collection we used a semi-structured interview. The data obtained from 204 interviews was analyzed with the help of the Alceste software version 2010. The results indicated five classes or categories: vision of aging,psychosocial dimensions, a time of doubts, aging as a process, and aging versus disease, with positive content: joy, care, children, retirement, caregiver rights, maturity and wisdom, as well as negative factors: impairments, decadence, neglect, fragility, limitation, wrinkles, dependency and disease. It was observed that these meanings associated with aging express the need for total and humanized elderly care. PMID:23405821

  9. Design study of primary ion provider for RHIC-EBIS

    SciTech Connect

    Kondo, K.; Kanesue, T.; Tamura, J.; Okamura, M.

    2009-09-20

    Brookhaven National Laboratory (BNL) has developed the new pre-injector system, Electron Beam Ion Source (EBIS) for Relativistic Heavy Ion Collider (RHIC) and NASA Space Radiation Laboratory (NSRL). Design of primary ion provider is an essential problem since it is required to supply beams with different ion species to multiple users simultaneously. The laser ion source with a defocused laser can provide a low charge state and low emittance ion beam, and is a candidate for the primary ion source for RHIC-EBIS. We show a suitable design with appropriate drift length and solenoid, which helps to keep sufficient total charge number with longer pulse length. The whole design of primary ion source, as well as optics arrangement, solid targets configuration and heating about target, is presented.

  10. Availability of primary care health personnel. The States speak out.

    PubMed

    Gamliel, S; Mullan, F; Politzer, R; Stambler, H

    1992-02-01

    The adequacy of the supply of health personnel, and primary care personnel in particular, has been assessed at the aggregate national level and the disaggregate or regional/state perspective. While Federal programs have been successful in expanding the Nation's supply of health care practitioners and alleviating aggregate national shortages in some occupations and specialties, problems of geographic distribution remain. In an effort to obtain information on the adequacy of the supply of health care personnel within each state and jurisdiction, the chief executives were asked to assess their most pressing personnel supply concerns. The two occupations most often cited as being in short supply were primary care physicians and registered nurses. The state assessment of shortages of registered nurses is in concert with national assessments. In contrast, the supply of primary care physicians appears to be adequate if not in excess at the national level, implying that aggregate assessments may camouflage significant regional and state shortages. Disaggregate assessments are essential to derive an appropriate picture of national supply adequacy. PMID:1739353

  11. A Conceptual Framework for Evaluation of Public Health and Primary Care System Performance in Iran

    PubMed Central

    Jahanmehr, Nader; Rashidian, Arash; Khosravi, Ardeshir; Farzadfar, Farshad; Shariati, Mohammad; Majdzadeh, Reza; Sari, Ali Akbari; Mesdaghinia, Alireza

    2015-01-01

    Introduction: The main objective of this study was to design a conceptual framework, according to the policies and priorities of the ministry of health to evaluate provincial public health and primary care performance and to assess their share in the overall health impacts of the community. Methods: We used several tools and techniques, including system thinking, literature review to identify relevant attributes of health system performance framework and interview with the key stakeholders. The PubMed, Scopus, web of science, Google Scholar and two specialized databases of Persian language literature (IranMedex and SID) were searched using main terms and keywords. Following decision-making and collective agreement among the different stakeholders, 51 core indicators were chosen from among 602 obtained indicators in a four stage process, for monitoring and evaluation of Health Deputies. Results: We proposed a conceptual framework by identifying the performance area for Health Deputies between other determinants of health, as well as introducing a chain of results, for performance, consisting of Input, Process, Output and Outcome indicators. We also proposed 5 dimensions for measuring the performance of Health Deputies, consisting of efficiency, effectiveness, equity, access and improvement of health status. Conclusion: The proposed Conceptual Framework illustrates clearly the Health Deputies success in achieving best results and consequences of health in the country. Having the relative commitment of the ministry of health and Health Deputies at the University of Medical Sciences is essential for full implementation of this framework and providing the annual performance report. PMID:25946937

  12. 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. PMID

  13. Primary health care approach: how did it evolve?

    PubMed

    Walt, G; Vaughan, P

    1982-10-01

    The authors outline some of the important factors that shaped the primary health care (PHC) approach. First, theories about development changed; rather than concentrating on physical growth and industry in the belief that as the economy grew benefits would spread to poorer groups, it become politically unacceptable to tolerate large differences in health care between the rich and the poor. Second, there was increasing concern about population growth in a world of finite resources and about the political instability of rapidly growing populations. These elements led to a trend against vertical family planning services, and towards integrated maternal and child health services with a family planning component; the perspective became child spacing rather than limitation. A 3rd factor was the trend away from technological medical solutions to more concern with social, psychological, behavioral, and economic factors. There was concern about western medical models being imposed on developing countries. In the 1960s Maurice King emphasized the need to provide basic health services in the community; community involvement was the 4th factor behind PHC. China, Cuba, Vietnam, and Tanzania all had successful community based PHC programs based on the idea that health was integral to development. These successes combined with the differences between rural and urban health status gave the impulse to the PHC approach. The 5th influence was the World Health Organization (WHO) and international agencies which emphasized that health was linked to development; in 1975 WHO launched the idea of health for all by the year 2000 with the strategy of the setting of minimum targets for food consumption, clothing, housing, and provision of water, sanitation, education, health, and public transport services. WHO and UNICEF called a meeting in Alma Ata, USSR in 1978 as a culmination of all of these efforts. PMID:7179436

  14. Primary adherence to antidepressant prescriptions in primary health care: a population-based study in Sweden

    PubMed Central

    Freccero, Carl; Sundquist, Kristina; Sundquist, Jan; Ji, Jianguang

    2016-01-01

    Background Medical adherence is important in the treatment of depression. Primary medical adherence, i.e. patients collecting their newly prescribed medications from pharmacies, is very different depending on the drug prescribed Objective To assess the rate of primary medical adherence in patients prescribed antidepressants and to identify characteristics that make patients less likely to pick up prescriptions. Methods An observational study was performed using primary health care data from Sweden on patients who were prescribed antidepressants. Univariate and multivariate logistic regression was used to determine differences in pick-up rate according to patient characteristics. Main outcome Pick-up rate, defined as collection of a prescription within 30 days. Results A total of 11 624 patients received an antidepressant prescription during the study period, and the overall pick-up rate was 85.1%. The pick-up rate differed according to country of birth: individuals born in the Middle East and other countries outside Europe had lower primary medical adherence than Swedes, with adjusted odds ratios (ORs) of 0.58 and 0.67, respectively. Patients at ages 64–79 years had a higher pick-up rate compared with those aged 25–44 years (OR 1.71). Divorced patients had a lower rate compared with married patients (OR 0.80). Conclusion Immigrants from the Middle East and other countries outside Europe and younger and divorced patients had lower primary medical adherence, which calls for clinical attention and preventive measures. Key pointsPrimary medical adherence is important in the treatment of depression.Are patient characteristics associated with primary medical adherence?The overall primary medical adherence rate was 85%.The rate differed by country of birth, age at diagnosis of depression, and marital status.Clinical attention is needed in patients who do not pick up their antidepressants. PMID:26828942

  15. Improving Primary Health Care in Chronic Musculoskeletal Conditions through Digital Media: The PEOPLE Meeting

    PubMed Central

    Cott, Cheryl; Jones, C Allyson; Badley, Elizabeth M; Davis, Aileen M

    2013-01-01

    indicated that this information is necessary for tailoring digital media interventions. Other priorities included: (1) studying barriers and ethical issues associated with the use of digital media to optimize MSK health and self-management, (2) improving the design of digital media tools for providing “just-in-time” health information to patients and health professionals, and (3) advancing knowledge on the effectiveness of new and existing digital media interventions. Conclusions We anticipate that the results of this meeting will be a catalyst for future research projects and new cross-sector research partnerships. Our next step will be to seek feedback on the research priorities from our collaborators and other potential partners in primary health care. PMID:23612113

  16. Mental health treatment in the primary care setting: patterns and pathways.

    PubMed

    Petterson, Stephen; Miller, Benjamin F; Payne-Murphy, Jessica C; Phillips, Robert L

    2014-06-01

    The redesign of primary care through the patient-centered medical home offers an opportunity to assess the role of primary care in treating mental health relative to the rest of the health care system. Better understanding the patterns of care between primary care and mental health providers helps guide necessary policy changes. This article reports the findings from 109,593 respondents to the 2002-2009 Medical Expenditure Panel Surveys (MEPS). We examined the extent to which persons with poor mental health visited primary care providers, and distinguished among 4 patterns of care: (a) mental health only, (b) primary care only, (c) dual care (both mental health and primary care) and (d) other provider combinations. Our findings indicate that poor mental health and specific mental health conditions remain prevalent in primary care. An increased focus on patient-centered care requires greater integration of primary and mental health care to reduce fragmentation of care and disparities in health outcomes. PMID:24773273

  17. The ethics of complex relationships in primary care behavioral health.

    PubMed

    Reiter, Jeff; Runyan, Christine

    2013-03-01

    Primary care settings are particularly prone to complex relationships that can be ethically challenging. This is due in part to three of the distinctive attributes of primary care: a whole family orientation; team-based care; and a longitudinal care delivery model. In addition, the high patient volume of primary care means that the likelihood of encountering ethically challenging relationships is probably greater than in a specialty setting. This article argues that one ethical standard of the American Psychological Association (APA, 2010, Ethical principles of psychologists and code of conduct, www.apa.org/ethics/code) (10.02, Therapy Involving Couples or Families) should be revised to better accommodate the work of psychologists in primary care. The corresponding Principles of Medical Ethics from the American Medical Association (AMA, 2012, Code of medical ethics: Current opinions with annotations, 2012-2013, Washington, DC: Author), most notably the principle regarding a physician's duty to "respect the rights of patients, colleagues, and other health professionals as well as safeguard privacy" are also noted. In addition, the article details how the three attributes of primary care often result in complex relationships, and provides suggestions for handling such relationships ethically. PMID:23566124

  18. The Montana Model: Integrated Primary Care and Behavioral Health in a Family Practice Residency Program

    ERIC Educational Resources Information Center

    Oakley, Claire; Moore, Douglas; Burford, Duncan; Fahrenwald, Roxanne; Woodward, Kathryn

    2005-01-01

    To address the local health care needs of both patients and primary care providers in Montana, an integrated primary care and behavioral health family practice clinic was developed. In this paper we describe our experience with integrating mental health and substance abuse services into a primary care setting (a community health center) while…

  19. Primary health care vs. emergency medical assistance: a conceptual framework.

    PubMed

    Van Damme, W I M; Van Lerberghe, W I M; Boelaert, Marleen

    2002-03-01

    Primary health care (PHC) and emergency medical assistance (EMA) are discussed as two fundamentally different strategies of delivering health care. PHC is conceptualized as part of overall development, while EMA is delivered in disaster or emergency situations. The article contrasts the underlying paradigms, and the characteristics of care in PHC and EMA. It then analyzes the characteristics of PHC and EMA health services, their structure, management and support systems. In strategic aspects, it contrasts how managerial and financial sustainability are fundamentally different, and how the term accountability is used differently in development and disaster situations. However, while PHC and EMA, development and disaster, are clear opposite poles, many field situations in the developing world are today somewhere in-between. In such non-development, non-emergency situations, the objectives and approach will have to vary and an adapted strategy combining characteristics from PHC and EMA will have to be developed. PMID:11861586

  20. Gamified Design for Health Workshop.

    PubMed

    Giunti, Guido

    2016-01-01

    Increasing lifespans for chronic disease sufferers means a population of young patients who require lifestyle intervention from an early age. For multiple sclerosis (MS) patients, social problems begin with the decline of cognitive skills and their quality of life is affected. In this workshop, organizers will propose participants to work on different gamification design approachs to solve MS patients' engagement problem. Participants will obtain skills that can be extrapolated to other conditions that require patients change to adopt a different behavior. At the end, participants will present their proposed gamification design and discuss and comment each solution, assessing potential unintended outcomes and advantages. PMID:27332273

  1. Health service utilization patterns of primary care patients with osteoarthritis

    PubMed Central

    Rosemann, Thomas; Joos, Stefanie; Szecsenyi, Joachim; Laux, Gunter; Wensing, Michel

    2007-01-01

    Background To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). Methods Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. Results 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the “symptom” scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. Conclusion Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully. PMID:17956605

  2. Primary care physician's attitude towards the German e-health card project--determinants and implications.

    PubMed

    Ernstmann, Nicole; Ommen, Oliver; Neumann, Melanie; Hammer, Antje; Voltz, Raymond; Pfaff, Holger

    2009-06-01

    In Germany e-health cards will be distributed nationwide to over 80 million patients. Given the impending mandatory introduction of the e-health technology, the objective of this study was to examine the determinants of primary care physicians' acceptance of the technological innovation. The study was conducted prior to the introduction of the e-health cards. A questionnaire survey was carried out addressing primary care physicians from different fields. The reduction of medication error rates and the improvement of communication between medical caregivers are central aspects of the perceived usefulness. Primary care physicians rate their involvement in the process of the development of the technology and their own IT expertise concerning the technological innovation as rather low. User involvement and IT expertise can explain 46 % of the variance of perceived usefulness of the e-health card. User involvement plays a crucial role in the adoption of the German e-health card. Primary care physician's perspective should be represented in the process of developing and designing the technology. PMID:19408451

  3. Diabetes Connect: Developing a Mobile Health Intervention to Link Diabetes Community Health Workers With Primary Care.

    PubMed

    Cherrington, Andrea L; Agne, April A; Lampkin, Yolanda; Birl, Annie; Shelton, Tanya C; Guzman, Alfredo; Willig, James H

    2015-01-01

    Community health worker (CHW) interventions can help improve diabetes self-management and health outcomes. There is limited evidence on how to effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the health care team and enhance care. We tested a model for the integration of a CHW-delivered mHealth intervention to improve diabetes self-management. Seventy-two African American patients with diabetes were followed using the mHealth tool. This project partnered an academic institution, a safety-net clinic, and African American churches. The integration of mHealth technology into CHW programs was successfully achieved and readily accepted. PMID:26353025

  4. 78 FR 75442 - Designation of the Primary Freight Network

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ...) notice, which was published on November 19, 2013, at 78 FR 69520. The original comment period is set to..., except Federal holidays. SUPPLEMENTARY INFORMATION: Background On November 19, 2013, at 78 FR 69520, the... TRANSPORTATION Federal Highway Administration Designation of the Primary Freight Network AGENCY: Federal...

  5. Primary Care Patients’ Perspectives of Barriers and Enablers of Primary Prevention and Health Promotion—A Meta-Ethnographic Synthesis

    PubMed Central

    Moreno-Peral, Patricia; Conejo-Cerón, Sonia; Fernández, Ana; Berenguera, Anna; Martínez-Andrés, María; Pons-Vigués, Mariona; Motrico, Emma; Rodríguez-Martín, Beatriz; Bellón, Juan A.; Rubio-Valera, Maria

    2015-01-01

    Background Primary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities. Methods and Findings A meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the

  6. [Primary health care in Ghana: no pay no cure?].

    PubMed

    Kyei-Faried, S; Hermans, M

    1995-11-11

    Between 1975 and 1983 health care expenditures in Ghana dropped to a low point as a consequence of the structural readjustment program instituted by the World Bank. During 1975-76 only 15% of available funds were spent on primary health care (PHC), which was officially introduced in the late 1970s. PHC made up 20-25% of the health care expenditures by 1991 with about 25% of health personnel engaged in PHC. 2/3 of health care delivery covered urban areas when 60% of the population lived in the countryside. The district of Ejisu-Juaben in the Ashanti region had high morbidity. Tetanus, polio, whooping-cough, and diphtheria had been brought under control, but measles, diarrhea, and malnutrition were still widespread among children under 5 years old. Malaria, bilharzia, intestinal parasites, respiratory infections, hepatitis, anemia, hypertension, and vitamin A deficiency were also grave problems. AIDS was on the rise. Child mortality amounted to 130/1000 live births and maternal mortality to 1400/100,000 cases. The medical structure of the district comprises 10 health posts (6 governmental and 4 mission). Only 72 villages and 120,000 people are cared for. Each post has a mobile team. In 1993 a new community-based health care program began funded by Save the Children Netherlands. In 60 villages a village health committee existed but they were substandard. They were either reactivated or new committees were set up. Training activities were also started in prenatal care, delivery, care of malnutrition and diarrhea, hygiene, and sanitation. Two years later safe motherhood indicators had improved; postnatal care increased from 16% to 49%; medical deliveries increased from 27% to 37%; the share of families with contraceptive acceptance increased from 7% to 21%; and tetanus vaccination among mothers was estimated to have increased from 27% to 86%. PMID:7501068

  7. Risk levels for suffering a traffic injury in primary health care. The LESIONAT* project

    PubMed Central

    2010-01-01

    Background Literature shows that not only are traffic injuries due to accidents, but that there is also a correlation between different chronic conditions, the consumption of certain types of drugs, the intake of psychoactive substances and the self perception of risk (Health Belief Model) and the impact/incidence of traffic accidents. There are few studies on these aspects in primary health care. The objectives of our study are: Main aim: To outline the distribution of risk factors associated with Road Traffic Injuries (RTI) in a driving population assigned to a group of primary health care centres in Barcelona province. Secondly, we aim to study the distribution of diverse risk factors related to the possibility of suffering an RTI according to age, sex and population groups, to assess the relationship between these same risk factors and self risk perception for suffering an RTI, and to outline the association between the number of risk factors and the history of reported collisions. Methods/Design Design: Cross-sectional, multicentre study. Setting: 25 urban health care centres. Study population: Randomly selected sample of Spanish/Catalan speakers age 16 or above with a medical register in any of the 25 participating primary health care centres. N = 1540. Unit of study: Basic unit of care, consisting of a general practitioner and a nurse, both of whom caring for the same population (1,500 to 2,000 people per unit). Instruments of measurement: Data collection will be performed using a survey carried out by health professionals, who will use the clinical registers and the information reported by the patient during the visit to collect the baseline data: illnesses, medication intake, alcohol and psychoactive consumption, and self perception of risk. Discussion We expect to obtain a risk profile of the subjects in relation to RTI in the primary health care field, and to create a group for a prospective follow-up. Trial Registration Clinical Trials.gov Identifier

  8. Choosing a Primary Health Care Provider (PCP): A Guide for Young Women

    MedlinePlus

    ... Conditions Nutrition & Fitness Emotional Health Choosing a Primary Health Care Provider (PCP): General Information Posted under Health Guides . ... needs. How do I find the names of health care providers? You should first make a list of ...

  9. Choosing a Primary Health Care Provider (PCP): A Guide for Young Men

    MedlinePlus

    ... Conditions Nutrition & Fitness Emotional Health Choosing a Primary Health Care Provider (PCP): General Information Posted under Health Guides . ... needs. How do I find the names of health care providers? Here are some ways to find a ...

  10. Health and Beyond... Strategies for a Better India: Concept Paper on Primary Health Care in India

    PubMed Central

    Bhaumik, Soumyadeep

    2014-01-01

    Background: India is one of the fastest growing economies of the world, and is posed to overtake China in terms of being the most populous nation of the world. The very essential components of primary health care – promotion of food supply, proper nutrition, safe water and basic sanitation and provision for quality health information concerning the prevailing health problems – is largely ignored. Access to healthcare services, provision of essential medicines and scarcity of doctors are other bottlenecks in the primary health care scenario. Complete absence of evidence-based guidelines on clinical scenarios and treatment plans in the primary health care sector, together with overburdening of the secondary and tertiary care sectors, has substantially lowered the quality of care in the nation. Aim: To discuss a strategy for a better primary healthcare model. Methods: This is a concept paper with an exploratory view of various problems and a suggested strategy to counter it. Results: This concept paper suggests a triad of strategies (technology, accountability and ink-blot strategy) that can be adapted to various problems in the primary healthcare scenario. Discussion: The concept paper is a preliminary document on a suggested model that needs to be worked out on a broader basis across all stakeholders with operational definitions, standards of procedure and protocols finalised. PMID:25161962

  11. The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.

    PubMed

    Nicholas, D D; Heiby, J R; Hatzell, T A

    1991-01-01

    Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems. PMID:1782383

  12. The health status of rural primary schoolchildren in Central Zambia.

    PubMed

    Ng'andu, N H; Nkowane, B M; Watts, T E

    1991-06-01

    In a study of 528 rural primary schoolchildren in Central Zambia, it was found that the health status of the schoolchildren was not good as indicated by inadequate nutrition, a high prevalence of S. haematobium (18%), hookworm (33%), and malaria (43%) infections. There were no statistically significant differences in prevalence of undernutrition between girls and boys and there were no significant trends with age. The treatment and control of hookworm disease, urinary schistosomiasis and malaria deserve a high priority in this area. As for malaria, until an international programme on its control can be developed, the acquisition of protective immunity is of paramount importance. This study shows how the use of 'simple' screening procedures can provide information to direct health education and other disease control measures in school health programmes. As the economic situation in Zambia is not good, the best hope for improvement of the children's health lies with environmental improvement in sanitation, water supplies and provision of basic health education. PMID:1711129

  13. Introducing quality management into primary health care services in Uganda.

    PubMed Central

    Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.

    1997-01-01

    In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements, increased morale of district health team members, improved satisfaction among patients, and greater involvement of local government in the decisions of district health committees have been observed. At the central level, the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health headquarters have led to a greater understanding by central staff of the issues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level, some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving. PMID:9185368

  14. [Health, power, and democracy. Notes for a primary care theory].

    PubMed

    Gyarmati, G

    1993-03-01

    Health services are relentlessly deteriorating due to the persistent increase in their costs. This deterioration not only affects people's health. This service is directly linked to personal and family security and populations social equity expectatives. Thus, its failure inevitably leads to a gradual loss of State and public authorities legitimacy, threatening the stability of the democratic system. In the long run, it also affects the legitimacy of medical profession. To overcome this problem, considering the limited possibilities of a relatively poor country, a new health services model is proposed, based on a massive strengthening of primary care, organized in a way in which the community assumes an important part of the responsibility for the health of its members. To achieve this purpose the use of the concept of "empowerment" is proposed, practically applied through the "pedagogic investigation-action". As a result a noticeable increase in the general health level of the population is expected. At the same time, one of the serious threatens to the legitimacy of the Democratic State will be eliminated. PMID:8248648

  15. Telemedicine in Primary Health: The Virtual Doctor Project Zambia

    PubMed Central

    2011-01-01

    This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront. PMID:21569490

  16. Mental Health Screening of Older Adults in Primary Care

    PubMed Central

    Davis, Mary J.; Moye, Jennifer; Karel, Michele J.

    2016-01-01

    In an effort to document mental health outreach in our primary care clinic, 316 veterans (mean age 72) not currently in psychiatric treatment were screened for multiple mental health symptoms. Depressed mood was reported by 18% of the sample, insomnia by 26%, and morbid/suicidal ideation by 6.9% for at least several days during the past 2 weeks. Of those who experienced a loss over the past year (43%), 36% remained affected by the loss. Also reported were anxiety symptoms (29%) and PTSD symptoms (14%). Two-fifths (39%) of patients reported drinking alcohol in the past week, 18% more than 5 days, and 13% more than 3 drinks per sitting. Twenty-six percent of the patients reported symptoms warranting intervention; of these, only 39% accepted a treatment referral. While screening for depressed mood and alcohol use is now common in primary care, we found it useful to screen for specific symptoms of depression (including insomnia and suicidal ideation), persisting grief reactions, anxiety, and PTSD in this setting. Further research is necessary to determine factors that underlie some patients’ refusal to accept mental health treatment.

  17. Primary health care in Saudi Arabia: applying global aspects of health for all, locally.

    PubMed

    Littlewood, J; Yousuf, S

    2000-09-01

    Primary health care in Saudi Arabia: applying global aspects of health for all, locally This paper describes the application of primary health care principles in the Islamic Kingdom of Saudi Arabia. It arose from a doctoral supervisory experience on a joint programme for women students, operating between a British and Saudi Arabian University. The research looked at nutritional advice given by diploma-level nurses to pregnant women attending primary health care centres in Saudi Arabia. The supervisor supported research that drew on internationally recognized trends in nursing research (the reflexive learner) whilst attending to local requirements and conventions of the culture. The student was encouraged explicitly to site the research within the framework of Islamic teaching and Saudi culture. The Qur'an was used as an overarching framework within which the tenets of primary health care were explored. This was seen to be crucial in addressing World Health Organisation and the International Council of Nurses' views on contextualizing nursing for the greatest benefit of the population. This was of particular relevance in Saudi Arabia where research carried out in the community by women is novel, and as yet there are no nurse theorists from within Saudi culture. PMID:11012811

  18. Patient Internet Use for Health Information at Three Urban Primary Care Clinics

    PubMed Central

    Dickerson, Suzanne; Reinhart, Amber M.; Feeley, Thomas Hugh; Bidani, Rakesh; Rich, Ellen; Garg, Vinod K.; Hershey, Charles O.

    2004-01-01

    Objective: To survey a cross section of patients presenting to three urban primary care clinics to understand online health information search behaviors. Design and analysis: At three urban primary care clinics affiliated with University at Buffalo, School of Medicine, 315 patients were interviewed. Interview questions included items on education, demographic information, employment, number of current prescriptions, insurance, online access, and specifics of health-searching behaviors. Chart review determined patient body mass index and number of chronic illnesses. Logistic regression and χ2 statistics were used to investigate the relationship between patient characteristics and the proportion of patients who use the Web for seeking health information. Results: Approximately 53% of respondents reported using Web or e-mail in the past year and 68% (33% of total sample) of those who accessed the Web used it to search for health information. The two most commonly cited search areas included information about a physical illness and nutrition/fitness. Education and race significantly predicted online health-seeking behavior when considering all factors in the study. Many patients (22%) relied on friends and family to navigate the Web, and 45% of patients reported that the information that they sought was unrelated to their clinical visit. Conclusion: Current use of the Internet for health information was limited among more disadvantaged patient groups. More research is needed to examine the relationship between health-seeking behavior and patients' management of their health and well-being. PMID:15298993

  19. Retail health clinics drive innovation into primary care practices.

    PubMed

    Kissinger, Mark

    2008-01-01

    A myriad of patient dissatisfaction issues stemming from antiquated approaches to primary care access are resulting in the establishment of retail health clinics (RHCs) throughout the country. RHCs are usually located within retail stores or stand-alone pharmacies and are staffed by nurse practitioners (NPs). They offer treatment for colds, coughs, skin rashes, and ear infections along with offering preventive care and physicals. As disruptive innovations, or innovations that offer services to ignored markets, these clinics are siphoning patient care visits away from primary care physicians because of their attention to quick access, affordable prices, and consumer-friendly approaches. In response, family and internal medicine physicians must follow three strategies to secure their patient population as well as attract new patients: build relationships with RHCs through referral networks and NP supervisory agreements, transform the provision of patient access through the development of physician-owned RHCs, and support the concept of the advanced medical home. PMID:18472612

  20. Cost analysis of a primary health care centre in Bangladesh

    PubMed Central

    Hussain, A. M. Zakir

    1983-01-01

    This report describes the first-ever cost analysis of a primary health care centre in Bangladesh. The aim was to provide information on costs incurred on various health care activities available in a thana health complex, in relation to the number of patients and the intensity of use of services. Overall costs were estimated by examining records and papers and by interviewing staff. Cost apportionment was carried out in three stages. In the first stage, all direct expenditure was calculated for each activity, e.g., wards, outpatient department, tuberculosis services, etc. In the second stage, general service costs, covering water, sanitation, security, and administration were divided among the various services. In the third stage, the costs of laboratory services were distributed according to the number of examinations carried out for each service. The capital costs for 1979 were US$ 36 382, of which 84.6% were incurred on the buildings. Recurrent costs for 1979 were US$ 59 556, i.e., 62% of overall costs, reflecting the labour intensiveness of the health complex. The distribution of the costs among the various health care activities was detailed. It was found that, in general, the cost per unit of activity depended mainly on the intensity of use of the resources, e.g., unit costs incurred in the outpatient department, maternal and child health services, and subcentres were relatively low because of the high rate of utilization of services. This study has demonstrated that it is possible to estimate unit costs in a thana health complex. It is hoped that the methods used here will provide a basis for further work of a similar nature. PMID:6603921

  1. Predictors of Adolescents’ Health- promoting Behaviors Guided by Primary Socialization Theory

    PubMed Central

    Rew, Lynn; Arheart, Kristopher L.; Thompson, Sanna; Johnson, Karen

    2013-01-01

    Purpose The purpose of this study was to determine the influence of parents and peers on adolescents’ health-promoting behaviors, framed by Primary Socialization Theory. Design and Method Longitudinal data collected annually from 1,081 rural youth (mean age = 17 ±.7; 43.5% males; 44% Hispanic) and once from their parents were analyzed using generalized linear models. Results Parental monitoring and adolescent’s religious commitment significantly predicted all health-promoting behaviors (nutrition, physical activity, safety, health practices awareness, stress management). Other statistically significant predictors were parent’s responsiveness and health-promoting behaviors. Peer influence predicted safety and stress management. Practice Implications Nurses may facilitate adolescents’ development of health-promoting behaviors through family-focused interventions. PMID:24094123

  2. The temporal association of excessive health expenditure with suicidal ideation among primary income earners: a cross-sectional design using the Korean Welfare Panel Survey (KoWePS)

    PubMed Central

    Shin, Jaeyong; Choi, Jae Woo; Jang, Sung-in; Choi, Young; Lee, Sang Gyu; Ihm, Tae Hwan; Park, Eun-Cheol

    2015-01-01

    Objective Excessive health expenditure (EHE) is a global issue for households suffering from high-cost medical conditions, low incomes and limited insurance coverage. After the international financial crisis of 2008, EHE became a social problem in developed countries. Such economic crisis might induce severe mental stress, resulting in suicidal ideation. Methods We used the Korean Welfare Panel Study (KoWePS) from 2011 to 2013 and selected primary income earners, who were defined as practical and economic representatives of households; the total number of analysed samples was 4247 of 5717 households in the database. We only included households that had never experienced EHE before 2011. To examine the temporal relationship between EHE and suicidal ideation, we conducted a logistic regression analysis. Results Among 4247 participants, 146 (3.4%) experienced suicidal ideation, whereas 4101 (96.6%) did not. One scale of depression score (OR=1.28, CI 1.23 to 1.34, p<0.001) was associated with increased suicidal ideation. Such ideation was influenced to a greater extent by a recent EHE above 10% of disposable income (OR=1.91, CI 1.16 to 3.15, p=0.012) than by either a remote EHE (OR=1.29, CI 0.71 to 2.32) or one in 2011 and 2012 (OR=1.67, CI 1.01 to 2.78, p=0.048). Conclusions In this study, more recent EHE resulted in more suicidal ideation. In conclusion, we suggest that recent household EHE might be considered as an important factor to prevent suicidal ideation and to improve the mental health of individuals. PMID:26082463

  3. Replicating impact of a primary school HIV prevention programme: primary school action for better health, Kenya.

    PubMed

    Maticka-Tyndale, E; Mungwete, R; Jayeoba, O

    2014-08-01

    School-based programmes to combat the spread of HIV have been demonstrated to be effective over the short-term when delivered on a small scale. The question addressed here is whether results obtained with small-scale delivery are replicable in large-scale roll-out. Primary School Action for Better Health (PSABH), a programme to train teachers to deliver HIV-prevention education in upper primary-school grades in Kenya demonstrated positive impact when tested in Nyanza Province. This article reports pre-, 10-month post- and 22-month post-training results as PSABH was delivered in five additional regions of the country. A total of 26 461 students from 110 primary schools in urban and rural, middle- and low-income settings participated in this repeated cross-sectional study. Students ranged in age from 11 to 16 years, were predominantly Christian (10% Muslim), and the majority were from five different ethnic groups. Results demonstrated positive gains in knowledge, self-efficacy related to changes in sexual behaviours and condom use, acceptance of HIV+ students, endorsement of HIV-testing and behaviours to post-pone sexual debut or decrease sexual activity. These results are as strong as or stronger than those demonstrated in the original impact evaluation conducted in Nyanza Province. They support the roll-out of the programme across Kenyan primary schools. PMID:23962492

  4. Strategies for Primary Care Stakeholders to Improve Electronic Health Records (EHRs).

    PubMed

    Olayiwola, J Nwando; Rubin, Ashley; Slomoff, Theo; Woldeyesus, Tem; Willard-Grace, Rachel

    2016-01-01

    The use of electronic health records (EHRs) and the vendors that develop them have increased exponentially in recent years. While there continues to emerge literature on the challenges EHRs have created related to primary care provider satisfaction and workflow, there is sparse literature on the perspective of the EHR vendors themselves. We examined the role of EHR vendors in optimizing primary care practice through a qualitative study of vendor leadership and developers representing 8 companies. We found that EHR vendors apply a range of strategies to elicit feedback from their clinical users and to engage selected users in their development and design process, but priorities are heavily influenced by the macroenvironment and government regulations. To improve the "marriage" between primary care and the EHR vendor community, we propose 6 strategies that may be most impactful for primary care stakeholders seeking to influence EHR development processes. PMID:26769884

  5. Academic medicine: a key partner in strengthening the primary care infrastructure via teaching health centers.

    PubMed

    Rieselbach, Richard E; Crouse, Byron J; Neuhausen, Katherine; Nasca, Thomas J; Frohna, John G

    2013-12-01

    In the United States, a worsening shortage of primary care physicians, along with structural deficiencies in their training, threaten the primary care system that is essential to ensuring access to high-quality, cost-effective health care. Community health centers (CHCs) are an underused resource that could facilitate rapid expansion of the primary care workforce and simultaneously prepare trainees for 21st-century practice. The Teaching Health Center Graduate Medical Education (THCGME) program, currently funded by the Affordable Care Act, uses CHCs as training sites for primary-care-focused graduate medical education (GME).The authors propose that the goals of the THCGME program could be amplified by fostering partnerships between CHCs and teaching hospitals (academic medical centers [AMCs]). AMCs would encourage their primary care residency programs to expand by establishing teaching health center (THC) tracks. Modifications to the current THCGME model, facilitated by formal CHC and academic medicine partnerships (CHAMPs), would address the primary care physician shortage, produce physicians prepared for 21st-century practice, expose trainees to interprofessional education in a multidisciplinary environment, and facilitate the rapid expansion of CHC capacity.To succeed, CHAMP THCs require a comprehensive consortium agreement designed to ensure equity between the community and academic partners; conforming with this agreement will provide the high-quality GME necessary to ensure residency accreditation. CHAMP THCs also require a federal mechanism to ensure stable, long-term funding. CHAMP THCs would develop in select CHCs that desire a partnership with AMCs and have capacity for providing a community-based setting for both GME and health services research. PMID:24128617

  6. Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis: a Review Featuring a Women's Health Perspective

    PubMed Central

    Marchioni Beery, Renée M.; Vaziri, Haleh; Forouhar, Faripour

    2014-01-01

    Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are two major types of chronic cholestatic liver disease. Each disorder has distinguishing features and variable progression, but both may ultimately result in cirrhosis and hepatic failure. The following offers a review of PBC and PSC, beginning with a general overview of disease etiology, pathogenesis, diagnosis, clinical features, natural course, and treatment. In addition to commonly associated manifestations of fatigue, pruritus, and fat-soluble vitamin deficiency, select disease-related topics pertaining to women's health are discussed including metabolic bone disease, hyperlipidemia and cardiovascular risk, and pregnancy-related issues influencing maternal disease course and birth outcomes. This comprehensive review of PBC and PSC highlights some unique clinical considerations in the care of female patients with cholestatic liver disease. PMID:26357630

  7. Closing the health equity gap: evidence-based strategies for primary health care organizations

    PubMed Central

    2012-01-01

    Introduction International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically-informed key dimensions and

  8. Incorporating Yoga Therapy into Primary Care: The Casey Health Institute.

    PubMed

    Ross, Alyson; Williams, Laurie; Pappas-Sandonas, Mary; Touchton-Leonard, Katharine; Fogel, David

    2015-01-01

    Individuals seek complementary and alternative medicine (CAM) for a variety of health conditions, and yoga is a popular CAM modality. Over the past few decades, yoga has become incorporated into hundreds of healthcare facilities, most commonly in large university medical centers. While research has shown yoga to be effective in reducing symptoms and improving outcomes in chronic health conditions, most patients seek yoga therapy on their own, as few primary care practitioners have incorporated yoga therapy into their practices. The purpose of this article is to describe the efforts of the Casey Health Institute to incorporate yoga therapy into their primary care integrative medicine center. At Casey Health, a full-time Clinical Yoga Specialist works alongside the physicians, nurses, and CAM providers in delivering care to a wide variety of patients. The majority of referrals to yoga therapy have been for pain-related musculoskeletal conditions, as well as hypertension, headaches, anxiety, depression, and sleep disturbances. Most patients attend weekly 60-minute individual sessions, and the Clinical Yoga Specialist stays in touch with the patient between appointments via telephone and email. T h e Clinical Yoga Specialist has become an integral part of Casey Health, participating in collaborative medical appointments in which two CAM practitioners provide simultaneous treatments to a patient. She also participates in the clinic's ongoing weight loss program. The Clinical Yoga Specialist spends one morning each week "floating" in the clinic, when she is on-call to the practitioners to assist in treatment and/or to introduce a yoga therapy experience to the patients. These brief interventions introduce the patients to the therapeutic benefits of yoga, while simultaneously demonstrating yoga's effectiveness to the healthcare providers. Casey Health has developed a unique teacher training program whose faculty includes senior Iyengar yoga teachers as well as physicians

  9. The public health leadership certificate: a public health and primary care interprofessional training opportunity.

    PubMed

    Matson, Christine C; Lake, Jeffrey L; Bradshaw, R Dana; Matson, David O

    2014-03-01

    This article describes a public health leadership certificate curriculum developed by the Commonwealth Public Health Training Center for employees in public health and medical trainees in primary care to share didactic and experiential learning. As part of the program, trainees are involved in improving the health of their communities and thus gain a blended perspective on the effectiveness of interprofessional teams in improving population health. The certificate curriculum includes eight one-credit-hour didactic courses offered through an MPH program and a two-credit-hour, community-based participatory research project conducted by teams of trainees under the mentorship of health district directors. Fiscal sustainability is achieved by sharing didactic courses with MPH degree students, thereby enabling trainees to take advantage of a reduced, continuing education tuition rate. Public health employee and primary care trainees jointly learn knowledge and skills required for community health improvement in interprofessional teams and gain an integrated perspective through opportunities to question assumptions and broaden disciplinary approaches. At the same time, the required community projects have benefited public health in Virginia. PMID:24578368

  10. Determinants of Health and Pediatric Primary Care Practices.

    PubMed

    Beck, Andrew F; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Cox, Joanne E; Gitterman, Benjamin A; Chamberlain, Lisa J; Grace, Aimee M; Hole, Michael K; Klass, Perri E; Lobach, Katherine S; Ma, Christine T; Navsaria, Dipesh; Northrip, Kimberly D; Sadof, Matthew D; Shah, Anita N; Fierman, Arthur H

    2016-03-01

    More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of poverty-related risks in ways that promote long-term health and well-being for children. PMID:26933205

  11. Prevention of mental handicaps in children in primary health care.

    PubMed Central

    Shah, P. M.

    1991-01-01

    Some 5-15% of children aged 3 to 15 years in both developing and developed countries suffer from mental handicaps. There may be as many as 10-30 million severely and about 60-80 million mildly or moderately mentally retarded children in the world. The conditions causing mental handicaps are largely preventable through primary health care measures in developing countries. Birth asphyxia and birth trauma are the leading causes of mental handicaps in developing countries where over 1.2 million newborns die each year from moderate or severe asphyxia and an equal number survive with severe morbidity due to brain damage. The other preventable or manageable conditions are: infections such as tuberculous and pyogenic meningitides and encephalopathies associated with measles and whooping cough; severe malnutrition in infancy; hyperbilirubinaemia in the newborn; iodine deficiency; and iron deficiency anaemia in infancy and early childhood. In addition, recent demographic and socioeconomic changes and an increase in the number of working mothers tend to deprive both infants and young children of stimulation for normal development. To improve this situation, the primary health care approach involving families and communities and instilling the spirit of self-care and self-help is indispensable. Mothers and other family members, traditional birth attendants, community health workers, as well as nurse midwives and physicians should be involved in prevention and intervention activities, for which they should be trained and given knowledge and skills about appropriate technologies such as the risk approach, home-based maternal record, partograph, mobilogram (kick count), home-risk card, icterometer, and mouth-to-mask or bag and mask resuscitation of the newborn. Most of these have been field-tested by WHO and can be used in the home, the health centre or day care centres to detect and prevent the above-mentioned conditions which can cause mental handicap. PMID:1786628

  12. Primary Health Care and partnerships: collaboration of a community agency, health department, and university nursing program.

    PubMed

    Leonard, L G

    1998-03-01

    Health care reform proposals emphasize health care that is essential, practical, scientifically sound, coordinated, accessible, appropriately delivered, and affordable. One route to achievement of improved health outcomes within these parameters is the formation of partnerships. Partnerships adopting the philosophy and five principles of Primary Health Care (PHC) focus on health promotion and prevention of illness and disability, maximum community participation, accessibility to health and health services, interdisciplinary and intersectoral collaboration, and use of appropriate technologies such as resources and strategies. A community service agency serving a multicultural population initiated a partnership with a health department and a university undergraduate nursing program. The result was a preschool health fair and there were benefits for each partner-benefits which could not have been realized without the collaboration. The health fair partnership planning, implementation, and evaluation process was guided by a framework shaped by the philosophy and five principles of PHC. The educational process described can be applied to other learning experiences where the goal is to help students understand and apply the concepts of PHC, develop myriad nursing competencies, and form collaborative relationships with the community and health agencies. Community health care dilemmas and nursing education challenges can be successfully addressed when various disciplines and sectors form effective partnerships. PMID:9535233

  13. Perceived Risk of Mental Health Problems in Primary Care

    PubMed Central

    Paúl, Constança; Teixeira, Laetitia; Azevedo, Maria João; Alves, Sara; Duarte, Mafalda; O’Caoimh, Rónán; Molloy, William

    2015-01-01

    In the face of limited resources and an aging population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalization, hospitalization and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care (PC). We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community to rank perceived risk of mental health concerns (including neurocognitive and mood disorders) from 1 (mild) to 3 (severe). The mean age of the 4499 people assessed was 76.3 years (SD = 7.3) and 2645 (58.8%) were female. According to the PC team 1616 (35.9%) were perceived to have mental health concerns of whom 847 (52.4%) were mild, 559 (34.6%) were moderate and 210 (13%) were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR = 2.22, 95% CI 1.83–2.69 for institutionalization; OR = 1.66, 95% CI 1.41–1.94 for hospitalization; OR = 1.69, 95% CI 1.42–2.01 for death). These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes. PMID:26635600

  14. Health information technology in primary health care in developing countries: a literature review.

    PubMed Central

    Tomasi, Elaine; Facchini, Luiz Augusto; Maia, Maria de Fatima Santos

    2004-01-01

    This paper explores the debate and initiatives concerning the use of information technology (IT) in primary health care in developing countries. The literature from 1992-2002 was identified from searches of the MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science databases. The search identified 884 references, 350 of which were classified according to the scheme described by the Pan American Health Organization (PAHO). For the analysis of advantages, problems and perspectives of IT applications and systems, 52 articles were selected according to their potential contribution to the primary health-care processes in non-developed countries. These included: 10 on electronic patient registries (EPR), 22 on process and programmatic action evaluation and management systems (PPAEM) and 20 on clinical decision-support systems (CDS). The main advantages, limitations and perspectives are discussed. PMID:15640923

  15. STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER

    PubMed Central

    Freed, Christopher R.; Hansberry, Shantisha T.; Arrieta, Martha I.

    2014-01-01

    Purpose: To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Methodology/approach: Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Findings: Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Research limitations/implications: Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. Originality/value: This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups. PMID:24532864

  16. National program for family planning and primary health care Pakistan: a SWOT analysis

    PubMed Central

    2013-01-01

    Background The National Program for Family Planning and Primary Healthcare was launched in 1994. It is one of the largest community based programs in the world, providing primary healthcare services to about 80 million people, most of which is rural poor. The program has been instrumental in improving health related indicators of maternal and child health in the last two decades. Methods SWOT analysis was used by making recourse to the structure and dynamics of the program as well as searching the literature. SWOT analysis Strengths of the program include: comprehensive design of planning, implementation and supervision mechanisms aided by an MIS, selection and recruitments processes and evidence created through improving health impact indicators. Weaknesses identified are slow progress, poor integration of the program with health services at local levels including MIS, and de-motivational factors such as job insecurity and non-payment of salaries in time. Opportunities include further widening the coverage of services, its potential contribution to health system research, and its use in areas other than health like women empowerment and poverty alleviation. Threats the program may face are: political interference, lack of funds, social threats and implications for professional malpractices. Conclusion Strengthening of the program will necessitate a strong political commitment, sustained funding and a just remuneration to this bare foot doctor of Pakistan, the Lady Health Worker. PMID:24268037

  17. Building effective service linkages in primary mental health care: a narrative review part 2

    PubMed Central

    2011-01-01

    Background Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care. Methods A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored. Results A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings. Conclusion The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers

  18. Simplified Analysis Methods for Primary Load Designs at Elevated Temperatures

    SciTech Connect

    Carter, Peter; Jetter, Robert I; Sham, Sam

    2011-01-01

    The use of simplified (reference stress) analysis methods is discussed and illustrated for primary load high temperature design. Elastic methods are the basis of the ASME Section III, Subsection NH primary load design procedure. There are practical drawbacks with this approach, particularly for complex geometries and temperature gradients. The paper describes an approach which addresses these difficulties through the use of temperature-dependent elastic-perfectly plastic analysis. Correction factors are defined to address difficulties traditionally associated with discontinuity stresses, inelastic strain concentrations and multiaxiality. A procedure is identified to provide insight into how this approach could be implemented but clearly there is additional work to be done to define and clarify the procedural steps to bring it to the point where it could be adapted into code language.

  19. Mechanical Design of the HER Synchrotron Light Monitor Primary Mirror

    SciTech Connect

    Daly, Edward F.; Fisher, Alan S.; Kurita, Nadine R.; Langton, J.; /SLAC

    2011-09-14

    This paper describes the mechanical design of the primary mirror that images the visible portion of the synchrotron radiation (SR) extracted from the High Energy Ring (HER) of the PEP-II B-Factory. During off-axis operation, the water-cooled GlidCop mirror is subjected to a heat flux in excess of 2000 W/cm2. When on-axis imaging occurs, the heat flux due to scattered SR, resistive wall losses and Higher-Order-Mode (HOM) heating is estimated at 1 W/cm2. The imaging surface is plated with Electroless Nickel to improve its optical characteristics. The design requirements for the primary mirror are listed and discussed. Calculated mechanical distortions and stresses experienced by the mirror during on-axis and off-axis operation will be presented.

  20. Subjective Well-Being among Primary Health Care Patients

    PubMed Central

    Ozcakir, Alis; Oflu Dogan, Fatma; Cakir, Yakup Tolga; Bayram, Nuran; Bilgel, Nazan

    2014-01-01

    Background The psychological importance of subjective well-being for a healthy life has been well recognized. It is also well known that depressive and anxiety disorders have a negative effect on subjective well-being. The aim of this cross-sectional, descriptive study was to assess the subjective well-being status of a group of primary healthcare patients in relation to socio-demographic characteristics, personal health and mood-status. Methods A total of 284 patients participated in the study. The Oxford Happiness Scale, Life Satisfaction Scale, DASS-42 (Depression, Anxiety and Stress Scales-42) and a questionnaire about socio-demographic characteristics were completed by the participants. Results In general, the participants were found to be moderately happy and satisfied with their lives. They had mild levels of depression, anxiety and stress. In terms of happiness, an older age (≥40 years), educated to secondary level or higher and not having depression or anxiety were found to be factors increasing happiness. In terms of life satisfaction, female gender, an older age (≥40 years), educated to secondary level or higher, being single and not having depression were found to increase life satisfaction. Conclusion Primary healthcare providers should give more importance to the mood status of their patients. Screening for depression and anxiety should be applied at the primary healthcare level because negative mood status is more important than some socio-demographic characteristics in respect of unhappiness and dissatisfaction. PMID:25486293

  1. Staff Perspectives on the Use of a Computer-Based Concept for Lifestyle Intervention Implemented in Primary Health Care

    ERIC Educational Resources Information Center

    Carlfjord, Siw; Johansson, Kjell; Bendtsen, Preben; Nilsen, Per; Andersson, Agneta

    2010-01-01

    Objective: The aim of this study was to evaluate staff experiences of the use of a computer-based concept for lifestyle testing and tailored advice implemented in routine primary health care (PHC). Design: The design of the study was a cross-sectional, retrospective survey. Setting: The study population consisted of staff at nine PHC units in the…

  2. How decentralisation influences the retention of primary health care workers in rural Nigeria

    PubMed Central

    Abimbola, Seye; Olanipekun, Titilope; Igbokwe, Uchenna; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra; Ihebuzor, Nnenna; Aina, Muyi

    2015-01-01

    Background In Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC – usually the only form of formal health service available in rural communities – is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees. Objective This study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities. Design The study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation. Results The results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular – in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also

  3. Privacy by design in personal health monitoring.

    PubMed

    Nordgren, Anders

    2015-06-01

    The concept of privacy by design is becoming increasingly popular among regulators of information and communications technologies. This paper aims at analysing and discussing the ethical implications of this concept for personal health monitoring. I assume a privacy theory of restricted access and limited control. On the basis of this theory, I suggest a version of the concept of privacy by design that constitutes a middle road between what I call broad privacy by design and narrow privacy by design. The key feature of this approach is that it attempts to balance automated privacy protection and autonomously chosen privacy protection in a way that is context-sensitive. In personal health monitoring, this approach implies that in some contexts like medication assistance and monitoring of specific health parameters one single automatic option is legitimate, while in some other contexts, for example monitoring in which relatives are receivers of health-relevant information rather than health care professionals, a multi-choice approach stressing autonomy is warranted. PMID:23978898

  4. Instructional design strategies for health behavior change.

    PubMed

    Kinzie, Mable B

    2005-01-01

    To help health educators build upon the best of different health behavior change theories, this paper offers a unified set of instructional design strategies for health education interventions. This set draws upon the recommendations of Rosenstock (Health Belief Model), Bandura (Social Cognitive Theory), and Dearing (Diffusion Theory), and uses a modified Events of Instruction framework (adapted from Robert Gagne): gain attention (convey health threats and benefits), present stimulus material (tailor message to audience knowledge and values, demonstrate observable effectiveness, make behaviors easy-to-understand and do), provide guidance (use trustworthy models to demonstrate), elicit performance and provide feedback (to enhance trialability, develop proficiency and self-efficacy), enhance retention and transfer (provide social supports and deliver behavioral cues). Sample applications of these strategies are provided. A brief review of research on adolescent smoking prevention enables consideration of the frequency with which these strategies are used, and possible patterns between strategy use and behavioral outcomes. PMID:15590217

  5. Designing online health services for patients.

    PubMed

    Crotty, Bradley H; Slack, Warner V

    2016-01-01

    Patients are increasingly interacting with their healthcare system through online health services, such as patient portals and telehealth programs. Recently, Shabrabani and Mizrachi provided data outlining factors that are most important for users or potential users of these online services. The authors conclude convincingly that while online health services have great potential to be helpful to their users, they could be better designed. As patients and their families play an increasingly active role in their health care, online health services should be made easier for them to use and better suited to their health-related needs. Further, the online services should be more welcoming to people of all literacy levels and from all socioeconomic backgrounds. PMID:27307985

  6. Effectiveness of service linkages in primary mental health care: a narrative review part 1

    PubMed Central

    2011-01-01

    Background With the move to community care and increased involvement of generalist health care providers in mental health, the need for health service partnerships has been emphasised in mental health policy. Within existing health system structures the active strategies that facilitate effective partnership linkages are not clear. The objective of this study was to examine the evidence from peer reviewed literature regarding the effectiveness of service linkages in primary mental health care. Methods A narrative and thematic review of English language papers published between 1998 and 2009. Studies of analytic, descriptive and qualitative designs from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted to examine what service linkages have been used in studies of collaboration in primary mental health care. Findings from the randomised trials were tabulated to show the proportion that demonstrated clinical, service delivery and economic benefits. Results A review of 119 studies found ten linkage types. Most studies used a combination of linkage types and so the 42 RCTs were grouped into four broad linkage categories for meaningful descriptive analysis of outcomes. Studies that used multiple linkage strategies from the suite of "direct collaborative activities" plus "agreed guidelines" plus "communication systems" showed positive clinical (81%), service (78%) and economic (75%) outcomes. Most evidence of effectiveness came from studies of depression. Long term benefits were attributed to medication concordance and the use of case managers with a professional background who received expert supervision. There were fewer randomised trials related to collaborative care of people with psychosis and there were almost none related to collaboration with the wider human service sectors. Because of the variability of study types we did not exclude on quality or attempt to weight findings according to power or effect size. Conclusion There is

  7. Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India

    PubMed Central

    Shidhaye, Rahul; Shrivastava, Sanjay; Murhar, Vaibhav; Samudre, Sandesh; Ahuja, Shalini; Ramaswamy, Rohit; Patel, Vikram

    2016-01-01

    Background The large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care. Aims To operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district. Method Mixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility. Results The MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment. Conclusions There are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models. PMID:26447172

  8. A sustainable behavioral health program integrated with public health primary care.

    PubMed

    Mims, Susan

    2006-01-01

    The need for behavioral healthcare for the poor and indigent is well documented in rural North Carolina, and integrated behavioral healthcare--that is, mental health screening and treatment offered as part of primary care services--has proven a very effective and efficient method to improve patients' health. In 2000, the Buncombe County Health Center (BCHC) began a grant-funded program treating depressed patients in its public health clinics and school health programs. The Health Center used the opportunity to send a team to the Management Academy for Public Health to learn business principles that could be applied to the challenge of sustaining this program as part of its ongoing public health service delivery for the county. Using their business plan from the Management Academy, the BCHC sought funding from various stakeholders, and, through their support, was able to institute a fully integrated behavioral health program in 2004. The BCHC has now joined forces with other partners in the state to address statewide policy changes in support of such programs. These efforts are an example of how a community health center can apply entrepreneurial thinking and strategic business planning to improve healthcare and effect wide-ranging change. PMID:16912608

  9. Unravelling the concept of consumer preference: implications for health policy and optimal planning in primary care.

    PubMed

    Foster, Michele M; Earl, Peter E; Haines, Terry P; Mitchell, Geoffrey K

    2010-10-01

    Accounting for consumer preference in health policy and delivery system design makes good economic sense since this is linked to outcomes, quality of care and cost control. Probability trade-off methods are commonly used in policy evaluation, marketing and economics. Increasingly applied to health matters, the trade-off preference model has indicated that consumers of health care discriminate between different attributes of care. However, the complexities of the health decision-making environment raise questions about the inherent assumptions concerning choice and decision-making behavior which frame this view of consumer preference. In this article, we use the example of primary care in Australia as a vehicle to examine the concept of 'consumer preference' from different perspectives within economics and discuss the significance of how we model preferences for health policy makers. In doing so, we question whether mainstream thinking, namely that consumers are capable of deliberating between rival strategies and are willing to make trade-offs, is a reliable way of thinking about preferences given the complexities of the health decision-making environment. Alternative perspectives on preference can assist health policy makers and health providers by generating more precise information about the important attributes of care that are likely to enhance consumer engagement and optimise acceptability of health care. PMID:20466449

  10. Preliminary Exploration of the Mental Health Education Competency Survey of Primary and Middle School Head Teachers

    ERIC Educational Resources Information Center

    Liu, Chunyu; Liu, Yanling; Guo, Cheng; Lan, Haiying

    2014-01-01

    Despite a recent focus on the mental health of students, primary and middle school mental health education in China has been hampered by a lack of resources and inadequate professional training. This study assessed the mental health education competency of primary and middle school head teachers using the Mental Health Education Competency…

  11. On Being in Charge: A Guide for Middle-Level Management in Primary Health Care.

    ERIC Educational Resources Information Center

    McMahon, Rosemary; And Others

    Intended for middle-level health workers with managerial responsibilities, this guide aims to help improve their efficiency in the support and supervision of community health workers and in the organization and continuous support of primary health care programs. It is a sequel to "The Primary Health Worker," available separately--see note. The…

  12. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    ERIC Educational Resources Information Center

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  13. Experiences of primary health care nurses regarding the provision of free health care services in the northern region of the Limpopo Province.

    PubMed

    Netshandama, V O; Nemathaga, L; Shai-Mahoko, S N

    2005-02-01

    The purpose of the study was to explore the experiences of primary health care nurses working in the clinics and health centres involved in the provision of free health care services. The research design followed was exploratory, descriptive and qualitative. The population of the study included all primary health care nurses working at the clinics and health centres in the Vhembe (northern) region of the Limpopo Province. The sampling method used was purposive for the samples of both the clinics and the nurses. The inclusion criteria for the nurses included experience of two or more years in providing primary health care. The inclusion criteria for the selection of clinics included being a busy clinic (a minimum of 2000 patients per month) with a staff establishment of four or more primary health care nurses. In conducting this research, ethical principles were taken into account. Data was collected from 23 participants in the Northern Region. The research question read as follows: What are your experiences regarding the provision of free health care services? An open coding method consisting of eight steps provided by Tesch's (1990:140-145) eight-step method of analysing data was used. The research findings revealed that the primary health care nurses working in the clinics experience feelings of failure to provide adequate primary health care services due to the increased workload, misuse of the service, and fear associated with lack of security in the clinics and health centres. The conclusions drawn from this research are that on the one hand a poor mechanism exists for the monitoring of the implementation of free health services, and on another hand, there has been misuse of the facilities by the community. The concept "free health care service" has been misinterpreted. PMID:15850154

  14. Design development of graphite primary structures enables SSTO success

    SciTech Connect

    Biagiotti, V.A.; Yahiro, J.S.; Suh, D.E.; Hodges, E.R.; Prior, D.J.

    1997-01-01

    This paper describes the development of a graphite composite wing and a graphite composite intertank primary structure for application toward Single-Stage to Orbit space vehicles such as those under development in NASA{close_quote}s X-33/Reusable Launch Vehicle (RLV) Program. The trade study and designs are based on a Rockwell vertical take-off and horizontal landing (VTHL) wing-body RLV vehicle. Northrop Grumman{close_quote}s approach using a building block development technique is described. Composite Graphite/Bismaleimide (Gr/BMI) material characterization test results are presented. Unique intertank and wing composite subcomponent test article designs are described and test results to date are presented. Wing and intertank Full Scale Section Test Article (FSTA) objectives and designs are outlined. Trade studies, supporting building block testing, and FSTA demonstrations combine to develop graphite primary structure composite technology that enables developing X-33/RLV design programs to meet critical SSTO structural weight and operations performance criteria. {copyright} {ital 1997 American Institute of Physics.}

  15. Utilization of the Primary Health Care Services in the Tshwane Region of Gauteng Province, South Africa

    PubMed Central

    Nteta, Thembi P.; Mokgatle-Nthabu, Matilda; Oguntibeju, Oluwafemi O.

    2010-01-01

    Background In South Africa, the provision of primary health care is a basic service designed to be cost effective and bring healthcare as close as possible to the population, particularly to those people of low economic status. It is a service which is provided free of charge by the South African government and as part of the millennium health goals, it is intended that the service should be accessible to the populace and be effectively utilized. Objective This study was designed to investigate the accessibility and utilization of the primary health care services in three community health care centres in the Tshwane of the Gauteng Province, South Africa. Methodology Data were obtained from participants attending three Community Health Care Centres in the Tshwane Region using self-administered structured questionnaires. A document review of the Community Health Care Centres records was conducted to investigate the utilization trends of the services provided and descriptive statistics were used to analyze the data obtained. Results The results showed that the Community Health Care Centres in the Tshwane Region are accessible to most participants who lived within 5 km of such centres and who traveled 30 minutes or less to the clinic. Using a taxi or walking were found to be the most common means of transport used to gain access to such a clinic. The findings showed that generally, participants were satisfied with the services provided. Conclusion Participants of this study have access to the community health care centres in the Tshwane Region and there seems to be effective utilization by patients attending them. PMID:21085475

  16. Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis

    PubMed Central

    2012-01-01

    Background Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables. Methods A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index. Results The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant. Conclusions Despite the adverse contextual conditions and the limitations imposed by the Colombian health

  17. Evaluation of computerized health management information system for primary health care in rural India

    PubMed Central

    2010-01-01

    Background The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India. Methods The data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors) and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews. Results There have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR) 1674,217 (USD 35,622). Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213). The annual savings is around INR 894,283 (USD 11,924). Conclusion The major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision. PMID:21078203

  18. Optimization of the National Ignition Facility primary shield design

    SciTech Connect

    Annese, C.E.; Watkins, E.F.; Greenspan, E.; Miller, W.F.; Latkowski, J.; Lee, J.D.; Soran, P.; Tobin, M.L.

    1993-10-01

    Minimum cost design concepts of the primary shield for the National Ignition laser fusion experimental Facility (NIF) are searched with the help of the optimization code SWAN. The computational method developed for this search involves incorporating the time dependence of the delayed photon field within effective delayed photon production cross sections. This method enables one to address the time-dependent problem using relatively simple, time-independent transport calculations, thus significantly simplifying the design process. A novel approach was used for the identification of the optimal combination of constituents that will minimize the shield cost; it involves the generation, with SWAN, of effectiveness functions for replacing materials on an equal cost basis. The minimum cost shield design concept was found to consist of a mixture of polyethylene and low cost, low activation materials such as SiC, with boron added near the shield boundaries.

  19. Structural health monitoring and impact detection for primary aircraft structures

    NASA Astrophysics Data System (ADS)

    Kosters, Eric; van Els, Thomas J.

    2010-04-01

    The increasing use of thermoplastic carbon fiber-reinforced plastic (CFRP) materials in the aerospace industry for primary aircraft structures, such as wing leading-edge surfaces and fuselage sections, has led to rapid growth in the field of structural health monitoring (SHM). Impact, vibration, and load can all cause failure, such as delamination and matrix cracking, in composite materials. Moreover, the internal material damage can occur without being visible to the human eye, making inspection of and clear insight into structural integrity difficult using currently available evaluation methods. Here, we describe the detection of impact and its localization in materials and structures by high-speed interrogation of multiple-fiber Bragg grating (FBG) sensors mounted on a composite aircraft component.

  20. Primary health care team workshop: team members' perspectives.

    PubMed

    Long, S

    1996-05-01

    This study explored members' perceptions of teamwork in two primary health care teams (PHCTs). It also examined the effect of a team-building intervention on members' perceptions centred around five topics: the PHCT, role perception, communication, leadership and conflict. The study used a qualitative approach with semistructured interviews before and after the intervention. It was found that members perceived each other's roles only in the light of their interactions with each other. Issues of hierarchy in leadership and interpersonal conflicts were raised. It is concluded that the team-building intervention had some positive effects on team members' perceptions and behaviour. However, further research is needed into management structures and conflict resolution in the PHCT. PMID:8732520

  1. 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

  2. Design Optimization of Structural Health Monitoring Systems

    SciTech Connect

    Flynn, Eric B.

    2014-03-06

    Sensor networks drive decisions. Approach: Design networks to minimize the expected total cost (in a statistical sense, i.e. Bayes Risk) associated with making wrong decisions and with installing maintaining and running the sensor network itself. Search for optimal solutions using Monte-Carlo-Sampling-Adapted Genetic Algorithm. Applications include structural health monitoring and surveillance.

  3. Assessing the impact of mental health programs upon community: the perspectives of primary caregivers and consumers.

    PubMed

    Mira, J J; Fernández-Gilino, E; Lorenzo, S

    1997-04-01

    Since 1985, there has been a significant movement in Spanish mental health services away from provision of care in psychiatric hospitals and toward a community mental health model (CMMH). This reform has ushered in changes not only for the patients but also for both their relatives and their primary caregivers. However, no survey has ever been carried out to obtain these parties' perceptions of the CMMH. Two studies have now been designed to describe the acceptability of the CMMH to these two key groups. The goals of the two projects were, firstly, to assess the opinions of primary care professionals about CMMH and, secondly, to sample the opinions of the patients' relatives regarding mental health care. In the first survey, 884 primary caregivers (general practitioners (GPs), pediatricians, nurses and social workers) filled out a 14-item questionnaire with a five-point response scale. Several aspects of care were evaluated: accessibility, referral facilities, therapeutic support, training or teaching activities, communication between primary care and mental health professionals for their mutual collaboration, and appropriateness of resources. Most of the primary caregivers reported that the community psychiatric model improved accessibility, treatment and communication between the different levels. Nurses and pediatricians reported dissatisfaction with the CMMH. In the second survey, the satisfaction of patients' relatives with the services provided by the therapists was assessed, using the Satisfaction with Therapist Questionnaire (STQ). The STQ consists of 15 items with a three-point response scale. Amount and adequacy of the information provided, accessibility, and style of conducting the appointment were assessed as measures of satisfaction. A sample of relatives of schizophrenic patients was surveyed by mail (76 relatives answered, a response rate of 31.13%). In summary, relatives were satisfied with therapists' competence but dissatisfied with their

  4. 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s)

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... of Primary Medical Care Professional(s) A Appendix A to Part 5 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS DESIGNATION OF HEALTH PROFESSIONAL(S) SHORTAGE... Medical Care Professional(s) Part I—Geographic Areas A. Federal and State Correctional Institutions....

  5. 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s)

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of Primary Medical Care Professional(s) A Appendix A to Part 5 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS DESIGNATION OF HEALTH PROFESSIONAL(S) SHORTAGE... Medical Care Professional(s) Part I—Geographic Areas A. Federal and State Correctional Institutions....

  6. 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s)

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... of Primary Medical Care Professional(s) A Appendix A to Part 5 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS DESIGNATION OF HEALTH PROFESSIONAL(S) SHORTAGE... Medical Care Professional(s) Part I—Geographic Areas A. Federal and State Correctional Institutions....

  7. Self-Reported Health Status in Primary Health Care: The Influence of Immigration and Other Associated Factors

    PubMed Central

    Salinero-Fort, Miguel Á.; Jiménez-García, Rodrigo; del Otero-Sanz, Laura; de Burgos-Lunar, Carmen; Chico-Moraleja, Rosa M.; Martín-Madrazo, Carmen; Gómez-Campelo, Paloma

    2012-01-01

    Objective The aims of this study are to compare self-reported health status between Spanish-born and Latin American-born Spanish residents, adjusted by length of residence in the host country; and additionally, to analyse sociodemographic and psychosocial variables associated with a better health status. Design This is a cross-sectional population based study of Latin American-born (n = 691) and Spanish-born (n = 903) in 15 urban primary health care centres in Madrid (Spain), carried out between 2007 and 2009. The participants provided information, through an interview, about self-reported health status, socioeconomic characteristics, psychosocial factors and migration conditions. Descriptive and multiple logistic regression analyses were conducted. Results The Spanish-born participants reported a better health status than the Latin America-born participants (79.8% versus 69.3%, p<0.001). Different patterns of self-reported health status were observed depending on the length of residence in the host country. The proportion of immigrants with a better health status is greater in those who have been in Spain for less than five years compared to those who have stayed longer. Better health status is significantly associated with being men, under 34 years old, being Spanish-born, having a monthly incomes of over 1000 euros, and having considerable social support and low stress. Conclusions Better self-reported health status is associated with being Spanish-born, men, under 34 years old, having an uppermiddle-socioeconomic status, adequate social support, and low stress. Additionally, length of residence in the host country is seen as a related factor in the self-reported health status of immigrants. PMID:22675564

  8. Improving the Prevention of Cardiovascular Disease in Primary Health Care: The Model for Prevention Study Protocol

    PubMed Central

    Davey, Rachel C; Cochrane, Thomas; Williams, Lauren T; Clancy, Tanya

    2014-01-01

    Background Cardiovascular disease (CVD) is the leading cause of death globally, and accounted for nearly 31% of all deaths in Australia in 2011. The primary health care sector is at the frontline for addressing CVD, however, an evidence-to-practice gap exists in CVD risk assessment and management. General practice plays a key role in CVD risk assessment and management, but this sector cannot provide ongoing lifestyle change support in isolation. Community-based lifestyle modification services and programs provided outside the general practice setting have a key role in supporting and sustaining health behavior change. Fostering linkages between the health sector and community-based lifestyle services, and creating sustainable systems that support these sectors is important. Objective The objective of the study Model for Prevention (MoFoP) is to take a case study approach to examine a CVD risk reduction intervention in primary health care, with the aim of identifying the key elements required for an effective and sustainable approach to coordinate CVD risk reduction across the health and community sectors. These elements will be used to consider a new systems-based model for the prevention of CVD that informs future practice. Methods The MoFoP study will use a mixed methods approach, comprising two complementary research elements: (1) a case study, and (2) a pre/post quasi-experimental design. The case study will consider the organizations and systems involved in a CVD risk reduction intervention as a single case. The pre/post experimental design will be used for HeartLink, the intervention being tested, where a single cohort of patients between 45 and 74 years of age (or between 35 and 74 years of age if Aboriginal or Torres Strait Islander) considered to be at high risk for a CVD event will be recruited through general practice, provided with enhanced usual care and additional health behavior change support. A range of quantitative and qualitative data will be

  9. Primary Health Care: Expectations and Tasks for Public Health in Trinidad and Tobago.

    PubMed

    Johnson, Emmanuel Janagan; Rodrigues, Vincent

    2016-06-01

    The government of Trinidad and Tobago considers that the enjoyment of the highest attainable level of health is a basic right of every citizen and has a goal to achieve health for all by 2020. Thus it lays emphasis on caring and assures standards of excellence to promote, protect and improve the health status of the people of Trinidad and Tobago. To achieve these goals it is very important to increase curative services as well as preventive services in the country. In view of this situation there is a need to overcome the challenges the public health by involving community and individuals and self-reliance to achieve Health for all at 2020. Community participation is one of the domains of community capacity building in a small island country. It is one of the mechanisms to empower people to take part in community development. In this paper, the nature, the dimensions of community participation, and its role and scope in implementation of different components of primary health care have been described. The health services in public and remedial care have been discussed. The article highlights some important milestone achievements in the health sector in Trinidad. PMID:26687151

  10. Mental Health Technologies: Designing With Consumers

    PubMed Central

    Matthews, Ben; Bidargaddi, Niranjan; Jones, Gabrielle; Lawn, Sharon; Venning, Anthony; Collin, Philippa

    2016-01-01

    Despite growing interest in the promise of e-mental and well-being interventions, little supporting literature exists to guide their design and the evaluation of their effectiveness. Both participatory design (PD) and design thinking (DT) have emerged as approaches that hold significant potential for supporting design in this space. Each approach is difficult to definitively circumscribe, and as such has been enacted as a process, a mind-set, specific practices/techniques, or a combination thereof. At its core, however, PD is a design research tradition that emphasizes egalitarian partnerships with end users. In contrast, DT is in the process of becoming a management concept tied to innovation with strong roots in business and education. From a health researcher viewpoint, while PD can be reduced to a number of replicable stages that involve particular methods, techniques, and outputs, projects often take vastly different forms and effective PD projects and practice have traditionally required technology-specific (eg, computer science) and domain-specific (eg, an application domain, such as patient support services) knowledge. In contrast, DT offers a practical off-the-shelf toolkit of approaches that at face value have more potential to have a quick impact and be successfully applied by novice practitioners (and those looking to include a more human-centered focus in their work). Via 2 case studies we explore the continuum of similarities and differences between PD and DT in order to provide an initial recommendation for what health researchers might reasonably expect from each in terms of process and outcome in the design of e-mental health interventions. We suggest that the sensibilities that DT shares with PD (ie, deep engagement and collaboration with end users and an inclusive and multidisciplinary practice) are precisely the aspects of DT that must be emphasized in any application to mental health provision and that any technology development process must

  11. Mental Health Technologies: Designing With Consumers.

    PubMed

    Orlowski, Simone; Matthews, Ben; Bidargaddi, Niranjan; Jones, Gabrielle; Lawn, Sharon; Venning, Anthony; Collin, Philippa

    2016-01-01

    Despite growing interest in the promise of e-mental and well-being interventions, little supporting literature exists to guide their design and the evaluation of their effectiveness. Both participatory design (PD) and design thinking (DT) have emerged as approaches that hold significant potential for supporting design in this space. Each approach is difficult to definitively circumscribe, and as such has been enacted as a process, a mind-set, specific practices/techniques, or a combination thereof. At its core, however, PD is a design research tradition that emphasizes egalitarian partnerships with end users. In contrast, DT is in the process of becoming a management concept tied to innovation with strong roots in business and education. From a health researcher viewpoint, while PD can be reduced to a number of replicable stages that involve particular methods, techniques, and outputs, projects often take vastly different forms and effective PD projects and practice have traditionally required technology-specific (eg, computer science) and domain-specific (eg, an application domain, such as patient support services) knowledge. In contrast, DT offers a practical off-the-shelf toolkit of approaches that at face value have more potential to have a quick impact and be successfully applied by novice practitioners (and those looking to include a more human-centered focus in their work). Via 2 case studies we explore the continuum of similarities and differences between PD and DT in order to provide an initial recommendation for what health researchers might reasonably expect from each in terms of process and outcome in the design of e-mental health interventions. We suggest that the sensibilities that DT shares with PD (ie, deep engagement and collaboration with end users and an inclusive and multidisciplinary practice) are precisely the aspects of DT that must be emphasized in any application to mental health provision and that any technology development process must

  12. Importance of community engagement in primary health care: the case of Afghan refugees.

    PubMed

    Cheng, I-Hao; Wahidi, Sayed; Vasi, Shiva; Samuel, Sophia

    2015-01-01

    Refugees can experience problems accessing and utilising Australian primary health care services, resulting in suboptimal health outcomes. Little is known about the impact of their pre-migration health care experiences. This paper demonstrates how the Afghan pre-migration experiences of primary health care can affect engagement with Australian primary care services. It considers the implications for Australian primary health care policy, planning and delivery. This paper is based on the international experiences, insights and expert opinions of the authors, and is underpinned by literature on Afghan health-seeking behaviour. Importantly, Afghanistan and Australia have different primary health care strategies. In Afghanistan, health care is predominantly provided through a community-based outreach approach, namely through community health workers residing in the local community. In contrast, the Australian health care system requires client attendance at formal health service facilities. This difference contributes to service access and utilisation problems. Community engagement is essential to bridge the gap between the Afghan community and Australian primary health care services. This can be achieved through the health sector working to strengthen partnerships between Afghan individuals, communities and health services. Enhanced community engagement has the potential to improve the delivery of primary health care to the Afghan community in Australia. PMID:25102862

  13. The UP College of Nursing Collaborating Center for Nursing Development in Primary Health Care.

    PubMed

    Yapchiongco, A S

    1990-01-01

    Officially designated as one of WHO's Collaborating Centers for Nursing Development (CCND), the UP College of Nursing in the Philippines will take on a leading role in achieving "health for all" through primary health care (PHC). The 1978 Declaration of Alma-Ata called for the goal of health for all by the year 2000, and recognized the key role of the nursing profession in this effort. In order to be designated a WHO collaborating center, an institution must be able to provide scientific and technical leadership at the national and international level, must be a stable institution, and must have the capacity to contribute to WHO programs. A WHO collaborating center forms part of an international network of institutions. Having become such a center, the UP College will form part of the Global Network for Nursing Development, organized in March 1987. The Global Network's functions include: 1) coordinating activities and promoting technical cooperation; 2) disseminating and exchanging informational; 3) monitoring trends in health services development and assessing their implications for nursing development; 4) supporting research; 5) gathering support and resources; and 6) promoting the goals of nursing development. As part of the Global Network, the UP College has developed a 4-year plan to fulfill the network's functions. During the June 1989 inauguration of the CCND, the Philippine Secretary of Health, Dr. Alfredo R. A. Bengzon, noted the country's lopsided ratio of health personnel per population, and issued a challenge to the UP College to lead the country in accelerating nursing development. PMID:2093189

  14. Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

    PubMed Central

    Krist, Alex H.; Woolf, Steven H.; Bello, Ghalib A.; Sabo, Roy T.; Longo, Daniel R.; Kashiri, Paulette; Etz, Rebecca S.; Loomis, John; Rothemich, Stephen F.; Peele, J. Eric; Cohn, Jeffrey

    2014-01-01

    PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODS We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. PMID:25354405

  15. Racial/Ethnic Differences in the Use of Primary Care Providers and Preventive Health Services at a Midwestern University.

    PubMed

    Focella, Elizabeth S; Shaffer, Victoria A; Dannecker, Erin A; Clark, Mary J; Schopp, Laura H

    2016-06-01

    Many universities seek to improve the health and wellbeing of their faculty and staff through employer wellness programs but racial/ethnic disparities in health care use may still persist. The purpose of this research was to identify racial/ethnic disparities in the use of preventive health services at a Midwestern university. A record review was conducted of self-reported health data from University employees, examining the use of primary care and common screening procedures collected in a Personal Health Assessment conducted by the University's wellness program. Results show that there were significant racial/ethnic differences in the use of primary care and participation in screening. Notably, Asian employees in this sample were less likely to have a primary care provider and participate in routine cancer screenings. The observed racial/ethnic differences in screening behavior were mediated by the use of primary care. Together, these data show that despite equal access to care, racial and ethnic disparities in screening persist and that having a primary care provider is an important predictor of screening behavior. Results suggest that health communications designed to increase screening among specific racial/ethnic minority groups should target primary care use. PMID:27271072

  16. Mobilizing Lithuanian Health Professionals as Community Peer Leaders for AIDS Prevention: An International Primary Health Care Collaboration.

    ERIC Educational Resources Information Center

    Norr, Kathleen F.; McElmurry, Beverly J.; Slutas, Frances M.; Christiansen, Carol D.; Misner, Susan J.; Marks, Beth A.

    2001-01-01

    Using primary health care and peer leadership models, U.S. nurses trained Lithuanian health professionals as community peer leaders in AIDS prevention. A national continuing education program is in place to sustain the initiative in Lithuania. (SK)

  17. Primary Health Care--The Chinese Experience. Report of an Inter-regional Seminar on Primary Health Care (China, June 13-16, 1982).

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

    Addresses and team reports from an inter-regional seminar which examined aspects of primary health care in China are presented. Background information about the seminar is given along with an introduction to rural health services in China. The report considers four key issues: China's three-level health care network; involvement of the people;…

  18. The Systemic Changes to Improve Efficiency in Polish Primary Health Care

    PubMed Central

    Holecki, Tomasz; Romaniuk, Piotr; Woźniak-Holecka, Joanna

    2016-01-01

    Primary health care is an important part of any health care system. In highly developed countries it secures the population's most elementary health needs, with particular emphasis on preventive care and early intervention. Polish PHC model is currently undergoing a thorough transformation, associated with the need to adapt to standards designated based on the WHO's criteria, and with reference to the experience of other European countries. The paper describes the process of changes being carried out, in the context of previous experiences of reform relating to the sphere of organization, processes and efficiency. A review and systematization has been made, with regard to the undertaken activities in the field of deregulation and change of legal provisions, which are aimed at achieving the improvement of the efficiency of treatment and resource allocation. A set of recommendations based on expert's discourse have also been provided, with respect to future directions of Polish PHC transformation. PMID:27468269

  19. Disaster severity and emotional disturbance: implications for primary mental health care in developing countries.

    PubMed

    Lima, B R; Chavez, H; Samaniego, N; Pompei, M S; Pai, S; Santacruz, H; Lozano, J

    1989-01-01

    Two months following the 1987 earthquakes in Ecuador, 150 patients in the primary health care clinics of the area were screened for emotional problems; 40% of them were emotionally distressed. Risk factors included not being married, reporting poor physical or emotional health, and having ill-defined physical complaints. The findings from this research are discussed in relation to a disaster of much greater intensity, whose victims were studied by the authors, utilizing the same instrument and research design. The comparison between these 2 groups of disaster victims revealed that: 1) the prevalence of emotional distress was smaller among the Ecuador victims, but the frequency of symptoms among the distressed was similar for both groups; 2) the symptom profiles were remarkably similar; and 3) the most frequent symptoms and the strongest predictors of emotional distress were very similar. These findings support a focused training of health care workers on selected emotional problems that are regularly present among victims of different disasters. PMID:2929384

  20. The Systemic Changes to Improve Efficiency in Polish Primary Health Care.

    PubMed

    Holecki, Tomasz; Romaniuk, Piotr; Woźniak-Holecka, Joanna

    2016-01-01

    Primary health care is an important part of any health care system. In highly developed countries it secures the population's most elementary health needs, with particular emphasis on preventive care and early intervention. Polish PHC model is currently undergoing a thorough transformation, associated with the need to adapt to standards designated based on the WHO's criteria, and with reference to the experience of other European countries. The paper describes the process of changes being carried out, in the context of previous experiences of reform relating to the sphere of organization, processes and efficiency. A review and systematization has been made, with regard to the undertaken activities in the field of deregulation and change of legal provisions, which are aimed at achieving the improvement of the efficiency of treatment and resource allocation. A set of recommendations based on expert's discourse have also been provided, with respect to future directions of Polish PHC transformation. PMID:27468269

  1. Health changes in Sri Lanka: benefits of primary health care and public health.

    PubMed

    Karunathilake, Indika Mahesh

    2012-07-01

    The Democratic Socialist Republic of Sri Lanka is an island in the Indian Ocean that has achieved a unique status in the world with health indicators that are comparable with those of developed countries. This is illustrated, among others, by the reduction in both child and maternal mortality in the country. This achievement is the result of a range of long-term interventions, including providing education and health care free of charge, training of health care workers, developing public health infrastructure in rural areas, and adopting steps to improve sanitation, nutrition, and immunization coverage. PMID:22815304

  2. 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s)

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... of Primary Medical Care Professional(s) A Appendix A to Part 5 Public Health PUBLIC HEALTH SERVICE... Medical Care Professional(s) Part I—Geographic Areas A. Federal and State Correctional Institutions. 1... facilities will be designated as having a shortage of primary medical care professional(s) if both...

  3. 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s)

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of Primary Medical Care Professional(s) A Appendix A to Part 5 Public Health PUBLIC HEALTH SERVICE... Medical Care Professional(s) Part I—Geographic Areas A. Federal and State Correctional Institutions. 1... facilities will be designated as having a shortage of primary medical care professional(s) if both...

  4. Greater access to information on how to prevent oral cancer among elderly using primary health care.

    PubMed

    Martins, Andréa Maria Eleutério de Barros Lima; Barreto, Sandhi Maria; dos Santos-Neto, Pedro Eleutério; de Sá, Maria Aparecida Barbosa; Souza, João Gabriel Silva; Haikal, Desireé Sant'Ana; Ferreira e Ferreira, Efigenia; Pordeus, Isabela Almeida

    2015-07-01

    Educative actions are an important component of health promotion in Brazil's primary healthcare program, the Family Health Strategy (FHS). The efficacy of these actions is evidenced by compliance with healthy behaviors and in the reduction of rates of mortality and morbidity. The objective of this study was to identify whether access to information regarding the prevention of oral cancer is greater among elders whose residences are registered with the FHS. SPSS® was utilized to obtain estimates that were corrected for sample design, considering the magnitude of the associations between access to such information with personal determinants, the use and cost of healthcare, health-related behaviors and health outcomes. 58.9% of the 492 participating elders reported having access to such information. We verified that there was a greater chance for access among residents of houses registered by the FHS; those with greater per capita income (2.01/1.183.43); non-smokers (2.00/1.16-3.46); those that realized oral self-examination (6.35/3.46-11.64); and those that did not perceive discomfort in the mouth, head or neck (2.06/1.02-4.17). Access was greater among residents of homes registered by the FHS. Personal determinants of health, health-related behaviors and health outcomes are influenced or influence access to information regarding the prevention and management of oral diseases. PMID:26132263

  5. Pupils' Perceptions of Sex and Reproductive Health Education in Primary Schools in Tanzania: A Phenomenological Study

    ERIC Educational Resources Information Center

    Kapinga, Orestes Silverius; Hyera, Daniel Frans

    2015-01-01

    This study explored pupils' perceptions of sex and reproductive health education in primary schools in Tanzania. Specifically, the study aimed at (i) exploring pupils' views on sex and reproductive health education in primary schools; (ii) determining opinions on the appropriateness of sex and reproductive health education for pupils in primary…

  6. A qualitative study on primary health care professionals’ perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua

    PubMed Central

    2014-01-01

    Background Mental health problems among young peoples are a growing public health issue around the world. In low- income countries health systems are characterized by lack of facilities, human resources and primary health care is rarely an integrated part of overall health care services. This study aims at exploring how primary health care professionals in Nicaragua perceive young people’s mental health problems, suicidal problems and help–seeking behaviour. Methods Twelve in-depth interviews were conducted with nurses and doctors working in primary health care services in León, Nicaragua. A qualitative research design was applied. Data was analysed using thematic analysis approach. Results This study revealed that doctors and nurses were reluctant to deal with young people presenting with suicidal problems at the primary health care. This was more likely to stem from feelings of incompetence rather than from negative attitudes. Other barriers in providing appropriate care to young people with mental health problems were identified such as lack of time, lack of privacy, lack of human resources, lack of trained professionals and difficulties in communicating with young people. The primary health care (PHC) professionals suggested different solutions to improve care for young people with suicidal problems. Conclusion PHC doctors and nurses in Nicaragua felt that providing skilled mental health services to young people was a priority for them but they also identified a number of barriers to be able to do so. They discussed ways to improve young people’s willingness to share sensitive issues with them and suggested ways to make PHC more appreciated by young people. PMID:24989871

  7. 78 FR 28896 - Design Limits and Loading Combinations for Metal Primary Reactor Containment System Components

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ... COMMISSION Design Limits and Loading Combinations for Metal Primary Reactor Containment System Components... Combinations for Metal Primary Reactor Containment System Components,'' in which there are no substantive... loading combinations for metal primary reactor containment system components. ADDRESSES: Please refer...

  8. General practice and primary health care in Denmark.

    PubMed

    Pedersen, Kjeld Møller; Andersen, John Sahl; Søndergaard, Jens

    2012-03-01

    General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized by 5 key components: (1) a list system, with an average of close to 1600 persons on the list of a typical GP; (2) the GP as gatekeeper and first-line provider in the sense that a referral from a GP is required for most office-based specialists and always for in- and outpatient hospital treatment; (3) an after-hours system staffed by GPs on a rota basis; (4) a mixed capitation and fee-for-service system; and (5) GPs are self-employed, working on contract for the public funder based on a national agreement that details not only services and reimbursement but also opening hours and required postgraduate education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges. Practice units are fairly small: close to 2 GPs per unit plus nurses and secretaries. The units are fully computerized, that is, with computer-based patient records and submission of prescriptions digitally to pharmacies etc. Over the past few years a decrease in solo practices has been seen and is expected to accelerate, in part because of the GP age structure, with many GPs retiring and new GPs not wanting to practice alone. This latter workforce trend is pointing toward a new model with employed GPs, particularly in rural areas. PMID:22403249

  9. Nutrition: an essential element of primary health care.

    PubMed

    Rao, K S

    1989-02-01

    In India, major social discrepancies linger despite major advances since 1947 with the result of overeating by the rich and undernutrition of the poor. Anemia affected 65% of pregnant women in Hyderabad hospitals, and in Calcutta it hovered around 88.5-90/1% for males and 96.5-96.7% for females aged 15-44. Malnutrition accounted for 15% of hospitalizations often because of infant diarrhea. Parasitic infestations leading to anemia and subsequent malnutrition also resulted in premature births and low birth weight. Weaning practices including its late initiation and prolongation of breast feeding for up to 12 months (or 18 months in rural areas) led to growth retardation. About 25,000 children become blind annually because of vitamin A deficiency, and 55% of women also suffer from it. Almost 120-170 million people suffer from endemic goiter. Socio economic and socio cultural factors are also associated with nutritional problems. Some Brahmin communities in South India avoid garlic and onions because they are considered taboo foods. The Tridosha Theory holds the there are heat-producing foods, cooling foods, and gas-producing foods that have to be avoided. Some of these are brown sugar, eggs, tomatoes, oranges, cereals, and vegetables. In West Bengal they believe that milk and fish can cause leprosy. The population nearing 800 million is another factor, as smaller families have better nutrition. Education by nurses should include the use of exhibits, songs, and plays to teach women proper nutrition. Nurses also have to change their attitudes to avoid commercial foods, identify harmful practices, and promote nutritional education. The project of the National Institute of Nutrition involving 23 villages combated vitamin A deficiency successfully by laying stress on available vegetables and fruits. If nurses participate if such primary health care programs the objectives of Health for All by 2000 will be achieved. PMID:2726585

  10. Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services.

    PubMed

    Straiton, Melanie L; Powell, Kathryn; Reneflot, Anne; Diaz, Esperanza

    2016-01-01

    Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term "immigrants" masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success. PMID:26251953

  11. [Governance of primary health-care-based health-care organization].

    PubMed

    Báscolo, Ernesto

    2010-01-01

    An analytical framework was developed for explaining the conditions for the effectiveness of different strategies promoting integrated primary health-care (PHC) service-based systems in Latin-America. Different modes of governance (clan, incentives and hierarchy) were characterised from a political economics viewpoint for representing alternative forms of regulation promoting innovation in health-service-providing organisations. The necessary conditions for guaranteeing the modes of governance's effectiveness are presented, as are their implications in terms of posts in play. The institutional construction of an integrated health system is interpreted as being a product of a social process in which different modes of governance are combined, operating with different ways of resolving normative aspects for regulating service provision (with the hierarchical mode), resource distribution (with the incentives mode) and on the social values legitimising such process (with the clan mode). PMID:20963299

  12. Utilization of village health workers within a primary health care programme in The Gambia.

    PubMed

    Menon, A

    1991-08-01

    The utilization of Village Health Workers (VHWs) was studied in a rural area of The Gambia 3 years after the introduction of a village-based Primary Health Care (PHC) programme. Of 23 children who died from conditions treatable at village level, only five were first seen by the VHW. Fourteen were seen elsewhere in the region by staff more qualified than the first tier workers. The implications of this pattern of utilization on the lack of impact of VHWs on mortality are discussed. Only half of the non-fatal illnesses were attended to by VHWs. Reasons for this included such factors as lack of knowledge of services available, shortages of money, absence of the VHW at critical periods and social or political disputes with VHWs. Attempts must be made to tackle these fundamental problems if VHWs are to be successfully incorporated into the health services. PMID:1880830

  13. Development of Health Equity Indicators in Primary Health Care Organizations Using a Modified Delphi

    PubMed Central

    Wong, Sabrina T.; Browne, Annette J.; Varcoe, Colleen; Lavoie, Josée; Fridkin, Alycia; Smye, Victoria; Godwin, Olive; Tu, David

    2014-01-01

    Objective The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations' capacity and strategies for enhancing equity-oriented care. Methods Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff (n = 114) using procedures for qualitatively derived data. We used a modified Delphi process where the indicators were circulated to staff at the Health Centers who served as participants (n = 63) over two rounds. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1–9, where a higher score meant more importance. Results Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (<8.0) in both rounds and were either redundant or more than one participant commented that taking action on the indicator was highly unlikely. In order to achieve health care equity, performance at the organizational level is as important as assessing the performance of staff. Two of the highest rated “treatment” or processes of care indicators reflects the need for culturally safe and trauma and violence-informed care. There are four indicators that can be used to measure outcomes which can be directly attributable to equity responsive primary health care. Discussion These indicators and subsequent development of items can be used to measure equity in the domains of treatment and outcomes. These areas represent targets for higher performance in relation to equity for organizations (e.g., funding allocations to ongoing training in equity-oriented care provision) and providers (e.g., reflexive practice, skill in working with the health effects of trauma). PMID:25478914

  14. The role of mental health in primary prevention of sexual and gender-based violence.

    PubMed

    Gevers, Aník; Dartnall, Elizabeth

    2014-01-01

    In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV). However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research. PMID:25226417

  15. The role of mental health in primary prevention of sexual and gender-based violence

    PubMed Central

    Gevers, Aník; Dartnall, Elizabeth

    2014-01-01

    In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV). However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research. PMID:25226417

  16. Expanded programme on immunization and primary health care.

    PubMed

    Basu, R N

    1982-09-01

    The ultimate objective of the Expanded Program on Immunication, better known as EPI, is to reduce the morbidity of the diseases for which vaccine is available. The EPI is a key component of the country effort to provide Health for All by the year 2000. It is planned that by 1990 immunization services will be available for all infants against diphtheria, whooping cough, tetanus, tuberculosis, and poliomyelitis and for all school children for diptheria, tetanus, and typhoid, and for all pregnant women against tetanus. The immunization services will be a part of the comprehensive health care and will be integrated with all hospitals and dispensaries in urban areas and primary health centers/subcenters in the rural areas. Outreach operations are encouraged to bring these services as close to the mother and children as possible. Steps have already been taken to make the country self-sufficient in the production of different quality vaccines to meet the program requirements. New vaccines will be added where found to be epidemiologically necessary and administratively feasible. The vaccination program is effective only if given at the right age. A national immunization schedule has been prepared which emphasizes vaccination of all infants with 1 dose of BCG, 3 doses of DPT and polio at a minimum interval of 1 month, by the 1st birthday. School entrants are given a booster dose of DT and 2 doses of typhoid vaccine at an interval of 1 month. The children leaving primary school and leaving high school are given 1 booster dose of tetanus toxoid. In case of history of tetanus toxoid immunization in the earlier preganancy, 1 booster dose is adequate. Important components of management of EPI are cold chain maintenance, record keeping and evaluation, uniform vaccination coverage standards, and communication with the public through various media. A table gives the number of children/women proposed to be covered with full course of vaccine during each year of the 6th Plan. Disease

  17. Health care reform and job satisfaction of primary health care physicians in Lithuania

    PubMed Central

    Buciuniene, Ilona; Blazeviciene, Aurelija; Bliudziute, Egle

    2005-01-01

    Background The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. Methods Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%), working at Kaunas primary health care level establishments, in October – December 2003. Results 15 men (7.9%) and 176 women (92.1%) participated in the research, among which 133 (69.6%) were GPs and 58 (30.4%) physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale). Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09), social status (3.36), and workload (3.93) turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio) was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. Conclusion Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job. PMID:15748299

  18. A multimedia oral health promoting project in primary schools in central Italy

    PubMed Central

    Vozza, Iole; Guerra, Fabrizio; Marchionne, Massimiliano; Bove, Ercole; Corridore, Denise; Ottolenghi, Livia

    2014-01-01

    Summary Aim The purpose of the study Project was to test the effectiveness of a multimedia game designed in order to attract the attention of primary school children to oral health basic concepts and use the instrument to assess students’ knowledge. Materials and methods An originally designed multimedia game on oral health was administered in the computer class rooms, before (T0) and after (T1) an educational stage, to third (8–9 years) and fifth graders (10–11 years) of primary schools in urban and rural areas of two provinces of medium-small cities in Center Italy (Terni and Latina). Considered variables were: age, gender, school time schedule (only antemeridian, extended schedule). The statistical test used was the non-parametric Wilcox on signed-rank test. Results Response rate was 90.6% (due to absence on the due date). 1,300 students were involved. Overall, the average of the correct answers was 40.7% before oral health lessons and 59.2% after. An improving trend of correct answers was recorded from T0 to T1, significantly (p < 0.05) among: fifth graders (+ 17.5%), extended school time schedulers (+18.1%) and females (+18.9%). The results, however, show poor global oral health knowledge, being total percentage of correct answers below 60%. Conclusions The results stress the importance of the school environment as access to health promotion for all socio-economic classes. The multimedia educational approach has proved a valuable and updated tool to attract the attention of digital native children. PMID:25506412

  19. Designing Work, Family & Health Organizational Change Initiatives.

    PubMed

    Kossek, Ellen Ernst; Hammer, Leslie B; Kelly, Erin L; Moen, Phyllis

    2014-01-01

    For decades, leaders and scholars have been advocating change efforts to improve work-life relationships. Yet most initiatives have lacked rigor and not been developed using scientific principles. This has created an evidence gap for employer support of work and personal life as a win-win for productivity and employees' well-being. This paper examines the approach used by the U.S. Work Family Health Network (WFRN) to develop an innovative workplace intervention to improve employee and family health. The change initiative was designed to reduce organizationally based work-family conflict in two contrasting contexts representative of major segments of today's U.S. workforce: health care employees and informational technology professionals. The WFRN Intervention (called STAR) had three theoretically based change elements. They were: 1) increase job control over work time and schedule; 2) increase supervisor social support for family and job effectiveness; and 3) improve organizational culture and job design processes to foster results orientation. Seven practical lessons for developing work-life interventions emerged from this groundbreaking endeavor. PMID:24683279

  20. Designing Work, Family & Health Organizational Change Initiatives

    PubMed Central

    Hammer, Leslie B.; Kelly, Erin L.; Moen, Phyllis

    2014-01-01

    Executive Summary For decades, leaders and scholars have been advocating change efforts to improve work-life relationships. Yet most initiatives have lacked rigor and not been developed using scientific principles. This has created an evidence gap for employer support of work and personal life as a win–win for productivity and employees’ well-being. This paper examines the approach used by the U.S. Work Family Health Network (WFRN) to develop an innovative workplace intervention to improve employee and family health. The change initiative was designed to reduce organizationally based work-family conflict in two contrasting contexts representative of major segments of today’s U.S. workforce: health care employees and informational technology professionals. The WFRN Intervention (called STAR) had three theoretically based change elements. They were: 1) increase job control over work time and schedule; 2) increase supervisor social support for family and job effectiveness; and 3) improve organizational culture and job design processes to foster results orientation. Seven practical lessons for developing work-life interventions emerged from this groundbreaking endeavor. PMID:24683279

  1. 24 CFR 3282.361 - Design Approval Primary Inspection Agency (DAPIA).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... deviations from accepted engineering practice standards for design calculations or any deviations from... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Design Approval Primary Inspection... REGULATIONS Primary Inspection Agencies § 3282.361 Design Approval Primary Inspection Agency (DAPIA)....

  2. 24 CFR 3282.361 - Design Approval Primary Inspection Agency (DAPIA).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... deviations from accepted engineering practice standards for design calculations or any deviations from... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Design Approval Primary Inspection... REGULATIONS Primary Inspection Agencies § 3282.361 Design Approval Primary Inspection Agency (DAPIA)....

  3. [Can strategy for primary health care be revitalized 30 years after Alma-Ata?].

    PubMed

    Lund, Stine; Probst, Helene Bilsted; Bygbjerg, Ib Christian

    2010-12-01

    Thirty years ago the Alma-Ata declaration on primary health care was developed. Implementation has been compounded by inadequate financing, changing disease patterns and immature health systems, and there is an ongoing discussion between selective and comprehensive primary health care supporters. Globally, child mortality for under-five-year-olds has been reduced by 50%, but there are still large regional differences. This year the WHO development report is about revitalisation of the primary health care strategy. Recognition of this strategy may be the best instrument to improve health globally. PMID:21129319

  4. Assessment of cardiovascular risk in primary health care

    PubMed Central

    Korhonen, Päivi; Vesalainen, Risto; Aarnio, Pertti; Kautiainen, Hannu; Järvenpää, Salme; Kantola, Ilkka

    2012-01-01

    Objective This study aimed at investigating whether cardiovascular risk factors and their impact on total risk estimation differ between men and women. Design Cross-sectional cohort study. Subjects Finnish cardiovascular risk subjects (n = 904) without established cardiovascular disease, renal disease, or known diabetes. Main outcome measures Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), oral glucose tolerance test, and total cardiovascular risk using SCORE risk charts. Results According to the SCORE risk charts, 27.0% (95% CI 23.1–31.2) of the women and 63.1% (95% CI 58.3–67.7) of the men (p < 0.001) were classified as high-risk subjects. Of the women classified as low-risk subjects according to SCORE, 25% had either subclinical peripheral arterial disease or renal insufficiency. Conclusions The SCORE system does not take into account cardiovascular risk factors typical in women, and thus underestimates their total cardiovascular risk. Measurement of ABI and eGFR in primary care might improve cardiovascular risk assessment. especially in women. PMID:22643155

  5. Are health workers motivated by income? Job motivation of Cambodian primary health workers implementing performance-based financing

    PubMed Central

    Khim, Keovathanak

    2016-01-01

    Background Financial incentives are widely used in performance-based financing (PBF) schemes, but their contribution to health workers’ incomes and job motivation is poorly understood. Cambodia undertook health sector reform from the middle of 2009 and PBF was employed as a part of the reform process. Objective This study examines job motivation for primary health workers (PHWs) under PBF reform in Cambodia and assesses the relationship between job motivation and income. Design A cross-sectional self-administered survey was conducted on 266 PHWs, from 54 health centers in the 15 districts involved in the reform. The health workers were asked to report all sources of income from public sector jobs and provide answers to 20 items related to job motivation. Factor analysis was conducted to identify the latent variables of job motivation. Factors associated with motivation were identified through multivariable regression. Results PHWs reported multiple sources of income and an average total income of US$190 per month. Financial incentives under the PBF scheme account for 42% of the average total income. PHWs had an index motivation score of 4.9 (on a scale from one to six), suggesting they had generally high job motivation that was related to a sense of community service, respect, and job benefits. Regression analysis indicated that income and the perception of a fair distribution of incentives were both statistically significant in association with higher job motivation scores. Conclusions Financial incentives used in the reform formed a significant part of health workers’ income and influenced their job motivation. Improving job motivation requires fixing payment mechanisms and increasing the size of incentives. PBF is more likely to succeed when income, training needs, and the desire for a sense of community service are addressed and institutionalized within the health system. PMID:27319575

  6. Peer support workers: an untapped resource in primary mental health care.

    PubMed

    Tellez, Juan J; Perez, Juan; Kidd, Jacquie

    2015-03-01

    The treatment of moderate to severe mental illness in a primary health care setting is an area under development and can be contentious. The capacity, capability, resourcing and willingness of staff and organisations all feature in the discussions among specialist services and primary health care providers about the opportunities and barriers associated with primary mental health care. This paper presents the peer support worker as an untapped resource that has the potential to support the patient, primary health care staff, and general practitioner in the care of people who fall outside the current understanding of "mild" mental health problems, but who would nonetheless benefit from receiving their care in a primary health care setting. PMID:25770722

  7. International experts’ perspectives on a curriculum for psychologists working in primary health care: implication for Indonesia

    PubMed Central

    Setiyawati, Diana; Colucci, Erminia; Blashki, Grant; Wraith, Ruth; Minas, Harry

    2014-01-01

    Enhancing primary health care to incorporate mental health services is a key strategy for closing the treatment gap for people with mental disorders. The integration of psychological care into primary health care is a critical step in addressing poor access to mental health specialists. As the psychology profession is increasingly called upon to prepare psychologists for primary health care settings, an international experts' consensus is valuable in guiding the development of a high-quality curriculum for psychologists working in the primary health care context. A Delphi method was used to gain a consensus on the most appropriate roles and training for psychologists. Initial constructs and themes were derived from a detailed literature review and sent to 114 international experts in primary mental health care from five continents. Overall, 52 experts who participated agreed that psychologists should have wide-ranging roles and skills including clinical, health promotion and advocacy skills. This study has identified the specific roles and training needed by psychologists to enable them to work more effectively in primary health care settings. The consensus will inform the development of a curriculum for psychologists working in primary health care in Indonesia, and is part of a broader suite of studies. PMID:25750818

  8. Primary Care Patients with Depression Are Less Accepting of Treatment Than Those Seen by Mental Health Specialists

    PubMed Central

    Van Voorhees, Benjamin W; Cooper, Lisa A; Rost, Kathryn M; Nutting, Paul; Rubenstein, Lisa V; Meredith, Lisa; Wang, Nae-Yuh; Ford, Daniel E

    2003-01-01

    OBJECTIVE This study examined whether depressed patients treated exclusively in primary care report less need for care and less acceptability of treatment options than those depressed patients treated in the specialty mental health setting after up to 6 months of treatment. DESIGN Cross-sectional study. SETTING Forty-five community primary care practices. PARTICIPANTS A total of 881 persons with major depression who had received mental health services in the previous 6 months and who enrolled in 3 of the 4 Quality Improvement for Depression Collaboration Studies. MEASUREMENTS AND RESULTS Patients were categorized into 1 of 2 groups: 1) having received mental health services exclusively from a primary care provider (45%), or 2) having received any services from a mental health specialist (55%) in the previous 6 months. Compared with patients who received care from mental health specialists, patients who received mental health services exclusively from primary care providers had 2.7-fold the odds (95% confidence interval [CI], 1.6 to 4.4) of reporting that no treatment was definitely acceptable and had 2.4-fold the odds (95% CI, 1.5 to 3.9) of reporting that evidence-based treatment options (antidepressant medication) were definitely not acceptable. These results were adjusted for demographic, social/behavioral, depression severity, and economic factors using multiple logistic regression analysis. CONCLUSIONS Patients with depression treated exclusively by primary care providers have attitudes and beliefs more averse to care than those seen by mental health specialists. These differences in attitudes and beliefs may contribute to lower quality depression care observed in comparisons of primary care and specialty mental health providers. PMID:14687257

  9. Imbalance between Goals and Organizational Structure in Primary Health Care in Iran- a Systematic Review

    PubMed Central

    ZANGANEH BAYGI, Mehdi; SEYEDIN, Hesam

    2013-01-01

    Background: In recent years, the main focus of health sector reforms in Iran is the family physician and referral system plan. Fundamental changes in the goals and strategies, has increased the necessity of the need to reform the organizational structure. This study tries to review and summarize all cases about the organizational structure of Iran and its challenges in primary health care system. Methods: This study was a systematic review of published and grey literature. We searched the relevant databases, bibliography of related papers, and laws, using appropriate search strategies and key words. The CASP tool was used by two experts to evaluate the quality of retrieved papers and inconsistencies were resolved by discussion. Results: After removal of duplicate citations, a total of 52 titles were identified through database searching, among which 30 met the inclusion criteria. Considering the research quality criteria, 14 papers were recognized qualified, which were categorized into two groups of: articles and policies. The results showed ineffectiveness of the current organizational structure at different level. The majority of the papers recommend performing reforms in the system because of changes in goals and strategies. Also, some suggest an appropriate information system to be designed in the current structures. Centralization and delegation process are the main discussions for the studies. Conclusion: Because of fundamental changes in goals and strategies, reforms in the organizational structure of primary health system in Iran especially in peripheral levels are highly recommended. PMID:24427745

  10. Adverse health effects of spousal violence among women attending Saudi Arabian primary health-care clinics.

    PubMed

    Eldoseri, H M; Tufts, K A; Zhang, Q; Fish, J N

    2014-11-01

    This study aimed to investigate the frequency of spousal violence among Saudi women and document the related health effects and injuries, as well as their attitudes to gender and violence. Structured interviews were conducted with 200 ever-married women recruited from primary-care centres in Jeddah. Nearly half of the surveyed women (44.5%) reported ever experiencing physical violence from their spouse. Although 37 women (18.5%) had received violence-related injuries, only 6.5% had reported these injuries to a health-care provider. Victims of spousal violence had poor perceptions of their overall health, and reported pain or discomfort, antidepressant use and suicidal thoughts. Women mostly disagreed with the presented justifications for wife-beating. However, the association between gender attitudes and spousal violence was not significant. The results of this study support calls for integration of education about partner violence into health-care curricula to enhance the access and quality of services. PMID:25601810

  11. How Do Health Care Providers Diagnose Primary Ovarian Insufficiency (POI)?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose POI? Skip sharing on social media ... having periods for 4 months or longer, her health care provider may take these steps to diagnose the ...

  12. Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation).

    PubMed

    Atun, Rifat Ali; Menabde, Nata; Saluvere, Katrin; Jesse, Maris; Habicht, Jarno

    2006-11-01

    All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance

  13. Promoting oral health practice among patients with diabetes attending primary health care clinics

    PubMed Central

    Aljaber, Abeer; Al-Surimi, Khaled

    2015-01-01

    The oral public health program for patients with diabetes was initiated by Saudi Arabia Ministry of Health (MoH) based on international quality standard to control the severity of oral disease in patients with diabetes through improving the accessibility of patients to dental clinics in primary health care centers (PHCC). This program intends to deliver oral health care (OHC) for each patient with diabetes at least one visit every six months. However, we found that more than 90% of patients with diabetes that visited prince Mohammed bin Saud PHCC in Riyadh do not get their regular dental check up every six months. We developed a quality improvement project (QIP) using the quality improvement model to activate MoH oral health program for patients with diabetes visiting prince Mohamed bin Saud PHCC. The aim of our QIP was to increase number of patients with diabetes receiving their regular oral health check up during the PHC visit. The quality team tested two simple improvement ideas. The first idea was having the dentist signature on appointment request. The testing of the first idea led to the second idea, that both physician and dentist should sign the referral form. After running several PDSA cycles to test these interventions ideas, we found the number of patients with diabetes seen in dental clinic had increased dramatically compared with the baseline assessment. We conclude that the idea of signing the referral form by both physician and dentist is a practical and simple strategy to be executed and has a direct impact on the patient clinical flow between clinics. PMID:26734427

  14. Promoting oral health practice among patients with diabetes attending primary health care clinics.

    PubMed

    Aljaber, Abeer; Al-Surimi, Khaled

    2015-01-01

    The oral public health program for patients with diabetes was initiated by Saudi Arabia Ministry of Health (MoH) based on international quality standard to control the severity of oral disease in patients with diabetes through improving the accessibility of patients to dental clinics in primary health care centers (PHCC). This program intends to deliver oral health care (OHC) for each patient with diabetes at least one visit every six months. However, we found that more than 90% of patients with diabetes that visited prince Mohammed bin Saud PHCC in Riyadh do not get their regular dental check up every six months. We developed a quality improvement project (QIP) using the quality improvement model to activate MoH oral health program for patients with diabetes visiting prince Mohamed bin Saud PHCC. The aim of our QIP was to increase number of patients with diabetes receiving their regular oral health check up during the PHC visit. The quality team tested two simple improvement ideas. The first idea was having the dentist signature on appointment request. The testing of the first idea led to the second idea, that both physician and dentist should sign the referral form. After running several PDSA cycles to test these interventions ideas, we found the number of patients with diabetes seen in dental clinic had increased dramatically compared with the baseline assessment. We conclude that the idea of signing the referral form by both physician and dentist is a practical and simple strategy to be executed and has a direct impact on the patient clinical flow between clinics. PMID:26734427

  15. Examining the Relationship between Teacher Organizational Commitment and School Health in Turkish Primary Schools

    ERIC Educational Resources Information Center

    Sezgin, Ferudun

    2009-01-01

    The purpose of this study was to examine the relationships between teachers' perceptions of organizational commitment and school health in Turkish primary schools. The Organizational Commitment Scale and the Organizational Health Inventory were used to gather data from 323 randomly selected teachers employed in 20 primary schools in Ankara.…

  16. Optimized Battery-Type Reactor Primary System Design Utilizing Lead

    SciTech Connect

    Yu, Yong H.; Son, Hyoung M.; Lee, Il S.; Suh, Kune Y.

    2006-07-01

    A number of small and medium size reactors are being developed worldwide as well as large electricity generation reactors for co-generation, district heating or desalination. The Seoul National University has started to develop 23 MWth BORIS (Battery Optimized Reactor Integral System) as a multi-purpose reactor. BORIS is an integral-type optimized fast reactor with an ultra long life core. BORIS is being designed to meet the Generation IV nuclear energy system goals of sustainability, safety, reliability and economics. Major features of BORIS include 20 consecutive years of operation without refueling; elimination of an intermediate heat transport loop and main coolant pump; open core without individual subassemblies; inherent negative reactivity feedback; and inherent load following capability. Its one mission is to provide incremental electricity generation to match the needs of developing nations and especially remote communities without major electrical grid connections. BORIS consists of a reactor module, heat exchanger, coolant module, guard vessel, reactor vessel auxiliary cooling system (RVACS), secondary system, containment and the seismic isolation. BORIS is designed to generate 10 MWe with the resulting thermal efficiency of 45 %. BORIS uses lead as the primary system coolant because of the inherent safety of the material. BORIS is coupled with a supercritical carbon dioxide Brayton cycle as the secondary system to gain a high cycle efficiency in the range of 45 %. The reference core consists of 757 fuel rods without assembly with an active core height of 0.8 m. The BORIS core consists of single enrichment zone composed of a Pu-MA (minor actinides)-U-N fuel and a ferritic-martensitic stainless steel clad. This study is intended to set up appropriate reactor vessel geometry by performing thermal hydraulic analysis on RVACS using computational fluid dynamics codes; to examine the liquid metal coolant behavior along the subchannels; to find out whether the

  17. Assessing & Developing Primary Care for Children: Reforms in Health Systems.

    ERIC Educational Resources Information Center

    Grason, Holly Allen, Ed.; Guyer, Bernard, Ed.

    This publication is a compilation of papers presented at an April 1994 workshop sponsored by the National Center for Education in Maternal and Child Health and the Bureau-funded Johns Hopkins Child and Adolescent Health Policy Center (CAHPC). The papers are as follows: (1) "Defining the Issues and Planning for Change: Health Care Systems, Primary…

  18. Coordinating Mental Health Care Across Primary Care and Schools: ADHD as a Case Example

    PubMed Central

    Power, Thomas J.; Blum, Nathan J.; Guevara, James P.; Jones, Heather A.; Leslie, Laurel K.

    2012-01-01

    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between healthcare and educational professionals, role restrictions among professionals, and privacy laws. Strategies for overcoming these barriers that can be applied in both primary care and school settings are described. The paper has a primary focus on children with ADHD, but the principles and strategies described are applicable to children with a range of mental health and health conditions. PMID:23459527

  19. Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women's Health.

    ERIC Educational Resources Information Center

    Crabtree, M. Katherine; Stanley, Joan; Werner, Kathryn E.; Schmid, Emily

    This document presents the nurse practitioner primary care competencies that a national panel of representatives of nine national organizations of the five primary care nurse practitioner specialties--adult, family, gerontological, pediatric, and women's health--identified as necessary for entry-level primary care nurse practitioners. Section 1…

  20. Health promotion practices as perceived by primary healthcare professionals at the Ministry of National Guard Health Affairs, Saudi Arabia

    PubMed Central

    Altamimi, Samar; Alshoshan, Feda; Al Shaman, Ghada; Tawfeeq, Nasser; Alasmary, May; Ahmed, Anwar E.

    2016-01-01

    Introduction: In recent years, several research studies have investigated health promotion practices in Saudi healthcare organizations, yet no published literature exists on health promotion practices of primary healthcare professionals working for the Ministry of National Guard Health Affairs (MNG-HA). Methods: A cross-sectional study was conducted in a convenience sample of 206 primary healthcare professionals at the MNG-HA. A self-reporting questionnaire was used to investigate the attitudes, awareness, satisfaction, and methods regarding health promotion practices of primary healthcare professionals. Results: Of the 206 primary healthcare professionals surveyed, 58.1% reported awareness of health promotion programs conducted in the hospitals and 64.6% reported that the health promotion system in the hospitals needs to be improved. Language barriers and cultural beliefs were viewed as obstacles to carrying out effective health promotion by 65% and 64.6% of primary healthcare professionals, respectively. The majority (79.9%) of the primary healthcare professionals perceived themselves as having the necessary skills to promote health and 80.6% believed that printed educational materials are the most prevalent method of health promotion/education, whereas 55.8% reported that counseling was the most preferred method of health promotion. Conclusion: The awareness level of health promotion policies, strategies, and programs conducted in the hospitals was not found to be satisfactory. Therefore, widespread training programs are recommended to improve the health promotion system in the hospitals. These programs include facilitating behavioral change, introducing health promotion policies and strategies in hospitals, mandatory workshops, and systematic reminders. PMID:27482512

  1. Oral Health Knowledge, Attitude, and Approaches of Pre-Primary and Primary School Teachers in Mumbai, India.

    PubMed

    Mota, Ankita; Oswal, Kunal C; Sajnani, Dipti A; Sajnani, Anand K

    2016-01-01

    Background. School teachers have an internationally recognized potential role in school-based dental education and considerable importance has therefore been attributed to their dental knowledge. The objectives of this study were to determine the oral health related knowledge, attitudes, and approaches of pre-primary and primary school teachers in the city of Mumbai. Methods. The descriptive cross-sectional study was conducted in the suburban regions of Mumbai using a self-administered questionnaire and involved 511 teachers. Results. Teachers demonstrated inappropriate or incomplete knowledge regarding children's oral health. Only 53.2% knew that an individual has two sets of dentition. Moreover, only 45.4% of the teachers knew that a primary dentition consists of 20 teeth. Only 56.9% of the teachers asked their children to clean their mouth after snacking during school hours. 45.0% of the teachers were unaware of fluoridated tooth pastes whilst 78.9% of them were unaware of school water fluoridation programmes. Also, 54.8% of the teachers never discussed the oral health of children with their parents during parents meet. Conclusions. The studied school teachers demonstrated incomplete oral health knowledge, inappropriate oral practices, and unfavourable approaches to children's oral health. There is a definite and immediate need for organized training of school teachers on basic oral health knowledge. PMID:27034901

  2. Oral Health Knowledge, Attitude, and Approaches of Pre-Primary and Primary School Teachers in Mumbai, India

    PubMed Central

    Mota, Ankita; Oswal, Kunal C.; Sajnani, Dipti A.

    2016-01-01

    Background. School teachers have an internationally recognized potential role in school-based dental education and considerable importance has therefore been attributed to their dental knowledge. The objectives of this study were to determine the oral health related knowledge, attitudes, and approaches of pre-primary and primary school teachers in the city of Mumbai. Methods. The descriptive cross-sectional study was conducted in the suburban regions of Mumbai using a self-administered questionnaire and involved 511 teachers. Results. Teachers demonstrated inappropriate or incomplete knowledge regarding children's oral health. Only 53.2% knew that an individual has two sets of dentition. Moreover, only 45.4% of the teachers knew that a primary dentition consists of 20 teeth. Only 56.9% of the teachers asked their children to clean their mouth after snacking during school hours. 45.0% of the teachers were unaware of fluoridated tooth pastes whilst 78.9% of them were unaware of school water fluoridation programmes. Also, 54.8% of the teachers never discussed the oral health of children with their parents during parents meet. Conclusions. The studied school teachers demonstrated incomplete oral health knowledge, inappropriate oral practices, and unfavourable approaches to children's oral health. There is a definite and immediate need for organized training of school teachers on basic oral health knowledge. PMID:27034901

  3. Oral health related knowledge, attitude and practices among the primary health care workers of a district in India

    PubMed Central

    Bhoopathi, Praveen Haricharan; Reddy, Peddi Reddy Parthasarthi; Kotha, Arpitha; Mancherla, Monica; Boinapalli, Prathibha; Samba, Amit

    2014-01-01

    Aim: To assess the knowledge, attitude, and practices of the primary health care workers in our country. Materials and Methods: Data was gathered by means of a closed-ended questionnaire form. A total of 30 primary health centers (PHCs) and 60 subcenters (SCs) were included in the study. Frequency distribution was used together with Chi-square tests and analysis of variance (ANOVA) in this study. A P value of < 0.05 was considered significant. Results: Only 40% of the primary health care workers knew that dental caries is multifactorial, majority of them could not identify the symptoms of gum diseases, a meager number of the primary health care workers (28%) knew about the oral health aspects of a pregnant lady, and with the exception of doctors, the other health care workers were not sure of the etiology of oral cancer. Conclusion: About one-tenth of the primary care workers had high knowledge regarding oral health, only one-tenth of them had highly favorable oral health attitudes, and 9% of them had highly favorable oral health practices. PMID:25452921

  4. Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria

    PubMed Central

    Garg, Lalit; Eze, Godson

    2016-01-01

    Background Nigeria contributes only 2% to the world’s population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. Objective The purpose of this study was to document costs associated with a mobile technology–supported, community-based health insurance scheme. Methods This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. Results All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (P<.001). This indicates that average out-of-pocket cost of services at private health care facilities is significantly

  5. Indonesian experts' perspectives on a curriculum for psychologists working in primary health care in Indonesia

    PubMed Central

    Setiyawati, Diana; Blashki, Grant; Wraith, Ruth; Colucci, Erminia; Minas, Harry

    2014-01-01

    Mental health is a critical issue in Indonesia, since its population ranks among the top five in the world and the prevalence of common mental disorders is 11.6% of the adult population. However, the need to build an effective mental health-care system that is accessible to the whole population has only been recently addressed. The Aceh tsunami in 2004 brought to the forefront an unexpected window of opportunity to build a mental health-care system. Integration of mental health care into primary health care is a key strategy to close the treatment gap for people with mental disorders. Existing integration of psychologists into primary health care is a big step to meet the shortage of mental health-care specialists. As primary mental health care is an emerging field, the perspectives of Indonesian experts on Indonesian mental health care are needed to develop a curriculum for training psychologists to work in primary health care. In this study, data have been collected through semi-structured interviews with 24 Indonesian mental health experts, and three focus group discussions with 26 psychologists. Overall, experts agreed that to be able to work in primary health-care psychologists should have roles and training ranging from clinical to advocacy skills. Participants also agreed that psychologists should work in the community and contribute to primary health care as service providers and that strong collaborations between psychologists and other primary health-care providers are the key; these can be developed partly through referral and by respecting each other's unique strengths. PMID:25750806

  6. Primary Care and Public Health Activities in Select US Health Centers: Documenting Successes, Barriers, and Lessons Learned

    PubMed Central

    Shi, Leiyu; Chowdhury, Joya; Sripipatana, Alek; Zhu, Jinsheng; Sharma, Ravi; Hayashi, A. Seiji; Daly, Charles A.; Tomoyasu, Naomi; Nair, Suma; Ngo-Metzger, Quyen

    2012-01-01

    Objectives. We examined primary care and public health activities among federally funded health centers, to better understand their successes, the barriers encountered, and the lessons learned. Methods. We used qualitative and quantitative methods to collect data from 9 health centers, stratified by administrative division, urban–rural location, and race/ethnicity of patients served. Descriptive data on patient and institutional characteristics came from the Uniform Data System, which collects data from all health centers annually. We administered questionnaires and conducted phone interviews with key informants. Results. Health centers performed well on primary care coordination and community orientation scales and reported conducting many essential public health activities. We identified specific needs for integrating primary care and public health: (1) more funding for collaborations and for addressing the social determinants of health, (2) strong leadership to champion collaborations, (3) trust building among partners, with shared missions and clear expectations of responsibilities, and (4) alignment and standardization of data collection, analysis, and exchange. Conclusions. Lessons learned from health centers should inform strategies to better integrate public health with primary care. PMID:22690975

  7. The primary health care physician and the cancer patient: tips and strategies for managing sexual health

    PubMed Central

    Zhou, Eric S.; Nekhlyudov, Larissa

    2015-01-01

    There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples. PMID:26816826

  8. Health facilitation in primary care seen from practice and education.

    PubMed

    Thomson, Karen; Gripton, Jane; Lutchmiah, John; Caan, Woody

    'Valuing People: A New Strategy for Learning Disability for the 21st Century' (Department of Health, 2001a,b) aimed to introduce 'health facilitation' to improve the identification of health needs and access to appropriate care for people with learning disabilities. One London Borough took a leading role in implementing this new function, in the form of dedicated, full-time health facilitators. The authors examined the implementation and its impact, employing an innovative collaboration between professionals from practice, education and research. The clinical nurse involved was observed during her first year of health facilitation. The authors evaluated her impact on professionals, people with learning disabilities and the wider system of health. In some areas (for example, information technology) the health facilitator could make little progress in one year. However, she connected with a widening circle of local people and services, for example, in introducing health action plans for adults with a learning disability. Across the Borough some professionals became more aware of specific health issues in their local population. PMID:18073691

  9. Primary care interventions to improve transition of youth with chronic health conditions from paediatric to adult healthcare: a systematic review

    PubMed Central

    Bhawra, Jasmin; Toulany, Alene; Cohen, Eyal; Moore Hepburn, Charlotte; Guttmann, Astrid

    2016-01-01

    Objective To determine effective interventions to improve primary care provider involvement in transitioning youth with chronic conditions from paediatric to adult care. Design Systematic review. Multiple electronic databases were searched including Ovid MEDLINE, EMBASE and Web of Science (from 1 January 1947 to 5 August 2015). Evidence quality was assessed using a 36-point scoring system for disparate study designs. Setting Studies with paediatric-to-adult transition programmes and interventions involving primary care providers or in primary care settings. Participants Youth aged 16 years and over. Outcomes Relevant outcomes were grouped into 3 main domains based on the Triple Aim Framework: experience of care, population health, cost. Results A total of 1888 unique citations were identified, yielding 3 studies for inclusion. Overall, primary care provider roles were not well defined. 2 studies used case managers to facilitate referrals to primary care, and the remaining study was the only 1 situated in a primary care setting. None of the studies examined transition in all 3 Triple Aim Framework domains. The most commonly reported outcomes were in the cost domain. Conclusions There is limited empiric evidence to guide primary care interventions to improve transition outcomes for youth with chronic conditions. Future research and policy should focus on developing and evaluating coordinated transition interventions to better integrate primary care for high need populations. PMID:27150188

  10. A mental health intervention strategy for low-income, trauma-exposed Latina immigrants in primary care

    PubMed Central

    Kaltman, Stacey; de Mendoza, Alejandra Hurtado; Serrano, Adriana; Gonzales, Felisa A.

    2016-01-01

    Latinos in the United States face significant mental health disparities related to access to care, quality of care, and outcomes. Prior research suggests that Latinos prefer to receive care for common mental health problems (e.g., depression and anxiety disorders) in primary care settings, suggesting a need for evidence-based mental health services designed for delivery in these settings. This study sought to develop and preliminarily evaluate a mental health intervention for trauma-exposed Latina immigrants with depression and/or PTSD for primary care clinics that serve the uninsured. The intervention was designed to be simultaneously responsive to patients’ preferences for individual psychotherapy, to the needs of safety-net primary care clinics for efficient services, and to address the social isolation that is common to the Latina immigrant experience. Developed based on findings from the research team’s formative research, the resulting intervention incorporated individual and group sessions and combined evidence-based interventions to reduce depression and PTSD symptoms, increase group readiness, and improve perceived social support. Twenty-eight trauma-exposed low-income Latina immigrant women who screened positive for depression and/or PTSD participated in an open pilot trial of the intervention at a community primary care clinic. Results indicated that the intervention was feasible, acceptable, and safe. A randomized controlled trial of the intervention is warranted. PMID:26913774

  11. A mental health intervention strategy for low-income, trauma-exposed Latina immigrants in primary care: A preliminary study.

    PubMed

    Kaltman, Stacey; Hurtado de Mendoza, Alejandra; Serrano, Adriana; Gonzales, Felisa A

    2016-01-01

    Latinos in the United States face significant mental health disparities related to access to care, quality of care, and outcomes. Prior research suggests that Latinos prefer to receive care for common mental health problems (e.g., depression and anxiety disorders) in primary care settings, suggesting a need for evidence-based mental health services designed for delivery in these settings. This study sought to develop and preliminarily evaluate a mental health intervention for trauma-exposed Latina immigrants with depression and/or posttraumatic stress disorder (PTSD) for primary care clinics that serve the uninsured. The intervention was designed to be simultaneously responsive to patients' preferences for individual psychotherapy and to the needs of safety-net primary care clinics for efficient services and to address the social isolation that is common to the Latina immigrant experience. The resulting intervention, developed on the basis of findings from the research team's formative research, incorporated individual and group sessions and combined evidence-based interventions to reduce depression and PTSD symptoms, increase group readiness, and improve perceived social support. Low-income Latina immigrant women (N = 28), who screened positive for depression and/or PTSD participated in an open pilot trial of the intervention at a community primary care clinic. Results indicated that the intervention was feasible, acceptable, and safe. A randomized controlled trial of the intervention is warranted. (PsycINFO Database Record PMID:26913774

  12. Measuring health-related quality of life in adults with chronic conditions in primary care settings

    PubMed Central

    Hand, Carri

    2016-01-01

    Abstract Objective To describe health-related quality of life (HRQOL) conceptual frameworks, critically review 3 commonly used HRQOL scales relevant to adults with chronic conditions in primary care settings, and make recommendations for using HRQOL scales in primary care practice. Data sources Information was accessed regarding HRQOL conceptual and theoretical approaches. A comprehensive search strategy identified 3 commonly used scales that met the review criteria and evidence regarding use of the scales in adults with chronic conditions in community settings. Scale selection Scales were selected if they were designed for clinical use; were easy to administer; were generic and broad in content areas; and contained some individualized items. Scales were critiqued according to content development, theoretical basis, psychometric properties, scoring, feasibility, the concepts being measured, and the number of items that measured an individualized concept. Synthesis Early HRQOL approaches focused on health and functional status while recent approaches incorporate individualized concepts such as the person’s own values and the environment. The abbreviated World Health Organization Quality of Life Scale (WHOQOL-BREF), the 36-Item Short Form Health Survey (SF-36), and the Duke Health Profile were critiqued. All address physical, mental, and social domains, while the WHOQOL-BREF also addresses environment. Psychometric evidence supports use of the SF-36 and WHOQOL-BREF with this population. The SF-36 has the most evidence of responsiveness but has some floor and ceiling effects, while the WHOQOL-BREF does not appear to have floor or ceiling effects but has limited evidence of responsiveness. The WHOQOL-BREF has the highest proportion of individualized items. Conclusion Measurement of HRQOL in adults with chronic conditions can support patient management and contribute to primary care service evaluation. Scales that are based on a broad definition of health and that

  13. Genetics and Common Disorders: Implications for Primary Care and Public Health Providers

    SciTech Connect

    McInerney, Joseph D.; Greendale, Karen; Peay, Holly L.

    2005-06-01

    organized around two case studies designed to appeal to primary care providers (thrombophilia) and public health professionals (development of a screening grogram for colorectal cancer). NCHPEG has distributed more than 0000 copies of the CD-ROM to NCHPEG member organizations and to other organizations and individuals in response to requests. The program also is available at www.nchpeg.org.

  14. Acceptability of quality reporting and pay for performance among primary health centers in Lebanon.

    PubMed

    Saleh, Shadi S; Alameddine, Mohamad S; Natafgi, Nabil M

    2013-01-01

    Primary health care (PHC) is emphasized as the cornerstone of any health care system. Enhancing PHC performance is considered a strategy to enhance effective and equitable access to care. This study assesses the acceptability of and factors associated with quality reporting among PHC centers (PHCCs) in Lebanon. The managers of 132 Lebanese Ministry of Health PHCCs were surveyed using a cross-sectional design. Managers' willingness to report quality, participate in comparative quality assessments, and endorse pay-for-performance schemes was evaluated. Collected data were matched to the infrastructural characteristics and services database. Seventy-six percent of managers responded to the questionnaire, 93 percent of whom were willing to report clinical performance. Most expressed strong support for peer-performance comparison and pay-for-performance schemes. Willingness to report was negatively associated with the religious affiliation of centers and presence of health care facilities in the catchment area and favorably associated with use of information systems and the size of population served. The great willingness of PHCC managers to employ quality-enhancing initiatives flags a policy priority for PHC stakeholders to strengthen PHCC infrastructure and to enable reporting in an easy, standardized, and systematic way. Enhancing equity necessitates education and empowerment of managers in remote areas and those managing religiously affiliated centers. PMID:24397238

  15. Patients' perceptions of need for primary health care services: useful for priority setting?

    PubMed Central

    Hopton, J. L.; Dlugolecka, M.

    1995-01-01

    OBJECTIVES--To assess the feasibility of using patients' perceptions of need for primary health care services to develop priorities. DESIGN--A postal survey of a random sample of 3478 patients registered with five general practices. SETTING--Lothian, Scotland. MAIN OUTCOME MEASURES--Comparison of rankings of 36 different kinds of help or advice according to (a) popularity in the sample size as a whole and in healthy and unhealthy subgroups and (b) health status (severity of need) of potential service users. RESULTS--Popularity rankings differed between the healthy and unhealthy subgroups and the whole sample. Popularity rankings were almost the inverse of rankings based on health status. The analysis identified two areas of substantial need both in terms of popularity and severity: pain management and advice about welfare benefits. CONCLUSIONS--Methodological efforts to ensure equal participation in the processes of assessing health needs and of priority setting do not in themselves promote equity. To promote equity some opinions may need to be given greater weight. PMID:7767195

  16. Restructuring the primary health care services and changing profile of family physicians in Turkey.

    PubMed

    Ersoy, F; Sarp, N

    1998-12-01

    A new health-reform process has been initiated by Ministry of Health in Turkey. The aim of that reform is to improve the health status of the Turkish population and to provide health care to all citizens in an efficient and equitable manner. The restructuring of the current health system will allow more funds to be allocated to primary and preventive care and will create a managed market for secondary and tertiary care. In this article, we review the current and proposed primary care services models and the role of family physicians therein. PMID:10078801

  17. Design Strategy for Flexible Health Sciences Facilities

    PubMed Central

    Weeks, John; Best, Gordon

    1970-01-01

    A statistical analysis of spatial allocations in university teaching hospitals and medical schools in three countries supports the hypothesis that on the “macro” level of major functional zones there is a considerable degree of invariance in space ratios, despite wide divergence in size, organization, and operating policies. On the basis of these findings a model is developed that makes it possible to predict, from a variety of indicators of space “needs,” the total area of a health sciences facility defined by levels of support servicing. The outputs of the model are seen as the inputs to a design strategy for potentially flexible medical facilities served by a communication lattice capable of indefinite extension. Images Fig. 9 PMID:5494269

  18. Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities

    ERIC Educational Resources Information Center

    Kastner, Theodore A.; Walsh, Kevin K.

    2006-01-01

    Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…

  19. Effects of improved patient participation in primary care on health-related outcomes: a systematic review

    PubMed Central

    Sanders, Ariëtte R J; van Weeghel, Inge; Vogelaar, Maartje; Verheul, William; Pieters, Ron H M; de Wit, Niek J; Bensing, Jozien M

    2013-01-01

    Background. In primary care, many consultations address symptom-based complaints. Recovery from these complaints seldom exceeds placebo effects. Patient participation, because of its supposed effects on trust and patient expectancies, is assumed to benefit patients’ recovery. While the idea is theoretically promising, it is still unclear what the effects of increased patient participation are on patient outcomes. Aim. To review the effects of controlled intervention studies aiming to improve patient participation in face-to-face primary care consultations on patient-oriented and/or disease-oriented outcomes. Methods. This study is a systematic review. A systematic search was undertaken for randomized controlled trials designed to measure the effects of interventions that aimed to improve adult patients’ participation in primary care visits. The CINAHL, Cochrane, EMBASE, PsycINFO and PubMed databases were searched. Results. Seven different trials fulfilled the inclusion criteria. Three of the studies were related to symptom-based complaints. Five studies measured patient-oriented outcomes, the primary outcome of interest for this review. All studies suffered from substantial bias. Studies varied widely in their aims, types of complaints/diseases, strength of the interventions and their outcomes. The effects on patient-oriented outcomes and disease-oriented outcomes were ambiguous. Conclusion. Little research has been performed on health outcomes of interventions aiming to increase patient participation in general practice visits among patients suffering from symptom-based complaints. The results still are non-conclusive. The quality of the trials has been weak, possibly due to the complexity of the concept. This weak quality may explain the lack of conclusive results. Proposals for future research designs are offered. PMID:23629738

  20. Exploring why quality circles work in primary health care: a realist review protocol

    PubMed Central

    2013-01-01

    Background Quality circles (QCs) are commonly used in primary health care in Europe to consider and improve standard practice over time. They represent a complex social intervention that occurs within the fast-changing system of primary health care. Numerous controlled trials, reviews, and studies have shown small but unpredictable positive effect sizes on behavior change. Although QCs seem to be effective, stakeholders have difficulty understanding how the results are achieved and in generalizing the results with confidence. They also lack understanding of the active components of QCs which result in changes in the behavior of health care professionals. This protocol for a realist synthesis will examine how configurations of components and the contextual features of QCs influence their performance. Methods/Design Stakeholder interviews and a scoping search revealed the processes of QCs and helped to describe their core components and underlying theories. After clarifying their historical and geographical distribution, a purposive and systematic search was developed to identify relevant papers to answer the research questions, which are: understanding why, how, and when QCs work, over what time frame, and in what circumstances. After selecting and abstracting appropriate data, configurations of contexts and mechanisms which influence the outcome of QCs within each study will be identified. Studies will be grouped by similar propositional statements in order to identify patterns and validation from stakeholders sought. Finally, theories will be explored in order to explain these patterns and to help stakeholders maintain and improve QC performance. Discussion Analyzing context-mechanism-outcome (CMO) patterns will reveal how QCs work and how contextual factors interact to influence their outcome. The aim is to investigate unique configurations that enable them to improve the performance of health care professionals. Using a standardized reporting system, this

  1. Primary health-care nurses and Internet health information-seeking: Access, barriers and quality checks.

    PubMed

    Gilmour, Jean; Strong, Alison; Chan, Helen; Hanna, Sue; Huntington, Annette

    2016-02-01

    Online information is a critical resource for evidence-based practice and patient education. This study aimed to establish New Zealand nurses' access and evaluation of online health information in the primary care context using a postal questionnaire survey; there were 630 respondents from a random sample of 931 nurses. The majority of respondents were satisfied with work access to online information (84.5%, n = 501) and searched for online information at least several times a week (57.5%, n = 343). The major barrier to online information seeking was insufficient time, but 68 respondents had no work online information access. The level of nursing qualification was significantly correlated with computer confidence and information quality checking. A range of information evaluation approaches was used. Most nurses in study accessed and evaluated Internet information in contrast to the findings of earlier studies, but there were barriers preventing universal integration into practice. PMID:25355072

  2. Nurse Practitioner Mental Health Care in the Primary Context: A Californian Case Study

    PubMed Central

    Theophilos, Theane; Green, Roger; Cashin, Andrew

    2015-01-01

    In America, mental health needs surpass the availability of specialized providers. This vulnerable population also has other obstacles for comprehensive care including gaps in medical coverage, stigma, economic barriers, and a geographical mal-distribution of qualified mental health professionals. A wide availability of primary care providers, including primary care and family nurse practitioners, are well-positioned to deliver integrated mental and physical health care. A case study from a Southern California Coachella Valley primary care clinic with integrated services is used to demonstrate the much-needed approach of care to address health disparities that face low-income immigrants, migrant workers, and others without access to specialized care centers and providers. It is argued that mental health care should be part of all holistic treatment provided by primary care and family nurse practitioners. This has implications for curricula and practice development. PMID:27417754

  3. Developing a multivariate electronic medical record integration model for primary health care.

    PubMed

    Lau, Francis; Price, Morgan; Lesperance, Mary

    2013-01-01

    This paper describes the development of a multivariate electronic medical record (EMR) integration model for the primary health care setting. Our working hypothesis is that an integrated EMR is associated with high quality primary health care. Our assumption is that EMR integration should be viewed as a form of complex intervention with multiple interacting components that can impact the quality of care. Depending on how well the EMR is integrated in the practice setting, one can expect a corresponding change in the quality of care as measured through a set of primary health care quality indicators. To test the face validity of this model, a Delphi study is being planned where health care providers and information technology professionals involved with EMR adoption are polled for their feedback. This model has the potential to quantify and explain the factors that influence successful EMR integration to improve primary health care. PMID:23388317

  4. Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

    PubMed Central

    Manjomo, R. C.; Mwagomba, B.; Ade, S.; Ali, E.; Ben-Smith, A.; Khomani, P.; Bondwe, P.; Nkhoma, D.; Douglas, G. P.; Tayler-Smith, K.; Chikosi, L.; Gadabu, O. J.

    2016-01-01

    Setting: Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi. Objective: Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015. Design: A cross-sectional study. Results: Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged ⩾65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for ⩾1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80–90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60–75% with asthma had no severe attacks. Control of blood pressure (41–51%) and diabetes (15–38%) was poor. Conclusion: It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes. PMID:27358797

  5. Introduction to integrative primary care: the health-oriented clinic.

    PubMed

    Fortney, Luke; Rakel, Dave; Rindfleisch, J Adam; Mallory, Jill

    2010-03-01

    Integrative medicine is healing-oriented medicine that accounts for the whole person (body, mind, and spirit), including all aspects of lifestyle. Integrative medicine emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative. This article describes ways to bring the integrative perspective into primary care practice. Several approaches are described, including some that are routinely used in the authors' practice. Changes in practice philosophy that can (1) help inform primary care redesign, (2) facilitate the creation of patient-centered medical homes, (3) strengthen provider-patient relationships, and (4) enhance patient satisfaction are also provided. PMID:20188994

  6. Survey of Mental Health Consultation and Referral Among Primary Care Pediatricians

    PubMed Central

    Guevara, James P.; Greenbaum, Paul E.; Shera, David; Bauer, Laura; Schwarz, Donald F.

    2008-01-01

    Objective To determine availability of and test whether on-site mental health providers (MHP) is associated with greater odds of reported mental health consultation and referral among primary care pediatricians. Methods Pediatricians were identified from the American Medical Association's 2004 Physician Directory, stratified by region, and 600 were randomly selected to receive a mail survey. The main independent variable was on-site MHP. The dependent variable was reported frequency (4-point rating) of mental health consultation and referral. Estimates were weighted to account for survey design and non-response. Results Overall response rate was 51%. The majority of respondents were male (56%), age ≥46 years old (59%), white (68%), and practicing in suburban locations (52%). Approximately half reported consultation with (44%) or referral to (51%) MHP always or often, but few (17%) reported on-site MHP. After adjustment for demographic and practice characteristics, pediatricians with on-site MHP were more likely to consult (Odds Ratio [OR] 6.58, 95% confidence interval [CI] 3.55-12.18) or refer (OR 4.25, 95% CI 2.19-8.22) than those without on-site MHP. Among those without on-site MHP, pediatricians with greater practice burden were less likely to consult (OR 0.69, 95% CI 0.48-0.99) or refer (OR 0.75, 95% CI 0.54-1.04) than those with lesser burden. Conclusions Most pediatricians in the U.S. experienced practice-related burdens that limit mental health collaboration, but those with collocated services reported a greater likelihood of consultation and referral. Policy changes that encourage collocation of mental health services and limit practice burden may facilitate mental health consultation and referral. PMID:19329104

  7. Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya

    PubMed Central

    2014-01-01

    Background The World Health Organization (WHO) and the Government of Kenya alike identify a well-performing health workforce as key to attaining better health. Nevertheless, the motivation and retention of health care workers (HCWs) persist as challenges. This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. Methods A cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention. Results The levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important compensatory factors. Conclusions There are distinct motivational and retention factors that affect

  8. "Primary" rationing of health services in ageing societies--a normative analysis.

    PubMed

    Breyer, Friedrich; Schultheiss, Carlo

    2002-11-01

    While most of the debate on "rationing in health care" focusses on the distribution of scarce medical resources among competing needs, which we propose to call "secondary rationing," this paper is concerned with "primary rationing," i.e., the conscious decision by society to limit the amount of resources devoted to a collectively financed health care system. Based upon a number of transparent normative criteria, we analyze whether primary rationing should be performed and, if so, what type should be chosen (hard vs. soft, explicit vs. implicit). Finally we discuss whether age should be used as a criterion in any systematic attempt at primary rationing of health care. PMID:14625993

  9. Primary health care in support of community development.

    PubMed

    Ferrinho, P; Robb, D; Cornielje, H; Rex, G

    1993-01-01

    A community development approach has been adopted in the outreach component of the work of the Alexandra Health Centre in South Africa. The importance of local township organizations has been recognized and the Centre is seen not only as providing technical solutions but also as helping people to achieve improved living conditions. This requires clear motivation, rigorous management, purposeful action by teams of health staff, and planning in conjunction with the community. PMID:8185757

  10. The integrated project: a promising promotional strategy for primary health care.

    PubMed

    Daniel, C; Mora, B

    1985-10-01

    The integrated project using parasite control and nutrition as entry points for family planning practice has shown considerable success in promoting health consciousness among health workers and project beneficiaries. This progress is evident in the Family Planning, Parasite Control and Nutrition (FAPPCAN) areas. The project has also mobilized technical and financial support from the local government as well as from private and civic organizations. The need for integration is underscored by the following considerations: parasite control has proved to be effective for preventive health care; the integrated project uses indigenous community health workers to accomplish its objectives; the primary health care (PHC) movement depends primarily on voluntary community participation and the integrated project has shown that it can elicit this participation. The major health problems in the Philippines are: a prevalence of communicable and other infectious diseases; poor evironmental sanitation; malnutrition; and a rapid population growth rate. The integrated program utilizes the existing village health workers in identifying problems related to family planning, parasite control and nutrition and integrates these activities into the health delivery system; educates family members on how to detect health and health-related problems; works out linkages with government agencies and the local primary health care committee in defining the scope of health-related problems; mobilizes community members to initiate their own projects; gets the commitment of village officials and committe members. The integrated project operates within the PHC. A health van with a built-in video playback system provides educational and logistical support to the village worker. The primary detection and treatment of health problems are part of the village health workers' responsibilities. Research determines the project's capability to reactivate the village primary health care committees and sustain

  11. Food, Environment and Health: A Guide for Primary School Teachers.

    ERIC Educational Resources Information Center

    Williams, Trefor; And Others

    This book for primary school teachers provides a practical collection of facts, advice, projects, games, stories, and sample questions for use in teaching children the importance of healthy habits. Food, personal hygiene, and the home environment are areas of particular concern. Details range from advice on ways to start a school garden or design…

  12. Primary Care Quality among Different Health Care Structures in Tibet, China

    PubMed Central

    Yin, Aitian; Mao, Zongfu; Liu, Xiaoyun

    2015-01-01

    Objective. To compare the primary care quality among different health care structures in Tibet, China. Methods. A self-administered questionnaire survey including Primary Care Assessment Tool-Tibetan version was used to obtain data from a total of 1386 patients aged over 18 years in the sampling sites in two prefectures in Tibet. Multivariate analysis was performed to assess the association between health care structures and primary care quality while controlling for sociodemographic and health care characteristics. Results. The services provided by township health centers were more often used by a poor, less educated, and healthy population. Compared with prefecture (77.42) and county hospitals (82.01), township health centers achieved highest total score of primary care quality (86.64). Factors that were positively and significantly associated with higher total assessment scores included not receiving inpatient service in the past year, less frequent health care visits, good self-rated health status, lower education level, and marital status. Conclusions. This study showed that township health centers patients reported better primary care quality than patients visiting prefecture and county hospitals. Government health reforms should pay more attention to THC capacity building in Tibet, especially in the area of human resource development. PMID:25861619

  13. Region Emilia Romagna: Primary Health Care Integration/Regione Emilia-Romagna: l’integrazione nel sistema di Cure Primarie

    PubMed Central

    Basenghi, Maria

    2012-01-01

    The politics of Region Emilia-Romagna have been meant to improve social and health care integration through an architecture of local services coherent with this purpose, setting up a Department dedicated to Primary Care inside the Social and Health District. The territorial basis of the Local Health Units (LHU), the resident people, the sustained public spending, the employed human resources and the provided services all delineate the organization of the LHU. The purpose is to grant strong integration among local bodies and LHUs through a governance system (planning, management and administration) that makes a distinction between commissioning and supply. The Committenza (commissioning department), which reports to the Strategic Direction and the District, directs the offer in connection with the need analysis, whereas the Primary Care Department arranges activities and provides services by means of integrated networks which ensure continuity to the care. The main hub in the network is known as the Casa della Salute (House of Health), which works through structured practices, protocols and procedures. LHU professionals and freelancers under contract supply primary, in-home and nursing home care, plus specialist outpatient treatment. The Casa della Salute, whose size will depend on the context (large, medium and small), are reliable reference points for citizens, who can address to them in every moment of the day. On behalf of the Regione Emilia-Romagna, it is the Primary Care Observatory which registers the functions existing in the 42 Houses of Health and their organizational and structural characteristics. The analysis of the obtained data will increase enhance the Houses’ implementation.

  14. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors

    PubMed Central

    2012-01-01

    ≤ 3 points of contact hours) and setting (primary health, community or other). Studies were analyzed by intervention category and whether significant positive changes in SNAPW and health literacy outcomes were reported. Results 52 studies were included. Many different intervention types and settings were associated with change in health literacy (73% of all studies) and change in SNAPW (75% of studies). More low intensity interventions reported significant positive outcomes for SNAPW (43% of studies) compared with high intensity interventions (33% of studies). More interventions in primary health care than the community were effective in supporting smoking cessation whereas the reverse was true for diet and physical activity interventions. Conclusion Group and individual interventions of varying intensity in primary health care and community settings are useful in supporting sustained change in health literacy for change in behavioral risk factors. Certain aspects of risk behavior may be better handled in clinical settings while others more effectively in the community. Our findings have implications for the design of programs. PMID:22656188

  15. [Primary health care in a prison environment, the Cameroon experience].

    PubMed

    Demoures, B; Nkodo-Nkodo, E; Mbam-Mbam, L

    1998-01-01

    People isolated from their families, such as prisoners, are the most vulnerable to the consequences of the economic crisis in Africa. Some non-governmental organizations are taking action to improve health care conditions in prisons. We describe herein such a project, conducted in the town of Ngaoundéré, Adamaoua Province, Cameroon. The prison houses 400 prisoners, mostly men. Catholic missionaries have been involved in improving conditions since 1988, at the request of a magistrate from the local tribunal. They have introduced a community store, handicrafts and the teaching of reading and writing, carried out by the prisoners themselves. The Catholic Health Service was asked to join the project in October 1992. Its participation was part of the provincial policy of collaboration between private and public organizations for the improvement of health institutions. Meetings between health workers and prisoners first created an opportunity for the prisoners to talk about their concerns and what they wanted. A health committee, consisting of about 10 prisoners took several initiatives related to hygiene. Access to curative care was then improved by increasing the stock of medicines to include 37 drugs, standardizing the therapeutic recommendations (including those of the national program against tuberculosis) and increasing the prisoners' access to health care by making the pharmacy self-sufficient. The pharmacy's prices are low and the wardens and their families are encouraged to use it. Any profit made goes towards a "solidarity fund" managed by the prisoners, which enables them to buy their own drugs (3 to 5 patients are seen each day by the nurse). The link between money entering the system and the supply of drugs was studied. Most of the diseases reported between July 1994 and July 1995 were infectious, including scabies infections and acute respiratory infections (mean of 5 cases per month). Fifteen cases of tuberculosis were diagnosed and treated. AIDS was not

  16. Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study

    PubMed Central

    2014-01-01

    Background Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Methods/Design Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers’s diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods — pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance — with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation

  17. Australian experts' perspectives on a curriculum for psychologists working in primary health care: implication for Indonesia

    PubMed Central

    Setiyawati, Diana; Blashki, Grant; Wraith, Ruth; Colucci, Erminia; Minas, Harry

    2014-01-01

    In Indonesia there is a pressing need to scale up mental health services due to a substantial unmet need for mental health care. Integrating psychologists into primary health care can potentially deliver affordable mental health services to communities and help to close the treatment gap. Australia is one of the pioneers in integrating mental health into primary health care, and the mental health reforms in Australia may have some implications for Indonesia. The aim of this paper is to examine the Australian experience and to reflect in particular on lessons that may be learnt to inform the development of curriculum for psychologists working in primary health care in Indonesia. Data were collected through semi-structured interviews with 12 Australian experts in primary mental health care. The focus of the interview was on the roles and skills of psychologists working in primary health care with a particular focus on the appropriate curriculum for psychologists. Overall, the Australian experts agreed that psychologists' roles and training should include both clinical skills and public mental health skills. The experts also agreed that psychologists should be able to educate the community about mental health issues and be capable of undertaking research and evaluation of programs. A central theme was the need for strong collaborations with general practitioners and existing agencies in the community so that psychologists are able to make appropriate referrals and also accept referrals. The lessons learnt from the Australian experience, which are most applicable to the Indonesian setting are: (1) the importance of adequate government funding of psychologists; (2) the value of evidence-based treatments such as Cognitive Behavioural Therapy; (3) the need to specifically train psychologists for primary care; (4) the need for flexibility in the psychologist workforce (e.g. location); and (5) the value of continuing supervision for psychologists to support them in their

  18. Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle

    PubMed Central

    2011-01-01

    Background Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour. Methods A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview. Results The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia. Conclusions The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men. PMID:21569395

  19. Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia.

    PubMed

    Curry, Leslie A; Alpern, Rachelle; Webster, Tashonna R; Byam, Patrick; Zerihun, Abraham; Tarakeshwar, Nalini; Cherlin, Emily J; Bradley, Elizabeth H

    2012-01-01

    Government-community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings. PMID:22621744

  20. Change in primary health care: new wine in old bottles?

    PubMed

    Newton, J; Graham, J; McLoughlin, K; Moore, A; McTavish, D

    2000-01-01

    Describes the findings from the first year of an evaluation of change at a PMS+ site in West Cumbria. The study has used qualitative methods including non-participant observation at the site; face to face interviews with 28 clinical staff; group interviews with administrative and secretarial staff; and the collection of documents. Analysis of the data against a set of "outcome indicators" shows that significant progress has been made towards implementing the model of primary care delivery described in the pilot proposal. Multidisciplinary working is developing in the clinical action groups and the establishment of a primary care emergency unit has changed general practitioner workloads. The new organisation structure is not yet working wholly as anticipated but recently initiated changes are intended to strengthen the role and authority of the management board. PMID:11183997

  1. Integrating Primary Care and Behavioral Health: A Nurse Practitioner’s Perspective

    PubMed Central

    Thai, Le; Saw, Anne

    2016-01-01

    Health equity for individuals with serious mental illness (SMI) requires collaborative partnerships between primary care and behavioral health organizations. This paper presents the experiences and perspectives of a nurse practitioner in a large-scale pilot program to integrate primary care and behavioral health between an FQHC and a community mental health center, both serving predominantly Asian immigrant populations. This paper discusses lessons learned through program implementation and provides insights on developing a truly integrated system involving equal and full cooperation across disciplines to provide quality and holistic care for patients with SMI. Implications for clinical practice and policy are discussed. PMID:26900384

  2. [Differences and similarities of primary care in the German and Spanish health care systems].

    PubMed

    Salvador Comino, María Rosa; Krane, Sibylla; Schelling, Jörg; Regife García, Víctor

    2016-02-01

    An efficient primary care is of particular importance for any countries' health care system. Many differences exist on how distinctive countries try to obtain the goal of an efficient, cost-effective primary care for its population. In this article we conducted a selective literature review, which includes both scientific and socio-political publications. The findings are complemented with the experience of a Spanish physician from Seville in her last year of training in family medicine, who completed a four months long rotation in the German health care system. We highlighted different features by comparing both countries, including their health care expenditure, the relation between primary and secondary care, the organization in the academic field and the training of future primary care physicians. It is clear that primary care in both countries plays a central role, have to deal with shortcomings, and in some points one system can learn from the other. PMID:26363955

  3. Primary Health Centres: Preferred Option for Birthing Care in Tamilnadu, India, from Users’ Perspectives

    PubMed Central

    Suresh, Saradha; Padmanaban, P.

    2015-01-01

    ABSTRACT Tamilnadu state of India witnessed an increasing trend of institutional deliveries since the beginning of 1990s, with decline of domiciliary deliveries to nearly zero now. Among the institutional deliveries, a shift has been observed since 2006 wherein primary health centres (PHC) have shown a four-fold increase in the number of deliveries while other public and private health facilities showed a decline, despite equal access by people to all categories of health facilities. A qualitative study was designed to explore the determinants that led to increased preference of PHCs for birthing care. In-depth interviews and FGDs were conducted with recently-delivering women and their spouses. User-friendly ambience, courteous attitude and behaviour of staff, good infrastructure, availability of qualified staff, and relative absence of informal payments have contributed to increased preference for birthing care in PHCs. Barriers to seeking care from secondary and tertiary-level public hospitals and private hospitals have also made women prefer PHCs. PMID:25995734

  4. Economics, Work, and Mental Health: Implications for Primary Prevention.

    ERIC Educational Resources Information Center

    Cahill, Janet

    Recent research on the impact of economics on mental and physical health has raised fundamental questions about structural elements in the macro-economy and their role in creating stress. This paper reviews and integrates these sometimes conflicting findings into a cohesive model. Structural elements of our current economic system are identified…

  5. DESIGN STRATEGIES FOR EPIDEMIOLOGIC STUDIES OF ENVIRONMENTAL IMPACTS ON HEALTH

    EPA Science Inventory

    The papers describes epidemiologic designs and methods in studies of health effects of air pollution, whose implications, however, can be extended to the detection of health effects of other environmental exposures. Recent advances in measurement technology for the assessment of ...

  6. The gender gap in primary health care resource utilization in Central Asia.

    PubMed

    Cashin, Cheryl E; Borowitz, Michael; Zuess, Olga

    2002-09-01

    There is a large gender gap in life expectancy in some countries of the former Soviet Union. Life expectancy of males is as much as 13 years less than that of females, and a significant portion of the excess male mortality is caused by cardiovascular disease. Although effective primary health care is necessary to manage cardiovascular disease and reduce acute episodes and mortality, the primary health care system is under-utilized by adult males in the region. This study combines disaggregated utilization data with cost data to analyze patterns of per capita primary care resource consumption in urban and rural regions of Kazakhstan and Uzbekistan. The results show that both in absolute and per capita terms, the principal users of primary health are women of reproductive age and children under five. Based on a combination of utilization and cost of services, women of reproductive age consume approximately 1.5 times the average per capita primary health care resources, while men in the same age group consume approximately one-half of the average. Children under five consume about three to five times the average per capita primary care resources. Based on the results of the study, regional government health purchasers worked together with providers to develop a new per capita payment system with age/sex adjustments and incentives for outreach to bring adult men into the primary care system. PMID:12135992

  7. Coordinating Mental Health Care across Primary Care and Schools: ADHD as a Case Example

    ERIC Educational Resources Information Center

    Power, Thomas J.; Blum, Nathan J.; Guevara, James P.; Jones, Heather A.; Leslie, Laurel K.

    2013-01-01

    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual…

  8. Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis

    ERIC Educational Resources Information Center

    Klein, Michael C.; Ciotoli, Carlo; Chung, Henry

    2011-01-01

    Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between…

  9. Primary Prevention in Mental Health and Social Work: A Sourcebook of Curriculum and Teaching Materials.

    ERIC Educational Resources Information Center

    Nobel, Milton, Ed.

    A sourcebook of curriculum and teaching materials pertaining to primary prevention in mental health and social work is presented. Contents include: two articles addressing the theoretical dimensions of primary prevention and the relationship to social work education and practice; five articles describing preventive content that can be integrated…

  10. Health coaching in primary care: a feasibility model for diabetes care

    PubMed Central

    2014-01-01

    Background Health coaching is a new intervention offering a one-on-one focused self-management support program. This study implemented a health coaching pilot in primary care clinics in Eastern Ontario, Canada to evaluate the feasibility and acceptability of integrating health coaching into primary care for patients who were either at risk for or diagnosed with diabetes. Methods We implemented health coaching in three primary care practices. Patients with diabetes were offered six months of support from their health coach, including an initial face-to-face meeting and follow-up by email, telephone, or face-to-face according to patient preference. Feasibility was assessed through provider focus groups and qualitative data analysis methods. Results All three sites were able to implement the program. A number of themes emerged from the focus groups, including the importance of physician buy-in, wide variation in understanding and implementing of the health coach role, the significant impact of different systems of team communication, and the significant effect of organizational structure and patient readiness on Health coaches’ capacity to perform their role. Conclusions It is feasible to implement health coaching as an integrated program within small primary care clinics in Canada without adding additional resources into the daily practice. Practices should review their organizational and communication processes to ensure optimal support for health coaches if considering implementing this intervention. PMID:24708783

  11. 30 CFR 250.916 - What are the CVA's primary duties during the design phase?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What are the CVA's primary duties during the... Structures Platform Verification Program § 250.916 What are the CVA's primary duties during the design phase... appropriate for the intended service life at the proposed location. (b) Primary duties of the CVA during...

  12. [Conflicts of interests in clinical research in primary health care].

    PubMed

    González-de Paz, L; Navarro-Rubio, M D; Sisó-Almirall, A

    2014-03-01

    Conflicts of interests between professionals and patients in biomedical research, is an ethical problem. None of the laws in Spain mention whether the clinical researcher has to clarify to participants the reasons why it proposes them to participate in a clinical trial. In this article, conflicts of interests in research are discussed in the context of primary healthcare. In this area conflicts of interests might alter the confidence between patients and healthcare professionals. Finally, we suggest some practical strategies that can help participants make the decision to participate in a clinical trial more willingly and freely. PMID:24055589

  13. Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System.

    PubMed

    Dobmeyer, Anne C; Hunter, Christopher L; Corso, Meghan L; Nielsen, Matthew K; Corso, Kent A; Polizzi, Nicholas C; Earles, Jay E

    2016-09-01

    The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed. PMID:27484777

  14. Understanding the culture of primary health care: implications for clinical practice.

    PubMed

    Camillo, Pat

    2004-01-01

    A qualitative, ethnographic study was undertaken to determine whether older women experienced barriers to health care related to gender and power relations within biomedical culture. A feminist perspective was utilized, incorporating concepts from critical medical anthropology. Data collection methods included individual interviews, focus groups and participant observation. The participants were active in guiding the research and validating the findings. Barriers related to gender and age were observed during primary health care visits, although they were not always directly apparent to the women. There is evidence to suggest that older women's ability to access primary health care depends on the degree of cultural connectedness they encounter within their particular health care facility. Using the findings of this study, a theoretical model is proposed to understand the culture of primary health care within a critical and cultural context. PMID:15587545

  15. Nurse managed center: access to primary health care for urban Native Americans.

    PubMed

    Neff, Donna Felber; Kinion, Elizabeth S; Cardina, Christen

    2007-01-01

    Urban Native Americans represent a small, diverse minority with unique health needs. The purposes of this descriptive retrospective study were to describe (a) the characteristics and primary health problems of urban Native Americans who receive primary health care at an urban nurse managed center (NMC) and (b) the nursing interventions provided at an urban NMC to urban Native Americans. A sample of 334 participants patient data were abstracted from a computerized clinical data set and coded based on the Omaha Classification System. The majority were over 40 years of age, were female, were single, completed high school, and were poor and uninsured, and many were unemployed. The most frequent health problems were related to pain, cardiovascular symptoms, dentition problems, and respiratory illnesses. The most frequent nursing interventions were for surveillance of physical signs and symptoms. The NMC was an accessible source of primary health care for urban Native Americans in northeastern Ohio. PMID:17266403

  16. The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints

    PubMed Central

    2013-01-01

    Background The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. Methods Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. Results While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services’ responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse “dilemmatic space” in their work. Conclusions The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health’s recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and

  17. Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project

    PubMed Central

    Labonté, Ronald; Sanders, David; Packer, Corinne; Schaay, Nikki

    2014-01-01

    Background The 4-year (2007–2011) Revitalizing Health for All international research program (http://www.globalhealthequity.ca/projects/proj_revitalizing/index.shtml) supported 20 research teams located in 15 low- and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. Teams were organized in a triad comprised of a senior researcher, a new researcher, and a ‘research user’ from government, health services, or other organizations with the authority or capacity to apply the research findings. Multiple regional and global team capacity-enhancement meetings were organized to refine methods and to discuss and assess cross-case findings. Objective Most research projects used mixed methods, incorporating analyses of qualitative data (interviews and focus groups), secondary data, and key policy and program documents. Some incorporated historical case study analyses, and a few undertook new surveys. The synthesis of findings in this report was derived through qualitative analysis of final project reports undertaken by three different reviewers. Results Evidence of comprehensiveness (defined in this research program as efforts to improve equity in access, community empowerment and participation, social and environmental health determinants, and intersectoral action) was found in many of the cases. Conclusions Despite the important contextual differences amongst the different country studies, the similarity of many of their findings, often generated using mixed methods, attests to certain transferable health systems characteristics to create and sustain CPHC practices. These include:  Well-trained and supported community health workers (CHWs) able to work effectively with marginalized communities Effective mechanisms for community participation, both informal (through participation in projects and programs, and meaningful consultation) and formal (though program

  18. Design Considerations for Construction of Rural Primary Schools.

    ERIC Educational Resources Information Center

    Siddiqui, Kalim A.; And Others

    Widely differing local conditions, increased community participation in education, more lifelong education, and decentralization of schools are factors which should affect the architecture of rural primary schools in Pakistan. Also significant are the results of a 1977 survey which indicate that building quality is unrelated to school attendance…

  19. [Evaluation of cost effectiveness in primary health care].

    PubMed

    Busse, R; Graf von der Schulenburg, J M; Drummond, M

    1997-08-01

    Evaluation of Cost-Effectiveness in Health Care considers the background, methodology and potential political influence of economic evaluation (EE) in health care, the following conclusions can be drawn: EE is not just about cost cutting--it considers both costs and outcomes. EE needs to be integrated with decision-making procedures at different levels, namely the macro (policy) level, the meso (management) level, and the micro (clinical) level. EE needs to be seen as a part of a broader effort in health technology assessment and in relation to parallel efforts, e.g. guidelines development, quality assurance, evidence-based medicine. EE needs to be methodologically sound, but is not always possible to undertake the perfect study due to constraints of resources, time, information availability. Ways of setting priorities for EE need to be developed; this means selecting relevant topics and researchable questions. EE needs to be locally relevant; this means taking into account the variations of setting--within and between countries--and differences between trials (efficacy) and regular practice (community effectiveness). Factors that either encourage or inhibit the adoption of study results, i.e. adequate dissemination, professional support, financial incentives or political will, have to be considered. PMID:9377699

  20. Role of the registered nurse in primary health care: meeting health care needs in the 21st century.

    PubMed

    Smolowitz, Janice; Speakman, Elizabeth; Wojnar, Danuta; Whelan, Ellen-Marie; Ulrich, Suzan; Hayes, Carolyn; Wood, Laura

    2015-01-01

    There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered. PMID:25261382

  1. Web-Based Designed Activities for Young People in Health Education: A Constructivist Approach

    ERIC Educational Resources Information Center

    Goldman, Juliette D. G.

    2006-01-01

    Modern Health Education in primary schools is increasingly using computer technologies in a variety of ways to enhance teaching and learning. Here, a Constructivist approach for a web-based educational activity for Grade 7 is discussed using an example of designing a healthy Food Handling Manual in the food industry. The Constructivist principles…

  2. Diffusion of complex health innovations--implementation of primary health care reforms in Bosnia and Herzegovina.

    PubMed

    Atun, Rifat A; Kyratsis, Ioannis; Jelic, Gordan; Rados-Malicbegovic, Drazenka; Gurol-Urganci, Ipek

    2007-01-01

    Most transition countries in Central and Eastern Europe and Central Asia are engaged in health reform initiatives aimed at introducing primary health care (PHC) centred on family medicine to enhance performance of their health systems. But, in these countries the introduction of PHC reforms has been particularly challenging; while some have managed to introduce pilots, many have failed to these scale up. Using an innovation lens, we examine the introduction and diffusion of family-medicine-centred PHC reforms in Bosnia and Herzegovina (BiH), which experienced bitter ethnic conflicts that destroyed much of the health systems infrastructure. The study was conducted in 2004-05 over a 18-month period and involved both qualitative and quantitative methods of inquiry. In this study we report the findings of the qualitative research, which involved in-depth interviews in three stages with key informants that were purposively sampled. In our research, we applied a proprietary analytical framework which enables simultaneous and holistic analysis of the context, the innovation, the adopters and the interactions between them over time. While many transition countries have struggled with the introduction of family-medicine-centred PHC reforms, in spite of considerable resource constraints and a challenging post-war context, within a few years, BiH has managed to scale up multifaceted reforms to cover over 25% of the country. Our analysis reveals a complex setting and bidirectional interaction between the innovation, adopters and the context, which have collectively influenced the diffusion process. Family-medicine-centred PHC reform is a complex innovation-involving organizational, financial, clinical and relational changes-within a complex adaptive system. An important factor influencing the adoption of this complex innovation in BiH was the perceived benefits of the innovation: benefits which accrue to the users, family physicians, nurses and policy makers. In the case of Bi

  3. Restructuring Primary Health Care Markets in New Zealand: from Welfare Benefits to Insurance Markets

    PubMed Central

    Howell, Bronwyn

    2005-01-01

    Background New Zealand's Primary Health Care Strategy (NZPHCS) was introduced in 2002. Its features are substantial increases in government funding delivered as capitation payments, and newly-created service-purchasing agencies. The objectives are to reduce health disparities and to improve health outcomes. Analysis The NZPHCS changes New Zealand's publicly-funded primary health care payments from targeted welfare benefits to universal, risk-rated insurance premium subsidies. Patient contributions change from fee-for-service top-ups to insurance premium top-ups, and are collected by service providers who, depending upon their contracts with purchasers, may also be either insurance agents or risk-bearing insurance companies. The change invokes the tensions associated with allocating risk-bearing amongst providers, patients and insurance companies that accompany all insurance-based funding instruments. These include increases in existing incentives for over-consumption and new incentives for insurers to limit their exposure to variations in patient health states by engaging in active patient pool selection. The New Zealand scheme is complex, but closely resembles United States insurance-based, risk-rated managed care schemes. The key difference is that unlike classic managed care models, where provider remuneration is determined by the insurer, the historic right for general practitioners to autonomously set patient charges alters the fiscal incentives normally available to managed care organisations. Consequently, the insurance role is being devolved to individual service providers with very small patient pools, who must recoup the premium top-ups from insured individuals. Premium top-ups are being collected only from those individuals consuming care, in proportion to the number of times care is sought. Co-payments thus constitute perfectly risk-rated premium levies set by inefficiently small insurers, raising questions about the efficiency and equity of a

  4. Primary Health Care Experiences of Hispanics with Serious Mental Illness: A Mixed-Methods Study

    PubMed Central

    Cabassa, Leopoldo J.; Gomes, Arminda P.; Meyreles, Quisqueya; Capitelli, Lucia; Younge, Richard; Dragatsi, Dianna; Alvarez, Juana; Nicasio, Andel; Druss, Benjamin; Lewis-Fernández, Roberto

    2013-01-01

    This mixed-methods study examines the primary health care experiences of Hispanic patients with serious mental illness. Forty patients were recruited from an outpatient mental health clinic. Participants reported a combination of perceived discrimination and stigmatization when receiving medical care. They rated the quality of chronic illness care as poor and reported low levels of self-efficacy and patient activation. These indicators were positively associated with how patients viewed their relationships with primary care providers. A grounded model was developed to describe the structural, social, and interpersonal processes that shaped participants’ primary care experiences. PMID:24162079

  5. Cyclone-Resistant Rural Primary School Construction - A Design Guide. Educational Building Report 7.

    ERIC Educational Resources Information Center

    Sinnamon, Ian T.; Loo, G. A. van't

    One of a series of documents on design of disaster-resistant buildings, this publication treats construction of rural primary schools to resist destruction by wind and water from cyclones. Also appropriate for other buildings, material is aimed at rural primary schools because they are less likely to be professionally designed or supervised; the…

  6. 30 CFR 285.707 - What are the CVA's primary duties for facility design review?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What are the CVA's primary duties for facility design review? 285.707 Section 285.707 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE... primary duties for facility design review? If you are required to use a CVA: (a) The CVA must use...

  7. 75 FR 52860 - Final Airworthiness Design Standards for Acceptance Under the Primary Category Rule; Orlando...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-30

    ... Register on June 21, 2010, 75 FR 34953. No comments were received, and the airworthiness design standards... Under the Primary Category Rule; Orlando Helicopter Airways (OHA), Inc., Models Cessna 172I, 172K, 172L... Proposed Airworthiness Design Standards for Acceptance Under the Primary Category Rule; Orlando...

  8. Management of diarrhoea by the primary health team.

    PubMed

    Kerrigan, P

    1996-01-01

    For all age groups, fluid replacement with oral rehydration sachets is the mainstay of treatment. Antibiotic therapy will occasionally be needed where specific pathogens have been identified. Traveller's diarrhoea may be alleviated with antibiotic therapy. Attacks of viral gastroenteritis in the under-twos are common. Consistent advice from health visitors, practice nurses, midwives and the GP helps prevent parents from receiving conflicting messages. *In a baby, colic accompanied by diarrhoea and especially by blood in the stool, needs urgent referral to a doctor--it could be intussusception. Persistent diarrhoea should always be investigated. PMID:8704415

  9. Primary health care in the context of rapid urbanization.

    PubMed

    Rossi-espagnet, A

    1983-01-01

    A review of demographic trends and health and social problems in the fast growing urban areas of the world indicates that, in the future, increasing numbers of people will be living in precarious socioeconomic conditions which impede the achievement of health. It is estimated that from 4.4 billion in 1980 the world's population will increase to 6.2 billion by the year 2000. The urban population will increase from 1.8 to 3.2 billion during the same period, over 2 billion of which will be in developing countries. The rapid and often uncontrollable demographic growth of cities, especially in the developing world, stimulates the demand for resources, intensifies their utilization and creates an intolerable pressure on the urban infrastructure and physical environment. A number of action oriented projects to combat disease and contamination have been successful. Projects in Addis Ababa, Ethiopia, Colombo, Sri Lanka, Hyderabad, India, Guayaquil, Ecuador, Lima, Peru, and Rio de Janeiro have been implemented under a partnership among WHO, UNICEF, the Netherlands Aid Agency, the World Bank, and other international organizationals and governments. These projects all emphasize the fundamental role of community organizations, especially that of women; low-cost technology and the need to mobilize and efficiently use locally available resources; an ecological multisectoral concept of health whereby action concerning the environment, education, income generation and the availability of food, all with a powerful disease preventive potential, carry equal if not greater weight than the efforts to provide the population with health centers or implement curative practices. All these projects are focused on marginal groups; many were initiated by imaginative individuals or groups with a considerable amount of social orientation and motivation, and often, at least in the beginning, without the support of governments, nongovernmental or international organizations. It is important to

  10. Infusing Mental Health Services into Primary Care for Very Young Children and Their Families

    ERIC Educational Resources Information Center

    Kaplan-Sanoff, Margot; Talmi, Ayelet; Augustyn, Marilyn

    2012-01-01

    Thinking beyond physical health to include mental health and emotional well-being offers the pediatric clinician different approaches to old challenges and a new lens through which to view infant and parent behavior. Because pediatric primary care is accessible, universally available, has no entrance criteria, and is nonstigmatizing, clinicians…

  11. Focus Points for School Health Promotion Improvements in Dutch Primary Schools

    ERIC Educational Resources Information Center

    Leurs, Mariken T. W.; Bessems, Kathelijne; Schaalma, Herman P.; de Vries, Hein

    2007-01-01

    To enable improvements in school health promotion, this paper examines associations between the number of health-promotion issues addressed by primary school teachers in the Netherlands and factors thought to influence this behavior. The main factors studied are context characteristics and constructs of attitude, social influence, self-efficacy…

  12. Modeling the Factors Associated with Children's Mental Health Difficulties in Primary School: A Multilevel Study

    ERIC Educational Resources Information Center

    Humphrey, Neil; Wigelsworth, Michael

    2012-01-01

    The current study explores some of the factors associated with children's mental health difficulties in primary school. Multilevel modeling with data from 628 children from 36 schools was used to determine how much variation in mental health difficulties exists between and within schools, and to identify characteristics at the school and…

  13. Alcohol Use in Students Seeking Primary Care Treatment at University Health Services

    ERIC Educational Resources Information Center

    Zakletskaia, Larissa; Wilson, Ellen; Fleming, Michael Francis

    2010-01-01

    Objective: Given the high rate of at-risk drinking in college students, the authors examined drinking behaviors and associated factors in students being seen in student health services for primary care visits from October 30, 2004, to February 15, 2007. Methods: Analyses were based on a Health Screening Survey completed by 10,234 college students…

  14. Rural Health Clinics and Diabetes-Related Primary Care for Medicaid Beneficiaries in Oregon

    ERIC Educational Resources Information Center

    Kirkbride, Kelly; Wallace, Neal

    2009-01-01

    Background: This study assessed whether Rural Health Clinics (RHCs) were associated with higher rates of recommended primary care services for adult beneficiaries diagnosed with diabetes in Oregon's Medicaid program, the Oregon Health Plan (OHP). Methods: OHP claims data from 2002 to 2003 were used to assess quality of diabetic care for…

  15. Education and Primary Health Care. UNESCO-UNICEF Co-operative Programme Digest No. 17.

    ERIC Educational Resources Information Center

    Jabre, Bushra

    This digest concentrates on UNICEF's program priorities and summarizes the contents of the first 17 issues of its series on education and primary health care (PHC). Chapter I offers an introduction to PHC. Chapter II describes UNICEF's child health revolution, focusing on the direct and immediate interventions of growth monitoring, oral…

  16. Understanding the Mental Health Needs of Primary School Children in an Inner-City Local Authority

    ERIC Educational Resources Information Center

    Hackett, Latha; Theodosiou, Louise; Bond, Caroline; Blackburn, Clare; Spicer, Freya; Lever, Rachel

    2010-01-01

    There is growing awareness of mental health problems among children, and schools are increasingly being encouraged to take a wider role in preventing mental health difficulties. Local population studies are needed to inform delivery of universal through to targeted services. In the current study, parents and teachers of 2% of primary school…

  17. Health Checks in Primary Care for Adults with Intellectual Disabilities: How Extensive Should They Be?

    ERIC Educational Resources Information Center

    Chauhan, U.; Kontopantelis, E.; Campbell, S.; Jarrett, H.; Lester, H.

    2010-01-01

    Background: Routine health checks have gained prominence as a way of detecting unmet need in primary care for adults with intellectual disabilities (ID) and general practitioners are being incentivised in the UK to carry out health checks for many conditions through an incentivisation scheme known as the Quality and Outcomes Framework (QOF).…

  18. The Primary Health Worker, Working Guide, Guidelines for Training, Guidellnes for Adaptation.

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

    This working guide outlines the structure and content of training for the primary health worker (PHW) on the basis of the most common health problems of communities in developing countries. Part 1 is intended for use by the PHW as a learning text and reference in his work. It covers thirty-four problems considered to be most common which are…

  19. First Contact, Simplified Technology, or Risk Anticipation? Defining Primary Health Care.

    ERIC Educational Resources Information Center

    Frenk, Julio; And Others

    1990-01-01

    The article proposes a change in medical paradigm from that of curative practice to one emphasizing primary health care (PHC). Discussed are origins and dilemmas of PHC; conflicting PHC values and practices; organizational changes and PHC; health care reform examples from Latin America; and implications for medical education. (DB)

  20. Designing health insurance exchanges: key decisions.

    PubMed

    Starc, Amanda; Kolstad, Jonathan T

    2012-02-01

    A cornerstone of health care reform is the establishment of state-level insurance exchanges where individuals and small businesses can purchase health insurance in an online marketplace. States are required to develop an exchange by 2014, or participate in a federal one. The exchanges will help people without employer-sponsored insurance find and choose a health plan to meet their needs. This Issue Brief reviews the experience of Massachusetts in developing a health insurance exchange and offers policymakers guidance on key features and likely consumer responses. PMID:22451998

  1. Master of Primary Health Care degree: who wants it and why?

    PubMed

    Andrews, Abby; Wallis, Katharine A; Goodyear-Smith, Felicity

    2016-06-01

    INTRODUCTION The Department of General Practice and Primary Health Care at the University of Auckland is considering developing a Master of Primary Health Care (MPHC) programme. Masters level study entails considerable investment of both university and student time and money. AIM To explore the views of potential students and possible employers of future graduates to discover whether there is a market for such a programme and to inform the development of the programme. METHODS Semi-structured interviews were conducted with 30 primary health care stakeholders. Interviews were digitally recorded, transcribed and analysed using a general inductive approach to identify themes. FINDINGS Primary care practitioners might embark on MPHC studies to develop health management and leadership skills, to develop and/or enhance clinical skills, to enhance teaching and research skills, or for reasons of personal interest. Barriers to MPHC study were identified as cost and a lack of funding, time constraints and clinical workload. Study participants favoured inter-professional learning and a flexible delivery format. Pre-existing courses may already satisfy the post-graduate educational needs of primary care practitioners. Masters level study may be superfluous to the needs of the primary care workforce. CONCLUSIONS Any successful MPHC programme would need to provide value for PHC practitioner students and be unique. The postgraduate educational needs of New Zealand primary care practitioners may be already catered for. The international market for a MPHC programme is yet to be explored. PMID:27477552

  2. A Reemerging Political Space for Linking Person and Community Through Primary Health Care

    PubMed Central

    Bazemore, Andrew; Phillips, Robert L.; Etz, Rebecca S.; Stange, Kurt C.

    2012-01-01

    Objectives. We sought to understand how national policy key informants perceive the value and changing role of primary care in the context of emerging political opportunities. Methods. We conducted 13 semistructured interviews in May 2011 with leaders of federal agencies, think tanks, nonprofits, and quality standard–defining organizations with influence over health care reform policies and implementation. We recorded the interviews and used an editing and immersion–crystallization analysis approach to identify themes. Results. We identified 4 themes: (1) affirmation of primary care as the foundation of a more effective health care system, (2) the patient-centered medical home as a transitional step to foster practice innovation and payment reform, (3) the urgent need for an increased focus on community and population health in primary care, and (4) the ongoing need for advocacy and research efforts to keep primary care on public and policy agendas. Conclusions. Current efforts to reform primary care are only intermediate steps toward a system with a greater focus on community and population health. Transformed and policy-enabled primary care is an essential link between personalized care and population health. PMID:22690969

  3. Integrating mental health services into primary HIV care for women: the Whole Life project.

    PubMed Central

    Dodds, Sally; Nuehring, Elane M.; Blaney, Nancy T.; Blakley, Theresa; Lizzotte, Jean-Marie; Lopez, Myriam; Potter, JoNell E.; O'Sullivan, Mary J.

    2004-01-01

    The high rate of mental health problems in HIV-infected women jeopardizes the health of this vulnerable population, and constitutes a mandate for integrating mental health services into HIV primary care. The Whole Life project-a collaboration of the departments of Psychiatry and Obstetrics/Gynecology at the University of Miami School of Medicine-successfully integrated mental health services into primary HIV care for women. This article describes the conceptual framework of the integration, implementation strategies, effects of the service integration, and lessons learned. Funded by the Health Resources and Services Administration (HRSA) as a Special Program of National Significance (SPNS), Whole Life efforts have been sustained beyond the demonstration funding period as a result of the changes brought about in organizational structures, service delivery, and the providers' conceptualization of health for HIV-infected women. PMID:15147649

  4. Home accidents in older people: role of primary health care team.

    PubMed Central

    Graham, H. J.; Firth, J.

    1992-01-01

    OBJECTIVES--To determine the incidence and nature of unreported and reported home accidents in older people and to investigate associated environmental factors. DESIGN--Postal questionnaire requesting information on home accidents in the preceding month. SETTING--Inner London general practice. SUBJECTS--All registered patients aged over 65 years (n = 1662), of whom 120 were inappropriately registered and 1293 responded. MAIN OUTCOME MEASURE--Circumstances and consequences of accidents in the home. RESULTS--108 accidents were recorded in 100 patients, giving a home accident rate of 84/1000 patients, equivalent to an annual rate of 1002/1000. 73 accidents were falls, and 83 were unreported. Of the 25 reported accidents, 19 were reported to general practice and six to accident and emergency departments (5.6% of all events). Rates of home accidents increased with age and were higher in women than men (79/819 upsilon 29/474; chi 2 = 4.5, df = 1, p less than 0.05). CONCLUSIONS--The incidence of home accidents in people aged over 65 years was high but few events were reported to medical services. General practice provided the main contact for patients who reported home accidents, and primary care workers have important opportunities for advising elderly patients on home accident prevention. Improved publicity on home safety targeted at older people and their carers would support the primary health care team in this role. PMID:1638198

  5. Active Learning by Design: An Undergraduate Introductory Public Health Course

    PubMed Central

    Yeatts, Karin B.

    2014-01-01

    Principles of active learning were used to design and implement an introductory public health course. Students were introduced to the breadth and practice of public health through team and individual-based activities. Team assignments covered topics in epidemiology, biostatistics, health behavior, nutrition, maternal and child health, environment, and health policy. Students developed an appreciation of the population perspective through an “experience” trip and related intervention project in a public health area of their choice. Students experienced several key critical component elements of a public health undergraduate major; they explored key public health domains, experience public health practice, and integrated concepts with their assignments. In this paper, course assignments, lessons learned, and student successes are described. Given the increased growth in the undergraduate public health major, these active learning assignments may be of interest to undergraduate public health programs at both liberal arts colleges and research universities. PMID:25566526

  6. Mental Health Service Use for Patients with Co-occurring Mental and Physical Chronic Health Care Needs in Primary Care Settings

    PubMed Central

    Haynes-Maslow, Lindsey; Roberts, Megan C.; Dusetzina, Stacie B.

    2016-01-01

    Background Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Objectives Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Research Design Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3,000 physicians in office-based settings. Subjects Office visits from 2007–2010 were pooled for adults ages 35–85 with a depression diagnosis at the time of visit (N=3,659 visits). Measures Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Results Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least one physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (p<0.05). There were no differences in service use by race/ethnicity after controlling for other factors. Conclusions Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves towards an integrated care model. PMID:26147863

  7. MAIN TRENDS IN ACCESS TO PRIMARY HEALTH CARE FOR ADOLESCENTS IN GEORGIA.

    PubMed

    Mirzikashvili, N; Kazakhashvili, N

    2016-03-01

    This study identifies barriers to accessing primary health care among youth in Georgia to inform strategies for improving the appropriateness, quality and usage of primary health care services. The quantitative survey was conducted throughout Georgia among 1000 adolescents 11-19 years of age via interview. Multi stage probability sampling was used to administer questionnaires in the schools, universities and in the streets between March-May 2014 and September-October 2014. Young people in Georgia identified a range of problems in accessing primary health services. By far the most important issues were preventive checkups, geographical access, cost of care, and perceptions about the quality of care. The majority of respondents (78.4%) declared that they do not visit family doctor when well, and 81.9% said that no information was provided about reproductive health issues. Most (77.3%) stated that their family doctor had never talked about health promotion or life style risk factors. Access to health care is still problematic in the villages; and in some areas young people must travel more than 30 minutes by public transport. Limited access in rural areas compared to urban areas was statistically significant (p<0.05). As our survey data shows, most adolescents do not visit a health provider annually, obviating opportunities to integrate prevention into clinical encounters. Because repeated contacts with a primary care provider may occur over several years, clinicians should ideally have multiple opportunities to screen and counsel an adolescent patient for risky health behaviors. However, young people report that there is little screening or discussion about healthy lifestyles. The biggest health challenge for young people in Georgia is overcoming barriers (socioeconomic, geographic, trust, and perceived competence) to visit a doctor for regular preventive checkups and to get health behavior advice from health professional. Addressing the health and development needs

  8. Primary Teachers' and Students' Understanding of School Situated Design in Canada and England

    NASA Astrophysics Data System (ADS)

    Hill, Ann Marie; Anning, Angela

    2001-02-01

    How do teachers in primary schools translate curriculum requirements for teaching design, within technology frameworks, in their primary classrooms? We call teachers' and students' designerly thinking and behaviours school situated design. The results discussed in this paper are part of a larger study that explored: the relationships between designerly thinking and behaviours situated in primary/elementary classrooms in Ontario (Canada) and England (UK); beliefs about how designing is learned in schools and how they compare to learning and designing in the real world and children's and teachers' understanding of design. Data were collected from teachers, children and designers through interviews, classroom observations and dialogue, photographs and design documents. This paper focuses on the school situated design evidence from the study - the teacher and student data - and refers only briefly to designer data to compare school activities to workplace design. We call professional designers' designerly thinking and behaviours workplace design. Similarities and differences between primary school situated design in Ontario (Canada) and England (UK) are discussed.

  9. Health Care Austerity Measures in Times of Crisis: The Perspectives of Primary Health Care Physicians in Madrid, Spain.

    PubMed

    Heras-Mosteiro, Julio; Sanz-Barbero, Belén; Otero-Garcia, Laura

    2016-01-01

    The current financial crisis has seen severe austerity measures imposed on the Spanish health care system, including reduced public spending, copayments, salary reductions, and reduced services for undocumented migrants. However, the impacts have not been well-documented. We present findings from a qualitative study that explores the perceptions of primary health care physicians in Madrid, Spain. This article discusses the effects of austerity measures implemented in the public health care system and their potential impacts on access and utilization of primary health care services. This is the first study, to our knowledge, exploring the health care experiences during the financial crisis of general practitioners in Madrid, Spain. The majority of participating physicians disapproved of austerity measures implemented in Spain. The findings of this study suggest that undocumented migrants should regain access to health care services; copayments should be minimized and removed for patients with low incomes; and health care professionals should receive additional help to avoid burnout. Failure to implement these measures could result in the quality of health care further deteriorating and could potentially have long-term negative consequences on population health. PMID:26825100

  10. Bone health as a primary target in the pediatric age.

    PubMed

    Caradonna, P; Rigante, D

    2009-01-01

    Bone tissue is constantly renewed during childhood and adolescence to assure skeleton growth both in size and mineral density: up to 90 percent of peak bone mass is acquired by age 18 in girls and age 20 in boys, which makes youth the best time to "invest" in bone health. The reduction in bone mineral density leading to compromised strength and microarchitecture of bone tissue can favour the occurrence of fragility fractures in the pediatric age. Assessing the normality of bone density measurements in childhood by current methods is hampered by the lack of normative control data. The understanding of factors useful for maximizing peak bone mass, as well as the knowledge of diagnostic tools and therapeutic strategies for managing a state of reduced bone mineral density are crucial to prevent fractures throughout lifetime. PMID:19499847

  11. Injector Cavities Fabrication, Vertical Test Performance and Primary Cryomodule Design

    SciTech Connect

    Wang, Haipeng; Cheng, Guangfeng; Clemens, William; Davis, G; Macha, Kurt; Overton, Roland; Spell, D.

    2015-09-01

    After the electromagnetic design and the mechanical design of a β=0.6, 2-cell elliptical SRF cavity, the cavity has been fabricated. Then both 2-cell and 7-cell cavities have been bench tuned to the target values of frequency, coupling external Q and field flatness. After buffer chemistry polishing (BCP) and high pressure rinses (HPR), Vertical 2K cavity test results have been satisfied the specifications and ready for the string assembly. We will report the cavity performance including Lorenz Force Detuning (LFD) and Higher Order Modes (HOM) damping data. Its integration with cavity tuners to the cryomodule design will be reported.

  12. Abrams Primary School passive solar design. Phase 1. Final report

    SciTech Connect

    1980-01-01

    The general project documentation and the design process documentation for the project are presented. The following are appended: analysis of thermal transfer and internal heat contributions to the heating and cooling loads for a typical four-classroom teaching module using bin-chart temperature data, trace simulation for the original building design, Teanet simulation of original building design for the month of January 1959, Teanet simulation of Solar 2 for the month of January 1959, incremental solar cost assessment, and diffuse radiation incident on the monitor glass. (MHR)

  13. High need patients receiving targeted entitlements: what responsibilities do they have in primary health care?

    PubMed

    Buetow, S

    2005-05-01

    Patient responsibilities in primary health care are controversial and, by comparison, the responsibilities of high need patients are less clear. This paper aims to suggest why high need patients receiving targeted entitlements in primary health care are free to have prima facie special responsibilities; why, given this freedom, these patients morally have special responsibilities; what these responsibilities are, and how publicly funded health systems ought to be able to respond when these remain unmet. It is suggested that the special responsibilities and their place in public policy acquire moral significance as a means to discharge a moral debt, share special knowledge, and produce desirable consequences in regard to personal and collective interests. Special responsibilities magnify ordinary patient responsibilities and require patients not to hesitate regarding attendance for primary health care. Persistent patient disregard of special responsibilities may necessitate limiting the scope of these responsibilities, removing system barriers, or respecifying special rights. PMID:15863693

  14. Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt.

    PubMed

    Gadallah, M; Zaki, B; Rady, M; Anwer, W; Sallam, I

    2003-05-01

    This study compares patient satisfaction with primary health care services and identifies factors associated with patient satisfaction in two health districts in Egypt where a project for upgrading primary health care services had been running for three years. An exit interview was conducted for 1108 patients using a structured questionnaire. The results revealed that most clients using primary health care services were females. Patient satisfaction was high for accessibility, waiting area conditions and performance of doctors and nurses. The main complaints centred on the availability of prescribed drugs and laboratory investigations. Additionally, level of privacy in the consultation room was described as unsatisfactory by 33% of patients. There was no association between overall patient satisfaction and age, gender, education level or type of service received. PMID:15751936

  15. Integrating primary care and public health: learning from the Brazilian way

    PubMed Central

    2012-01-01

    After a long history of vertical programming, specialisation and disintegration, general practitioners are now being urged to take on wider commissioning and public health responsibilities. The support structures are not in place, and integration of primary care with good public health practice is new territory. Innovation can be found in unlikely places. The Brazilian government has a 20-year history of a nationwide, integrated, comprehensive, community health programme that seamlessly bridges two important interfaces – between the community and primary care, and between primary care and public health. Some elements of this approach could be translated into the UK and would likely bring about improved clinical care, cost savings, improved understanding of local epidemiological variations and therefore commissioning. Understanding this approach is the first step to a new way of integrated commissioning, spanning and not reinforcing traditional clinical domains. PMID:26265950

  16. Integrating primary care and public health: learning from the Brazilian way.

    PubMed

    Harris, Matthew

    2012-01-01

    After a long history of vertical programming, specialisation and disintegration, general practitioners are now being urged to take on wider commissioning and public health responsibilities. The support structures are not in place, and integration of primary care with good public health practice is new territory. Innovation can be found in unlikely places. The Brazilian government has a 20-year history of a nationwide, integrated, comprehensive, community health programme that seamlessly bridges two important interfaces - between the community and primary care, and between primary care and public health. Some elements of this approach could be translated into the UK and would likely bring about improved clinical care, cost savings, improved understanding of local epidemiological variations and therefore commissioning. Understanding this approach is the first step to a new way of integrated commissioning, spanning and not reinforcing traditional clinical domains. PMID:26265950

  17. Women's Satisfaction with Their On-Going Primary Health Care Services: A Consideration of Visit-Specific and Period Assessments

    PubMed Central

    Anderson, Roger T; Weisman, Carol S; Camacho, Fabian; Scholle, Sarah Hudson; Henderson, Jillian T; Farmer, Deborah F

    2007-01-01

    Objective To compare and contrast patient ratings of satisfaction with primary care on the day of visit versus over the last 12 months. Data Sources/Study Setting Survey data were collected from female participants at primary care centers affiliated with the University of Michigan, University of Pittsburgh, and Wake Forest University. Study Design One thousand and twenty-one patients attending a primary care visit with at least one prior visit to the study site were consented on site, enrolled in the study, and surveyed at two time points: pre- and immediately postvisit. Data Collection The previsit survey included demographics, self-rated health, visit history (site continuity), and expectations for health care; the postvisit survey focused on patient experiences during the visit, assessment of health care quality using the Primary Care Satisfaction Survey for Women instrument, and global satisfaction with visit and health care over the past 12 months. Expectation discrepancy scores were constructed from the linked expectation–experience ratings. Path analysis and indices of model fit were used to investigate the strength of theoretical links among the variables in an analytic model considering both day-of-visit and past-year ratings with global measures of patient satisfaction as the dependent variables. Principal Findings General health, site continuity and fulfillment of patient expectations for care were linked to global ratings of satisfaction through effects on communication, care coordination, and office staff and administration. Importantly, past-year ratings were mediated largely by care coordination and continuity; day-of-visit ratings were mediated by communication. Conclusion Ratings of health care quality for a specific visit appear to be conceptually distinct from ratings of care over the past 12 months, and thus are not interchangeable. PMID:17362212

  18. Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

    PubMed Central

    2011-01-01

    Background After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services? Methods A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics. Results Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector. Conclusions There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC

  19. A typology of electronic health record workarounds in small-to-medium size primary care practices

    PubMed Central

    Friedman, Asia; Crosson, Jesse C; Howard, Jenna; Clark, Elizabeth C; Pellerano, Maria; Karsh, Ben-Tzion; Crabtree, Benjamin; Jaén, Carlos Roberto; Cohen, Deborah J

    2014-01-01

    Objective Electronic health record (EHR) use in ambulatory care can improve safety and quality; however, problems with design, implementation, and poor interface with other systems lead users to develop ‘workarounds’, or behaviors users adopt to overcome perceived limitations in a technical system. We documented workarounds used in independent, community-based primary care practices, and developed a typology of their key features. Materials and methods Comparative case study of EHR use in seven independent primary care practices. Field researchers spent approximately 1 month in each practice to observe EHR use, conduct patient pathways, and interview clinicians and staff. Results We observed workarounds addressing a wide range of EHR-related problems, including: user interface issues (eg, insufficient data fields, limited templates), barriers to electronic health information exchange with external organizations, and struggles incorporating new technologies into existing office space. We analyzed the observed workarounds inductively to develop a typology that cuts across specific clinical or administrative processes to highlight the following key formal features of workarounds in general: temporary/routinized, which captures whether the workaround is taken for granted as part of daily workflow or is understood as a short-term solution; avoidable/unavoidable, referring to the extent to which the workaround is within the practice's power to eliminate; and deliberately chosen/unplanned, which differentiates strategically chosen adaptations from less thoughtful workarounds. Conclusions This workaround typology provides a framework for EHR users to identify and address workarounds in their own practices, and for researchers to examine the effect of different types of EHR workarounds on patient safety, care quality, and efficiency. PMID:23904322

  20. The Rise of Primary Care Physicians in the Provision of US Mental Health Care.

    PubMed

    Olfson, Mark

    2016-08-01

    Primary care physicians have assumed an increasingly important role in US outpatient mental health care. They are providing an increasing volume of outpatient mental health services, prescribing a growing number and variety of psychotropic medications, and treating patients with a broader array of mental health conditions. These trends, which run counter to a general trend toward specialization and subspecialization within US health care, place new strains on the clinical competencies of primary care physicians. They also underscore the importance of implementing more effective models of collaboration between primary care physicians and mental health specialists. Several elements of the Affordable Care Act provide options for financing and organizing the delivery of integrated general medical and behavioral services. Such integrated services have the potential to improve access and quality of outpatient mental health care for a range of psychiatric disorders. Because people with severe and persisting mental disorders commonly require a higher-level medical expertise than is readily available within primary care as well as a complex array of social services, separate specialized mental health will likely continue to play a vitally important role in caring for this population. PMID:27127264

  1. Integration of basic dermatological care into primary health care services in Mali.

    PubMed Central

    Mahé, Antoine; Faye, Ousmane; N'Diaye, Hawa Thiam; Konaré, Habibatou Diawara; Coulibaly, Ibrahima; Kéita, Somita; Traoré, Abdel Kader; Hay, Roderick J.

    2005-01-01

    OBJECTIVE: To evaluate, in a developing country, the effect of a short training programme for general health care workers on the management of common skin diseases--a neglected component of primary health care in such regions. METHODS: We provided a one-day training programme on the management of the skin diseases to 400 health care workers who worked in primary health care centres in the Bamako area. We evaluated their knowledge and practice before and after training. FINDINGS: Before training, knowledge about skin diseases often was poor and practice inadequate. We found a marked improvement in both parameters after training. We analysed the registers of primary health care centres and found that the proportion of patients who presented with skin diseases who benefited from a clear diagnosis and appropriate treatment increased from 42% before the training to 81% after; this was associated with a 25% reduction in prescription costs. Improved levels of knowledge and practice persisted for up to 18 months after training. CONCLUSIONS: The training programme markedly improved the basic dermatological abilities of the health care workers targeted. Specific training may be a reasonable solution to a neglected component of primary health care in many developing countries. PMID:16462986

  2. Where Are We on the Diffusion Curve? Trends and Drivers of Primary Care Physicians’ Use of Health Information Technology

    PubMed Central

    Audet, Anne-Marie; Squires, David; Doty, Michelle M

    2014-01-01

    Objective To describe trends in primary care physicians’ use of health information technology (HIT) between 2009 and 2012, examine practice characteristics associated with greater HIT capacity in 2012, and explore factors such as delivery system and payment reforms that may affect adoption and functionality. Data We used data from the 2012 and 2009 Commonwealth Fund International Health Policy Surveys of Primary Care Physicians. The data were collected in both years by postal mail between March and July among a nationally representative sample of primary care physicians in the United States. Study Design We compared primary care physicians’ HIT capacity in 2009 and 2012. We employed multivariable logistic regression to analyze whether participating in an integrated delivery system, sharing resources and support with other practices, and being eligible for financial incentives were associated with greater HIT capacity in 2012. Principal Findings Primary care physicians’ HIT capacity has significantly expanded since 2009, although solo practices continue to lag. Practices that are part of an integrated delivery system or share resources with other practices have higher rates of electronic medical record (EMR) adoption, multifunctional HIT, electronic information exchange, and electronic access for patients. Receiving or being eligible for financial incentives is associated with greater adoption of EMRs and information exchange. Conclusions Federal efforts to increase adoption have coincided with a rapid increase in HIT capacity. Delivery system and payment reforms and federally funded extension programs could offer promising pathways for further diffusion. PMID:24358958

  3. Using Usability Evaluation to Inform Alberta's Personal Health Record Design.

    PubMed

    Price, Morgan; Bellwood, Paule; Davies, Iryna

    2015-01-01

    Alberta Health is deploying the Personal Health Portal (PHP) (MyHealth.Alberta.ca) to all people in the province of Alberta, Canada. The PHP will include several components such as a Personal Health Record (PHR) where users can enter and access their own health data. For the first PHR of its kind in Canada, Alberta Health asked the University of Victoria's eHealth Observatory to evaluate the PHP, including the PHR. The evaluation includes pre-design, design, and adoption evaluation. This paper focuses on early usability evaluations of the PHR software. Persona-based usability inspection was combined with usability testing sessions using think aloud. These evaluations found that while people were familiar with the web-based technology, several aspects of the PHR information architecture, content, and presentation could be improved to better support and provide value to the users. The findings could be helpful to others designing and implementing similar PHR software. PMID:25676994

  4. Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

    PubMed Central

    Whitehead, J.; Shaver, John; Stephenson, Rob

    2016-01-01

    Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405

  5. Making twin concerns of family planning and primary health care.

    PubMed

    Wang, Y

    1985-10-01

    The implementation of the Integrated FP/MCH/Parasite Control project by JOICFP in 1984 was envisioned to strengthen international cooperation, promote international exchange of knowledge and expand approaches in the practice of family planning. 2 municipalities in China were selected as pilot project areas. The objectives set in the 3-year plan of the integrated project are: to publicize the advantages of family planning and improve people's knowledge and practice of family planning; to stengthen technical guidance on family planning and control the growth and improve the quality of the population; to improve maternal and child care; and to reduce the infection rate of soil-transmitted helminthiasis. Steering committees on the integrated project at the municipal, county, township and village levels were set up in the pilot areas; the significance of the project has been communicated through film and slide presentations. Training courses for the administrative workers and technicians have been held. As a result of the family planning education activities, the contraceptive rates in the 2 pilot areas remained stable at 85%. Neonatal mortality was reduced significantly. Parasite control has benefitted 52,546 people in the pilot areas. An improvement was noted in environmental hygiene, the proper disposal of waste and the provision of safe drinking water. Further improvement can be achieved by intensifying public health education in the project areas, improving working systems and accomplishing all the tasks that the integrated project has set forth. PMID:12313888

  6. Not Near Enough: Racial and Ethnic Disparities in Access to Nearby Behavioral Health Care and Primary Care

    PubMed Central

    VanderWielen, Lynn M.; Gilchrist, Emma C.; Nowels, Molly A.; Petterson, Stephen M.; Rust, George; Miller, Benjamin F.

    2016-01-01

    Background Racial, ethnic, and geographical health disparities have been widely documented in the United States. However, little attention has been directed towards disparities associated with integrated behavioral health and primary care services. Methods Access to behavioral health professionals among primary care physicians was examined using multinomial logistic regression analyses with 2010 National Plan and Provider Enumeration System, American Medical Association Physician Masterfile, and American Community Survey data. Results Primary care providers practicing in neighborhoods with higher percentages of African Americans and Hispanics were less likely to have geographically proximate behavioral health professionals. Primary care providers in rural areas were less likely to have geographically proximate behavioral health professionals. Conclusion Neighborhood-level factors are associated with access to nearby behavioral health and primary care. Additional behavioral health professionals are needed in racial/ ethnic minority neighborhoods and rural areas to provide access to behavioral health services, and to progress toward more integrated primary care. PMID:26320931

  7. Access of primary and secondary literature by health personnel in an academic health center: implications for open access*

    PubMed Central

    Steinberg, Ryan M.; Moorhead, Laura; O'Brien, Bridget; Willinsky, John

    2013-01-01

    Purpose: The research sought to ascertain the types and quantity of research evidence accessed by health personnel through PubMed and UpToDate in a university medical center over the course of a year in order to better estimate the impact that increasing levels of open access to biomedical research can be expected to have on clinical practice in the years ahead. Methods: Web log data were gathered from the 5,042 health personnel working in the Stanford University Hospitals (SUH) during 2011. Data were analyzed for access to the primary literature (abstracts and full-text) through PubMed and UpToDate and to the secondary literature, represented by UpToDate (research summaries), to establish the frequency and nature of literature consulted. Results: In 2011, SUH health personnel accessed 81,851 primary literature articles and visited UpToDate 110,336 times. Almost a third of the articles (24,529) accessed were reviews. Twenty percent (16,187) of the articles viewed were published in 2011. Conclusion: When it is available, health personnel in a clinical care setting frequently access the primary literature. While further studies are needed, this preliminary finding speaks to the value of the National Institutes of Health public access policy and the need for medical librarians and educators to prepare health personnel for increasing public access to medical research. PMID:23930091

  8. Local politicization of Primary Health Care as an instrument for development: a case study of community health workers in Zambia.

    PubMed

    Twumasi, P A; Freund, P J

    1985-01-01

    The integrated approach of the Primary Health Care Concept has obvious implications for development. In view of Zambia's commitment to Primary Health Care it is important to evaluate the effectiveness of present institutional frameworks and the problems that may arise in shifting towards community responsibility for the provision of health. It is often assumed that the Primary Health Care approach of working through the community should be free of serious implementation problems. However, experience from community participation projects in a wide variety fields carried out in many countries, including Zambia has shown that failure to account for local institutional arrangements and political interests has hindered success. This article presents the theoretical issues involved in community participation research, reviews relevant literature and presents a case study of a community health worker in Western Province, Zambia. The case study derives from an on-going UNICEF/Government of Zambia sponsored project which is monitoring and evaluating the impact of child health and nutrition services in rural areas. The study illustrates some of the problems encountered by a CHW because of clashes with local political interests. An alternative model is proposed which if implemented can help alleviate and/or avoid these types of conflicts. PMID:4012349

  9. Participatory design of computer-supported organizational learning in health care: methods and experiences.

    PubMed Central

    Timpka, T.; Sjöberg, C.; Hallberg, N.; Eriksson, H.; Lindblom, P.; Hedblom, P.; Svensson, B.; Marmolin, H.

    1995-01-01

    This paper outlines a Computer-Supported Co-operative Work (CSCW) system for primary care and presents from its participatory design process time consumption, costs, and experiences. The system integrates a hypermedia environment, a computerized patient record, and an electronicmessage system. It is developed to coordinate organizational learning in primary care from micro to macro levels by connecting strategic planning to monitoring of patient routines. Summing up design experiences, critical issues for making CSCW systems support cost-effectiveness of health care are discussed. PMID:8563401

  10. Primary and specialist diabetes care three years after introduction of health care system reform in Poland.

    PubMed

    Mardarowicz, Grazyna; Łopatyński, Jerzy

    2002-01-01

    The authors discuss epidemics of diabetes in the world and in Poland. In the Lublin region (eastern Poland), for instance, they found type 2 diabetes (DM 2) in 15.6% of the examined aged over 35 (according to the WHO criteria of 1985). The health care system reform in Poland has made more difficult the access of the diabetic to a specialist that treats this disease. Therefore doctors and nurses of primary health care have become more responsible for diabcare than before. The authors believe that the systematic education of primary health care doctors by specialists so that they can treat patients according to the modern standards of practical diabetology as well as sharing of tasks and responsibilities between primary and specialist diabetologic care, are very important. Primary health care would be in charge of prevention and early diagnosis of DM 2 as well as prevention and early diagnosis of concomitant complications of the disease. Specialists would have consultation on the patients at the moment of diagnosis and then at least once a year. They would also take care of search for and diagnosis of remote diabetes complications. Primary health care doctors would still treat most of diabetics with DM 2; specialist centres doctors would treat most of diabetics with DM type 1, patients with complications and from special risk groups (e.g. women with gestational diabetes). PMID:12898974

  11. Type of health insurance and the quality of primary care experience.

    PubMed Central

    Shi, L

    2000-01-01

    OBJECTIVES: This study examined the association between type of health insurance coverage and quality of primary care as measured by its distinguishing attributes--first contact, longitudinality, comprehensiveness, and coordination. METHODS: The household component of the 1996 Medical Expenditure Panel Survey was used for this study. The analysis primarily focused on subjects aged younger than 65 years who identified a usual source of care. Logistic regressions were used to examine the independent effects of insurance status on primary care attributes while individual sociodemographic characteristics were controlled for. RESULTS: The experience of primary care varies according to insurance status. The insured are able to obtain better primary care than the uninsured, and the privately insured are able to obtain better primary care than the publicly insured. Those insured through fee-for-service coverage experience better longitudinal care and less of a barrier to access than those insured through health maintenance organizations (HMOs). CONCLUSIONS: While expanding insurance coverage is important for establishing access to care, efforts are needed to enhance the quality of primary health care, particularly for the publicly insured. Policymakers should closely monitor the quality of primary care provided by HMOs. PMID:11111255

  12. [Legislation on primary care in Brazilian Unified National Health System: document analysis].

    PubMed

    Domingos, Carolina Milena; Nunes, Elisabete de Fátima Polo de Almeida; Carvalho, Brígida Gimenez; Mendonça, Fernanda de Freitas

    2016-03-01

    A reflection on Brazil's legislation for primary care helps understand the way health policy is implemented in the country. This study focuses on the legal provisions aimed at strengthening primary care, drawing on an analysis of documents from the Ministry of Health's priority actions, programs, and strategies. A total of 224 provisions were identified, in two groups of documents, so-called instituting provisions and complementary provisions. The former include the principles and guidelines of the Brazilian Unified National Health System (SUS) and also involve the expansion of actions. Financing was a quantitatively central theme, especially in the complementary provisions. The analysis led to reflection on the extent to which these strategies can induce linkage between health system managers and civil society in building a political project resulting in improvements and meeting the population's health needs. PMID:27027459

  13. Healthy Gaming – Video Game Design to promote Health

    PubMed Central

    Brox, E.; Fernandez-Luque, L.; Tøllefsen, T.

    2011-01-01

    Background There is an increasing interest in health games including simulation tools, games for specific conditions, persuasive games to promote a healthy life style or exergames where physical exercise is used to control the game. Objective The objective of the article is to review current literature about available health games and the impact related to game design principles as well as some educational theory aspects. Methods Literature from the big databases and known sites with games for health has been searched to find articles about games for health purposes. The focus has been on educational games, persuasive games and exergames as well as articles describing game design principles. Results The medical objectives can either be a part of the game theme (intrinsic) or be totally dispatched (extrinsic), and particularly persuasive games seem to use extrinsic game design. Peer support is important, but there is only limited research on multiplayer health games. Evaluation of health games can be both medical and technical, and the focus will depend on the game purpose. Conclusion There is still not enough evidence to conclude which design principles work for what purposes since most of the literature in health serious games does not specify design methodologies, but it seems that extrinsic methods work in persuasion. However, when designing health care games it is important to define both the target group and main objective, and then design a game accordingly using sound game design principles, but also utilizing design elements to enhance learning and persuasion. A collaboration with health professionals from an early design stage is necessary both to ensure that the content is valid and to have the game validated from a clinical viewpoint. Patients need to be involved, especially to improve usability. More research should be done on social aspects in health games, both related to learning and persuasion. PMID:23616865

  14. Aren't technological choices central to designing health systems?

    PubMed

    Priya, Ritu

    2013-01-01

    This paper argues that delivery of technology-based preventive, promotive and curative care is one of the central tasks of any health-care system and therefore it forms one of the central pivots for rational structuring/re-structuring of a health-care system. The development of our public health system has, historically, adopted health technologies (HT) uncritically and thereby not explicitly developed institutional mechanisms to assess them for rational choice. Determinants of HT policy choices and structuring of a service delivery system based on that are discussed with examples of modern low cost HT, technologies of codified health knowledge systems other than the modern and local health traditions. Various forms of institutional structures for HT assessment and R and D using a comprehensive primary health-care approach are suggested. PMID:24351381

  15. The Impact of Electronic Health Records on Workflow and Financial Measures in Primary Care Practices

    PubMed Central

    Fleming, Neil S; Becker, Edmund R; Culler, Steven D; Cheng, Dunlei; McCorkle, Russell; da Graca, Briget; Ballard, David J

    2014-01-01

    Objective To estimate a commercially available ambulatory electronic health record’s (EHR’s) impact on workflow and financial measures. Data Sources/Study Setting Administrative, payroll, and billing data were collected for 26 primary care practices in a fee-for-service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008. Study Design An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for 2004–2009. Changes were evaluated 1–6, 7–12, and >12 months postimplementation. Data Collection/Extraction Methods Data were accessed through a SQLserver database, transformed into SAS®, and aggregated by practice. Practice-level data were divided by full-time physician equivalents for comparisons across practices by month. Principal Findings Staffing and practice expenses increased following EHR implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received. Conclusions Expenses increased and productivity decreased following EHR implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined. PMID:24359533

  16. Determinants of primary care nurses' intention to adopt an electronic health record in their clinical practice.

    PubMed

    Leblanc, Genevieve; Gagnon, Marie-Pierre; Sanderson, Duncan

    2012-09-01

    A provincial electronic health record is being developed in the Province of Quebec (and in all other provinces in Canada), and authorities hope that it will enable a safer and more efficient healthcare system for citizens. However, the expected benefits can occur only if healthcare professionals, including nurses, adopt this technology. Although attention to the use of the electronic health record by nurses is growing, better understanding of nurses' intention to use an electronic health record is needed and could help managers to better plan its implementation. This study examined the factors that influence primary care nurses' intention to adopt the provincial electronic health record, since intention influences electronic health record use and implementation success. Using a modified version of Ajzen's Theory of Planned Theory of Planned Behavior, a questionnaire was developed and pretested. Questionnaires were distributed to 199 primary care nurses. Multiple hierarchical regression indicated that the Theory of Planned Behavior variables explained 58% of the variance in nurses' intention to adopt an electronic health record. The strong intention to adopt the electronic health record is mainly determined by perceived behavioral control, normative beliefs, and attitudes. The implications of the study are that healthcare managers could facilitate adoption of an electronic health record by strengthening nurses' intention to adopt the electronic health record, which in turn can be influenced through interventions oriented toward the belief that using an electronic health record will improve the quality of patient care. PMID:22592453

  17. Impacts of Natural Hazards on Primary Health Care Facilities of Iran: A 10-Year Retrospective Survey

    PubMed Central

    Ardalan, Ali; Mowafi, Hani; Yousefi, Homa

    2013-01-01

    Public health facilities in Iran are exposed to a wide range of natural hazards. This article presents the first survey of the impacts of such natural hazards on primary health care (PHC) centers in Iran from 2001 to 2011. A retrospective survey was conducted in 25 out of 30 provinces of Iran. Archival reports at provincial public health departments were cross-referenced with key informant interviews. During a 10-year period, 119 natural hazard events were recorded that led to physical damage and/or functional failure in 1,401 health centers, 127 deaths and injury or illness in 644 health staff. Earthquakes accounted for the most physical damage and all health-worker deaths. However, there was an increasing trend of impacts due to hydro-meteorological hazards. Iran’s health system needs to establish a registry to track the impact of natural hazards on health facilities, conduct regular hazard and vulnerability assessments and increase mitigation and preparedness measures. Keywords: Disaster, primary health care, facility, Iran, natural hazard Corresponding author: Ali Ardalan MD, PhD. Iran’s National Institute of Health Research, Tehran University of Medical Sciences. Harvard Humanitarian Initiative. Email: aardalan@tums.ac.ir PMID:23863871

  18. Reducing the health care burden for marginalised migrants: The potential role for primary care in Europe.

    PubMed

    O'Donnell, Catherine Agnes; Burns, Nicola; Mair, Frances Susanne; Dowrick, Christopher; Clissmann, Ciaran; van den Muijsenbergh, Maria; van Weel-Baumgarten, Evelyn; Lionis, Christos; Papadakaki, Maria; Saridaki, Aristoula; de Brun, Tomas; MacFarlane, Anne

    2016-05-01

    There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed. PMID:27080344

  19. Design and analysis of large spaceborne light-weighted primary mirror and its support system

    NASA Astrophysics Data System (ADS)

    Yan, Yong; Jin, Guang; Yang, Hong-bo

    2007-12-01

    With the development of the resolution of spaceborne remote sensor, the diameter of the primary mirror of spaceborne telescope becomes larger and larger. The distortion of primary mirror which is influenced by the mirror material, structure, self-weight, support system and temperature environment affects optical image quality finally. In this paper, an on-axis TMA high-resolution Cassegrain optical payload with a primary mirror whose diameter is φ 650mm was designed and the effects of the influence factors of the distortion acts on the on-axis TMA optical system primary mirror had been analyzed by means of Finite Element Analysis. During work, the technology of the primary mirror design had been summarized and general consideration of the primary mirror design technology also had been described at the same time. Considering the telescope manufacture and work station, a reasonable and optimal structure of the primary mirror sub-assembly is taken finally. In the end, the distortion of the primary mirror during its fabrication station and work station had been analyzed by integrated Finite Element Analysis Method. The results implicated the synthesis profile error (P-V value) for the primary mirror is less than λ/10 and all the indexes of the primary mirror satisfy the requirements of the optical system.

  20. Designing eHealth that Matters via a Multidisciplinary Requirements Development Approach

    PubMed Central

    Wentzel, Jobke; Van Gemert-Pijnen, Julia EWC

    2013-01-01

    Background Requirements development is a crucial part of eHealth design. It entails all the activities devoted to requirements identification, the communication of requirements to other developers, and their evaluation. Currently, a requirements development approach geared towards the specifics of the eHealth domain is lacking. This is likely to result in a mismatch between the developed technology and end user characteristics, physical surroundings, and the organizational context of use. It also makes it hard to judge the quality of eHealth design, since it makes it difficult to gear evaluations of eHealth to the main goals it is supposed to serve. Objective In order to facilitate the creation of eHealth that matters, we present a practical, multidisciplinary requirements development approach which is embedded in a holistic design approach for eHealth (the Center for eHealth Research roadmap) that incorporates both human-centered design and business modeling. Methods Our requirements development approach consists of five phases. In the first, preparatory, phase the project team is composed and the overall goal(s) of the eHealth intervention are decided upon. Second, primary end users and other stakeholders are identified by means of audience segmentation techniques and our stakeholder identification method. Third, the designated context of use is mapped and end users are profiled by means of requirements elicitation methods (eg, interviews, focus groups, or observations). Fourth, stakeholder values and eHealth intervention requirements are distilled from data transcripts, which leads to phase five, in which requirements are communicated to other developers using a requirements notation template we developed specifically for the context of eHealth technologies. Results The end result of our requirements development approach for eHealth interventions is a design document which includes functional and non-functional requirements, a list of stakeholder values, and end

  1. [Human ecology and interdisciplinary cooperation for primary prevention of environmental risk factors for public health].

    PubMed

    Dobrowolski, Jan W

    2007-01-01

    Human ecology makes a scientific base for more effective prevention against contamination of the air, water and food, and other environmental factors making common risk factors for human health. It integrates interdisciplinary cooperation of experts from natural, technological, socio-economical and other sciences. Complex study is necessary for better estimation of real risk factors for an individual person. This risk is connected with the exposure of people to pollutants in working places, housing environment, areas for recreation and by food (including synergistic effects). Such study implicates real tasks for representatives of different sciences (technological and agricultural in particular) as well as for teachers and journalists. Especially dangerous are environmental risk factors when principles of human ecology are not taking into consideration at the intensification of food production, processing and conservation, as well as at designing of housing environment (where the exposure to harmful physical, chemical and biological factors is the longest) and also while selecting of the main directions of development of technical infrastructure for motorization (e.g. designing of cars, roads and their surrounding). EU recognize study of the human ecology as basis for sustainable development (sponsoring e.g. diploma and doctoral studies in this field at the Free University of Brussels). Author's experiences connected with the participation as a visiting professor taking part in related training activity at this University as well as during study visits in several countries were useful for the introduction of human ecology in linkage with ecotoxicology and environmental biotechnology as the subject of study at environmental engineering at the Faculty of Mining Surveying and Environmental Engineering at AGH-UST. Methodological experience of 40 years of interdisciplinary case studies and problem-oriented education in this field may be useful for modernization of

  2. The Role of Community Health Workers in the Re-Engineering of Primary Health Care in Rural Eastern Cape

    PubMed Central

    le Roux, Karl; le Roux, Ingrid; Mbewu, Nokwanele; Davis, Emily

    2014-01-01

    Background Primary Health Care in South Africa is being re-engineered to create a model of integrated care across different levels of the health care system. From hospitals to clinics, in the community and in the home, health care will focus more on prevention, health-promotion and advocacy for healthy lifestyles and wellbeing, in addition to clinical services. We provide a best practise model of integrating community health workers (CHWs) trained as generalists into a multi-level health system in the Oliver Tambo district of the rural Eastern Cape. Methods Based at Zithulele Hospital, a health care network between the hospital, 13 clinics, and 50 CHWs has been created. The functions of each tier of care are different and complementary. This article describes the recruitment, training, supervision, monitoring, and outcomes when CHWs who deliver maternal, child health, nutrition and general care through home visits. Results CHWs, especially in rural settings, can find and refer new TB/HIV cases, ill children and at-risk pregnant women; rehabilitate malnourished children at home; support TB and HIV treatment adherence; treat diarrhoea, worm infestation and skin problems; and, distribute Vitamin A. CHWs provide follow-up after clinic and hospital care, support families to apply health information, problem-solve the health and social challenges of daily living, and assist in accessing social grants. Case examples of how this model functions are provided. Conclusion This generalist CHW home intervention is a potential model for the re-engineering of the primary health care system in South Africa. PMID:26279948

  3. Planning for primary health care: the case of the Sierra Leone National Action Plan.

    PubMed

    Decosas, J

    1990-01-01

    The National Action Plan for Primary Health Care, a planning document of the Sierra Leonean Ministry of Health for the restructuring of the country's rural health services, is analyzed in its social, economic, and historical context. It appears to be an attempt of the national government to gain control over the highly devolved health care delivery system, but the state has neither the political will nor the power to achieve this goal. The utility of the document is therefore in doubt, which raises two important questions: Whose interests does this plan serve, and at whose cost? PMID:2307554

  4. Health Literacy and Weight Change in a Digital Health Intervention for Women: A Randomized Controlled Trial in Primary Care Practice.

    PubMed

    Lanpher, Michele G; Askew, Sandy; Bennett, Gary G

    2016-01-01

    In the United States, 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12-month digital health treatment aimed at preventing weight gain among overweight and Class I obese Black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. More than half (55%) of participants had low health literacy, which was more common among those with fewer years of education and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal-focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy. PMID:27043756

  5. Towards a Healthy District: Organizing and Managing District Health Systems Based on Primary Health Care.

    ERIC Educational Resources Information Center

    Tarimo, E.

    This book is concerned with orienting health care workers in district health systems in developing countries to ways and means of overcoming problems, and describes briefly how district health systems can be improved. The book is organized around nine issues in nine chapters, each of which is an integral part of a district planning cycle. The…

  6. National Institutes of Health eliminates funding for national architecture linking primary care research.

    PubMed

    Peterson, Kevin A

    2007-01-01

    With the ending of the National Electronic Clinical Trial and Research Network (NECTAR) pilot programs and the abridgement of Clinical Research Associate initiative, the National Institutes of Health Roadmap presents a strategic shift for practice-based research networks from direct funding of a harmonized national infrastructure of cooperating research networks to a model of local engagement of primary care clinics performing practice-based research under the aegis of regional academic health centers through Clinical and Translational Science Awards. Although this may present important opportunities for partnering between community practices and large health centers, for primary care researchers, the promise of a transformational change that brings a unified national primary care community into the clinical research enterprise seems likely to remain unfulfilled. PMID:17341760

  7. Hypertensive patients in primary health care: access, connection and care involved in spontaneous demands.

    PubMed

    Girão, Ana Lívia Araújo; Freitas, Consuelo Helena Aires de

    2016-06-01

    Objective To assess the impacts of inclusion of care for spontaneous demands in the treatment of hypertensive patients in primary health care. Methods Third generation qualitative assessment survey conducted with 16 workers in a Primary Care Health Unit (PHCU) of the city of Fortaleza, state of Ceara, in the period between July and September of 2015. To collect data, systematic field observation and semi-structured interviews were used, and the stages of thematic content analysis were adopted for data analysis. Results Participants revealed that access, connection and care are fundamental to the treatment of hypertension. However, they said that the introduction of free access for spontaneous demands compromised the flow of care in the hypertension programs. Conclusion A dichotomy between the practice of care recommended by health policies and the one existing in the reality of PHCUs was shown, causing evident losses to the care of hypertensive patients in primary care. PMID:27253602

  8. Policy statement--The future of pediatrics: mental health competencies for pediatric primary care.

    PubMed

    2009-07-01

    Pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems in the medical home. In this report, the American Academy of Pediatrics proposes competencies requisite for providing mental health and substance abuse services in pediatric primary care settings and recommends steps toward achieving them. Achievement of the competencies proposed in this statement is a goal, not a current expectation. It will require innovations in residency training and continuing medical education, as well as a commitment by the individual clinician to pursue, over time, educational strategies suited to his or her learning style and skill level. System enhancements, such as collaborative relationships with mental health specialists and changes in the financing of mental health care, must precede enhancements in clinical practice. For this reason, the proposed competencies begin with knowledge and skills for systems-based practice. The proposed competencies overlap those of mental health specialists in some areas; for example, they include the knowledge and skills to care for children with attention-deficit/hyperactivity disorder, anxiety, depression, and substance abuse and to recognize psychiatric and social emergencies. In other areas, the competencies reflect the uniqueness of the primary care clinician's role: building resilience in all children; promoting healthy lifestyles; preventing or mitigating mental health and substance abuse problems; identifying risk factors and emerging mental health problems in children and their families; and partnering with families, schools, agencies, and mental health specialists to plan assessment and care. Proposed interpersonal and communication skills reflect the primary care clinician's critical role in overcoming barriers (perceived and/or experienced by children and families) to seeking help for mental health and substance abuse concerns

  9. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

    PubMed Central

    2011-01-01

    Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men) and 10 district nurses (7 women, 3 men) from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and profession differences in this

  10. Towards Primary School Physics Teaching and Learning: Design Research Approach. Research Report 256

    ERIC Educational Resources Information Center

    Juuti, Kalle

    2005-01-01

    This thesis describes a project to design a primary school physics learning environment which takes into account teachers' needs, design procedures, properties of the learning environment, and pupil learning outcomes. The project's design team has wide experience in research and development work in relation to science education, the use of ICT in…

  11. The Effect of Iteration on the Design Performance of Primary School Children

    ERIC Educational Resources Information Center

    Looijenga, Annemarie; Klapwijk, Remke; de Vries, Marc J.

    2015-01-01

    Iteration during the design process is an essential element. Engineers optimize their design by iteration. Research on iteration in Primary Design Education is however scarce; possibly teachers believe they do not have enough time for iteration in daily classroom practices. Spontaneous playing behavior of children indicates that iteration fits in…

  12. Re-Designing Community Mental Health Services for Urban Children: Supporting Schooling to Promote Mental Health

    PubMed Central

    Atkins, Marc S.; Shernoff, Elisa S.; Frazier, Stacy L.; Schoenwald, Sonja K.; Cappella, Elise; Marinez-Lora, Ane; Mehta, Tara G.; Lakind, Davielle; Cua, Grace; Bhaumik, Runa; Bhaumik, Dulal

    2015-01-01

    Objective This study examined a school- and home-based mental health service model, Links to Learning (L2L), focused on empirical predictors of learning as primary goals for services in high poverty urban communities. Method Teacher key opinion leaders (KOLs) were identified through sociometric surveys and trained, with mental health providers (MHPs) and parent advocates (PAs), on evidence-based practices to enhance children’s learning. KOLs and MHPs co-facilitated professional development sessions for classroom teachers to disseminate two universal (Good Behavior Game, Peer Assisted Learning) and two targeted (Good News Notes, Daily Report Card) interventions. Group-based and home-based family education and support were delivered by MHPs and PAs for K-4th grade children diagnosed with one or more disruptive behavior disorder. Services were Medicaid-funded through four social service agencies (N = 17 providers) in seven schools (N = 136 teachers, 171 children) in a two (L2L vs. services-as-usual SAU]) by six (pre- and post-tests for three years) longitudinal design with random assignment of schools to conditions. SAU consisted of supported referral to a nearby social service agency. Results Mixed effects regression models indicated significant positive effects of L2L on mental health service use, classroom observations of academic engagement, teacher report of academic competence and social skills, and parent report of social skills. Nonsignificant between-group effects were found on teacher and parent report of problem behaviors, daily hassles, and curriculum based measures. Effects were strongest for young children, girls, and children with fewer symptoms. Conclusions Community mental health services targeting empirical predictors of learning can improve school and home behavior for children living in high poverty urban communities. PMID:26302252

  13. Strengthening Intersectoral Collaboration for Primary Health Care in Developing Countries: Can the Health Sector Play Broader Roles?

    PubMed Central

    Adeleye, Omokhoa Adedayo; Ofili, Antoinette Ngozi

    2010-01-01

    Many strategic challenges impeding the success of primary health care are rooted in weak strategic inputs, including intersectoral collaboration. Some encouraging evidence from programmes, projects, and studies suggests that intersectoral collaboration is feasible and useful. The strategy has the potential to fast-track the attainment of Millenium Development Goals. However, the strategy is not commonly utilised in developing countries. The health sector expects inputs from other sectors which may not necessarily subscribe to a shared responsibility for health improvement, whereas the public expects ‘‘health” from the health sector. Yet, the health sector rarely takes on initiatives in that direction. The sector is challenged to mobilise all stakeholders for intersectoral collaboration through advocacy and programming. Pilot projects are advised in order to allow for cumulative experience, incremental lessons and more supportive evidence. PMID:20454703

  14. Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach

    PubMed Central

    2013-01-01

    Background There is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services. Methods The study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider’s perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis. Results The average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery. Conclusion The high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to

  15. Gaps In Primary Care And Health System Performance In Six Latin American And Caribbean Countries.

    PubMed

    Macinko, James; Guanais, Frederico C; Mullachery, Pricila; Jimenez, Geronimo

    2016-08-01

    The rapid demographic and epidemiological transitions occurring in Latin America and the Caribbean have led to high levels of noncommunicable diseases in the region. In addition to reduced risk factors for chronic conditions, a strong health system for managing chronic conditions is vital. This study assessed the extent to which populations in six Latin American and Caribbean countries receive high-quality primary care, and it examined the relationship between experiences with care and perceptions of health system performance. We applied a validated survey on access, use, and satisfaction with health care services to nationally representative samples of the populations of Brazil, Colombia, El Salvador, Jamaica, Mexico, and Panama. Respondents reported considerable gaps in the ways in which primary care is organized, financed, and delivered. Nearly half reported using the emergency department for a condition they considered treatable in a primary care setting. Reports of more primary care problems were associated with worse perceptions of health system performance and quality and less receipt of preventive care. Urgent attention to primary care performance is required as the region's population continues to age at an unprecedented rate. PMID:27503978

  16. An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on 'Psychological Problems in General Health Care'.

    PubMed

    Sartorius, N; Ustün, T B; Costa e Silva, J A; Goldberg, D; Lecrubier, Y; Ormel, J; Von Korff, M; Wittchen, H U

    1993-10-01

    This article describes a large longitudinal multicenter collaborative study that investigated the form, frequency, course, and outcome of psychological problems that were seen in primary health care settings in 15 different sites around the world. The research employed a two-stage sampling design in which the 12-item General Health Questionnaire was administered to 26,422 persons aged 18 to 65 years who were consulting health care services. Of these persons, 5604 were selected for detailed examinations using standardized instruments and were followed up at 3 months and 1 year to provide information on course and outcome. All assessment instruments have been translated into 13 different languages. The project has produced a database that allows for the exploration of the nature of psychological disorders experienced by patients in general medical care and their association with physical illness, illness behavior, and disability over time. PMID:8215805

  17. Quality Over Quantity: Integrating Mental Health Assessment Tools into Primary Care Practice

    PubMed Central

    Hudson, Darrell L

    2016-01-01

    Depression is one of the most common, costly, and debilitating psychiatric disorders in the US. There are also strong associations between depression and physical health outcomes, particularly chronic diseases such as diabetes mellitus. Yet, mental health services are underutilized throughout the US. Recent policy changes have encouraged depression screening in primary care settings. However, there is not much guidance about how depression screeners are administered. There are people suffering from depression who are not getting the treatment they need. It is important to consider whether enough care is being taken when administering depression screeners in primary care settings. PMID:27352418

  18. [Features and developments of Primary Care in a Public Health perspective].

    PubMed

    Damiani, Gianfranco; Azzolini, Elena; Silvestrini, Giulia; Ricciardi, Walter

    2014-01-01

    In recent years, substantial changes of the population structure have occurred, both at the national and international levels, due to several factors, including demographic changes and technological progress. At the same time, an epidemiological transition is occurring, characterized by a shift from diseases with an acute onset and a rapid resolution, to chronic-degenerative conditions which require more long-term care solutions. This shift seems to contribute to an increased life expectancy of the population, and a larger proportion of elderly individuals having complex health needs. The above described changes of the population structure, in combination with the current economic and financial crisis, require a redefinition of health system priorities at different levels, and the identification of specific intervention approaches. Today Primary Care is generally considered to have a key role in the progress of health systems and governments and international agencies, including the World Bank and the World Health Organisation have already increased investments and introduced reforms of Primary Care. However, there still remains much to be done, particularly with regards to the definition of specific aspects related to Primary Care. In this article the characteristics and developments of two main concepts, Primary Care (PC), which describes the delivery of Primary Care services, and Primary Health Care (PHC), which is more broadly defined by a level of governance or stewardship, are described. The distinction between PC and PHC implies the need for a characterization of system governance or stewardship, and of governance for care delivery. The first entails decision-making mechanisms for protecting the health both of individuals and of communities, by setting health, appropriateness and economic sustainability goals. These decisionmaking mechanisms further take into account the consequent responsibilities and risks compared to the achieved results toward citizens

  19. Patient engagement and the design of digital health

    PubMed Central

    Birnbaum, Faith; Lewis, Dana M.; Rosen, Rochelle; Ranney, Megan L.

    2015-01-01

    Digital health is an area of growing interest for physicians, patients, and technology companies alike. It promises the ability to engage patients in their care, before, during, and after an emergency department visit. Current efforts to create, study, and disseminate digital health have been limited by lack of user engagement. In this commentary, we outline the imperative for engaging end-users in each phase of digital health design, as well as a few techniques to facilitate better digital health design and implementation. PMID:25997375

  20. Female college athletes: a special population for health promotion in primary care.

    PubMed

    Langford, T L

    1995-03-01

    Female college athletes constitute a population with potential health problems beyond those of their age-mates. The expectations of the elite college athlete for academic and athletic accomplishment and for exemplary personal behavior, in combination with the typical developmental crises of late adolescence, create health risks. This presents the opportunity for effective health promotion as a part of primary care for these young women. The HealthCoRE Program at Texas Tech University Health Sciences Center School of Nursing is an example of how a program approach using a community health perspective, in contrast to an episodic or an "array-of-available-services-cafeteria" approach, can affect the health of female college athletes. Program elements include identification of group and individual health risks and health information interests, individual physical examination including a gynecologic examination, individual client contracts for group and individual activities, and crisis intervention. Three years of experience with the program shows value both from the athletes' perspectives and from their coaches' perspectives. Nurse practitioners are the ideal providers for this type of service because of their knowledge of the community health approach, their skills in health promotion and disease prevention, and their use of health teaching as a therapeutic tool. PMID:7767128

  1. Understanding partnership practice in primary health as pedagogic work: what can Vygotsky's theory of learning offer?

    PubMed

    Hopwood, Nick

    2015-01-01

    Primary health policy in Australia has followed international trends in promoting models of care based on partnership between professionals and health service users. This reform agenda has significant practice implications, and has been widely adopted in areas of primary health that involve supporting families with children. Existing research shows that achieving partnership in practice is associated with three specific challenges: uncertainty regarding the role of professional expertise, tension between immediate needs and longer-term capacity development in families, and the need for challenge while maintaining relationships based on trust. Recently, pedagogic or learning-focussed elements of partnership practice have been identified, but there have been no systematic attempts to link theories of learning with the practices and challenges of primary health-care professionals working with families in a pedagogic role. This paper explores key concepts of Vygotsky's theory of learning (including mediation, the zone of proximal development, internalisation, and double stimulation), showing how pedagogic concepts can provide a bridge between the policy rhetoric of partnership and primary health practice. The use of this theory to address the three key challenges is explicitly discussed. PMID:24215942

  2. Review of behavioral health integration in primary care at Baylor Scott and White Healthcare, Central Region

    PubMed Central

    Fluet, Norman R.; Reis, Michael D.; Stern, Charles H.; Thompson, Alexander W.; Jolly, Gillian A.

    2016-01-01

    The integration of behavioral health services in primary care has been referred to in many ways, but ultimately refers to common structures and processes. Behavioral health is integrated into primary care because it increases the effectiveness and efficiency of providing care and reduces costs in the care of primary care patients. Reimbursement is one factor, if not the main factor, that determines the level of integration that can be achieved. The federal health reform agenda supports changes that will eventually permit behavioral health to be fully integrated and will allow the health of the population to be the primary target of intervention. In an effort to develop more integrated services at Baylor Scott and White Healthcare, models of integration are reviewed and the advantages and disadvantages of each model are discussed. Recommendations to increase integration include adopting a disease management model with care management, planned guideline-based stepped care, follow-up, and treatment monitoring. Population-based interventions can be completed at the pace of the development of alternative reimbursement methods. The program should be based upon patient-centered medical home standards, and research is needed throughout the program development process. PMID:27034543

  3. 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

  4. Object representations and their relationship to psychopathology and physical health status in African-American women in primary care.

    PubMed

    Porcerelli, John H; Huprich, Steven K; Binienda, Juliann; Karana, Dunia

    2006-11-01

    Object relations theories hypothesize a relationship between self/other representations and level of psychopathology. Research has lent support to this hypothesis. This study was conducted to examine the link between object representation and psychopathology, stress, physical health status, and alcohol abuse in 110 African-American women in primary care. Object representations were assessed through spontaneous descriptions of parents. Psychopathology and physical health status were assessed with the Patient Health Questionnaire and the Medical Outcomes Study Short-Form Health Survey, both of which were designed for medical settings. The results support the link between dimensions of object representations (developmental level, benevolence, punitiveness) and psychopathology and between object representations and aspects of health status. Punitive maternal and paternal representations were most robustly associated with psychopathology and health status and were the only representational variables associated with alcohol abuse. The findings provide additional support for the object representations-psychopathology link and extend the research by demonstrating associations among object representations, alcohol abuse, and health status. PMID:17102708

  5. Assessing Conscientious Personality in Primary Care: An Opportunity for Prevention and Health Promotion

    PubMed Central

    Israel, Salomon; Moffitt, Terrie E.

    2014-01-01

    The articles in this special section bolster the already strong evidence base that personality differences in the trait of conscientiousness predict health. What is now needed is a research agenda for translating documented risk associations between low conscientiousness and poor health into policies and interventions that improve health outcomes for individuals and populations. In this commentary, we highlight 1 such avenue: introducing brief personality assessment into primary care practice. We provide examples of how conscientiousness assessment may help health care professionals get to know their patients better and potentially serve as a guide for more personalized care. We also raise key considerations for implementation research aimed at examining the feasibility and utility of integrating conscientiousness assessment into primary care settings. PMID:24773110

  6. Integrated primary care and behavioral health services for Latinos: a blueprint and research agenda.

    PubMed

    Manoleas, Peter

    2008-01-01

    Disparities in Latino utilization of mental health services have been documented for some years. Factors such as stigma, low rates of health insurance, paucity of culturally competent providers, and linguistic inaccessibility have contributed to this underutilization. The documented tendency of many Latinos to experience the mind and body as a unified whole, often referred to as "non-dualism"; provides a unique opportunity to address these disparities in utilization. This article advocates a specific model of engagement of Latinos into a continuum of needed behavioral health services via the primary care clinic, and suggests a variety of clinical and administrative outcome measures for evaluating the effectiveness of the model. The model centers on the inclusion of a behavioral health specialist who is "nested" within the primary care team. The preparation and perspectives of clinically trained social workers make them ideal for this role. PMID:19042495

  7. New York City's Child Health Clinics: Providing Quality Primary Care to Children in Low-Income and Immigrant Families.

    ERIC Educational Resources Information Center

    Citizens' Committee for Children of New York, NY.

    A study was conducted to determine whether the New York City Health and Hospitals Corporation (HHC) is fulfilling dual public health and primary care missions of its Child Health Clinics, which provide services to 78,000 New York City children every year. Among the services provided by Child Health Clinics are health examinations for school and…

  8. Primary Design and Analysis of Feeder for ITER Poloidal Field

    NASA Astrophysics Data System (ADS)

    Lei, Mingzhun; Song, Yuntao; Liu, Sumei; Lu, Kun; Wang, Zhongwei

    2011-10-01

    An electromagnetic (EM) analytic model for the PF feeder, applied to ITER and needed to convey the cryogenic supply and electrical power to the PF magnets, was built up. The magnetic flux density and the EM force under the worst conditions with the maximum working current in each coil were then calculated. Based on the EM analysis and theoretical calculation, the relationship between the busbar stress and the distance of neighbouring busbar supports was obtained, which provides an approach to optimize the design of the busbar supports. In order to check the feasibility of the PF feeder structure, a finite element model was built up and the ANSYS code was applied to analyze the stress and displacement. The numerical results show that the stress of the PF feeder is within the allowable limits and the structure is feasible.

  9. Huge "wellness incentives" are more about health plan benefit design than health promotion.

    PubMed

    O'Donnell, Michael P

    2014-01-01

    Regulations governing employers' use of financial incentives for employees who participate in health promotion programs or are successful in achieving health goals go into effect today (January 1, 2014). It is important to recognize that huge incentives have more to do with health plan design and less to do with effective strategies to improve health. Comprehensive health promotion programs need to increase awareness of the link between lifestyle and health, enhance motivation to improve health, build the skills important for a healthy lifestyle, and provide an abundance of opportunities to practice a healthy lifestyle. PMID:24380428

  10. A Patient-Centered Understanding of the Referral System in Ethiopian Primary Health Care Units

    PubMed Central

    Abrahim, Orit; Linnander, Erika; Mohammed, Halima; Fetene, Netsanet; Bradley, Elizabeth

    2015-01-01

    Background Primary healthcare systems in sub-Saharan Africa have undergone substantial development in an effort to expand access to appropriate facilities through a well-functioning referral system. The objective of this study was to evaluate the current patterns of seeking prior care before arriving at a health center or a hospital as a key aspect of the referral system of the primary health care unit (PHCU) in three regions in Ethiopia. We examined what percentage of patients had either sought prior care or had been referred to the present facility and identified demographic and clinical factors associated with having sought prior care or having been referred. Methods and Findings We conducted a cross-sectional study using face-to-face interviews in the local language with 796 people (99% response rate) seeking outpatient care in three primary health care units serving approximately 100,000 people each and reflecting regional and ethnic diversity; 53% (N = 418) of the sample was seeking care at hospital outpatient departments, and 47% of the sample was seeking care at health centers (N = 378). We used unadjusted and adjusted logistic regression to identify factors associated with having been referred or sought prior care. Our findings indicated that only 10% of all patients interviewed had been referred to their current place of care. Among those in the hospital population, 14% had been referred; among those in the health center population, only 6% had been referred. Of those who had been referred to the hospital, most (74%) had been referred by a health center. Among those who were referred to the health center, the plurality portion (32%) came from a nearby hospital (most commonly for continued HIV treatment or early childhood vaccinations); only 18% had come from a health post. Among patients who had not been formally referred, an additional 25% in the hospital sample and 10% in the health center sample had accessed some prior source of care for their present

  11. Designing the experience of health care.

    PubMed

    Whitney, Patrick

    2008-01-01

    New ideas and information services will be best served when they are examined from both the users' and the corporate perspective. It is imperative to identify what best serves the needs of the user while understanding the corporate context that would allow these products/services to be sustainable. The desired result is for users to feel included and become more active and involved in their lives and to be able to do so at a reasonable, sustainable price point. This collaboration is illustrated by several examples of health care product development including the development of a medication management system for patients and a diet assistance program for cardiac patients. In these examples, success is dependent on a solid relationship between people who have the methods to understand users and to develop products and people who have knowledge of the health care field and understand it in a business context. PMID:18430677

  12. Job Satisfaction of Primary Health-Care Providers (Public Sector) in Urban Setting

    PubMed Central

    Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Sharma, Nandini

    2013-01-01

    Introduction: Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health care providers in public sector. Materials and Methods: Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health care providers. Pretested structured questionnaire was administered to 227 health care providers. Data was analyzed using SPSS and relevant statistical test were applied. Results: Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01). Age and education level of health care providers don’t show any significant difference in job satisfaction. All the health care providers are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Conclusion: Job satisfaction is poor for all the four groups of health care providers in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi. PMID:24479088

  13. Structural and Contextual Dimensions of Iranian Primary Health Care System at Local Level

    PubMed Central

    Zanganeh Baygi, Mehdi; Seyedin, Hesam; Salehi, Masoud; Jafari Sirizi, Mehdi

    2014-01-01

    Background: In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago. Objectives: This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level. Materials and Methods: A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests. Results: Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value < 0.001). Goals and culture dimensions had strongest effects on structural dimensions. Conclusions: Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system. PMID:25763257

  14. Professional competencies and training needs of professional social workers in integrated behavioral health in primary care.

    PubMed

    Horevitz, Elizabeth; Manoleas, Peter

    2013-01-01

    The Affordable Care Act has led to a widespread movement to integrate behavioral health services into primary care settings. Integrated behavioral health (IBH) holds promise for treating mild to moderate psychiatric disorders in a manner that more fully addresses the biopsychosocial spectrum of needs of individuals and families in primary care, and for reducing disparities in accessing behavioral health care. For behavioral health practitioners, IBH requires a shift to a brief, outcome-driven, and team-based model of care. Despite the fact that social workers comprise the majority of behavioral health providers in IBH settings, little research has been done to assess the extent to which social workers are prepared for effective practice in fast-paced primary care. We conducted a survey of social workers (N = 84) in IBH settings to assess the following: (1) Key competency areas for social work practice in IBH settings and (2) Self-rated preparedness for effective practice in IBH settings. Online snowball sampling methods were used over a period of 1 month. Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBH-specific competency areas identified in the survey. Findings can help guide social work training to improve workforce preparedness for practice in IBH settings in the wake of health care reform. PMID:24028739

  15. The decentralisation of the sexually transmitted diseases service and its integration into primary health care.

    PubMed

    Latif, A S; Mbengeranwa, O L; Marowa, E; Paraiwa, E; Gutu, S

    1986-10-01

    As part of National Health Policy, the City Health Department in Harare, Zimbabwe decentralized sexually transmitted diseases (STD) services and integrated it into primary health care. A central referral STD clinic was created to concentrate expertise. Simplified treatment protocols were distributed to primary care clinics, and nurses in these clinics received an intensive 2-week training course at the central clinic. This was part of a larger plan to provide comprehensive health care in easily accessible settings. The Harare City Health Department has 14 primary care clinics and 9 polyclinics staffed mainly by nursing personnel. The training course taught curative treatment of STDs and prevention by patient education and locating sexual contacts. Participants were expected to be able to utilize physical and laboratory diagnostic techniques accurately to identify common STDs, and to order appropriate treatment. The program emphasized "bedside" teaching with continuous exposure to clinical problems and discussion of those problems. The textbook used included management guidelines in the form of flow charts adapted from World Health Organization guidelines. Over 16 weeks, 49 trainees attended the course. Trainees were mainly female, while patients are mainly male. Trainees performed well, gaining self confidence and ability to manage STDs. The main problems encountered were overwork of staff in clinics when 1 lest for the program, and reluctance of male patients to be examined by female trainees. PMID:12281132

  16. Mental health communications skills training for medical assistants in pediatric primary care.

    PubMed

    Brown, Jonathan D; Wissow, Lawrence S; Cook, Benjamin L; Longway, Shaina; Caffery, Emily; Pefaure, Chris

    2013-01-01

    Paraprofessional medical assistants (MAs) could help to promote pediatric primary care as a source of mental health services, particularly among patient populations who receive disparate mental health care. This project piloted a brief training to enhance the ability of MAs to have therapeutic encounters with Latino families who have mental health concerns in pediatric primary care. The evaluation of the pilot found that MAs were able to master most of the skills taught during the training, which improved their ability to have patient-centered encounters with families during standardized patient visits coded with the Roter Interaction Analysis System. Parents interviewed 1 and 6 months following the training were more than twice as willing as parents interviewed 1 month before the training to discuss mental health concerns with MAs, and they had better perceptions of their interactions with MAs (all p < 0.01) even after controlling for a range of patient and visit characteristics. Before training, 10.2% of parents discussed a mental health concern with the MA but not the physician; this never happened 6 months after training. This pilot provides preliminary evidence that training MAs holds potential to supplement other educational and organizational interventions aimed at improving mental health services in pediatric primary care, but further research is necessary to test this type of training in other settings and among different patient populations. PMID:23070564

  17. A gendered users' perspective on decentralized primary health services in rural Tanzania.

    PubMed

    Masanyiwa, Zacharia S; Niehof, Anke; Termeer, Catrien J A M

    2015-01-01

    Since the 1990s, Tanzania has been implementing health sector reforms including decentralization of primary healthcare services to districts and users. The impact of the reforms on the access, quality and appropriateness of primary healthcare services from the viewpoint of users is, however, not clearly documented. This article draws on a gendered users' perspective to address the question of whether the delivery of gender-sensitive primary health services has improved after the reforms. The article is based on empirical data collected through a household survey, interviews, focus group discussions, case studies and analysis of secondary data in two rural districts in Tanzania. The analysis shows that the reforms have generated mixed effects: they have contributed to improving the availability of health facilities in some villages but have also reinforced inter-village inequalities. Men and women hold similar views on the perceived changes and appropriateness to women on a number of services. Gender inequalities are, however, reflected in the significantly low membership of female-headed households in the community health fund and their inability to pay the user fees and in the fact that women's reproductive and maternal health needs are as yet insufficiently addressed. Although over half of users are satisfied with the services, more women than men are dissatisfied. The reforms appear to have put much emphasis on building health infrastructure and less on quality issues as perceived by users. PMID:24285278

  18. Use of primary health care prior to a postpartum psychiatric episode

    PubMed Central

    Pedersen, Henrik Søndergaard; Laursen, Thomas Munk; Fenger-Grøn, Morten; Vedsted, Peter; Vestergaard, Mogens

    2015-01-01

    Objective. Childbirth is a strong trigger of psychiatric episodes. Nevertheless, use of primary care before these episodes is not quantified. The aim was to study the use of general practice in Denmark from two years before to one year after childbirth in women who developed postpartum psychiatric disorders. Design. A matched cohort study was conducted including women who gave birth in the period 1996–2010. Women were divided into four groups: (i) all mothers with postpartum psychiatric episodes 0–3 months after birth, n = 939; 2: All mothers with a postpartum psychiatric episode 3–12 months after birth, n = 1 436; and (iii) two comparison groups of mothers, total n = 6 630 among 320 620 eligible women. Setting. Denmark. Subjects. Women born in Denmark after 1 January 1960, restricting the cohort to women who gave birth to their first singleton child between 1 January 1996 and 20 October 2010. Main outcome measures. The main outcome measures were consultation rates, consultation rate ratios, and rate differences. Results. Women who developed a psychiatric episode after childbirth had higher GP consultation rates before, during, and after the pregnancy. Women with a psychiatric episode 0–3 months postpartum had 6.89 (95% CI 6.60; 7.18) mean number of consultations during pregnancy, corresponding to 1.52 (95% CI 1.22; 1.82) more visits than the comparison group. Conclusion. Women with a postpartum psychiatric episode had higher use of GP-based primary health care services years before the childbirth, and in this specific group of patients childbirth itself triggered a marked increase in the number of GP contacts postpartum. PMID:26174691

  19. Conceptual Design for Lower-Energy Primary Aluminum

    NASA Astrophysics Data System (ADS)

    Warner, N. A.

    2008-04-01

    Operating parameters have been identified such that slag melts typical of other carbothermic aluminum processes are thermodynamically unstable. This facilitates the direct reaction of carbon in carbon-saturated aluminum with alumina under dispersed-contact high-intensity conditions. A conceptual design for one million tonnes per annum (1 Mtpa) aluminum production from Bayer alumina is developed. Freestanding graphite reactors and an ancillary plant encapsulated by inert gas are totally unconstrained within refractory-lined shells. Electrical conductive heating and melt circulation in closed loops, employing a 10 vol pct dispersion of fine carbon particles in aluminum (slurry), transports sensible heat to a single pressurized metal-producing reactor (MPR) to satisfy the endothermicity. In the proposed plant, an MPR at 0.28 MPa (2.8 bar) and 2433 K (2160 °C) with a hearth 2-m-wide × 190-m-long leads the melt via a barometric leg back to essentially atmospheric pressure, for further in-line processing. The impeller-stirred assimilation of fine carbon particles is followed by multistage gas-lift pumping to provide a 5.4-m total head, as required by two parallel straight-line melt-conductive heaters 1 m in diameter × 226 m in length. Overall energy-consumption figures 28.7 pct lower than today’s more recently installed Hall Heroult electrolytic plants are predicted, with 51.3 pct less purchased electricity, supplemented with 1.10 times the stoichiometric elemental carbon.

  20. Design and Testing of the X-38 Spacecraft Primary Parafoil

    NASA Technical Reports Server (NTRS)

    Machin, Ricardo A.

    2000-01-01

    In August of 1995 the NASA began testing large ram-air parafoils for potential use in the landing phase of spacecraft recovery. This effort eventually became a part of the X-38 project, a technology demonstrator for the International Space Station Emergency Crew Return Vehicle. This paper traces how the original parafoil, used in the U.S. Army Graded Precision Air Delivery System (GPADS), was modified to improve the initial deployment dynamics. A discussion of how test experience with 750 sq ft parafoils has been used to scale up to the full-scale 5500 sq ft and 7500 sq ft parafoils is presented. In particular, the development of two techniques that have greatly improved the repeatability of the parafoil initial deployment and decreased the first stage deployment dynamics are discussed: a first stage upper surface energy modulator and floor vents. Comparisons of trends and results from the various scale parachutes are presented as well as constraints that at times have driven the direction that the design has taken.

  1. Medical provider attitudes about behavioral health consultants in integrated primary care: a preliminary study.

    PubMed

    Torrence, Nicole D; Mueller, Anne E; Ilem, Allison A; Renn, Brenna N; DeSantis, Brian; Segal, Daniel L

    2014-12-01

    Integrated behavioral health increases service utilization and treatment success, particularly with high-risk populations. This study assessed medical personnel's attitudes and perceptions of behavioral health clinicians (BHCs) in primary care using a brief self-report measure. A 6-item survey was given to medical providers (n = 45) from a health care system that includes integrated behavioral health services. Survey items assessed providers' attitudes and perceptions about BHCs. Attitudes about behavioral health were largely favorable. For all items, 73.3% to 100% of participants endorsed strongly agree or agree. Chi-square analyses revealed that those who interacted more frequently with BHCs were more comfortable discussing behavioral health issues with their patients, χ²(6, n = 45) = 13.43, p < .05, and that physicians believe that BHCs help patients effectively address their behavioral health problems, χ²(2, n = 45) = 6.36, p < .05. Age, gender, and health center in which the providers worked were not significantly related to any survey items. Medical providers surveyed believe that BHCs are valuable members of integrated health care, improving their abilities to provide care and to address their patients' physical and behavioral health problems. Although these preliminary results are promising, the setting surveyed has well-integrated behavioral health care services and thus might not be representative of other settings without such integration. Future studies should address medical providers' opinions of BHCs in a variety of settings with larger samples. PMID:25329753

  2. Patient Perceptions and Expectations From Primary Health-care Providers in India

    PubMed Central

    Ardey, Rashmi; Ardey, Rajeev

    2015-01-01

    Introduction: The study of patient satisfaction at the primary care level has been mostly neglected in India. Aim: This objective of this study was to assess indices of Patient Satisfaction at the level of the family physician which is usually the first point of contact between the patient and the health-care system. Materials and Methods: This study was carried out at a Private Primary Health-Care Center in a semirural area in New Delhi, by exit interviews in the form of a questionnaire from patients randomly selected from people visiting the center during the study period. Statistical Analysis: Descriptive statistical analysis was carried out on the data collected. Results: The findings revealed that 83.58% of the patients were satisfied with the general experience and the behavior of the health-care provider and 85.9% were satisfied with the treatment and care provided, only 65.5% were satisfied with the physical environment of the clinic. However, the percentage of patients who would recommend the facility to their friends was overwhelming (94.6%). Conclusion: These results show that private health-care providers are still the first choice for any form of medical care. However, there was definitely a gap between the increasing expectations of the patients for more information, better Patient–Provider interaction, more control over the treatment process and better amenities even at the Primary Care level. It is this gap, which needs to be fulfilled to facilitate better utilization of Primary Health-Care Services in the community and reduce pressure on tertiary care services in order to ensure Universal Health Coverage. This study would also help us understand the challenges for Primary Care service providers, private and public, in a low socioeconomic urban setting. PMID:25810990

  3. [Primary care pediatrics in the public health system of the twenty-first century. SESPAS report 2012].

    PubMed

    Domínguez Aurrecoechea, Begoña; Valdivia Jiménez, Carlos

    2012-03-01

    Today in our country, the primary care pediatrician is the first contact between children and adolescents with the health system, being also a highly resolving specialist that addresses over 90% of the health needs of this population, monitors growth and development and participates in all activities of prevention, health promotion and health education within primary care teams with nurses and family doctors. Witnessing rapid and profound demographic, social, cultural, scientific and technological changes as well as the demands and expectations of health care for citizens, which should enhance the value and response capacity of primary care. These changes also affect infant morbidity and health care priorities in child and adolescent, posing new challenges for primary care practice and reinforce the role of the pediatrician in primary care. Primary care is not only the gateway to the health system. Primary care teams have to take responsibility for the care of people assigned to coordinate the necessary resources and advising citizens on their health problems and his itinerary care by the health system. It identifies the need to foster teamwork within the health department involved nursing staff to take care activities in this age group. It aims to foster a model based on cooperation and complementarity. A recent systematic review recommended maintaining the figure of the pediatrician in primary care teams and strengthen their specific role as first point of contact with the child's health care system, found significant benefits for children. PMID:22196036

  4. Participatory Design of an Integrated Information System Design to Support Public Health Nurses and Nurse Managers

    PubMed Central

    Reeder, Blaine; Hills, Rebecca A.; Turner, Anne M.; Demiris, George

    2014-01-01

    Objectives The objectives of the study were to use persona-driven and scenario-based design methods to create a conceptual information system design to support public health nursing. Design and Sample We enrolled 19 participants from two local health departments to conduct an information needs assessment, create a conceptual design, and conduct a preliminary design validation. Measures Interviews and thematic analysis were used to characterize information needs and solicit design recommendations from participants. Personas were constructed from participant background information, and scenario-based design was used to create a conceptual information system design. Two focus groups were conducted as a first iteration validation of information needs, personas, and scenarios. Results Eighty-nine information needs were identified. Two personas and 89 scenarios were created. Public health nurses and nurse managers confirmed the accuracy of information needs, personas, scenarios, and the perceived usefulness of proposed features of the conceptual design. Design artifacts were modified based on focus group results. Conclusion Persona-driven design and scenario-based design are feasible methods to design for common work activities in different local health departments. Public health nurses and nurse managers should be engaged in the design of systems that support their work. PMID:24117760

  5. Research in college health. 2: Designing the study.

    PubMed

    Steenbarger, B N; Manchester, R A

    1993-07-01

    Building upon an initial article, which described the processes of literature review and hypothesis development, the authors summarize issues of research design. General issues encountered by researchers in college health settings include the establishment of a clear research focus, selection of a representative and adequate study sample, use of reliable and valid measures, and adherence to professional ethics. Specific means of addressing these design concerns are summarized, using examples from college health research. PMID:8376673

  6. Violence against Primary Health Care Workers in Al-Hassa, Saudi Arabia

    ERIC Educational Resources Information Center

    El-Gilany, Abdel-Hady; El-Wehady, Adel; Amr, Mostafa

    2010-01-01

    This self-report questionnaire study was carried out in Al-Hassa, Saudi Arabia to highlight the magnitude, predictors, and circumstances of workplace violence against primary health care (PHC) workers. A total of 1,091 workers completed a self-administered questionnaire. About 28% were exposed to at least one violent event during the past year.…

  7. Can Implementation of a Resilience Program for Primary School Children Enhance the Mental Health of Teachers?

    ERIC Educational Resources Information Center

    Tyson, Orla; Roberts, Clare M.; Kane, Robert

    2009-01-01

    This study investigated whether a mental health promotion program delivered by primary school teachers to prevent internalising problems in children had any impact on the teachers' job-related affective wellbeing. Teacher job related anxiety and job-related depression were measured before teaching the Aussie Optimism program, and after…

  8. Experimental Activities in Primary School to Learn about Microbes in an Oral Health Education Context

    ERIC Educational Resources Information Center

    Mafra, Paulo; Lima, Nelson; Carvalho, Graça S.

    2015-01-01

    Experimental science activities in primary school enable important cross-curricular learning. In this study, experimental activities on microbiology were carried out by 16 pupils in a Portuguese grade-4 classroom (9-10?years old) and were focused on two problem-questions related to microbiology and health: (1) do your teeth carry microbes? (2) why…

  9. Evaluation of an Interprofessional Continuing Professional Development Initiative in Primary Health Care

    ERIC Educational Resources Information Center

    Curran, Vernon; Sargeant, Joan; Hollett, Ann

    2007-01-01

    Introduction: Interest in collaborative care approaches and in interprofessional education (IPE) to prepare providers for interprofessional collaboration is increasing and particularly so in the field of primary health care. Although evidence for the effectiveness of IPE is mixed, Barr et al. (2005) have proposed a useful framework for evaluating…

  10. The reality of waste management in primary health care units in Brazil.

    PubMed

    Alves, Sergiane B; e Souza, Adenícia C S; Tipple, Anaclara F V; Rezende, Keyti C A D; de Resende, Fabiana R; Rodrigues, Érika G; Pereira, Milca S

    2014-09-01

    A large number of users are serviced in primary health care units in Brazil, both in health facilities and in households. These services generate waste that must be managed safely, but there is no legislation that regulates this type of waste management in Brazil. The objective of this study was to analyse the production and management of waste in primary health care. A direct observation was performed of the stages in the handling and weighing of waste generated in primary health care units in the municipality of Goiânia (Brazil). The units generated infectious, chemical, and common waste, as well as sharp objects. The generation of waste ranged between 0.027 and 0.075 kg user-day. The generated waste was classified mostly as common and recyclable. Flaws were observed in the management of all types of waste. The critical point is segregation. Only 34.1% of the waste disposed of as infectious actually belonged to this group, the rest was ordinary waste. Flaws at this stage increase the volume of infectious waste, the occupational and environmental risks, and associated costs. Intervention to change this reality is needed and it requires the careful preparation of a waste management plan, corroborating structural changes to the implementation of this plan, and professional training and public policies to guide waste management in primary care, especially those generated in households. PMID:25034368

  11. Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease

    ERIC Educational Resources Information Center

    Thompson, Megan R.; Stone, Ramona F.; Ochs, V. Dan; Litvan, Irene

    2013-01-01

    In order to determine primary health care providers' (PCPs) knowledge gaps on Parkinson's disease, data were collected before and after a one-hour continuing medical education (CME) lecture on early Parkinson's disease recognition and treatment from a sample of 104 PCPs participating at an annual meeting. The main outcome measure…

  12. Health Imperatives in Primary Schools across Three Countries: Intersections of Class, Culture and Subjectivity

    ERIC Educational Resources Information Center

    Wright, Jan; Burrows, Lisette; Rich, Emma

    2012-01-01

    In this article, we want to focus on the impact of the new health imperatives on young children attending primary schools because the evidence from both our own and others work suggests that younger and younger children are talking in very negative and disturbing ways about themselves and their bodies. We see this in a context where in the name of…

  13. Learning Motivational Interviewing: Exploring Primary Health Care Nurses' Training and Counselling Experiences

    ERIC Educational Resources Information Center

    Soderlund, Lena Lindhe; Nilsen, Per; Kristensson, Margareta

    2008-01-01

    Objective: This article explores the training and counselling experiences of 20 nurses, aiming to identify key elements in the process of learning and applying motivational interviewing (MI) counselling skills with adherence to protocols. Setting/method: The nurses were recruited from 10 primary health care units in Ostergotland, Sweden. The study…

  14. Parents, Mental Illness, and the Primary Health Care of Infants and Young Children.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    1993-01-01

    This bulletin issue contains five papers on the theme of adults with mental illness who are parents of very young children. "Parents, Mental Illness, and the Primary Health Care of Infants and Young Children" (John N. Constantino) offers the experience of a trainee in a combined residency in pediatrics and psychiatry, focusing on identification,…

  15. Increasing the Screening and Counseling of Adolescents for Risky Health Behaviors: A Primary Care Intervention

    ERIC Educational Resources Information Center

    Ozer, Elizabeth M.; Adams, Sally H.; Lustig, Julie L.; Gee, Scott; Garber, Andrea K.; Gardner, Linda Rieder; Rehbein, Michael; Addison, Louise; Irwin, Charles E., Jr.

    2005-01-01

    Objective: To determine whether a systems intervention for primary care providers resulted in increased preventive screening and counseling of adolescent patients, compared with the usual standard of care. Methods: The intervention was conducted in 2 out-patient pediatric clinics; 2 other pediatric clinics in the same health maintenance…

  16. Screening of Infants at Eight Months for Atypical Development in Primary Health Care in Southern Sweden

    ERIC Educational Resources Information Center

    Sivberg, Bengt; Lundqvist, Pia; Johanson, Ingmarie; Nordström, Berit; Persson, Bengt A.

    2016-01-01

    Screening studies of a population in primary health care are sparsely reported. The aim was to describe observed atypical behaviours that may be associated with autism spectrum conditions, in a population (n?=?4,329) of infants at eight months. Observations were performed by paediatric nurses. An observational instrument, named SEEK developed for…

  17. Web-Based SBIRT Skills Training for Health Professional Students and Primary Care Providers

    ERIC Educational Resources Information Center

    Tanner, T. Bradley; Wilhelm, Susan E.; Rossie, Karen M.; Metcalf, Mary P.

    2012-01-01

    The authors have developed and assessed 2 innovative, case-based, interactive training programs on substance abuse, one for health professional students on alcohol and one for primary care providers on screening, brief intervention, and referral to treatment (SBIRT). Both programs build skills in substance abuse SBIRT. Real-world effectiveness…

  18. Teachers' Knowledge and Confidence for Promoting Positive Mental Health in Primary School Communities

    ERIC Educational Resources Information Center

    Askell-Williams, Helen; Lawson, Michael J.

    2013-01-01

    This paper reports an investigation into Australian primary school teachers' knowledge and confidence for mental health promotion. Questionnaires were delivered to 1397 teachers. In-depth interviews were held with 37 teachers. Quantitative results showed that half to two thirds of teachers felt efficacious and knowledgeable about selected…

  19. How do primary health-care practitioners identify and manage communication impairments in preschool children?

    PubMed

    Woolfenden, Sue; Short, Kate; Blackmore, Roger; Pennock, Rene; Moore, Michael

    2015-01-01

    Communication impairments (CIs) in preschool children are common and can have long-term adverse consequences if not detected and treated early. This study investigated the knowledge, training and practice of primary health-care practitioners in the identification and management of CIs in preschool-aged children. A cross-sectional survey of 277 primary health-care practitioners in the Inner West and South West Sydney was undertaken. The majority of practitioners surveyed understood the importance of early identification of CIs. Eight per cent ofpractitioners correctly identified all of the 'red flags' for verbal and non-verbal communication. The majority (80%) correctly described the management of a typical case presentation. Two-thirds of practitioners reported using a tool in their practice for developmental surveillance, but the quality of surveillance tools was variable. One-third felt their training in this area was poor and 90% indicated they would like further training. Barriers to referral included waiting times, availability and cost of services. We concluded that primary health-care practitioners are aware that CIs are significant and they need to be identified early. There are opportunities for further training and promoting high-quality developmental surveillance in primary care. In addition, there are broader health system issues that include promotion of an integrated response to the detection and management of CIs. PMID:26509204

  20. Designing a Multi-Disciplinary Geriatrics Health Professional Mentoring Program

    ERIC Educational Resources Information Center

    Cotter, J. James; Coogle, Constance L.; Parham, Iris A.; Head, Colleen; Fulton, LaQuana; Watson, Kathleen; Curtis, Angela

    2004-01-01

    This paper describes a Geriatric Health Professionals Mentoring Program designed to address recruitment and retention of health professionals in geriatrics and gerontology. The training provided information on the mentoring process, negotiating mentoring agreements, and coaching mentees. The evaluative framework described examines: (a) the effects…

  1. Health Care Reform: Designing the Standard Benefits Package.

    ERIC Educational Resources Information Center

    McArdle, Frank B.

    1994-01-01

    Considerations in designing a standard health care benefits package as a part of national health care reform are discussed. Specific features examined include deductibles, employer contributions, regional variations, cost management techniques such as managed care and higher copayments, annual out-of-pocket maximums, and lifetime benefit maximums.…

  2. Experiencing "change" from within: situating the transition to primary health care in a remote Australian context.

    PubMed

    Lockhart, Chris

    2002-01-01

    The transition to primary health care (PHC) is often described in an idealized manner, which either ignores or obscures the experiences associated with its implementation at the local level. By adopting an anthropological perspective, this article highlights some of these experiences and the context within which they occur for one health care organisation in remote Western Australia. It specifically focuses on problems associated with economic rationalism, managerialism, and the inherently fragmented character of health service organisations. Such issues must be allowed to inform idealized PHC models in order to make them more applicable and attuned to local needs and realities. PMID:12404964

  3. Primary health care in Spain and Catalonia: a nursing model perspective.

    PubMed

    López, Carmen Caja

    2011-12-01

    Many years have passed since the Health Care Reform in Spain, nevertheless there are still questions about the achievements in this health care level, as well as the aspects and expectations that are still pending for the medical discipline as well as for nursing. The present article analyzes whether the innovation plans recently put into action in different communities, particularly that taking place in Catalonia. Furthermore, it also addressed the current academic development in nursing in Spain, the development of the different nursing areas and aspects related to nursing prescription, screening and care to acute pathologies in Primary Health Care. PMID:22569662

  4. Reducing health care costs by rationalizing staffing in primary care settings.

    PubMed

    Mawajdeh, S; Khoury, S A; Yoder, R; Qtaishat, M

    2004-05-01

    Jordan spends around 9% of its GDP on health care services, a high figure compared with similar developing countries. This study assessed staffing patterns in relation to Ministry of Health expenditures in a nationally representative sample of 97 primary care facilities. The economic costs of primary care facilities amounted to Jordanian dinar (JD) 42.3 million. Personnel costs consumed 53.8% of recurrent costs and in monetary terms the amount of down time (time not being used effectively) amounted to JD 9.7 million (about US$ 13.7 million). The Ministry should consider changing the functioning of its primary care facilities to obtain a more cost-effective use of staff time. PMID:16212216

  5. Using the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) to identify practice patterns.

    PubMed

    Beehler, Gregory P; Funderburk, Jennifer S; King, Paul R; Wade, Michael; Possemato, Kyle

    2015-12-01

    Primary care-mental health integration (PC-MHI) is growing in popularity. To determine program success, it is essential to know if PC-MHI services are being delivered as intended. The investigation examines responses to the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) to explore PC-MHI provider practice patterns. Latent class analysis was used to identify clusters of PC-MHI providers based on their self-report of adherence on the PPAQ. Analysis revealed five provider clusters with varying levels of adherence to PC-MHI model components. Across clusters, adherence was typically lowest in relation to collaboration with other primary care staff. Clusters also differed significantly in regard to provider educational background and psychotherapy approach, level of clinic integration, and previous PC-MHI training. The PPAQ can be used to identify PC-MHI provider practice patterns that have relevance for future clinical effectiveness studies, development of provider training, and quality improvement initiatives. PMID:26622911

  6. Assessment of primary care nursing in relation to adolescent health behaviour by means of trigger films.

    PubMed

    Eshed, H; Epstein, L

    1991-01-01

    The patterns of adolescents' behaviour place them at a risk from developing health and social pathology. In order to assess whether primary care nursing meets adolescents' health needs, the reported performance of 306 registered nurses working in different primary health care settings was studied. The research tool developed especially for the study was a video-taped trigger film. Demographic, education and work-related variables were studied by means of a questionnaire. The behaviour patterns studied were smoking, sexual activity, alcohol and drug consumption, and eating habits. The clinical issues were hypertension, obesity and anorexia nervosa. Reported performance was low--35% of the total possible score--with the lowest scores in the areas of preventive care, data gathering and recording, and somewhat higher in the areas of curative care and follow-up. The video-taped trigger films were considered to have face validity; they were found to be reliable, with an ability to assess the nurses' reported performance and to differentiate between the nurses in the three different work settings. This is the first study of its kind in Israel. The results show that primary health nursing of adolescents is insufficient, and that teenagers should get higher priority as a target population from the nursing profession in order to achieve WHO's aims of 'health for all by the year 2000'. PMID:2005286

  7. Availability and Primary Health Care Orientation of Dementia-Related Services in Rural Saskatchewan, Canada

    PubMed Central

    Morgan, Debra G.; Kosteniuk, Julie G.; Stewart, Norma J.; O’Connell, Megan E.; Kirk, Andrew; Crossley, Margaret; Dal Bello-Haas, Vanina; Forbes, Dorothy; Innes, Anthea

    2015-01-01

    Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes. PMID:26496646

  8. Reducing health disparities through primary care reform: the New Zealand experiment.

    PubMed

    Hefford, Martin; Crampton, Peter; Foley, Jon

    2005-04-01

    New Zealand experiences significant health disparities related to both ethnicity and deprivation; the average life expectancy for Maori New Zealanders is 9 years less than for other New Zealanders. The government recently introduced a set of primary care reforms aimed at improving health and reducing disparities by reducing co-payments, moving from fee-for-service to capitation, promoting population health management and developing a not for profit infrastructure with community involvement to deliver primary care. Funding for primary care visits will increase by some 43% over 3 years. This paper reviews policy documents and enrollment and payment data for the first 15 months to assess the likely impact on health disparities. The policy has been successfully introduced; over half the New Zealand population (of four million) enrolled in new Primary Health Organizations within 15 months. Over 400,000 people (half of them in vulnerable groups) gained improved access to primary care subsidies in the first 15 months. The combined effect of new payment rules and the deprived nature of the minority populations was that the average per person payment to PHOs on behalf of Maori and Pacific enrollees was more than 70% greater than the per person amount for other ethnicities for the period. The policy is consistent with the principles of the Alma Alta Declaration. Barriers to successful implementation include the risk of middle class capture of the additional funding; the risk that co-payments are not low enough to improve access for the poor; PHO inexperience; and the small size of many PHOs. Transitional equity and efficiency issues with the use of aggregate population characteristics to target higher subsidies are being ameliorated by the introduction of low cost access based on age. A tension between the twin policy goals of low cost access for all, and very low cost access for the most vulnerable populations is identified as a continuing and unresolved policy issue. PMID

  9. Outlining the scope of behavioral health practice in integrated primary care: dispelling the myth of the one-trick mental health pony.

    PubMed

    Miller, Benjamin F; Brown Levey, Shandra M; Payne-Murphy, Jessica C; Kwan, Bethany M

    2014-09-01

    Patient presentation in primary care ranges from psychosocial considerations to physical and mental health concerns including serious mental illness. To best prepare for addressing all aspects of health, integrated primary care practices should be equipped with the expertise and resources to appropriately treat the range of presentations. We conducted a literature review of research articles to determine the span of service types provided by behavioral health providers in primary care settings. Among 675 articles retrieved, only 17 addressed health behaviors, 64 examined both health behaviors and mental health, and 160 included only mental health topics. Within these groups, depression was the dominant screening, assessment, and treatment target, and only 42% of all studies included Method and Results sections. Literature supports that integrating behavioral health providers and services into primary care settings benefits patients, primary care providers, and the practice at large, resulting in improved care experiences. However, primary care practices appear to not use the full range of services behavioral health providers can offer. Increased health policy efforts and payment reform are needed to enable a more expansive view of what behavioral health providers could do in a primary care context. PMID:25020071

  10. Teacher-reported prevalence and management of child health problems at primary school.

    PubMed

    Leyland, Anna F; Pickett, Kate E; Barber, Sally; McEachan, Rosemary; Wright, John

    2016-06-01

    We explored primary school teacher-reported experiences, prevalence and management of child health and developmental problems and medication administration from one multi-ethnic urban community in England. A survey was delivered to 90 reception class teachers in 45 primary schools, and semi-structured interviews were conducted with a purposive sample of eight respondents. Fifty-six percent of teachers completed the questionnaire. Findings suggest that teachers and school staff may represent an underused resource for identifying children with developmental and health conditions and that the connections formed between schools and families could be utilized by other services by delivering interventions in schools where possible. Whilst most schools use a policy to inform the management of child health in school, some key areas such as training and documentation of medication administration may not be followed in practice. Interview findings supported and expanded on survey data by identifying barriers to collaboration between services and families. PMID:25713008

  11. 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

  12. Primary care and the maelstrom of health care reform in the United States of America.

    PubMed Central

    Curtis, P

    1995-01-01

    Recent reform in the National Health Service has moved general practice towards a more intense market and competition structure. Meanwhile in the United States of America there has been an attempt to modify the free enterprise approach to medical care towards a more socially responsive system. This discussion paper provides a family doctor's perspective of primary care and the maelstrom of health care reform in the USA. The cultural, economic and organizational issues underlying the need for reform are considered in turn, and the current situation with regard to health care provision, medical research, medical education and primary care are outlined. General practitioners in the United Kingdom would do well to pay attention to the effects of market reform occurring in general practice among their American counterparts. PMID:7576850

  13. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India

    PubMed Central

    Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh

    2016-01-01

    Background With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. Methods We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. Results The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630–10,294,065) and INR 26.9 million (95% CI: 22,225,159.3–32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6–208.3) and INR162.1 (95% CI: 112–219

  14. Factors related to fatigue among older patients with heart failure in primary health care.

    PubMed

    Hägglund, Lena; Boman, Kurt; Stenlund, Hans; Lundman, Berit; Brulin, Christine

    2008-06-01

    Aim.  Our aim was to explore the relationship between fatigue and physical, mental, social and demographic factors among older patients with heart failure, with special reference to gender. Background.  If interventions aimed at preventing or alleviating fatigue are to be successful, more knowledge about factors associated with fatigue is needed. Design.  A cross-sectional design was used. Methods.  Forty-nine patients aged 77.7 ± 8.7 years (21 men and 28 women) with verified heart failure from one primary healthcare centre answered a questionnaire including Multi-dimensional Fatigue Inventory, 36-item Short-Form Health Survey, Geriatric Depression Scale, Self-Transcendence Scale, Resilience Scale, Social Provision Scale and demographic variables. Descriptive statistics and multiple linear regression analyses were conducted. Results.  Levels of general fatigue were high (mean 14.6 ± 3.9). Female gender (β = 0.280, P = 0.033) and role function for physical reasons (β = -0.458, P = 0.001) explained 36% of the variance in general fatigue. Conclusions.  Fatigue was more closely related to limitations in role functioning for physical reasons than to reduced physical function per se or to mental and social factors. Women reported more fatigue than men. Relevance to clinical practice.  Caregivers should examine the impact of fatigue in everyday life for each individual. PMID:20925898

  15. A Few Observations on Health Service for Immigrants at a Primary Health Care Centre

    PubMed Central

    2016-01-01

    Objective. Icelandic society is rapidly changing, from being an ethnically homogeneous population towards a multicultural immigrant society. In the hope of optimizing the service for immigrants at the health care centre, we decided to evaluate health care utilization by immigrants. Methods. As a case control study we invited all immigrants that attended the health care centre during a two-week period to participate. Paired controls of Icelanders were invited for comparison. Results. There were 57 immigrants, 48 females and 9 males, from 27 countries. Significantly more of the immigrant women were married, P < 0.001. Interpreters were needed in 21% of the consultations. The immigrants often attended the clinic and had the same diagnoses as did the nonimmigrants. The immigrants evaluated the quality of the service in Iceland as 4.3 and the service in their homeland as 1.68, P < 0.001. Conclusion. Immigrants attending a health care centre in Iceland came from all over the world, had the same diagnoses, and attended the clinic as often per annum as the nonimmigrants. Only one-fifth of them needed translators. The health and health care utilization of immigrants were similar to those of nonimmigrants. PMID:27563465

  16. Determinants Associated with the Utilization of Primary and Specialized Mental Health Services

    PubMed Central

    Grenier, Guy; Bamvita, Jean-Marie; Perreault, Michel; Caron, Jean

    2016-01-01

    The study aims to compare variables associated with the exclusive and joint use of primary and specialized care for mental health reasons by individuals diagnosed with a mental disorder in a Montreal/Canadian catchment area. Data were collected from a random sample (2,443 individuals). Among 406 people, diagnosed with a mental disorder 12 months pre-interview, 212 (52%) reported having used healthcare services. Compared to users of primary care only, people who sought both primary and specialized care presented more mental disorders and lower quality of life. People using only specialized healthcare received significantly less social support than persons using primary care exclusively and lived in neighborhoods with a high proportion of rental housing. Healthcare service provision should favor social networking and enable social cohesion and integration, particularly in neighborhoods with a high proportion of rental housing. Shared care and enhanced collaboration with other public and community-based resources should be encouraged. PMID:21607642

  17. Common mental health problems in immigrants and refugees: general approach in primary care

    PubMed Central

    Kirmayer, Laurence J.; Narasiah, Lavanya; Munoz, Marie; Rashid, Meb; Ryder, Andrew G.; Guzder, Jaswant; Hassan, Ghayda; Rousseau, Cécile; Pottie, Kevin

    2011-01-01

    Background: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. Methods: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. Results: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. Interpretation: Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally