Kamaludin, Kauthar Mohamad; Muhammad, Mazanah; Wahat, Nor Wahiza Abdul; Ibrahim, Rahimah
The involvement of non-government organizations (NGOs) and support groups has helped strengthen public health services in addressing cancer care burden. Owing to the contribution of volunteers in cancer care, this article documents a qualitative study that examined challenges in attracting and retaining cancer care volunteers as part of the effort to develop a volunteer recruitment model. Data were collected through three focus group discussions involving 19 cancer support group members in Malaysia. Findings of the study revealed that mobility and locality appeared to be significant in Malaysian context, while the need for financial support and time flexibility are challenges faced by cancer support groups to attract and retain volunteers. The findings imply that cancer care initiatives can benefit from more local volunteers but at the same time these volunteers require flexibility and financial support to sustain their engagement. PMID:24083746
Communication skills are as important as vital needs. Health care professionals have to be aware of their own communication practices and need to undergo periodic appraisal of the same. Training programmes in communication skills are unfortunately not part of our academic curriculum. The article highlights the need and the overview of such training programmes. PMID:21811359
Burbeck, Rachel; Low, Joe; Sampson, Elizabeth L; Scott, Rosalind; Bravery, Ruth; Candy, Bridget
Objective To assess the involvement of volunteers with direct patient/family contact in UK palliative care services for children and young people. Method Cross-sectional survey using a web-based questionnaire. Setting UK specialist paediatric palliative care services. Participants Volunteer managers/coordinators from all UK hospice providers (n=37) and one National Health Service palliative care service involving volunteers (covering 53 services in total). Main outcomes Service characteristics, number of volunteers, extent of volunteer involvement in care services, use of volunteers’ professional skills and volunteer activities by setting. Results A total of 21 providers covering 31 hospices/palliative care services responded (30 evaluable responses). Referral age limit was 16–19?years in 23 services and 23–35?years in seven services; three services were Hospice at Home or home care only. Per service, there was a median of 25 volunteers with direct patient/family contact. Services providing only home care involved fewer volunteers than hospices with beds. Volunteers entirely ran some services, notably complementary therapy and pastoral/faith-based care. Complementary therapists, school teachers and spiritual care workers most commonly volunteered their professional skills. Volunteers undertook a wide range of activities including emotional support and recreational activities with children and siblings. Conclusions This is the most detailed national survey of volunteer activity in palliative care services for children and young people to date. It highlights the range and depth of volunteers’ contribution to specialist paediatric palliative care services and will help to provide a basis for future research, which could inform expansion of volunteers’ roles. PMID:24644170
Perspectives in Peer Programs, 2005
Cambridge Health Alliance's Volunteer Health Advisor (VHA) Program was developed to create an effective and cost efficient outreach network to improve community health status. The program's mission is to improve community health by working collaboratively with faith-based and community-based organizations to recruit, train, and support a…
Stephen Claxton-Oldfield; Emily Hastings; Jane Claxton-Oldfield
A total of 50 nurses (hospital and home care) responded to a survey designed to measure: (1) their attitudes toward, and knowledge of, hospice palliative care volunteers; (2) the types of tasks they felt it was appropriate for volunteers to perform; and (3) how valuable they felt different members of the hospice palliative care team are. In addition, they were
Söderhamn, Ulrika; Landmark, Bjørg; Aasgaard, Live; Eide, Hilde; Söderhamn, Olle
Introduction The number of people suffering from dementia will increase dramatically in the future, and this will be a great challenge and concern for health care services. It is assumed that volunteers will strengthen community health care services more in the future than they do today. Aim The aim of this study was to elucidate lived experiences of working as a volunteer in an activity center with adapted activities for home-dwelling people with early stage dementia. Methods Qualitative interviews were implemented in a group of nine female volunteers from an activity center in southern Norway. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method. Results Volunteering in an activity center for home-dwelling people with early stage dementia was reported to provide experiences of being useful and feeling satisfied with performing a good job. It was an advantage for the volunteers to have had experiences from life in general, but also as a health professional or as being the next of kin of a dementia sufferer. It was important for the volunteers to focus on the dementia sufferer and show caring behavior, and interaction with and the appreciation of the health care professionals were also important. The volunteers were motivated by being able to have influence and participate in the planning of the work, to be a part of the social setting, and to learn. However, for some volunteers it was difficult to adjust to an appropriate role. Conclusion In order to promote volunteering in a caring context, mutual trust and freedom should be emphasized. Being conscious of important volunteer characteristics like their experiences, knowledge, and caring behavior, as well as a focus on the staff showing appreciation and providing feedback, may be the difference between success and failure. PMID:22396627
Morrow, Melanie; Davis, Thomas; Borger, Sarah; Weiss, Jennifer; DeCoster, Mary; Ricca, Jim; Ernst, Pieter
The Care Group approach, described in detail in a companion paper in this journal, uses volunteers to convey health promotion messages to their neighbors. This article summarizes the available evidence on the effectiveness of the Care Group approach, drawing on articles published in the peer-reviewed literature as well as data from unpublished but publicly available project evaluations and summary analyses of these evaluations. When implemented by strong international NGOs with adequate funding, Care Groups have been remarkably effective in increasing population coverage of key child survival interventions. There is strong evidence that Care Groups can reduce childhood undernutrition and reduce the prevalence of diarrhea. Finally, evidence from multiple sources, comprising independent assessments of mortality impact, vital events collected by Care Group Volunteers themselves, and analyses using the Lives Saved Tool (LiST), that Care Groups are effective in reducing under-5 mortality. For example, the average decline in under-5 mortality, estimated using LiST, among 8 Care Group projects was 32%. In comparison, among 12 non-Care Group child survival projects, the under-5 mortality declined, on average, by an estimated 11%. Care Group projects cost in the range of US$3–$8 per beneficiary per year. The cost per life saved is in the range of $441–$3,773, and the cost per disability-adjusted life year (DALY) averted is in the range of $15–$126. The Care Group approach, when implemented as described, appears to be highly cost-effective based on internationally accepted criteria. Care Groups represent an important and promising innovative, low-cost approach to increasing the coverage of key child survival interventions in high-mortality, resource-constrained settings. Next steps include further specifying the adjustments needed in government health systems to successfully incorporate the Care Group approach, testing the feasibility of these adjustments and of the effectiveness of Care Groups in pilot programs in government health systems, and finally assessing effectiveness at scale under routine field conditions in government health programs. PMID:26374799
Perry, Henry; Morrow, Melanie; Davis, Thomas; Borger, Sarah; Weiss, Jennifer; DeCoster, Mary; Ricca, Jim; Ernst, Pieter
The Care Group approach, described in detail in a companion paper in this journal, uses volunteers to convey health promotion messages to their neighbors. This article summarizes the available evidence on the effectiveness of the Care Group approach, drawing on articles published in the peer-reviewed literature as well as data from unpublished but publicly available project evaluations and summary analyses of these evaluations. When implemented by strong international NGOs with adequate funding, Care Groups have been remarkably effective in increasing population coverage of key child survival interventions. There is strong evidence that Care Groups can reduce childhood undernutrition and reduce the prevalence of diarrhea. Finally, evidence from multiple sources, comprising independent assessments of mortality impact, vital events collected by Care Group Volunteers themselves, and analyses using the Lives Saved Tool (LiST), that Care Groups are effective in reducing under-5 mortality. For example, the average decline in under-5 mortality, estimated using LiST, among 8 Care Group projects was 32%. In comparison, among 12 non-Care Group child survival projects, the under-5 mortality declined, on average, by an estimated 11%. Care Group projects cost in the range of US$3-$8 per beneficiary per year. The cost per life saved is in the range of $441-$3,773, and the cost per disability-adjusted life year (DALY) averted is in the range of $15-$126. The Care Group approach, when implemented as described, appears to be highly cost-effective based on internationally accepted criteria. Care Groups represent an important and promising innovative, low-cost approach to increasing the coverage of key child survival interventions in high-mortality, resource-constrained settings. Next steps include further specifying the adjustments needed in government health systems to successfully incorporate the Care Group approach, testing the feasibility of these adjustments and of the effectiveness of Care Groups in pilot programs in government health systems, and finally assessing effectiveness at scale under routine field conditions in government health programs. PMID:26374799
Manal Guirguis-Younger; Soti Grafanaki
The long and evolving tradition of palliative care has always had a strong volunteer dimension. The difficult nature of palliative care invites questions around why volunteers choose this particular line of contribution. To expand our knowledge of the elements that create meaning and capture the essence of volunteer experience, we asked volunteers to share the rewards and the challenges of
Nelson, Col James H.; Stracener, Col Carl E.; Gannon, Constance
A child health assessment and screening program, staffed by volunteers, has evaluated approximately 5,000 children in a general pediatric clinic. A sample of 500 children was studied to determine characteristics of the population served, quality of the work of the volunteers and the number of new problems identified. Use of well-trained volunteers, provided with adequate supervision and follow-up physical examination of the children, identified many new problems at minimal cost and proved an effective means of expanding quality health care. PMID:706361
Stephen Claxton-Oldfield; Jane Claxton-Oldfield
The goal of this study was to examine the impact of hospice palliative care work on volunteers' lives. In-depth interviews were conducted with 23 direct-patient care volunteers. More than half of the volunteers became involved in hospice palliative care because of their own experiences with family members and\\/or friends who have died. Most of the volunteers reported that they were
... Modlin, who is Deputy Director of Communications and Public Liaison at the National Library of Medicine, participated in a clinical research trial studying the impact of changes in hormone levels on cognitive (thinking) ability and ... interested in public service, in volunteering, and wanted to contribute, in ...
Background Volunteering has been advocated by the United Nations, and American and European governments as a way to engage people in their local communities and improve social capital, with the potential for public health benefits such as improving wellbeing and decreasing health inequalities. Furthermore, the US Corporation for National and Community Service Strategic Plan for 2011–2015 focused on increasing the impact of national service on community needs, supporting volunteers’ wellbeing, and prioritising recruitment and engagement of underrepresented populations. The aims of this review were to examine the effect of formal volunteering on volunteers’ physical and mental health and survival, and to explore the influence of volunteering type and intensity on health outcomes. Methods Experimental and cohort studies comparing the physical and mental health outcomes and mortality of a volunteering group to a non-volunteering group were identified from twelve electronic databases (Cochrane Library, Medline, Embase, PsychINFO, CINAHL, ERIC, HMIC, SSCI, ASSIA, Social Care Online, Social Policy and Practice) and citation tracking in January 2013. No language, country or date restrictions were applied. Data synthesis was based on vote counting and random effects meta-analysis of mortality risk ratios. Results Forty papers were selected: five randomised controlled trials (RCTs, seven papers); four non-RCTs; and 17 cohort studies (29 papers). Cohort studies showed volunteering had favourable effects on depression, life satisfaction, wellbeing but not on physical health. These findings were not confirmed by experimental studies. Meta-analysis of five cohort studies found volunteers to be at lower risk of mortality (risk ratio: 0.78; 95% CI: 0.66, 0.90). There was insufficient evidence to demonstrate a consistent influence of volunteering type or intensity on outcomes. Conclusion Observational evidence suggested that volunteering may benefit mental health and survival although the causal mechanisms remain unclear. Consequently, there was limited robustly designed research to guide the development of volunteering as a public health promotion intervention. Future studies should explicitly map intervention design to clear health outcomes as well as use pragmatic RCT methodology to test effects. PMID:23968220
Leistikow, Bruce N.
-2013 Health Education & Promotion Volunteers Health Education & Promotion, Student Health & Counseling Services Volunteer Opportunities Health Education and Promotion (HEP) is a campus leader in providing student-centered education and advocating for health promoting environments to improve students
Zhou, Xianghong Jasmine
/about-us/volunteer-services/ The UCLA Care Extender Internship Program www.uclahealth.org/body.cfm?id=74 Trojan Health Volunteers JEPVolunteer Opportunities for Pre-Health Students Local Hospitals-LA Area Children's Hospital Los Medical Center www.glendaleadventist.org Glendale Memorial Hospital and Health Center www
White, Gretchen E.; Mazurek, Jacek M.; Moorman, Jeanne E.
Objective To estimate the prevalence of current asthma and the proportion of asthma that is work-related among health care and non–health care workers. Methods We used 2008 and 2010 Behavioral Risk Factor Surveillance System High Risk/Health Care Worker Module and Asthma Call-Back Survey data collected in 35 states and the District of Columbia to estimate prevalence ratios (PRs). Results Significantly more health care workers/volunteers than non–health care workers/volunteers with current asthma had asthma attacks (PR = 1.23; 95% confidence interval = 1.03 to 1.46) and asthma symptoms within the past year (PR = 1.07; 95% confidence interval = 1.00 to 1.14). There was no significant difference in the proportion of health care and non–health care workers/volunteers diagnosed with current asthma or work-related asthma. Conclusions The results of this study are consistent with previous research showing that health care workers with asthma have higher proportions of asthma attacks than non–health care workers. PMID:24270301
Pesut, Barbara; Hooper, Brenda; Lehbauer, Suzanne; Dalhuisen, Miranda
Hospice volunteers play an essential role in the primary care network for end of life. The purpose of this review was to examine the evidence on hospice volunteers published between 2002 and July 2012. An electronic search of PubMed, CINAHL and PsychINFO using controlled vocabulary, and a reference scan, yielded 54 studies focusing on hospice volunteers. Studies were primarily descriptive using quantitative, qualitative and mixed methods. Findings from studies were grouped thematically into descriptions of the work of hospice volunteers; recruitment, preparation and retention of hospice volunteers; and perspectives and outcomes of the volunteer role. A substantial body of evidence exists describing the roles, stresses and rewards of hospice volunteering. Less is known about how to adequately recruit, prepare and retain volunteers. A small but intriguing body of evidence exists around volunteers' contributions to family satisfaction and patient longevity. Although the evidence around hospice volunteers continues to grow, there is an urgent need for further research. Findings indicate that volunteers make important contributions to high quality end of life care. However, more focused research attention is required to better understand how to maximize this contribution while providing better support for volunteers. PMID:23277631
We invited men to discuss their volunteer careers with hospice-palliative care (HPC) to better understand how to recruit and train, retain and support, and then successfully end their volunteer experience. Nine male current or former HPC volunteers participated in face-to-face interviews which were transcribed and analyzed. The men described a complex interplay of individual characteristics with the unique roles available
Claxton-Oldfield, Stephen; Jones, Richard
In all, 119 hospice palliative care volunteers from 3 community-based hospice programs completed the Volunteer Retention Questionnaire (VRQ), a 33-item survey designed for this study. The VRQ asks volunteers to rate the importance of each item to their decision to continue volunteering. The items that received the highest mean importance ratings included enjoying the work they do, feeling adequately prepared/trained to perform their role, and learning from their patients' experiences/listening to their patients' life stories. Being recognized (eg, pins for years of service or being profiled in the hospice newsletter), receiving phone calls/cards from their volunteer coordinator on special occasions, and being reimbursed for out-of-pocket expenses were among the items that received the lowest mean importance ratings. Suggestions for improving volunteer retention are provided. PMID:22811213
Freeman, M; Ramanathan, S; Aitken, A; Dunn, P; Aird, J
The present paper looks at the challenges of palliative care delivery in rural and remote areas and proposes the establishment, education and coordination of a network of palliative care volunteers to assist in the delivery of non-clinical services. The development of a rural palliative care volunteer education and support training package is documented, together with details of the trailing of the package and its evaluation. Possible benefits of the program and some key issues to be considered when establishing a volunteer network are raised. PMID:9883110
G Threlkeld; B Bidstrup; J Downing
This presentation reports findings about the volunteer's role in an intervention developed through research to establish an accessible and sustainable model of advance care planning (ACP) for older people in rural communities in south eastern Australia. Entrust-U is innovative for initiating ACP through engaging volunteers in a number of roles, including: focussed interviews which move from an evaluative life review
Maes, Kenneth; Shifferaw, Selamawit
With the rollout of AIDS therapies, volunteer AIDS care has been promoted across Africa under the assumption that volunteerism is economically imperative in settings of health professional and resource scarcity. As low-income volunteers have become a major part of HIV/AIDS prevention and treatment workforces, it is imperative to question how poverty impacts their well-being. This chapter presents epidemiologic data collected during the 2008 food crisis from a sample of 110 AIDS care volunteers in Addis Ababa, Ethiopia, as well as narratives offered by HIV-positive volunteers, highlighting a widely overlooked way in which food insecurity and mental distress impact efforts to treat AIDS in sub-Saharan Africa. Food insecurity and elevated common mental disorder (CMD) symptom loads were common and tightly linked among the volunteers in the sample. Volunteers who were HIV-positive (17 percent) fared slightly worse in terms of food insecurity and psychosocial well-being. However, positive HIV serostatus was not associated with CMD in multivariate analyses accounting for food insecurity. Narratives illustrate how being HIV-positive shaped experiences of psychosocial stress, which involved unemployment and lack of prospects for marital relationships or strife within them. Our focus demonstrates the potential for mixing ethnographic and epidemiological methods to inform policy questions regarding poverty-reduction through compensation for volunteers' valuable labor, as well as AIDS care program sustainability. [volunteerism, AIDS care, food insecurity, livelihoods, HIV, psychosocial health]. PMID:24077603
Kammen, Daniel M.
University Health Services Volunteer Program HEALTH CLEARANCE Required Immunizations shown below Volunteer Name: Birthdate: Please either · Attach a COPY of your IMMUNIZATION RECORD (signed by a health TB Clearance (cannot expire within volunteering period) Negative TB skin test Negative T
This case study examines the current state of cultural competence in hospice and palliative care in the Greater Toronto Area (GTA). Because of changing demographic trends and ethnic minorities underutilizing hospice palliative care services, this research examined the current state of culturally competent care in a hospice setting, and the challenges to providing culturally competent care in a hospice in the GTA. A case study was conducted with a hospice and included in-depth interviews with 14 hospice volunteers. The findings reveal that volunteers encountered cultural clashes when their level of cultural competency was weak. Second, volunteers revealed there was a lack of adequate cultural competency training with their hospice, and finally, there was a lack of ethnic, cultural, and linguistic diversity among the hospice volunteers. PMID:21636588
Swygard, Heidi; Stafford, Renae E
Little is known about the risks, hazards, and health outcomes for health care personnel and volunteers working in disaster relief. We sought to characterize risks and outcomes in volunteers deployed to provide relief for victims of Hurricane Katrina. We performed a longitudinal e-mail survey that assessed preventive measures taken before and during deployment, exposures to hazards while deployed, and health outcomes at 1, 3, and 6 months postdeployment. Overall response rate was 36.1 per cent and one-third of those who responded did so for all three surveys. Exposures to different types of hazards changed over time with exposures to contaminated water being common. Despite predeployment and on-site education, use of preventive measures such as vaccination, appropriate clothing, hydration, sunscreen, and insect repellant was variable. Few injuries were sustained. Insect bites were common despite the use of insect repellants. Skin lesions, diarrhea, and other gastrointestinal complaints occurred most commonly early on during or after deployment. Psychological complaints were common at 3 and 6 months. In conclusion, identification of at risk volunteer cohorts with longitudinal surveillance is critical for future disaster planning to provide training for volunteers and workers and to allow for deployment of appropriate resources pre, during, and postdeployment. PMID:19774944
Brua, Charles R.
Health-care access for immigrants in the United States is often problematic because of language barriers, lack of health insurance, or differing expectations based on divergent medical systems in the U.S. and the immigrants' home countries. Such difficulties are exacerbated when a linguistic-minority population lives in a rural community that has…
This pilot study explored the view from six long-term care residents on the contributions of religious volunteers. The findings suggest that religious volunteers may contribute to long-term care residents' religious or spiritual health more than non-religious volunteers. However, since religious volunteers lack professional training and competence to attend to patients' religious needs, they may not afford in-depth spiritual and religious services. Under certain conditions when qualified chaplains are not available, inadequate religious services performed by religious volunteers are still better than no such care at all. However, in order to provide this important aspect of holistic care, we propose that health care policy makers should pay more attention to this topic. PMID:20306226
Respiratory Home Health Care Respiratory care at home can contribute to improved quality of life and significant cost savings. Your respiratory care ... your family and home situation to help your health care provider plan for your care after you are ...
Piliavin, Jane Allyn; Siegl, Erica
We investigate positive effects of volunteering on psychological well-being and self-reported health using all four waves of the Wisconsin Longitudinal Study. Confirming previous research, volunteering was positively related to both outcome variables. Both consistency of volunteering over time and diversity of participation are significantly…
Mathieson, C. M.
OBJECTIVE: To explore lesbian and bisexual women's experiences with their family physicians to learn about barriers to care and about how physicians can provide supportive care. DESIGN: Qualitative study that was part of a larger study of lesbian and bisexual women's health care. SETTING: The province of Nova Scotia, both urban and rural counties. PARTICIPANTS: Ninety-eight self-identified lesbian or bisexual women who volunteered through snowball sampling. Women were interviewed by lesbian, bisexual, or heterosexual female interviewers. METHOD: Semistructured, audiotaped, face-to-face interviews, exploring questions about demographic information, sexual orientation, general health care patterns, preferences for health care providers, disclosure issues, health care information, access issues, and important health care services. Transcription of audiotapes of interviews was followed by content, thematic, and discourse analyses. Thematic analysis is reported in this paper. MAIN OUTCOME FINDINGS: Three themes important for family physicians emerged: the importance of being gay positive, barriers to care, and strategies for providing appropriate care. CONCLUSIONS: Family physicians are in a pivotal position to ensure supportive care for lesbian and bisexual women. Physicians need to recognize barriers to care and to use gay-positive strategies, paying attention to self-education, health history, and clinic environment. PMID:9721419
Nicoletti, John; Flater-Benz, Lottie
Volunteerism has a poor reputation these days, because many human service programs have "used" volunteers and given them nothing in return. Discusses a different approach, one in which both service recipients and volunteers gain. (Author)
Stephen Claxton-Oldfield; Jane Claxton-Oldfield
This paper examines 4 common problems that many hospice palliative care volunteers in Canada (and the United States) encounter, namely, being underutilized, being placed with a patient too late in the patient's illness, feeling undervalued by some members of the medical staff, and not being able to do more to help patients and their families. The implications of each of
& County of Honolulu's Hanauma Bay Nature Preserve and will cover the history of Hanauma Bay volunteers will also have the opportunity to explore the Hanauma Bay Nature Preserve through fun activities
Stephen Claxton-Oldfield; Natasha Gosselin; Kirsten Schmidt-Chamberlain; Jane Claxton-Oldfield
A total of 22 family members, whose deceased loved ones had used the services of a hospice palliative care volunteer, responded to a brief survey designed to assess the importance of the different kinds of support offered to them (family members) by the volunteer, their impressions of the volunteers’ personal qualities\\/characteristics, their general experiences with the volunteer, and their overall
Morren, Mattijn; Yzermans, C Joris; van Nispen, Ruth M A; Wevers, Stephan J M
On May 13, 2000, a firework depot exploded in a residential area of the city of Enschede, The Netherlands. Many disaster workers responded, including volunteer firefighters, a group that has received little attention in disaster research. This study examined the presence of health problems in volunteer firefighters who were involved in disaster work, three years after the disaster. Furthermore, it was investigated whether demographic characteristics and disaster exposure predicted health problems. The study population consisted of 246 volunteer firefighters who were deployed in disaster work and 71 non-deployed controls. These firefighters completed a questionnaire which inquired about their perceived health and health change, physical symptoms, post-traumatic stress, mental health problems, and health care utilization. Three years after the disaster, no health differences emerged between deployed and non-deployed firefighters. Good health and health improvement over the previous year were reported. Respondents who encountered more distressing experiences during disaster work or carried out more direct disaster-related recovery tasks reported more mental health problems and health care utilization. However, the most reliable predictors of health problems were distressing experiences unrelated to the disaster in personal life or during work. Three years after the disaster, the health of volunteer firefighters involved in the disaster work was not much impaired, possibly because aftercare was available and utilized. Nevertheless, disaster exposure was associated with elevated post-traumatic stress symptoms and mental health care utilization. Health care workers should direct specific attention to the treatment and prevention of post-traumatic stress symptoms in cases of major accidents or disasters. PMID:16369116
Fegan, Colette; Cook, Sarah
The aim of the study was to investigate how people with serious mental illness perceived the experience of volunteering for the health care organisation in which they had received a service. The study took a qualitative approach and in phase one, eleven service user volunteers were purposefully sampled and interviewed. In depth interviews were analysed using grounded theory. This paper describes the findings from phase one, and highlights the following themes to represent the volunteering experience: 1) rehearsing for a new direction; 2) treading carefully at first; 3) discovering my new self; and, 4) using my experience and extending relationships. These themes further support a tentative theoretical framework that considers supported volunteering to enhance recovery because it fosters positive risk taking and gives individuals a valued identity that integrates their mental health experience. In phase two, this framework will be tested with service users in more diverse volunteer positions. The findings of my study suggest that mental health services are in a unique position to build partnerships with service users to support their recovery and journeys toward employment by providing opportunities for volunteering. PMID:22907319
Powell, Suzanne K
Health care tourism is often a preplanned event carefully laying out all the details. Sometimes, when one least expects it, medical care is needed outside of the mainland. This Editorial speaks to an unplanned experience. PMID:25436438
... and help you avoid problems. Talk to your health care provider or visit a travel clinic 4 - 6 ... If you are taking medicine, talk to your health care provider before leaving. Carry all medicines with you ...
Bulger, R J
As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals. PMID:2394563
In health care, one sector's surge can mean another's stall. So goes the story for companies that make up our first-ever Health Care 250, a ranking of 1998 performance compiled for H&HN by the HealthCare Markets Group. "It's a far cry from the halcyon days of 1995," says John Cumming, the group's managing director, "when health care stocks gained an average of 40 percent." PMID:10224968
This paper describes the Portage County, Ohio community hospice program, emphasizing the linkages between family life specialists, health professionals, volunteers, and students. Hospice service is defined as a specialized, home-based program for the management of pain and other symptoms of terminal illness, with the family as the unit of care.…
Leistikow, Bruce N.
HEALTH CARE COMPLIANCE ASSOCIATION 5780 Lincoln Drive · Suite 120 · Minneapolis, MN 55436 · 888 of the following document, "Evaluating and Improving a Compliance Program, A Resource for Health care Board Members, Health care Executives and Compliance Officers." This resource is now available to all HCCA members
The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment
Compares the American health care system with those of England and Sweden; presents evidence to support view that cultural factors influence health care significantly. Health care systems in small countries with homogenous populations tend to accept cultural factors, but do so with less ease in countries with heterogenous populations and…
Klein, Nicole Aydt; And Others
Researchers conducted focus group interviews with college student peer health educators to determine what factors motivated them to volunteer for a peer health education program. Examination of their life experiences, motivations, and program expectations indicated that life experiences, belief in the effectiveness of peer health education, and…
Barron, Jeremy S; Tan, Erwin J; Yu, Qilu; Song, Meilin; McGill, Sylvia; Fried, Linda P
Volunteer service opportunities for older adults may soon be expanded. Although volunteering is thought to provide health benefits for healthier older adults, it is not known whether older adults in less than very good health are suitable candidates for high-intensity volunteering and can derive health benefits. This manuscript presents a prospective analysis of 174 older adult volunteers serving in Experience Corps Baltimore, a high-intensity senior volunteer program in Baltimore, Maryland. Volunteers served > or =15 h per week, for a full school year, in elementary schools helping children with reading and other skills between 1999 and 2002. Volunteers were assessed with standardized questionnaires and performance-based testing including grip strength, walking speed, chair stand speed, and stair-climbing speed prior to school volunteering and at the end of the school year. Results were stratified by health status. Among 174 volunteers, 55% initially reported "good" and 12% "fair" or "poor" health status. At baseline, those in fair health reported higher frequencies of disease and disability than volunteers in excellent or very good health. After volunteering, a majority of volunteers in every baseline health status category described increased strength and energy. Those in fair health were significantly more likely to display improved stair-climbing speed than those in good or excellent/very good health (100.0% vs. 53.4% vs. 37.5%, p = 0.05), and many showed clinically significant increases in walking speed of >0.5 m/s. Satisfaction and retention rates were high for all health status groups. Clinicians should consider whether their patients in fair or good health, as well as those in better health, might benefit from high-intensity volunteer programs. Productive activity such as volunteering may be an effective community-based approach to health promotion for older adults. PMID:19488860
Pillemer, Karl; Fuller-Rowell, Thomas E.; Reid, M. C.; Wells, Nancy M.
Purpose: This study tested the hypothesis that volunteering in environmental organizations in midlife is associated with greater physical activity and improved mental and physical health over a 20-year period. Design and Methods: The study used data from two waves (1974 and 1994) of the Alameda County Study, a longitudinal study of health and…
Stephen Claxton-Oldfield; Simone Guigne; Jane Claxton-Oldfield
Two separate studies were conducted to better understand why so few middle-aged and older men volunteer in hospice palliative care; only about 10% of the patient\\/family care volunteers in New Brunswick’s community-based hospice palliative care volunteer programs are men. In study 1, 15 (22%) of the 68 men who read a brief description about the kinds of things that hospice
This case study of 14 hospice and palliative care volunteers looked for recommendations and suggestions on how to increase cultural competency among hospice volunteers. In-depth interviews were conducted with a hospice in Toronto, Canada, and findings reveal that volunteers have very specific and diverse recommendations on how they prefer to be briefed and educated on cultural competency issues surrounding their
... to do the following: Refuse or withdraw life-enhancing care Refuse or stop tube feeding or other ... be: Your doctor or health care provider An employee of your doctor or of a hospital, nursing ...
Campbell, Catherine; Gibbs, Andy; Maimane, Sbongile; Nair, Yugi
With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV/AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS - as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a 3-year project which sought to train and support volunteer health workers in a rural community in South Africa. Given the growing emphasis on involving community voices in project research, we conducted 17 discussions with 34 community members, including those involved and uninvolved in project activities - at the end of this 3-year period. These discussions aimed to elicit local people's perceptions of the project, its strengths and its weaknesses. Community members perceived the project to have made various forms of positive progress in empowering volunteers to run a more effective home nursing service. However, discussions suggested that it was unlikely that these efforts would be sustainable in the long term, due to lack of support for volunteers both within and outside of the community. We conclude that those seeking to increase the role and capacity of community volunteers in AIDS care need to make substantial efforts to ensure that appropriate support structures are in place. Chief among these are: sustainable stipends for volunteers; commitment from community leaders and volunteer team leaders to democratic ideals of project management; and substantial support from external agencies in the health, welfare and NGO sectors. PMID:19194598
Following the September 11, 2001, incident in the United States (US) and subsequent natural disasters, the US, like other countries, has focused on improving its overall disaster response capabilities. One mechanism that is under development to improve the country's surge capacity, i.e., its ability to substantially increase the number of volunteer health care professionals available to respond during a disaster, is the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). Registries, like ESAR-VHP, are significant tools for disaster planning and deployment. The goal of ESAR-VHP is to create a state-based registry of volunteer health professionals, verify their credentials prior to a disaster, and provide opportunities for education and training in disaster response. Each of these steps is necessary in ensuring access to patient services during an emergency, while also providing for the safety of the volunteer health professional. This article speaks to the registered nurse as a volunteer acting within these types of registries. Specifically, it addresses the development of a personal and professional response plan, and registration programs that provide the preparation needed to enable a nurse responder to work effectively within a disaster response team and facilitate preregistration with one and only one registry. The legal implications of responding are also discussed. PMID:17279858
The United States health care is presently challenged by a significant economic crisis. The purpose of this report is to introduce the readers of Medicinski Pregled to the root causes of this crisis and to explain the steps undertaken to reform health care in order to solve the crisis. It is hoped that the information contained in this report will be of value, if only in small measure, to the shaping of health care in Serbia. PMID:24245454
Burbeck, Rachel; Low, Joe; Sampson, Elizabeth L.; Bravery, Ruth; Hill, Matthew; Morris, Sara; Ockenden, Nick; Payne, Sheila
Abstract Background: Worldwide, the demand for specialist palliative care is increasing but funding is limited. The role of volunteers is underresearched, although their contribution reduces costs significantly. Understanding what volunteers do is vital to ensure services develop appropriately to meet the challenges faced by providers of palliative care. Objective: The study's objective is to describe current involvement of volunteers with direct patient/family contact in U.K. specialist palliative care. Design: An online survey was sent to 290?U.K. adult hospices and specialist palliative care services involving volunteers covering service characteristics, involvement and numbers of volunteers, settings in which they are involved, extent of involvement in care services, specific activities undertaken in each setting, and use of professional skills. Results: The survey had a 67% response rate. Volunteers were most commonly involved in day care and bereavement services. They entirely ran some complementary therapy, beauty therapy/hairdressing, and pastoral/faith-based care services, and were involved in a wide range of activities, including sitting with dying patients. Conclusions: This comprehensive survey of volunteer activity in U.K. specialist palliative care provides an up-to-date picture of volunteer involvement in direct contact with patients and their families, such as providing emotional care, and the extent of their involvement in day and bereavement services. Further research could focus on exploring their involvement in bereavement care. PMID:24475743
... to start search site map [a-z] Health Health Care Information A-Z Health Topic Finder My Health ... General QUICK LIST Apply for Benefits Apply for Health Care Prescriptions My Health e Vet eBenefits Life Insurance ...
Notkin, Herbert; Meader, Leland V.
Emphasizing risk management, the authors point out that health care cost containment is feasible and outline a number of areas--including health maintenance organizations--in which cost containment has been successful in specific instances. (IRT)
Lindgren, Mark C; Ross, Lawrence S
Most patients in the United States with reproductive health disorders are not covered by their health insurance for these problems. Health insurance plans consider reproductive care as a lifestyle choice not as a disease. If coverage is provided it is, most often, directed to female factor infertility and advanced reproductive techniques, ignoring male factor reproductive disorders. This article reviews the history of reproductive health care delivery and its present state, and considers its possible future direction. PMID:24286778
Klein, N A; Sondag, K A; Drolet, J C
We conducted focus group interviews with students who were current peer health educators at a mid-sized university to determine what factors motivate individuals to volunteer for a peer health education program. Specifically, we asked the participants questions designed to explore their life experiences, their expectations of the peer education program, and their motivations. Constructs from social learning theory were used to categorize and contribute to our understanding of the responses. Many participants specified experiences with family members or friends, such as alcoholism or other illnesses, that had influenced their decisions. Participants' expectation of the program varied greatly and did not indicate a strong link to the decision to volunteer. The peer health educators' motivations for volunteering were altruistic, such as wanting to help others; egotistic, such as wanting job training; or related to self-efficacy beliefs, such as satisfying a personal need for health education. This study indicated that life experiences, a belief in the effectiveness of peer health education programs, and positive reinforcement to join influence the decision to volunteer. Implications for coordinating peer education programs are discussed. PMID:7814769
Volunteers for Days of Caring '99 set up the paint trays for painting at Baxley Manor, an apartment building for senior citizens on Merritt Island. Coordinated by the KSC Community Relations Council, Days of Caring provides an opportunity for employees to volunteer their services in projects such as painting, planting flowers, reading to school children, and more. Organizations accepting volunteers include The Embers, Yellow Umbrella, Serene Harbor, Domestic Violence Program, the YMCA of Brevard County, and others.
A volunteer for Days of Caring '99 prepares a light fixture before painting the walls in the hallway at Baxley Manor, an apartment building for senior citizens on Merritt Island. Coordinated by the KSC Community Relations Council, Days of Caring provides an opportunity for employees to volunteer their services in projects such as painting, planting flowers, reading to school children, and more. Organizations accepting volunteers include The Embers, Yellow Umbrella, Serene Harbor, Domestic Violence Program, the YMCA of Brevard County, and others.
KSC volunteers for Days of Caring '99 unfold protective materials before getting ready to paint at Baxley Manor, an apartment building for senior citizens on Merritt Island. Coordinated by the KSC Community Relations Council, Days of Caring provides an opportunity for employees to volunteer their services in projects such as painting, planting flowers, reading to school children, and more. Organizations accepting volunteers include The Embers, Yellow Umbrella, Serene Harbor, Domestic Violence Program, the YMCA of Brevard County, and others.
KSC volunteers with Days of Caring '99 share tasks while getting ready to paint at Baxley Manor, an apartment building for senior citizens on Merritt Island. Coordinated by the KSC Community Relations Council, Days of Caring provides an opportunity for employees to volunteer their services in projects such as painting, planting flowers, reading to school children, and more. Organizations accepting volunteers include The Embers, Yellow Umbrella, Serene Harbor, Domestic Violence Program, the YMCA of Brevard County, and others.
Karen M. Robinson; Kay F. Kiesler; Stephen W. Looney
This pilot study explored the effect that respite care training had on volunteers' knowledge about Alzheimer's disease (AD), their attitudes toward the cognitively impaired, and their self-esteem. Volunteer respite providers (n = 52) were recruited and participated in four different day (seven-hour) respite care training programs. The sample was predominantly female (85 percent) and white (90 percent). Knowledge about AD
Sprinkle, R H
Standard models of patient demand for health care and health care suppliers' response to that demand imply that some manner of manipulation of the prices faced by patients must be chief among the mechanisms of systemic cost control. However convenient econometrically, these standard models cannot reflect the complexity of patient demand behavior, and they say little about the predominant causes of health-care cost escalation. This paper describes a richer Jevonian political-economic model that sensibly portrays patient demand and physician and corporate supply behaviors and suggests a range of cost-controlling and care-enhancing compensatory steps, some professional, some societal. This new model implies that reformers in the United States could take respectful advantage of the fundamentally self-regulating nature of patient demand for health care by shifting their attention away from its further discouragement and toward the modulation of other factors. PMID:8014422
Fischinger, Janez; Fischinger, Ales; Fischinger, Dusa
Not only the health service but also several other humanitarian institutions and societies were active in Abbazia÷Opatija, the most important town on the once Austrian Riviera, the town that was also known as the Austrian Nice. The most important of the societies was The Health Resort Opatija Volunteer Fire Brigade and Rescue Society. The authors of this article have been particularly interested in the society's founding and its activity until it moved into the new building at 6, St. Florjan's Street in 1910. The fast urbanisation and the development of the industry raised the need of the well organised activity of putting out fires. The German gymnastics societies were the first to include the education and the skills development of the volunteer firemen into their programmes. The first volunteer fire brigades appeared in Austria after 1863. The huge fire that broke out in Vienna in 1881 showed that the fast and efficient rescuing demanded a well prepared organization of a team of rescuers. Based on the initiative of the chimney sweep Franz Drescher and The South Railway Company, the volunteer fire brigade was founded in Opatija already in 1886. The founding of the volunteer rescue society was based on the idea given by dr. Jaromir Mundy, the permanent guest in Opatija and a friend of prof. dr. Theodor Billroth, in 1894. The intertwining activity of the both societies resulted in their formal joining. The head physician became dr. Franz Tripold, the chief commander was Franz Doberlet junior. For his special merits, the general assembly of the Health Resort Opatija Volunteer Fire Brigade and Rescue Society appointed him the honourable commander of the society in 1903 and he received a special photo album with the photos of the volunteer firemen and the rescuers' practice. The Emperor Franz Joseph I Jubilee Fire Station, the Rescue Station And the Sanatorium (Kaiser Franz Joseph I Jubiläums - Feuerwehrrüstungshaus, Rettungsstation und Erholungsheim) was given to the use on 1st October 1910. Since then, the two societies worked at this same location. The Volunteer Fire Brigade Opatija has been located in this building ever since. PMID:22047481
Piontkovski, V; Novakovska, L; Pasternak, V
The purpose of the discussion is to evaluate certain aspects of the Polish health care system - its ability to respond to contemporary dynamic social, economic and epidemiological changes (including the spread of chronic diseases, aging population or family crisis - its possibilities for providing care of the sick). The analysis of such a problem was based on a critically-oriented perspective that is developed in the field of the sociology of health and illness. The text pays particular attention to the problem of deepening social inequalities, which can be considered as one of the major factors that hinder access to health care and influence poorer health condition: In this context the mechanism of "saving health" and borrowing in order to satisfy the health needs in the face of financial difficulties was mentioned. Moreover, the text includes the attempt to evaluate the effectiveness of health promo- tion programs in our country as potentially the most effective way of raising the level of public health. There is also the issue of public confidence in health care institutions and the approval of attempts towards reforming the medical system in our country. A separate part of the discussion was devoted to criticism of the idea of reducing the role of the state in the health care sector. PMID:25509924
ANDREW M. JONES
This chapter presents the econometric methods that are used in health economics to model individuals health care costs. These methods are used for prediction, projection and forecasting, in the context of risk adjustment, resource allocation, technology assessment and policy evaluation. The chapter reviews the literature on the comparative performance of the methods, especially in the context of forecasting individual health
Court decisions taking away someone's freedom by requiring them to serve a jail sentence should not deny them access to the same health care available to free citizens in full compliance with patient confidentiality. Health institutions, responsible for administering somatic care, offer a comprehensive response to the medical needs of those under justice control, both in jails and conventional care units. For a physician, working in the correctional setting implies accepting its constraints, and violence, and protecting and enforcing fundamental rights, as well as rights to dignity, confidential care and freedom to accept or refuse a treatment. PMID:23457834
KSC volunteers at Miracle City Mall, Titusville, help unload containers for Meals on Wheels delivery as part of their '99 Days of Caring participation. The volunteers will also help deliver the meals. Coordinated by the KSC Community Relations Council, Days of Caring provides an opportunity for employees to volunteer their services in projects such as painting, planting flowers, reading to school children, and more. Organizations accepting volunteers include The Embers, Yellow Umbrella, Serene Harbor, Domestic Violence Program, the YMCA of Brevard County, and others.
This paper explores the manner in which two hospices--one located in Denmark and one in Australia--negotiate and determine the boundaries of volunteer workers vis-à-vis paid staff. A comparative case study approach was used to juxtapose organisations with similar activity fields located in different welfare state systems, i.e. a social democratic welfare state and a liberal welfare state. This study involved non-participant observation of volunteers at work and unstructured interviews with volunteers, staff and management in the hospices (n = 41). Data were collected between August 2012 and February 2013. Data were managed using NVivo and analysed thematically. A key finding is that volunteers in the Danish hospice were excluded from all direct care work due to the effective monopoly of the professional care providers, whereas the Australian volunteers participated in the provision of care to the extent that risk could be eliminated or mitigated to an acceptable level. The findings suggest two different models of the roles of volunteers in tension with professional care providers. Both models recognise that volunteers add to the level of care delivered by the organisations and allow for a discussion that moves away from the normative discussions of 'not taking somebody's job', while also recognising that volunteers must be more than just the 'nice extra' if they are to be of any real value to the organisation and to care receivers. PMID:25442013
Brown, M S
This is the third and last article reporting professional exchange tours between American nurses and nurses of other countries. In this article, the health care system of Kenya is discussed and comparisons made between this system and our own. Out of this comparison come several insights into our own way of doing things and possibilities for improving them. "Health Care in the Soviet Union" appeared in the April 1984 issue of The Nurse Practitioner. "Health Care in China" appeared in the May 1984 issue of the journal. PMID:6462542
Gaetano, Diana E; Ackerman, Susan; Clark, Arleen; Hodge, Bernadette; Hohensee, Thomas; May, John; Whiteman, Wendy
The purpose of this study was to assess the effectiveness of coronary heart disease risk screening as a primary prevention tool. Screening included a lipid screening and American College of Cardiology Framingham cardiac risk profile for volunteers 45 years and older desiring A (interior) or B (exterior) classifications. Health surveillance records from 1998 to 2003 were reviewed for all firefighters and emergency medical services personnel in a rural New York county. Of the 1,458 volunteers evaluated, 1,166 were men and 292 were women. Three hundred fifteen individuals were screened for coronary heart disease risk; 52 had scores indicative of substantially increased risk. Subsequently, a health care provider or cardiologist saw 39 of these individuals, 26 (67%) of whom received pharmacologic, surgical, or other health care intervention. Coronary heart disease risk screening is an effective intervention in this population, and provides volunteers and their primary care providers with added motivation to actively reduce the risk of coronary heart disease via early intervention. PMID:17323871
Wilson, Ronald W.; And Others
Discusses current trends in health and health care, assesses significance of current data, and investigates causes and implications of the data for future health and health care. For journal availability, see SO 506 144. (Author/DB)
Ramsaran-Fowdar, Roshnee R
Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. PMID:16318013
Health care automation companies: card transaction processing/EFT/EDI-capable banks; claims auditing/analysis; claims processors/clearinghouses; coding products/services; computer hardware; computer networking/LAN/WAN; consultants; data processing/outsourcing; digital dictation/transcription; document imaging/optical disk storage; executive information systems; health information networks; hospital/health care information systems; interface engines; laboratory information systems; managed care information systems; patient identification/credit cards; pharmacy information systems; POS terminals; radiology information systems; software--claims related/computer-based patient records/home health care/materials management/supply ordering/physician practice management/translation/utilization review/outcomes; telecommunications products/services; telemedicine/teleradiology; value-added networks. PMID:10153839
Heyssel, R M
The author discusses the need to make corrections in the U.S. health care system, describes the simplistic and money-oriented definition that many persons have of "health care reform," and discusses the issues he thinks will and will not be dealt with in the coming reforms of the health care system. He maintains that true reform would deal with matters such as restraining expansion of the health care industry, setting reasonable fees, and confronting the harmful social and environmental conditions that result in high "medical" care costs and poor health statistics. The medical profession--including academic medical centers--has a large role to play in true health care reform, which will involve facing the major barriers (which he outlines) that are now impeding important reforms (e.g., increasing the number of generalist physicians; finding better ways to pay for medical students' and residents' education). The profession cannot make progress in true reform without developing a vision of what the U.S. health care system should be and becoming active in moving toward that vision, acting in the interests of both the individual patient and the community as a whole. The author outlines some of the barriers to finding that vision (such as the influence of third-party payers on the doctor-patient relationship and the fragmentation of medicine and medical education by specialties and subspecialties) and proposes the characteristics and values of the kind of medical education and community involvement of academic medical centers that can help create the needed vision, regain the trust of the public, and thereby reform health care in the interests of both the community and the profession. PMID:8447905
Rustagi, Neeti; Singh, Ritesh
Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries’ health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now. PMID:21120080
Rustagi, Neeti; Singh, Ritesh
Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries' health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now. PMID:21120080
Kentucky State Dept. for Social Services, Frankfort.
The goal for this project was to recognize the volunteers at the beginning of the project and to focus on a program to increase the utilization of volunteers in essential service delivery to at-risk persons in the Big Sandy region of eastern Kentucky. A diverse committee made up of business, education, civil leaders, service providers, and…
Fullner, Sheryl Kindle
Not all volunteers respond the same way to the same stimuli. The purpose of this article is to suggest several ways to nurture volunteers in a library media center setting. Some might respond best to a printed word of appreciation or recognition in a district newsletter, while others would value a book or pin as a gift. Perks, like allowing…
This case study of 14 hospice and palliative care volunteers looked for recommendations and suggestions on how to increase cultural competency among hospice volunteers. In-depth interviews were conducted with a hospice in Toronto, Canada, and findings reveal that volunteers have very specific and diverse recommendations on how they prefer to be briefed and educated on cultural competency issues surrounding their patients. Findings also reveal hospice volunteers want more cultural competency training and acknowledge the importance of being culturally competent. This article concludes with a précis on recommendations for increasing cultural competency in hospice and palliative care for both volunteers and agencies and discusses the top 4 future trends in cultural competency for hospice care. PMID:21727150
Herbert, Solomon J.
The health care crisis faced by African Americans must be addressed by the nation as a whole with the same energy that erupts when a natural disaster occurs. On an individual basis, blacks can improve their own health with attention to child nurturing and personal nutrition. (SLD)
This article examines issues on health care costs and describes measures taken by public districts to reduce spending. As in most companies in America, health plan designs in public districts are being changed to reflect higher out-of-pocket costs, such as higher deductibles on visits to providers, hospital stays, and prescription drugs. District…
Stephen Claxton-Oldfield; Natasha Gosselin; Jane Claxton-Oldfield
A community sample of 100 adults was asked to imagine that they had been recently diagnosed with a life-threatening illness. After reading about the services provided by hospice palliative care volunteers, participants were asked whether they would choose to have a volunteer help them and to give a reason for their answer. Eighty-nine of the 100 participants indicated that they
The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.
Medina, J L; De Melo, P C
Quality assurance is a relatively recent concern but already plays a major role in health care management and provision. Quality involves the definition of a comprehensive programme tailored by realistic and effective objectives and norms that include the structured review of procedures (namely clinical audits) and the use of up-to-date protocols. The involvement and motivation of health professionals, together with an adequate internal and external communication strategy, play a key role in the planning and application of these programmes. The use of programmed assessment, based on a solid knowledge of current practice, should have practical implications, optimising procedures in order to improve the quality of care. This commitment towards quality in health care should go far beyond governmental policy and should have clear support from health professionals. PMID:11234496
Diane Gage Lofgren; Sonia Rhodes; Todd Miller; Jared Solomon
One of the most elusive challenges in health care marketing is hitting on a strategy to substantially differentiate your organization in the community and drive profitable business. This article describes how Sharp HealthCare, the largestintegrated health care delivery system in San Diego, has proven that focusing first on improving the health care experience for patients, physicians, and employees can provide
Doctors in developing countries where the majority of the population live in rural areas are facing difficult adjustments of their roles to attain health for all of the rural population. In Thailand, doctors directing remote district hospitals act as the focal points of other health care facilities serving the entire population of the districts. To supplement the existing governmental health service network and in accordance with principles of primary health care, community primary health care volunteers are being developed to expand service coverage to rural communities. These lead to changes in doctors' roles. Doctors are required to be not only competent clinicians but also good managers of health promotive and preventive programmes, effective hospital administrators, competent trainers and qualified researchers. They must not only work within the hospital but also support the health personnel and activities of the entire district, and in particular the community primary health care workers. However, as it is now, they are graduates of traditional medical schools, whose educational programmes do not equip them adequately for their emerging new roles in rural hospitals. Reorientation of the existing health system, including its health personnel, is needed. The critical factor in such a process is the development of appropriate attitudes at all levels of health services. This is a difficult but challenging task, as it involves long established medical institutions which hold firmly to old traditions and values. PMID:7179451
Ko, Nai-Ying; Feng, Ming-Chu; Chiu, Dan-Ying; Wu, Mei-Hsin; Feng, Jui-Ying; Pan, Shung-Mei
Severe acute respiratory syndrome (SARS) spread worldwide after an outbreak in Guangdong Province, China, in mid-November 2002. Health care workers were at highest risk of infection. The purpose of this study, which was based on Ajzen's theory of planned behavior (TPB), was to determine the extent to which personal attitudes, subjective norms, and perceived control influence nurses' intention and volunteering to care for SARS patients. After the SARS outbreak, a total of 750 staff nurses (response rate 90%) at one hospital completed a questionnaire assessing their intention to provide care to SARS patients. Overall, 42.7% of nurses had a positive intention to provide care to SARS patients, and 25.4% of nurses would volunteer to care for SARS patients. Four factors explaining 35% of the variance in nurses' intention to care for SARS patients were self-efficacy (beta = 0.39, p < 0.001), attitude (beta = 0.25, p < 0.001), years of working in the study hospital (beta = -0.15, p < 0.001), and receiving resources from the hospital (beta = 0.13, p < 0.001). Two factors explaining 15% of the variance in nurses' volunteering to care for SARS patients were intention (beta = 0.31, p < 0.001) and attitude (beta = 0.15, p < 0.001). The final model shows that the variables of the TPB contributed significantly to the explanation of a portion of variance in nurses' intention and volunteering to care for SARS patients. The results are helpful for human resources managers facing a new contagious disease. PMID:15473650
Coble, Theresa G.
CONNECTIONS OF CARING: A STUDY OF SEATTLE AQUARIUM VOLUNTEER BEACH NATURALISTS By DAOUD NEIL MILLER in Resource Interpretation STEPHEN F. AUSTIN STATE UNIVERSITY JANUARY 2010 #12;2 CONNECTIONS OF CARING concerning people's emotional connections to natural environments, their caring practices, and their adoption
Stephen Claxton-Oldfield; Yana Banzen
The goal of this study was to examine the personality characteristics of hospice palliative care volunteers by measuring the so-called big five personality traits and 4 separate aspects of empathy. A total of 99 hospice palliative care volunteers completed the NEO Five-Factor Inventory (NEO-FFI) of Costa Jr and McCrae and the Interpersonal Reactivity Index (IRI) of Davis. The vast majority
Meades, Karen; Roberts, Robert
To inaugurate its fifth year of publication, The American Heart Hospital Journal (AHHJ) focused its Winter 2007 issue on health care systems from around the world, with 8 articles contributed by national leaders in their respective countries. Due to the interest and wide range of expertise in the international cardiac community, we continued to publish Special Reports throughout 2007 on this topic. In this issue we present the final two international perspectives, for a total of 12 individual international perspectives plus a final report from Robert Roberts, MD, that surveys the health care systems of an additional 4 countries, including his own, Canada. Our goal in publishing the series: to highlight the variety of systems currently employed worldwide, in the hope that such an international exchange of commentaries would result in debate and reforms where needed. We welcome your comments on the series, as well as your aspirations and ideas for the future of our national system of health care. PMID:17982309
Volunteers can contribute a great deal to people receiving health or social care. Some of the quirky activities they offer are contact with owls and the provision of arts and crafts materials. PMID:19323106
Stephen Claxton-Oldfield; Jessica MacDonald; Jane Claxton-Oldfield
A study was conducted to determine the kind of information palliative care volunteers would like to know about the patients they are being asked to support before they actually meet with them for the first time. Thirty-one palliative care volunteers responded to a brief questionnaire, developed for this study. At least half of the volunteers indicated that their coordinator provided
Ludwick, Teralynn; Brenner, Jennifer L; Kyomuhangi, Teddy; Wotton, Kathryn A; Kabakyenga, Jerome Kahuma
Globally, health worker shortages continue to plague developing countries. Community health workers are increasingly being promoted to extend primary health care to underserved populations. Since 2004, Healthy Child Uganda (HCU) has trained volunteer community health workers in child health promotion in rural southwest Uganda. This study analyses the retention and motivation of volunteer community health workers trained by HCU. It presents retention rates over a 5-year period and provides insight into volunteer motivation. The findings are based on a 2010 retrospective review of the community health worker registry and the results of a survey on selection and motivation. The survey was comprised of qualitative and quantitative questions and verbally administered to a convenience sample of project participants. Between February 2004 and July 2009, HCU trained 404 community health workers (69% female) in 175 villages. Volunteers had an average age of 36.7 years, 4.9 children and some primary school education. Ninety-six per cent of volunteer community health workers were retained after 1 year (389/404), 91% after 2 years (386/404) and 86% after 5 years (101/117). Of the 54 'dropouts', main reasons cited for discontinuation included 'too busy' (12), moved (11), business/employment (8), death (6) and separation/divorce (6). Of 58 questionnaire respondents, most (87%) reported having been selected at an inclusive community meeting. Pair-wise ranking was used to assess the importance of seven 'motivational factors' among respondents. Those highest ranked were 'improved child health', 'education/training' and 'being asked for advice/assistance by peers', while the modest 'transport allowance' ranked lowest. Our findings suggest that in our rural, African setting, volunteer community health workers can be retained over the medium term. Community health worker programmes should invest in community involvement in selection, quality training, supportive supervision and incentives, which may promote improved retention. PMID:23650334
Ludwick, Teralynn; Brenner, Jennifer L; Kyomuhangi, Teddy; Wotton, Kathryn A; Kabakyenga, Jerome Kahuma
Globally, health worker shortages continue to plague developing countries. Community health workers are increasingly being promoted to extend primary health care to underserved populations. Since 2004, Healthy Child Uganda (HCU) has trained volunteer community health workers in child health promotion in rural southwest Uganda. This study analyses the retention and motivation of volunteer community health workers trained by HCU. It presents retention rates over a 5-year period and provides insight into volunteer motivation. The findings are based on a 2010 retrospective review of the community health worker registry and the results of a survey on selection and motivation. The survey was comprised of qualitative and quantitative questions and verbally administered to a convenience sample of project participants. Between February 2004 and July 2009, HCU trained 404 community health workers (69% female) in 175 villages. Volunteers had an average age of 36.7 years, 4.9 children and some primary school education. Ninety-six per cent of volunteer community health workers were retained after 1 year (389/404), 91% after 2 years (386/404) and 86% after 5 years (101/117). Of the 54 ‘dropouts’, main reasons cited for discontinuation included ‘too busy’ (12), moved (11), business/employment (8), death (6) and separation/divorce (6). Of 58 questionnaire respondents, most (87%) reported having been selected at an inclusive community meeting. Pair-wise ranking was used to assess the importance of seven ‘motivational factors’ among respondents. Those highest ranked were ‘improved child health’, ‘education/training’ and ‘being asked for advice/assistance by peers’, while the modest ‘transport allowance’ ranked lowest. Our findings suggest that in our rural, African setting, volunteer community health workers can be retained over the medium term. Community health worker programmes should invest in community involvement in selection, quality training, supportive supervision and incentives, which may promote improved retention. PMID:23650334
This paper provides first-time grant writers with suggestions on how to approach a private funding source. While intended for rural health care advocates, the remarks are equally applicable for educators and others. The rural crisis has produced many heart-rending stories about medically indigent people, but there is a lack of reliable statistics…
2012 Health Care Basics: Choosing the Best Option for Your Health "Creating A More Educated Georgia" #12;Health Care Basics 2 Medical Options for Plan Year 2012 The University System of Georgia's Plan of Regents will offer the following health care options: · Blue Choice HMO · Kaiser Permanente HMO · HSA Open
This case study examines the current state of cultural competence in hospice and palliative care in the Greater Toronto Area (GTA). Because of changing demographic trends and ethnic minorities underutilizing hospice palliative care services, this research examined the current state of culturally competent care in a hospice setting, and the challenges to providing culturally competent care in a hospice in
Kowitt, S D; Emmerling, D; Fisher, E B; Tanasugarn, C
The village health volunteers (VHVs) have been a regular part of Thailand's health system since the 1960s. Despite widespread recognition, little research has been conducted to describe VHV activities, the settings in which VHVs provide help, how the program is administered, and how changing politics and health problems in Thailand have influenced the program. In order to understand the roles and practices of the VHVs, we conducted in-depth semi-structured interviews and focus groups with VHVs, community leaders and members, and public health officials in three semi-urban communities in central Thailand. Using the Social Ecological Framework, we mapped factors that influenced how the VHVs provided support, including governmental oversight, collaboration with public health officials, and community trust. These influences are discussed as "points of consideration," which help to identify the strengths and tensions within the VHV program and best practices in supporting and assessing community health worker efforts. PMID:25744815
Librett, John; Yore, Michelle M.; Buchner, David M.; Schmid, Thomas L.
The authors discuss the role that volunteer programs may play in increasing levels of physical activity. In some cases volunteer programs may simultaneously improve individual health, benefit the environment and increase the public's opportunities for physical activity. From a survey of 2,032 respondents, results suggest that volunteers are more…
Shelley, Greg K; Castro, Carmen; Cron, Stanley G
In this descriptive study, former and current volunteer ombudsmen (n = 65) completed an online survey and Chi-square analyses were used to determine group differences in order to examine the impact of internet-based communication on the recruitment and retention of volunteer long-term care ombudsmen. The results showed that the program's shift to internet-based recruitment and communication methods helped increase the number of volunteers by 50% and contributed to a positive shift in role perception and satisfaction. Consequently, the proliferation of internet and social media usage permits greater volunteer management opportunities than previously were available. These tools also allow for consistency of message, extended training opportunities, and recourse to resources at need which permit ombudsmen volunteers to identify more readily with the role of resident advocate and receive greater performance satisfaction as it relates to that role. PMID:25498919
Guo, Lining; Milburn, Michael V.; Ryals, John A.; Lonergan, Shaun C.; Mitchell, Matthew W.; Wulff, Jacob E.; Alexander, Danny C.; Evans, Anne M.; Bridgewater, Brandi; Miller, Luke; Gonzalez-Garay, Manuel L.; Caskey, C. Thomas
Precision medicine, taking account of human individuality in genes, environment, and lifestyle for early disease diagnosis and individualized therapy, has shown great promise to transform medical care. Nontargeted metabolomics, with the ability to detect broad classes of biochemicals, can provide a comprehensive functional phenotype integrating clinical phenotypes with genetic and nongenetic factors. To test the application of metabolomics in individual diagnosis, we conducted a metabolomics analysis on plasma samples collected from 80 volunteers of normal health with complete medical records and three-generation pedigrees. Using a broad-spectrum metabolomics platform consisting of liquid chromatography and GC coupled with MS, we profiled nearly 600 metabolites covering 72 biochemical pathways in all major branches of biosynthesis, catabolism, gut microbiome activities, and xenobiotics. Statistical analysis revealed a considerable range of variation and potential metabolic abnormalities across the individuals in this cohort. Examination of the convergence of metabolomics profiles with whole-exon sequences (WESs) provided an effective approach to assess and interpret clinical significance of genetic mutations, as shown in a number of cases, including fructose intolerance, xanthinuria, and carnitine deficiency. Metabolic abnormalities consistent with early indications of diabetes, liver dysfunction, and disruption of gut microbiome homeostasis were identified in several volunteers. Additionally, diverse metabolic responses to medications among the volunteers may assist to identify therapeutic effects and sensitivity to toxicity. The results of this study demonstrate that metabolomics could be an effective approach to complement next generation sequencing (NGS) for disease risk analysis, disease monitoring, and drug management in our goal toward precision care. PMID:26283345
Guo, Lining; Milburn, Michael V; Ryals, John A; Lonergan, Shaun C; Mitchell, Matthew W; Wulff, Jacob E; Alexander, Danny C; Evans, Anne M; Bridgewater, Brandi; Miller, Luke; Gonzalez-Garay, Manuel L; Caskey, C Thomas
Precision medicine, taking account of human individuality in genes, environment, and lifestyle for early disease diagnosis and individualized therapy, has shown great promise to transform medical care. Nontargeted metabolomics, with the ability to detect broad classes of biochemicals, can provide a comprehensive functional phenotype integrating clinical phenotypes with genetic and nongenetic factors. To test the application of metabolomics in individual diagnosis, we conducted a metabolomics analysis on plasma samples collected from 80 volunteers of normal health with complete medical records and three-generation pedigrees. Using a broad-spectrum metabolomics platform consisting of liquid chromatography and GC coupled with MS, we profiled nearly 600 metabolites covering 72 biochemical pathways in all major branches of biosynthesis, catabolism, gut microbiome activities, and xenobiotics. Statistical analysis revealed a considerable range of variation and potential metabolic abnormalities across the individuals in this cohort. Examination of the convergence of metabolomics profiles with whole-exon sequences (WESs) provided an effective approach to assess and interpret clinical significance of genetic mutations, as shown in a number of cases, including fructose intolerance, xanthinuria, and carnitine deficiency. Metabolic abnormalities consistent with early indications of diabetes, liver dysfunction, and disruption of gut microbiome homeostasis were identified in several volunteers. Additionally, diverse metabolic responses to medications among the volunteers may assist to identify therapeutic effects and sensitivity to toxicity. The results of this study demonstrate that metabolomics could be an effective approach to complement next generation sequencing (NGS) for disease risk analysis, disease monitoring, and drug management in our goal toward precision care. PMID:26283345
Stephen Claxton-Oldfield; Maggie Crain; Jane Claxton-Oldfield
Before and immediately after the 2 most recent offerings of a local palliative care volunteer training program, 17 participants completed the Collett-Lester Fear of Death Scale and Bugen's Coping with Death Scale. The training program consisted of approximately 27 hours of training presented in 3-hour blocks during a 9-week period. Topics included the philosophy and goals of palliative care, spiritual
Kane Low, Lisa; Moffat, Amy; Brennan, Patty
Doulas, women who primarily provide social support during childbirth, have been associated with a number of positive health outcomes. Because the primary model of practice for doulas is a fee-for-service model in which families privately hire a doula, many expectant women who could benefit from doula support are unable to access the service. The Doulas Care program, located in Ann Arbor, Michigan, represents one model in which doulas provide services without charge. As a result of their extended role in the community, doulas who work with the Doulas Care program have unique educational needs. Through the use of focus groups with the program's volunteer doulas, educational needs related to overcoming barriers to being a doula working in the community were identified. Recommendations for education and training are made to improve the support doulas offer as community health outreach workers. PMID:17541457
Stephen Claxton-Oldfield; Laura Gibbon; Kirsten Schmidt-Chamberlain
A total of 79 hospice palliative care volunteers from 2 community-based hospice programs responded to a 27-item Boundary Issues Questionnaire that was specifically developed for this study. Volunteers were asked to indicate whether or not they considered each item (eg, “Lend personal belongings to a patient or family,” “Agree to be a patient’s power of attorney,” “Attend\\/go into a patient’s
Guralnick, Eva, Ed.; Zamani, Rahman, Ed.; Evinger, Sara, Ed.; Dailey, Lyn, Ed.; Sherman, Marsha, Ed.; Oku, Cheryl, Ed.; Kunitz, Judith, Ed.
This document is comprised of the six 2002 issues of a bimonthly newsletter on children's health for California's child care professionals. The newsletter provides information on current and emerging health and safety issues relevant to child care providers and links the health, safety, and child care communities. Regular features include columns…
Runy, Lee Ann
This month's gatefold examines the distribution of the health care workforce state by state. It also compares the commitment level of health care workers with workers in other fields and within health care by job category and organization type. PMID:15720027
J. Karnon; Mark Mackay
We will describe several cases studies that illustrate how we have used modelling to improve the delivery of health care. The studies cover various settings in health care, utilise a variety of mathematical modelling techniques, and include descriptions of the impact of the model on the health care system. The studies can be described briefly as follows. In the financial
Fadope, Cece Modupe; And Others
A series of articles that examine environmental health and discuss health care reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for health care professionals who want to address…
Congress of the U.S., Washington, DC. Office of Technology Assessment.
Health needs and health services in rural America are key issues directly related to education as well as community well-being. This report examines rural America's access to basic health care services and discusses options for congressional consideration. The focus is on trends in availability of primary and acute rural health care and on factors…
Maes, Kenneth C; Shifferaw, Selamawit; Hadley, Craig; Tesfaye, Fikru
Low-income volunteers constitute a major part of AIDS care workforces in sub-Saharan Africa, yet little research has been conducted to determine how poverty and insecurity among volunteers impact their wellbeing and the sustainability of the AIDS treatment programmes they support. This paper presents longitudinal ethnographic and epidemiological research documenting how the 2008 food crisis in Addis Ababa affected AIDS care volunteers’ care relationships and motivations. Ethnographic results highlight the distress and demotivation that rising food costs created for caregivers by contributing to their own and their care recipients’ experiences of food insecurity and HIV-related stigmatization. Epidemiological results underscore a high prevalence of food insecurity (approximately 80%) even prior to the peak of food prices. Rising food prices over the 3 years prior to 2008, underemployment and household per capita incomes averaging less than US$1/day, likely contributed to the very high prevalence of food insecurity reported by caregivers in our sample. We also show that new volunteers recruited in early 2008 by one of the non-governmental organizations (NGOs) involved in this study were more likely to be dependants within their households, and that these participants reported lower rates of food insecurity and higher household income. While this shift in volunteer recruitment may help sustain volunteer care programmes in the face of widespread poverty and underemployment, food insecurity was still highly prevalent (58–71%) among this sub-group. Given the inability of the local NGOs that organize volunteers to address the challenge of food insecurity for programme sustainability, our results raise important policy questions regarding compensation for volunteers’ valuable labour and poverty reduction through public health sector job creation. PMID:20439347
Parker, S S; Vitelli, T
In health care, as quality improves, costs tend to decline. The goals of excellent care and affordable costs are not mutually exclusive. Borrowing quality improvement techniques from manufacturing industries, physicians and other health care professionals are achieving breakthroughs in improving the quality and reducing the cost of care. Quality improvement continues the tradition of scientific inquiry in medicine and places new emphasis on accountability to the customers of health care: patients and payers. By examining processes, clinicians look at the delivery of care across different treatment modalities and rely on the insights of employees involved at every stage of the processes. Intermountain Health Care is one American health care organization that has experienced significant success in improving quality and reducing cost through the use of quality improvement methods. PMID:10174542
Health care firms of all types helped fuel the biggest short-selling frenzy in the New York Stock Exchange's history, recently hitting a record 2.2 billion shares. While some analysts say this means nothing, the fact is that many investors are "shorting" the stock; in other words, they're betting against it. What appears as a lack of confidence may be nothing more than a simple quirk of Wall Street. Good, bad or indifferent, selling short is no tall tale. PMID:8640268
Rodríguez, Michael A.; Vega, William A.
information about Latino health care perceptions, utilization behaviors,information about health and health care, promoting personal and family healthy behaviors,information from patients about their family, cultural background, health and health care behaviors,
Cheapness was 1 of the elements in the definition of primary health care (PHC) which emerged from the 1978 Alma Ata Conference. For poor countries, PHC represented a way of overcoming the resource limitations which stand in the way of a transformation of the health situation. PHC leads to lower costs through technical efficiency--the choice of an appropriate balance between preventive and curative activities, and the identification of risk groups. Other kinds of efficiency involved are economic efficiency, social efficiency, and system efficiency. The most important factor in the limits on cost reduction through PHC is the need for support for PHC institutions and personnel from the rest of the health care system. In the transition phase of the introduction of PHC the catchment poulation will be increasing. PHC is likely to represent not a cheaper way of handling a fixed volume of health problems, but a way of providing more service for a given (or modestly increased) total cost. The transition period is also likely to carry a disproportionate share of "setting up" costs. A final transition problem concerns the role of the volunteer. In pilot schemes volunteers are useful--but they are not when PHC is part of a government controlled or sponsored scheme. An estimated of cost in US dollars of a PHC contact in a Caribbean country is given. The mobilization of financial resources for health care is mainly a national concern. There are 3 main mechanisms for resource mobilization which are useful: 1) private payment by consumers directly to providers; 2) insurance and social security schemes; and 3) contributions to the general revenue of a government unit from which some part is set aside to finance health services. PMID:6729958
... With Us A long term health study for oil spill clean-up workers and volunteers Follow-up ... health study for individuals who helped with the oil spill cleanup, took training, signed up to work, ...
Chochinov, Harvey M; McClement, Susan E; Hack, Thomas F; McKeen, Nancy A; Rach, Amanda M; Gagnon, Pierre; Sinclair, Shane; Taylor-Brown, Jill
BACKGROUND Patients who are facing life-threatening and life-limiting cancer almost invariably experience psychological distress. Responding effectively requires therapeutic sensitivity and skill. In this study, we examined therapeutic effectiveness within the setting of cancer-related distress with the objective of understanding its constituent parts. METHODS Seventy-eight experienced psychosocial oncology clinicians from 24 health care centers across Canada were invited to participate in 3 focus groups each. In total, 29 focus groups were held over 2 years, during which clinicians articulated the therapeutic factors deemed most helpful in mitigating patient psychosocial distress. The content of each focus group was summarized into major themes and was reviewed with participants to confirm their accuracy. Upon completion of the focus groups, workshops were held in various centers, eliciting participant feedback on an empirical model of therapeutic effectiveness based on the qualitative analysis of focus group data. RESULTS Three primary, interrelated therapeutic domains emerged from the data, forming a model of optimal therapeutic effectiveness: 1) personal growth and self-care (domain A), 2) therapeutic approaches (domain B), and 3) creation of a safe space (domain C). Areas of domain overlap were identified and labeled accordingly: domain AB, therapeutic humility; domain BC, therapeutic pacing; and domain AC, therapeutic presence. CONCLUSIONS This empirical model provides detailed insights regarding the elements and pedagogy of effective communication and psychosocial care for patients who are experiencing cancer-related distress. [See editorial on pages 000–000, this issue.] Cancer 2013. © 2013 American Cancer Society. PMID:23341092
National Consortium on Health Science and Technology Education, Okemos, MI.
This document presents the National Health Care Skill Standards, which were developed by the National Consortium on Health Science and Technology and West Ed Regional Research Laboratory, in partnership with educators and health care employers. The document begins with an overview of the purpose and benefits of skill standards. Presented next are…
... GYNs are doctors who specialize in obstetrics and gynecology, including women's health care, wellness, and prenatal care. ... Nephrology -- kidney disorders Neurology -- nervous system disorders ... and women's reproductive disorders Oncology -- cancer treatment ...
Sanon, Martine; Baumlin, Kevin M; Kaplan, Shari Sirkin; Grudzen, Corita R
Older adults who present to an emergency department (ED) generally have more-complex medical conditions with complicated care needs and are at high risk for preventable adverse outcomes during their ED visit. The Care and Respect for Elders with Emergencies (CARE) volunteer initiative is a geriatric-focused volunteer program developed to help prevent avoidable complications such as falls, delirium and use of restraints, and functional decline in vulnerable elders in the ED. The CARE program consists of bedside volunteer interventions ranging from conversation to various short activities designed to engage and reorient high-risk, older, unaccompanied individuals in the ED. This article describes the development and characteristics of the CARE program, the services provided, the experiences of the elderly patients and their volunteers, and the growth of the program over time. CARE volunteers provide elders with the additional attention needed in an often chaotic, unfamiliar environment by enhancing their care, improving satisfaction, and preventing potential decline. PMID:24428229
Sherertz, R. J.; Bassetti, S.; Bassetti-Wyss, B.
Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the existence of cloud health-care workers. PMID:11294715
Objective: To determine an appropriate, cost-effective and sustainable model of health services for prevention and control of hypertension in a primary care unit. Study Design: Operational research. Material and Method: The presented study was to develop a model that utilized health personnel, village health volunteers (VHVs) and family health leaders (FHLs) to improve health services to prevent and control hypertension
... of health care providers: Nurse practitioners Physician assistant profession ... low back injury, spinal cord injuries, and stroke Psychiatry -- emotional or mental disorders Pulmonary (lung) -- respiratory tract ...
Schellekens, O P; Lindner, M E; van Esch, J P L; van Vugt, M; Rinke de Wit, T F
Long-term substantial development aid has not prevented many African countries from being caught in a vicious circle in health care: the demand for care is high, but the overburdened public supply of low quality care is not aligned with this demand. The majority of Africans therefore pay for health care in cash, an expensive and least solidarity-based option. This article describes an innovative approach whereby supply and demand of health care can be better aligned, health care can be seen as a value chain and health insurance serves as the overarching mechanism. Providing premium subsidies for patients who seek health care through private, collective African health insurance schemes stimulates the demand side. The supply of care improves by investing in medical knowledge, administrative systems and health care infrastructure. This initiative comes from the Health Insurance Fund, a unique collaboration of public and private sectors. In 2006 the Fund received Euro 100 million from the Dutch Ministry of Foreign Affairs to implement insurance programmes in Africa. PharmAccess Foundation is the Fund's implementing partner and presents its first experiences in Africa. PMID:18179087
Cohen, S S; Williams, D R
Managed care poses special challenges to midwives providing reproductive health care. This is owing to the sensitive nature of issues surrounding reproductive health and aspects of managed care that may impede a woman's ability to obtain continuous, confidential, and comprehensive care from the provider of her choice. Variations across payers (ie, Medicare, Medicaid, and commercial insurers) regarding covered benefits and reimbursement of midwifery services also may create obstacles. Furthermore, some physicians and managed care organizations are embracing policies that threaten the ability of midwives to function as primary health care providers for women. Despite these hurdles, midwives have the potential to remain competitive in the new marketplace. This article underscores the importance of being knowledgeable about legislation and policy issues surrounding the financing of midwifery services, quality performance measurement for HMOs as they pertain to reproductive health, and discussions regarding which clinicians should be defined as primary care providers. PMID:9674347
The Indian Community Health Volunteer (CHV) Scheme is a major large scale experiment in people's participation into primary health care. This study intended to elicit the origins, the formulation and decision making process and the implementation of this programme. The evolution of the CHV programme is a particularly striking example of the contradictions of participation policies in a populist regime. Political awakening of the rural masses makes it absolutely necessary to take action so as to re-direct a portion of state interventions for their benefit. But the determining influence of the dominant classes, in both political and intermediate level bureaucracy of the state apparatus, tends to divert most of the resources made available by the State from their initial object, while inevitable reforms are constantly delayed. Thus the development of a popular participation policy would seem to be the necessary complement to the centre's reform policies. Yet the implementation of this participation policy can be realized only through the intermediary apparatus which must be verified and reoriented. Participation policy is thus distorted in order to reinforce the patronage capacities of existing political apparatus. In its present configuration, the CHV programme would appear first as an effort to constitute a poor-people's medicine circuit, answering the aspirations awakened by a populist political system, and much less the springboard for collective mobilization of communities in order to master their own development. As a whole, the order of priorities has been deeply altered in the course of implementation. The curative action took precedence over preventive action; individual action over collective action. This distortion could be explained both by the nature of people's demand and by the prevalence of clientelism and patronage as mode of political control. PMID:3975665
Rushmer, R; Davies, H
Learning in health care is essential if healthcare organisations are to tackle a challenging quality of care agenda. Yet while we know a reasonable amount about the nature of learning, how learning occurs, the forms it can take, and the routines that encourage it to happen within organisations, we know very little about the nature and processes of unlearning. We review the literature addressing issues pivotal to unlearning (what it is, why it is important, and why it is often neglected), and go further to explore the conditions under which unlearning is likely to be encouraged. There is a difference between routine unlearning (and subsequent re-learning) and deep unlearning—unlearning that requires a substantive break with previous modes of understanding, doing, and being. We argue that routine unlearning merely requires the establishment of new habits, whereas deep unlearning is a sudden, potentially painful, confrontation of the inadequacy in our substantive view of the world and our capacity to cope with that world competently. PMID:15576685
Maes, Kenneth C.; Hadley, Craig; Tesfaye, Fikru; Shifferaw, Selamawit
The 2008 food crisis may have increased household food insecurity and caused distress among impoverished populations in low-income countries. Policy researchers have attempted to quantify the impact that a sharp rise in food prices might have on population wellbeing by asking what proportion of households would drop below conventional poverty lines given a set increase in prices. Our understanding of the impact of food crises can be extended by conducting micro-level ethnographic studies. This study examined self-reported household food insecurity (FI) and common mental disorders (CMD) among 110 community health AIDS care volunteers living in Addis Ababa, Ethiopia during the height of the 2008 food crisis. We used generalized estimating equations that account for associations between responses given by the same participants over 3 survey rounds during 2008, to model the longitudinal response profiles of FI, CMD symptoms, and socio-behavioral and micro-economic covariates. To help explain the patterns observed in the response profiles and regression results, we examine qualitative data that contextualize the cognition and reporting behavior of AIDS care volunteers, as well as potential observation biases inherent in longitudinal, community-based research. Our data show that food insecurity is highly prevalent, that is it associated with household economic factors, and that it is linked to mental health. Surprisingly, the volunteers in this urban sample did not report increasingly severe FI or CMD during the peak of the 2008 food crisis. This is a counter-intuitive result that would not be predicted in analyses of population-level data such as those used in econometrics simulations. But when these results are linked to real people in specific urban ecologies, they can improve our understanding of the psychosocial consequences of food price shocks. PMID:20189698
Andre, David; Teller, Astro
What if clinical quality medical equipment were available to every consumer in a form factor that was inexpensive, accurate, and easy to use? What if this equipment provided information that previously was un-measurable or very difficult to measure? What if the physiological state of individuals, at resolutions measured in thousandths of a second instead of in visits per year, could be measured easily, making it possible to ascertain caloric intake and expenditure, patterns of sleep, contextual activities such as working-out and driving, even parameters of mental state and health. What aspect of healthcare would not change? We present a system that is available today that enables this vision. This award-winning multi-channel wearable physiological monitor has enabled the collection of more than 90 million minutes of data in natural settings from thousands of subjects engaged in diverse activities. Data modeling efforts are resulting in applications that present meaningful and actionable information in real-time to users and their designated collaborators (physicians, family members, counselors, coaches, etc.) We describe the SenseWear system, its design, and a summary of validation studies, current commercial applications, and ongoing research. This discussion will show how the convergence of design for wearability, advances in machine learning, and improvements in wireless technology will manifest the future of health care as personal, ubiquitous, and collaborative. PMID:16301772
Daoud, Nihaya; Shtarkshall, Ronny; Laufer, Neri; Verbov, Gina; Bar-El, Hagar; Abu-Gosh, Nasreen; Mor-Yosef, Shlomo
Ambiguous feelings regarding women engaging in formal volunteering and concerns about their exploitation might explain the dearth of studies regarding the volunteering benefits specifically experienced by low socioeconomic status women. The current study examined benefits of volunteering among women participating in Women for Women's Health (WWH), a lay health volunteers (LHV) programme implemented in Jewish and Arab communities in Israel, and aiming at empowering such women to become active volunteers and promote health activities in their communities. Two years after the introduction of WWH in each community, all 45 Jewish and 25 Arab volunteers were contacted by phone and invited to participate in the focus group discussions. Five focus group discussions were conducted with 25/42 Jewish volunteers in 2003 and four with 20/25 Arab volunteers in 2005. The other volunteers could not attend the scheduled meetings or became inactive for personal reasons. Four benefit categories were identified in both ethnic groups: 1. Personal benefits of having increased knowledge, feeling self-satisfaction, mastering new skills and performing healthy behaviours; 2. Group-social benefits of social support and sense of cohesion; 3. Purposive benefits of achieving the WWH mission and goals; 4. Sociopolitical benefits of learning to accept the other and experiencing increased solidarity. However, the relatively less privileged Arab volunteers enumerated more benefits within the personal and purposive categories. They also identified the unique sociocultural category of improving women's status in the community by creating a legitimate space for women by public sphere involvement, traditionally solely a male domain. We conclude that volunteering in community-based health promotion programmes can be an empowering experience for lay women without being exploitative. Positive volunteering benefits will be even more discernable among underprivileged women who enjoy fewer opportunities in the personal and public domains. More studies need to explore volunteering benefits as reported by LHVs, making these benefits more visible and desirable. PMID:20039970
Baoping Shang; Melinda Buntin; Dana Goldman
There is strong evidence that managed care lowers health care costs for managed care enrollees. Managed care also affects health care costs of non-managed care enrollees through the spillover effects. However, the findings are mixed on the effects of managed care on health outcomes and there is little evidence on the effects of managed care on health care cost growth.
The publication of Caring for People, The NHS and Community Care Act 1990, and The Patient's Charter, placed involving users at the forefront of discussions concerning the future organisation and management of health and social care services. Ray Higgins describes the evaluation of an advocacy project and the challenges for managers it presented. PMID:10133759
Health care reform at last: After nearly a century of effort by Presidents from Theodore Roosevelt on down, the Congress finally agreed on and President Barack Obama signed into law a system that covers most Americans, regulates sharp insurance practices, and embraces a paradigm shift from acute institutionally focused care to chronic disease management based on home and community-based care. PMID:20465039
There are several myths about the impact of decentralization of health care governance. These include a worsening of regional inequalities, greater privatization of health care, greater inefficiency resulting from duplication of managerial activities such as human resource policies, and lower productivity. These myths have partly arisen from a lack of rigorous assessments of the effects of decentralization. PMID:23007139
McDavid, Lolita M
Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care. PMID:26318955
Al-Mutawa, chief psychologist at Kuwait's psychiatric hospital, focuses on three topics in his brief essay on health care ethics in his country. The first is the conflict between the Western moral framework of many aspects of health care and the religious and social traditions of an Islamic country. This conflict manifests itself in such areas as reproductive medicine, truthtelling and informed consent, and terminal care. The care of the mentally ill is Al-Mutawa's second area of interest, particularly the issues of involuntary commitment, methods of treatment, informed consent, and the allocation of psychiatric resources. Kuwait's proposed independent Health Care Research Centre is the author's third topic. The center will identify and investigate moral and conceptual problems in the provision of health care in Kuwait, and provide a focus for research into the relation between Islamic perspectives and Western technologies and practice. PMID:11650224
Kenagy, J W; Berwick, D M; Shore, M F
Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them. PMID:10029131
In this grounded theory analysis I sought to understand dignity violation in health care and to explore the context in which such violations take place. I found that dignity violation in health care occurs through processes of rudeness, indifference, condescension, dismissal, disregard, dependence, intrusion, objectification, restriction, labeling, contempt, discrimination, revulsion, deprivation, assault, and abjection. The conditions that promote these processes reside in the positions of the actors involved; in the asymmetrical relationships between the actors; in the health care setting itself, which is characterized by multiple tensions-including those between needs and resources, crisis and routine, experience and expertise, and rhetoric and reality; and in the embeddedness of health care in a broader social order of inequality. These findings suggest several interventions that might mitigate dignity violation in health care. PMID:19797155
Leanza, Francesco; Hauser, Diane
Teens are avid users of new technologies and social media. Nearly 95% of US adolescents are online at least occasionally. Health care professionals and organizations that work with teens should identify online health information that is both accurate and teen friendly. Early studies indicate that some of the new health technology tools are acceptable to teens, particularly texting, computer-based psychosocial screening, and online interventions. Technology is being used to provide sexual health education, medication reminders for contraception, and information on locally available health care services. This article reviews early and emerging studies of technology use to promote teen health. PMID:25124206
Hughes, Edward F. X.
The trend now driving American health care is that the payors are refusing to pay the true economic costs. Health care technology and the public's demand for it, the growth of managed care (Health Maintenance Organizations), and the need to increase the effectiveness of health care are affecting health care delivery. (MLW)
Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane
Forty-one hospice palliative care volunteers (from 6 community- and 3 hospital-based programs) participated in informal group discussions regarding (1) what aspects of their work provide them with the most (and least) satisfaction; (2) why they continue to volunteer; and (3) why they might stop. In 5 of the 9 programs, volunteers said that feeling appreciated by the patients/families they support gave them great satisfaction. Boundary issues and/or role ambiguities were among the least satisfying aspects of their work, mentioned by volunteers in 4 programs. Volunteers in all 9 programs mentioned that they continue to volunteer because it makes a difference/helps others/meets a need in other people's lives. Among the reasons given for potentially stopping volunteering were a family crisis, burnout, old age, and other commitments. PMID:22241460
Having reversed its pronatalist policies in 1988, the Islamic Republic of Iran implemented one of the most successful family planning programs in the developing world. This achievement, particularly in urban centers, is largely attributable to a large women-led volunteer health worker program for low-income urban neighborhoods. Research in three cities demonstrates that this successful program has had a host of unintended consequences. In a context where citizen mobilization and activism are highly restricted, volunteers have seized this new state-sanctioned space and successfully negotiated many of the familial, cultural, and state restrictions on women. They have expanded their mandate from one focused on health activism into one of social, if not political, activism, highlighting the ways in which citizens blur the boundaries of state and civil society under restrictive political systems prevalent in many of the Middle Eastern societies. PMID:20882703
Merlino, James I; Raman, Ananth
The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life. PMID:23898737
Hussein, Shereen; Manthorpe, Jill
In the UK context of financial austerity and the promotion of the social responsibility through the concept of the "Big Society," volunteers are becoming a more important part of the labor workforce. This is particularly so in the long-term care (LTC) sector, where both shortages of staff and demands for support are particularly high. This article investigate the levels and profile of contribution of volunteers in the LTC sector using a large national data set, National Minimum Data Set for Social Care, linked to local area levels of rurality and socio-economic status. The analysis shows that volunteer activity in formal care services varies between sectors and service types, with no strong relationship between local area deprivation, unemployment levels, and levels of volunteering. However, some significant association was found with level of rurality. The contribution of volunteers is most evident in provision of counseling, support, advocacy, and advice. PMID:25332302
Vlachantoni, A; Evandrou, M; Falkingham, J; Robards, J
Informal care provision is an activity in which individuals are increasingly likely to become involved across their life course, and particularly in later life, as a result of demographic changes such as increasing longevity and changes in co-residential living arrangements in later life. Academic research so far has highlighted the adverse impact of informal care provision on the financial position of the carer, however, the evidence on the impact of informal care provision on the carer's physical, mental and emotional health, and on their mortality, presents a more complex picture. This paper reviews research from the UK and beyond on the provision of informal care and its subsequent impact on health and mortality outcomes. Two key findings emerge from this review paper. Firstly, the cross-sectional analysis of data shows mixed associations between informal care provision and poor health outcomes for the carer. Such research highlights the importance of the demographic and socio-economic characteristics of the carer and the person cared for, and of the specific characteristics and nature of the care provided (e.g. duration, level). Secondly, longitudinal analysis, which typically benefits from a longer timeframe to follow up the impact of caring, shows that although informal care provision is not per se associated with adverse health and mortality outcomes, nevertheless particular types and durations of caring have shown negative outcomes. PMID:23218988
Ewing, James I; Denham, Claude A; Osborne, Cynthia R; Green, Nathan B; Divers, Josephine; Pippen, John E
A group from Texas Oncology and Baylor Charles A. Sammons Cancer Center traveled to Huê´, Vietnam, as part of Health Volunteers Overseas. From February 21 to March 6, 2012, five Baylor Sammons medical oncologists and an oncology nurse worked with a medical oncologist and a surgeon at the Huê´ College of Medicine and Pharmacy, suggesting approaches based on available resources. The two groups worked together to find optimal solutions for the patients. What stood out the most for the Baylor Sammons group was the Huê´ team's remarkable work ethic, empathy for patients, and treatment resourcefulness. The Baylor Sammons group also identified several unmet needs that could potentially be addressed by future volunteers in Huê´, including creation of an outpatient hospice program, establishment of breast cancer screening, modernization of the pathology department, instruction in and better utilization of pain management, better use of clinic space, and the teaching of oncology and English to medical students. There was a mutual exchange of knowledge between the two medical teams. The Baylor Sammons group not only taught but also learned how to take good care of patients with limited resources. PMID:23543968
Kay, Mark A.
1 Stanford Medicine Stanford Health Care Stanford Children's Health Statement of Commitment and conduct provided through the clinical departments of the School of Medicine, whether in STANFORD HEALTH to Graduate Medical Education (GME) In accordance with its mission, Stanford Medicine is dedicated to pursuing
Stephen Claxton-Oldfield; Natasha Gosselin
A total of 143 adults were asked to imagine that they had recently been diagnosed with a life-threatening illness. After reading about the roles of hospice palliative care volunteers, participants were asked whether they would use the services of a volunteer to help them and their loved ones get through this difficult time. The vast majority (94.4%) of the participants
Shaw, Diana V
The concerns over ever-rising health care costs has motivated physicians, hospitals, and insurance carriers to search for ways to increase efficiency, decrease costs, and maintain or improve quality. Mergers have been recognized as having the capability to accomplish all three goals-but not without some concerns. This article's intent is to provide the reader with basic knowledge that will assist in understanding the discussion regarding the appropriateness of mergers in health care. It reviews issues raised by mergers and examines a few case studies of merged health care organizations. PMID:12635992
Jensen, R G
The military health care system is currently facing a critical provider supply versus patient demand imbalance. Contracting out health care through the Civilian Health and Medical Program of the Uniformed Services and the Primary Medical Care for the Uniformed Services programs is one approach that Army Medical Department leaders have taken to correct the problem. This article critically analyzes the success of this approach using data from an Army hospital in the eastern United States. The article concludes with three suggestions aimed at improving the current situation. PMID:2505166
Perttula, W; Lowe, D; Quon, N S
This paper describes the results of a survey of health care attitudes of a sample of respondents primarily of Asian American background. The importance of bilingualism, Asian background, age, and other attributes of a physician are discussed with relation to subgroups in the sample. The relative importance of the influence of doctors, family, and friends on the choice of physician and health care facility are also presented. The findings may help with the development of effective market segmentation and improved health care service to the Asian American community. PMID:10538733
Hodge, James G; Gable, Lance A; Cálves, Stephanie H
Volunteer health professionals (VHPs) are essential in emergencies to fill surge capacity and provide needed medical expertise. While some VHPs are well-organized and trained, others arrive spontaneously at the site of a disaster. Lacking organization, training, and identification, they may actually impede emergency efforts. Complications involving medical volunteers in New York City after September 11, 2001, led Congress to authorize federal authorities to assist states and territories in developing emergency systems for the advance registration of volunteer health professionals (ESARVHP). Through advance registration, volunteers can be vetted, trained, and mobilized more effectively during emergencies. The use of VHPs, however, raises multiple legal questions: What constitutes an emergency, how is it declared, and what are the consequences? When are volunteers liable for their actions? When may volunteers who are licensed or certified in one state legally practice their profession in another state? Are volunteers entitled to compensation for harms they incur? This article examines the legal framework underlying the registration and use of volunteers during emergencies and offers recommendations for legal reform, including: (1) establish minimum standards to facilitate interjurisdictional emergency response, improve coordination, and enhance reciprocity of licensing and credentialing; (2) develop liability provisions for VHPs that balance their need to respond without significant fear of civil liability with patients' rights to legal recourse for egregious harms; and (3) provide basic levels of protections for VHPs harmed, injured, or killed while responding to emergencies. PMID:16181044
The population and demographics of rural America are shifting once again. As our nation's unprecedented health care reform unfolds, it is becoming clear that rural communities have unique strengths, and capitalizing on these strengths can position them well for this health care transformation. Equally important are the distinct challenges that--with careful planning, attention, and resources--can be transformed into opportunities to thrive in the new health care environment. The North Carolina Institute of Medicine's Task Force on Rural Health recently published a report that highlights the strengths and challenges of rural communities . In order to fully leverage these opportunities, we must continue to acknowledge the fundamental importance of access to basic health care, while also broadening our discussion to collectively tackle the additional components necessary to create healthy, thriving rural communities. As we reexamine the needs of rural communities, we should broaden our discussions to include an expansion of the types of access that are necessary for strengthening rural health. Collaboration, successful recruitment and retention, availability of specialty services, quality care, and cost effectiveness are some of the issues that must come into discussions about access to services. With this in mind, this issue of the NCMJ explores opportunities to strengthen the health of North Carolina's rural communities. PMID:25621473
Barack Obama's re-election as president of the United States means the major domestic achievement of his first term of office--the Affordable Care Act--cannot be reversed. Here, US nurses explain how the act's extension of healthcare insurance and preventive services is improving care and changing nursing roles. PMID:23431935
Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.
Describes the essential features of a health care system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and health care reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)
Fookson, Maxine; And Others
Developed to meet Washington State Day Care Minimum Licensing Requirements, guidelines in this handbook concern 10 health topics. Discussion focuses on (1) preventing illness in day care settings; (2) illnesses, their treatment, ways to limit their spread, and what caregivers can do when they have a sick child at their center; (3) caregivers'…
Aronson, Susan; Smith, Herberta
Drawn from a review of policies at over 100 child care programs nationwide, the model health policies presented in this report are intended for adaptation and selective use by out-of-home child care facilities. Following an introduction, the report presents model policy forms with blanks for adding individualized information for the following…
Congress of the U.S., Washington, DC. Office of Technology Assessment.
Undertaken at the request of House and Senate committees with responsibility for Indian affairs and government health programs, this study examines the health status of Indians and the services and technologies that are provided to them through Federal Indian health programs. The first half of the report contains background information and the…
...Implementation specifications: Health care clearinghouses. 162.414 ...Standard Unique Health Identifier for Health Care Providers § 162.414 Implementation specifications: Health care clearinghouses. A health...
Coleman, J V; Patrick, D L
The paper presents a study of psychiatric morbidity in the general health care program of a Health Maintenance Organization. Mental health services are built into the program as an integral component of primary care teams in internal medicine and pediatrics. The following were some of the findings: 15.7% of patients visiting the Health Center over a two-year period presented emotional problems; 72% were treated by primary care clinicians alone and 28% by mental health clinicians. Treatment by primary and mental health clinicians is broken down by diagnostic categories. A study of patients with chronic emotional problems revealed that they tended to be high utilizers of all Health Center services for both physical and emotional difficulties. Chronic patients represented 2% of all patients who visited in 1974; of these, 54% were seen by mental health clinicians and 46% by primary care clinicians. In the case of patients with non-chronic emotional problems, over a two-year period, there was an increase in the per cent seen by primary clinicians. The use of psychoactive drugs by primary physicians and the advantages and difficulties of developing a program of integrated health-mental services are described. PMID:645993
Background Volunteers make a major contribution to palliative patient care, and qualitative studies have been undertaken to explore their involvement. With the aim of making connections between existing studies to derive enhanced meanings, we undertook a systematic review of these qualitative studies including synthesising the findings. We sought to uncover how the role of volunteers with direct contact with patients in specialist palliative care is understood by volunteers, patients, their families, and staff. Methods We searched for relevant literature that explored the role of the volunteer including electronic citation databases and reference lists of included studies, and also undertook handsearches of selected journals to find studies which met inclusion criteria. We quality appraised included studies, and synthesised study findings using a novel synthesis method, thematic synthesis. Results We found 12 relevant studies undertaken in both inpatient and home-care settings, with volunteers, volunteer coordinators, patients and families. Studies explored the role of general volunteers as opposed to those offering any professional skills. Three theme clusters were found: the distinctness of the volunteer role, the characteristics of the role, and the volunteer experience of the role. The first answers the question, is there a separate volunteer role? We found that to some extent the role was distinctive. The volunteer may act as a mediator between the patient and the staff. However, we also found some contradictions. Volunteers may take on temporary surrogate family-type relationship roles. They may also take on some of the characteristics of a paid professional. The second cluster helps to describe the essence of the role. Here, we found that the dominant feature was that the role is social in nature. The third helps to explain aspects of the role from the point of view of volunteers themselves. It highlighted that the role is seen by volunteers as flexible, informal and sometimes peripheral. These characteristics some volunteers find stressful. Conclusions This paper demonstrates how qualitative research can be sythnesised systematically, extending methodological techniques to help answer difficult research questions. It provides information that may help managers and service planners to support volunteers appropriately. PMID:24506971
Grazier, Kyle L; Metzler, Bridget
Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects. PMID:16583848
... virus. It is spread by poor or no hand washing after going to the bathroom or changing a ... and then preparing food. In addition to good hand washing, day care staff and children should get the ...
Richardson, Scott; Leet, Jeanne
The increasing health needs of students over the last 20 years have left many school personnel with questions and fears about helping these students. This program outline offers suggestions for school health care plans for students. It is essential that all people involved with the student be invited to be a part of the team. Key team members are:…
A booklet on health care for limited English speakers provides information on choosing the right doctor, buying medicine, paying the bill, and the individual's role in maintaining his or her health. Cartoons, questions and puzzles concerning the message in cartoons and narrative passages, checklists about an individual's personal habits related to…
The South East Asian state of Vietnam is currently undergoing a transition from a centralised socialism to a so-called socialist market economy strongly promoting the private sector. For the last 17 years economy experienced an impressive growth. If the assumption is true that economic growth is positively correlated with the health status of the population, the strengthened economy of Vietnam must go along with an improved health situation and health care system of this country. The following paper evaluates this assumption. It is demonstrated that there is indeed a strongly positive correlation between health and development in many aspects. However, it becomes obvious that economic growth is definitely accompanied by increasing regional and social disparity challenging the health care policy of Vietnam and her international partners. PMID:12772076
NTID Health Care Initiatives October 1, 2011 (Based on Interim Report, Task Force on Health Care Careers for the Deaf and Hard-of-Hearing Community, June, 2011) "Building Pathways to Health Care Careers for the Deaf and Hard-of- Hearing Community: Interim Report" submitted by the Task Force on Health Care Careers
Sepulveda, Martin-J; Bodenheimer, Thomas; Grundy, Paul
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
A two-week health study tour in Nicaragua in 1987 organized by the Health Network of the (British) Nicaragua Solidarity Campaign afforded the author of this report access to health service planning, first-hand observation of the immunization programme, and visits to centres for rehabilitation of the disabled, both from the war and civil causes. The efficacy of the low technology immunization and oral rehydration programmes is contrasted with the struggle to rehabilitate the war disabled with grossly inadequate resources. PMID:2796849
Disorders 3 PSYCH 101 Introduction to Psychology 3 HS (HCA) 102 Health Care Delivery in the United States 3 Microcomputers for Health Care Professionals 3 COMSDIS 380 Bases of Hearing Science 3 HS (HCA) 250 Allied Health
It is a long-term, sustainable commitment to changing the culture of health care to become more collaborative, more transparent, and more proactive. Knowledge management, implemented well, will transform the health care delivery system over the next few decades, into a more cost-effective, error-averse, and accountable public resource. For the sake of simplicity, this article will limit the application of knowledge management principles to the context of hospitals, hospital systems or associations, or other groupings of hospitals based on a common interest or focus. The field of knowledge management has tremendous application and value to the health care industry, particularly for hospitals and hospital systems. For many who have invested in a knowledge management infrastructure, it has become the measure of value of belonging to a hospital system or membership organization. PMID:16080410
Goodman, Melody S.; Gonzalez, Maria; Gil, Sandra; Si, Xuemei; Pashoukos, Judith L.; Stafford, Jewel D.; Ford, Elsa; Pashoukos, Dennis A.
Background The Community Alliance for Research Empowering Social Change (CARES) is an academic–community research partnership designed to train community members on research methods and develop the infrastructure for community-based participatory research (CBPR) to examine and address racial/ethnic health disparities. The Brentwood Community Health Assessment (BCHA) was developed through a CBPR pilot project grant from CARES. Objectives The purpose of the BCHA is to assess health care utilization and identify existing barriers to health care access among a multi-ethnic community in the Hamlet of Brentwood, New York. Methods Using CBPR approaches, the community–academic research partnership develop the study design and survey instrument. Trained Bilingual (English/Spanish) data collectors verbally administered surveys door-to-door to residents of Brentwood from October 2010 to May 2011. Inclusion criteria required participants to be at least 18 years of age and speak either English or Spanish. Results Overall, 232 residents completed the BCHA; 49% were male, 66% Hispanic, 13% non-Hispanic White, 13% non-Hispanic Black, 29% had less than a high school education, and 33% were born in United States. The assessment results revealed that most residents are able to access health care when needed and the most significant barriers to health care access are insurance and cost. Conclusions We describe the community–academic partnered process used to develop and implement the BCHA and report assessment findings; the community-partnered approach improved data collection and allowed access into one of Suffolk County’s most vulnerable communities. PMID:24859100
Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio
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
OBJECTIVE: To assess the role of management practices for acute respiratory infections (ARIs) in improving the competency of community health volunteers in diagnosing and treating acute respiratory infections among children. METHODS: Data were collected by a group of research physicians who observed the performance of a sample of 120 health volunteers in 10 sub-districts in Bangladesh in which Bangladesh Rural Advancement Committee (BRAC) had run a community-based ARI control programme since mid-1992. Standardized tests were conducted until the 95% interphysician reliability on the observation of clinical examination was achieved. FINDINGS:The sensitivity, specificity, and overall agreement rates in diagnosing and treating ARIs were significantly higher among the health volunteers who had basic training and were supervised routinely than among those who had not. CONCLUSION: Diagnosis and treatment of ARIs at the household level in developing countries are possible if intensive basic training and the close supervision of service providers are ensured. PMID:12764514
Hoge, M A; Thakur, N M; Jacobs, S
Managed care can be understood from an historical perspective as a reaction to perceived abuses by providers or an extension of earlier efforts to manage care in the public sector. It can be viewed as a young and emerging force--a fourth party to the health care transaction--that is rapidly progressing through a series of generations that redefine the approach to organizing and delivering services. And finally, because managed care emerges with so many faces, consumers and providers can perhaps best understand its implementation in a specific state or community by examining the multiple dimensions, such as those outlined herein, on which these initiatives vary. Until the forms and functions are more uniform, no simple definition of managed care will exist. PMID:10909105
Raju, Mohan; Varadharajan, Kiruba S.; Krishnamurthy, Aditi; Ananthkumar, S.R.; Mony, Prem K.
ABSTRACT About 700,000 Accredited Social Health Activists (ASHA) have been deployed as community health volunteers throughout India over the last few years. The objective of our study was to assess adherence to selection criteria in the recruitment of ASHA workers and to assess their performance against their job descriptions in Karnataka state, India. A cross-sectional survey, using a combination of quantitative and qualitative methods, was undertaken in 2012. Three districts, 12 taluks (subdistricts), and 300 villages were selected through a sequential sampling scheme. For the quantitative survey, 300 ASHAs and 1,800 mothers were interviewed using sets of structured questionnaire. For the qualitative study, programme officers were interviewed via in-depth interviews and focus group discussions. Mean±SD age of ASHAs was 30.3±5.0 years, and about 90% (261/294) were currently married, with eight years of schooling. ASHAs were predominantly (>80%) involved in certain tasks: home-visits, antenatal counselling, delivery escort services, breastfeeding advice, and immunization advice. Performance was moderate (40-60%) for: drug provision for tuberculosis, caring of children with diarrhoea or pneumonia, and organizing village meetings for health action. Performance was low (<25%) for advice on: contraceptive-use, obstetric danger sign assessment, and neonatal care. This was self-reported by ASHAs and corroborated by mothers. In conclusion, ASHA workers were largely recruited as per preset selection criteria with regard to age, education, family status, income, and residence. The ASHA workers were found to be functional in some areas with scope for improvement in others. The role of an ASHA worker was perceived to be more of a link-worker/facilitator rather than a community health worker or a social activist. PMID:25995730
California at San Diego, University of
SHIP San Diego SHIP UCSD Student Health Services (primary care)(urgent care) RAFT San Diego) 246-0469 email@example.com #12; SHIP San Diego SHIP UCSD Student Health Services (primary care)(urgent care) RAFT San Diego San Diego Kaiser, Medi-Cal, HMO San Diego San Diego (temporary patient ID
Discusses changing nature of volunteers in Peter Drucker's book "Managing the Nonprofit Corporation." Points out that most volunteers have full-time jobs, families, very little leisure; they are not willing to do such routine work as stuffing envelopes; they want carefully defined projects with beginning and end. Discusses real requirements for…
De Leo, Gianluca; Ponder, Michal; Molet, Tom; Fato, Marco; Thalmann, Daniel; Magnenat-Thalmann, Nadia; Bermano, Francesco; Beltrame, Francesco
In order to guarantee an effective and punctual medical intervention to injured people involved in health emergency situations, where usually both professional and non-professional health operators are involved, a fast and accurate treatment has to be carried out. In case of catastrophic or very critical situations, non-professional operators who did not receive proper training (volunteers are among them) could be affected by psychological inhibitions. Their performances could slow down in such way that would affect the quality of the treatment and increase both direct and indirect costs. Our virtual reality system that is currently in use at the health care emergency center of San Martino Hospital in Genoa, Italy, has been designed and developed to check health emergency operators' capabilities to adopt correct decision-making procedures, to make optimal use of new technological equipment and to overcome psychological barriers. Our system is composed of (1) a high-end simulation PC, whose main functions are execution of the main software module, rendering of 3D scenes in stereo mode, rendering of sound, and control of data transmission from/to VR devices; (2) a low-end control PC, which controls the VR simulation running on the simulation PC, manages medical emergency simulation scenarios, introduces unexpected events to the simulation and controls the simulation difficulty level; (3) a magnetic-based motion tracking device used for head and hand tracking; (4) a wireless pair of shutter glasses together with a cathode ray tube wall projector; and (5) a high-end surround sound system. The expected benefits have been verified through the design and implementation of controlled clinical trials. PMID:12855082
, NY 10468 (E-mail: Carolyn.firstname.lastname@example.org). Home Health Care Services Quarterly, Vol. 27(1) 2008 health care or in- formal care was not influenced by utilization of the other. doi:10.1300/ J027v27n01 health and informal care utilization relate dif- ferently to patient characteristics. Utilization of home
Mawn, Barbara; Siqueira, Eduardo; Koren, Ainat; Slatin, Craig; Devereaux Melillo, Karen; Pearce, Carole; Hoff, Lee Ann
In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field. PMID:19940090
Greer, Scott L; Jacobson, Peter D
Health policy debates are replete with discussions of federalism, most often when advocates of reform put their hopes in states. But health policy literature is remarkably silent on the question of allocation of authority, rarely asking which levels of government ought to lead. We draw on the larger literatures about federalism, found mostly in political science and law, to develop a set of criteria for allocating health policy authority between states and the federal government. They are social justice, procedural democracy, compatibility with value pluralism, institutional capability, and economic sustainability. Of them, only procedural democracy and compatibility with value pluralism point to state leadership. In examining these criteria, we conclude that American policy debates often get federalism backward, putting the burden of health care coverage policy on states that cannot enact or sustain it, while increasing the federal role in issues where the arguments for state leadership are compelling. We suggest that the federal government should lead present and future financing of health care coverage, since it would require major changes in American intergovernmental relations to make innovative state health care financing sustainable outside a strong federal framework. PMID:20388867
Tramonte, Michael R.
The goals of this presentation were to help mental health professionals learn more about intervening in aviation disasters, learn about the uniqueness of disaster mental health, and share the presenter's mental health disaster experiences as they relate to aviation disasters. Survivors' emotional phases during the disaster recovery process are…
Campbell, Robert James
This article introduces health care managers to the theories and philosophies of John Kotter and William Bridges, 2 leaders in the evolving field of change management. For Kotter, change has both an emotional and situational component, and methods for managing each are expressed in his 8-step model (developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short-term wins, don't let up, and making it stick). Bridges deals with change at a more granular, individual level, suggesting that change within a health care organization means that individuals must transition from one identity to a new identity when they are involved in a process of change. According to Bridges, transitions occur in 3 steps: endings, the neutral zone, and beginnings. The major steps and important concepts within the models of each are addressed, and examples are provided to demonstrate how health care managers can actualize the models within their health care organizations. PMID:18510142
McKee, Margaret; Kelley, Mary Lou; Guirguis-Younger, Manal; MacLean, Michael; Nadin, Shevaun
Although volunteers are widely acknowledged as important members of the palliative care team, their unique contribution to whole-person care has not been well documented or theorized, especially in rural communities. We conducted a focused ethnography in a small rural community, asking key community informants about their understanding of the role of hospice volunteers with dying people and their families. Our results show that these volunteers inhabit a unique third culture of care that fuses elements of formal care with the informal visiting of friends and neighbours. Their role is shaped to a community context where dying is not a private medical event, but rather a whole-person-in-community event, and where care is offered as a natural expression of the interdependence and reciprocity that characterizes rural community life. Our results are a reminder that it takes an entire community to care for the dying, and that hospice volunteers are a crucial link in the network of care that allows people to die with dignity and quality of life. PMID:20718395
Nevada Univ. and Community Coll. System, Reno. Office of the Chancellor.
This document attempts to determine whether the University and Community College System of Nevada (UCCSN) is preparing a health care workforce that is appropriate for the current and future health care needs of the state of Nevada. To assess this issue, the system collected and analyzed current data in terms of the state of health and health care…
Bodenmann, P; Bossart, R; Di Bernardo, N; Dominice Dao, M; Durieux, S; Faucherre, F; Hudelson, P; Keller, M; Schuster, S; Zellweger, E; Houmard, S
The development of Migrant Friendly Hospitals is an important first step towards eliminating health care disparities in Switzerland and an important reminder to health policy makers and practitioners across the health care system of their responsibility to provide non-discriminatory quality health care to all patients. PMID:25603570
France, K R; Grover, R
Because of the current competitive environment, health care providers (hospitals, HMOs, physicians, and others) are constantly searching for better products and better means for delivering them. The health care product is often loosely defined as a service. The authors develop a more precise definition of the health care product, product line, and product mix. A bundle-of-elements concept is presented for the health care product. These conceptualizations help to address how health care providers can segment their market and position, promote, and price their products. Though the authors focus on hospitals, the concepts and procedures developed are applicable to other health care organizations. PMID:10119211
Sousa, Raquel; Alves, Marco; Gonçalves, Gil
Wireless sensing is part of our lives; major technological breakthroughs in the areas of sensors, integrated circuits, and also on wireless communications, led to the creation of wireless sensor networks (WSNs). Such networks have multiple uses, from monitoring and tracking of people and goods, to the coordination and processing of activities in different contexts; they are used in industry, defence and healthcare applications. As part of this use in healthcare applications KeepCare, a solution based on monitoring, tracking and processing of healthcare related information, is presented in this paper. This solution uses a WSN based application to monitor peoples' health and quality of life through vital signs and activity information received via wireless sensors. This solution monitors users such as elderly, people suffering from chronic conditions in their home environment, but can as well be used in athletes or other professionals (e.g. first responders) that need to be monitored under hazardous conditions. PMID:22942032
The American Academy of Pediatrics advocates that all children must have health insurance coverage that ensures them access to affordable and comprehensive quality care. Access to care depends on the design and implementation of payment systems that ensure the economic viability of the medical home; support and grow the professional pediatric workforce; promote the adoption and implementation of health information technology; enhance medical education, training, and research; and encourage and reward quality-improvement programs that advance and strengthen the medical home. Health insurance plans must be portable from state to state, with administrative procedures to eliminate breaks and gaps in coverage to ensure continuous coverage from year to year. Plans should ensure free choice of clinicians and foster coordination with public and private community-based programs for infants, children, and adolescents through the age of 26. The scope of services provided by all health plans must include preventive, acute and chronic illness, behavioral, inpatient, emergency, and home health care. These plans must be affordable and have cost-sharing policies that protect patients and families from financial strain and are without risk of loss of benefits because of plan design, current illness, or preexisting condition. PMID:20974786
Andersen, Kathryn; Singh, Anuja; Shrestha, Meena Kumari; Shah, Mukta; Pearson, Erin; Hessini, Leila
ABSTRACT Background: Female community health volunteers (FCHVs) are a possible entry point for Nepali women to access timely reproductive health services at the village level. This evaluation assessed the success of a pilot program that trained FCHVs in early pregnancy detection using urine pregnancy tests (UPTs), counseling, and referral to appropriate antenatal, safe abortion, or family planning services. Methods: Between July 2008 and June 2009, the program trained 1,683 FCHVs from 6 districts on how to provide UPTs and appropriate counseling and referral; 1,492 FCHVs (89%) provided follow-up data on the number of clients served and the type of services provided. In addition, the program conducted in-depth interviews with selected FCHVs and other reproductive health service providers on their perceptions of the program. Results: Of the FCHVs with follow-up data, 80% reported providing UPTs to women in the 8-month follow-up period. In total, they conducted 4,598 UPTs, with a mean number of 3.1 tests per FCHV. Among the women with a negative pregnancy test (47%), FCHVs provided 24% of them with oral contraceptive pills and 20% with condoms; referred 10% for other contraceptive services; and provided contraceptive counseling only to 46%. Among the women with positive pregnancy tests (53%), FCHVs referred 68% for antenatal care and 32% for safe abortion services. Conclusions: Providing FCHVs with the skills and supplies required for early pregnancy detection allowed them to make referrals for appropriate reproductive health services. Results of this evaluation suggest that community health workers such as FCHVs are a promising channel for early pregnancy detection and referral. As the intervention is scaled up, the focus should be on ensuring service availability and awareness of available services, UPT supply, and creating viable options for record keeping. PMID:25276550
Deodhar, Jayita Kedar; Muckaden, Mary Ann
Context: Training programs for volunteers prior to their working in palliative care are well-established in India. However, few studies report on continuing professional development programs for this group. Aims: To conduct a preliminary assessment of educational needs of volunteers working in palliative care for developing a structured formal continuing professional development program for this group. Settings and Design: Cross-sectional observational study conducted in the Department of Palliative Medicine of a tertiary care cancer institute in India. Materials and Methods: Participant volunteers completed a questionnaire, noting previous training, years of experience, and a comprehensive list of topics for inclusion in this program, rated in order of importance according to them. Statistical Analysis Used: Descriptive statistics for overall data and Chi-square tests for categorical variables for group comparisons were applied using Statistical Package for Social Sciences version 18. Results: Fourteen out of 17 volunteers completed the questionnaire, seven having 5–10-years experience in working in palliative care. A need for continuing professional development program was felt by all participants. Communication skills, more for children and elderly specific issues were given highest priority. Spiritual-existential aspects and self-care were rated lower in importance than psychological, physical, and social aspects in palliative care. More experienced volunteers (>5 years of experience) felt the need for self-care as a topic in the program than those with less (<5-years experience) (P < 0.05). Conclusions: Understanding palliative care volunteers’ educational needs is essential for developing a structured formal continuing professional development program and should include self-care as a significant component. PMID:26009668
Sokolov, J J
Other than hold on tight, how does a health care system successfully weather the turbulent conditions facing the industry? This article focuses on key drivers in the three main segments of the health care market: employer-based, commercial/ERISA, and Medicare and Medicaid. Effectively managing the dynamics within these markets will be vital to a delivery system's success and its ability to withstand the forces of change. Given the market changes that are occurring, how does an academic medical center, emerging hospital-sponsored IDS, or a large physician clinic trying to develop a system determine the necessary components and structure? What kind of system will work best? The considerations are numerous and explored in this article. PMID:10167479
Wasserman, R C; Hassuk, B M; Young, P C; Land, M L
In anecdotal reports, problems have been cited in the health care of physicians' children, but no systematic study of this issue has been attempted. Pediatricians in a community of high physician density were interviewed to determine whether and how the health care of physicians' children differs from that of children of equivalent socioeconomic status. Of the community's 33 pediatricians, 94% responded to items in a 45-minute structured interview, for which test-retest reliability was demonstrated. Systematic differences in the care of physicians' children included delayed help seeking and increased self-referral to specialists by parents, and poor documentation of psychosocial history, less detailed instruction giving, and a reluctance to discuss problem behavior by pediatricians. Reasons cited by pediatricians for these problems included inappropriate assumptions concerning the medical knowledge of the physician's family, confusion between the roles of healer and help seeker, and embarrassment about discussing personal issues with colleagues. Pediatricians and physician parents need to become aware of and communicate about the potential for problems in the health care of physicians' children. PMID:2919137
Rook, Karen S.; Sorkin, Dara H.
This study examined the effects on older adults' psychological health of participation in a volunteer role that afforded opportunities to form friendships with age peers and to express nurturance toward another person. Access to these important social provisions was expected, in turn, to contribute to greater self-esteem, less loneliness, and less…
During the last decade there has been a recognition that all health care systems, public and private, are characterised by perverse incentives (especially moral hazard and third party pays) which generate inefficiency in the use of scarce economic resources. Inefficiency is unethical: doctors who use resources inefficiently deprive potential patients of care from which they could benefit. To eradicate unethical and inefficient practices two economic rules have to be followed: (i) no service should be provided if its total costs exceed its total benefits; (ii) if total benefits exceed total costs, the level of provision should be at that level at which the additional input cost (marginal cost) is equal to the additional benefits (marginal benefit). This efficiency test can be applied to health care systems, their component parts and the individuals (especially doctors) who control resource allocation within them. Unfortunately, all health care systems neither generate this relevant decision making data nor are they flexible enough to use it to affect health care decisions. There are two basic varieties of budgeting system: resource based and production targeted. The former generates obsession with cash limits and too little regard of the benefits, particularly at the margins, of alternative patterns of resource allocation. The latter generates undue attention to the production of processes of care and scant regard for costs, especially at the margins. Consequently, one set of budget rules may lead to cost containment regardless of benefits and the other set of budget rules may lead to output maximization regardless of costs. To close this circle of inefficiency it is necessary to evolve market-like structures. To do this a system of client group (defined broadly across all existing activities public and private) budgets is advocated with an identification of the budget holder who has the capacity to shift resources and seek out cost effective policies. Negotiated output targets with defined budgets and incentives for decision makers to economise in their use of resources are being incorporated into experiments in the health care systems of Western Europe and the United States. Undue optimism about the success of these experiments must be avoided because these problems have existed in the West and in the Soviet bloc for decades and efficient solutions are noticeable by their absence. PMID:10269645
Gould, Stephen J.
Questionnaires returned by 343 out of 350 subjects measured health attitudes and health status. Results suggest that some consumers take a more scientific approach to health care and prevention. Demographic factors, health status, and health consciousness are partial predictors of consumer attitudes and approach to health care. (SK)
Bhatnagar, Kavita; Srivastava, Kalpana
Job satisfaction among health-care professionals acquires significance for the purpose of maximization of human resource potential. This article is aimed at emphasizing importance of studying various aspects of job satisfaction in health-care organizations. PMID:23766585
Huynh, Jasmine-Yan; Winefield, Anthony H; Xanthopoulou, Despoina; Metzer, Jacques C
This study examined the role of burnout and connectedness in the job demands-resources (JD-R) model among palliative care volunteers. It was hypothesized that (a) exhaustion mediates the relationship between demands and depression, and between demands and retention; (b) cynicism mediates the relationship between resources and retention; and (c) connectedness mediates the relationship between resources and retention. Hypotheses were tested in 2 separate analyses: structural equation modeling (SEM) and path analyses. The first was based on volunteer self-reports (N = 204), while the second analysis concerned matched data from volunteers and their family members (N = 99). While strong support was found for cynicism and connectedness as mediators in both types of analyses, this was not altogether the case for exhaustion. Implications of these findings for the JD-R model and volunteer organizations are discussed. PMID:22207713
Barogui, Yves Thierry; Sopoh, Ghislain Emmanuel; Johnson, Roch Christian; de Zeeuw, Janine; Dossou, Ange Dodji; Houezo, Jean Gabin; Chauty, Annick; Aguiar, Julia; Agossadou, Didier; Edorh, Patrick A.; Asiedu, Kingsley; van der Werf, Tjip S.; Stienstra, Ymkje
Background Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually BU begins as a painless nodule, plaque or edema, ultimately developing into an ulcer. The high number of patients presenting with ulcers in an advanced stage is striking. Such late presentation will complicate treatment and have long-term disabilities as a consequence. The disease is mainly endemic in West Africa. The primary strategy for control of this disease is early detection using community village volunteers. Methodology/Principal Findings In this retrospective, observational study, information regarding Buruli ulcer patients that reported to one of the four BU centers in Bénin between January 2008 and December 2010 was collected using the WHO/BU01 forms. Information used from these forms included general characteristics of the patient, the results of diagnostic tests, the presence of functional limitations at start of treatment, lesion size, patient delay and the referral system. The role of the different referral systems on the stage of disease at presentation in the hospital was analyzed by a logistic regression analysis. About a quarter of the patients (26.5%) were referred to the hospital by the community health volunteers. In our data set, patients referred to the hospital by community health volunteers appeared to be in an earlier stage of disease than patients referred by other methods, but after adjustment by the regression analysis for the health center, this effect could no longer be seen. The Polymerase Chain Reaction (PCR) for IS2404 positivity rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. Conclusions/Significance This study clarifies the role played by community health volunteers in Bénin, and shows that they play an important role in the control of BU. PMID:25275562
Rice, N.; Smith, P.
Important variations in access to health care and health outcomes are associated with geography, giving rise to profound ethical concerns. This paper discusses the consequences of such concerns for the allocation of health care finance to geographical regions. Specifically, it examines the ethical drivers underlying capitation systems, which have become the principal method of allocating health care finance to regions in most countries. Although most capitation systems are based on empirical models of health care expenditure, there is much debate about which needs factors to include in (or exclude from) such models. This concern with legitimate and illegitimate drivers of health care expenditure reflects the ethical concerns underlying the geographical distribution of health care finance. Key Words: Health economics • resource allocation • ethics of regional health care finance • capitation systems PMID:11479357
Chen, P C
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
Marmor, Theodore Richard
This article is a condensed and edited version of a speech delivered to The Business of Medicine: A Course for Physician Leaders symposium presented by Yale-New Haven Hospital and the Medical Directors Leadership Council at Yale University in November 2012 and drawn from Politics, Health, and Health Care: Selected Essays by Theodore R. Marmor and Rudolf Klein . It faithfully reflects the major argument delivered, but it does not include the typical range of citations in a journal article. The material presented here reflects more than 40 years of teaching a course variously described as Political Analysis and Management, Policy and Political Analysis, and The Politics of Policy. The aim of all of these efforts is to inform audiences about the necessity of understanding political conflict in any arena, not least of which is the complex and costly world of medical care. PMID:24058315
Background Community-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival. Care Groups are a community-based implementation strategy for the delivery of social and behavior change interventions. This study assessed if supervision of Care Group activities by Ministry of Health (MOH) personnel could achieve the same child health outcomes as supervision provided by specialized non-governmental organization (NGO) staff. Methods The study was a pretest-posttest quasi-experimental design implemented in Burundi. A total of 45 MOH-led Care Groups with 478 Care Group Volunteers (CGVs) were established in the intervention area; and 50 NGO-led Care Groups with 509 CGVs were formed in the comparison area. Data were collected from 593 and 700 mothers of children 0-23 months at baseline and endline, respectively. Pearson’s chi-squared test and difference-in-difference analysis assessed changes in 40 child health and nutrition outcomes. A qualitative process evaluation was also conducted midway through the study. Results The MOH-led Care Group model performed at least as well as the NGO-led model in achieving specific child health and nutrition outcomes. Mothers of children 0-23 months in the intervention and comparison sites reported similar levels of knowledge and practices for 38 of 40 dependent variables measured in the study, and these results remained unchanged after accounting for differences in the indicator values at baseline. Process monitoring data confirmed that the MOH-led Care Group model and the NGO-led Care Group model were implemented with similar intervention strength. Conclusions The study demonstrated that behavior change interventions traditionally led by NGOs can be implemented through the existing MOH systems and achieve similar results, thereby increasing the potential for sustainable child health outcomes. Future research on the MOH-led Care Group model is required to systematically document all inputs and monetary costs borne by the MOH to implement the model. PMID:26062624
Amin, Alpesh; Kollef, Marin H
Traditionally, pneumonia developing in patients who receive health care services in the outpatient environment, such as nursing homes, long-term care facilities, and dialysis centers, has been classified and treated as community-acquired pneumonia (CAP). Recent studies, however, have shown that this type of infection, known as health care-associated pneumonia (HCAP) is distinct from CAP in terms of its epidemiology and etiology, and increases the risk for infection with multidrug-resistant (MDR) pathogens. A review of available clinical data about HCAP was conducted to determine effective empiric treatment strategies and improve clinical outcomes. Analysis of multi-institutional clinical data showed that mortality associated with HCAP is higher than with CAP, suggesting that patients with HCAP may have been treated as hospitalized patients with CAP and received inappropriate initial empiric antibiotic treatment. All patients presenting to the hospital with suspected HCAP or CAP should be evaluated for their underlying risk of infection with MDR pathogens. Because HCAP may be similar to hospital-acquired pneumonia (HAP) both clinically and etiologically, it should be treated as HAP until culture data become available. A greater recognition of HCAP as a new class of pneumonia with a distinct epidemiologic, microbiologic, and clinical profile should lead physicians to initiate appropriate empiric antibiotic therapy more often, thereby improving the likelihood for optimal clinical outcomes and patient care. PMID:20499775
In this paper, we examine whether engaging in voluntary work leads to greater well-being, as measured by self-reported health and happiness. Drawing on data from the USA, our estimates suggest that people who volunteer report better health and greater happiness than people who do not, a relationship that is not driven by socio-economic differences between volunteers and non-volunteers. We concentrate on voluntary labor for religious groups and organizations and using second stage least square regressions we find that religious volunteering has a positive, causal influence on self-reported happiness but not on self-reported health. We explore reasons that could account for the observed causal effect of volunteering on happiness. Findings indicate that low relative socio-economic status is associated with poor health both among those who volunteer and those who do not. Low status, however, is associated with unhappy states only among those who do not volunteer, while volunteers are equally likely to be happy whether they have high or low status. We propose that volunteering might contribute to happiness levels by increasing empathic emotions, shifting aspirations and by moving the salient reference group in subjective evaluations of relative positions from the relatively better-off to the relatively worse-off. PMID:18321629
Ethics have long been recognized as underpinning primary health care. While dis- crete understandings of ethics have developed to support many areas of health care and research, there has been little attempt to formulate an ethics framework which is focused on primary health care. Developments both within and external to primary health care practice make it timely to address primary
Chater 4 Roles of Child Health-Care Providers 4 Roles of Child Health-Care Providers in Childhood Lead Poisoning Prevention Roles of Child Health-Care Providers 1. Use and disseminate information from 7 #12;Chater 4 Roles of Child Health-Care Providers In addition to routine screening and follow
Claxton-Oldfield, Stephen; Marrison-Shaw, Hayley
Two separate studies were conducted to identify perceived barriers and enablers to referrals to community-based hospice palliative care volunteer programs in 2 Atlantic Canadian provinces. In study 1, a physician, home support nurse manager, social worker, and volunteer coordinator (VC) were interviewed. More barriers than enablers were identified. Based on these results and a review of the literature, a "Perceived Barriers and Enablers to Hospice Palliative Care Volunteer Referrals Questionnaire" (PBEQ) was developed. In study 2, a total of 10 VCs completed the PBEQ and (1) rated the extent to which they perceived 18 items to be barriers to referrals; (2) rated the extent to which they perceived 12 items to be enablers to referrals; and (3) described additional barriers and enablers. A Tips for Referrals sheet was created. PMID:24037541
Strech, Scott; Wyatt, David A
Health care has a long-held perception of perioperative nurses as providers who advocate for patients and who carry out physician orders. According to the Institute of Medicine's 2010 report on the future of nursing, not only must that view evolve, but nurses also must play a leading role, in partnership with physicians and other health care colleagues, if health care reform is to succeed. Several factors will prepare nurses for this new role of partnering to advance health, including advancing their formal education, developing leadership as a core competency, acquiring leadership skills, and being active in new models of leadership (ie, mentorship, volunteering, advocacy). PMID:23978176
Syre, Thomas R.; Wilson, Richard W.
This article discusses role delineation in the health education profession, defines and presents principles of health care marketing, describes marketing plan development, and examines major ethical issues associated with health care marketing when utilized by community health educators. A marketing plan format for community health education is…
Since 1997 post-communist Bulgaria has started structural and financial Health Care reform. The reform's framework is laid down by new health legislation. The main law regulating the broad framework of the health system is the Bulgarian Health Act (BHA) 2004 which came into force in January 2005. The aim of this paper is to introduce and analyze the main features of the Bulgarian Health Care Reform and Health Care Act 2004. Key issues in BHA include: organization and financing of health care; health protection; health promotion, patients' rights, accessibility and quality of health care, mental health, alternative medical services, medical education, medical profession and medical science, and administrative-punitive measures. BHA is a policy document justifying that Bulgaria is prepared and willing to meet the challenge to bring the health status of the Bulgarian population to the current average European health level, as well as that in the EU Member States. PMID:17511405
Sorrell, Jeanne M
Health care was an important issue for both the Obama and McCain election campaigns. Now that Barack Obama is poised to serve as the 44th President of the United States, many health care providers are focused on what Obama's administration will mean for new health care initiatives. This article focuses specifically on aspects of the Obama and Biden health care plan that affects mental health care for older adults. PMID:19227106
Kislev, Livia; Yaffe, Aliza; Ziv, Miri; Waller, Alexander
The Israel Cancer Association has contributed, as a key player, to the establishment and upgrade of palliative care in Israel. The aim of this article is to describe the involvement and contribution of the ICA, as a volunteer organization, from a clinical, educational, legal, and organizational perspective. Another main goal of this survey is to shed light on the palliative care network in Israel, in each one of these infrastructures. PMID:23171783
Morrisette, Shelley; Oberman, William D; Watts, Allison D; Beck, Joseph B
The current U.S. health care system, with both rising costs and demands, is unsustainable. The combination of a sense of individual entitlement to health care and limited acceptance of individual responsibility with respect to personal health has contributed to a system which overspends and underperforms. This sense of entitlement has its roots in a perceived right to health care. Beginning with the so-called moral right to health care (all life is sacred), the issue of who provides health care has evolved as individual rights have trumped societal rights. The concept of government providing some level of health care ranges from limited government intervention, a 'negative right to health care' (e.g., prevention of a socially-caused, preventable health hazard), to various forms of a 'positive right to health care'. The latter ranges from a decent minimum level of care to the best possible health care with access for all. We clarify the concept of legal rights as an entitlement to health care and present distributive and social justice counter arguments to present health care as a privilege that can be provided/earned/altered/revoked by governments. We propose that unlike a 'right', which is unconditional, a 'privilege' has limitations. Going forward, expectations about what will be made available should be lowered while taking personal responsibility for one's health must for elevated. To have access to health care in the future will mean some loss of personal rights (e.g., unhealthy behaviors) and an increase in personal responsibility for gaining or maintaining one's health. PMID:23494290
When the Taliban swept into Kabul, Afghanistan in September 1996, they began a reign of terror over the people of that city, especially the women. Adhering to a fundamentalist interpretation of Islamic law, the group has severely restricted women's freedom of movement and access to health care, education, and employment. Some female physicians and nurses have been able to continue working because the Taliban has decreed that male doctors can not treat women patients unless they are their relatives. Female physicians and nurses have been subjected to beatings by armed Taliban guards who enforce "morals." Male and female doctors are viewed with suspicion by the Taliban and are routinely ridiculed in public. Women are attacked when they venture into the streets to seek medical care for themselves or their children, and a pregnant woman recently delivered her baby in the street while her husband was being beaten for trying to take her to the hospital. This interference with the delivery of health care has occurred at a time when many people require treatment for injuries inflicted in connection with the war and when the public utility system has collapsed. Few physicians are willing to discuss the patients they treat for injuries inflicted by the torturous Taliban, especially since some physicians have collaborated with the Taliban in order to avoid reprisals. PMID:9130961
Ostoji?, Rajko; Bilas, Vlatka; Franc, Sanja
The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services. PMID:23213924
Dowden, Shauna L.; Calvert, Richard D.; Davis, Lisa; Gullotta, Thomas P.
This article explores an approach for better serving the complete health care needs of children, specifically, the efficacy of school-based health centers (SBHCs) to provide a service delivery mechanism capable of functioning as a medical home for children, providing primary care for both their physical and behavioral health care needs. The…
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894
Núñez, Alicia; Chi, Chunhuei
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894
Yeravdekar, Rajiv; Yeravdekar, Vidya Rajiv; Tutakne, M A; Bhatia, Neeta P; Tambe, Murlidhar
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
Jopang, Yupin; Petchmark, Suthep; Jetsrisuparb, Arunee; Sanchaisuriya, Kanokwan; Sanchaisuriya, Pattara; Schelp, Frank Peter
The study was conducted to assess the achievement of a thalassemia screening program at a community level supported by village health volunteers (VHVs) of 2 subdistricts in the northeast of Thailand. One subdistrict served as the intervention and the other as the control area. A training program was organized for the village health volunteers from the intervention area. Essential information about the risk and danger of thalassemia was given to the participants who wanted to have children in the community as well. Of the 206 individuals who wanted to have children living in the intervention area, 190 (92.2%) agreed to undergo screening. Of the 196 individuals within the control area, only 26 (13.3%) voluntarily participated in the screening tests. Attitude toward prevention and knowledge about the disease improved significantly in both areas, but the differences between the scores were statistically significantly higher for individuals living in the intervention area. PMID:22332179
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Widmer, Geraldine; And Others
Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)
Schraiber, Lilia Blima; Figueiredo, Wagner dos Santos; Gomes, Romeu; Couto, Márcia Thereza; Pinheiro, Thiago Félix; Machin, Rosana; Silva, Geórgia Sibele Nogueira da; Valença, Otávio
This study deals with the relations between masculinities and health care, approaching the recognition of health needs among male users of primary health care and the responses by the services. The study is part of a larger research project in four Brazilian States, with a convenience sample of eight health services. Ethnographic observation was compared with semi-structured interviews with 182 health care users from 15 to 65 years of age and 72 health professionals. Thematic analysis of the ethnographic records and interviews was based on gender references and studies on health work. The findings show how medicalization of health needs affects users, professionals, and services, disguising issues related to masculinity. Primary care focuses mainly on women, thereby reproducing gender inequalities in health services operations and professional performance, with women receiving disciplined care and men receiving insufficient attention and care. PMID:20563396
Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners. PMID:22390510
Colangelo, Gary A
Improving access to oral health care requires an understanding of the social, cultural, political, financial, and manpower factors that influence access. Armed with this knowledge, individuals and organizations desiring to improve access can innovate to change public policy, garner resources, create clinical programs, and expand public health interventions as demonstrated by the examples in this article. This article highlights past and contemporary innovations that have improved access, or have the potential to improve access to oral health care. These innovations are grouped into six categories: the dental profession, public health, community-based care delivery, oral health care funding, dental education, and evidence-based dentistry. PMID:19482132
Health and Pre-Professional Health care is currently Canada's second-largest service industry. In addition to traditional health-related roles (e.g., physician, nurse, dentist, pharmacist), a wealth of new health care careers are opening as a result of recent scientific, medical and technological advances
Brower, Mary R.; Sull, Theresa M.
Contends that child care facility owners, boards of directors, staff, and parents need to focus on financial management, as poor financial health compromises the quality of care for children. Specifically addresses the issues of: (1) concern for providing high quality child care; (2) the connection between quality and money; and (3) strengthening…
Uses statistics from the National Center for Health Statistics to show that rural elders have greater health needs than urban elders but receive less care. Barriers to adequate health care include ignorance and denial, a tendency to use lay rather than professional treatment, and financial and transportation difficulties. (JAC)
Younger, Sandra Millers
Strategies for containing the cost of providing health insurance for college employees include cost sharing with employees, cost reduction through options such and managed care, incentives for use of health maintenance organizations, offering health care alternatives, and entering into multiple-employer purchasing groups. (MSE)
Doherty, William J., Ed.; McCubbin, Hamilton I., Ed.
Discusses research and interventions related to family health care. Topics include health promotion; risk behaviors; vulnerability and illness onset; choosing health care systems; stress; caregiving and coping; family counseling; and family responses to Alzheimer's Disease, pediatric cancer, cystic fibrosis, diabetes, and obesity. (JAC)
Hillman, D.A.; Hillman, E.S.; Steckley, Gail
The goal of “Health for All” has not changed since it was orginally promoted in 1977, but the strategy for reaching this goal has been revised dramatically. Primary health care, through preventive measures, simple lifestyle improvements, human resource development, and health education, is now promoted as a means to attain “Health for All” by the year 2000. The authors report the results of a health care project in Kenya's western province. ImagesFigure 1 PMID:21249115
Hall, Mark A
National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding health care delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status. PMID:23262771
There are many ways in which long-term care facilities attempt to cope with the mental health problems of the elderly. The author reviews five factors crucial to effective care for the aged in these facilities. (Author/RK)
Rich, Preston B; Adams, Sasha D
National health care expenditures constitute a continuously expanding component of the US economy. Health care resources are distributed unequally among the population, and geriatric patients are disproportionately represented. Characterizing this group of individuals that accounts for the largest percentage of US health spending may facilitate the introduction of targeted interventions in key high-impact areas. Changing demographics, an increasing incidence of chronic disease and progressive disability, rapid technological advances, and systemic market failures in the health care sector combine to drive cost. A multidisciplinary approach will become increasingly necessary to balance the delicate relationship between our constrained supply and increasing demand. PMID:25459539
Balarajan, Y; Selvaraj, S; Subramanian, S V
In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population. PMID:21227492
Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R
As the US health care system transitions toward a value-based system, providers and health care organizations will have to closely scrutinize their current processes of care. To do this, a value chain analysis can be performed to ensure that only the most efficient steps are followed in patient care. Ultimately this will produce a higher quality or equal quality product for less cost by eliminating wasteful steps along the way. PMID:26356585
Background Volunteer community health workers (CHWs) are a key approach to improving community-based maternal and child health services in developing countries. BRAC, a large Bangladeshi non-governmental organization (NGO), has employed female volunteer CHWs in its community-based health programs since 1977, recently including its Manoshi project, a community-based maternal and child health intervention in the urban slums of Bangladesh. A case–control study conducted in response to high dropout rates in the first year of the project showed that financial incentives, social prestige, community approval and household responsibilities were related to early retention in the project. In our present prospective cohort study, we aimed to better understand the factors associated with retention of volunteer CHWs once the project was more mature. Methods We used a prospective cohort study design to examine the factors affecting retention of volunteer CHWs who remained in the project after the initial start-up period. We surveyed a random sample of 542 CHWs who were working for BRAC Manoshi in December 2008. In December 2009, we revisited this cohort of CHWs and interviewed those who had dropped out about the main reasons for their dropping out. We used a multivariable generalized linear model regression analysis with a log link to estimate the relative risk (RR) of independent factors on retention. Results Of the 542 CHWs originally enrolled, 120 had dropped out by the end of one year, mainly because they left the slums. CHWs who received positive community appraisal (adjusted RR?=?1.45, 95% confidence interval (CI)?=?1.10 to 1.91) or were associated with other NGOs (adjusted RR?=?1.13, 95% CI?=?1.04 to 1.23) were more likely to have been retained in the project. Although refresher training was also associated with increased retention (adjusted RR?=?2.25, 95% CI?=?1.08 to 4.71) in this study, too few CHWs had not attended refresher training regularly to make it a meaningful predictor of retention that could be applied in the project setting. Conclusion Factors that affect retention of CHWs may change over time, with some factors that are important in the early years of a project losing importance as the project matures. Community health programs operating in fragile urban slums should consider changing factors over program duration for better retention of volunteer CHWs. PMID:24886046
We show that when health care providers have market power and engage in Cournot competition, a competitive upstream health insurance market results in over-insurance and over-priced health care. Even though consumers and firms anticipate the price interactions between these two markets - the price set in one market affects the demand expressed in the other - Pareto improvements are possible. The results suggest a beneficial role for Government intervention, either in the insurance or the health care market. PMID:16647770
Market forces inevitable in health care. - Free markets exist everywhere and have provided us, as a society, with many benefits. A truly free market does not exist: all market sectors are bound within legal frameworks. For health care, the question is not whether a free market is feasible, but within which frameworks does it work exclusively. Establishing the framework is a particular political responsibility. Without the framework, health care will fall prey to political opportunists and lobbyists for pressure groups. PMID:16715864
de Brantes, Francois; D'Andrea, Guy; Rosenthal, Meredith B
How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding "warranties" to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers' behavior and profitability. We conclude that warranties could motivate providers to improve quality and could increase their profit margins. PMID:19531556
With the reforms expected for US health care, the question remains as to the impact on family planning services. Although the focus is on health care finance reform, the mix of patients seen, the incentives for decision making, and the interactions between health care providers will change. Definition of key concepts is provided for universal access, managed competition, and managed care. The position of the obstetrician/gynecologist (Ob/Gyn) does not fit well within the scheme for managed health care, because Ob/Gyns are both primary care providers and specialists in women's health care. Most managed health care systems presently consider Ob/Gyn to be a specialty. Public family planning clinics, which have a client constituency of primarily uninsured women, may have to compete with traditional private sector providers. "Ambulatory health care providers" have developed a reputation for high quality, cost effective preventive health care services; this record should place providers with a range of services in a successful position. Family planning providers in a managed competition system will be at a disadvantage. 3 scenarios possible under managed competition are identified as the best case, out of the mainstream, and most likely. The best case is when primary reproductive health care services, contraception, sexually transmitted disease screening and management, and preventive services are all obtained directly from reproductive health care providers. Under managed care, this means allowing for an additional entry gatekeeper to specialized services. The benefits are to clients who prefer seeing reproductive health care providers first; reproductive services would be separated from medical services. The out of the mainstream scenario would place contraceptive services and other preventive services as outside the mandated benefits. The government would still provide Title X type programs for the indigent. The most likely scenario is one where primary care providers offer contraceptive services, and some family planning providers would expand their services to include nonreproductive health care. Abortion services are presently out of the health care mainstream, and efforts will need to be made to identify impact on reproductive and family planning practices and to advocate for specific provisions in health care reform. PMID:12286566
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Vidaeff, Alex C; Kerrigan, Anthony J; Monga, Manju
Culturally sensitive health care represents a real ethical and practical need in a Western healthcare system increasingly serving a multiethnic society. This review focuses on cross-cultural barriers to health care and incongruent aspects from a cultural perspective in the provision of health care. To overcome difficulties in culturally dissimilar interactions and eventually remove cross-cultural barriers to health care, a culturally sensitive physician considers his or her own identity, values, and beliefs; recognizes the similarities and differences among cultures; understands what those similarities and differences mean; and is able to bridge the differences to accomplish clear and effective communication. PMID:25580748
Goodman, John C
To control health care costs, someone must choose between health care and other uses of money. The value of most health care is experienced subjectively, as is the value of other goods and services. No one is in a better position to make these subjective trade-offs than patients themselves. The current system not only systematically denies patients the opportunity to make such choices, it distorts the incentives of providers in the process. Chronic patients in particular would be much better off if they could manage more of their own health care dollars and if providers were free to compete to meet their needs. PMID:17062593
Oliver, Douglas L.
Effective Dates July 1, 2009 -- June 30, 2012 #12;#12;PROFESSIONAL HEALTH CARE EMPLOYEES BARGAINING UNIT (P 3 Union Security And Payroll Deduction ............................................ 4 ARTICLE 4
Wenger, A F
Decisions about health promotion and illness prevention occur within a cultural context that is influenced by the contemporary context of community and family in addition to the ethnohistorical and language contexts, worldview and sociocultural factors of the particular culture and the available folk and professional health care resources. Using information about the health and care beliefs and values and health care decision making process in negotiating culturally congruent nursing and health care interventions is imperative, especially in a world with limited health care resources and an increasing demand for recognition of cultural diversity. This article uses data on health and health care decision-making from an ethnonursing study of the Old Order Amish to demonstrate the role of cultural context in health care practices and decision making. Leininger's cultural care theory and Hall's conceptualization of high context culture were used to investigate these phenomena. High context features of the Old Order Amish culture are used to explain how Amish are actively involved in decisions and actions taken to promote health and prevent and treat illness using a broad array of folk, alternative and professional services simultaneously. As nurses learn to involve clients in decisions and actions using the guiding principles of cultural care preservation, accommodation and repatterning they will provide culturally congruent care for Amish and other culture-specific groups. PMID:8716100
Kawakami, Tsuyoshi; Van, Vhu Nhu; Theu, Nguyen Van; Khai, Ton That; Kogi, Kazutaka
The government of Viet Nam places a high priority on upgrading the quality of farmers' lives. Providing adequate occupational safety and health (OSH) protection for all farmers is an important challenge. The Ministry of Labour, Invalids and Social Affairs (MOLISA) of Viet Nam trained WIND (Work Improvement in Neighbourhood Development) farmer volunteers. From 2004-2007, MOLISA in cooperation with ministries of health and agriculture trained 480 WIND farmer volunteers in selected 14 provinces. Trained farmer volunteers trained their neighbouring farmers and expanded their networks. The WIND training programme produced in Cantho, Viet Nam in 1996, was used as the core training methodology. The WIND action-checklist, good example photo-sheets, and other participatory training materials were designed for WIND farmer volunteers as practical training tools. The volunteers trained 7,922 farmers. The trained farmers implemented 28,508 improvements in materials handling, work posture, machine and electrical safety, working environments and control of hazardous chemicals, and welfare facilities. The provincial support committees organized follow-up workshops and strengthen the WIND farmer volunteer networks. The system of WIND farmer volunteers proved effective in extending practical OSH protection measures to farmers at grassroots level. The system of WIND farmer volunteers was adopted in the First National Programme on Labour Protection and OSH of Viet Nam as a practical means in OSH and is now further expanding within the framework of the National Programme. PMID:18840935
Kulshreshtha, Archana; Zacharia, Anish J; Jarouliya, Urmila; Bhadauriya, Pratiksha; Prasad, G B K S; Bisen, P S
Spirulina is a photosynthetic, filamentous, spiral-shaped and multicellular edible microbe. It is the nature's richest and most complete source of nutrition. Spirulina has a unique blend of nutrients that no single source can offer. The alga contains a wide spectrum of prophylactic and therapeutic nutrients that include B-complex vitamins, minerals, proteins, gamma-linolenic acid and the super anti-oxidants such as beta-carotene, vitamin E, trace elements and a number of unexplored bioactive compounds. Because of its apparent ability to stimulate whole human physiology, Spirulina exhibits therapeutic functions such as antioxidant, anti-bacterial, antiviral, anticancer, anti-inflammatory, anti-allergic and anti-diabetic and plethora of beneficial functions. Spirulina consumption appears to promote the growth of intestinal micro flora as well. The review discusses the potential of Spirulina in health care management. PMID:18855693
Heron, W. David; Donatelli, Ben
Describes how, through a shared plan, the Health Insurance Initiative of the Independent Colleges and Universities in Florida (ICUF) is saving participating institutions millions in costs associated with providing employee health care. (EV)
Twickler, Th B Marcel; Hoogstraaten, Evelien; Reuwer, Anne Q; Singels, Loes; Stronks, Karien; Essink-Bot, Marie-Louise
Health literacy is the combination of cognitive and social skills that is necessary for adequate response to information about health, illness and health care. Subjects with limited health literacy often experience difficulty in understanding the information provided by health care professionals and finding their way in the health care system, with consequent increased morbidity and mortality. Health literacy is a wider concept than literacy. Approximately 1.5 million people in the Netherlands, of which two thirds are of ethnic Dutch origin, have low literacy skills or are illiterate. The group with low health literacy is even larger. Health care professionals, including physicians, must be able to recognise limited health literacy in order to react appropriately, for example by adapting information provision, checking understanding, supporting communication with visual aids, and making longer appointments.Such measures may be expected to improve results, but investigation of their effectiveness is necessary. PMID:19785884
Martinez, Iveris L; Frick, Kevin; Glass, Thomas A; Carlson, Michelle; Tanner, Elizabeth; Ricks, Michelle; Fried, Linda P
Engagement in social and generative activities has benefits for the well-being of older adults; hence, methods for broadly engaging them in such activities are desired. Experience Corps Baltimore, a social model for health promotion for older adult volunteers in public schools, offers insight to such successful recruitment and retention. We report on data over a 4-year period in Baltimore City, Maryland, and describe a five-stage screening process implemented to recruit a diverse group of senior volunteers who would remain in the program for at least 1 year. The sample consisted of 443 older adults expressing an interest in and screened for volunteering. Comparisons were made with Chi-square and Fisher's t-test between those who entered the program and those who did not and those who were retained in the program. Gender, race, age group, and prior volunteering were significant in ultimate volunteer service in the schools. Overall, 38% of 443 persons recruited entered the schools; 94% of participants were over 60 years (p = 0.05) with a mean age of 69 years; 90% were women (p = 0.03), and 93% African-American (p = 0.005); 57% had not volunteered in the past year (p = 0.004). Ninety-two percent were retained in the first year; 80% returned a second year. Among the latter, 83% had <12 years of education (p = 0.001). Participants remained in the program for a second year of volunteering regardless of baseline MMSE score, self-reported health, and motivation for volunteering. In conclusion, it is possible to recruit and retain a diverse pool of older adults to participate in a high-intensity volunteer program, including non-traditional volunteers. Of special note is the success in recruiting African-American women and those with lower education, who may particularly benefit from health promotion. PMID:16758336
Drati, Nathan; Kleiner, Brian
Managed care has become one of the leading developments in health care financial management, but ignorance and confusion surround its meaning and origins. Managed care seeks to reduced costs and increase profits while maintaining quality, yet the evidence that it is able to achieve these aims is mixed. The following analysis is a review of the events leading to the establishment of managed care and what it has become. Various terms and health care organizations involved in managed care are identified, with emphasis placed on the strengths and weaknesses of managed care programs. This analysis is performed to gain insight and better understanding of the direction health care financial management is headed in the 21st century. PMID:18972972
Coile, R C
The arrival of the Internet offers the opportunity to fundamentally reinvent medicine and health care delivery. The "e-health" era is nothing less than the digital transformation of the practice of medicine, as well as the business side of the health industry. Health care is only now arriving in the "Information Economy." The Internet is the next frontier of health care. Health care consumers are flooding into cyberspace, and an Internet-based industry of health information providers is springing up to serve them. Internet technology may rank with antibiotics, genetics, and computers as among the most important changes for medical care delivery. Utilizing e-health strategies will expand exponentially in the next five years, as America's health care executives shift to applying IS/IT (information systems/information technology) to the fundamental business and clinical processes of the health care enterprise. Internet-savvy physician executives will provide a bridge between medicine and management in the adoption of e-health technology. PMID:10788126
Kaiser, Dagmar Elaine; Bianchi, Fabiana
The professionals who work on primary health care are affected by violence as they deal with very diverse patients. This exploratory descriptive study, with a qualitative approach, aimed at determining the situations in which primary health care professionals suffer aggressions. Data were collected in 2007, and included all members of a primary health care unit. Content analysis revealed seven categories of answers: work process in primary health care; health needs of the population; the risk of exposure to aggression, the aggressor; the types of aggression suffered; and the role of health management and health professionals in the primary health care context. The study showed the factors associated to risk of exposure to violence and its consequences, contributing with information and knowledge that may mitigate these events. PMID:19068571
Masys, D R
Health care in the United States has entered a period of economic upheaval. Episodic, fee-for-service care financed by indemnity insurance is being replaced by managed care financed by fixed-price, capitated health plans. The resulting focus on reducing costs, especially in areas where there is competition fueled by oversupply of health services providers and facilities, poses new threats to the livelihood of medical libraries and medical librarians but also offers new opportunities. Internet services, consumer health education, and health services research will grow in importance, and organizational mergers will provide librarians with opportunities to assume new roles within their organizations. PMID:8938325
...Implementation specifications: Health care providers. 162.410 Section 162.410...Unique Health Identifier for Health Care Providers § 162.410 Implementation specifications: Health care providers. (a) A covered entity that...
K. Arrow; A. Auerbach; J. Bertko; L. P. Casalino; F. J. Crosson; A. Enthoven; E. Falcone; R. C. Feldman; V. R. Fuchs; A. M. Garber; M. R. Gold; D. A. Goldman; G. K. Hadfield; M. A. Hall; R. I. Horwitz; M. Hooven; P. D. Jacobson; T. S. Jost; L. J. Kotlikoff; J. Levin; S. Levine; R. Levy; K. Linscott; H. S. Luft; R. Mashal; D. McFadden; D. Mechanic; D. Meltzer; J. P. Newhouse; R. G. Noll; J. B. Pietzsch; P. Pizzo; R. D. Reischauer; S. Rosenbaum; W. Sage; L. D. Schaeffer; E. Sheen; B. N. Silber; J. Skinner; S. M. Shortell; S. O. Thier; S. Tunis; L. Wulsin Jr; P. Yock; G. B. Nun; S. Bryan; O. Luxenburg; Ven van de W. P. M. M; J. Cooper
The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others
...unique health identifier for health care providers. 162.406 Section 162.406...Unique Health Identifier for Health Care Providers § 162.406 Standard unique health identifier for health care providers. (a) Standard. The...
Leslie, L K; Sarah, R; Palfrey, J S
Unprecedented transformations in the financing and organization of child health care are driving change in the practice of pediatrics at a remarkably fast pace. The health care needs of children also are evolving, reflecting changing disease patterns, new technologies, and shifting socioeconomic and demographic characteristics of children and families. Changes in the financing and organization of child health services catalyzed by managed care and legislative initiatives need to be responded to proactively by the pediatric community. Yet, the anticipated health care needs of children also must be addressed as models for both pediatric training and practice in the future are developed. This article summarizes briefly these changes in health care services and in child health needs, addresses training implications, and discusses several initiatives the pediatric community is undertaking to develop guidelines for training pediatricians for the 21st century. PMID:9544178
Washington State Workforce Training and Education Coordinating Board, Olympia.
A work group consisting of representatives of public agencies, education, the health care industry, and unions and professional associations was formed to examine education and training issues related to the shortage of health care workers in Washington state. The group concluded that the shortage of available workers in many health care…
John L Nealon; Antonio Moreno
In this paper we briefly describe the initial work of the proposed AgentCities Working Group on Health Care. Issues that are particularly relevant to the adoption of an agent- oriented approach to deve loping software systems in health care are discussed: the characteristics of health care domains, agent-based solutions, and the research and development challenges inherent in employing agents to
Grumbach, Kevin; Bodenheimer, Thomas
In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices. PMID:15010447
There is a spectrum of reasons for inquiries into health care: learning, catharsis, reassurance, and accountability. The tension is immediately obvious. Is the primary purpose learning or lynching? We need to learn from major health inquiries. New Zealand needs a culture of inquiry that encourages health professionals to discuss their concerns. We need mechanisms that enable health professionals to share,
German Statutory Health Insurance (national health insurance) has remained relatively intact over the past century, even in the face of governmental change and recent reforms. The overall story of German national health insurance is one of political compromise and successful implementation of communitarian values. Several key lessons from the German experience can be applied to the American health care system. PMID:12511381
Dulal, R K
Nepal has entered from its unitary system into a new "Federal Democratic Republic State". The current constitution presents basic health care services as a fundamental right. The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes, e.g., life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously. PMID:20387368
Loeppke, R R
As we stand on the threshold of the 21st century, writes Ron Loeppke, M.D., M.P.H., corporate health is emerging as a cornerstone in the restructuring of the American health care system. Whereas traditional managed care models have been reactive, corporate health management is proactive, building on the best elements of managed care with increased emphasis on prevention and risk management. PMID:10124707
By comparing models of market-based allocation with state-controlled national health care systems, it will be suggested that the way in which different communities deal with the allocation of health care is central to their expression of what might be called a moral self-understanding. That is to say that the provision of health care may be expected to be a focus of communal debate, not simply about morally acceptable and unacceptable actions, but also about the community's understanding of what it is that makes for a worthwhile and morally defensible human life. This moral self-understanding is seen to be entwined with the different concepts of 'health' that are implicit in different systems of allocation. In conclusion, it will be suggested that decisions concerning health care allocation must be made in response to a continuing, public and open debate about what health and health care mean to a particular community. PMID:10185170
Fuehrer, Laura; Buckler, Elizabeth; Bowman, Elizabeth; Gregory, Tanya; McDaniel, Janie
Recommendations that all women of reproductive age have preconception care integrated into their primary care visits have been made since 1990. By looking at every premenopausal woman as a potential mother and advising her accordingly, primary care PAs can help women improve both their health and pregnancy outcomes. PMID:26164048
Stone, T R; Warren, W E; Stevens, R E
The authors report the results of a segmentation study of the mental health care market. A random sample of 387 residents of a western city were interviewed by telephone. Cluster analysis of the data identified six market segments. Each is described according to the mental health care services to which it is most sensitive. Implications for targeting the segments are discussed. PMID:10104017
Josyula, Lakshmi; Lyle, Roseann
Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only…
Klecun, Ela; Lichtner, Valentina; Cornford, Tony
This paper explores notions of e-Literacy (otherwise IT literacy or digital literacy) in health care. It proposes a multi-dimensional definition of e-Literacy in health care and provides suggestions for policy makers and managers as to how e-Literacy might be accounted for in their decisions. PMID:25160306
BCEL Brief, 1991
This brief gives an overview of the topic of workplace literacy in the health care industry and lists program contacts. The following 35 organizations operate basic skills upgrading programs for health care workers: American Hospital Association; Chinese American Civic Association; Massachusetts Department of Employment and Training; BostonWorks;…
Health Care Financing Administration (DHEW), Washington, DC.
This document provides guidelines for individuals giving health care to adolescents through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. Chapter One briefly indicates needs of adolescents and outlines legal aspects of health care for adolescents such as age of majority, informed consent, confidentiality, disclosure of…
Bezzina, Paul; Keogh, Johann J.; Keogh, Mariana
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)
Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L
To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs. PMID:10845383
THOMAS F. DEUTSCH
Lasers and optics have affected health care in a myriad of ways. This paper surveys their impact on three aspects of health care: (1) surgery and medicine, (2) biology, and (3) biotechnology. In surgery, fiber optics have enabled the development of endoscopes, which allow access to most sites within the body. Endoscopes have, in turn, led to the development of
Begoña Álvarez; Marcos Vera-Hernández
In this paper we provide a model and data structure to identify the determinants of health care use by low income children, and the channels through which they operate. The most distinguishing feature of our approach is that we decompose the decision to use health care into three stages. The advantage of our approach is that variables can in‡uence each
Scott, R. D.; Solomon, S. L.; McGowan, J. E.
Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering health care in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control. PMID:11294724
Bjerneld, Magdalena; Lindmark, Gunilla; McSpadden, Lucia Ann; Garrett, Martha J
International nongovernmental organizations (NGOs) involved in humanitarian assistance employ millions of volunteers. One of the major challenges for the organizations is the high turnover rate among their personnel. Another is recruiting the right persons. As part of a series of studies investigating factors that affect the recruitment process and the success of assignment, this qualitative study examined health professionals' motivations for volunteering, their various concerns, and their expectations about themselves and the organizations for which they would work. The findings from focus group interviews with potential humanitarian volunteers were considered within the framework of Hertzberg's theory of motivations and Maslow's hierarchy of needs. The study has significant implications for personnel policy and practice in the humanitarian sector. Recruitment officers should have the self-actualized person, as described by Maslow, in mind when interviewing candidates. This perspective would make it easier for them to understand the candidates' thoughts and concerns and would lead to more effective interventions. Program officers should have satisfiers and dissatisfiers, as identified by Herzberg, in mind when planning programs. The probability that personnel will leave humanitarian work is lower if they perceive working conditions as good. PMID:16580984
Devore, Susan; Champion, R Wesley
Accountable care organizations, scheduled to become part of the Medicare program under the Affordable Care Act, have been promoted as a way to improve health care quality, reduce growth in costs, and increase patients' satisfaction. It is unclear how these organizations will develop. Yet in principle they will have to meet quality metrics, adopt improved care processes, assume risk, and provide incentives for population health and wellness. These capabilities represent a radical departure from today's health delivery system. In May 2010 the Premier healthcare alliance formed the Accountable Care Implementation Collaborative, which consists of health systems that seek to pursue accountability by forming partnerships with private payers to evolve from fee-for-service payment models to new, value-driven models. This article describes how participants in the collaborative are building models and developing best practices that can inform the implementation of accountable care organizations as well as public policies. PMID:21209436
Boncz, Imre; Nagy, Júlia; Sebestyén, Andor; Korösi, László
In this paper we give a practical overview of the changes in the financing of health care in Hungary. We describe the financing system of general practitioners, home care (nursing), out-patient care and the acute and chronic care of hospitals. We show how the financial system has changed after the political changes of 1990. The global budget approach of the 1980s was replaced by performance-related financing methods including the ICPM (International Classification of Procedures in Medicine) code system of the WHO (World Health Organization) in out-patient care and the introduction of HBCS (Homogen Betegsegcsoportok, "Homogeneous Disease Groups") in in-patient care. We underline that the efforts made towards reforming health care financing resulted in an activity-related financing system. PMID:15714346
Guth, Kim Ann; Kleiner, Brian
The purpose of this article is to explore the quality assurance methods commonly used in the health care industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the health care industry is described. Quality improvement efforts that are utilized by health care institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care. PMID:16080413
In the United Kingdom and elsewhere, the preconditions for well-functioning internal markets (in relation to market structure, transaction costs, and information) may not exist in health care. Similar doubts exist about the impact of internal markets on cost-effectiveness. While the quantity of health care has increased, the effects on quality are ambiguous and costs have not been successfully restrained. With respect to equity of health care, fears have been raised that sections of the population may be discriminated against. In the United Kingdom, resources have been shifted away from deprived areas and toward the more affluent. Health care services are once again being reformed, by New Labour in the United Kingdom and similar administrations elsewhere. The rhetoric of competition has given way to talk of partnership. The imposition of new forms of rationing has been reshaped, not abandoned. Additional funding is required, along with an effective commitment to the pursuit of equity and quality in health care. PMID:10862376
Pappas, S. C.; Fisher, M. M.
Exposure to hepatitis B virus (HBV) infection is a potentially serious occupational hazard for health care workers. Data indicate an increased risk of HBV infection in health care workers. This risk appears to be related to the frequency of contact with patients' blood and exposure to high risk patient populations. Strategies available for preventing HBV infection in the health care setting include HBV vaccine, which is the most efficacious and practical strategy. In view of the potential consequences of HBV infection, health care employers have a responsibility to provide education, serological testing and vaccination. Health care workers have a responsibility to use these programs, and to assess their own risk of infection. PMID:21274208
Toussaint, John S; Berry, Leonard L
An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations. PMID:23274021
Gerdtham, U G
The purpose of this paper is twofold. The first is to analyse the statistical relationship between real health care expenditure per capita and aggregate income, public share in finance, age-dependency ratio and inflation. The second purpose deals with methodological problems involved in pooling health care expenditure data. The empirical work is based on pooled cross-sectional, time-series data for 22 OECD countries from 1972 to 1987. Public finance share and inflation were found to be associated with lower per capita health care expenditure. No consistent correlation was found between the age-dependency ratio and health care expenditure. Contrary to results of earlier studies, we found that health care expenditure does not appear to be income (GDP) elastic. However, the results do not appear to be robust to changes in the time periods and countries included. PMID:1341938
Honekamp, Ivonne; Possenriede, Daniel
This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing. PMID:18347823
Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M
To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings. PMID:25480844
Quail, M Thomas
Technology continues to evolve and improve making our everyday tasks appear sometimes routine and mundane. The health care industry has embraced technological advances to improve on its daily operations in an effort to run more efficiently. Health care providers must be aware that these technologies collect data, lots of data, which is discoverable and may be used to defend or refute your actions as a nurse. This article will take a closer look at health care technology, cell phones, medical equipment, social media, telematics, and Health Insurance Portability and Accountability Act requirements, so that you will become familiar with the information and electronic fingerprint left behind. PMID:25463007
Anderson, E A; Zwelling, L A
Quality management has become one of the most important and most debated topics within the service sector. This is especially true for health care, as the controversy rages on how the existing American system should be restructured. Health care reform aimed at reducing costs and ensuring access to all Americans cannot be allowed to jeopardize the quality of care. As such, total quality management (TQM) has become a vital ingredient to strategic planning within the health care domain. At the heart of any such quality improvement effort is the issue of measurement. TQM cannot be effectively utilized as a competitive weapon unless quality can be accurately defined, measured, evaluated, and monitored over time. Through such analysis a hospital can elect how to expend its limited resources toward those quality improvement projects which will impact customer perceptions of service quality the most. Thus, the purpose of this report is to establish a framework by which to approach the issue of quality measurement, delineate the various components of quality that exist in health care, and explore how these elements affect one another. We propose that the issue of quality measurement in health care be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to health care. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the health care domain and encourage other researchers to address the interactions of the various quality attributes. PMID:8763215
González, Claudio; Araujo, Gloria; Agoglia, Rosanna; Hernández, Silvana; Seguel, Isabel; Saenz, César
The objective of this work was to address the problem of tuberculosis (TB) infection among Health Care Workers (HCW), based on an experience in a TB Prevention and Treatment Programme at a General Acute Hospital in Buenos Aires City. The objectives of the programme were to provide health education and periodic screening of HCW, to detect TB cases and to implement control measures. TB infection was defined by a 10 mm reaction to 2 UT PPD. Two prevalence studies of TB infection were performed. In 1998 infection prevalence was 31.7% (n = 533), and in 2008 it was 35% (n = 670). Nurses presented the highest percentage. An increase in TB infection prevalence was observed in 2008 among physicians (p = 0.02). A sample of 45 HCW integrating the first prevalence study group was analysed by applying 2 UT PPD three month later. Eight tuberculin conversions were detected (17%), all of them in nurses; 163 HCW who had contact with other eight HCW who developed TB were evaluated, four of whom were nurses. PPD reactions were positive in 39.9% with no any new case of TB detected among them. In nurses, five tuberculin conversions were observed. Other 127 HCW from low risk areas were also evaluated, 25.9% of whom had positive reactions to 2 UT PPD, while this percentage was 39.9% in the previous group (p = 0.01).Despite the scarcity of human resources that limit the planning of TB incidence studies, personal protective measures, teaching HCW about TB and chemoprophylaxis might reduce the risk of TB in this group. PMID:20228020
Leistikow, Bruce N.
to our volunteer program. Please review the volunteer requirements on the web site. If you are ready/F __________ Black/African American ____ (A) Black/African American (Not of Hispanic origin) Hispanic (Includes Black
Rose, Kathleen C.; Blout, JoAnn; DiGregorio, Heiddy; Selekman, Janice
It is the position of the National Association of School Nurses (NASN) that quality health care within the school environment can best be attained through the employment of a full-time registered professional school nurse (hereinafter referred to as school nurse) for each school building. The health services needed by students at school continue…
Daaleman, Timothy P.
Aims To introduce a health services framework of spiritual care that addresses the empirical and applied issues surrounding spirituality and nursing practice. Background Despite over 20 years of study, the concept of spirituality is still under development, which limits application to nursing practice. Methods Three studies using a health services framework are reviewed: (1) a survey study of dying patients and family that describes the providers, types, and outcomes of spiritual care; (2) an exploratory study of the process of spiritual care; and (3) a multi-level study of the structure and outcomes of spiritual care in long-term care facilities. Results Spiritual care recipients identify family or friends (41%), clergy (17%), and health care providers (29%) as spiritual care providers. The most frequently reported type of spiritual care was help in coping with illness (87%). Just over half (55%) of spiritual care recipients were very satisfied or somewhat satisfied with the care that they received. The processes of spiritual care involved: (1) presence, or the deliberate ideation and purposeful action of providing care that went beyond medical treatment; (2) opening eyes, or the process by which providers became aware of their patient’s storied humanity and the individualized experience of their current illness, and; (3) co-creating, which was a mutual and fluid activity between patients, family members, and care providers that began with an affirmation of the patient’s life experience and led to the generation of a holistic care plan that focused on maintaining the patient’s humanity and dignity. In long term care facilities, decedents who received spiritual care were perceived as receiving better overall care in the last month of life, when compared with those decedents who did not receive spiritual care. In addition, among those receiving support for their spiritual needs, care was rated more highly among those who received support from facility staff, such as nurses, than those who did not; no differences were observed based on the presence of other sources of support. Conclusions A health services framework provides a holistic view of spiritual care, one that is consistent with integrated nursing models. Implications for Nursing Management By focusing on the structure, process, and outcome elements of spiritual care within organizational settings, nursing management can develop feasible approaches to implement, improve, and evaluate the delivery of this unique type of care. PMID:23151104
Oliver, Douglas L.
UNIVERSITY OF CONNECICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE POLICY AND PROCEDURES FOR USE WITHIN THE CONNECTICUT DEPARTMENT OF CORRECTION NUMBER: E 1.01 Page 1 of 2 INFORMATION ON HEALTH SERVICES Effective Date: 04/01/01 POLICY: University of Connecticut Health Center (UCHC), Correctional
Balarajan, Yarlini; Selvaraj, S; Subramanian, S V
India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year. In this paper, we identify key challenges to equity in service delivery, and equity in financing and financial risk protection in India. These include imbalanced resource allocation, limited physical access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care. Complementing other paper in this Series, we argue for the application of certain principles in the pursuit of equity in health care in India. These are the adoption of equity metrics in monitoring, evaluation and strategic planning, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process of deliberative decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population. PMID:21227492
Background The model of volunteer community health workers (CHWs) is a common approach to serving the poor communities in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in this area, has been using female CHWs as core workers in its community-based health programs since 1977. After 25?years of implementing of the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through a community-based maternal health intervention. However, BRAC experiences high dropout rates among CHWs suggesting a need to better understand the impact of their dropout which would help to reduce dropout and increase program sustainability. The main objective of the study was to estimate impact of dropout of volunteer CHWs from both BRAC and community perspectives. Also, we estimated cost of possible strategies to reduce dropout and compared whether these costs were more or less than the costs borne by BRAC and the community. Methods We used the ‘ingredient approach’ to estimate the cost of recruiting and training of CHWs and the so-called ‘friction cost approach’ to estimate the cost of replacement of CHWs after adapting. Finally, we estimated forgone services in the community due to CHW dropout applying the concept of the friction period. Results In 2009, average cost per regular CHW was US$ 59.28 which was US$ 60.04 for an ad-hoc CHW if a CHW participated a three-week basic training, a one-day refresher training, one incentive day and worked for a month in the community after recruitment. One month absence of a CHW with standard performance in the community meant substantial forgone health services like health education, antenatal visits, deliveries, referrals of complicated cases, and distribution of drugs and health commodities. However, with an additional investment of US$ 121 yearly per CHW BRAC could save another US$ 60 invested an ad-hoc CHW plus forgone services in the community. Conclusion Although CHWs work as volunteers in Dhaka urban slums impact of their dropout is immense both in financial term and forgone services. High cost of dropout makes the program less sustainable. However, simple and financially competitive strategies can improve the sustainability of the program. PMID:22897922
This paper derives a conception of ideal socialist and communist medical care and health policy. This model is based on a review of Marxist and allied critiques of capitalist medical care policy and on theoretical work on socialist social policy. The ideal conception, operationalized in terms of 16 criteria, is then applied to a review of medical care and health policy in the Soviet Union. Hungary, and Poland. It is concluded that medical care policy in all three countries exhibits very few characteristics of socialist medical care. The possibility (for the moment repressed) provided by the Solidarity movement in Poland of a new development toward a more genuine socialist medical care and health policy is also described. PMID:6490265
Gardner, Deborah B
The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point. PMID:17847662
Meier, Carlos A; Fitzgerald, Maria C; Smith, Joseph M
eHealth holds the promise of revolutionizing health care by improving its efficiency; extending and enhancing its reach; energizing and engaging its practitioners and their patients; and in the process, democratizing, decentralizing, and even partially demystifying the practice of medicine. In emerging and developing countries, the use of eHealth and smart health-care planning has the potential to expand access to necessary treatments and prevention services that can serve as underpinnings of rapid economic development. In developed countries, the application of eHealth promises to restructure the business model of health-care delivery, while at the same time improving and personalizing the quality of care received. This article reviews the past, present, and future of eHealth in an effort to illuminate the potential of its impact. PMID:23683088
South, Jane; Purcell, Martin E; Branney, Peter; Gamsu, Mark; White, Judy
Lay involvement in public health programmes occurs through formalised lay health worker (LHW) and other volunteer roles. Whether such participation should be supported, or indeed rewarded, by payment is a critical question. With reference to policy in England, UK, this paper argues how framing citizen involvement in health only as time freely given does not account for the complexities of practice, nor intrinsic motivations. The paper reports results on payment drawn from a study of approaches to support lay people in public health roles, conducted in England, 2007-9. The first phase of the study comprised a scoping review of 224 publications, three public hearings and a register of projects. Findings revealed the diversity of approaches to payment, but also the contested nature of the topic. The second phase investigated programme support matters in five case studies of public health projects, which were selected primarily to reflect role types. All five projects involved volunteers, with two utilising forms of payment to support engagement. Interviews were conducted with a sample of project staff, LHWs (paid and unpaid), external partners and service users. Drawing on both lay and professional perspectives, the paper explores how payment relates to social context as well as various motivations for giving, receiving or declining financial support. The findings show that personal costs are not always absorbed, and that there is a potential conflict between financial support, whether sessional payment or expenses, and welfare benefits. In identifying some of the advantages and disadvantages of payment, the paper highlights the complexity of an issue often addressed only superficially. It concludes that, in order to support citizen involvement, fairness and value should be considered alongside pragmatic matters of programme management; however policy conflicts need to be resolved to ensure that employment and welfare rights are maintained. PMID:24581065
Romøren, Tor Inge; Torjesen, Dag Olaf; Landmark, Brynjar
Introduction The Norwegian health care system is well organized within its two main sectors—primary health and long-term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures. Policy practice Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy in the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term “Coordination Reform”. These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented. Discussion The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden. PMID:22128282
Trotter, Robert T., II
This guide furnishes health care providers serving migrant and seasonal farmworkers with information to cope with the complexities of health care delivery in a multiethnic, multicultural environment. Section I provides an introduction to basic cultural concepts that influence the outcome of interactions between providers and their migrant…
McGaha, Glenda S.
Presents health profile of the female offender. Discusses needs in areas of gynecology, breast assessment, and health education and services related to childbearing and parenting. Describes incarcerated health care delivery system and looks to communication and education, nursing personnel, and community resources for potential solutions to…
Hazard, Sprague W.
New trends in campus health care delivery were discussed at a workshop in Chicago sponsored by the Society for College and University Planning on January 30-31, 1975. Consideration was given to the repercussions of strong consumer demands for broader and more accessible health services, the emergence of health maintenance organizations, and…
Capecchi, Mario R.
: half Percent of providers sharing health data outside of their system: 14 Number of people worldwide, resources, people, data, even money to solve the impossible problems we face in health care today. Having imposed readmission fines on hospitals: $227 million Petabytes of health data amassed on Americans: 500
Rados, D M
Characteristic feature of the aggression to BiH are attacks to medical facilities, equipment and staff, as well as to the patients in hospitals. All international conventions were broken, as well as all elementary human rights. Organisation of the work in all medical institutions was spontaneous. Nevertheless, continuity and availability of health care delivery was satisfactory. Many governmental and non-governmental organizations have helped health care system during the war. During the war number of health care institutions increased for several reasons: a) founding 86 points of humanitarian organizations; b) founding 19 temporary hospitals; c) founding new 14 homes of health. Due to war destruction, it is necessary to determine the priorities in sanation of certain segments of health care system. PMID:9623085
...2010-10-01 false Cooperation with health care facilities. 476.76 Section... § 476.76 Cooperation with health care facilities. Before implementation...review procedures with each involved health care...
... 2013-07-01 false Provision of health care. 17.901 Section 17.901...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Health Care Benefits for Certain Children...Birth Defects § 17.901 Provision of health care. (a) Spina bifida....
...2014-10-01 2014-10-01 false Health care provider contribution. 54.633...SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.633 Health care provider contribution. (a)...
... 2012-07-01 false Provision of health care. 17.901 Section 17.901...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Health Care Benefits for Certain Children...Birth Defects § 17.901 Provision of health care. (a) Spina bifida....
... 2014-07-01 false Provision of health care. 17.901 Section 17.901...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Health Care Benefits for Certain Children...Birth Defects § 17.901 Provision of health care. (a) Spina bifida....
...2013-10-01 2013-10-01 false Health care provider contribution. 54.633...SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.633 Health care provider contribution. (a)...
... 2011-07-01 false Provision of health care. 17.901 Section 17.901...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Health Care Benefits for Certain Children...Birth Defects § 17.901 Provision of health care. (a) Spina bifida....
...2010-04-01 2010-04-01 false Health care information. 402.65 Section...INFORMATION AND RECORDS TO THE PUBLIC § 402.65 Health care information. We have some information about health care programs under titles XVIII...
This manual on health and safety considerations in caring for young children with exceptional health care needs is a product of Project EXCEPTIONAL (EXceptional Children: Education in Preschool Techniques for Inclusion, Opportunity-building, Nurturing And Learning), which has the goal of increasing the quality and quantity of inclusive child care…
Children and adolescents who enter foster care often do so with complicated and serious medical, mental health, developmental, oral health, and psychosocial problems rooted in their history of childhood trauma. Ideally, health care for this population is provided in a pediatric medical home by physicians who are familiar with the sequelae of childhood trauma and adversity. As youth with special health care needs, children and adolescents in foster care require more frequent monitoring of their health status, and pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services, health care coordination, and advocacy on their behalves. PMID:26416941
Crema, Maria; Verbano, Chiara
This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. PMID:24255600
Nikula, R E
The demands on the health care sector are increasing both from the outside, e.g. political push for cost containment, improved service and quality, and from within as new technologies and procedures are introduced. This calls for an organisation that can adjust to new conditions through flexibility and creativeness. The concept of organisational learning has been introduced as a potential way to meet these challenges. The objectives for this paper are to focus on central topics within the concept of organisational learning relevant for health care organisations and discuss the consequences of these applied to health care organisations. PMID:10659935
Studying 'the best way of doing things' does expedite performance improvement. Using cost as the only measure of health care has provided a one dimensional view of 'the best'. Now there is an urgency to improve the value of clinical outcomes, the real product of health care. For this to be achieved by any method, more effective and comparable measures of quality are needed to focus improvement efforts. This paper comments on the application of the best practice principles, developed for other Australian industries, to health care. PMID:10139620
Kovner, A R; Lusk, E J
State regulation of health care costs has been increasing at the same time as criticism of governmental regulation in other sectors of the economy has been increasing. The authors examine major system elements necessary to effect cost control in health care, present normative models of value preferences which underlie alternative state cost control systems, and indicate control foci and intervention strategies for state government under the alternative models. The authors conclude that state governments should assume responsibility for controlling health care costs. Presently, state regulatory agencies should emphasize development of adequate information systems, strengthening of state regulatory capability, and implementation of experimental reimbursement programs rather than comprehensive and detailed rate setting. PMID:1152554
Kennedy, Michael H
This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement. PMID:19668066
Bauer, M; Bach, A
Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law. PMID:9676303
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
Noren, J; Kindig, D; Sprenger, A
Native American health care programs face complex and unprecedented challenges resulting from the increased assumption of clinical operations by tribal authorities, shortfalls in Federal funding, modifications in state and Federal health and welfare programs, and intensifying involvement with managed care organizations. These challenges are further complicated by service populations that are increasing at a faster rate than the growth in funding. The authors conducted onsite surveys of 39 Native American health programs in 10 states in order to assess the organizational and management problems they faced. The trend toward transfer of health programs from the Indian Health Service to tribal operation seems likely to continue and accelerate. The survey results indicate that in order for programs to be effective in the long run, they will need to be guided by skilled managers able to adapt to these powerful changes in the health care environment. Images p-a p27-a p28-a p30-a PMID:9885525
In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference subjects as cost objects and taking account of all their interrelations. Final products, specific assignments, resources and activities may all be regarded as cost objects. The ABC method is characterized by a very high informative value in terms of setting prices of products in the area of workers' health care. It also facilitates the assessment of costs of individual activities under a multidisciplinary approach to health care and the setting costs of varied products. The ABC method provides precise data on the consumption of resources, such as human labor or various materials. PMID:17533995
Health care at population level is a complex problem. Having this in mind, the purpose of this paper is to focus on the goods that are ethically relevant in the process of caring for health at this level. We briefly analyze some of the Chilean health statistics that, although they show important improvements along the years, demonstrate that certain conditions are to be deemed as inadequate by both healthcare providers and patients. Ethics is a central component to determine how to structure and organize health care systems and how they should operate. We emphasize human dignity as an ethical corner stone of the health care system, along with other important values such as justice and humanization, under the scope of the ends of medicine, and other components such as technical competence of providers and the financing of the whole process. We conclude that as far as a health care system is organized in a way that medical practice is well ordered, primarily and fundamentally according the ends of medicine and the good of persons, such a health care system is ethically adequate. PMID:24121582
Oliffe, John L; Bottorff, Joan L; McKenzie, Michael M; Hislop, T Gregory; Gerbrandt, Julieta S; Oglov, Valerie
In this article we describe the connections between prostate cancer support groups (PCSGs) and men's health literacy and consumer orientation to health care services. The study findings are drawn from participant observations conducted at 16 PCSGs in British Columbia, Canada and 54 individual interviews that focused on men's experiences of attending group meetings. Men's communication and interactions at PCSGs provide important insights for how men talk about and conceptualize health and illness. For example, biomedical language often predominated at group meetings, and men used numbers and measures to engage with risk discourses in linking prostate cancer markers to various treatment options and morbidity and mortality rates. Many groups afforded opportunities for men to interact with health care providers as a means to better understand the language and logic of prostate cancer management. The health literacy skills fostered at PCSGs along with specific group-informed strategies could be mobilized in the men's subsequent clinical consultations. Consumer discourses and strategies to contest power relations with health care professionals underpinned many men's search for prostate cancer information and their commitment to assisting other men. Key were patients' rights, and perhaps responsibility, to compare diverse health products and services in making decisions across the entire trajectory of their prostate cancer. Overall, the study findings reveal PCSGs as having the capacity to contest as well as align with medical expertise and services facilitating men's transition from patient to informed health care consumers. The processes through which this occurs may direct the design of older men's health promotion programs. PMID:21177714
A project was undertaken to develop new curriculum materials that could be incorporated into an existing health assistant program to cover recent advances in health care technology. Area physicians' offices were toured and meetings were held with administrators of local hospitals in order to discover what kinds of advances in health care…
Martin, Ralph R.
for a specialised degree in medicine, nursing or social work? If yes, then Health and Social Care could and interests based on work done in year one via the employability module. #12;Skills you gain from a Health communication skills · Research and analysis skills. · Work experience in a health and social care environment
J. M. P. Gevers; J. P. T. M. Gelissen; W. A. Arts; R. J. A. Muffels
Health care systems are important elements of western European welfare states. Earlier research indicates that public health care has always been warmly welcomed and supported by the public, even in periods of retreat of the welfare state due to retrenchment policies. Using data from 1973, Ardigó (1995) reviewed comparative evidence on the public opinion concerning health services in seven European
Walraven, G E
The introduction of community based reproductive health care programmes in Tanzania integrated within primary health care (PHC) programmes is discussed. These programmes should address safe motherhood, fertility awareness and sexually transmitted diseases (STDs), including AIDS. It is argued that the proposed primary reproductive health care programmes will only be sustainable if community participation is achieved, and if combined with improved woman and child health programmes. Sensitized communities, who have learned how to prioritize the problems identified and the appropriate actions to take, will have to be linked at the local level with well trained and supervised health workers, having proper equipment and supplies. A limited number of measurable indicators should give feedback on progress at any given time to both communities and health workers on mutually agreed objectives. The requirements demanded for these programmes add to the difficulties of a health service which experiences already considerable financial and other constraints. Major improvement in the financial support will be needed to raise quality and confidence in the health care system. Supplementation of domestic resources by considerable long-term external donor assistance is essential for filling the resource gap. Further, a more efficient and effective use of resources is required. This makes substantial health system reform and reallocation of public spending important, as well as consistent and coordinated support for district health systems. PMID:8909955
Being able to leverage the collective clinical knowledge that a health system acquires on a daily basis and then apply that knowledge to elevate productivity and maintain clinical quality would be nirvana for health system executives. Although it is difficult to bring knowledge management to health care, it is not impossible. Architects of knowledge management solutions in health care will need to balance what an organization hopes to achieve in its market (business strategy); how they hope to achieve it (operating strategy); and where information technology is needed to enable what they hope to achieve and how they hope to achieve it (information strategy). PMID:11234728
Chan, David C. (David Cchimin)
This thesis contains essays on health care delivery and financing. Chapter 1 studies the effect of organizational structure on physician behavior. I investigate this by studying emergency department (ED) physicians who ...
... spread between patients and across health care facilities. Antibiotic resistance is a threat. Nightmare germs called CRE (carbapenem- ... and preventing infections through investment in State HAI/Antibiotic Resistance Protect Programs, as described in the President's proposed ...
Kern, S I
SBME requires office manuals and additional paperwork, and limits dispensing of drugs and medical equipment. Multispecialty facilities with physicians and other health care professionals are permitted in the same professional corporation, with private investors funding the company. PMID:1620492
This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality. PMID:10175341
Fertonani, Hosanna Pattrig; de Pires, Denise Elvira Pires; Biff, Daiane; Scherer, Magda Duarte Dos Anjos
This is a theoretical reflection aiming to highlight the conceptual debate about the health care model and the challenges for primay health care in Brazil. The study characterizes different concepts and terminologies relating to the expression 'care model' and shows that the Family Health Strategy has improved access to health care, and also including user reception and humanization perspectives in health practices. However, one still sees: a centralizing attitude in the treatment of pathologies, and care focused on the biological body; difficulties in implementing comprehensive care; and deficits in training of teams, and in working conditions and relations. The study concludes that the term 'care model' is interpreted as polysemic and that, although there are structuring proposals and policies for a model that can make progress in relation to the biomedical paradigm, the difficulties for its implementation are significant. PMID:26060965
Tanner, Elizabeth K.; Seeman, Teresa E.; Xue, Qian-Li; Rebok, George W.; Frick, Kevin D.; Carlson, Michelle C.; Wang, Tao; Piferi, Rachel L.; McGill, Sylvia; Whitfield, Keith E.; Fried, Linda P.
Objectives. We present a social marketing conceptual framework for Experience Corps Baltimore City (EC) in which the desired health outcome is not the promoted product or behavior. We also demonstrate the feasibility of a social marketing–based recruitment campaign for the first year of the Baltimore Experience Corps Trial (BECT), a randomized, controlled trial of the health benefits of EC participation for older adults. Methods. We recruited older adults from the Baltimore, MD, area. Participants randomized to the intervention were placed in public schools in volunteer roles designed to increase healthy behaviors. We examined the effectiveness of a recruitment message that appealed to generativity (i.e., to make a difference for the next generation), rather than potential health benefits. Results. Among the 155 participants recruited in the first year of the BECT, the average age was 69 years; 87% were women and 85% were African American. Participants reported primarily generative motives as their reason for interest in the BECT. Conclusions. Public health interventions embedded in civic engagement have the potential to engage older adults who might not respond to a direct appeal to improve their health. PMID:20167888
Strøm, Anita; Andersen, Kirsti Lauvli; Korneliussen, Kari; Fagermoen, May Solveig
Background Relatives’ support is an important factor in how well people with chronic heart failure (CHF) manage their illness and everyday life. Deepening professionals’ understanding of the content of relatives’ invisible care activities, often characterized as care burden, is necessary to strengthen support services. Objective To explore the next of kin’s experiences of invisible care and the inherent responsibilities in caring for a relative with CHF. Design, setting, and methods Relatives were recruited from CHF outpatient clinics and home care services. Seventeen women and two men were interviewed, age range 45–83 years; 12 were partners, and seven were daughters. The qualitative interviews were taped and transcribed and thematic cross-case analyses were performed. Results Two main themes were revealed. The first, “being on the alert”, refers to a perceived need, real or assumed, to be aware day and night, whether present with the patient or not, that occupies the mind, emotions, and body. The second theme, “being a forced volunteer”, refers to two different dimensions: relatives’ own perceptions of responsibility with regard to the patient’s needs; and voiced or silent expectations from the patient, family members, and health personnel that the relative will help the patient. Both findings appeared to have positive and negative impacts on the relationship with the patient. Conclusion The identified themes reflect how challenging being a next of kin of CHF patients can be. The results may deepen professionals’ understanding of the relatives’ invisible care burden and the importance of their subjective task-related feelings. More studies on invisible care and the attendant responsibilities are needed and also on relatives’ inherent resources. PMID:26082643
Budin, Wendy C
In this column, the editor of The Journal of Perinatal Education discusses the current health-care crisis and the need for health-care reform to promote, support, and protect natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth. PMID:20174489
Reilly, R F; Rabe, J R
Health care entities (and especially medical practices) are valued for a number of reasons: sale transaction pricing and structuring, merger formation and dissolution, taxation and regulatory compliance, and litigation support and dispute resolution. The identification and quantification of the entity's intangible assets are often the most important aspects of the valuation. This article illustrates the generally accepted methods for valuing health care-related intangible assets. PMID:9143902
Sterns, J B
Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital. PMID:7614219
John L. Nealon; Antonio Moreno
In this paper we introduce the main issues related to the deployment of agent-based systems in health care. First, we comment on the characteristics of health care problems and we argue that multi-agent systems are a good choice to tackle problems with these features. This belief is supported with a number of exemplar applications of agent-based systems in medical domains.
John Nealon; Antonio Moreno
In this paper we introduce the main issues related to the deployment of agent-based systems in health care. First, we comment on the characteristics of health care problems and we argue that multi-agent systems are a good choice to tackle problems with these features. This be- lief is supported with a number of exemplar applications of agent-based systems in medical
Hodgkin, Dominic; Horgan, Constance M.; Garnick, Deborah W.; Merrick, Elizabeth
Data from a nationally representative sample of private health plans reveal that special lifetime limits on behavioral health care are rare (used by 16% of products). However, most plans have special annual limits on behavioral health utilization; for example, 90% limit outpatient mental health and 93% limit outpatient substance abuse treatment. As a result, enrollees in the average plan face substantial out-of-pocket costs for long-lasting treatment: a median of $2,710 for 50 mental health visits, or $2,400 for 50 substance abuse visits. Plans' access to new managed care tools has not led them to stop using benefit limits for cost containment purposes. PMID:19037721
Keith, Pat M.
Data was collected from ombudsmen (N=607) in nursing facilities about the factors that make their jobs difficult. Hypotheses about support, relationships with peers, and efficacy were tested. Support from facility administrators and residents contributed to efficacy, whereas help from other volunteers had a negative effect. Results point to the…
McTaggart, Aubrey C.; McTaggart, Lorna, M.
The purpose of this book is to provide useful information about the components of quality health care and to suggest ways for the consumer to find and avail himself of the best care possible. The following subjects are covered, including brief histories of sociological background and suggestions on how to judge competency: (1) physicians,…
Kane, Robert L.; Mach, John R., Jr.
Purpose: The purpose of this article is to explore how medical care is delivered to older people in assisted living (AL) settings and to suggest ways for improving it. Design and Methods: We present a review of the limited research available on health care for older AL residents and on building testable models of better ways to organize primary…
Seifert, Mary Lee; Heffler, Stephen K.; Donham, Carolyn S.
This regular feature of the journal includes a discussion of recent trends in health care spending, employment, and prices. The statistics presented in this article are valuable in their own right and for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data. PMID:25372024
It is well acknowledged that physicians and other health care providers have an obligation to provide clinical care to their patients even under occasionally difficult circumstances. However, the exact degree and extent of that obligation, and the various scenarios under which it might be lessened or even cease to exist, have recently become the focus of much discussion and debate. The reason for this emerging debate is twofold: the recent occurrence of pandemic viruses such as severe acute respiratory syndrome and H1N1, and the emergence of highly resistant strains of infectious pathogens such as multi and extensively drug-resistant tuberculosis (TB). Health care providers have been asked to place themselves at risk to an extent many did not foresee when they chose to enter their profession, and many have done so under difficult conditions, often without adequate supplies and support. The present article explores the ethical obligations as well as the reciprocal rights of health care providers who are caring for patients with TB, with a particular focus on drug-resistant strains of the bacterium. It is a condensed version of a World Health Organization (WHO) Working Paper prepared for the WHO Working Group on Ethics and Tuberculosis. PMID:21740654
This review will summarize the current state of preventive health care systems for farmers in the world. It is obvious that well-organized occupational health care systems for farmers occur sporadically in only a few countries, and generally are in the initial stages of development. Large cooperative farms and plantations may have industrialized occupational health care. In some countries in Europe, e.g., France and Austria, farmers' organizations may include a certain amount of health and safety activity within their social insurance systems for farmers. Moreso than in other places, the Scandinavian countries have tried different approaches to provide comprehensive health services among farmers. Regardless of the kind of system, it is obvious from experiences worldwide that agriculture is a risky occupation and farmers are exposed to numerous hazards which may result in injuries, work-related diseases, and death. It is promising to note an increased interest in this situation from many parts of the world. PMID:2248236
Although the National Health Service (NHS) is regarded as a national treasure, it is no longer immune from the colossal financial pressures brought about by global recession. Economic sustainability has largely driven the reform process leading to the Health and Social Care Act (HSCA) 2012, however; other considerations have also played a role in the journey to turn the health and social care service into an institution which is fit for the 21st-century needs. This article examines the impact of the HSCA 2012 on those made vulnerable through mental ill health. It then considers three issues: First, whether parity between mental and physical health can have life beyond political rhetoric; second, what impact driving up efficiency within the NHS will have upon mental health patients; and finally, the extent to which the personalisation agenda can be meaningfully applied within the mental health context. PMID:26273147
Mascarenhas, O A
Providing cost-contained comprehensive quality health care to maintain healthy and productive employees is a challenging problem for all employers. Using a representative panel of metropolitan employees, the author investigates the internal and external structure of employee satisfaction with company-sponsored health care plans. Employee satisfaction is differentiated into four meaningful groups of health care benefits, whereas its external structure is supported by the traditional satisfaction paradigms of expectation-disconfirmation, attribution, and equity. Despite negative disconfirmation, employees register sufficiently high health care satisfaction levels, which suggests some useful strategies that employers may consider implementing. PMID:10129814
Walker, Lawrence R.
of stethoscopes, reflex hammers, otoscopes, splints, wraps, supports, and lab tests. Furthermore-traditional chiropractors frequently work closely with other health care professionals in their communities. As such
The practice of medicine stands at the threshold of a transformation from its current focus on the treatment of disease events to an emphasis on enhancing health, preventing disease and personalizing care to meet each individual's specific health needs. Personalized health care is a new and strategic approach that is driven by personalized health planning empowered by personalized medicine tools, which are facilitated by advances in science and technology. These tools improve the capability to predict health risks, to determine and quantify the dynamics of disease development, and to target therapeutic approaches to the needs of the individual. Personalized health care can be implemented today using currently available technologies and know-how and thereby provide a market for the rational introduction of new personalized medicine tools. The need for early adoption of personalized health care stems from the necessity to reduce the egregious and wasteful burden of preventable chronic diseases, which is not effectively addressed by our current approach to care. PMID:22180345
By identifying and applying advanced revenue cycle analytics, healthcare providers can: Free up cash. Find new revenues without harming core services. Improve productivity, profitability, and patient care. PMID:23413667
Bao, Yuhua; Eggman, Ashley; Richardson, Joshua; Bruce, Martha
Objective Depression affects one in four older adults receiving home health care. Medicare policies are influential in shaping home health practice. This study aims to identify Medicare policy areas that are aligned or misaligned with depression care quality improvement in home health care. Methods Qualitative study based on semi-structured interviews with nurses and administrators from five home health agencies in five states (n=20). Digitally recorded interviews were transcribed and analyzed using the grounded theory method. A multi-disciplinary team iteratively developed a codebook from interview data to identify themes. Results Several important Medicare policies are largely misaligned with depression care quality improvement in home health care: Medicare eligibility requirements for patients to remain homebound and to demonstrate a need for skilled care restrict nurses’ abilities to follow up with depressed patients for sufficient length of time; the lack of explicit recognition of nursing time and quality of care in the home health Prospective Payment System (PPS) provides misaligned incentives for depression care; incorporation of a two-item depression screening tool in Medicare-mandated comprehensive patient assessment raised clinician awareness of depression; however, inclusion of the tool at Start-of-Care only but not any other follow-up points limits its potential in assisting nurses with depression care management; under-development of clinical decision support for depression care in vendor-developed electronic health records constitutes an important barrier to depression quality improvement in home health care. Conclusions Several influential Medicare policies and regulations for home health practice may be misaligned with evidence-based depression care for home health patients. PMID:24632686
information. To receive a paper copy of this notice. 3. How to file a complaint if you believe your privacy Services, Inc. (dba Davis Ambulatory Surgery Center) Private Diagnostic Clinic, PLLCDuke PRMO, LLC Duke Surgical Center; and offices or services of Duke Primary Care, Private Diagnostic Clinic; CAPS, Duke
Mullner, R M; Young, G W; Andersen, R M
The purpose of this study has been to investigate how coalitions have changed during 1983-1986, to describe the current characteristics of coalitions, and to speculate about their future roles and likely evolution. Several insights emerge from the empirical findings of this study. First, the number of operational health care coalitions has greatly expanded over the last several years to the point where almost every state and metropolitan area of the country has at least one. Second, the service area of most coalitions is generally county-wide, although there has been significant growth in the number of coalitions that serve states. Third, coalitions are expanding their membership composition and including not only business members but also hospitals, physicians, insurance companies, and labor organizations. Fourth, coalitions are becoming more financially secure; most have annual cash budgets, and most rely on dues. Fifth, coalitions are increasingly hiring and using paid professional staff. Last, coalitions are expanding their agendas beyond investigating direct health care costs to examine some of the underlying issues (such as hospital and medical professional liability issues, the financing of uncompensated care, and ethical issues) and are developing programs to address them. For the near future, the extension of recent trends suggests how coalitions will look and function. Further down the road, health care coalitions may evolve into health care public/private policy forums or associations of health benefits managers and/or associations for managed care purchasers. In conclusion, the trends we documented and the projections of the future of coalitions appear to be in keeping with the summary perspective of John T. Dunlop (1987) who indicates: Coalitions provide a continuing forum in which parties become more interested and informed about health care costs, utilization and the problems and operations of the other participants. The discourse encourages a more extensive and informed development and sharing of data. Coalitions reflect and need to recognize the inevitable internal conflicts and interests of the constituent organizations. While some coalitions tend to flounder on internal conflicts and capacity to generate effective leadership; many are fruitfully addressing the hard issues of health care in a community, such as managed care, capitation payments, excess beds and capital requirements, and access to health care by the uninsured. As coalitions mature, beyond discourse and data, they are likely to concentrate on a few of the distinctive problems of their communities and the interaction within the health care environment to address these problems. PMID:10304443
Shriniwas; Srivastva, L; Sengupta, D; Lal, S
If health care workers abide by universal precautions when dealing with blood and body fluids, the risk of HIV transmission from infected patients to health care workers is minimal. Few health care workers have become infected with HIV via needle stick injuries or exposure to mucous membranes. HIV-1 and HIV-2 are inactivated by heating at 60 degrees Celsius for 20 minutes, by disinfectants such as 70% alcohol for 2 minutes, and by high doses of ultraviolet irradiation. HIV reservoirs are blood, semen, vaginal secretions, breast milk, epithelial cells, cerebrospinal fluid, organs, and tissues. Health care workers should concentrate on preventing needle stick injuries and injuries due to sharp instruments. Health care workers should immediately and thoroughly wash hands and other parts of the body exposed to blood and body fluids with soap and water. They should also wash hands after removing protective gloves and in between handling of patients. They should wear gloves for all direct contact with blood and body fluids and during cleaning and decontaminating procedures. A face shield or mask, eye glasses, and waterproof gowns should be worn during all procedures where splashing of blood may occur. No one should perform mouth pipetting of blood or other body fluids. Health workers should reduce the number of unnecessary injections. They should use single-use syringes and needles and discard of them in puncture-proof containers. If single-use equipment is not available, all equipment needs to be autoclaved before reuse. If a wound occurs due to injury from contaminated equipment, bleeding should be encouraged. The health care worker must also wash it with soap and much water. Health care workers should immerse vaginal speculums, proctoscopes, nasal speculums, and instruments used for laryngeal and tracheal exams in a suitable disinfectant (e.g., embalming fluid) for at least 20 minutes. PMID:8207281
Sabo, L E; Kibirige, J S
In both colonial and post-colonial eras, the creation of nation states has often been accompanied by conflict and violence in Third World countries, particularly if such attempts have ignored previously existing cultural, religious and/or ethical differences. The illegitimacy of national state construction becomes even more apparent when the attempt is associated with conflicting geopolitical interests of the 'super-powers', as is in the case of the Horn of Africa. The 27 years of armed struggle of Eritrea to free itself from Ethiopian domination is a consequence of previous and continuing attempts to create a nation state serve the interests of the ex-colonialists and 'super-powers' at the expense of the needs and desires of the people. Throughout the 27 years of struggle with its inevitable disruption of civilian life and service provisions, Eritrea has continued to develop a needs-based health care system. The Eritrean People's Liberation Front (EPLF) has developed a health care system which directly involves the people themselves. Through careful selection of priorities and a national allocation system for the distribution of scarce resources, it has provided remarkably effective emergency services, primary care and preventive health services. Such an approach has avoided the errors committed by many other Third World countries who, through copying modern western medical care systems, developed secondary and tertiary medical care facilities which were irrelevant to the health care needs of the vast majority of their populations. PMID:2711219
Fuchs, Victor R
This article applies major economic concepts, such as supply, demand, monopoly, monopsony, adverse selection, and moral hazard, to central features of U.S. health care. These illustrations help explain some of the principal problems of health policy-high cost and the uninsured-and why solutions are difficult to obtain. PMID:25732280
Odeh, Bassel; Kayyali, Reem; Nabhani-Gebara, Shereen; Philip, Nada
The survival rates for patients living with cancer are increasing, due to recent advances in detection, prevention and treatment. It has been estimated that there were 28 million cancer survivors around the world in 2012. In the UK, for patients diagnosed in 2007, it is predicted that more than half of them will survive their cancer for 5 years or more. A large majority of cancer survivors report unmet supportive care needs and distressing symptoms and adverse long-term consequences related to their cancer. Cancer management could be optimized to better meet patients demand through technology, including mobile health (m-Health). m-Health is defined as the use of mobile communications and network technologies for health care. m-Health can help both patients and health-care professionals and play an important part in managing and delivering cancer care including managing side effects, supporting drug adherence, providing cancer information, planning and follow up and detecting and diagnosing cancer. Health authorities have already published guidelines regulating m-Health to insure patient safety and improve the accountability of its applications. PMID:25649121
A dynamic, proactive health-care environment is beckoning. Fueled by consumer-led awareness, digital television, the Internet and a preoccupation with preventative health maintenance, it will define a new genre of products. In a series of provocative statements, this visionary article explores what the future may hold for diagnostics and medical devices. PMID:10387620
Health plays an important role in economic well-being. The relationship between poor health and poverty is multifaceted. Globally, reproductive health conditions are the second highest cause of ill health. This study uses district-level data from India to investigate how an index of maternal health care is impacted by the rate of poverty, and a development index based on the performance in electrification, sanitation and safe drinking water. The initial results from a linear regression model show that maternal health care improves by 0.617 percentage point for every 1 percentage point increase in development intervention but by only 0.078 percentage point for every 1 percentage point decline in poverty rate. After checking for possible simultaneity problem between maternal health care index (MHCI) and poverty rate, it is revealed that the low negative relationship between poverty and MHCI at the initial stage does not hold any more while the district development index continues to show the considerable and statistically significant impact. The findings underscore the need for direct government intervention in improving maternal health care in Indian districts. PMID:22014841
... Resources Model Organisms supported seccyd Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) Biological Testing Facility Building Interdisciplinary Research in Women's Health ( ...
Varkey, Prathibha; Reller, M Katherine; Resar, Roger K
With the rapid expansion of knowledge and technology and a health care system that performs far below acceptable levels for ensuring patient safety and needs, front-line health care professionals must understand the basics of quality improvement methodologies and terminology. The goals of this review are to provide clinicians with sufficient information to understand the fundamentals of quality improvement, provide a starting point for improvement projects, and stimulate further inquiry into the quality improvement methodologies currently being used in health care. Key quality improvement concepts and methodologies, including plan-do-study-act, six-sigma, and lean strategies, are discussed, and the differences between quality improvement and quality-of-care research are explored. PMID:17550754
Mark, Barbara A.
We investigated the relationship between health care expenditures for Special Health Care Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special Health Care Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child’s health care expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that health care expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the health care team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special health care needs. PMID:20495615
Morrow, Melanie; Borger, Sarah; Weiss, Jennifer; DeCoster, Mary; Davis, Thomas; Ernst, Pieter
In view of the slow progress being made in reducing maternal and child mortality in many priority countries, new approaches are urgently needed that can be applied in settings with weak health systems and a scarcity of human resources for health. The Care Group approach uses facilitators, who are a lower-level cadre of paid workers, to work with groups of 12 or so volunteers (the Care Group), and each volunteer is responsible for 10–15 households. The volunteers share messages with the mothers of the households to promote important health behaviors and to use key health services. The Care Groups create a multiplying effect, reaching all households in a community at low cost. This article describes the Care Group approach in more detail, its history, and current NGO experience with implementing the approach across more than 28 countries. A companion article also published in this journal summarizes the evidence on the effectiveness of the Care Group approach. An estimated 1.3 million households—almost entirely in rural areas—have been reached using Care Groups, and at least 106,000 volunteers have been trained. The NGOs with experience implementing Care Groups have achieved high population coverage of key health interventions proven to reduce maternal and child deaths. Some of the essential criteria in applying the Care Group approach include: peer-to-peer health promotion (between mothers), selection of volunteers by mothers, limited workload for the volunteers, limited number of volunteers per Care Group, frequent contact between the volunteers and mothers, use of visual teaching tools and participatory behavior change methods, and regular supervision of volunteers. Incorporating Care Groups into ministries of health would help sustain the approach, which would require creating posts for facilitators as well as supervisors. Although not widely known about outside the NGO child survival and food security networks, the Care Group approach deserves broader recognition as a promising alternative to current strategies for delivering key health interventions to remote and underserved communities. PMID:26374798
Perry, Henry; Morrow, Melanie; Borger, Sarah; Weiss, Jennifer; DeCoster, Mary; Davis, Thomas; Ernst, Pieter
In view of the slow progress being made in reducing maternal and child mortality in many priority countries, new approaches are urgently needed that can be applied in settings with weak health systems and a scarcity of human resources for health. The Care Group approach uses facilitators, who are a lower-level cadre of paid workers, to work with groups of 12 or so volunteers (the Care Group), and each volunteer is responsible for 10-15 households. The volunteers share messages with the mothers of the households to promote important health behaviors and to use key health services. The Care Groups create a multiplying effect, reaching all households in a community at low cost. This article describes the Care Group approach in more detail, its history, and current NGO experience with implementing the approach across more than 28 countries. A companion article also published in this journal summarizes the evidence on the effectiveness of the Care Group approach. An estimated 1.3 million households-almost entirely in rural areas-have been reached using Care Groups, and at least 106,000 volunteers have been trained. The NGOs with experience implementing Care Groups have achieved high population coverage of key health interventions proven to reduce maternal and child deaths. Some of the essential criteria in applying the Care Group approach include: peer-to-peer health promotion (between mothers), selection of volunteers by mothers, limited workload for the volunteers, limited number of volunteers per Care Group, frequent contact between the volunteers and mothers, use of visual teaching tools and participatory behavior change methods, and regular supervision of volunteers. Incorporating Care Groups into ministries of health would help sustain the approach, which would require creating posts for facilitators as well as supervisors. Although not widely known about outside the NGO child survival and food security networks, the Care Group approach deserves broader recognition as a promising alternative to current strategies for delivering key health interventions to remote and underserved communities. PMID:26374798
Background Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Methods Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Results Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. Conclusion For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced. PMID:21708026
Dewi, Wan Nishfa; Evans, David; Bradley, Helen; Ullrich, Sandra
Person-centred care (PCC) is defined as the health-care providers selecting and delivering interventions or treatments that are respectful of and responsive to the characteristics, needs, preferences and values of the individual person. This model of care puts the person at the centre of care delivery. The World Health Organization suggests that PCC is one of the essential dimensions of health care and as such is an important indicator of health-care quality. However, how PCC is implemented differs between countries in response to local cultures, resources and consumer expectations of health care. This article discusses person-centred care in the Indonesian health-care system. PMID:24219813
Beacham, Barbara L.; Deatrick, Janet A.
Synopsis Health care autonomy typically occurs during late adolescence but health care providers and families often expect children with chronic health conditions to master self-care earlier. Few studies have examined the development of health care autonomy as it pertains to self-care and family management. This review will link the three concepts and discuss implications for families and health care providers. Case studies are provided as exemplars to highlight areas where intervention and research is needed. PMID:23659815
Fitch Ratings continues to believe that the current and projected personnel shortages, especially among registered nurses (RNs). present one of the greatest operating challenges for health care providers nationwide. As noted in Fitch Research on "Health Care Staffing Shortage," dated June 21, 2001 (available on Fitch's web site at www.fitchratings. com), staffing is an area that is creating enormous expense inflation for health care providers and presenting one of the biggest areas of uncertainty in assessing an organization's credit quality. Shortages are becoming increasingly widespread, affecting health care providers in urban and rural areas regardless of size. Since health care is a labor intensive business, salary and benefit costs are key determinants of profitability. Fitch believes the attention given to the nursing shortage and potential looming crisis has created a sense of urgency, with many hospitals developing innovative strategies for work force development. In addition, federal, state, and local governments are creating programs and/or providing financial support to help alleviate shortages. Yet, the benefits of many of these initiatives may not be realized for many years, and Fitch expects health care providers to continue experiencing inflating salary and benefit expenses with growing temporary staffing usage and competitive pressure to increase overall compensation. Fitch believes managing labor costs is critical to achieving profitability, especially as the ability to increase revenue diminishes. Fitch believes the nursing shortage will continue to represent an area of extreme expense pressure for health care providers for years to come. Imbalanced supply and demand, which is expected to worsen as retiring nurses outstrip replacements, should create financial strain for many providers in an industry that is gearing up to meet the aging population's anticipated demand for more services. Fitch plans to closely monitor management strategies for dealing with vacancy and turnover rates, as well as trends in agency spending, to determine financial implications among its rated portfolio. PMID:14528733
DO, YOUNG KYUNG; NORTON, EDWARD C.; STEARNS, SALLY C.; VAN HOUTVEN, COURTNEY HAROLD
This study aims to measure the causal effect of informal caregiving on the health and health care use of women who are caregivers, using instrumental variables. We use data from South Korea, where daughters and daughters-in-law are the prevalent source of caregivers for frail elderly parents and parents-in-law. A key insight of our instrumental variable approach is that having a parent-in-law with functional limitations increases the probability of providing informal care to that parent-in-law, but a parent-in-law’s functional limitation does not directly affect the daughter-in-law’s health. We compare results for the daughter-in-law and daughter samples to check the assumption of the excludability of the instruments for the daughter sample. Our results show that providing informal care has significant adverse effects along multiple dimensions of health for daughter-in-law and daughter caregivers in South Korea. PMID:24753386
Ellis, Randall P; McGuire, Thomas G
This paper re-examines the relation between the predictability of health care spending and incentives due to adverse selection. Within an explicit model of health plan decisions about service levels, we show that predictability (how well spending on certain services can be anticipated), predictiveness (how well the predicted levels of certain services contemporaneously co-vary with total health care spending), and demand responsiveness all matter for adverse selection incentives. The product of terms involving these three measures of predictability, predictiveness, and demand responsiveness define an empirical index of the direction and magnitude of selection incentives. We quantify the relative magnitude of adverse selection incentives bearing on various types of health care services in Medicare. Our results are consistent with other research on service-level selection. The index of incentives can readily be applied to data from other payers. PMID:16908083
Brondani, Cecília Maria; Beuter, Margrid
This study aimed at describing and analyzing family carers' experiences in taking care of chronic patients at home. It is a qualitative research, developed in Service of Home Health Care of Santa Maria's University Hospital (SIDHUSM), Rio Grande do Sul, Brazil, to which 15 family carers contributed. In order to produce data, one made use of Creative-Sensitive Method as well as the dynamics of creativity and sensitivity: Life Line, Body-Knowledge and Almanac. Data were analyzed according to the conceptual premises of discourse analysis. Thus, there were developed the following themes: the care as an inherent experience to human beings; the experience of taking care in a disease situation; the learning with the experience of being a carer. The results pointed to the necessity of valuing the care activities developed by home carers at patients' home, and they also highlighted the home care as a modality of humanizing and innovating attention which aims to invert health professionals' logic of action. PMID:20027951
This article critically appraises a process of recognising prior learning (RPL) using analytical tools from Habermas' theory of communicative action. The RPL process is part of an in-service training program for health care assistants where the goal is to become a licensed practical nurse. Data about the RPL process were collected using interviews…
Klein, J. D.; Slap, G. B.; Elster, A. B.; Cohn, S. E.
The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of health care settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across health care, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America's adolescents will not have access to appropriate health services. Current efforts to minimize current health care expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America's youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8148842
Sirmans, Meredith F.
In the past few years there has been an increase in the discussion of health care as a right. Although the statement that health care is a right sounds good and altruistic, it does not deal with the political or economic realities of health care, especially for blacks. The health care industry represents approximately 8% of the Gross National…
Naughton, June C., Ed.; And Others
This handbook consists of 24 papers addressing various aspects on health care and health care systems and services for foreign students from the Asia Pacific Region. The papers are: "Providing Health Care for International Students" (Donald F. B. Char); "Major Health Care Systems in Asia and the Pacific: Mainland China, Taiwan, Hong Kong" (Julia…
Thormar, Sigridur Bjork; Gersons, Berthold P R; Juen, Barbara; Djakababa, Maria Nelden; Karlsson, Thorlakur; Olff, Miranda
During disasters, aid organizations often respond using the resources of local volunteer members from the affected population who are not only inexperienced, but who additionally take on some of the more psychologically and physically difficult tasks in order to provide support for their community. Although not much empirical evidence exists to justify the claim, it is thought that preparation, training, and organizational support limit (or reduce) a volunteer's risk of developing later psychopathology. In this study, we examined the effects of preparation, training, and organizational support and assigned tasks on the mental health of 506 Indonesian Red Cross volunteers who participated in the response to a massive earthquake in Yogyakarta, Indonesia, in 2006. Controlling for exposure level, the volunteers were assessed for post-traumatic stress disorder (PTSD), anxiety, depression, and subjective health complaints (SHCs) 6, 12, and 18 months post-disaster. Results showed high levels of PTSD and SHCs up to 18 months post-disaster, while anxiety and depression levels remained in the normal range. Higher levels of exposure as well as certain tasks (e.g., provision of psychosocial support to beneficiaries, handling administration, or handing out food aid) made the volunteers more vulnerable. Sense of safety, expressed general need for support at 6 months, and a lack of perceived support from team leaders and the organization were also related to greater psychopathology at 18 months. The results highlight the importance of studying organizational factors. By incorporating these results into future volunteer management programs the negative effects of disaster work on volunteers can be ameliorated. PMID:23205850
This article comes out of a series of discussions among a diverse group of chief executive officers (CEOs) and other leaders of nonprofit hospitals, long-term care facilities, health maintenance organizations, and other insurance providers, including several nonprofit Blue Cross Blue Shield (BCBS) plans. The group was convened as part of Howard Berman's Walter J. McNerney Fellowship project. (Berman is CEO of Excellus, Inc., a nonprofit Blue Cross Blue Shield affiliate that insures the health of more than 2.15 million people in upstate New York. He was awarded the McNerney Fellowship in April 2001 by the Health Research and Educational Trust, an American Hospital Association affiliate. The Fellowship goes annually to at least one fellow to highlight or pursue work that will provide new insights into how different sectors of the health care system can better work together for improved outcomes.) The group has met several times over the past year around a shared concern: the current challenges to nonprofit health care organizations and the future role for nonprofits in the re-visioning and creation of an American health care system that is characterized by universal access, patient-centered quality, and national affordability. Members have supported the public relations campaign of the "Alliance for Advancing Nonprofit Health Care," an effort initiated by the Caucus, an independent group of nonprofit BCBS plans. The group continues to explore the need for a broad-based coalition of providers, insurers, and other organizations to effectively protect and enhance the role of nonprofit health care. PMID:12371573
Qulieyeva, D P; Huseynov, S A
Of Azerbaijan's 7,564,800 inhabitants, 52.2% live in urban and 47.8% in rural areas. With the transition to market-oriented economy, health problems have worsened. Expenditures for health care fell from 2.9% of GDP in 1990 to 1.2% in 1997. In case of illness, 37% of population prefer self-treatment, and 68% of treatment refusals are due to the inability of patients to pay for the treatment. Maternal mortality rate increased from 10.5 deaths per 100,000 live births in 1991 to 52 deaths per 100,000 live births in 1996. However, diphteria has been reduced to sporadic cases, whereas polio has not been reported since 1996. A pilot reform of primary health care was initiated in one of the districts, and soon expanded to four more districts. The aims were the improvement of health management, rationalization/optimization through development of traditional services, organization of preventative activities, rational use of drugs, institution of sustainable financial mechanisms through affordable fees for services, drug sales within health facilities with corresponding management and the accounting systems for the revenues, development of the exemption system, and community participation in district health. Increased patient attendance to health facilities, improved access to the vulnerable population health services, empowered health system management, better quality of care, and reduced overall individual expenditures were observed. PMID:10234064
... 2013 Use of Electronic Health Records in Residential Care Communities On This Page Key findings Most residential ... National Survey of Residential Care Facilities Most residential care communities did not use electronic health records in ...
... care providers Alternate Language URL ?Talking with Your Health Care Professionals Page Content The most important person on ... if you already have it. Tips for Your Health Care Visits Be prepared. The more you plan for ...
... will have to decide is what kind of health care provider you would like to care for you ... practice doctor Certified nurse-midwife Each of these health care providers is described below. Each one has different ...
Trastek, Victor F; Hamilton, Neil W; Niles, Emily E
Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients. PMID:24486078
...COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers...care provider eligibility for the Healthcare Connect Fund. Health care providers in the Healthcare Connect Fund may certify...
Fernandes, Ritabelle; Riklon, Sheldon; Langidrik, Justina R; Williams, Shellie N; Kabua, Neiar
Implementation lessons: (1) The development and testing of a culturally appropriate palliative care navigation curriculum for countries facing high cancer and non-communicable diseases burden requires collaboration with the local Ministry of Health. (2) Lay volunteers from non-governmental and faith-based organizations are potential candidates to provide patient navigation services. PMID:26250636
Detmer, Don E
Background Improving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII) offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach. Discussion A national health information infrastructure for the United States should address the needs of personal health management, health care delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries). The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' health care system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security) framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges. Summary A national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors. If you cannot measure it, you cannot improve it. Lord Kelvin PMID:12525262
People often make decisions in health care that are not in their best interest, ranging from failing to enroll in health insurance to which they are entitled, to engaging in extremely harmful behaviors. Traditional economic theory provides a limited tool kit for improving behavior because it assumes that people make decisions in a rational way, have the mental capacity to deal with huge amounts of information and choice, and have tastes endemic to them and not open to manipulation. Melding economics with psychology, behavioral economics acknowledges that people often do not act rationally in the economic sense. It therefore offers a potentially richer set of tools than provided by traditional economic theory to understand and influence behaviors. Only recently, however, has it been applied to health care. This article provides an overview of behavioral economics, reviews some of its contributions, and shows how it can be used in health care to improve people's decisions and health. PMID:23297657
Baker, L C
OBJECTIVE: Measuring competition is increasingly important for analysis of health care markets and policies. Measurement of competition in health care is made complex by the breadth of potential issues under study, by the lack of necessary data, and by rapid changes in health care financing and delivery. This study reviews key issues in the measurement of competition and is designed to familiarize researchers and policymakers interested in competition measurement, but not steeped in its practice, with key concepts, data sources, and ways of adapting measures to fit ongoing changes in health care markets. PRINCIPAL FINDINGS: Attention to several key issues will strengthen measurement. Important components of successful measurement are: careful identification of the products and market areas for study; selection of Herfindahl-Hirschman or other indices to fit the issues being considered; consideration of econometric problems, like endogeneity, with common measures; and attention to the ways that current marketplace changes, like growth in managed care, affect the performance of classic measures. Data needed for constructing measures are also frequently scarce, insufficient, or both. Measurement could be improved with access to better data. PMID:11327175
Marcus, Stuart G; Reid-Lombardo, Kaye M; Halverson, Amy L; Maker, Vijay; Demetriou, Achilles; Fischer, Josef E; Bentrem, David; Rudnicki, Marek; Hiatt, Jonathan R; Jones, Daniel
The Patient Protection and Affordable Care Act signed into law in March 2010, has led to sweeping changes to the US health care system. The ensuing pace of change in health care regulation is unparalleled and difficult for physicians to keep up with. Because of the extraordinary challenges that have arisen, the public policy committee of the Society for Surgery of the Alimentary tract conducted a symposium at their 52nd Annual Meeting in May 2011 to educate participants on the myriad of public policy changes occurring in order to best prepare them for their future. Expert speakers presented their views on policy changes affecting diverse areas including patient safety, patient experience, hospital and provider fiscal challenges, and the life of the practicing surgeon. In all areas, surgical leadership was felt to be critical to successfully navigate the new health care landscape as surgeons have a long history of providing safe, high quality, low cost care. The recognition of shared values among the diverse constituents affected by health care policy changes will best prepare surgeons to control their own destiny and successfully manage new challenges as they emerge. PMID:22399268
Patel, Aniruddh D.
) an effectiveness trial of CBT for depression and anxiety (including post- traumatic stress), and behavioral parent and anxiety (including post-traumatic stress), and behavioral parent training for conduct problems and (bRESEARCH VOLUNTEER - Laboratory for Youth Mental Health Judge Baker Children's Center, Harvard
Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.
Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…
Barakat-Haddad, C; Siddiqua, A
This study examined primary health care use and accessibility among adolescents living in the United Arab Emirates. In a cross-sectional study, we collected health care use, sociodemographic and residential data for a sample of 6363 adolescents. Logistic regression modelling was used to examine predictors of health care use. The most-consulted health professionals were dentists or orthodontists, family doctors and eye specialists. Local adolescents were more likely to attend public clinics/hospitals than private facilities, while the opposite was true for expatriates. In the previous 12 months 22.6% of the participants had not obtained the health care they needed and 19.5% had not had a routine health check-up. Common reasons for not obtaining care were busy schedules, dislike/fear of doctors and long waiting times. Predictors of not obtaining needed care included nationality and income, while those for having a routine check-up were mother's education and car ownership. Improvements to the health care sector may increase health care accessibility among adolescents. PMID:26074217
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:18700871
Ulin, P R
The role of nurses in global collaboration in primary health care is explored in this address. The concept of primary care differs in various countries depending on needs, so re-education of nurses parallels these needs. Nursing practice is adapting to shortages of physicians in some areas, but reacting to excess of physicians in Spain for example. Only the United States makes a distinction between primary health care and community health nursing: most other countries emphasize team approach to a greater extent, integrating nutrition, agriculture, social work, education and other fields into nursing practice. One great challenge to international collaboration by nurses is their failure to be more assertive in initiating local and regional health programs. Another obstacle is communication, not only language but also unfamiliarity with professional development in terms of advanced academic education and professional journals. International nursing collaboration can begin by developing strategies for solving the problems of refugees, agricultural migrants, homeless, and marginal people of all kinds. International collaboration could improve primary care, for example the infant low birth weight and mortality in the Black U.S. population, 34th among all nations. The primary health care movement challenges nurses to break through barriers that maintain professional isolation. PMID:2470032
Herzog, Almut; Lind, Leili
The growing number of the elderly in industrialised countries is increasing the pressure on respective health care systems. This is one reason for recent trends in the development and expansion of home health care organisations. With Internet access available to everyone and the advent of wireless technologies, advanced telehomecare is a possibility for a large proportion of the population. In the near future, one of the authors plans to implement a home health care infrastructure for patients with congestive heart failure and patients with chronic obstructive pulmonary disease. The system is meant to support regular and ad-hoc measurements of medical parameters in patient homes and transmission of measurement data to the home health care provider. In this paper we look at network technologies that connect sensors and input devices in the patient home to a home health care provider. We consider wireless and Internet technologies from functional and security-related perspectives and arrive at a recommendation for our system. Security and usability aspects of the proposed network infrastructures are explored with special focus on their impact on the patient home. PMID:12697950
Morris, M; Gambone, J C
Health care organizations are looking for new ways to optimize the way that they provide health services. The notion that high quality health care means high costs is no longer accepted without question. Business organizations that found themselves at very high levels of inefficiency, not unlike the levels being seen in hospitals and clinics today, were able to transform their businesses by applying the principles of continual improvement. The components of knowledge for improvement, i.e., knowledge of a system, knowledge of variation, knowledge of psychology, and the theory of knowledge may seem to some too obvious to be recognized and applied on a daily basis in the workplace. Businesses and organizations that are failing, however, often lack this knowledge. We cannot be certain that management by continual improvement can or should be applied or modified to work in all health care organizations. Although the delivery of health care services is a business unlike any other, it has much in common with other service industries. The idea that the quality of patient care can be improved by using the principles of continual improvement currently is being tested. PMID:8194204
Specchia, Maria Lucia; de Belvis, Antonio Giulio; Capizzi, Silvio; Veneziano, Maria Assunta; Kheiraoui, Flavia; Morelli, Luca; Ferriero, Anna Maria; Cadeddu, Chiara; Ricciardi, Walter
Public Health (PH) and Primary Health Care (PHC) need to be better integrated, at different levels of the healthcare system, in order to improve health and social outcomes. The aim of this study was to review international models and approaches supporting the integration of PH and PHC and to classify these according to their main focus. A literature search was performed using the main scientific databases, to identify national and international journal publications regarding models to support integration between PH and PHC. The final set of the documents provided a broad coverage of the topic. Four models of integration were identified: general integration, chronic disease prevention, targeted prevention or care delivery and infection control. Models differed in their levels of implementation, stages of development and focus. This review, by classifying the main characteristics and results of the experiences retrieved, indicates a relatively scarce use of integration models in the global health care landscape, with the exception of Canada. In fact, Canada has been a leader in developing models of integrated health systems that combine tailored approaches to influence personal health behaviour and community-oriented approaches to influence the health of the population. The review also revealed a general lack of experience in evaluating the sustainability of integration between PH and PHC, not only in terms of cost-effectiveness, but also in terms of better health and work conditions and self-perceived quality of care in the population. Collaboration between PH and PHC seems to be an important strategy for achieving principles of equity and access in health care and for ensuring a more equal distribution of health care services. PMID:24091844
Szilagyi, Moira A; Rosen, David S; Rubin, David; Zlotnik, Sarah
Children and adolescents involved with child welfare, especially those who are removed from their family of origin and placed in out-of-home care, often present with complex and serious physical, mental health, developmental, and psychosocial problems rooted in childhood adversity and trauma. As such, they are designated as children with special health care needs. There are many barriers to providing high-quality comprehensive health care services to children and adolescents whose lives are characterized by transience and uncertainty. Pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services in the context of a medical home, and health care coordination and advocacy on their behalf. This technical report supports the policy statement of the same title. PMID:26416934
Liégeois, Axel; Eneman, Marc
Because of the development towards community care, care providers not only exchange information in a team, but increasingly also in networks. This is a challenge to confidentiality. The ethical question is how care providers can keep information about the care receiver confidential, whilst at the same time exchanging information about that care receiver in a team or network? Can shared confidentiality be extended from a team to a network? To clarify this question, the article refers to the advice of an expert ethics committee in mental health care. The advice regards exchange of information in a network as a further step in enhancing collaboration among care providers. Therefore, the good and evident practice of shared confidentiality in a team can be extended to a network if the same conditions are met. First, the care providers participate in a clearly defined and identifiable team or network. Secondly, they have a shared care responsibility. Thirdly, they have a duty of confidentiality. Fourth, they dialogue with the care receiver and obtain his or her consent. Finally, they apply the filter of relevance. Hence, conditional shared confidentiality is an ethical justification for the exchange of information in a team or network. PMID:25209901
The paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a "managed competition" delivery model. The second is the Ministry of Health and Long-Term Care's privileging of "health care" over "social care" through changes to which types of home care and home…
Leppäkoski, Tuija; Paavilainen, Eija
This study aimed to examine possible changes from 2008 to 2012 in the skills of health care staff in identifying and intervening in domestic violence (DV). A longitudinal descriptive study design with volunteer samples (baseline; n = 68, follow-up; n = 100) was used to acquire information regarding the present state and needs of the staff in practices related to DV. The results of the baseline survey were used as a basis for planning two interventions: staff training and drafting practical guidelines. Information was collected by questionnaires from nurses, physicians, and social workers and supplemented by responses from the interviews. The data were analysed using both quantitative and qualitative methods. A chi-square test was used to test the statistical significance of the data sets. In addition, participants' quotes are used to describe specific phenomena or issues. The comparison showed that overall a small positive change had taken place between the study periods. However, the participants were aware of their own shortcomings in identifying and intervening in DV. Changes happen slowly, and administrative support is needed to sustain such changes. Therefore, this paper offers recommendations to improve health care providers' response to DV. Moreover, there is a great need for evaluating the training programme used. PMID:24864205
Allibone, A.; Oakes, D.; Shannon, H. S.
A postal survey of 1,500 doctors who had qualified between 1935 and 1959 and were in active practice in Great Britian elicited 988 replies (a 66 per cent response rate). Nine hundred and thirty-two of the replies were suitable for analysis. There were few differences between hospital doctors and general practitioners in reported medical histories: respiratory tuberculosis had occurred more often among hospital doctors; other respiratory diseases were slightly more common among general practitioners, as were diseases of the digestive tract. The view held by some members of the profession that doctors receive poor medical care was not confirmed. There is, however, cause for disquiet at the possible consequences of self-treatment and the financial implications of illness. PMID:7338866
Chun, Thomas H.; Katz, Emily R.; Duffy, Susan J.
SYNOPSIS Children with mental health problems are increasingly being evaluated and treated by both pediatric primary care and pediatric emergency physicians. This article focuses on the epidemiology, evaluation, and management of the two most common pediatric mental health emergencies, suicidal and homicidal/aggressive patients, as well as the equally challenging population of children with autism or other developmental disabilities. PMID:24093903
Institute of Medicine (NAS), Washington, DC.
This book is addressed to anyone involved with or affected by the Acquired Immune Deficiency Syndrome (AIDS) epidemic, including legislators, researchers, health care personnel, insurance providers, educators, health officials, executives in the pharmaceutical industry, blood bank administrators, and other concerned individuals. The following…
...or Services § 15b.38 Health care facilities. (a) Communications...recipient hospital that provides health services or benefits shall...purpose of providing emergency health care. (c) Drug and alcohol...person's drug or alcohol abuse or...
Health care financing has undergone numerous structural changes over the years. Change continues while extreme growth seriously affects the health care focus. The author examines the multiclass system and health financing trends. Restructuring techniques are also discussed. PMID:10269056
Cuellar, Alison Evans; Cheema, Jehanzeb
The 2010 Patient Protection and Affordable Care Act (ACA) has a number of important features for individuals who are involved with the criminal justice system. Among the most important changes is the expansion of Medicaid to more adults. The current study estimates that 10% of the total Medicaid expansion could include individuals who have experienced recent incarceration. The ACA also emphasizes the importance of mental health and substance abuse benefits, potentially changing the landscape of behavioral health treatment providers willing to serve criminal justice populations. Finally, it seeks to promote coordinated care delivery. New care delivery and appropriate funding models are needed to address the behavioral health and other chronic conditions experienced by those in criminal justice and to coordinate care within the complex structure of the justice system itself. PMID:24807645
Sukumar, Sreenivas R; Natarajan, Ramachandran; Ferrell, Regina K
Purpose - The current trend in Big Data analytics and in particular health information technology is toward building sophisticated models, methods and tools for business, operational and clinical intelligence. However, the critical issue of data quality required for these models is not getting the attention it deserves. The purpose of this paper is to highlight the issues of data quality in the context of Big Data health care analytics. Design/methodology/approach - The insights presented in this paper are the results of analytics work that was done in different organizations on a variety of health data sets. The data sets include Medicare and Medicaid claims, provider enrollment data sets from both public and private sources, electronic health records from regional health centers accessed through partnerships with health care claims processing entities under health privacy protected guidelines. Findings - Assessment of data quality in health care has to consider: first, the entire lifecycle of health data; second, problems arising from errors and inaccuracies in the data itself; third, the source(s) and the pedigree of the data; and fourth, how the underlying purpose of data collection impact the analytic processing and knowledge expected to be derived. Automation in the form of data handling, storage, entry and processing technologies is to be viewed as a double-edged sword. At one level, automation can be a good solution, while at another level it can create a different set of data quality issues. Implementation of health care analytics with Big Data is enabled by a road map that addresses the organizational and technological aspects of data quality assurance. Practical implications - The value derived from the use of analytics should be the primary determinant of data quality. Based on this premise, health care enterprises embracing Big Data should have a road map for a systematic approach to data quality. Health care data quality problems can be so very specific that organizations might have to build their own custom software or data quality rule engines. Originality/value - Today, data quality issues are diagnosed and addressed in a piece-meal fashion. The authors recommend a data lifecycle approach and provide a road map, that is more appropriate with the dimensions of Big Data and fits different stages in the analytical workflow. PMID:26156435
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. Multi-national research may provide guidance about how to scale up eye health interventions that are integrated into primary health systems. PMID:23506686
I examine the role of household permanent income in determining who bribes and how much they bribe in health care in Uganda. I find that rich patients are more likely than other patients to bribe in public health care: doubling household expenditure increases the bribery probability by 1.2 percentage points compared to a bribery rate of 17%. The income elasticity of the bribe amount is about 0.37. Bribes in the Ugandan public sector appear to be fees-for-service extorted from the richer patients amongst those exempted by government policy from paying the official fees. Bribes in the private sector appear to be flat-rate fees paid by patients who do not pay official fees. I do not find evidence that the public health care sector is able to price discriminate less effectively than public institutions with less competition from the private sector. PMID:20638738
Arnett, Ross H.; McKusick, David R.; Sonnefeld, Sally T.; Cowell, Carol S.
National health expenditures are projected to grow to $640 billion by 1990, 11.3 percent of the gross national product. Growth in health spending is expected to moderate to an 8.7 percent average annual rate from 1984 to 1990, compared with a 12.6 percent rate from 1978 to 1984. These projections assume lower estimates of overall economic price growth, lower use of hospital care, and increased use of less expensive types of care. A preliminary analysis of demographic factors reveals that the aging of the population has almost as great an impact as the growth in total population on projected expenditures for many types of health care services. PMID:10311492
Barrett, Craig; Lee, Peter V
Unless President-elect Barack Obama-America's CEO-and the CEOs who run large businesses work together, health care changes will not occur. The government and private sector must abandon business as usual to reduce costs, reward outcomes, and stimulate innovative ways to achieve those outcomes. President-elect Obama will find a willing partner in corporate America if he reaches out in ways that recognize that solutions must put the patient at the center of our health care system and also drive efficiencies to allow U.S. companies to compete globally. It is past time for the nation's elected and appointed CEOs to take action to transform U.S. health care. PMID:19151004
Trimmer, Kenneth J; Pumphrey, Lela D; Wiggins, Carla
Enterprise resource planning (ERP) systems provide organizations with the opportunity to integrate individual, functionally-oriented information systems. Although much of the focus in the popular press has been placed on ERP systems in large for-profit organizations, small hospitals and clinics are candidates for ERP systems. Focusing information systems on critical success factors (CSFs) allows the organization to address a limited number of areas associated with performance. This limited number of factors can provide management with an insight into dimensions of information that must be addressed by a system. Focuses on CSFs for small health-care organizations. In addition, also considers factors critical to the implementation of health-care information systems. Presents two cases. The results indicate support for the continuing use of CSFs to help focus on the benefits of ERPs. Focusing on groups of tangible and intangible benefits can also assist the rural health-care organization in the use of ERPs. PMID:12211339
Lynch, R P
Like it or not, the health care profession is being "shifted" into a revolutionary new world. The question is not will it change but rather how will it change? Who will determine its fate? What form will these changes take? What are the best alternatives for physicians, institutions, health care workers, insurers, employers, and, most importantly, patients? Some of the changes will come from government mandate, others from market forces. To understand what the future might bring, we should look at both the driving forces behind the changes and how other industries have responded to similar forces. An important consideration for health care professionals will be how, if at all, the concepts of collaboration and cooperation that are inherent in networking and alliances will guide their planning. PMID:10130280
Kissick, W L
Appropriate is defined by Webster as "especially suitable or compatible". Historically, health care has been appropriate in the eyes of physicians. Now we recognize that health care, like beauty, is in the eyes of the beholder, and the beholders include the consumer and society as well. These two increasingly vigorous players are sensitive to cost and alternative use of their dollars. In fact, a projection of trends over the past 25 years would have us running out of dollars in the middle of the 21st century. My medical colleagues tell me, "No cost is too great to save a human life or treat disease." My Wharton colleagues tell me, "Resources by definition are limited and choices must be made." Therein lies the challenge of "Appropriate Health Care: Setting the Limits." PMID:10295802
Several ways in which elderly people may assume an active role when using welfare services are discussed here. Selected findings are presented from a study that explored the experience and behaviour of elderly people on discharge from inpatient care with regard to criteria indicating user influence or control (namely participation, representation, access, choice, information and redress). Data were collected via semistructured interviews with service users (n = 30) soon after their return home from hospital. A number of differences were revealed between health care and social care in relation to users being provided with opportunities to assume an active role and in being willing and able to assume an active role. These differences were manifest in elderly service users accessing services, seeking information, exercising choice and acting independently of service providers. It appeared paradoxical that contact points were more easily defined with regard to health care yet users were more likely to exercise choice and act independently in securing social care. It is suggested that social care needs and appropriate service delivery are more easily recognised than making the link between perceived health care needs and appropriate services. In addition, it appeared that informal and private providers are more widely available and accessible for social care. If comprehensive continuing care is to be provided, incorporating both health and social care elements, greater uniformity appears to be required across the welfare sector. Lessons for social care provision from the delivery of health care suggest the clear definition of contact points to facilitate service use. Making health care more accessible, however, does not appear to be easily attainable due to the monopoly provision of health care and the lack of direct purchasing power by potential users. PMID:11560726
Alessio, L; Bonfiglioli, R; Buselli, R; Buzzi, F; Camerino, D; Campagna, M; Cassitto, M G; Castelli, F; Costa, G; Fattorini, E; Franco, G; Lucchini, R; Mattioli, S; Placidi, D; Polato, R; Porru, S; Violante, F S
The board of the Thematic Section on Preventive Medicine for Health Care Workers of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) programmed a national conference on occupational risks of health care workers to be held in late 2009. Main topics will be: a) biohazards; b) biomechanical risk; c) psychosocial factors. Three different working groups were established to tackle critical aspects and suggest practical recommendations to occupational health professionals. Preliminary issues are presented while final results will be presented at the conference on September 2009. PMID:19069220
Patel, Unnati; Pharr, Jennifer R; Ihesiaba, Chidi; Oduenyi, Frances U; Hunt, Aaron T; Patel, Dina; Obiefune, Michael; Chukwumerije, Nkem; Ezeanolue, Echezona E
In many low-income countries, volunteer health advisors (VHAs) play an important role in disseminating information, especially in rural or hard-to-reach locations. When the world's largest outbreak of Ebola virus disease (EVD) occurred in 2014, a majority of cases were concentrated in the West African countries of Guinea, Liberia, and Sierra Leone. Twenty cases were reported in Nigeria initially and there was a need to rapidly disseminate factual information on Ebola virus. In southeast Nigeria, a group of VHAs was being used to implement the Healthy Beginning Initiative [HBI], a congregation based intervention to increase HIV testing among pregnant women and their male partners. The purpose of this study was to assess the baseline and post EVD training knowledge of VHAs during the outbreak in Nigeria. In September 2014, 59 VHAs attending a HBI training workshop in the Enugu State of Nigeria participated in an Ebola awareness training session. Participants completed a 10-item single-answer questionnaire that assessed knowledge of Ebola epidemiology, symptoms, transmission, prevention practices, treatment and survival prior to the Ebola awareness training. After the training, the VHAs repeated the questionnaire. Answers to pre and post questionnaires were analyzed using paired t-tests. Multiple linear regression was used to examine the relationship between pre and post total questionnaire scores and age, education, current location and employment. The average pre-test score was 7.3 and average post-test score was 7.8 which was a significant difference (t=-2.5, p=0.01). Prior to the training, there was a significant difference in Ebola knowledge based on the VHAs education only (p<0.01). After training, education was no longer significant for Ebola knowledge. Existing community health programs can be used as a platform to train VHAs in times of epidemics for quick dissemination of vital health information in areas lacking adequate health infrastructure and personnel. PMID:26234990
This article reviews large-scale digital developments in the National Health Service in England in recent years and argues that there is a mismatch between digital and organisational thinking and practice. The arguments are based on new institutional thinking, where the digital infrastructure is taken to be an institution, which has been shaped over a long period, and which in turn shapes the behaviour of health professionals, managers and others. Many digital services are still being designed in line with a bureaucratic data processing model. Yet health services are increasingly based on a network model, where health professionals and service managers require information systems that allow them to manage risks proactively and to coordinate multiple services on behalf of patients. This article further argues that the data processing model is being reinforced by Open Data policies and by related developments in the acquisition of genomic and telehealth data, suggesting that the mismatch will persist. There is, therefore, an ongoing tension between frontline and central objectives for digital services. It may be that the tension can only be resolved when--or if--there is trust between the interested parties. PMID:25183607
... degree in social work (M.S.W.); Licensed Clinical Social Workers (L.C.S.W.) have additional supervised training and clinical work experience. Licensed Professional Counselor: Master’s degree in psychology, counseling or a related field. Mental Health Counselor: ...
Natural disasters frequently cause major problems which affect a population's health and hinder a nation's socioeconomic development by draining its scarce financial resources in an effort to repair damages. For example, the tsunami disaster in the Indian Ocean is one of the worst natural disasters in modern times. Well over 200,000 people died and more than 1.5 million people lost their homes and often their livelihoods. Losses are estimated to total more than US dollar 7 billion. Private assets, including housing and business equipment, account for the largest share of the losses. In the largest countries, the impact on GDP is likely to be minimal, but the damage in the affected areas is extreme. Poor people were disproportionately affected. A country's health systems and public health infrastructure must be organised and ready to act in disaster situations as well as under normal conditions and must be cognisant of the type of measures to be taken in event of a disaster. These will differ according to the severity of the disaster's impact on the national health system. PMID:15881821
Benjamins, Maureen R; Whitman, Steven
Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23% of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers. PMID:23456249
The United States has made little progress during the past decade in addressing health care disparities. Recent health care reforms offer an historic opportunity to create a more equitable health care system. Key elements of health care reform relevant to promoting equity include access, support for primary care, enhanced health information technology, new payment models, a national quality strategy informed by research, and federal requirements for health care disparity monitoring. With effective implementation, improved alignment of resources with patient needs, and most importantly, revitalization of primary care, these reforms could measurably improve equity. PMID:21242565
Dougherty, Charles J
Since the proposal was first broached in 1987, a storm of controversy has engulfed Oregon's plan to prioritize the health care services offered to its Medicaid recipients. After two years of debate, community consultation, and public opinion polls, the Oregon Health Services Commission was mandated in 1989 to study prioritization as part of a package of bills enacted as the Oregon Basic Health Services Act. In March 1990 the commission released a draft list of ranked health care services for public comment... As part of the ongoing debate, the Hastings Center and the Wesley Foundation sponsored a two-day meeting in January 1991 in Wichita, Kansas, to provide opportunity for thoughtful, in-depth, informal analysis of the OBHSA model for health care reform...a majority felt that OBHSA, in the framework of progress toward larger reform goals, is an experiment worth trying. Some felt that even if OBHSA doesn't attain its larger goals it should be tried since it will extend access and may lead to better health outcomes among the poor. But the general view was that OBHSA is a valuable experiment only to the extent that it leads to a statewide system of universal health insurance in Oregon without creating special burdens for the state's poor.... PMID:11642897
Mobley, M F; Elkins, R L
Megamarketing, as coined by Kotler (1968), is a strategic way of thinking which takes an enlarged view of the skills and resources needed to enter and operate in obstructed or protected markets. The concept of megamarketing emphasizes the mastering and coordination of economic, psychological, political, and public relation skills and suggest that organizations can take a proactive stance in shaping macroenvironmental conditions. As health care delivery is characterized by a highly regulated environment, this marketing approach has definite applications for the health care marketer. PMID:10106844
Fakhr El-Islam, M
This selective review describes recent literature and the author's experience with mental illness and mental health care, and the impact of cultural transformation on mental health in some Arab Islamic cultures, particularly in Egypt, Qatar and Kuwait. Traditional extended Arab families provide a structure for their members that may sometimes prevent and or compensate for the effects of parental loss and mental disability. The role of traditional families in the care of members and in medical decision-making is discussed. The impact of cultural change on Arab culture is also examined, as is the effect of intergenerational conflict in traditional families. PMID:19091731
Liaropoulos, Lycourgos; Goranitis, Ilias
The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability. PMID:26369417
Bhandari, Dilip P; Wollen, Terry S
Livestock contribute to the livelihoods of around 70% of the world's poor. Heifer International provides high quality livestock, training, and related support to communities to assist with food security and to improve livelihoods. Heifer provides training and extension services so families can provide improved animal housing, management, breeding, nutrition, and veterinary health. Heifer conducts training programs for para-vets or Community Animal Health Workers (CAHWs) in areas where local professional veterinary care is not available. Beneficiaries get animal health and husbandry services through trained technicians who are selected from within the community and trained in improved local practices, using basic selection guidelines. The selected community men and women get hands-on training based on the principle of community-based animal health care, using participatory principles in the farmers' fields. Basic tasks of CAHWs in the Heifer-supported project are described. Heifer International is providing sustainable solutions to the well-being of the livestock where it works. PMID:19120163
Robinson, J C
As health policy emphasizes the use of private sector mechanisms to pursue public sector goals, health services research needs to develop stronger conceptual frameworks for the interpretation of empirical studies of health care markets and organizations. Organizational relationships should not be interpreted exclusively in terms of competition among providers of similar services but also in terms of relationships among providers of substitute and complementary services and in terms of upstream suppliers and downstream distributors. This article illustrates the potential applicability of transactions cost economics, agency theory, and organizational economics more broadly to horizontal and vertical markets in health care. Examples are derived from organizational integration between physicians and hospitals and organizational conversions from nonprofit to for-profit ownership. PMID:11327173
Mårdh, P A; Shoubnikova, M; Genç, M; Chaplinkas, S; Unzeitig, V
This article highlights health issues related to prostitution, with special reference to the situation in Europe. Strategies aimed at improving the health care of commercial sex workers, including programs for screening for sexually transmitted infections, are discussed. Problems related to failure to follow-up, particularly of mobile (migratory, international) commercial sex workers, are considered. Other topics covered include counselling on sexual risk reduction, including medical hotline telephone services and clinical outreach work. Counselling commercial sex workers on contraception, desired termination of pregnancy and hazards of illicit drug use are also highlighted. The public-health consequences of delivering poor health care to commercial sex workers are generally severely underestimated, particularly in societies where prostitution is illegal. PMID:10574642
Stevanovi?, Ranko; Tiljak, Hrvoje; Stani?, Arsen; Varga, Sinisa; Not, Teodora; Jovanovi?, Aleksandar
A consensus reached by the medical profession, Croatian Institute of Health Insurance, Croatian Institute of Public Health, and Ministry of Health constitutes a solution to the problem of a data standard required in building an information system for primary health care. This consists of accepting ICPC-2 as a data standard for our Family Medicine, Pediatrics and Women's Health. The classification structure of the International Classification of Primary Care allows, recommends and urges that special codes be established by individual states or local authorities when registering patients' reasons for seeking medical aid or medical procedures. Namely, it urges the authorities to set the codes for such reasons about which a state or local agreement or determination has been made. This is the first public presentation of the proposal Croatia's Additions to the International Classification of Primary Care. They are essential to its implementation in our health insurance, health statistics and medical informatics. PMID:16095202
Pombortsis, A S
A successful implementation of hierarchical health care networks is dependent on a number of different technical and non technical factors. This paper investigates how the networking technologies, both 'traditional' and broadband, can support the communication requirements of medical environments. The general purpose is to implement communication infrastructures and services, which will improve the collaboration between the different partners in the health sector in offering better healthcare services at affordable costs. PMID:9848403
Kim, Duck O.
.1 Organisms present on patient skin or in the inanimate environment 7.2 Organism transfer to healthWHO Guidelines on Hand Hygiene in Health Care First Global Patient Safety Challenge Clean Care is Safer Care WHOGuidelinesonHandHygieneinHealthCare #12;WHO Library Cataloguing-in-Publication Data WHO
Henning, George F.; Graybill, Marie; George, John
Purpose: The purpose of this pilot study was to determine the reasons for which migrant agricultural workers in Pennsylvania seek health care. Methods: Participants were individuals 14 years of age and over, actively involved in agricultural labor and presenting for medical care at 6 migrant health care centers. Bilingual health care providers…
Fournier, A M; Dodard, M
With its 7 million people inhabiting an area the size of the state of New Jersey and with average annual per capita income of $225, Haiti is the poorest and most densely populated country in the Western Hemisphere. 85% of children in rural Haiti have clinical evidence of malnutrition, the infant mortality rate is 94/1000 live births, the maternal mortality rate is 4.5/1000 live births, life expectancy is 55 years, and there are rapidly growing rates of tuberculosis, malaria, and AIDS. Much of Haiti's health crisis is tied to the country's recent troubled political and economic past. That past has disrupted Haiti's health infrastructure to such an extent that Haitian people routinely suffer with, and often die from, readily preventable and treatable illnesses. Haiti's health care infrastructure cannot be rebuilt without humanitarian support and technical assistance from the international community. The authors explain the history, politics, and economics which have contributed to the health care delivery crisis in Haiti and why family medicine will be crucial for the recovery of the country's health care. The development of family medicine will check certain elements which favor emigration and specialization, and will provide the country with well-trained physicians who can treat most common health problems in the country. PMID:9354875
The article focuses on the need for and the characteristics and positive consequences of interdisciplinary teamwork in health care. Interprofessional collaboration is an important element in total quality management. Factors that determine the success of team work are described, such as a management that promotes openness and an administrative organization that promotes interdisciplinary consultation. Other factors have to do with leadership, shared goals and values, meeting management and planning skills, communication, and also the (degree of) knowledge and the (quality of) perception of competences of other health care workers. The shared care plan is stressed as an important tool. In this, the joint planning of goals for intervention and care is essential. Health care workers with different professional knowledge and background have to harmonize their intervention plan according to the competences and goal settings of the other team members. The core of effective interprofessional teamwork is the presence of interprofessional competences such as these. A brief description of the components and performance criteria of the competence of interprofessional collaboration is given. PMID:18393329
Reddy, R; Jagannathan, V; Srinivas, K; Karinthi, R; Reddy, S M; Gollapudy, C; Friedman, S
Patient centered healthcare delivery is an inherently collaborative process. This involves a wide range of individuals and organizations with diverse perspectives: primary care physicians, hospital administrators, labs, clinics, and insurance. The key to cost reduction and quality improvement in health care is effective management of this collaborative process. The use of multi-media collaboration technology can facilitate timely delivery of patient care and reduce cost at the same time. During the last five years, the Concurrent Engineering Research Center (CERC), under the sponsorship of DARPA (Defense Advanced Research Projects Agency, recently renamed ARPA) developed a number of generic key subsystems of a comprehensive collaboration environment. These subsystems are intended to overcome the barriers that inhibit the collaborative process. Three subsystems developed under this program include: MONET (Meeting On the Net)--to provide consultation over a computer network, ISS (Information Sharing Server)--to provide access to multi-media information, and PCB (Project Coordination Board)--to better coordinate focussed activities. These systems have been integrated into an open environment to enable collaborative processes. This environment is being used to create a wide-area (geographically distributed) research testbed under DARPA sponsorship, ARTEMIS (Advance Research Testbed for Medical Informatics) to explore the collaborative health care processes. We believe this technology will play a key role in the current national thrust to reengineer the present health-care delivery system. PMID:8130536
Shaw, Susan J; Armin, Julie
Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is "culturally competent." We explore the diverse methods that cultural competence trainings use to foster a health care provider's ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace. PMID:21553151
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
Lorant, V; Boland, B; Humblet, P; Deliege, D
Design: A cross sectional Health Interview Survey was carried out in 1997 by face to face interview and self administered questionnaire. Two types of health care utilisation were considered (contacts with GPs and with specialists) and four preventive care mostly delivered in a GP setting (flu vaccination, cholesterol screening) or in a specialty setting (mammography and pap smear). Setting: Belgium. Participants: A representative sample of 7378 residents aged 25 years and over (participation rate: 61%). Outcome measure: Socioeconomic inequity was measured by the HIwvp index , which is the difference between use inequality and needs inequality. Needs was computed as the expected use by the risk factors or target groups. Main results: There was significant inequity for all medical contacts and preventive medicine. Medical contacts showed inequity favouring the rich for specialist visits and inequity favouring the poor for contacts with GPs. Regarding preventive medicine, inequity was high and favoured the rich for mammography and cervical screening; inequity was lower for flu immunisation and cholesterol screening but still favoured the higher socioeconomic groups. In the general practice setting, inequity in prevention was higher than inequity in health care; in the specialty setting, inequity in prevention was not statistically different from inequity in health care, although it was higher than in the general practice setting. Conclusions: If inequity in preventive medicine is to be lowered, the role of the GP must be fostered and access to specialty medicine increased, especially for cancer screening. PMID:12080158
There was a time when innovation in health care information technology meant being at the cutting edge of managerial systems. Hospitals made significant investments in financially oriented technology. In the past five years, the investment in clinical IT appears to have outstripped the investment in managerial systems, including enterprise resource planning aimed at improving the supply chain. PMID:15453607
Missouri Univ., Columbia. Instructional Materials Lab.
This instructor's guide contains 65 lessons designed to aid teachers in presenting a course in basic nursing procedures for students studying for careers as health care assistants. Lesson plans consist of a scope, objectives, suggested supplementary teaching and learning items; references, an introduction, a lesson outline, handouts, evaluation…
Feilner, Veronica; Robling, Jeannine
This document contains the core curriculum for a basic high school course for health care assistants. It is designed as a 1-semester course of study, after which students can take a course in an emphasis area, such as veterinary, nursing, pharmacology, or physical therapy, in which they learn skills for specific entry-level jobs. The curriculum…
Lin, H C; Zhang, Y
The purpose of this review is to describe the training of dental professionals and to give an overview of the oral health care system in Mainland China. It may be of interest and importance for American readers to become aware that there are alternative practice structures and the world is getting smaller. PMID:18232574
North Carolina State Dept. of Community Colleges, Raleigh. Occupational Information Center.
Designed for use in community colleges, technical colleges, and technical institutes, this manual contains a course for teaching emergency care skills to both licensed practical and registered nurses employed in occupational health. The manual consists of three sections. In section 1 the need for the course, its content, objectives, length,…
The Nash Equilibrium (put forward by John Nash and celebrated in the film, A Beautiful Mind) mathematically describes multi-player, infinite games. It is a general description of large human transactions, such as health care. Learn how new inputs, new players or new resources can disrupt these transactions. PMID:12219533
Pirrie, Anne; Wilson, Valerie; Elsegood, John; Hall, John; Hamilton, Sheila; Harden, Ronald; Lee, Diana; Stead, Joan
A 2-year study evaluated students' and course organizers' perceptions of the effectiveness of multidisciplinary education (ME) in health care and factors that facilitate or inhibit its development. The study had three phases: a survey of ME provision in the United Kingdom; 42 qualitative interviews and focus groups in 14 sites; and data feedback.…
This article summarizes observations made by the author during a recent trip to China and compares these views to those of other observers over the past decade. The discussion is undoubtedly influenced by the Chinese tendency to speak in terms of the ideal rather than what exists. It was often difficult to sort out “what is” from “what ought to be,” even though our hosts appeared very candid, and, for the most part, our observations confirmed what we were told. Interpretation of observations is also colored by China's new surge of leadership, which causes health care policies to be in a continual state of transition. This makes any paper on contemporary Chinese health care somewhat outdated by the time it is published. However, there appear to be larger concerns reflecting basic Chinese attitudes toward health care that have evolved during the post “Liberation” period and which underlie day-to-day policy fluctuations. The analysis which follows attempts to isolate basic trends from more transitory events to clarify the essential aspects of Chinese health care policy. PMID:10309363
Albert M. Lai; Justin B. Starren
Background: Anecdotally, the use of Remote Display Protocols (RDPs) in health care organizations is increasing. Objective: To gauge RDPs use in heathcare, of number and diversity of sites and in terms of the reasons for use. Methods: Computerized literature searches of the MEDLINE database, ACM Digital Library, and IEEE Explore were performed. The literature search was extended to the gray
Currie, B F; Renner, J H
Increasingly, patients are insisting on becoming partners in their own health care. Physicians who welcome such involvement should try to determine the medical IQ and knowledge base of the patient and then provide appropriate educational experiences. An atmosphere encouraging genuine dialogue is essential to a successful partnership. PMID:310548
Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect is stigma; namely, to avoid the label of mental illness and the harm it brings, people decide not to seek or fully participate in care. Stigma yields 2 kinds of harm that may…
Describes career path of Franketta Guinn, who founded her own home health care business. Claims equally important to the financial reward is the opportunity to provide minority members with jobs. Guinn cites family values, a strong personal belief system, and ability to draw from diverse educational, job-related, and personal experiences as keys…
Garrett, T M; Klonoski, R J; Baillie, H W
The health care industry operates in the margin between market competition and social welfare programs. Violations of business ethics on the market side add considerably to costs. When the inefficient use of resources and market distortions due to power and ignorance as well as legal and subsidized monopolies are added, increased costs can approach $100 billion. Modest remedies are suggested. PMID:8282546
At our University, the Faculty of Health, Social Care and Education has delivered a variety of undergraduate and postgraduate courses via flexible distance learning for many years. Distance learning can be a lonely experience for students who may feel isolated and unsupported. However e-learning provides an opportunity to use technology to…
Murata, Chiyoe; Yamada, Tetsuji; Chen, Chia-Ching; Ojima, Toshiyuki; Hirai, Hiroshi; Kondo, Katsunori
Japan is undergoing a set of health care reforms aimed at cutting rising health care costs and increasing the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people 65 years and older (56.0% women) conducted in seven municipalities in 2006, to reveal clear-cut evidence of barriers to necessary care. The reasons for not getting health care is attributed to health care cost for the elderly with lower income, while higher income counterparts reported being busy or having a condition not serious enough to seek care. PMID:20617033
In the US, when one of the two hospitals involved in a merger is a Catholic hospital, comprehensive reproductive health care tends to suffer. The Catholic Church forbids its hospitals from providing and making direct referrals for many reproductive health services (i.e., reversible contraception, infertility treatments, male and female sterilization, abortion, condoms for HIV prevention, and emergency contraception). These mergers are especially severe in small towns and rural areas. Several groups have formed to address this hidden crisis. In Troy, New York, a settlement was reached about 12 months after a law suit was filed against the conditions of a merger between a Catholic hospital and a nonsectarian hospital. After a long fight, the settlement essentially guaranteed that patients who are dependent on religious institutions obtain the contraceptive and sterilization services they need and want, but abortion services and referrals continued to be denied. The state of Montana considered the impact of a merger of a Catholic institution and a nonsectarian institution, yet continued availability of all reproductive health services was not guaranteed. The American Civil Liberties Union asked the Federal Trade Commission (FTC) to investigate the merger's impact on reproductive health care, since the merger created a monopoly on acute care in Great Falls. FTC took no action. Key factors to provision of reproductive health services other than abortion in cases of mergers between a Catholic hospital and a nonsectarian hospital include the type of association the two hospitals enter into, the local bishop's willingness to accept a creative solution, and the willingness of the state to consider the implications of such a merger and take steps to guarantee the continued availability of services. State reproductive health care advocacy groups (e.g., MergerWatch in New York) are increasing public awareness of the risks these mergers pose and helping residents ensure that reproductive health services remain available. Pressures to reduce costs will likely require Catholic hospitals to continue to merge with nonsectarian hospitals. PMID:8959420
Uncertainty is unavoidable in health care, yet frequently tacit. When uncertainty is acknowledged, it tends to be defined in terms of the unpredictable nature of the care, and limits to human knowledge. It is cast as a problem that evidence-based health care can minimize. Challenging that simplistic perspective, this paper reconstructs uncertainty as a property whose meaning derives from how people are relationally disposed to perceive it in the social context in which they are embedded. Five conditions are suggested to define a need to protect and cultivate uncertainty as a virtue or positive disposition. These conditions are that uncertainty is natural, promotes creativity and a critical attitude, can signify wisdom, nurtures safety, sustains hope and protects against excess. In contrast, certainty is a delusion. Believing in certainty is unscientific and antiscientific because it can obscure and devalue critique in scientific practice. PMID:21848939
Saca-Hazboun, Hanan; Glennon, Catherine A
International cancer care efforts are focusing increasingly on why cancer typically is diagnosed at later stages in the developing world. In Middle Eastern countries, cancer usually is diagnosed at a more advanced stage of disease. For example, in Palestine, 42% of cases were reported stage III and 18% were stage IV. Receiving a cancer diagnosis and seeking treatment is influenced by cultural values and how the community views cancer. Healthcare providers need to understand the disparities and the influence of those disparities on health outcomes. This article is constructed using the Culture Care Theory,which depicts the importance of culture on the health behavior of the individual, and will focus on how cultural values of Palestinian patients with cancer and their families affect attitudes toward and decisions about cancer care. PMID:21624863
Wiersema, Mary; Stacy, Carole Ann
This curriculum guide explains the national health care skills standards and lists skill standards for health care technicians, especially in Michigan. The 10 sections of the guide cover the following: (1) introduction to the national health care skills strands; (2) allied health technologies multiskilled curriculum framework and program design…
Sisira Sarma; Wayne Simpson
Understanding health care utilization is important to design efficient and effective health systems. Toward this end, we develop a relatively simple and intutively appealing microeconometric framework to analyse health care utilization and illustrate its use with recent Canadian microdata. We find that health care utilization consists of distinct stochastic processes requiring the use of two stochastic regression models. In particular,
Vareilles, Gaëlle; Pommier, Jeanine; Kane, Sumit; Pictet, Gabriel; Marchal, Bruno
Introduction The recruitment of community health volunteers to support the delivery of health programmes is a well-established approach in many countries, particularly where health services are not readily available. However, studies on management of volunteers are scarce and current research on human resource management of volunteers faces methodological challenges. This paper presents the protocol of a realist evaluation that aims at identifying the factors influencing the performance of community health volunteers involved in the delivery of a Red Cross immunisation programme in Kampala (Uganda) with a specific focus on motivation. Methods and analysis The realist evaluation cycle structures the protocol. To develop the theoretical basis for the evaluation, the authors conducted interviews and reviewed the literature on community health volunteers’ performance, management and organisational behaviour. This led to the formulation of the initial programme theory, which links the intervention inputs (capacity-building strategies) to the expected outcomes (positive work behaviour) with mechanisms that point in the direction of drivers of motivation. The contextual elements include components such as organisational culture, resource availability, etc. A case study design will be adopted. We define a case as a Red Cross branch, run by a programme manager, and will select two cases at the district level in Kampala. Mixed methods will be used in data collection, including individual interviews of volunteers, participant observation and document review. The thematic analysis will be based on the initial programme theory and will seek for context-mechanism-outcome configurations. Findings from the two cases will be compared. Discussion We discuss the scope for applying realist evaluation and the methodological challenges we encountered in developing this protocol. Ethics and dissemination The study was approved by the Ethical Committee at Rennes University Hospital, France. Results will be published in scientific journals, and communicated to respondents and relevant institutions. PMID:25631314
Kimsey, Diane B
Lean production is a process management philosophy that examines organizational processes from a customer perspective with the goal of limiting the use of resources to those processes that create value for the end customer. Lean manufacturing emphasizes increasing efficiency, decreasing waste, and using methods to decide what matters rather than accepting preexisting practices. A rapid improvement team at Lehigh Valley Health Network, Allentown, Pennsylvania, implemented a plan, do, check, act cycle to determine problems in the central sterile processing department, test solutions, and document improved processes. By using A3 thinking, a consensus building process that graphically depicts the current state, the target state, and the gaps between the two, the team worked to improve efficiency and safety, and to decrease costs. Use of this methodology has increased teamwork, created user-friendly work areas and processes, changed management styles and expectations, increased staff empowerment and involvement, and streamlined the supply chain within the perioperative area. PMID:20619772
of Health Care Provider for U.S. Department of Labor Employee's Serious Health Condition (Family and Medical health condition to submit a medical certification issued by the employee's health care provider. Please: _____________________________ Regular work schedule: _______________________ Employee's essential job functions
Robbins, Catherine J; Rudsenske, Todd; Vaughan, James S
Sophisticated private equity investors in health services provide venture capital for early-stage companies, growth capital for mid-stage companies, and equity capital for buyouts of mid-stage and mature companies. They pursue opportunities in provider sectors that are large and have a stable reimbursement environment, such as acute care services; sectors with room to execute consolidation strategies, such as labs; alternative-site sectors, such as "storefront" medicine; and clinical services, such as behavioral health, that are subject to profitably increasing quality and lowering costs. The innovations created through private equity investments could challenge established health services organizations. PMID:18780929
Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan
Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486
Oliván Gonzalvo, G
In Spain, between 8,000 and 10,000 children and adolescents enter foster or residential care every year. This article aims to provide a review to increase knowledge of the health problems of minors in foster care.Sixty-five percent of the studies consulted were performed in the USA, 25 % in Spain and 10 % in other developed and industrialized countries. These studies report that a high percentage of these minors present complicated and serious physical, mental, and/or developmental problems. However, no appreciable qualitative differences in the most frequent health problems presented by these minors have been observed and there is general consensus that the high-priority health needs are the provision of preventive and/or therapeutic psychopedagogic, psychiatric, dermatologic, dental, nutritional, ophthalmologic, respiratory and immunization services. Failure to identify and provide early treatment of the health needs of these minors not only adversely affects their quality of life and future physical, emotional and intellectual development, but can also increase their difficulties in adaptation while in foster care and their future social adaptation. Their permanent relationship with the biological or adoptive family when foster care stops could also be jeopardized. Therefore, all children and adolescents in foster care should receive initial health screenings, comprehensive assessments and monitoring of their physical, mental health, and developmental status. We provide guidelines for the healthcare of these minors, which should be of use to healthcare professionals taking care of these children and adolescents while they remain in foster care. PMID:12628143
Health education and health literacy programs have implications on health care policy and health care status insurance. There are many benefits of a transition from disease management to a health care system, which includes priorities in prediction, prevention, and health education. Health care and disease management could best be implemented by multiple-tier, market-oriented models of universal coverage allowing for competition among health status insurers and educational, pharmaceutical, nursing, and other health service providers. Promotion of health literacy will allow citizens to become educated customers and consumers of health care services. Internationally, health literacy might narrow the gap between economically richer and poorer countries. PMID:14515414
Under the Compacts of Free Association (COFA), people from the Freely Associated States — the Republic of Palau (ROP), the Republic of the Marshall Islands (RMI), and the Federated States of Micronesia (FSM) — have been migrating to the United States in increasing numbers. In 1996, Congress passed broad welfare reform (Personal Responsibility and Work Opportunity Reconciliation Act) which limited certain federal benefits previously available to COFA migrants, including Medicaid benefits. Prior to July 2010, the State of Hawai‘i had continued to include COFA migrants under its state-funded Medicaid program. In the face of budget constraints, the State removed these people from its Medicaid rolls. A challenge on the legal basis of the denial of equal protection of the laws, ie, the Fourteenth Amendment to the US Constitution, was successful in reinstating health care to the COFA migrants in December 2010. From the health worker's perspective, regardless of various social justice arguments that may have been marshaled in favor of delivering health care to the people, it was an appeal to the judicial system that succeeded. From the attorney's perspective, the legal victories are potentially limited to the four walls of the courtroom without community involvement and related social justice movements. Together, the authors propose that in order to better address the issue of health care access for Micronesian peoples, we must work together, as health and legal advocates, to define a more robust vision of both systems that includes reconciliation and community engagement. PMID:22235150
Lee, Thomas H; Cosgrove, Toby
A health care revolution is under way, and doctors must be part of it. But many are deeply anxious and angry about the transformation, fearing loss of autonomy, respect, and income. Given their resistance, how can health system Leaders engage them in redesigning care? In this article, Dr. Thomas H. Lee, Press Ganey's chief medical officer, and Dr. Toby Cosgrove, the CEO of the Cleveland Clinic, describe a framework they've developed for encouraging buy-in. Adapting Max Weber's "typology of motives," and applying behavioral economics and other motivational principles, they describe four tactics leadership must apply in concert: engaging doctors in a noble shared purpose; addressing their economic self-interest; leveraging their desire for respect; and appealing to their sense of tradition. Drawing from experiences at the Mayo Clinic, Geisinger Health System, Partners HealthCare, the Cleveland Clinic, Ascension Health, and others, the authors show how the four motivational levers work together to bring this critical group of stakeholders on board. PMID:25051859
Dunn, Abe; Shapiro, Adam Hale
This study examines the impact of major health insurance reform on payments made in the health care sector. We study the prices of services paid to physicians in the privately insured market during the Massachusetts health care reform. The reform increased the number of insured individuals as well as introduced an online marketplace where insurers compete. We estimate that, over the reform period, physician payments increased at least 11 percentage points relative to control areas. Payment increases began around the time legislation passed the House and Senate-the period in which their was a high probability of the bill eventually becoming law. This result is consistent with fixed-duration payment contracts being negotiated in anticipation of future demand and competition. PMID:25497755
Puri, Mahesh; Tamang, Anand; Shrestha, Prabhakar; Joshi, Deepak
Medical abortion was introduced in Nepal in 2009, but rural women's access to medical abortion services remained limited. We conducted a district-level operations research study to assess the effectiveness of training 13 auxiliary nurse-midwives as medical abortion providers, and 120 female community health volunteers as communicators and referral agents for expanding access to medical abortion for rural women. Interviews with service providers and women who received medical abortion were undertaken and service statistics were analysed. Compared to a neighbouring district with no intervention, there was a significant increase in the intervention area in community health volunteers' knowledge of the legal conditions for abortion, the advantages and disadvantages of medical abortion, safe places for an abortion, medical abortion drugs, correct gestational age for home use of medical abortion, and carrying out a urine pregnancy test. In a one-year period in 2011-12, the community health volunteers did pregnancy tests for 584 women and referred 114 women to the auxiliary nurse-midwives for abortion; 307 women in the intervention area received medical abortion services from auxiliary nurse-midwives. There were no complications that required referral to a higher-level facility except for one incomplete abortion. Almost all women who opted for medical abortion were happy with the services provided. The study demonstrated that auxiliary nurse-midwives can independently and confidently provide medical abortion safely and effectively at the sub-health post level, and community health volunteers are effective change agents in informing women about medical abortion. PMID:25702073
Conway-Welch, Colleen; And Others
Fundamental features of excellent women's health care are as follows: awareness of women's lives and diversity, comprehensive life-span care, a range of services and providers, and accessibility. Policy recommendations include not limiting health care benefits to employment, focus on prevention and promotion, and expansion of advanced practice…
Charles P. Quesenberry; Bette Caan; Alice Jacobson
Background: Obesity is an independent risk factor for a variety of chronic diseases and is therefore a potential source of avoidable excess health care expenditures. Pre- vious studies of obesity and health care costs have used group level data, applying estimates of population- attributable risks to estimates of US total costs of care for each obesity-related disease. Objective: To quantify
Sparling, Joseph, Ed.; And Others
Workshop sessions focusing on the issue of collaboration between health care services and day care services are documented in this report. The keynote address elaborates the thesis that day care programs should provide therapeutic care, particularly primary health care for ill children and staff, and assistance in obtaining secondary care. In…
The quality of health information on the World Wide Web is ver variable. There are no accepted standards for publishing health information on the Internet. Core standards for health Web sites include: authorship, attribution, disclosure and currency. Irish health care Web sites are disappointing. They are poorly designed. In the main, no target audience is specified, no details are given of dates that information is posted or updated and no e-mail contact addresses are available. There is a paucity of health information and lack of details on authorship and attribution of the information that is available. Information on services, aimed at a public audience, has an excessively high reading age. Sites provide static information and are not interactive. Little maintenance and updating of sites takes place and many are out of date. PMID:10453113
Economic development and reforms have had profound impacts on China's health care sector. As a result, the health care sector in China is in transition. This report reviews the major changes, and the possible policy response to these changes in China's health care sector. It discusses resource availability in the Chinese health sector, and analyses the trend of household demand for health care goods and services. This study also examines the trade and investment situations in China's health sector and investigates the major forces that are driving the transition in health care and comments on the potential policy responses. PMID:10165043
Hauck, F R; King, J; Vian, T
USAID began funding the Rural Health Delivery Services Project (RHDS) in Sine Saloum region (later divided into 2 regions--Kaolack and Fatick) of Senegal in 1977. Its aim was to improve the health of rural inhabitants and to set up a model health care delivery system. It specifically set out to increase agricultural output by reducing illness-related absence from work. USAID funds and local taxes paid for the construction of almost 400 village health huts, each staffed by a 1st aid worker and a traditional birth attendant. In 1982, 90% of villagers sought preventive and curative services from the health huts. In 1984, USAID extended funding to a 2nd phase of the RHDS II/Child Survival (CS) project which aimed to expand preventive health efforts and to introduce new preventive services targeting pregnant women and children. These services were immunizations, malaria control, oral rehydration therapy, and growth monitoring. Other objectives were to integrate these services and to institute program sustainability. Other agencies also were involved, such as UNICEF. RHDS II/CS successfully integrated several interventions at health hut and health post levels. An evaluation team found that the spirit of village-based primary health care made the RHDS system work. No follow-up survey to a 1982-83 baseline survey occurred, making it difficult for the team to determine whether RHDS II/CS achieved child survival goals. It recommended that teams have both expatriate and native representatives who are flexible and adaptable to local conditions and constraints and that agencies be pragmatic in their objectives and expectations about what evaluation teams can accomplish and provide advance documents to team members to allow them more of their often limited time in the country to do field work. The team called for donor agencies to cooperate on reporting requirements. It also suggested that new programs should be added to existing health systems and structures instead of forsaking previous successes. PMID:1458220
Maust, Donovan T; Oslin, David W; Marcus, Steven C
The Centers for Medicare and Medicaid Services (CMS) is promoting formation of accountable care organizations (ACOs). In these population-based models, CMS aligns a Medicare beneficiary population to an ACO with associated expenditure and quality targets, transitioning away from purely volume-based revenue of fee-for-service Medicare. Patients with mental illness are among high-cost Medicare beneficiaries, but this population has received little attention in ACO implementation. Although the ACO goals of providing chronic and preventive care in a coordinated, patient-centered manner are consistent with what some mental health providers have long advocated, the population-based orientation may be unfamiliar. In addressing the needs of high-cost, high-risk patients to meet quality and expenditure targets, an ACO should examine the quality of mental health care it provides as well as medical quality for patients with mental illness. In addition, federal agencies should invest to ensure understanding of the impact of population-based initiatives on patients with mental illness. PMID:23771432
Bao, Yuhua; Eggman, Ashley A; Richardson, Joshua E; Bruce, Martha L
Semistructured interviews with nurses working for home health care agencies in five states raise serious questions about the deleterious effects of Medicare policies and procedures on depression care. The agencies have strong incentives to limit nursing time in a given payment episode and to increase volume, making it difficult to provide high-quality depression care for homebound patients. Some nurses felt forced to "abandon" many patients with depression. The authors call for incremental policy changes in several key areas. PMID:24632686
Seifert, Mary Lee; Heffler, Stephen K.; Donham, Carolyn S.
This feature presents highlights from statistics on health care utilization, prices, expenses, employment, and work hours, as well as on national economic activity, with brief analysis of these economic indicators. These statistics provide an early indication of changes occurring in the health care sector and within the general economy. Although most data are for the first quarter of 1999, American Hospital Association data (Tables 1 and 2) refer to the third quarter of 1998. PMID:11481737
Oehlert, Julie Kennedy; Potter, Teddie
The complex nature of health care requires a culture of interprofessionality that supports high-functioning interprofessional teams. Wolf and Prince (2014) wrote, "Culture is the foundation on which any healthcare encounter is delivered" (p. 3). It is therefore important for nursing to elevate thought leaders who can address the culture of health care organizations and how culture can be transformed. Julie Kennedy Oehlert is one of these leaders. PMID:25842523
Angwenyi, Vibian; Kamuya, Dorcas; Mwachiro, Dorothy; Marsh, Vicki; Njuguna, Patricia; Molyneux, Sassy
Community engagement is increasingly emphasized in biomedical research, as a right in itself, and to strengthen ethical practice. We draw on interviews and observations to consider the practical and ethical implications of involving Community Health Workers (CHWs) as part of a community engagement strategy for a vaccine trial on the Kenyan Coast. CHWs were initially engaged as an important network to be informed about the trial. However over time, and in response to community advice, they became involved in trial information sharing and identifying potential participants; thereby taking on roles that overlapped with those of employed fieldworkers (FWs). While CHWs involvement was generally perceived as positive and appreciated, there were challenges in their relations with FWs and other community members, partly related to levels and forms of remuneration. Specifically, payment of CHWs was not as high as for FWs and was based on 'performance'. This extrinsic motivation had the potential to crowd out CHWs intrinsic motivation to perform their pre-existing community roles. CHWs remuneration potentially also contributed to CHWs distorting trial information to encourage community members to participate; and to researchers encouraging CHWs to utilize their social connections and status to increase the numbers of people who attended information giving sessions. Individual consent processes were protected in this trial through final information sharing and consent being conducted by trained clinical staff who were not embedded in study communities. However, our experiences suggest that roles and remuneration of all front line staff and volunteers involved in trials need careful consideration from the outset, and monitoring and discussion over time. PMID:23521823
Kirk, Maggie; Lea, Dale; Skirton, Heather
In some areas of health care, genomics is having a steadily increasing impact on clinical practice. Yet, in other areas, genomic developments are considered to be at the periphery of care. Health-care professionals from such areas might feel that the potential of genomics is exaggerated. To explore this issue, genetic nurse specialists were invited to submit case studies and to identify barriers and facilitators in incorporating genomics into mainstream nursing practice. Twenty-five cases were submitted and a total of 10 barriers and seven facilitators were identified. These cases were presented as a basis for debate in a session conducted at the 2006 Annual Conference of the International Society of Nurses in Genetics. The majority of delegates agreed that genomics would have a profound effect on health care and nursing within the next 5 years, particularly in oncology. That nurses do not see genomics as being relevant to their practice was identified as the greatest barrier, by a narrow majority. Specialist nurses in any field have a role in acting as agents of change, educators, and consultants to non-specialists. It is clear that genetics nurse specialists still have a considerable challenge in raising awareness about the relevance of genomics to mainstream nursing practice. PMID:18466380
Liechty, Janet M.
One-third of U. S. adults do not have adequate health literacy to manage their health care needs; and low health literacy is a major concern due to its association with poor health outcomes, high health care costs, and health communication problems. Low health literacy is a potential driver of health disparities, and its alleviation is central to…
Ortega-Calvo, Manuel; Santos, José Manuel; Lapetra, José
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
Zilz, D A
The historical development and future of home health-care (HHC) services are reviewed from the perspectives of hospitals and hospital pharmacists. Hospitals have had three choices available to them for offering HHC services: refer patients to outside vendor, establish joint ventures, or establish independent programs. The market strategies of HHC vendors are reviewed, and the factors that portend continued rapid growth for HHC are discussed. An active role by hospital pharmacy directors in planning hospital HHC services is advocated. HHC offers an opportunity for hospital pharmacists to contribute to the financial well-being of the institution and to better patient care. PMID:4073073
Parnaby, John; Towill, Denis R
Achieving lasting performance improvement in health care is a demanding challenge. Service delivery processes are frequently fragmented with many symptoms of poor behaviour observable. Competing vested interests within the National Health Service (NHS) and experiences of muddled and muddied top-down government exhortation suggest the need for a balanced perspective in which the expectations of patients, staff, management and government can be considered, agreed and enabled. Our conclusion is that effective innovation is best achieved by establishing a 'Train-Do-Train-Do' cycle in which all 'players' in the system must be actively involved. The particular methodology of 'managing by projects' for effective bottom-up step-by-step innovation in NHS practice is described. It takes a holistic and systematic view of health-care delivery as a service business process to be optimized via a five-step procedure. The core tool element of this methodology is the multidiscipline natural-group task force used to execute the change process in an enterprise. When properly constituted, motivated and driven, it is very capable of transforming a 'mess' into an effective health-care delivery process. PMID:18647942