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Sample records for primary healthcare sector

  1. Primary healthcare information system--the cornerstone for the next generation healthcare sector in Republic of Croatia.

    PubMed

    Koncar, Miroslav; Gvozdanović, Darko

    2006-01-01

    At no time in the history of medicine has the growth in knowledge and technologies been so profound [Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine (IOM), 2001. ISBN 0-309-07280-8]. However, healthcare delivery systems today are not able to keep up with the pace. Studies have shown that it takes an average of about 17 years for new knowledge generated by randomized trials to be incorporated into practice [B. Andrew, S. Boren, Managing clinical knowledge for health care improvement, in: Yearbook of Medical Informatics, National Library of Medicine, Bethesda, MD, 2000, pp. 65-70]. It is safe to say that today healthcare systems "have the data, but not information". In order to provide highest quality patient care, Republic of Croatia has started the process of introducing enterprise information systems to support business processes in the healthcare domain. Two major requirements are in focus: to provide efficient healthcare related data management in support of decision-making processes; and to support continuous process of healthcare resources spending optimization. The first initiated project refers to Primary Healthcare Information System (PHCIS) that provides domain of primary care with state-of-the-art enterprise information system that connects General Practitioners, Pediatricians and Gynecologists offices with the Croatian Institute for Health Insurance and Public Health Institute. In the years to come, PHCIS will serve as the main integration platform for connecting all other stakeholders and levels of healthcare (e.g. hospitals, pharmacies, laboratories) into single enterprise healthcare network. This article gives an overview of PHCIS, explains challenges that were faced in designing and implementing the system, and elaborates PHCIS role as the cornerstone for the next generation healthcare provisioning in Republic of Croatia. PMID:16213189

  2. Healthcare is primary.

    PubMed

    Kumar, Raman

    2015-01-01

    India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2(nd) National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation. PMID:26985402

  3. Primary Care Shortages: Strengthening This Sector Is Urgently Needed, Now and in Preparation for Healthcare Reform

    PubMed Central

    Collins, Sarah

    2012-01-01

    Background The United States currently faces great challenges in primary care, particularly when the Patient Protection and Affordable Care Act (ACA) greatly expands the health insurance market. Objectives To (1) discuss key areas where primary care needs to be strengthened, including advanced models of physician reimbursement, chronic disease management, and improved patient adherence to medications, and (2) to review initiatives applying evidence-based medicine (EBM) where positive changes have in fact occurred. Discussion This article discusses initiatives that have implemented EBM as their model for change and presents interviews with primary care experts to support the growing need for change in primary care. To improve the quality of care and reduce costs, more needs to be done, particularly by fostering the number of primary care physicians (PCPs) and other healthcare professionals in PCP offices, as well as adjusting payment methods that much more strongly support and reward the primary care and the patient-centered medical home (PCMH) models. An additional area where substantial improvements are needed involves inner-city, rural, and other underserved populations. Provider- and managed care–driven changes are taking place, but much more needs to be done, particularly as a result of the ACA-associated health insurance enrollment expansion. Innovation in payment for PCPs and PCMHs (and corresponding changes in care delivery and improvements in clinically significant outcomes) will be key factors toward the successful implementation of ACA changes. In addition, several examples are discussed, in which the flexibility of managed care and its results-driven orientation are crucial factors for success. Future initiatives that will likely be more challenging and will require significant government funding include the US underserved populations and incentives to encourage medical school students and residents to choose primary care as a specialty. Conclusion

  4. Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.

    PubMed

    McCollum, Rosalind; Chen, Lieping; ChenXiang, Tang; Liu, Xiaoyun; Starfield, Barbara; Jinhuan, Zheng; Tolhurst, Rachel

    2014-01-01

    China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training. PMID:23576191

  5. Job Satisfaction of Primary Health-Care Providers (Public Sector) in Urban Setting

    PubMed Central

    Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Sharma, Nandini

    2013-01-01

    Introduction: Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health care providers in public sector. Materials and Methods: Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health care providers. Pretested structured questionnaire was administered to 227 health care providers. Data was analyzed using SPSS and relevant statistical test were applied. Results: Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01). Age and education level of health care providers don’t show any significant difference in job satisfaction. All the health care providers are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Conclusion: Job satisfaction is poor for all the four groups of health care providers in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi. PMID:24479088

  6. [Results of primary healthcare].

    PubMed

    Duponchel, J L

    2004-01-01

    The concept of primary healthcare was formulated at the international conference held in Alma-Ata (USSR) on September 6 to 12, 1978. Over the past quarter-century, the term "primary healthcare" has been widely used as a basis for implementing healthcare policies in various nations, especially those considered as developing countries. However many programs initiated in the name of the primary healthcare concept have only partially complied with the spirit of the final declaration of Alma-Ata. Analysis of the healthcare in Mali shows that the system followed that evolution. Although considerable time and energy were regrettably wasted in implementing the village health agent strategy, this phase may have been a necessary step in the political development of the state at that time. Recent changes in the country's healthcare system in compliance with the original principles of primary healthcare show that the 1978 declaration is sound and remains pertinent as democracy makes further gains in the world. PMID:15816127

  7. [The primary healthcare centres].

    PubMed

    Brambilla, Antonio; Maciocco, Gavino

    2014-04-01

    The central attributes of primary care are: first contact (accessibility), longitudinality (person- focused preventive and curative care overtime), patient-oriented comprehensiveness and coordination (including navigation towards secondary and tertiary care). Besides taking care of the needs of the individuals, primary health care teams are also looking at the community, especially when addressing social determinants of health. The rationale for the benefits for primary care for health has been found in: 1) greater access to needed services; 2) better quality of care; 3) a greater focus on prevention; 4) early management of health problems; 5) organizing and delivering high quality care for chronic non-communicable diseases. This paper describes the role of primary healthcare centres in strengthening community primary services and in reducing health inequalities. Furthemore, the experiences of Regional Health Services from Tuscany and Emilia-Romagna are discussed, with a brief overview of the literature. PMID:24770539

  8. Accountability and primary healthcare.

    PubMed

    Mukhi, Shaheena; Barnsley, Jan; Deber, Raisa B

    2014-09-01

    This paper examines the accountability structures within primary healthcare (PHC) in Ontario; in particular, who is accountable for what and to whom, and the policy tools being used. Ontario has implemented a series of incremental reforms, using expenditure policy instruments, enforced through contractual agreements to provide a defined set of publicly financed services that are privately delivered, most often by family physicians. The findings indicate that reporting, funding, evaluation and governance accountability requirements vary across service provider models. Accountability to the funder and patients is most common. Agreements, incentives and compensation tools have been used but may be insufficient to ensure parties are being held responsible for their activities related to stated goals. Clear definitions of various governance structures, a cohesive approach to monitoring critical performance indicators and associated improvement strategies are important elements in operationalizing accountability and determining whether goals are being met. PMID:25305392

  9. Accountability and Primary Healthcare

    PubMed Central

    Mukhi, Shaheena; Barnsley, Jan; Deber, Raisa B.

    2014-01-01

    This paper examines the accountability structures within primary healthcare (PHC) in Ontario; in particular, who is accountable for what and to whom, and the policy tools being used. Ontario has implemented a series of incremental reforms, using expenditure policy instruments, enforced through contractual agreements to provide a defined set of publicly financed services that are privately delivered, most often by family physicians. The findings indicate that reporting, funding, evaluation and governance accountability requirements vary across service provider models. Accountability to the funder and patients is most common. Agreements, incentives and compensation tools have been used but may be insufficient to ensure parties are being held responsible for their activities related to stated goals. Clear definitions of various governance structures, a cohesive approach to monitoring critical performance indicators and associated improvement strategies are important elements in operationalizing accountability and determining whether goals are being met. PMID:25305392

  10. Management by missions in the healthcare sector.

    PubMed

    Fonseca Pires, J; Rey, C; Más-Machuca, M; Bastons, M

    2016-01-01

    This article discusses the importance of the mission statement in the healthcare sector. It's also argued that only formal declaration of the mission it's insufficient to the appropriate professional coordination of doctors, nurses and managers. It's proposed a systematic approach to facilitate the introduction of the mission within the systems of the organization, what is called "Management by missions." It promotes horizontal and vertical integration between doctors, nurses and managers. Criteria that ensure this integration are specified. PMID:27068141

  11. Health sector reforms for 21(st) century healthcare.

    PubMed

    Shankar, Darshan

    2015-01-01

    The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India's health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India's Medical Heritage. Health seeking behavior studies reveal that 40-70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21(st) century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India's public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of "integrative healthcare" because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own. PMID:25878456

  12. Health sector reforms for 21st century healthcare

    PubMed Central

    Shankar, Darshan

    2015-01-01

    The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India's health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India's Medical Heritage. Health seeking behavior studies reveal that 40–70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21st century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India's public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of “integrative healthcare” because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own. PMID:25878456

  13. Healthcare reform: implications for knowledge translation in primary care

    PubMed Central

    2013-01-01

    Background The primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector. Methods 431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed. Results All six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources – both double-sided A4-placards – had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care. Conclusions Findings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care. PMID:24274773

  14. The role of criminal law within the healthcare sector.

    PubMed

    Alhafaji, Yasmin

    2012-12-01

    Health is for most of us the most precious thing one can have. However, in practice situations occur where the patient is harmed within the healthcare institution. Traditionally, there are several ways to protect individuals in society: with civil, criminal and administrative procedures. Over the years in the Netherlands complaints procedures were established in which the complaints about healthcare providers' performance can be handled. Recently, there are some developments within the criminal law that concern the healthcare sector. Examples are: the establishment of the Public Prosecution Service's Expertise Center on Medical Matters, appointments of medical prosecutors. In addition, in legal literature suggestions are made that criminal law is nowadays applied in order to provide redress to the patients (relatives) and as a 'safety tool' that is to ensure security and to counter the risks within the healthcare sector. The article discusses the role of criminal law within the healthcare sector, and in particular, whether criminal procedure is suitable for handling complaints about healthcare. PMID:23447904

  15. Privatization and management development in the healthcare sector of Georgia.

    PubMed

    West, Daniel J; Costello, Michael; Ramirez, Bernardo

    2011-01-01

    Healthcare reforms in Georgia parallel some of the major changes made by other Central and Eastern European countries. This is especially true of efforts to privatize the health sector and secure capital investments from Western Europe. Privatization of Georgian healthcare requires an understanding of the Soviet-era healthcare system and ideological orientation. Many of the issues and problems of privatization in Georgia require new knowledge to enhance equity outcomes, improve financial performance, increase access to care and encourage healthcare competition. Training existing and future healthcare leaders in modern management theory and practice is paramount. A university based health-management education partnership model was developed and implemented between several universities in the United States and Europe, along with two Georgian universities, to address workforce demands, changing market conditions, management knowledge and leadership competencies. Health-management education concentrations were developed and implemented along with several short courses to meet market demand for trained leaders and managers. PMID:21677531

  16. Interprofessional Competencies in Integrative Primary Healthcare.

    PubMed

    Kligler, Benjamin; Brooks, Audrey J; Maizes, Victoria; Goldblatt, Elizabeth; Klatt, Maryanna; Koithan, Mary S; Kreitzer, Mary Jo; Lee, Jeannie K; Lopez, Ana Marie; McClafferty, Hilary; Rhode, Robert; Sandvold, Irene; Saper, Robert; Taren, Douglas; Wells, Eden; Lebensohn, Patricia

    2015-09-01

    In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 "meta-competencies" through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year. PMID:26421232

  17. Interprofessional Competencies in Integrative Primary Healthcare

    PubMed Central

    Brooks, Audrey J.; Maizes, Victoria; Goldblatt, Elizabeth; Klatt, Maryanna; Koithan, Mary S.; Kreitzer, Mary Jo; Lee, Jeannie K.; Lopez, Ana Marie; McClafferty, Hilary; Rhode, Robert; Sandvold, Irene; Saper, Robert; Taren, Douglas; Wells, Eden; Lebensohn, Patricia

    2015-01-01

    In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 “meta-competencies” through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year. PMID:26421232

  18. Data Hemorrhages in the Health-Care Sector

    NASA Astrophysics Data System (ADS)

    Johnson, M. Eric

    Confidential data hemorrhaging from health-care providers pose financial risks to firms and medical risks to patients. We examine the consequences of data hemorrhages including privacy violations, medical fraud, financial identity theft, and medical identity theft. We also examine the types and sources of data hemorrhages, focusing on inadvertent disclosures. Through an analysis of leaked files, we examine data hemorrhages stemming from inadvertent disclosures on internet-based file sharing networks. We characterize the security risk for a group of health-care organizations using a direct analysis of leaked files. These files contained highly sensitive medical and personal information that could be maliciously exploited by criminals seeking to commit medical and financial identity theft. We also present evidence of the threat by examining user-issued searches. Our analysis demonstrates both the substantial threat and vulnerability for the health-care sector and the unique complexity exhibited by the US health-care system.

  19. [The importance of waste from healthcare services for teachers, students and graduates of the healthcare sector].

    PubMed

    Moreschi, Claudete; Rempel, Claudete; Backes, Dirce Stein; Carreno, Ioná; de Siqueira, Daiana Foggiato; Marina, Bruna

    2014-06-01

    This study aimed to explore the perception healthcare sector teachers, students and graduates from two institutions of higher learning in Rio Grande do Sul, on the generation of waste from healthcare services. It used a qualitative research approach, performed with 13 teachers, 18 students and 12 healthcare professionals, who were collected through a focus group. The main results showed there is a perception toward the importance of proper segregation and disposal of Healthcare Service Waste, also there is a lack of concern for the reduction of these wastes. Therefore, the issue requires a broader understanding of the environment, with a view of planetary sustainability, exposing needs to provide the healthcare professionals with knowledge and awareness of the importance of handling these types of waste. PMID:25158456

  20. Development of Performance Dashboards in Healthcare Sector: Key Practical Issues

    PubMed Central

    Ghazisaeidi, Marjan; Safdari, Reza; Torabi, Mashallah; Mirzaee, Mahboobeh; Farzi, Jebraeil; Goodini, Azadeh

    2015-01-01

    Background: Static nature of performance reporting systems in health care sector has resulted in inconsistent, incomparable, time consuming, and static performance reports that are not able to transparently reflect a round picture of performance and effectively support healthcare managers’ decision makings. So, the healthcare sector needs interactive performance management tools such as performance dashboards to measure, monitor, and manage performance more effectively. The aim of this article was to identify key issues that need to be addressed for developing high-quality performance dashboards in healthcare sector. Methods: A literature review was established to search electronic research databases, e-journals collections, and printed journals, books, dissertations, and theses for relevant articles. The search strategy interchangeably used the terms of “dashboard”, “performance measurement system”, and “executive information system” with the term of “design” combined with operator “AND”. Search results (n=250) were adjusted for duplications, screened based on their abstract relevancy and full-text availability (n=147) and then assessed for eligibility (n=40). Eligible articles were included if they had explicitly focused on dashboards, performance measurement systems or executive information systems design. Finally, 28 relevant articles included in the study. Results: Creating high-quality performance dashboards requires addressing both performance measurement and executive information systems design issues. Covering these two fields, identified contents were categorized to four main domains: KPIs development, Data Sources and data generation, Integration of dashboards to source systems, and Information presentation issues. Conclusion: This study implies the main steps to develop dashboards for the purpose of performance management. Performance dashboards developed on performance measurement and executive information systems principles and

  1. Stakeholders’ Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions

    PubMed Central

    Nkomazana, Oathokwa; Mash, Robert; Shaibu, Sheila; Phaladze, Nthabiseng

    2015-01-01

    Background An adequate health workforce force is central to universal health coverage and positive public health outcomes. However many African countries have critical shortages of healthcare workers, which are worse in primary healthcare. The aim of this study was to explore the perceptions of healthcare workers, policy makers and the community on the shortage of healthcare workers in Botswana. Method Fifteen focus group discussions were conducted with three groups of policy makers, six groups of healthcare workers and six groups of community members in rural, urban and remote rural health districts of Botswana. All the participants were 18 years and older. Recruitment was purposive and the framework method was used to inductively analyse the data. Results There was a perceived shortage of healthcare workers in primary healthcare, which was believed to result from an increased need for health services, inequitable distribution of healthcare workers, migration and too few such workers being trained. Migration was mainly the result of unfavourable personal and family factors, weak and ineffective healthcare and human resources management, low salaries and inadequate incentives for rural and remote area service. Conclusions Botswana has a perceived shortage of healthcare workers, which is worse in primary healthcare and rural areas, as a result of multiple complex factors. To address the scarcity the country should train adequate numbers of healthcare workers and distribute them equitably to sufficiently resourced healthcare facilities. They should be competently managed and adequately remunerated and the living conditions and rural infrastructure should also be improved. PMID:26284617

  2. [Decisive factors relating to workload in a primary healthcare unit].

    PubMed

    da Silva, Nilson Rogério

    2011-08-01

    Work-related diseases o either physical or emotional origin have been on the increase in contemporary society in the different work sectors. They have had a profound impact on health professionals, such as physicians, dentists, nurses, nursing assistants and administrative assistants in the primary healthcare units. This study aimed to establish the decisive factors relating to workload, seeking to identify possible relations between the working conditions and their potential impact on worker health. Thirty-one individuals comprised the sample, namely 12 physicians, 3 dentists, 1 nurse, 9 nursing assistants, 3 dental assistants and 3 business assistants at a PHU (Primary Healthcare Unit) in a city in the interior of the State of São Paulo. For the data collection, structured interviews were conducted through meetings with the specific groups of workers, such that a detailed description of the activities performed by each group could be drafted, as well as a survey of the problems and desirable features involved. The results indicated the presence of physical, cognitive and psychological demands; inadequate communication processes; obsolete equipment; excessive number of users and an inefficient structure to deal with absenteeism. PMID:21860938

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

    PubMed

    Myers, Kathleen M; Lieberman, Daniel

    2013-06-01

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

  4. A case study of outsourced primary healthcare services in Sindh, Pakistan: is this a real reform?

    PubMed Central

    2014-01-01

    Background Since a decade, low and middle income countries have a rising trend of contracting their primary healthcare services to NGOs. In Pakistan, public sector often lacks capacity to effectively & equitably manage the healthcare services. It led the government to outsource the administration of primary health care services to a semi-autonomous government entity i.e. Peoples’ Primary Healthcare Initiative (PPHI). This small scale study has assessed the quality of healthcare services at the contracted Basic Health Units (BHUs) with the PPHI and compared it with those managed by the local district government in the province of Sindh. Methods A cross-sectional mix methods survey was conducted in November 2011. Two BHUs of each type were selected from the districts Karachi and Thatta in Sindh province. BHUs were selected randomly and a purposive sampling technique was used to recruit the study participants at the two study sites. Focus group discussions were conducted with patients visiting the facility while in-depth interviews were conducted with service providers. An observation based resource availability checklist was also administered. Results There was a significant difference between the PPHI and the district government administered BHUs with regard to infrastructure, availability of essential medicines, basic medical appliances, mini-lab facilities and vehicles for referrals. These BHUs were found to have sufficient number of trained clinical staff and no punctuality and retention issues whatsoever. The district government administered BHUs presented a dismal picture in all the aspects. Conclusion Out-sourcing of primary healthcare facilities has resulted in significantly improved certain aspects quality and responsiveness of primary healthcare services. This strategy is likely to achieve an efficient and perhaps an equitable healthcare delivery in low and middle income countries where governments have limited capacity to manage healthcare services. PMID

  5. Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers

    PubMed Central

    Duncan, Laura G.; Mendoza, Sonia; Hansen, Helena

    2015-01-01

    Background Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians’ offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind. Results Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma. Conclusion As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination. PMID:27088135

  6. Healthcare in Asia: a perspective from primary care at the gateway to a continent.

    PubMed

    Jiwa, Moyez; Othman, Sajaratulnisah; Hanafi, Nik Sherina; Ng, Chirk Jenn; Khoo, Ee Ming; Chia, Yook Chin

    2012-01-01

    Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resources. PMID:23113999

  7. Coordination between primary and secondary healthcare in Denmark and Sweden

    PubMed Central

    Wadmann, Sarah; Strandberg-Larsen, Martin; Vrangbæk, Karsten

    2009-01-01

    Introduction Insights into effective policy strategies for improved coordination of care is needed. In this study we describe and compare the policy strategies chosen in Denmark and Sweden, and discuss them in relation to interorganisational network theory. Policy practice The policy initiatives to improve collaboration between primary and secondary healthcare in Denmark and Sweden include legislation and agreements aiming at clarifying areas of responsibility and defining requirements, creation of links across organisational boarders. In Denmark many initiatives have been centrally induced, while development of local solutions is more prominent in Sweden. Many Danish initiatives target the administrative level, while in Sweden initiatives are also directed at the operational level. In both countries economic incentives for collaboration are weak or lacking, and use of sanctions as a regulatory mean is limited. Discussion and conclusion Despite a variety of policy initiatives, lacking or poorly developed structures to support implementation function as barriers for coordination. The two cases illustrate that even in two relatively coherent health systems, with regional management of both the hospital and general practice sector, there are issues to resolve in regard to administrative and operational coordination. The interorganisational network literature can provide useful tools and concepts for interpreting such issues. PMID:19340328

  8. How and why are communities of practice established in the healthcare sector? A systematic review of the literature

    PubMed Central

    2011-01-01

    Background Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they are structured and operate in the sector. If CoPs are to be cultivated to benefit healthcare organisations, there is a need to examine and understand their application to date. To this end, a systematic review of the literature on CoPs was conducted, to examine how and why CoPs have been established and whether they have been shown to improve healthcare practice. Methods Peer-reviewed empirical research papers on CoPs in the healthcare sector were identified by searching electronic health-databases. Information on the purpose of establishing CoPs, their composition, methods by which members communicate and share information or knowledge, and research methods used to examine effectiveness was extracted and reviewed. Also examined was evidence of whether or not CoPs led to a change in healthcare practice. Results Thirty-one primary research papers and two systematic reviews were identified and reviewed in detail. There was a trend from descriptive to evaluative research. The focus of CoPs in earlier publications was on learning and exchanging information and knowledge, whereas in more recently published research, CoPs were used more as a tool to improve clinical practice and to facilitate the implementation of evidence-based practice. Means by which members communicated with each other varied, but in none of the primary research studies was the method of communication examined in terms of the CoP achieving its objectives. Researchers are increasing their efforts to assess the effectiveness of CoPs in healthcare, however the interventions have been complex and multifaceted, making it difficult to directly attribute the change to the CoP. Conclusions In keeping with Wenger and colleagues' description, CoPs in the healthcare sector vary in form and purpose

  9. The variety of primary healthcare organisations in Australia: a taxonomy

    PubMed Central

    2013-01-01

    Background Healthcare policy appears to treat healthcare organisations as being homogenous, despite evidence that they vary considerably. This study develops a taxonomy of primary health care practices using characteristics associated with the job satisfaction of general medical practitioners (GPs) and the practices. Methods The study used data from 3,662 survey respondents who were GPs in the 2009 wave of the MABEL survey. Cluster analyses were used to determine natural groups of medical practices based on multidimensional characteristics. Results Seven configurations of primary health care practices emerged from multivariate cluster analyses: optimised team, independent craft, reactive, winding down, classic, practitioner flexible, and scale efficiency. Conclusions This taxonomy of configurations moves beyond simplistic categorisations such as geographic location and highlights the complexity of primary health care organisations in Australia. Health policy, workforce and procedure interventions informed by taxonomies can engage the diversity of primary health care practices. PMID:23565577

  10. Accelerated reforms in healthcare financing: the need to scale up private sector participation in Nigeria

    PubMed Central

    Ejughemre, Ufuoma John

    2014-01-01

    The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government’s commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage. PMID:24596895

  11. Primary care training and the evolving healthcare system.

    PubMed

    Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. PMID:22786734

  12. Pediatric Hearing Healthcare in Kentucky's Appalachian Primary Care Setting.

    PubMed

    Bush, Matthew L; Alexander, David; Noblitt, Bryce; Lester, Cathy; Shinn, Jennifer B

    2015-08-01

    Diagnosis and intervention for infant hearing loss is often delayed in areas of healthcare disparity, such as rural Appalachia. Primary care providers play a key role in timely hearing healthcare. The purpose of this study was to assess the practice patterns of rural primary care providers (PCPs) regarding newborn hearing screening (NHS) and experiences with rural early hearing diagnosis and intervention programs in an area of known hearing healthcare disparity. Cross sectional questionnaire study. Appalachian PCP's in Kentucky were surveyed regarding practice patterns and experiences regarding the diagnosis and treatment of congenital hearing loss. 93 Appalachian primary care practitioners responded and 85% reported that NHS is valuable for pediatric health. Family practitioners were less likely to receive infant NHS results than pediatricians (54.5 versus 95.2%, p < 0.01). A knowledge gap was identified in the goal ages for diagnosis and treatment of congenital hearing loss. Pediatrician providers were more likely to utilize diagnostic testing compared with family practice providers (p < 0.001). Very rural practices (Beale code 7-9) were less likely to perform hearing evaluations in their practices compared with rural practices (Beale code 4-6) (p < 0.001). Family practitioners reported less confidence than pediatricians in counseling and directing care of children who fail newborn hearing screening. 46% felt inadequately prepared or completely unprepared to manage children who fail the NHS. Rural primary care providers face challenges in receiving communication regarding infant hearing screening and may lack confidence in directing and providing rural hearing healthcare for children. PMID:25672888

  13. [Today's jobs in the healthcare sector are comparable to other professions].

    PubMed

    Conrad, H-J

    2014-08-01

    By applying current standards of job descriptions and performance profiles in the healthcare sector, this article focuses on the issue whether there are fundamental differences between physicians and other healthcare professionals compared to other professions. There are special requirements for physicians, such as a university degree, but the same also holds true for other professions. The increasing economization of the healthcare sector in recent years has led to a situation where differences in the standards for healthcare professionals when compared to other occupations are no longer apparent. Medical directors at university hospitals also have to conform to standards that are applied to executive managers in other businesses. Besides the obvious professional skills, communication with patients and collaborators, knowledge of economics and leadership competence are also mandatory. This does not exclude the impression that physicians and nurses subjectively see in their profession more than just a job but truly a vocation. PMID:24840517

  14. Organizational culture in the primary healthcare setting of Cyprus

    PubMed Central

    2013-01-01

    Background The concept of organizational culture is important in understanding the behaviour of individuals in organizations as they manage external demands and internal social changes. Cyprus healthcare system is under restructuring and soon a new healthcare scheme will be implemented starting at the Primary Healthcare (PHC) level. The aim of the study was to investigate the underlying culture encountered in the PHC setting of Cyprus and to identify possible differences in desired and prevailing cultures among healthcare professionals. Methods The population of the study included all general practitioners (GPs) and nursing staff working at the 42 PHC centres throughout the island. The shortened version of the Organizational Culture Profile questionnaire comprising 28 statements on organizational values was used in the study. The instrument was already translated and validated in Greek and cross-cultural adaptation was performed. Participants were required to indicate the organization’s characteristic cultural values orientation along a five-point Likert scale ranging from “Very Much = 1” to “Not at all= 5”. Statistical analysis was performed using SPSS 16.0. Student t-test was used to compare means between two groups of variables whereas for more than two groups analysis of variance (ANOVA) was applied. Results From the total of 306 healthcare professionals, 223 participated in the study (72.9%). The majority of participants were women (75.3%) and mean age was 42.6 ± 10.7 years. Culture dimension “performance orientation” was the desired culture among healthcare professionals (mean: 1.39 ± 0.45). “Supportiveness” and “social responsibility” were the main cultures encountered in PHC (means: 2.37 ± 0.80, 2.38 ± 0.83). Statistical significant differences were identified between desired and prevailing cultures for all culture dimensions (p= 0.000). Conclusions This was the first study performed in Cyprus assessing organizational culture in

  15. [Scope and potential of Primary Healthcare in Argentina].

    PubMed

    Stolkiner, Alicia; Comes, Yamila; Garbus, Pamela

    2011-06-01

    This paper is part of the "Southern cone countries multicentric study of primary healthcare: healthcare models, health system integration and intersectoral relations in urban contexts in Argentina, Brazil, Paraguay and Uruguay". Its scope is to contextualize, describe and analyze the current state of the PHC strategy in Argentina and its potential for transforming the fragmented and segmented health system. The data-gathering methodology was review of the literature, study of documents, interviews with key informants and workshop discussions with stakeholders of the system. The dimensions of the data analysis were: (1) stewardship capability; (2) PHC financing; (3) provision, human resources and comprehensiveness; (4) integration and continuity. The transversal analytical categories in all the dimensions were the segmentation and fragmentation of governance and the health system. For this reason, the dynamics and actions of the social actors involved in the healthcare system and their position in relation to PHC were analyzed. The paper contains a theoretical introduction on the scope of current definitions of PHC and the description of the social, economic, political and epidemiological context of healthcare policies in Argentina. PHC based on the proposed dimensions is then analyzed. PMID:21709978

  16. Factors influencing the role of primary care providers as gatekeepers in the Malaysian public healthcare system.

    PubMed

    Ang, K T; Ho, B K; Mimi, O; Salmah, N; Salmiah, M S; Noridah, M S

    2014-01-01

    Primary care providers play an important gatekeeping role in ensuring appropriate referrals to secondary care facilities. This cross-sectional study aimed to determine the level, pattern and rate of referrals from health clinics to hospitals in the public sector, and whether the placement of resident family medicine specialist (FMS) had made a significant difference. The study was carried out between March and April in 2012, involving 28 public primary care clinics. It showed that the average referral rate was 1.56% for clinics with resident FMS and 1.94% for those without resident FMS, but it was not statistically significant. Majority of referred cases were considered appropriate (96.1%). Results of the multivariate analysis showed that no prior consultation with senior healthcare provider and illnesses that were not severe and complex were independently associated with inappropriate referrals. Severity, complexity or uncertain diagnosis of patients' illness or injury significantly contributed to unavoidable referrals. Adequate facilities or having more experienced doctors could have avoided 14.5% of the referrals. The low referral rate and very high level of appropriate referrals could indicate that primary care providers in the public sector played an effective role as gatekeepers in the Malaysian public healthcare system. PMID:26425299

  17. The role of the registered nurse in the marketing of primary healthcare services, as part of health promotion.

    PubMed

    Rall, M; Meyer, S M

    2006-03-01

    Existing literature on the marketing of primary healthcare services was reviewed to determine the role of registered nurses in this regard. The systematic review included five searches and ensured wide coverage of the results of available primary research studies on the topic. The results were summarised and the role of registered nurses in the marketing of primary healthcare services was identified. Primary research sources on the topic included textbooks on marketing by experts in the field and relevant journal articles by authorities on healthcare marketing. The data were analysed and four main categories identified. To ensure the trustworthiness of the research, Lincoln and Guba's (1981: 215-216) criteria, as explained by Krefting (1991: 217), were applied. Because the population consisted of only literature, ethical considerations concerning human subjects were irrelevant. Results indicated that the basic commercial marketing principles (the so-called 4Ps--product, price, place, and promotion) could be adapted for the health sector. The conclusion was that registered nurses could contribute to the marketing of primary healthcare services by communicating with the community (promotion) and by ensuring effective service (product) delivery at the right price and place. Registered nurses could influence the community's perceptions of health care and facilitate behaviour changes, thereby promote health. The implementation of the findings and recommendations of this research could create a new awareness among registered nurses of their role in the marketing of primary healthcare services in South Africa and improve their skills in this regard. PMID:16817488

  18. Institutional and matrix support and its relationship with primary healthcare

    PubMed Central

    dos Santos, Alaneir de Fátima; Machado, Antônio Thomaz Gonzaga da Matta; dos Reis, Clarice Magalhães Rodrigues; Abreu, Daisy Maria Xavier; de Araújo, Lucas Henrique Lobato; Rodrigues, Simone Cristina; de Lima, Ângela Maria de Lourdes Dayrell; Jorge, Alzira de Oliveira; Fonseca, Délcio

    2015-01-01

    OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams. METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test. RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23). CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result. PMID:26274872

  19. The financial crisis in Italy: implications for the healthcare sector.

    PubMed

    de Belvis, Antonio Giulio; Ferrè, Francesca; Specchia, Maria Lucia; Valerio, Luca; Fattore, Giovanni; Ricciardi, Walter

    2012-06-01

    The global economic and financial crisis is having and impact on the Italian healthcare system which is undergoing a devolution process from the central government to regions and where about one third of the regional governments (mainly in the central and southern part of the country) are facing large financial deficits. The paper briefly describes the current macro scenario and the main responses taken to face the crisis and highlights the downside risks of introducing "linear" cuts in the allocation of resources. While justified by the risk of a national debt default, present fiscal policies might increase inequalities in access to care, deteriorate overall health indicators and population wellbeing, and sharpen existing difference in the quality of care between regions. Preliminary evidence shows that the crisis is affecting the quality of nutrition and the incidence of psychiatric disorders. During this difficult financial situation Italy is also facing the risk of a major reduction in investments for preventive medicine, Evidence Based Medicine infrastructures, health information systems and physical capital renewal. This cost-cutting strategy may have negative long term consequences Also, important achievement in terms of limiting waiting lists, improving continuity of care and patients' centeredness, and promoting integration between social and health care may be negatively affected by unprecedented resources' cuts. It is essential that in such a period of public funding constraints health authorities monitor incidence of diseases and access to care of the most vulnerable groups and specifically target interventions to those who may be disproportionally hit by the crisis. PMID:22551787

  20. Herbal Medicine in Primary Healthcare in Germany: The Patient's Perspective

    PubMed Central

    Joos, Stefanie; Glassen, Katharina; Musselmann, Berthold

    2012-01-01

    Herbal medicine (HM) is one of the most widely used Complementary and Alternative Medicine (CAM) therapies throughout the world. The WHO has recognized HM as an essential component of primary healthcare. The aim of this study was to explore patients' attitudes towards using HM, their sources of information and the role of costs. Within a qualitative research approach, semi-standardized interviews with 18 patients using HM were conducted and analyzed according to Mayring's content analysis. Patients highlighted their active role and perceived autonomy choosing HM. Most interviewees experienced HM as better, with more sustainable effects and fewer side effects compared to conventional medicine. All media, family, friends, and healthcare professionals were reported as sources of information. Some patients complained that doctors and pharmacists have insufficient knowledge of HM. Most patients expressed their regret that HM is not reimbursed by statutory health insurances but also their general willingness to pay extra for HM. The main challenge for German primary care, besides the reintroduction of reimbursement, is the promotion of knowledge and skill development in HM. This is to ensure patient safety and work in partnership with patients. Appropriate strategies for education must be tailored to the specific needs of health professional groups. PMID:23346197

  1. Big Data Analysis Framework for Healthcare and Social Sectors in Korea

    PubMed Central

    Song, Tae-Min

    2015-01-01

    Objectives We reviewed applications of big data analysis of healthcare and social services in developed countries, and subsequently devised a framework for such an analysis in Korea. Methods We reviewed the status of implementing big data analysis of health care and social services in developed countries, and strategies used by the Ministry of Health and Welfare of Korea (Government 3.0). We formulated a conceptual framework of big data in the healthcare and social service sectors at the national level. As a specific case, we designed a process and method of social big data analysis on suicide buzz. Results Developed countries (e.g., the United States, the UK, Singapore, Australia, and even OECD and EU) are emphasizing the potential of big data, and using it as a tool to solve their long-standing problems. Big data strategies for the healthcare and social service sectors were formulated based on an ICT-based policy of current government and the strategic goals of the Ministry of Health and Welfare. We suggest a framework of big data analysis in the healthcare and welfare service sectors separately and assigned them tentative names: 'health risk analysis center' and 'integrated social welfare service network'. A framework of social big data analysis is presented by applying it to the prevention and proactive detection of suicide in Korea. Conclusions There are some concerns with the utilization of big data in the healthcare and social welfare sectors. Thus, research on these issues must be conducted so that sophisticated and practical solutions can be reached. PMID:25705552

  2. Health technology assessment and its role in the future development of the Indian healthcare sector.

    PubMed

    Hass, Bastian; Pooley, Jayne; Feuring, Martin; Suvarna, Viraj; Harrington, Adrian E

    2012-04-01

    Public expenditure on healthcare in India is low by international comparison, and access to essential treatment pushes many uninsured citizens below the poverty line. In many countries, policymakers utilize health technology assessment (HTA) methodologies to direct investments in healthcare, to obtain the maximum benefit for the population as a whole. With rising incomes and a commitment from the Government of India to increase the proportion of gross domestic product spent on health, this is an opportune moment to consider how HTA might help to allocate healthcare spending in India, in an equitable and efficient manner. Despite the predominance of out-of-pocket payments in the Indian healthcare sector, payers of all types are increasingly demanding value for money from expenditure on healthcare. In this review we demonstrate how HTA can be used to inform several aspects of healthcare provision. Areas in which HTA could be applied in the Indian context include, drug pricing, development of clinical practice guidelines, and prioritizing interventions that represent the greatest value within a limited budget. To illustrate the potential benefits of using the HTA approach, we present an example from a mature HTA market (Canada) that demonstrates how a new treatment for patients with atrial fibrillation - although more expensive than the current standard of care - improves clinical outcomes and represents a cost-effective use of public health resources. If aligned with the prevailing cultural and ethical considerations, and with the necessary investment in expert staff and resources, HTA promises to be a valuable tool for development of the Indian healthcare sector. PMID:22701823

  3. Community participation to design rural primary healthcare services

    PubMed Central

    2014-01-01

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

  4. How Business Cycles Affect the Healthcare Sector: A Cross-country Investigation.

    PubMed

    Cleeren, Kathleen; Lamey, Lien; Meyer, Jan-Hinrich; De Ruyter, Ko

    2016-07-01

    The long-term relationship between the general economy and healthcare expenditures has been extensively researched, to explain differences in healthcare spending between countries, but the midterm (i.e., business cycle) perspective has been overlooked. This study explores business cycle sensitivity in both public and private parts of the healthcare sector across 32 countries. Responses to the business cycle vary notably, both across spending sources and across countries. Whereas in some countries, consumers and/or governments cut back, in others, private and/or public healthcare buyers tend to spend more. We also assess long-term consequences of business cycle sensitivity and show that public cost cutting during economic downturns deflates the mortality rates, whereas private cut backs increase the long-term growth in total healthcare expenditures. Finally, multiple factors help explain variability in cyclical sensitivity. Private cost cuts during economic downturns are smaller in countries with a predominantly publicly funded healthcare system and more preventive public activities. Public cut backs during contractions are smaller in countries that rely more on tax-based resources rather than social health insurances. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25916435

  5. Responsiveness of Lebanon's primary healthcare centers to non-communicable diseases and related healthcare needs.

    PubMed

    Yassoub, Rami; Hashimi, Suha; Awada, Siham; El-Jardali, Fadi

    2014-01-01

    Lebanon currently faces a rise in non-communicable diseases (NCD) that is stressing the population's health and financial well-being. Preventive care is recognized as the optimal health equitable, cost-effective solution. The study aims to assess the responsiveness of primary health care centers (PHCs) to NCD, and identify the needed health arrangements and responsibilities of PHCs, the Ministry Of Public Health and other healthcare system entities, for PHCs to purse a more preventive role against NCD. Single and group interviews were conducted via a semi-structured questionnaire with 10 PHCs from Lebanon's primary health care network that have undergone recent pilot accreditation and are recognized for having quality services and facilities. This manifested administrative aspects and NCD-related services of PHCs and generated information regarding the centers' deficiencies, strengths and areas needing improvement for fulfilling a more preventive role. Administrative features of PHCs varied according to number and type of health personnel employed. Variations and deficiencies within and among PHCs were manifested specifically at the level of cardiovascular and respiratory diseases and cancer. PHCs identified the pilot accreditation as beneficial at the administrative and clinical levels; however, various financial and non-financial resources, in addition to establishing a strong referral system with secondary care settings and further arrangements with MOPH, are necessary for PHCs to pursue a stronger preventive role. The generated results denote needed changes within the healthcare system's governance, financing and delivery. They involve empowering PHCs and increasing their breadth of services, allocating a greater portion of national budget to health and preventive care, and equipping PHCs with personnel skilled in conducting community-wide preventive activities. PMID:23729408

  6. Primary healthcare providers’ views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua

    PubMed Central

    Jaruseviciene, Lina; Orozco, Miguel; Ibarra, Marcia; Ossio, Freddy Cordova; Vega, Bernardo; Auquilla, Nancy; Medina, Joel; Gorter, Anna C.; Decat, Peter; De Meyer, Sara; Temmerman, Marleen; Edmonds, Alexander B.; Valius, Leonas; Lazarus, Jeffrey V.

    2013-01-01

    Objectives To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. Methods Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. Results Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers’ awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become ‘gate-openers’ to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. Conclusions To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level. PMID:23680267

  7. Benefit Analyses of Technologies for Automatic Identification to Be Implemented in the Healthcare Sector

    NASA Astrophysics Data System (ADS)

    Krey, Mike; Schlatter, Ueli

    The tasks and objectives of automatic identification (Auto-ID) are to provide information on goods and products. It has already been established for years in the areas of logistics and trading and can no longer be ignored by the German healthcare sector. Some German hospitals have already discovered the capabilities of Auto-ID. Improvements in quality, safety and reductions in risk, cost and time are aspects and areas where improvements are achievable. Privacy protection, legal restraints, and the personal rights of patients and staff members are just a few aspects which make the heath care sector a sensible field for the implementation of Auto-ID. Auto-ID in this context contains the different technologies, methods and products for the registration, provision and storage of relevant data. With the help of a quantifiable and science-based evaluation, an answer is sought as to which Auto-ID has the highest capability to be implemented in healthcare business.

  8. Occupational and environmental risk factors for falls among workers in the healthcare sector.

    PubMed

    Drebit, Sharla; Shajari, Salomeh; Alamgir, Hasanat; Yu, Shicheng; Keen, Dave

    2010-04-01

    Falls are a leading cause of occupational injury for workers in healthcare, yet the risk factors of falls in this sector are understudied. Falls resulting in workers' compensation for time-loss from work from 2004-2007 for healthcare workers in British Columbia (BC) were extracted from a standardised incident-reporting database. Productive hours were derived from payroll data for the denominator to produce injury rates; relative risks were derived through Poisson regression modelling. A total of 411 falls were accepted for time-loss compensation. Compared to registered nurses, facility support workers (risk ratio (95% CI) = 6.29 (4.56-8.69)) and community health workers (6.58 (3.76-11.50)) were at high risk for falls. Falls predominantly occurred outdoors, in patients' rooms and kitchens depending on occupation and sub-sector. Slippery surfaces due to icy conditions or liquid contaminants were a leading contributing factor. Falls were more frequent in the colder months (January-March). The risk of falls varies by nature of work, location and worker demographics. The findings of this research will be useful for developing evidence-based interventions. STATEMENT OF RELEVANCE: Falls are a major cause of occupational injury for healthcare workers. This study examined risk factors including occupation type, workplace design, work setting, work organisation and environmental conditions in a large healthcare worker population in BC, Canada. The findings of this research should contribute towards developing evidence-based interventions. PMID:20309748

  9. A balanced scorecard approach in assessing IT value in healthcare sector: an empirical examination.

    PubMed

    Wu, Ing-Long; Kuo, Yi-Zu

    2012-12-01

    Healthcare sector indicates human-based and knowledge-intensive property. Massive IT investments are necessary to maintain competitiveness in this sector. The justification of IT investments is the major concern of senior management. Empirical studies examining IT value have found inconclusive results with little or no improvement in productivity. Little research has been conducted in healthcare sector. The balanced scorecard (BSC) strikes a balance between financial and non-financial measure and has been applied in evaluating organization-based performance. Moreover, healthcare organizations often consider their performance goal at customer satisfaction in addition to financial performance. This research thus proposed a new hierarchical structure for the BSC with placing both finance and customer at the top, internal process at the next, and learning and growth at the bottom. Empirical examination has found the importance of the new BSC structure in assessing IT investments. Learning and growth plays the initial driver for reaching both customer and financial performance through the mediator of internal process. This can provide deep insight into effectively managing IT resources in the hospitals. PMID:22366918

  10. Needs Assessment of the Healthcare Sector in the Washington, D.C., Metropolitan Area. Research Report. Business Needs Assessment Study.

    ERIC Educational Resources Information Center

    Northern Virginia Community Coll., Annandale. Office of Institutional Research.

    According to the U.S. Bureau of Labor Statistics, the growing population of elderly citizens will result in an increased demand for healthcare services that will rise for a full 50 years. This study assesses the need for healthcare sector workers in the Washington, D.C. metropolitan area. Information on the skills, education, and experience that…

  11. Apprenticeship and Progression in the Healthcare Sector: Can Labour Market Theory Illuminate Barriers and Opportunities in Contrasting Occupations?

    ERIC Educational Resources Information Center

    Turbin, Jill; Fuller, Alison; Wintrup, Julie

    2014-01-01

    There is growing research and policy interest in the extent to which government supported Apprenticeship in England provides a platform for educational and career progression in different occupational sectors. This paper makes a contribution to this debate by presenting research on the healthcare sector undertaken in a regional health authority in…

  12. Prohibit, constrain, encourage, or purchase: how should we engage with the private health-care sector?

    PubMed

    Montagu, Dominic; Goodman, Catherine

    2016-08-01

    The private for-profit sector's prominence in health-care delivery, and concern about its failures to deliver social benefit, has driven a search for interventions to improve the sector's functioning. We review evidence for the effectiveness and limitations of such private sector interventions in low-income and middle-income countries. Few robust assessments are available, but some conclusions are possible. Prohibiting the private sector is very unlikely to succeed, and regulatory approaches face persistent challenges in many low-income and middle-income countries. Attention is therefore turning to interventions that encourage private providers to improve quality and coverage (while advancing their financial interests) such as social marketing, social franchising, vouchers, and contracting. However, evidence about the effect on clinical quality, coverage, equity, and cost-effectiveness is inadequate. Other challenges concern scalability and scope, indicating the limitations of such interventions as a basis for universal health coverage, though interventions can address focused problems on a restricted scale. PMID:27358250

  13. Healthcare identities at the crossroads of service modernisation: the transfer of NHS clinicians to the independent sector?

    PubMed

    Waring, Justin; Bishop, Simon

    2011-07-01

    Health policies increasingly support private businesses to take an active role in the organisation and delivery of public healthcare services. For the English NHS, this is exemplified by the introduction of Independent Sector Treatment Centres. A number of these facilities involve the wholesale secondment of NHS clinicians to the private sector which, we suggest, raises important questions about the identities of healthcare professionals accustomed to working in the public sector. Our paper investigates this transition highlighting three prominent discontinuities in clinical work: the ethos of private sector ownership, new lines of authority and fragmented relationships. Drawing on Giddens, we examine how clinicians experience and interpret these changes and how they keep their biographical 'narrative going'. The 'pioneers' interpreted the independent sector as an opportunity to re-invigorate their practice through new roles, relationships and higher quality care; the 'guardians' as an opportunity to replicate and protect the customs and standards of the NHS in the private sector; whilst the 'marooned' longed to return to the NHS. Our study illustrates how the sectoral context can shape healthcare identities, and how contemporary reforms aimed at promoting partnerships across public and private sectors can have profound implications for clinicians. PMID:21314688

  14. Healthcare

    ERIC Educational Resources Information Center

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  15. Primary Care Providers' Perceptions of and Experiences with an Integrated Healthcare Model

    ERIC Educational Resources Information Center

    Westheimer, Joshua M.; Steinley-Bumgarner, Michelle; Brownson, Chris

    2008-01-01

    Objective and Participants: The authors examined the experiences of primary care providers participating in an integrated healthcare service between mental health and primary care in a university health center. In this program, behavioral health providers work collaboratively with primary care providers in the treatment of students. Participants…

  16. Enhancing research capacity across healthcare and higher education sectors: development and evaluation of an integrated model

    PubMed Central

    2012-01-01

    Background With current policy in healthcare research, in the United Kingdom and internationally, focused on development of research excellence in individuals and teams, building capacity for implementation and translation of research is paramount among the professionals who use that research in daily practice. The judicious use of research outcomes and evaluation of best evidence and practice in healthcare is integrally linked to the research capacity and capabilities of the workforce. In addition to promoting high quality research, mechanisms for actively enhancing research capacity more generally must be in place to address the complexities that both undermine and facilitate this activity. Methods A comprehensive collaborative model for building research capacity in one health professional group, speech and language therapy, was developed in a region within the UK and is presented here. The North East of England and the strong research ethos of this profession in addressing complex interventions offered a fertile context for developing and implementing a model which integrated the healthcare and university sectors. Two key frameworks underpin this model. The first addresses the individual participants’ potential trajectory from research consciousness to research participative to research active. The second embeds a model developed for general practitioners into a broader framework of practice-academic partnership and knowledge and skills exchange, and considers external drivers and impacts on practice and patient outcomes as key elements. Results and discussion The integration of practice and academia has been successful in building a culture of research activity within one healthcare profession in a region in the UK and has resulted, to date, in a series of research related outcomes. Understanding the key components of this partnership and the explicit strategies used has driven the implementation of the model and are discussed here. Conclusions A strong

  17. The Challenges and Issues Regarding E-Health and Health Information Technology Trends in the Healthcare Sector

    NASA Astrophysics Data System (ADS)

    Esmaeilzadeh, Pouyan; Sambasivan, Murali; Kumar, Naresh

    Like other industries, the utilization of the internet and Information Technology (IT) has increased in the health sector. Different applications attributed to the internet and IT in healthcare practice. It includes a range of services that intersect the edge of medicine, computer and information science. The presence of the internet helps healthcare practice with the use of electronic processes and communication. Also, health IT (HIT) deals with the devices, clinical guidelines and methods required to improve the management of information in healthcare. Although the internet and HIT has been considered as an influential means to enhance health care delivery, it is completely naive to imagine all new tools and mechanisms supported by the internet and HIT systems are simply adopted and used by all organizational members. As healthcare professionals play an important role in the healthcare sector, there is no doubt that mechanism of newly introduced HIT and new application of the internet in medical practice should be coupled with healthcare professionals' acceptance. Therefore, with great resistance by healthcare professionals new mechanism and tools supported by IT and the internet cannot be used properly and subsequently may not improve the quality of medical care services. However, factors affecting the healthcare professionals' adoption behavior concerning new e-health and HIT mechanism are still not conclusively identified. This research (as a theoretical study) tries to propose the source of resistance in order to handle the challenges over new e-technology in the health industry. This study uses the involved concepts and develops a conceptual framework to improve overall acceptance of e-health and HIT by healthcare professionals.

  18. Willingness to pay for private primary care services in Hong Kong: are elderly ready to move from the public sector?

    PubMed

    Liu, Su; Yam, Carrie H K; Huang, Olivia H Y; Griffiths, Sian M

    2013-10-01

    How to provide better primary care and achieve the right level of public-private balance in doing so is at the centre of many healthcare reforms around the world. In a healthcare system like Hong Kong, where inpatient services are largely funded through general taxation and ambulatory services out of pocket, the family doctor model of primary care is underdeveloped. Since 2008, the Government has taken forward various initiatives to promote primary care and encourage more use of private services. However, little is known in Hong Kong or elsewhere about consumers' willingness to pay (WTP) for private services when care is available in the public sector. This study assessed willingness of the Hong Kong elderly to pay for specific primary care and preventive services in the private sector, through a cross-sectional in-person questionnaire survey and focus group discussions among respondents. The survey revealed that the WTP for private services in general was low among the elderly; particularly, reported WTP for chronic conditions and preventive care both fell below the current market prices. Sub-group analysis showed higher WTP among healthier and more affluent elderly. Among other things, concerns over affordability and uncertainty (of price and quality) in the private sector were associated with this low level of WTP. These results suggest that most elderly, who are heavy users of public health services but with limited income, may not use more private services without seeing significant reduction in price. Financial incentives for consumers alone may not be enough to promote primary care or public-private partnership. Public education on the value of prevention and primary care, as well as supply-side interventions should both be considered. Hong Kong's policy-making process of the initiative studied here may also provide lessons for other countries with ongoing healthcare reforms. PMID:23161587

  19. Revitalising primary healthcare requires an equitable global economic system - now more than ever.

    PubMed

    Sanders, David; Baum, Fran E; Benos, Alexis; Legge, David

    2011-08-01

    The promised revitalisation of primary healthcare (PHC) is happening at a time when the contradictions and unfairness of the global economic system have become clear, suggesting that the current system is unsustainable. In the past two decades, one of the most significant impediments to the implementation of comprehensive PHC has been neoliberal economic policies and their imposition globally. This article questions what will be required for PHC to flourish. PHC incorporates five key principles: equitable provision of services, comprehensive care, intersectoral action, community involvement and appropriate technology. This article considers intersectoral action and comprehensiveness and their potential to be implemented in the current global environment. It highlights the constraints to intersectoral action through a case study of nutrition in the context of globalisation of the food chain. It also explores the challenges to implementing a comprehensive approach to health that are posed by neoliberal health sector reforms and donor practices. The paper concludes that even well-designed health systems based on PHC have little influence over the broader economic forces that shape their operation and their ability to improve health. Reforming these economic forces will require greater regulation of the national and global economic environment to emphasise people's health rather than private profit, and action to address climate change. Revitalisation of PHC and progress towards health equity are unlikely without strong regulation of the market. The further development and strengthening of social movements for health will be key to successful advocacy action. PMID:19955097

  20. Perceptions of rural primary healthcare personnel about expansion of early communication intervention

    PubMed Central

    Kritzinger, Alta

    2013-01-01

    Background Early communication intervention services rendered by speech-language therapists and audiologists to families of infants and young children with feeding difficulties, hearing loss or emerging communication disorders should be implemented throughout South Africa. Early intervention can ameliorate risks, enhance development and may prevent further delays. Based on research initiated during a community-service year experience in a rural subdistrict, an incremental process of establishing accessible early communication intervention services was deemed feasible. Such a process cannot be successful if the collaboration of primary healthcare personnel and managers is not ensured. Objectives The aim of the article was to describe the perceptions of primary healthcare personnel with regard to expansion of early communication intervention services to infants at risk of developmental delay. Method A qualitative descriptive survey design was followed. Semi-structured interviews were conducted with 20 primary healthcare nurses and sisters and eight primary healthcare programme managers in Ditsobotla subdistrict in the North West province of South Africa. Results The participants indicated that by improving team work, developing training programmes and evaluating identification methods and resources, the step-by-step rollout of early communication intervention functions on four organisational levels may be a realistic goal for sustainable services in the resource-limited district. Conclusion The positive perceptions and contributions by participants promise a rich human-resource basis for transdisciplinary collaboration between speech-language therapists, audiologists and primary healthcare personnel in order to reduce the burden of early communication disorders in a rural district.

  1. KEY ITEMS OF INNOVATION MANAGEMENT IN THE PRIMARY HEALTHCARE CENTRES CASE STUDY: FINLAND.

    PubMed

    Aslani, Alireza; Zolfagharzadeh, Mohammad Mahdi; Naaranoja, Marja

    2015-09-01

    Trends such as aging populations, excess costs, rising public expectations, and progress in medical science and technologies point out the necessity of adaptation and development of innovation in the healthcare systems particularly in developed countries. The main objective of this article is to review diffusion of innovation in the healthcare sector. Different types of innovation, diffusion characteristics, and adoption mechanisms are the subjects that are discussed in the selected case study, Finland. Finally, the key items of innovation management in the Finnish health system are introduced. The results can be implemented in other countries as well. PMID:26615647

  2. Primary healthcare in transition – a qualitative study of how managers perceived a system change

    PubMed Central

    2013-01-01

    Background Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. Methods In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. Results The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. Conclusions This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager

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

    PubMed Central

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

    2016-01-01

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

  4. A Results-Based Logic Model for Primary Healthcare: A Conceptual Foundation for Population-Based Information Systems

    PubMed Central

    Watson, Diane E.; Broemeling, Anne-Marie; Wong, Sabrina T.

    2009-01-01

    A conceptual framework for population-based information systems is needed if these data are to be created and used to generate information to support healthcare policy, management and practice communities that seek to improve quality and account for progress in primary healthcare (PHC) renewal. This paper describes work conducted in British Columbia since 2003 to (1) create a Results-Based Logic Model for PHC using the approach of the Treasury Board of Canada in designing management and accountability frameworks, together with a literature review, policy analysis and broad consultation with approximately 650 people, (2) identify priorities for information within that logic model, (3) use the logic model and priorities within it to implement performance measurement and research and (4) identify how information systems need to be structured to assess the impact of variation or change in PHC inputs, activities and outputs on patient, population and healthcare system outcomes. The resulting logic model distinguishes among outcomes for which the PHC sector should be held more or less accountable. PMID:21037902

  5. Future of primary healthcare education: current problems and potential solutions.

    PubMed

    Lord, J

    2003-10-01

    This review examines the origins of primary care and the pressures currently faced in terms of patient expectation, regulation, accountability, and work force shortages. It recognises the appropriateness of adding to the burden in primary care further by the shift both of more services and more medical education from secondary care. Some conclusions are drawn concerning potential solutions including skill mix changes, centralisation of services, a change in attitudes to professional mistakes, increased protected development time, evidence based education, and academic, leadership, and feedback skills for general practitioners. Six recommendations are offered as a prescription for organisational and educational change. PMID:14612596

  6. Perceptions of Obesity Treatment Options Among Healthcare Providers and Low-Income Primary Care Patients

    PubMed Central

    Kennedy, Betty M.; Kennedy, Kathleen B.; Sarpong, Daniel F.; Katzmarzyk, Peter T.

    2016-01-01

    Background: Primary care is a key component of medical care delivery and has a role to play in reducing obesity in the United States. The purpose of this study was to explore attitudes and perceptions about obesity in low-income primary care patients and to identify preferences for weight management interventions from the patient and healthcare provider perspectives. Methods: A convenience sample of 28 patients and 6 healthcare providers from across the state of Louisiana participated in 1 of 5 structured focus groups. Demographic information was collected from both the patients and healthcare providers using survey instruments. Results: Patients and healthcare providers were more similar than dissimilar in their perceptions of obesity in that both groups selected referral to a nutritionist, use of medication, and prescribed exercise as the top 3 strategies that would have the greatest impact on losing weight. Referral to a nutritionist was selected as the easiest strategy to implement. Conclusion: Receiving feedback from both patients and healthcare providers gives researchers the opportunity to acquire useful knowledge that may be beneficial in designing and conducting interventions suitable for patients desiring to lose weight, especially those in primary care settings. PMID:27303227

  7. Patients' Perception of Clinicians Use of ICT During Patient Consultation in the Different Sectors of Danish Healthcare.

    PubMed

    Petersen, Lone Stub; Bertelsen, Pernille

    2016-01-01

    In Denmark ICT is a central part of almost all healthcare professionals' daily practices, and patients are increasingly encouraged to take and active interest in own health data. Therefore, ICT is an important part of what happens at consultations between the patients and the healthcare professionals. We explore the impact of ICT based on a survey of citizens'/patients' experience of interaction with healthcare professionals. How often and for what ICT was used in communication with the patients in different sectors of the Danish healthcare. The results show that ICT is used in communication with citizens and during interaction with patient, however the use of ICT is mostly for the healthcare professionals own benefit and only about 15%-39% of the reported instances ICT was used to communication and interact with the patient. Through the concept of boundary objects we proposes a model that split the object of the technology mediated information into three setting for communication between patients and healthcare professionals. We propose further studies into how ICT can be used to explore the possibilities for more interactive and involving care processes as a key element in further development of eHealth. PMID:27577471

  8. Supporting Primary Healthcare Professionals to Care for People with Intellectual Disability: A Research Agenda

    ERIC Educational Resources Information Center

    Lennox, Nicholas; Van Driel, Mieke L.; van Dooren, Kate

    2015-01-01

    Background: The vast health inequities experienced by people with intellectual disability remain indisputable. Persistent and contemporary challenges exist for primary healthcare providers and researchers working to contribute to improvements to the health and well-being of people with intellectual disability. Over two decades after the only…

  9. Reasons for Consultation among Patients attending Primary Healthcare Centres in Oman

    PubMed Central

    Al-Mandhari, Ahmed; Al-Adawi, Samir; Al-Zakwani, Ibrahim; Dorvlo, Atsu; Al-Shafaee, Mohammed

    2013-01-01

    Objectives: Pathways to care or care-seeking, which translate into healthcare utilisation, have been investigated in many parts of the world, but there is a dearth of studies in the Arabian Gulf. The aim of this study was to examine the characteristics of attendees at primary healthcare centres in northern Oman and their reasons for visiting. Methods: Face-to-face interviews were conducted with 676 participants attending 12 primary healthcare centres between June and July 2006. The catchment area was selected to represent the population structure in Oman. The 12-item questionnaire was read to every fifth eligible patient entering each healthcare centre for a routine appointment. Analyses were conducted using univariate statistics. Results: About a third (n = 200; 29.6%) of the participants had a history of chronic illness; 231 (34%) were on regular medications; 211 (31%) were taking part in health education programmes; 130 (19%) were open to complementary medicine. The majority of the participants mentioned physician’s advice (n = 570; 84%) as the strongest reason for seeking consultation. Conversely, physician’s advice was strongly related to particular demographic factors. Conclusion: This observational study identified some characteristics and reasons for visiting healthcare facilities in northern Oman. These are discussed within the context of prevailing sociocultural factors. The implications for the prevention and detection of ill health in Oman are also discussed. PMID:23862030

  10. Accessibility and use of primary healthcare for immigrants living in the Niagara Region.

    PubMed

    Lum, Irene D; Swartz, Rebecca H; Kwan, Matthew Y W

    2016-05-01

    Although the challenges of accessing and using primary healthcare for new immigrants to Canada have been fairly well documented, the focus has primarily been on large cities with significant immigrant populations. The experiences of immigrants living in smaller, less diverse urban centres remain largely unknown. The purpose of this study was to examine the lived experiences of immigrants living in a small urban centre with regards to the primary healthcare system. A total of 13 immigrants living in the Greater Niagara Region participated in semi-structured interviews. All interviews were recorded, transcribed, and then coded and analyzed for emergent themes using NVivo. Five factors were found to impact primary care access and use: lack of social contacts, lack of universal healthcare coverage during their initial arrival, language as a barrier, treatment preferences, and geographic distance to primary care. Overall findings suggest that immigrants moving to smaller areas such as the Niagara Region face similar barriers to primary care as those moving into large cities. Some barriers, however, appear to be specific to the context of smaller urban centres, further exacerbated by living in a small city due to a smaller immigrant population, fewer services for immigrants, and less diversity in practicing physicians. More research is required to understand the contextual factors inhibiting primary care access and use among immigrants moving to smaller urban centres, and determine effective strategies to overcome these barriers. PMID:27017093

  11. Patient Perceptions and Expectations From Primary Health-care Providers in India

    PubMed Central

    Ardey, Rashmi; Ardey, Rajeev

    2015-01-01

    Introduction: The study of patient satisfaction at the primary care level has been mostly neglected in India. Aim: This objective of this study was to assess indices of Patient Satisfaction at the level of the family physician which is usually the first point of contact between the patient and the health-care system. Materials and Methods: This study was carried out at a Private Primary Health-Care Center in a semirural area in New Delhi, by exit interviews in the form of a questionnaire from patients randomly selected from people visiting the center during the study period. Statistical Analysis: Descriptive statistical analysis was carried out on the data collected. Results: The findings revealed that 83.58% of the patients were satisfied with the general experience and the behavior of the health-care provider and 85.9% were satisfied with the treatment and care provided, only 65.5% were satisfied with the physical environment of the clinic. However, the percentage of patients who would recommend the facility to their friends was overwhelming (94.6%). Conclusion: These results show that private health-care providers are still the first choice for any form of medical care. However, there was definitely a gap between the increasing expectations of the patients for more information, better Patient–Provider interaction, more control over the treatment process and better amenities even at the Primary Care level. It is this gap, which needs to be fulfilled to facilitate better utilization of Primary Health-Care Services in the community and reduce pressure on tertiary care services in order to ensure Universal Health Coverage. This study would also help us understand the challenges for Primary Care service providers, private and public, in a low socioeconomic urban setting. PMID:25810990

  12. Newborn care and knowledge translation - perceptions among primary healthcare staff in northern Vietnam

    PubMed Central

    2011-01-01

    Background Nearly four million neonatal deaths occur annually in the world despite existing evidence-based knowledge with the potential to prevent many of these deaths. Effective knowledge translation (KT) could help to bridge this know-do gap in global health. The aim of this study was to explore aspects of KT at the primary healthcare level in a northern province in Vietnam. Methods Six focus-group discussions were conducted with primary healthcare staff members who provided neonatal care in districts that represented three types of geographical areas existing in the province (urban, rural, and mountainous). Recordings were transcribed verbatim, translated into English, and analyzed using content analysis. Results We identified three main categories of importance for KT. Healthcare staff used several channels for acquisition and management of knowledge (1), but none appeared to work well. Participants preferred formal training to reading guideline documents, and they expressed interest in interacting with colleagues at higher levels, which rarely happened. In some geographical areas, traditional medicine (2) seemed to compete with evidence-based practices, whereas in other areas it was a complement. Lack of resources, low frequency of deliveries and, poorly paid staff were observed barriers to keeping skills at an adequate level in the healthcare context (3). Conclusions This study indicates that primary healthcare staff work in a context that to some extent enables them to translate knowledge into practice. However, the established and structured healthcare system in Vietnam does constitute a base where such processes could be expected to work more effectively. To accelerate the development, thorough considerations over the current situation and carefully targeted actions are required. PMID:21447179

  13. Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK

    PubMed Central

    2011-01-01

    Background The aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS). Consumerism was used as a theoretical framework to explore patients' experiences. Methods Semi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture. Results Five main themes were identified: value for money and willingness to pay; free and fair access; individualised holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and "just added extras": physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information. Conclusions Patients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS and private patients both had

  14. Effectiveness of a training programme to improve hand hygiene compliance in primary healthcare

    PubMed Central

    2009-01-01

    Background Hand hygiene is the most effective measure for preventing infections related to healthcare, and its impact on the reduction of these infections is estimated at 50%. Non-compliance has been highlighted in several studies in hospitals, although none have been carried out in primary healthcare. Main objective To evaluated the effect of a "Hand Hygiene for the reduction of healthcare-associated infections" training program for primary healthcare workers, measured by variation from correct hand hygiene compliance, according to regulatory and specific criteria, 6 months after the baseline, in the intervention group (group receiving a training program) and in the control group (a usual clinical practice). Secondary objectives -To describe knowledges, attitudes and behaviors as regards hand hygiene among the professionals, and their possible association with "professional burnout", stratifying the results by type of group (intervention and usual clinical practice). -To estimate the logistic regression model that best explains hand hygiene compliance. Methods/Design Experimental study of parallel groups, with a control group, and random assignment by Health Center. Area of study.- Health centers in north-eastern Madrid (Spain). Sample studied.- Healthcare workers (physicians, odontostomatologists, pediatricians, nurses, dental hygienists, midwife and nursing auxiliaries). Intervention.- A hand hygiene training program, including a theoretical-practical workshop, provision of alcohol-based solutions and a reminder strategy in the workplace. Other variables: sociodemographic and professional knowledges, attitudes, and behaviors with regard to hand hygiene. Statistical Analysis: descriptive and inferential, using multivariate methods (covariance analysis and logistic regression). Discussion This study will provide valuable information on the prevalence of hand hygiene non-compliance, and improve healthcare. PMID:20015368

  15. Potentiality of Big Data in the Medical Sector: Focus on How to Reshape the Healthcare System

    PubMed Central

    Jee, Kyoungyoung

    2013-01-01

    Objectives The main purpose of this study was to explore whether the use of big data can effectively reduce healthcare concerns, such as the selection of appropriate treatment paths, improvement of healthcare systems, and so on. Methods By providing an overview of the current state of big data applications in the healthcare environment, this study has explored the current challenges that governments and healthcare stakeholders are facing as well as the opportunities presented by big data. Results Insightful consideration of the current state of big data applications could help follower countries or healthcare stakeholders in their plans for deploying big data to resolve healthcare issues. The advantage for such follower countries and healthcare stakeholders is that they can possibly leapfrog the leaders' big data applications by conducting a careful analysis of the leaders' successes and failures and exploiting the expected future opportunities in mobile services. Conclusions First, all big data projects undertaken by leading countries' governments and healthcare industries have similar general common goals. Second, for medical data that cuts across departmental boundaries, a top-down approach is needed to effectively manage and integrate big data. Third, real-time analysis of in-motion big data should be carried out, while protecting privacy and security. PMID:23882412

  16. Warfarin treatment among Finnish patients with atrial fibrillation: retrospective registry study based on primary healthcare data

    PubMed Central

    Hallinen, Taru; Soini, Erkki J; Asseburg, Christian; Kuosmanen, Pekka; Laakkonen, Ari

    2014-01-01

    Objective To assess the frequency of warfarin use, the achieved international normalised ratio (INR) balance among warfarin users and the primary healthcare outpatient costs of patients with atrial fibrillation (AF). Design Retrospective, non-interventional registry study. Setting Primary healthcare. Participants All patients with AF (n=2746) treated in one Finnish health centre between October 2010 and March 2012. Methods Data on healthcare resource use, warfarin use, individually defined target INR range and INR test results were collected from the primary healthcare database for patients with AF diagnosis. The analysed dataset consisted of a 1-year follow-up. Warfarin treatment balance was estimated with the proportion of time spent in the therapeutic INR range (TTR). The cost of used healthcare resources was valued separately with national and service provider unit costs to estimate the total outpatient treatment costs. The factors potentially impacting the treatment costs were assessed with a generalised linear regression model. Results Approximately 50% of the patients with AF with CHADS-VASc ≥1 used warfarin. The average TTR was 65.2% but increased to 74.5% among patients using warfarin continuously (ie, without gaps exceeding 56 days between successive INR tests) during follow-up. One-third of the patients had a TTR of below 60%. The average outpatient costs in the patient cohort were €314.44 with the national unit costs and €560.26 with the service provider unit costs. The costs among warfarin users were, on average, €524.11 or €939.54 higher compared with the costs among non-users, depending on the used unit costs. A higher TTR was associated with lower outpatient costs. Conclusions The patients in the study centre using warfarin were, on average, well controlled on warfarin, yet one-third of patients had a TTR of below 60%. PMID:24578536

  17. How do primary health-care practitioners identify and manage communication impairments in preschool children?

    PubMed

    Woolfenden, Sue; Short, Kate; Blackmore, Roger; Pennock, Rene; Moore, Michael

    2015-01-01

    Communication impairments (CIs) in preschool children are common and can have long-term adverse consequences if not detected and treated early. This study investigated the knowledge, training and practice of primary health-care practitioners in the identification and management of CIs in preschool-aged children. A cross-sectional survey of 277 primary health-care practitioners in the Inner West and South West Sydney was undertaken. The majority of practitioners surveyed understood the importance of early identification of CIs. Eight per cent ofpractitioners correctly identified all of the 'red flags' for verbal and non-verbal communication. The majority (80%) correctly described the management of a typical case presentation. Two-thirds of practitioners reported using a tool in their practice for developmental surveillance, but the quality of surveillance tools was variable. One-third felt their training in this area was poor and 90% indicated they would like further training. Barriers to referral included waiting times, availability and cost of services. We concluded that primary health-care practitioners are aware that CIs are significant and they need to be identified early. There are opportunities for further training and promoting high-quality developmental surveillance in primary care. In addition, there are broader health system issues that include promotion of an integrated response to the detection and management of CIs. PMID:26509204

  18. Patterns of older and younger prisoners' primary healthcare utilization in Switzerland.

    PubMed

    Wangmo, Tenzin; Hauri, Sirin; Meyer, Andrea H; Elger, Bernice S

    2016-09-12

    Purpose The purpose of this paper is to identify primary health concerns prompting older and younger prisoners in Switzerland to consult a nurse or a general practitioner (GP) within the prison healthcare setting, and explores if these reasons for visits differ by age group (49 years and younger vs 50 years and older). The authors used 50 years and older as the benchmark for older prisoners in light of literature indicating accelerated aging among prisoners. Design/methodology/approach Retrospective information from medical records of 406 prisoners were collected for a period of six months. This study analyzed the reasons for which prisoners visited the nurses and GPs available to them through the prison healthcare service. These reasons were coded using the International Classification of Primary Care-version 2. Data were analyzed descriptively and four generalized linear models were built to examine whether there was an age group difference in reasons for visiting nurses and GPs. Findings The health reasons for visiting nurses and GPs by 380 male prisoners from 13 Swiss prisons are presented. In the six month period, a total of 3,309 reasons for visiting nurses and 1,648 reasons for visiting GPs were recorded. Prisoner participants' most common reasons for both visits were for general and unspecified complaints and musculoskeletal problems. Older prisoners sought significantly more consultations for cardiovascular and endocrine problems than younger prisoners. Research limitations/implications Nurses play an important role in addressing healthcare demands of prisoners and coordinating care in Swiss prisons. In light of age-related healthcare demands, continuing education and training of both nurses and GPs to adequately and efficiently address the needs of this prisoner group is critical. Allowing prisoners to carry out some care activities for minor self-manageable complaints will reduce the demand for healthcare. Originality/value This study presents unique

  19. Viability of healthcare service delivery alternatives for the Australian mining sector.

    PubMed

    Williams, Patricia A H; Giles, Margaret

    2012-01-01

    The changing and demanding nature of the mining workforce in rural and remote Australia brings unique challenges to the delivery of healthcare services. In an attempt to control costs whilst delivering cost effective and quality healthcare, new models of delivery must be considered. For a workforce that is fly-in/fly-out, the provision of healthcare is problematic given the lack of consistency in location. A cost-benefit framework is analysed comparing three models of service provision using travel to a major location, locum services and remote health monitoring. Ultimately, new models of care must be considered to address the issues of increasing workforce turnover, to cater for rising healthcare costs, and to improve the health of such communities. PMID:23138092

  20. Managing an Online Survey about Influenza Vaccination in Primary Healthcare Workers

    PubMed Central

    Toledo, Diana; Aerny, Nicole; Soldevila, Núria; Baricot, Maretva; Godoy, Pere; Castilla, Jesús; García-Gutierrez, Susana; Torner, Núria; Astray, Jenaro; Mayoral, José María; Tamames, Sonia; González-Candelas, Fernando; Martín, Vicente; Díaz, José; Domíguez, Angela

    2015-01-01

    Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians, nurses and pediatricians from primary healthcare teams from seven Spanish Autonomous Communities was designed. The centers were selected by simple random sampling. The survey remained active and accessible for 56 days and four reminders were sent. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association of sociodemographic variables and responding to the survey before the second reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder and more family physicians (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2–1.8) than nurses. The responses obtained in the first 24 h after the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders. PMID:25584421

  1. Improving chronic care through continuing education of interprofessional primary healthcare teams: a process evaluation

    PubMed Central

    Roberts, Sharon Ellen; Fournie, Meghan; Tyler, Marie; Brown, Judith; Harris, Stewart

    2014-01-01

    Process evaluations assess program structures and implementation processes so that outcomes can be accurately interpreted. This article reports the results of a process evaluation of Partnerships for Health, an initiative targeting interprofessional primary healthcare teams to improve chronic care in Southwestern Ontario, Canada. Program documentation, participant observation, and in-depth interviews were used to capture details about the program structure, implementation process, and experience of implementers and participants. Results suggest that the intended program was modified during implementation to better meet the needs of participants and to overcome participation barriers. Elements of program activities perceived as most effective included series of off-site learning/classroom sessions, practice-based/workplace information-technology (IT) support, and practice coaching because they provided: dedicated time to learn how to improve chronic care; team-building/networking within and across teams; hands-on IT training/guidance; and flexibility to meet individual practice needs. This process evaluation highlighted key program activities that were essential to the continuing education (CE) of interprofessional primary healthcare teams as they attempted to transform primary healthcare to improve chronic care. PMID:24397571

  2. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    PubMed

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective. PMID:26683238

  3. Are Nurses and Auxiliary Healthcare Workers Equally Effective in Delivering Smoking Cessation Support in Primary Care?

    PubMed Central

    Faulkner, Kathryn; Sutton, Stephen; Jamison, James; Sloan, Melanie; Boase, Sue

    2016-01-01

    Introduction: Smoking cessation support is increasingly delivered in primary care by auxiliary healthcare workers in place of healthcare professionals. However, it is unknown whether this shift might affect the quality and impact of the support delivered. Methods: Data from the iQuit in Practice randomized control trial of cessation support in General Practice was used (N = 602). Analyses assessed whether cessation advisor type (nurse or healthcare assistant [HCA]) was associated with abstinence (primary outcome: self-reported 2-week point prevalence abstinence at 8 weeks follow-up), the advice delivered during the initial consultation, pharmacotherapies prescribed, patient satisfaction, initial consultation length, and the number and type of interim contacts. Results: There were no statistically significant differences in abstinence for support delivered by HCAs versus nurses at 8 weeks (HCAs 42.8%, nurses 42.6%; unadjusted odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.73 to 1.40), or at 4 weeks or 6 months follow-up. There were no statistically significant differences in advice delivered, the types of pharmacotherapies prescribed or patient satisfaction. Compared with nurses, HCA consultations were longer on average (HCAs 23.6 minutes, nurses 20.8 minutes; P = .002) and they undertook more interim contacts (HCAs median 2, nurses median 1; P < .001), with contact more likely to be face-to-face than phone call (HCAs 91.2%, nurses 70.9%; OR = 4.23, 95% CI = 2.86 to 6.26). Conclusions: HCAs appear equally effective as nurses in supporting smoking cessation, although they do this with greater patient contact. Using auxiliary practitioners to deliver cessation support could free up nurse time and reduce costs. Implications: This study found that primary care patients receiving smoking cessation support from auxiliary healthcare workers were just as likely to be abstinent up to 6 months later as those patients seen by nurses. While the auxiliary healthcare

  4. Implementing the HL7v3 standard in Croatian primary healthcare domain.

    PubMed

    Koncar, Miroslav

    2004-01-01

    The mission of HL7 Inc. is to provide standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services. The scope of this work includes the specifications of flexible, cost-effective approaches, standards, guidelines, methodologies, and related services for interoperability between healthcare information systems. In the field of medical information technologies, HL7 provides the world's most advanced information standards. Versions 1 and 2 of the HL7 standard have on the one hand solved many issues, but on the other demonstrated the size and complexity of the health information sharing problem. As the solution, a complete new methodology has been adopted, which is being encompassed in version 3 recommendations. This approach standardizes the Reference Information Model (RIM), which is the source of all domain models and message structures. Message design is now defined in detail, enabling interoperability between loosely-coupled systems that are designed by different vendors and deployed in various environments. At the start of the Primary Healthcare Information System project, we have decided to go directly to HL7v3. Implementing the HL7v3 standard in healthcare applications represents a challenging task. By using standardized refinement and localization methods we were able to define information models for Croatian primary healthcare domain. The scope of our work includes clinical, financial and administrative data management, where in some cases we were compelled to introduce new HL7v3-compliant models. All of the HL7v3 transactions are digitally signed, using the W3C XML Digital Signature standard. PMID:15718621

  5. [The risk for illegal behaviour and corruption in the healthcare sector: what preventive measures can be taken?].

    PubMed

    Rivoiro, Chiara

    2016-05-01

    In the healthcare sector risk factors for illegal behavior and corruption are peculiar and greater than in other social areas, as it plays a crucial role in the community's economical, political and cultural life. The healthcare services is a complex network that require interaction between may people, constant contacts with the industry, safety and adequate facilities that require regular maintenance, upgrade and replacement of medical technology, connection with local and regional policy makers. This provides the opportunity of being exposed to improper influence. However, illegal behaviors can be prevented: first of all supporting all professionals that everyday work to protect our health with ethics and expertise; then with all instruments that anti-corruption action plans, such as the one introduced in Italy in 2012, aim to identify and target those areas most at risk of corruption phenomena. PMID:27311119

  6. Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study

    PubMed Central

    2010-01-01

    Background Healthcare workers are still recognised as a high-risk group for latent TB infection (LTBI). Therefore, the screening of people employed in the healthcare sector for active and LTBI is fundamental to infection control programmes in German hospitals. It was the aim of the study to determine the prevalence and putative risk factors of LTBI. Methods We tested 2028 employees in the healthcare sector with the QuantiFERON-Gold In-tube (QFT-IT) test between December 2005 and May 2009, either in the course of contact tracing or in serial testing of TB high-risk groups following German OSH legislation. Results A positive IGRA was found in 9.9% of the healthcare workers (HCWs). Nurses and physicians showed similar prevalence rates (9.7% to 9.6%). Analysed by occupational group, the highest prevalence was found in administration staff and ancillary nursing staff (17.4% and 16.7%). None of the individuals in the trainee group showed a positive IGRA result. In the different workplaces the observed prevalence was 14.7% in administration, 12.0% in geriatric care, 14.2% in technicians (radiology, laboratory and pathology), 6.5% in admission ward staff and 8.3% in the staff of pulmonary/infectious disease wards. Putative risk factors for LTBI were age (>55 years: OR14.7, 95% CI 5.1-42.1), being foreign-born (OR 1.99, 95% CI 1.4-2.8), TB in the individual's own history (OR 4.96, 95% CI 1.99-12.3) and previous positive TST results (OR 3.5, 95% CI 2.4-4.98). We observed no statistically significant association with gender, BCG vaccination, workplace or profession. Conclusion The prevalence of LTBI in low-incidence countries depends on age. We found no positive IGRA results among trainees in the healthcare sector. Incidence studies are needed to assess the infection risk. Pre-employment screening might be helpful in this endeavour. PMID:20429957

  7. Mobility and Transparency of Vocational Qualifications: An Overview of Studies on the Tourism, Chemical and Healthcare Sectors in Europe. CEDEFOP Panorama.

    ERIC Educational Resources Information Center

    Pettersson, Sten; Richards, Greg; Rolfe, Heather; Skar, Mariann

    Three studies covering the tourism, chemical industry, and healthcare sectors in the European Union investigated patterns of cross-border mobility at the sector level. Special focus was on transparency of vocational qualifications and the relation between transparency and mobility. A serious lack of information on labor force mobility within…

  8. Managing Self-Governing Primary Schools in the Locally Maintained, Grant-Maintained and Private Sectors.

    ERIC Educational Resources Information Center

    Bell, Les; And Others

    1996-01-01

    Discusses a study that surveyed heads of locally maintained, grant-maintained, and private sector (British) primary schools concerning their management styles. Questionnaire and interview data suggest that autonomous primary schools are characterized by collective decision making and high job satisfaction levels. Private sector school heads'…

  9. Development of an Automated Healthcare Kiosk for the Management of Chronic Disease Patients in the Primary Care Setting.

    PubMed

    Ng, Grace; Tan, Nicolette; Bahadin, Juliana; Shum, Eugene; Tan, Sze Wee

    2016-07-01

    An increase in the prevalence of chronic disease has led to a rise in the demand for primary healthcare services in many developed countries. Healthcare technology tools may provide the leverage to alleviate the shortage of primary care providers. Here we describe the development and usage of an automated healthcare kiosk for the management of patients with stable chronic disease in the primary care setting. One-hundred patients with stable chronic disease were recruited from a primary care clinic. They used a kiosk in place of doctors' consultations for two subsequent follow-up visits. Patient and physician satisfaction with kiosk usage were measured on a Likert scale. Kiosk blood pressure measurements and triage decisions were validated and optimized. Patients were assessed if they could use the kiosk independently. Patients and physicians were satisfied with all areas of kiosk usage. Kiosk triage decisions were accurate by the 2nd month of the study. Blood pressure measurements by the kiosk were equivalent to that taken by a nurse (p = 0.30, 0.14). Independent kiosk usage depended on patients' language skills and educational levels. Healthcare kiosks represent an alternative way to manage patients with stable chronic disease. They have the potential to replace physician visits and improve access to primary healthcare. Patients welcome the use of healthcare technology tools, including those with limited literacy and education. Optimization of environmental and patient factors may be required prior to the implementation of kiosk-based technology in the healthcare setting. PMID:27240840

  10. An operational study on implementation of mobile primary healthcare services for seasonal migratory farmworkers, Turkey.

    PubMed

    Simsek, Zeynep; Koruk, Ibrahim; Doni, Nebiye Yentür

    2012-12-01

    Maternal and child health is affected by exposure to unhealthy living and working conditions, by increased exposure to health hazards, and by poor utilization of primary healthcare services. The objective of this operational study was to implement mobile primary healthcare services (MPHS) for migratory seasonal farmworkers. This study, conducted in Şanlıurfa, Turkey, between March 2008 and April 2009, examined multiple stages of MPHS implementation in both a permanent settlement (336 children aged 5 and under; 580 women of reproductive age) and a working settlement (85 living units; 217 children and 257 women). The stages included: (1) identifying the problem, (2) identifying a potential solution and a quasi-experimental study to evaluate the effect of intervention, (3) utilizing and disseminating results to stakeholders, and (4) implementing sustainable MPHS county-wide. Rates of selected outcome measures, including full childhood and tetanus vaccination, phenylketonuria screening, and safer usage of pesticides, iodine salt, and sanitary toilet facilities, increased significantly following the intervention in both the permanent and temporary settlements (P < 0.05). The majority of cases of anemia (children: 16.6%, women: 17.8%) and parasitic infections (55.4%) were treated. The study results indicate that MPHS are necessary to ensure healthcare access for migratory farmworkers and to establish a stronger public health infrastructure for this risk group. PMID:22278354

  11. Learning from people with long-term conditions: new insights for governance in primary healthcare.

    PubMed

    Ross, Fiona; Smith, Pam; Byng, Richard; Christian, Sara; Allan, Helen; Price, Linnie; Brearley, Sally

    2014-07-01

    The introduction of top-down centrally driven solutions to governance of healthcare, at the same time as increasing policy emphasis on greater 'bottom up' patient and public involvement in all aspects of healthcare, has set up complex tensions for policy implementation and healthcare practice. This paper explores the interplay of these agendas in the context of changes in primary healthcare services provided by the National Health Service in England. Specifically, it looks at service user involvement in a qualitative study of the professional response to changes in the governance and incentives in the care of people with long-term conditions. Service users influenced and guided the study at local and national levels. Vignettes of patient stories developed by service users informed in-depth interviews with 56 health and social care professionals engaged in the development of local policies and services for people with complex long-term illness, and themes generated by cross case analysis were validated through service users. The findings presented here focus on four themes about risk and comparison of professionals' and service users' perspectives of the issues: managing risks/consistent support, the risks of letting go/feeling in control, professional identity/helping people to help themselves, and managing expectations/professionals losing out. In this study, service user involvement added value by validating understandings of governance, framing debates to focus on what matters at the point of care and enabling perspective sharing and interaction. We suggest that more collaborative forms of governance in healthcare that take account of service user perspectives and enable interaction with professional groups could help validate processes of quality assurance and provide motivation for continuous quality improvement. We offer a model for 'opening up' collaborative projects to evaluation and critical reflection of the interrelationships between the context, methods

  12. An Analysis of the Implementation and Impact of Speech-Recognition Technology in the Healthcare Sector

    PubMed Central

    Parente, Ronaldo; Kock, Ned; Sonsini, John

    2004-01-01

    This paper develops a conceptual framework and offers research propositions for understanding the adoption of speech-recognition technology, drawing from Rogers's work on the diffusion of innovation, from interview findings, and from case study analysis. The study's focus was the analysis of the implementation of speech recognition and its impact on performance in the healthcare industry. Our interview findings indicated that, while there is still much room for improvement in the way speech-recognition technology is adopted and implemented, this particular technology has had a significant impact on the ability of healthcare providers to operate more cost effectively and provide a better level of patient care. PMID:18066385

  13. Utilization of nurse practitioners to increase patient access to primary healthcare in Canada--thinking outside the box.

    PubMed

    DiCenso, Alba; Bourgeault, Ivy; Abelson, Julia; Martin-Misener, Ruth; Kaasalainen, Sharon; Carter, Nancy; Harbman, Patricia; Donald, Faith; Bryant-Lukosius, Denise; Kilpatrick, Kelley

    2010-12-01

    In the past decade, all Canadian provinces and territories have launched various team-based primary healthcare initiatives designed to improve access and continuity of care. Nurse practitioners (NPs) are increasingly becoming integral members of primary healthcare teams across the country. This paper draws on the results of a scoping review of the literature and qualitative key informant interviews conducted for a decision support synthesis about advanced practice nursing in Canada. We describe and analyze two novel approaches to NP integration designed to address the gap in patient access to primary healthcare: (1) the integration of NPs in traditional fee-for-service practices in British Columbia, and (2) the creation of NP-led clinics in Ontario. Although fee-for-service remuneration has been a barrier to collaborative practice, the integration of government-salaried NPs into fee-for-service practices in British Columbia has enabled the creation of inter-professional teams, and based on early evaluation findings, has increased patient access to care and patient and provider satisfaction. NP-led clinics are designed to provide inter-professional care in communities with high numbers of patients who do not have a regular primary healthcare provider. Given the shortage of physicians in communities where these clinics are being introduced, the ratio of physicians to NPs is lower than in other primary healthcare delivery models, and physicians function in more of a consulting role. Initial evaluation of the first of 26 NP-led clinics indicates increased access to care and high levels of patient and provider satisfaction. Implementing a creative mosaic of collaborative primary healthcare models that are responsive to patient needs challenges traditional assumptions about professional roles and responsibilities. To address this challenge, we endorse a recommendation that governments establish a mechanism to bring together both physician and non-physician primary

  14. Factors Influencing Early Detection of Oral Cancer by Primary Health-Care Professionals.

    PubMed

    Hassona, Y; Scully, C; Shahin, A; Maayta, W; Sawair, F

    2016-06-01

    The purposes of this study are to determine early detection practices performed by primary healthcare professionals, to compare medical and dental sub-groups, and to identify factors that influence the ability of medical and dental practitioners to recognize precancerous changes and clinical signs of oral cancer. A 28-item survey instrument was used to interview a total of 330 Jordanian primary health-care professionals (165 dental and 165 medical). An oral cancer knowledge scale (0 to 31) was generated from correct responses on oral cancer general knowledge. An early detection practice scale (0 to 24) was generated from the reported usage and frequency of procedures in oral cancer examination. Also, a diagnostic ability scale (0 to 100) was generated from correct selections of suspicious oral lesions. Only 17.8 % of the participants reported that they routinely performed oral cancer screening in practices. Their oral cancer knowledge scores ranged from 3 to 31 with a mean of 15.6. The early detection practice scores ranged from 2 to 21 with a mean of 11.6. A significant positive correlation was found between knowledge scores and early detection practice scores (r = 0.22; p < 0.001). The diagnostic ability scores ranged from 11.5 to 96 with a mean of 43.6. The diagnostic ability score was significantly correlated with knowledge scores (r = 0.39; p < 0.001), but not with early detection practice scores (r = 0.01; p = 0.92). Few significant differences were found between medical and dental primary care professionals. Continuous education courses on early diagnosis of oral cancer and oral mucosal lesions are needed for primary health-care professionals. PMID:25851202

  15. Primary care nurses’ experiences of how the mass media influence frontline healthcare in the UK

    PubMed Central

    2013-01-01

    Background Mass media plays an important role in communicating about health research and services to patients, and in shaping public perceptions and decisions about health. Healthcare professionals also play an important role in providing patients with credible, evidence-based and up-to-date information on a wide range of health issues. This study aims to explore primary care nurses’ experiences of how mass media influences frontline healthcare. Methods In-depth telephone interviews were carried out with 18 primary care nurses (nine health visitors and nine practice nurses) working in the United Kingdom (UK). Interviews were recorded and transcribed. The data was analysed using thematic analysis, with a focus on constant comparative analysis. Results Three themes emerged from the data. First, participants reported that their patients were frequently influenced by controversial health stories reported in the media, which affected their perceptions of, and decisions about, care. This, in turn, impinged upon participants’ workloads as they had to spend additional time discussing information and reassuring patients. Second, participants also recalled times in their own careers when media reports had contributed to a decline in their confidence in current healthcare practices and treatments. Third, the participants in this study suggested a real need for additional resources to support and expand their own media literacy skills, which could be shared with patients. Conclusion In an ever expanding media landscape with greater reporting on health, nurses working in the primary care setting face increasing pressure to effectively manage media stories that dispute current health policies and practices. These primary care nurses were keen to expand their media literacy skills to develop critical autonomy in relation to all media, and to facilitate more meaningful conversations with their patients about their health concerns and choices. PMID:24267614

  16. Quality of assistance provided to children with sickle cell disease by primary healthcare services

    PubMed Central

    Gomes, Ludmila Mourão Xavier; Reis, Tatiana Carvalho; Vieira, Magda Mendes; de Andrade-Barbosa, Thiago Luis; Caldeira, Antônio Prates

    2011-01-01

    Objective To evaluate the quality of healthcare provided to sickle cell disease children by primary healthcare services in a region of high prevalence. Methods A cross-sectional, descriptive study was performed by interviewing members of families with sickle cell disease children. The children had been identified from the Neonatal Screening Program in Minas Gerais state over the last 12 years in towns of the Montes Claros-Bocaiuva microregion. A structured questionnaire specially developed for this study and based on three axes was used: indicators of the child's health (immunization, growth and development, prophylaxis antibiotic therapy), perception of care by the family (health education and accessibility) and knowledge of the family about the disease. Results Sixty-three of 71 families with children identified as having sickle cell disease were interviewed. The predominant genotypes were Hb SS (44.4%) and Hb SC (41.2%). Adequate monitoring of growth and development was recorded for the first year of life in 23 children (36.6%) and for the second year of life in 18 children (28.6%). The basic vaccination schedule was completed by 44 children (69.8%) but 62 vaccination record cards (98.4%) identified delays of special vaccines. Regular use of prophylactic penicillin was reported by 55 caregivers (87.3%). The family's perception of the care provided suggests poor accessibility to health services and lack of opportunities to answer doubts. The average performance of families in knowledge testing was 59.8%. Conclusion The quality of healthcare is unsatisfactory. The care provided to children with sickle cell disease in primary healthcare services needs improvements. PMID:23049319

  17. Education in the Wake of Healthcare Reform: Increasing Primary Care Usage by Individuals Currently Reliant upon Emergency Departments for Care

    ERIC Educational Resources Information Center

    Tannebaum, Michael; Wilkin, Holley A.; Keys, Jobia

    2014-01-01

    Background: The Affordable Care Act (ACA) was introduced, in part, to increase access to primary care, which has been shown to provide patients with myriad health benefits. Objective: To increase primary care usage by understanding the beliefs about primary and emergency care most salient to those whose healthcare-seeking practices may be impacted…

  18. Evaluating the Quality of the Learning Outcome in Healthcare Sector: The Expero4care Model

    ERIC Educational Resources Information Center

    Cervai, Sara; Polo, Federica

    2015-01-01

    Purpose: This paper aims to present the Expero4care model. Considering the growing need for a training evaluation model that does not simply fix processes, the Expero4care model represents the first attempt of a "quality model" dedicated to the learning outcomes of healthcare trainings. Design/Methodology/Approach: Created as development…

  19. Can vouchers make a difference to the use of private primary care services by older people? Experience from the healthcare reform programme in Hong Kong

    PubMed Central

    2011-01-01

    Background As part of its ongoing healthcare reform, the Hong Kong Government introduced a voucher scheme, intended for encouraging older patients to use primary healthcare services in the private sector, thereby, reducing burden on the overwhelmed public sector. The voucher program is also considered one of the strategies to further develop the public private partnership in healthcare, a policy direction of high political priority as indicated in the Chief Executive Policy Address in 2008-09. This study assessed whether the voucher scheme, as implemented so far, has reached its intended goals, and how it might be further improved in the context of public-private partnership. Methods This was a cross-sectional study using structured questionnaires by face-to-face interviews with older people aged 70 or above in Hong Kong, the target group of the demand-side voucher program. Results 71.2% of 1,026 older people were aware of the new voucher scheme but only 35.0% had ever used it. The majority of the older people used the vouchers for acute curative services in the private sector (82.4%) and spent less on preventive services. Despite the provision of vouchers valued US$30 per year as an incentive to encourage the use of private primary care services, after 12-months of implementation, 66.2% of all respondents agreed with the statement that "the voucher scheme does not change their health seeking behaviours on seeing public or private healthcare professionals". The most common reasons for no change in their behaviours included "I am used to seeing doctors in the public system" and "The amount of the subsidy is too low". Those who usually used a mix of public and private doctors and those with better self-reported health condition compared to last year were more likely to perceive a change in their own health seeking behaviours. Conclusions Our study showed that despite a reasonably high awareness of the voucher scheme, its usage was low. The voucher alone was not

  20. Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: protocol for a mixed methods case study

    PubMed Central

    Fuller, Jeffrey; Oster, Candice; Dawson, Suzanne; O'Kane, Deb; Lawn, Sharon; Henderson, Julie; Gerace, Adam; Reed, Richard; Nosworthy, Ann; Galley, Philip; McPhail, Ruth; Cochrane, Eimear Muir

    2014-01-01

    Introduction An integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated servicing should occur, although interorganisational relations theory suggests a reflective network approach using evaluation feedback. This research will test a network management approach to help regional primary healthcare organisations improve mental health service integration. Methods and analysis This mixed methods case study in rural South Australia will test facilitated reflection within a network of health and social care services to determine if this leads to improved integration. Engagement of services will occur through a governance group and a series of three 1-day service stakeholder workshops. Facilitated reflection and evaluation feedback will use information from a review of health sector and local operational policies, a network survey about current service links, gaps and enablers and interviews with older people and their carers about their help seeking journeys. Quantitative and qualitative analysis will describe the policy enablers and explore the current and ideal links between services. The facilitated reflection will be developed to maximise engagement of senior management in the governance group and the service staff at the operational level in the workshops. Benefit will be assessed through indicators of improved service coordination, collective ownership of service problems, strengthened partnerships, agreed local protocols and the use of feedback for accountability. Ethics, benefits and dissemination Ethics approval will deal with the sensitivities of organisational network research where data anonymity is not preserved. The benefit will be the tested utility of a facilitated reflective process for a network of health and social care services to manage linked primary mental healthcare for older people in a rural region. Dissemination will

  1. Social franchising primary healthcare clinics--a model for South African National Health Insurance?

    PubMed

    Robinson, Andrew Ken Lacey

    2015-07-01

    This article describes the first government social franchise initiative in the world to deliver a 'brand' of quality primary healthcare (PHC) clinic services. Quality and standards of care are not uniformly and reliably delivered across government PHC clinics in North West Province, South Africa, despite government support, numerous policies, guidelines and in-service training sessions provided to staff. Currently the strongest predictor of good-quality service is the skill and dedication of the facility manager. A project utilising the social franchising business model, harvesting best practices, has been implemented with the aim of developing a system to ensure reliably excellent healthcare service provision in every facility in North West. The services of social franchising consultants have been procured to develop the business model to drive this initiative. Best practices have been benchmarked, and policies, guidelines and clinic support systems have been reviewed, evaluated and assessed, and incorporated into the business plan. A pilot clinic has been selected to refine and develop a working social franchise model. This will then be replicated in one clinic to confirm proof of concept before further scale-up. The social franchise business model can provide solutions to a reliable and recognisable 'brand' of quality universal coverage of healthcare services. PMID:26428744

  2. Solid waste management in primary healthcare centers: application of a facilitation tool 1

    PubMed Central

    Moreira, Ana Maria Maniero; Günther, Wanda Maria Risso

    2016-01-01

    Abstract Objectives: to propose a tool to facilitate diagnosis, formulation and evaluation of the Waste Management Plan in Primary Healthcare Centers and to present the results of the application in four selected units. Method: descriptive research, covering the stages of formulation /application of the proposed instrument and the evaluation of waste management performance at the units. Results: the tool consists in five forms; specific indicators of waste generation for outpatients healthcare units were proposed, and performance indicators that give scores for compliance with current legislation. In the studied units it is generated common waste (52-60%), infectious-sharps (31-42%) and recyclable (5-17%). The average rates of generation are: 0,09kg of total waste/outpatient assistance and 0,09kg of infectious-sharps waste/outpatient procedure. The compliance with regulations, initially 26-30%, then reached 30-38% a year later. Conclusion: the tool showed to be easy to use, bypassing the existence of a complex range of existing regulatory requirements, allowed to identify non-conformities, pointed out corrective measures and evaluated the performance of waste management. In this sense, it contributes to decision making and management practices relating to waste, tasks usually assigned to nurses. It is recommended that the tool be applied in similar healthcare units for comparative studies, and implementation of necessary adaptations for other medical services. PMID:27556874

  3. Quality of Care for Patients with Chronic Respiratory Diseases: Data for Accreditation Plan in Primary Healthcare.

    PubMed

    Kurpas, Donata; Szwamel, Katarzyna; Mroczek, Bożena

    2016-01-01

    There are scarce reports in the literature on factors affecting the assessment of the quality of care for patients with chronic respiratory diseases. Such information is relevant in the accreditation process on implementing the healthcare. The study group consisted of 133 adult patients with chronic respiratory diseases and 125 adult patients with chronic non-respiratory diseases. In the present study, the level of satisfaction from healthcare provided by the primary healthcare unit, disease acceptance, quality of life, health behaviors, and met needs were examined, as well as associations between variables with the use of correspondence analysis. The results are that in patients with chronic respiratory diseases an increase in satisfaction depends on the improvement of well-being in the mental sphere. The lack of problems with obtaining a referral to a specialist and a higher level of fulfilled needs also have a positive effect. Additionally, low levels of satisfaction should be expected in those patients with chronic respiratory diseases who wait for an appointment in front of the office for a long time, report problems with obtaining a referral to additional tests, present a low level of health behaviors, and have a low index of benefits. PMID:26820726

  4. Community health workers as a cornerstone for integrating HIV and primary healthcare.

    PubMed

    Mukherjee, J S; Eustache, Fr E

    2007-01-01

    Haiti is the poorest and most heavily HIV-burdened country in the Western hemisphere, with even less health infrastructure than many countries of sub-Saharan Africa. Since the early 1980s the HIV epidemic has affected the poorest communities in Haiti, who lack access to even basic healthcare. Large-scale HIV treatment requires that basic healthcare services be built and scaled up simultaneously with HIV-prevention and -care programmes. Such improvement in access to general healthcare will require substantial investments in health infrastructure, service delivery and human development. This study describes the contribution of the non-governmental organization, Zanmi Lasante (ZL) to the HIV prevention and treatment scale-up and to the ongoing efforts to improve primary healthcare (PHC) services in the public health system in Haiti. The model depends on community health workers (CHWs) who supervise antiretroviral therapy (ART) and provide community outreach, including active case finding and outreach to marginalized populations. Zanmi Lasante has recruited, trained and financed a large cadre of CHWs to provide such linkages between communities and health centres in rural Haiti. The study analysed key components of their work--their self-perception, their role in enhancing community uptake of services and their role in targeting vulnerable groups. We found that most patients at risk were properly identified at a community level. The CHWs are facilitating the uptake of PHC services, including by the most vulnerable households. The general training of CHWs has created a positive self-definition in these cadres of their medical, patient support and health service roles; although with some variability across different groups. The results of this study will be used to emphasize, standardized and strengthen the biosocial training of CHWs. PMID:17364390

  5. Factors Affecting Access to Healthcare: An Observational Study of Children under 5 Years of Age Presenting to a Rural Gambian Primary Healthcare Centre

    PubMed Central

    Hawkesworth, Sophie; Moore, Sophie E.; Dondeh, Bai L.; Unger, Stefan A.

    2016-01-01

    Main Objective Prompt access to primary healthcare before onset of severe illness is vital to improve morbidity and mortality rates. The Gambia has high rates of child mortality and research is needed to investigate contributing factors further. This study aimed to identify factors affecting access to primary healthcare for children <5 years (y) in rural Gambia focusing on delayed presentation and severe illness at presentation as indicators in a setting where primary healthcare is delivered free of charge. Methods Data were extracted from an electronic medical records system at a rural primary healthcare clinic in The Gambia for children (0–5y) between 2009 and 2012. First clinic attendances with malaria, lower respiratory tract infections (LRTI) and diarrhoeal disease, the main contributors to mortality in this setting, were identified and categorized as delayed/non-delayed and severe/non-severe representing our two main outcome measures. Potential explanatory variables, identified through a comprehensive literature review were obtained from an ongoing demographic surveillance system for this population. Variables associated with either delayed/non-delayed and/or with severe/non-severe presentations identified by univariate analysis (p<0.1) were assessed in multivariate models using logistic regression (p<0.05). Results Out of 6554 clinic attendances, 571 relevant attendances were identified. Delayed presentation was common (45% of all presentations) and there was a significantly reduced risk associated with being from villages with free regular access to transport (OR 0.502, 95%CI[0.310, 0.814], p = 0.005). Children from villages with free regular transport were also less likely to present with severe illness (OR 0.557, 95%CI[0.325, 0.954], p = 0.033). Conclusions Transport availability rather than distance to health clinic is an important barrier to accessing healthcare for children in The Gambia, and public health interventions should aim to reduce this

  6. Creating community-based access to primary healthcare for the uninsured through strategic alliances and restructuring local health department programs.

    PubMed

    Scotten, E Shirin L; Absher, Ann C

    2006-01-01

    In 2003, the Wilkes County Health Department joined with county healthcare providers to develop the HealthCare Connection, a coordinated and continuous system of low-cost quality care for uninsured and low-income working poor. Through this program, local providers of primary and specialty care donate specialty care or ancillary services not provided by the Health Department, which provides case management for the program. Basing their methods on business models learned through the UNC Management Academy for Public Health, planners investigated the best practices for extending healthcare coverage to the underinsured and uninsured, analyzed operational costs, discovered underutilized local resources, and built capacity within the organization. The HealthCare Connection is an example of how a rural community can join together in a common business practice to improve healthcare access for uninsured and/or low-income adults. PMID:16912606

  7. Successful partnerships with third sector organisations to enhance the healthcare student experience: a partnership evaluation.

    PubMed

    Bell, Katie; Tanner, Judith; Rutty, Jane; Astley-Pepper, Maxine; Hall, Richard

    2015-03-01

    There is limited research surrounding academic partnerships and more research is needed to educate universities, and the private, public and third sectors about the benefits and limitations of such partnerships. The aim of this study was to outline the unique partnership between Macmillan Cancer Support and De Montfort University and to evaluate the progress of this partnership. A qualitative approach was employed which involved interviews with nine members of the partnership's steering group. Interviews were transcribed and analysed using thematic analysis. The results showed that a partnership between a university and a third sector charity can have mutual benefits for all those involved, particularly for students and those affected by cancer. Furthermore, the module to develop volunteering among families affected cancer, created through this partnership is now being considered by other universities as a way of providing holistic and non-traditional lecture based learning experiences. Recommendations are made for future partnerships between third sector charities and universities. PMID:25575475

  8. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care.

    PubMed

    Gvozdanović, Darko; Koncar, Miroslav; Kojundzić, Vinko; Jezidzić, Hrvoje

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution. PMID:18005567

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

    PubMed Central

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

    2016-01-01

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

  10. Cases of mobbing activities as commonly seen in the healthcare sector in the world and in Turkey.

    PubMed

    Ofluoğlu, Gökhan; Somunoğlu, Sinem

    2012-01-01

    Service process on a site in the health sector does not only bring people and services into contact, but also all other people who share the fate of particular working medium. Although these people should cooperate and care about each other, contributing new merits to humanity with their synergy, meeting of people with the other people from time to time intertwine into a bitter, pain giving relation, like the way it happens with meeting of people with services. Owing to its controversy to humanitarian nature, religious and social values, the pain that human beings cause to one another is occasionally disguised behind a veil, thus turning into a life tragedy for individuals in the background. Mobbing which is commonly a confrontable problem in every workplace means psychological violence, enclosure, harassment, molestation or endurance. This study aims to draw attention to the precautions required to be taken against mobbing activities by analyzing situations of health employees who undergo mobbing actions in Turkey and in the World. To achieve this, the existing studies concerning mobbing in the healthcare sector have been examined. In conclusion; it is determined that mobbing activities towards healthcare workers have limited their communication possibilities, damaged social relations and social image, prevented vocational improvement and destroyed mental health of employees. With respect to mobbing behavior towards health employees, we should adopt a democratic, contributing, and guiding administration style, we should apply organizational justice, excessive work inspections must be reduced, work ethics and social responsibility awareness must be developed, we should clearly determine the duties and responsibilities, physical conditions must be improved and necessary legal arrangements concerning the subject must be made to be able to prevent mobbing. PMID:23216263

  11. Development of a computerised decisions support system for renal risk drugs targeting primary healthcare

    PubMed Central

    Helldén, Anders; Al-Aieshy, Fadiea; Bastholm-Rahmner, Pia; Bergman, Ulf; Gustafsson, Lars L; Höök, Hans; Sjöviker, Susanne; Söderström, Anders; Odar-Cederlöf, Ingegerd

    2015-01-01

    Objectives To assess general practitioners (GPs) experience from the implementation and use of a renal computerised decision support system (CDSS) for drug dosing, developed for primary healthcare, integrated into the patient’s electronic health record (EHR), and building on estimation of the patient's creatinine clearance (ClCG). Design Qualitative research design by a questionnaire and a focus group discussion. Setting and participants Eight GPs at two primary healthcare centres (PHCs). Interventions The GP at PHC 1, and the project group, developed and tested the technical solution of the CDSS. Proof-of-concept was tested by seven GPs at PHC 2. They also participated in a group discussion and answered a questionnaire. A web window in the EHR gave drug and dosage in relation to ClCG. Each advice was according to three principles: If? Why? Because. Outcome measures (1) The GPs’ experience of ‘easiness to use’ and ‘perceived usefulness’ at PHC 2, based on loggings of use, answers from a questionnaire using a 5-point Likert scale, and answers from a focus group discussion. (2) The number of patients aged 65 years and older with an estimation of ClCG before and after the implementation of the CDSS. Results The GPs found the CDSS fast, simple and easy to use. They appreciated the automatic presentation of the CICG status on opening the medication list, and the ability to actively look up specific drug recommendations in two steps. The CDSS scored high on the Likert scale. All GPs wanted to continue the use of the CDSS and to recommend it to others. The number of patients with an estimated ClCG increased 1.6-fold. Conclusions Acceptance of the simple graphical interface of this push and pull renal CDSS was high among the primary care physicians evaluating this proof of concept. The graphical model should be useful for further development of renal decision support systems. PMID:26150141

  12. How to monitor patient safety in primary care? Healthcare professionals' views

    PubMed Central

    Samra, R; Car, J; Majeed, A; Vincent, C

    2016-01-01

    Summary Objective To identify patient safety monitoring strategies in primary care. Design Open-ended questionnaire survey. Participants A total of 113 healthcare professionals returned the survey from a group of 500 who were invited to participate achieving a response rate of 22.6%. Setting North-West London, United Kingdom. Method A paper-based and equivalent online survey was developed and subjected to multiple stages of piloting. Respondents were asked to suggest strategies for monitoring patient safety in primary care. These monitoring suggestions were then subjected to a content frequency analysis which was conducted by two researchers. Main Outcome measures Respondent-derived monitoring strategies. Results In total, respondents offered 188 suggestions for monitoring patient safety in primary care. The content analysis revealed that these could be condensed into 24 different future monitoring strategies with varying levels of support. Most commonly, respondents supported the suggestion that patient safety can only be monitored effectively in primary care with greater levels of staffing or with additional resources. Conclusion Approximately one-third of all responses were recommendations for strategies which addressed monitoring of the individual in the clinical practice environment (e.g. GP, practice nurse) to improve safety. There was a clear need for more staff and resource set aside to allow and encourage safety monitoring. Respondents recommended the dissemination of specific information for monitoring patient safety such as distributing the lessons of significant event audits amongst GP practices to enable shared learning. PMID:27540488

  13. The Australian primary healthcare experiment: a national survey of Medicare Locals

    PubMed Central

    Robinson, Suzanne; Varhol, Richard; Ramamurthy, Vijaya; Denehy, Melissa; Hendrie, Delia; O'Leary, Peter; Selvey, Linda

    2015-01-01

    Objective The objectives of this study are to evaluate the development and implementation of Medicare Locals as new primary care organisations and consider the implications of these findings for the wider challenge of strengthening primary healthcare in Australia and internationally. Design National survey of Medicare Locals which involved the use of content analysis and a descriptive survey tool. Setting 61 Medicare Locals in Australia. Participants The survey was distributed electronically to all 61 Medicare Local Chief Executive Officers (CEOs) between October and December 2013. Main outcome measures The research was interested in exploring the following areas; the form and function of Medicare Locals; the confidence and capacity of Medicare Locals to perform against their objectives around population planning and system integration; their ability to engage relevant stakeholder groups; and the barriers and facilitators to reform. Results A total of 43 (70%) of Medicare Locals completed the survey with representation from six of the eight Australian states and Territories. Results suggest differences in the form and function of the Medicare Local organisations and considerable diversity in the implementation of Medicare Local organisations across Australia. This diversity and lack of guidance from government impacted on the overall success of the reform. Other barriers to reform included difficulties in stakeholder relationships and limited incentives (financial and other) to drive and influence change. Conclusions Findings from this study produce important insights for primary care reform in Australia; and internationally it adds to the growing body of knowledge around primary care reform. PMID:25818276

  14. Review of behavioral health integration in primary care at Baylor Scott and White Healthcare, Central Region

    PubMed Central

    Fluet, Norman R.; Reis, Michael D.; Stern, Charles H.; Thompson, Alexander W.; Jolly, Gillian A.

    2016-01-01

    The integration of behavioral health services in primary care has been referred to in many ways, but ultimately refers to common structures and processes. Behavioral health is integrated into primary care because it increases the effectiveness and efficiency of providing care and reduces costs in the care of primary care patients. Reimbursement is one factor, if not the main factor, that determines the level of integration that can be achieved. The federal health reform agenda supports changes that will eventually permit behavioral health to be fully integrated and will allow the health of the population to be the primary target of intervention. In an effort to develop more integrated services at Baylor Scott and White Healthcare, models of integration are reviewed and the advantages and disadvantages of each model are discussed. Recommendations to increase integration include adopting a disease management model with care management, planned guideline-based stepped care, follow-up, and treatment monitoring. Population-based interventions can be completed at the pace of the development of alternative reimbursement methods. The program should be based upon patient-centered medical home standards, and research is needed throughout the program development process. PMID:27034543

  15. Validation of the Recording of Acute Exacerbations of COPD in UK Primary Care Electronic Healthcare Records

    PubMed Central

    Rothnie, Kieran J.; Müllerová, Hana; Hurst, John R.; Smeeth, Liam; Davis, Kourtney; Thomas, Sara L.; Quint, Jennifer K.

    2016-01-01

    Background Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR. Methods We randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients’ AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated. Results The response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5–14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60–75%). A combined strategy of antibiotic and OCS prescriptions for 5–14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7–88.3%) and a sensitivity of 62.9% (55.4–70.4%). Conclusion Using a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events. PMID:26959820

  16. [Disaster nursing and primary school teachers' disaster-related healthcare knowledge and skills].

    PubMed

    Lai, Fu-Chih; Lei, Hsin-Min; Fang, Chao-Ming; Chen, Jiun-Jung; Chen, Bor-An

    2012-06-01

    The World Bank has ranked Taiwan as the 5th highest risk country in the world in terms of full-spectrum disaster risk. With volatile social, economic, and geologic environments and the real threat of typhoons, earthquakes, and nuclear disasters, the government has made a public appeal to raise awareness and reduce the impact of disasters. Disasters not only devastate property and the ecology, but also cause striking and long-lasting impacts on life and health. Thus, healthcare preparation and capabilities are critical to reducing their impact. Relevant disaster studies indicate children as a particularly vulnerable group during a disaster due to elevated risks of physical injury, infectious disease, malnutrition, and post-traumatic stress disorder. Primary school teachers are frontline educators, responders, and rehabilitators, respectively, prior to, during, and after disasters. The disaster prevention project implemented by the Taiwan Ministry of Education provides national guidelines for disaster prevention and education. However, within these guidelines, the focus of elementary school disaster prevention education is on disaster prevention and mitigation. Little guidance or focus has been given to disaster nursing response protocols necessary to handle issues such as post-disaster infectious diseases, chronic disease management, and psychological health and rehabilitation. Disaster nursing can strengthen the disaster healthcare response capabilities of school teachers, school nurses, and children as well as facilitate effective cooperation among communities, disaster relief institutes, and schools. Disaster nursing can also provide healthcare knowledge essential to increase disaster awareness, preparation, response, and rehabilitation. Implementing proper disaster nursing response protocols in Taiwan's education system is critical to enhancing disaster preparedness in Taiwan. PMID:22661028

  17. [Subjectivity and a clinical approach in primary healthcare: narratives, life histories and social reality].

    PubMed

    Barros, Rebeca Silva de; Botazzo, Carlos

    2011-11-01

    The focus of this article is on oral healthcare in Primary Healthcare. We discuss the issue taking the relationship of listening-host-link as a focus debating on the existence of a dichotomy between clinical-collective health. This investigation, took place in Cotia, São Paulo State between July and December 2007, based on the following assumptions: 1) answer the user's relevant oral care problem; 2) remove the dental focus; 3) establish the case through anamnesis; and 4) use electronic scheduling, medical files and sterilization of the health unit. Listening to the complaint, the oral clinical examination and compilation of the clinic history were recorded in the medical file, without using dental records. To discuss the approaches in the clinical area, we list 8 `Patographic Histories.' The objectives of communication during consultation are to listen, perform an accurate diagnosis and interfere to alleviate suffering by restoring the corporal homeostasis and creating a bond by modifying technical references and clinical language. The bond is the result of dialogue, the acceptance of responsibilities of both the professional and the user and the resolution of their complaints and needs. PMID:22124814

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

    PubMed

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

    2014-11-01

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

  19. Influence of a quality improvement learning collaborative program on team functioning in primary healthcare.

    PubMed

    Kotecha, Jyoti; Brown, Judith Belle; Han, Han; Harris, Stewart B; Green, Michael; Russell, Grant; Roberts, Sharon; Webster-Bogaert, Susan; Fournie, Meghan; Thind, Amardeep; Reichert, Sonja M; Birtwhistle, Richard

    2015-09-01

    Quality improvement (QI) programs are frequently implemented to support primary healthcare (PHC) team development and to improve care outcomes. In Ontario, Canada, the Quality Improvement and Innovation Partnership (QIIP) offered a learning collaborative (LC) program to support the development of interdisciplinary team function and improve chronic disease management, disease prevention, and access to care. A qualitative study using a phenomenological approach was conducted as part of a mixed-method evaluation to explore the influence of the program on team functioning in participating PHC teams. A purposive sampling strategy was used to identify PHC teams (n = 10), from which participants of different professional roles were selected through a purposeful recruitment process to reflect maximum variation of team roles. Additionally, QI coaches working with the interview participants and the LC administrators were also interviewed. Data were collected through semistructured telephone interviews that were audiotaped and transcribed verbatim. Thematic analysis was conducted through an iterative and interpretive approach. The shared experience of participating in the program appeared to improve team functioning. Participants described increased trust and respect for each other's clinical and administrative roles and were inspired by learning about different approaches to interdisciplinary care. This appeared to enhance collegial relationships, collapse professional silos, improve communication, and increase interdisciplinary collaboration. Teamwork involves more than just physically grouping healthcare providers from multiple disciplines and mandating them to work together. The LC program provided opportunities for participants to learn how to work collaboratively, and participation in the LC program appeared to enhance team functioning. PMID:25799255

  20. Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil

    SciTech Connect

    Moreira, A.M.M.; Guenther, W.M.R.

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized

  1. Feasibility and Acceptability of the Informant AD8 for Cognitive Screening in Primary Healthcare: A Pilot Study

    PubMed Central

    Dong, YanHong; Tsou, Keith Yu Kei; Chen, Christopher Li-Hsian

    2014-01-01

    Objectives. The utility of informant AD8 for case finding of cognitive impairment at primary healthcare settings is unknown and therefore its feasibility and acceptability for targeted screening at a primary healthcare clinic should be investigated. Methods. The informants of older adult patients attending a primary healthcare clinic in Singapore were administered the AD8. Positive screening findings were provided to patients' primary care physicians for referrals to specialist memory clinics. The acceptability of AD8 was evaluated by collecting feedbacks from the informants and primary care physicians. Results. 205 patients and their informants were recruited. However, 6 (2.9%) informants were uncontactable, while the majority of the remaining 199 patients with completed AD8 (96.5%, n = 192) found it acceptable where 59 (29.6%) patients were deemed cognitively impaired (AD8 ≥ 2). Clinicians (100%, n = 5) found the AD8 helpful in facilitating referrals to memory clinics. However, most referral recommendations (81.4%, n = 48) were declined by patients and/or informant due to limited insight of implications of cognitive impairment. Conclusions. The AD8 can be easily administered and is well tolerated. It detected cognitive impairment in one-third of older adult patients and therefore may be useful for case finding of cognitive impairment in the primary healthcare. PMID:25548780

  2. [Meanings of family violence against the elderly from the standpoint of professionals in Primary Healthcare].

    PubMed

    Wanderbroocke, Ana Claudia Nunes de Souza; Moré, Carmen Leontina Ojeda Ocampo

    2012-08-01

    This qualitative study sought to analyze the meanings attributed to domestic violence against the elderly by professionals in Primary Healthcare. A total of 10 health professionals from different backgrounds from a renowned health unit for care of the elderly took part, and the data was collected through semi-structured interviews. Taking the Grounded Theory as a benchmark, the data were integrated and organized into categories, subcategories and elements of analysis. The results revealed the participants' expectation that the family acts as support and protection for the elderly and that domestic violence violates this principle. The significance of abuse of the elder was found to be grounded in the idea "of the frail and dependent elderly person," limiting the viewing of cases that do not fit this profile. PMID:22899150

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

    PubMed

    Báscolo, Ernesto

    2010-01-01

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

  4. Assessment of Breast Cancer Risk and Belief in Breast Cancer Screening Among the Primary Healthcare Nurses.

    PubMed

    İz, Fatma Başalan; Tümer, Adile

    2016-09-01

    Breast cancer is the most frequently diagnosed cancer in women. Early detection of breast cancer is known to increase survival rates significantly after diagnosis. This research was carried out to determine the level of breast cancer risk among primary healthcare nurses and their belief in breast cancer screening. In this descriptive research, the data were collected in face-to-face interviews with the participants. The researchers contacted all primary healthcare nurses currently working in the province. The data collection tools included a questionnaire form on sociodemographic characteristics, breast cancer risk assessment form, and Champion's Health Belief Model Scale (CHBMS) for breast cancer screening. In data analysis, descriptive statistics, t test, and analysis of variance (ANOVA) were used. The mean age of nurses was 35 ± 3.6. The mean score for the breast cancer risk assessment form was calculated as 82.9 ± 18.7. The subscale scores for the CHBMS for breast cancer screening were as follows: susceptibility 7.3 ± 1.8, seriousness 19.5 ± 4.1, benefits of breast self-exam 15.5 ± 2.6, barriers to breast self-exam 15.1 ± 2.8, self-efficacy 40.3 ± 7.0, and motivation 19.5 ± 4.1. The risk of breast cancer was found to be low in the study group. The analysis of the subscale scores for the CHBMS for breast cancer screening revealed that nurses had a below-average susceptibility perception, a somewhat lower perception of seriousness, an above-average mean score for perceived benefits, a moderate barrier perception, a relatively high perceived self-efficacy, and motivation above average. PMID:26758047

  5. Integrating HIV care and treatment into primary healthcare: Are clinics equipped?

    PubMed Central

    Stellenberg, Ethelwynn L.

    2014-01-01

    Abstract Background The demand for HIV care and treatment services is increasing rapidly and strategies to sustain long-term care should be employed. The decentralisation and integration of HIV care and treatment services into primary healthcare (PHC) is vitally important in order to ensure optimal access to life-saving antiretroviral therapy and ongoing chronic care. Conversely, the PHC system is fraught with the current burden of disease. Setting The study was conducted in PHC clinics in the uMgungundlovu district, Kwa-Zulu Natal. Aim The objectives of the study were to assess whether PHC clinics were equipped to deliver integrated HIV services and to evaluate the availability of resources as well as support systems for HIV care and treatment in PHC clinics. Methods A quantitative, cross-sectional descriptive study was undertaken in 20 randomly-selected, eligible clinics in the uMgungundlovu district, KwaZulu-Natal, South Africa. An evaluation instrument was completed through observations and review of the clinic data records. Criteria were based on the World Health Organization's guide to indicators for antiretroviral programmes as well as South African HIV standards for PHC facilities. Results None of the clinics were equipped adequately. Clinics with a higher patient load had poorer scores, whilst clinics providing antiretroviral therapy were better equipped in terms of human resources and infrastructure. Conclusion HIV services are an essential part of primary healthcare and clinics need to be equipped adequately in order to render this service. It is unlikely that the over-burdened health system would be able to cope with an increased number of patients on antiretroviral therapy in the long term, whilst maintaining quality of services, without support being given to PHC clinics. PMID:26245407

  6. Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam

    PubMed Central

    Van Minh, Hoang; Tuan Anh, Tran; Rocklöv, Joacim; Bao Giang, Kim; Trang, Le Quynh; Sahlen, Klas-Göran; Nilsson, Maria; Weinehall, Lars

    2014-01-01

    Background As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. Objective This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. Design This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken. Results 1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely

  7. Staff perceptions of primary healthcare service change: influences on staff satisfaction.

    PubMed

    Tham, Rachel; Buykx, Penny; Kinsman, Leigh; Ward, Bernadette; Humphreys, John S; Asaid, Adel; Tuohey, Kathy; Jenner, Rohan

    2014-11-01

    Strong primary healthcare (PHC) services are efficient, cost-effective and associated with better population health outcomes. However, little is known about the role and perspectives of PHC staff in creating a sustainable service. Staff from a single-point-of-entry primary health care service in Elmore, a small rural community in north-west Victoria, were surveyed. Qualitative methods were used to collect data to show how the key factors associated with the evolution of a once-struggling medical service into a successful and sustainable PHC service have influenced staff satisfaction. The success of the service was linked to visionary leadership, teamwork and community involvement while service sustainability was described in terms of inter-professional linkages and the role of the service in contributing to the broader community. These factors were reported to have a positive impact on staff satisfaction. The contribution of service delivery change and ongoing service sustainability to staff satisfaction in this rural setting has implications for planning service change in other primary health care settings. PMID:25283371

  8. Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana

    PubMed Central

    Boachie, Micheal Kofi

    2016-01-01

    Background: In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP. Methods: Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome. Results: Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level. Conclusion: Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels

  9. Screening for Atrial Fibrillation – A Cross-Sectional Survey of Healthcare Professionals in Primary Care

    PubMed Central

    Taggar, Jaspal S.; Coleman, Tim; Lewis, Sarah; Jones, Matthew

    2016-01-01

    Introduction Screening for atrial fibrillation (AF) in primary care has been recommended; however, the views of healthcare professionals (HCPs) are not known. This study aimed to determine the opinions of HCP about the feasibility of implementing screening within a primary care setting. Methods A cross-sectional mixed methods census survey of 418 HCPs from 59 inner-city practices (Nottingham, UK) was conducted between October-December 2014. Postal and web-surveys ascertained data on existing methods, knowledge, skills, attitudes, barriers and facilitators to AF screening using Likert scale and open-ended questions. Responses, categorized according to HCP group, were summarized using proportions, adjusting for clustering by practice, with 95% C.Is and free-text responses using thematic analysis. Results At least one General Practitioner (GP) responded from 48 (81%) practices. There were 212/418 (51%) respondents; 118/229 GPs, 67/129 nurses [50 practice nurses; 17 Nurse Practitioners (NPs)], 27/60 healthcare assistants (HCAs). 39/48 (81%) practices had an ECG machine and diagnosed AF in-house. Non-GP HCPs reported having less knowledge about ECG interpretation, diagnosing and treating AF than GPs. A greater proportion of non-GP HCPs reported they would benefit from ECG training specifically for AF diagnosis than GPs [proportion (95% CI) GPs: 11.9% (6.8–20.0); HCAs: 37.0% (21.7–55.5); nurses: 44.0% (30.0–59.0); NPs 41.2% (21.9–63.7)]. Barriers included time, workload and capacity to undertake screening activities, although training to diagnose and manage AF was a required facilitator. Conclusion Inner-city general practices were found to have adequate access to resources for AF screening. There is enthusiasm by non-GP HCPs to up-skill in the diagnosis and management of AF and they may have a role in future AF screening. However, organisational barriers, such as lack of time, staff and capacity, should be overcome for AF screening to be feasibly implemented

  10. The environment of professional practice and Burnout in nurses in primary healthcare

    PubMed Central

    Lorenz, Vera Regina; Guirardello, Edinêis de Brito

    2014-01-01

    OBJECTIVES: to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare. METHOD: cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used. RESULTS: the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job. CONCLUSION: the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas. PMID:25517928

  11. Patient-reported confidence in primary healthcare: are there disparities by ethnicity or language?

    PubMed Central

    Wong, Sabrina T; Black, Charlyn; Cutler, Fred; Brooke, Rebecca; Haggerty, Jeannie L; Levesque, Jean-Frederic

    2014-01-01

    Objective To examine whether confidence in primary healthcare (PHC) differs among ethnic–linguistic groups and which PHC experiences are associated with confidence. Design A cross-sectional study where patient surveys were administered using random digit dialling. Regression models identify whether ethnic–linguistic group remains significantly associated with confidence in PHC. Setting British Columbia, Canada. Main outcome measures Confidence in PHC measured using a 0–10 scale, where a higher score indicates increased confidence in the ability to get needed PHC services. Participants Community-dwelling adults in the following ethnic–linguistic groups: English-speaking Chinese, Chinese-speaking Chinese, English-speaking South Asians, Punjabi-speaking South Asians and English-speakers of presumed European descent. Findings Based on a sample of 1211 respondents, confidence in PHC differed by ethnicity and the ability to speak English. Most of the differences in confidence by ethnic–linguistic group can be explained by various aspects of care experience. Patient experiences associated with lower confidence in PHC were: if care was received outside Canada, having to wait months to see their regular doctor and rating the quality of healthcare as good or fair/poor. Better patient experiences of their doctor being concerned about their feelings and being respectful and if they found wait times acceptable were associated with higher levels of confidence in PHC. The final regression model explained 30% of the variance. Conclusions Improving the delivery of PHC services through positive interactions between patients and their usual provider and acceptability of wait times are examples of how the PHC system can be strengthened. PMID:24568960

  12. Comparison of primary health-care models in the management of chronic kidney disease

    PubMed Central

    Cueto-Manzano, Alfonso M; Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura

    2013-01-01

    Negative lifestyle habits (potential risks for chronic kidney disease, CKD) are rarely modified by physicians in a conventional health-care model (CHCM). Multidisciplinary strategies may have better results; however, there is no information on their application in the early stages of CKD. Thus, the aim of this study was to compare a multiple intervention model versus CHCM on lifestyle and renal function in patients with type 2 diabetes mellitus and CKD stage 1–2. In a prospective cohort study, a family medicine unit (FMU) was assigned a multiple intervention model (MIM) and another continued with conventional health-care model (CHCM). MIM patients received an educational intervention guided by a multidisciplinary team (family physician (FP), social worker, dietitian, physical trainer); self-help groups functioned with free activities throughout the study. CHCM patients were managed only by the FP, who decided if patients needed referral to other professionals. Thirty-nine patients were studied in each cohort. According to a lifestyle questionnaire, no baseline differences were found between cohorts, but results reflected an unhealthy lifestyle. After 6 months of follow-up, both cohorts showed significant improvement in their dietary habits. Compared to CHCM diet, exercise, emotional management, knowledge of disease, and adherence to treatment showed greater improvement in the MIM. Blood pressure decreased in both cohorts, but body mass index, waist circumference, and HbA1C significantly decreased only in MIM. Glomerular filtration rate (GFR) was maintained equally in both cohorts, but albuminuria significantly decreased only in MIM. In conclusion, MIM achieves better control of lifestyle-related variables and CKD risk factors in type 2 diabetes mellitus (DM2) patients with CKD stage 1–2. Broadly, implementation of a MIM in primary health care may produce superior results that might assist in preventing the progression of CKD. PMID:25018986

  13. Comparison of primary health-care models in the management of chronic kidney disease.

    PubMed

    Cueto-Manzano, Alfonso M; Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura

    2013-05-01

    Negative lifestyle habits (potential risks for chronic kidney disease, CKD) are rarely modified by physicians in a conventional health-care model (CHCM). Multidisciplinary strategies may have better results; however, there is no information on their application in the early stages of CKD. Thus, the aim of this study was to compare a multiple intervention model versus CHCM on lifestyle and renal function in patients with type 2 diabetes mellitus and CKD stage 1-2. In a prospective cohort study, a family medicine unit (FMU) was assigned a multiple intervention model (MIM) and another continued with conventional health-care model (CHCM). MIM patients received an educational intervention guided by a multidisciplinary team (family physician (FP), social worker, dietitian, physical trainer); self-help groups functioned with free activities throughout the study. CHCM patients were managed only by the FP, who decided if patients needed referral to other professionals. Thirty-nine patients were studied in each cohort. According to a lifestyle questionnaire, no baseline differences were found between cohorts, but results reflected an unhealthy lifestyle. After 6 months of follow-up, both cohorts showed significant improvement in their dietary habits. Compared to CHCM diet, exercise, emotional management, knowledge of disease, and adherence to treatment showed greater improvement in the MIM. Blood pressure decreased in both cohorts, but body mass index, waist circumference, and HbA1C significantly decreased only in MIM. Glomerular filtration rate (GFR) was maintained equally in both cohorts, but albuminuria significantly decreased only in MIM. In conclusion, MIM achieves better control of lifestyle-related variables and CKD risk factors in type 2 diabetes mellitus (DM2) patients with CKD stage 1-2. Broadly, implementation of a MIM in primary health care may produce superior results that might assist in preventing the progression of CKD. PMID:25018986

  14. Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study.

    PubMed

    Bascombe, Ta Misha S; Scott, Kimberly N; Ballard, Denise; Smith, Samantha A; Thompson, Winifred; Berg, Carla J

    2016-06-01

    Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This qualitative study explored knowledge, beliefs and clinic-based practices regarding traditional and alternative tobacco products (cigar-like products, smokeless tobacco, hookah, e-cigarettes) and marijuana among rural and urban Georgia primary healthcare providers. The sample comprised 20 healthcare providers in primary care settings located in the Atlanta Metropolitan area and rural southern Georgia who participated in semi-structured interviews. Results indicated a lack of knowledge about these products, with some believing that some products were less harmful than traditional cigarettes or that they may be effective in promoting cessation or harm reduction. Few reported explicitly assessing use of these various products in clinic. In addition, healthcare providers reported a need for empirical evidence to inform their clinical practice. Healthcare providers must systematically assess use of the range of tobacco products and marijuana. Evidence-based recommendations or information sources are needed to inform clinical practice and help providers navigate conversations with patients using or inquiring about these products. PMID:26802106

  15. Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study.

    PubMed

    Alameddine, Mohamad; Khodr, Hiba; Mourad, Yara; Yassoub, Rami; Abi Ramia, Jinane

    2016-05-01

    The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success

  16. Consistency of denominator data in electronic health records in Australian primary healthcare services: enhancing data quality.

    PubMed

    Bailie, Ross; Bailie, Jodie; Chakraborty, Amal; Swift, Kevin

    2015-01-01

    The quality of data derived from primary healthcare electronic systems has been subjected to little critical systematic analysis, especially in relation to the purported benefits and substantial investment in electronic information systems in primary care. Many indicators of quality of care are based on numbers of certain types of patients as denominators. Consistency of denominator data is vital for comparison of indicators over time and between services. This paper examines the consistency of denominator data extracted from electronic health records (EHRs) for monitoring of access and quality of primary health care. Data collection and analysis were conducted as part of a prospective mixed-methods formative evaluation of the Commonwealth Government's Indigenous Chronic Disease Package. Twenty-six general practices and 14 Aboriginal Health Services (AHSs) located in all Australian States and Territories and in urban, regional and remote locations were purposively selected within geographically defined locations. Percentage change in reported number of regular patients in general practices ranged between -50% and 453% (average 37%). The corresponding figure for AHSs was 1% to 217% (average 31%). In approximately half of general practices and AHSs, the change was ≥ 20%. There were similarly large changes in reported numbers of patients with a diagnosis of diabetes or coronary heart disease (CHD), and Indigenous patients. Inconsistencies in reported numbers were due primarily to limited capability of staff in many general practices and AHSs to accurately enter, manage, and extract data from EHRs. The inconsistencies in data required for the calculation of many key indicators of access and quality of care places serious constraints on the meaningful use of data extracted from EHRs. There is a need for greater attention to quality of denominator data in order to realise the potential benefits of EHRs for patient care, service planning, improvement, and policy. We

  17. Multimorbidity and weight loss in obese primary care patients: longitudinal study based on electronic healthcare records

    PubMed Central

    Calderón-Larrañaga, Amaia; Hernández-Olivan, Paola; González-Rubio, Francisca; Gimeno-Feliu, Luis A; Poblador-Plou, Beatriz; Prados-Torres, Alexandra

    2015-01-01

    Objective To analyse the association between cardiovascular and mental comorbidities of obesity and weight loss registered in the electronic primary healthcare records. Design and setting Longitudinal study of a cohort of adult patients assigned to any of the public primary care centres in Aragon, Spain, during 2010 and 2011. Participants Adult obese patients for whom data on their weight were available for 2010 (n=62 901), and for both 2010 and 2011 (n=42 428). Outcomes Weight loss (yes/no) was calculated based on the weight difference between the first value registered in 2010 and the last value registered in 2011. Multivariate logistic regression models were adjusted for individuals’ age, sex, total number of chronic comorbidities, type of obesity and length of time between both weight measurements. Results According to the recorded clinical information, 9 of 10 obese patients showed at least one chronic comorbidity. After adjusting for covariates, weight loss seemed to be more likely among obese patients with a diagnosis of diabetes and/or dementia and less likely among those with hypertension, anxiety and/or substance use problems (p<0.05). The probability of weight loss was also significantly higher in male patients with more severe obesity and older age. Conclusions An increased probability of weight loss over 1 year was observed in older obese male patients, especially among those already manifesting high levels of obesity and severe comorbidities such as diabetes and/or dementia. Yet patients with certain psychological problems showed lower rates of weight reduction. Future research should clarify if these differences persist beyond potential selective weight documentation in primary care, to better understand the trends in weight reduction among obese patients and the underlying role of general practitioners regarding such trends. PMID:25783419

  18. Cultural aspects of primary healthcare in india: A case- based analysis

    PubMed Central

    2011-01-01

    Delivering quality primary care to large populations is always challenging, and that is certainly the case in India. While the sheer magnitude of patients can create difficulties, not all challenges are about logistics. Sometimes patient health-seeking behaviour leads to delays in obtaining medical help for reasons that have more to do with culture, social practice and religious belief. When primary care is accessed via busy state-run outpatient departments there is often little time for the physician to investigate causes behind a patient's condition, and these factors can adversely affect patient outcomes. We consider the case of a woman with somatic symptoms seemingly triggered by psychological stresses associated with social norms and familial cultural expectations. These expectations conflict with her personal and professional aspirations, and although she eventually receives psychiatric help and her problems are addressed, initially, psycho-social factors underlying her condition posed a hurdle in terms of accessing appropriate medical care. While for many people culture, belief and social norms exert a stabilising, positive influence, in situations where someone's personal expectations differ significantly from accepted social norms, individual autonomy can be directly challenged, and in which case, something has to give. The result of such challenges can negatively impact on health and well-being, and for patients with immature defence mechanisms for dealing with inner conflict, such an experience can be damaging and ensuing somatic disturbances are often difficult to treat. Patients with culture-bound symptoms are not uncommon within primary care in India or in other Asian countries and communities. We argue that such cases need to be properly understood if satisfactory patient outcomes are to be achieved. While some causes are structural, having to do with how healthcare is accessed and delivered, others are about cultural values, social practices and

  19. The Influence of Organizational Subculture on Information Technology Project Success in the Healthcare Sector: A Qualitative, Multi-Case Study

    ERIC Educational Resources Information Center

    Mallet, Richard Kofi

    2014-01-01

    Healthcare providers face high demands for technology based healthcare services due to global population increases and adapting information technology (IT) to achieve quality patient care. IT has become center stage in the operations and management of healthcare organizations. IT requirements emerge from the visions, values, and beliefs of…

  20. [Early childhood intervention - access to risk families and support through actors from the health-care sector].

    PubMed

    Clauß, D; Deutsch, J; Krol, I; Haase, R; Willard, P; Müller-Bahlke, T; Mauz-Körholz, C; Körholz, D

    2014-07-01

    Interdisciplinary cooperation and networking determine the success of activities for supporting families at risk for early childhood abuse. The integration of the healthcare sector might be important.The medical standard of perinatal care at the University hospital includes information exchange about family risk factors which may contribute to an increased risk of child abuse within the first year of life. As a result, the -pediatrician offered supporting services for the families at the time of the second examination during the official childhood health screening program (U2). A team of family-sponsorship was established and evaluated.In 281 of 1238 risk-factor questionnaires at least one stress factor was detected and 97 families had high-impact family stress. Families under the supervision of a family midwife or youth services had a significantly higher number of risk factors. The family-sponsorship program was institutionalized and positively evaluated by the families.The time of a hospital delivery is an excellent opportunity for the evaluation of familial risk factors and for the provision of supporting services. To increase the acceptance of such services by the families at risk repeated assessment of risk factors and support offers are required. PMID:25010130

  1. Firm-Level Perspectives on Public Sector Engagement with Private Healthcare Providers: Survey Evidence from Ghana and Kenya

    PubMed Central

    Sood, Neeraj; Burger, Nicholas; Yoong, Joanne; Kopf, Dan; Spreng, Connor

    2011-01-01

    Background Health systems in Sub-Saharan Africa (SSA) are in urgent need of improvement. The private health sector is a major provider of care in the region and it will remain a significant actor in the future. Any efforts by SSA governments to improve health systems performance therefore has to account for the private health sector. Regional and international actors increasingly recognize importance of effectively engaging with the private health sector, and initiatives to improve engagement are underway in several countries. However, there is little systematic analysis of private health providers' view and experience with engagement. Methodology/Principal Findings In this study we surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is “command-and-control” type regulations to improve the quality of care. There is little attention paid to building the capacity of health care businesses through either technical or financial assistance. The vast majority of these facilities also receive no government assistance in meeting public health and social goals. Finally, government engagement with private pharmacies is often neglected and clinics receive a disproportionate share of government assistance. Conclusions/Significance Overall, our findings suggest that there may be considerable untapped potential for greater engagement with private health facilities—particularly pharmacies. Improving engagement will likely help governments with limited resources to better take advantage of the private sector capacity to meet access and equity objectives and to accelerate the achievement of the Millennium Development Goals. PMID:22132092

  2. [Community vegetable gardens as a health promotion activity: an experience in Primary Healthcare Units].

    PubMed

    Costa, Christiane Gasparini Araújo; Garcia, Mariana Tarricone; Ribeiro, Silvana Maria; Salandini, Marcia Fernanda de Sousa; Bógus, Cláudia Maria

    2015-10-01

    Urban and peri-urban agriculture (UPA) is being practiced in different settings, contributing to the improvement of health in communities and healthier environments. In order to identify the meanings and implications of the practice of UPA in Primary Healthcare Units (PHU) as an activity of health promotion (HP), and to what extent its therapeutic dimension characterizes it as an activity aligned with complementary and integrative practices (CIP), a qualitative cross-sectional study was performed in Embu das Artes, State of São Paulo. From the analysis, the following main themes arose: health concept, health outcomes, the return to traditional practices and habits and the reorientation of health services. It was possible to identify the close link between the cultivation of vegetable gardens and HP guidelines and fields of action, such as creating healthier environments, boosting community actions, developing personal skills, stimulating autonomy and empowerment and demands for the reorientation of services. The garden activities, set up in PHU areas, proved to be an implementation strategy of CIP. The conclusion reached is that vegetable gardening activities in community gardens are seen to be health promotion practices that integrate key elements of CIP. PMID:26465852

  3. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    PubMed Central

    Adeniji, Adeloye Amoo

    2016-01-01

    Background In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. Aim This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting Gugulethu Community Health Centre, Cape Town. Methods A purposive sample consisted of five women (one coded green, three orange, one yellow) and four men (one coded green and three yellow). A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. Results All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners) for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. Conclusion Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened. PMID:27380788

  4. Integrated primary care improves access to healthcare for newly arrived refugees in Canada.

    PubMed

    McMurray, Josephine; Breward, Katherine; Breward, Michael; Alder, Rob; Arya, Neil

    2014-08-01

    In this study we quantify the impact of a partnership between a dedicated health clinic for government assisted refugees (GARs), a local reception centre and community providers, on wait times and referrals. This study used a before and after, repeated survey study design to analyze archived administrative data. Using various statistical techniques, outcomes for refugees arriving 18 months prior to the introduction of the clinic were compared with those of refugees arriving in the 18 months after the clinic was established. Our investigation revealed wait times to see a health care provider decreased by 30 % with the introduction of a dedicated refugee health clinic. The likelihood of GARs being referred to physician specialists decreased by 45 %, but those referred were more likely to require multiple referrals due to increasingly complex medical needs. Referrals to non-physician specialist health care providers nearly doubled following the availability of the clinic. The time-limited, but intense health needs of GARs, require an integrated community-based primary healthcare intervention that includes dedicated health system navigators to support timely, more culturally appropriate care and successful integration. PMID:24293090

  5. Patients' adoption of the e-appointment scheduling service: A case study in primary healthcare.

    PubMed

    Zhang, Xiaojun; Yu, Ping; Yan, Jun

    2014-01-01

    The aim of this study is to investigate patients' initial acceptance and ongoing use of a simple but typical type of consumer e-health service - an e-appointment scheduling (EAS) system - in order to identify facilitators and barriers for patients' adoption of e-health services in primary healthcare. In-depth, semi-structured interviews were conducted to gather patients' background information, their awareness of the system, their feedbacks on the characteristics of the system, and their reasons for use or not use the system. A total of 125 patients aged between 17 and 74 were interviewed. Study results show that 89% of the interviewed patients had shown reluctance to adopt this online service. The identified barriers for acceptance include many patients' lack of access to the internet, lack of awareness of the service, low computer skills and incompatibility of the online appointment service with many patients' habits of face-to-face or phone-call based medical appointment making. Health service providers need to consider the general public's acceptance for online services before implementing consumer e-health systems. PMID:25087546

  6. The Continuing Development of Primary Sector Physical Education: Working Together to Raise Quality of Provision

    ERIC Educational Resources Information Center

    Sloan, Stephen

    2010-01-01

    This paper sets out to provide further insight as to the reasons why many schools within the primary sector continue to find it difficult to ensure quality provision for physical education (PE) and school sport. It examines why class teachers, including the subject coordinator, possess concerns about teaching PE. It asks the question of who is…

  7. The role of the healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants in Morocco: a study of knowledge, attitudes and practices of healthcare workers

    PubMed Central

    2013-01-01

    Background Sub-Saharan transmigrants in Morocco are extremely vulnerable to sexual violence. From a public health perspective, the healthcare system is globally considered an important partner in the prevention of sexual violence. The aim of this study is twofold. In a first phase, we aimed to identify the current role and position of the Moroccan healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants. In a second phase, we wanted these results and available guidelines to be the topic of a participatory process with local stakeholders in order to formulate recommendations for a more desirable prevention of sexual violence against sub-Saharan transmigrants by the Moroccan healthcare sector. Methods Knowledge, attitudes and practices of healthcare workers in Morocco concerning sexual violence against sub-Saharan transmigrants and its prevention were firstly explored in semi-structured interviews after which they were discussed in a participatory process resulting in the formulation of recommendations. Results All participants (n=24) acknowledged the need for desirable prevention of sexual violence against transmigrants. Furthermore, important barriers in tertiary prevention practices, i.e. psychosocial and judicial referral and long-term follow-up, and in secondary prevention attitudes, i.e. active identification of victims were identified. Moreover, existing services for Moroccan victims of sexual violence currently do not address the sub-Saharan population. Thus, transmigrants are bound to rely on the aid of civil society. Conclusions This research demonstrates the low accessibility of existing Moroccan services for sub-Saharan migrants. In particular, there is an absence of prevention initiatives addressing sexual violence against the sub-Saharan transmigrant population. Although healthcare workers do wish to develop prevention initiatives, they are dealing with structural difficulties and a lack of expertise. Recommendations

  8. A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector

    PubMed Central

    Grant, Clare; Goodenough, Trudy; Harvey, Ian; Hine, Chris

    2000-01-01

    Objectives To compare outcome and resource utilisation among patients referred to the Amalthea Project, a liaison organisation that facilitates contact between voluntary organisations and patients in primary care, with patients receiving routine general practitioner care. Design Randomised controlled trial with follow up at one and four months. Setting 26 general practices in Avon. Participants 161 patients identified by their general practitioner as having psychosocial problems. Main outcome measures Primary outcomes were psychological wellbeing (assessed with the hospital anxiety and depression scale) and social support (assessed using the Duke-UNC functional social support questionnaire). Secondary outcomes were quality of life measures (the Dartmouth COOP/WONCA functional health assessment charts and the delighted-terrible faces scale), cost of contacts with the primary healthcare team and Amalthea Project, cost of prescribing in primary care, and cost of referrals to other agencies, over four months. Results The Amalthea group showed significantly greater improvements in anxiety (average difference between groups after adjustment for baseline −1.9, 95% confidence interval −3.0 to −0.7), other emotional feelings (average adjusted difference −0.5, −0.8 to −0.2), ability to carry out everyday activities (−0.5, −0.8 to −0.2), feelings about general health (−0.4, −0.7 to −0.1), and quality of life (−0.5, −0.9 to −0.1). No difference was detected in depression or perceived social support. The mean cost was significantly greater in the Amalthea arm than the general practitioner care arm (£153 v £133, P=0.025). Conclusion Referral to the Amalthea Project and subsequent contact with the voluntary sector results in clinically important benefits compared with usual general practitioner care in managing psychosocial problems, but at a higher cost. PMID:10669447

  9. Age-Specific Incidence Rates for Norovirus in the Community and Presenting to Primary Healthcare Facilities in the United Kingdom.

    PubMed

    O'Brien, Sarah J; Donaldson, Anna L; Iturriza-Gomara, Miren; Tam, Clarence C

    2016-02-01

    In a prospective, population-based cohort study and a study of primary-healthcare consultations, we had a rare opportunity to estimate age-specific rates of norovirus-associated infectious intestinal disease in the United Kingdom. Rates in children aged <5 years were significantly higher than those for other age groups in the community (142.6 cases per 1000 person-years [95% confidence interval {CI}, 99.8-203.9] vs 37.6 [95% CI, 31.5-44.7]) and those for individuals presenting to primary healthcare (14.4 cases per 1000 person-years [95% CI, 8.5-24.5] vs 1.4 [95% CI, .9-2.0]). Robust incidence estimates are crucial for vaccination policy makers. This study emphasises the impact of norovirus-associated infectious intestinal disease, especially in children aged <5 years. PMID:26744427

  10. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: Assessment and Management of Infertility at Primary Healthcare Level

    PubMed Central

    Loh, Seong Feei; Agarwal, Rachna; Chan, Jerry; Chia, Sing Joo; Cho, Li Wei; Lim, Lean Huat; Lau, Matthew Sie Kuei; Loh, Sheila Kia Ee; Hendricks, Marianne Sybille; Nair, Suresh; Quah, Joanne Hui Min; Tan, Heng Hao; Wong, PC; Yeong, Cheng Toh; Yu, Su Ling

    2014-01-01

    The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_ medical/2013/cpgmed_infertility.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:24570313

  11. Knowledge of midwives about hypertensive disorders during pregnancy in primary healthcare

    PubMed Central

    Ngwekazi, Nompumelelo L.

    2016-01-01

    Background Many factors or medical conditions may influence the outcome of pregnancy, which in turn, may increase infant and maternal morbidity and mortality. One such condition is an increase in blood pressure (BP). Setting The study was conducted in maternity obstetrical units (MOUs) in primary healthcare clinics (PHCs) in the Eastern Cape, South Africa. Objectives To determine the knowledge about hypertensive disorders during pregnancy (HDPs) of registered midwives working in MOUs in PHCs. Methods A quantitative descriptive correlation research design was applied. A simple random sample of 43 (44%) rural and urban clinics was selected, and all registered midwives (n = 101) working in these clinics completed a self-administered questionnaire. Data were collected over a period of 1 month. The reliability and validity of the methodology were supported by experts and a pilot study. Descriptive statistics including various statistical tests to determine any associations between variables using a 95% confidence interval were applied. Results A gap in the knowledge of midwives about HDPs was identified. Only 56.4% of the participants correctly answered the questions on the clinical manifestations of severe pre-eclampsia and 68.3% on the factors affecting BP, whereas 27.7% had no understanding about pre-eclampsia. Significant statistical differences were identified in the knowledge of staff in clinics where doctors visit regularly versus those in clinics where there are no visits (p = 0.04), and between experience of midwives and management of HDPs (p = 0.02). Conclusion The knowledge of midwives is deficient regarding HDPs. Continuous professional development is critical in midwifery both in theory and in clinical practice. PMID:27247155

  12. Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

    PubMed Central

    Shah, Sayed Masoom; Zaidi, Shehla; Ahmed, Jamil; Rehman, Shafiq Ur

    2016-01-01

    Background: Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan’s health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. Methods: An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Results: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Conclusion

  13. Pharmaceutical cost control in primary care: opinion and contributions by healthcare professionals

    PubMed Central

    2009-01-01

    Background Strategies adopted by health administrations and directed towards drug cost control in primary care (PC) can, according to earlier studies, generate tension between health administrators and healthcare professionals. This study collects and analyzes the opinions of general practitioners (GPs) regarding current cost control measures as well as their proposals for improving the effectiveness of these measures. Methods A qualitative exploratory study was carried out using 11 focus groups composed of GPs from the Spanish regions of Aragon, Catalonia and the Balearic Islands. A semi-structured guide was applied in obtaining the GPs' opinions. The transcripts of the dialogues were analyzed by two investigators who independently considered categorical and thematic content. The results were supervised by other members of the team, with overall responsibility assigned to the team leader. Results GPs are conscious of their public responsibility with respect to pharmaceutical cost, but highlight the need to spread responsibility for cost control among the different actors of the health system. They insist on implementing measures to improve the quality of prescriptions, avoiding mere quantitative evaluations of prescription costs. They also suggest moving towards the self-management of the pharmaceutical budget by each health centre itself, as a means to design personalized incentives to improve their outcomes. These proposals need to be considered by the health administration in order to pre-empt the feelings of injustice, impotence, frustration and lack of motivation that currently exist among GPs as a result of the implemented measures. Conclusion Future investigations should be oriented toward strategies that involve GPs in the planning and management of drug cost control mechanisms. The proposals in this study may be considered by the health administration as a means to move toward the rational use of drugs while avoiding concerns about injustice and feelings

  14. Pandemic influenza A(H1N1)pdm09: risk of infection in primary healthcare workers

    PubMed Central

    Hudson, Ben; Toop, Les; Mangin, Dee; Brunton, Cheryl; Jennings, Lance; Fletcher, Lynn

    2013-01-01

    Background Healthcare workers in primary care are at risk of infection during an influenza pandemic. The 2009 influenza pandemic provided an opportunity to assess this risk. Aim To measure the prevalence of seropositivity to influenza A(H1N1)pdm09 among primary healthcare workers in Canterbury, New Zealand, following the 2009 influenza pandemic, and to examine associations between seropositivity and participants’ sociodemographic characteristics, professional roles, work patterns, and seasonal influenza vaccination status. Design and setting An observational study involving a questionnaire and testing for influenza A(H1N1)pdm09 seropositivity in all primary healthcare workers in Canterbury, New Zealand between December 2009 and February 2010. Method Participants completed a questionnaire that recorded sociodemographic and professional data, symptoms of influenza-like illness, history of seasonal influenza vaccination, and work patterns. Serum samples were collected and haemagglutination inhibition antibody titres to influenza A(H1N1)pdm09 measured. Results Questionnaires and serum samples were received from 1027 participants, from a workforce of 1476 (response rate 70%). Seropositivity was detected in 224 participants (22%). Receipt of seasonal influenza vaccine (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.2 to 3.3), recall of influenza (OR = 1.9, 95% CI = 1.3 to 2.8), and age ≤45 years (OR = 1.4, 95% CI = 1.0 to 1.9) were associated with seropositivity. Conclusion A total of 22% of primary care healthcare workers were seropositive. Younger participants, those who recalled having influenza, and those who had been vaccinated against seasonal influenza were more likely to be seropositive. Working in a dedicated influenza centre was not associated with an increased risk of seropositivity. PMID:23735413

  15. Implementation of a low-budget, lifestyle-improvement method in an ordinary primary healthcare setting: a stepwise intervention study

    PubMed Central

    Blomstrand, Ann; Ariai, Nashmil; Baar, Ann-Christine; Finbom-Forsgren, Britt-Marie; Thorn, Jörgen; Björkelund, Cecilia

    2012-01-01

    Objective To evaluate, in an ordinary primary healthcare setting, the effects of a screening questionnaire and a self-administered health profile dealing with special reference to the involvement of motivated individuals in need of lifestyle changes. Design Intervention study in a naturalistic context, using a screening questionnaire offered to consecutive patients, followed by a self-administered health profile and a health dialogue. Setting Hisingen primary healthcare area (130 033 inhabitants), Gothenburg, Sweden. Participants Men and women aged between 18 and 79, visiting any of the eight public primary healthcare centres (PCC) during an 8-month period, were presented with a screening questionnaire and, were offered, a health profile, a plasma glucose (p-glucose), blood pressure check and a health dialogue. Main outcome measures Motivation level, negative lifestyle factors in screening questionnaire and intraindividual changes in blood pressure, p-glucose, body mass index (BMI) and lifestyle factors between baseline and 1-year follow-up. Results Subjects with less favourable lifestyle and higher motivation chose to participate. A higher percentage of presumptive participants reported a less favourable lifestyle. The presumptive participants also indicated higher motivation. Participants showed more readiness to initiate lifestyle changes compared to non-participants (p<0.001). At 1-year follow-up significant reductions in BMI, waist circumference, waist–hip ratio (WHR), blood pressure and p-glucose were observed. Conclusions The results indicate that the method is on target and applicable to motivated individuals with a ‘risk profile’. A pedagogical model including a self-administered health-profile and a health dialogue, combined with emphasising the individual's own resources, seems to be a feasible method for effective preventive work in primary healthcare. PMID:22874629

  16. "It gives them more options": preferences for preconception genetic carrier screening for fragile X syndrome in primary healthcare.

    PubMed

    Archibald, Alison D; Hickerton, Chriselle L; Wake, Samantha A; Jaques, Alice M; Cohen, Jonathan; Metcalfe, Sylvia A

    2016-04-01

    This study aims to explore stakeholder views about offering population-based genetic carrier screening for fragile X syndrome. A qualitative study using interviews and focus groups with stakeholders was undertaken to allow for an in-depth exploration of views and perceptions about practicalities of, and strategies for, offering carrier screening for fragile X syndrome to the general population in healthcare settings. A total of 188 stakeholders took part including healthcare providers (n = 81), relatives of people with fragile X syndrome (n = 29), and members of the general community (n = 78). The importance of raising community awareness about screening and providing appropriate support for carriers was emphasized. There was a preference for preconception carrier screening and for providing people with the opportunity to make an informed decision about screening. Primary care was highlighted as a setting which would ensure screening is accessible; however, challenges of offering screening in primary care were identified including time to discuss screening, knowledge about the test and possible outcomes, and the health professionals' approach to offering screening. With the increasing availability of genetic carrier tests, it is essential that research now focuses on evaluating approaches for the delivery of carrier screening programs. Primary healthcare is perceived as an appropriate setting through which to access the target population, and raising awareness is essential to making genetic screening more accessible to the general community. PMID:26842720

  17. Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad

    PubMed Central

    Clement, Yuri N; Morton-Gittens, Jamie; Basdeo, Luke; Blades, Alexander; Francis, Marie-Joanna; Gomes, Natalie; Janjua, Meer; Singh, Adelle

    2007-01-01

    Background The increasing global popularity of herbal remedies requires further investigation to determine the probable factors driving this burgeoning phenomenon. We propose that the users' perception of efficacy is an important factor and assessed the perceived efficacy of herbal remedies by users accessing primary health facilities throughout Trinidad. Additionally, we determined how these users rated herbal remedies compared to conventional allopathic medicines as being less, equally or more efficacious. Methods A descriptive cross-sectional study was undertaken at 16 randomly selected primary healthcare facilities throughout Trinidad during June-August 2005. A de novo, pilot-tested questionnaire was interviewer-administered to confirmed herbal users (previous or current). Stepwise multiple regression analysis was done to determine the influence of predictor variables on perceived efficacy and comparative efficacy with conventional medicines. Results 265 herbal users entered the study and cited over 100 herbs for the promotion of health/wellness and the management of specific health concerns. Garlic was the most popular herb (in 48.3% of the sample) and was used for the common cold, cough, fever, as 'blood cleansers' and carminatives. It was also used in 20% of hypertension patients. 230 users (86.8%) indicated that herbs were efficacious and perceived that they had equal or greater efficacy than conventional allopathic medicines. Gender, ethnicity, income and years of formal education did not influence patients' perception of herb efficacy; however, age did (p = 0.036). Concomitant use of herbs and allopathic medicines was relatively high at 30%; and most users did not inform their attending physician. Conclusion Most users perceived that herbs were efficacious, and in some instances, more efficacious than conventional medicines. We suggest that this perception may be a major contributing factor influencing the sustained and increasing popularity of herbs

  18. Knowledge, Attitudes, and Behaviors about Breast Self-Examination and Mammography among Female Primary Healthcare Workers in Diyarbakır, Turkey.

    PubMed

    Erdem, Özgür; Toktaş, İzzettin

    2016-01-01

    Aim. This study aims to determine the knowledge level of the female primary healthcare workers about breast cancer and to reveal their attitude and behaviors about breast self-examination and mammography. Methods. This cross-sectional study was conducted on female primary healthcare workers who work in family health centres. 91% (n = 369) of female primary healthcare workers agreed to participate in the study. The questionnaire consisted of three parts: sociodemographic characteristics, knowledge about breast self-examination, and actual practice of breast self-examination. Results. The mean (SD) age of the female primary healthcare workers was 33.1 ± 6.8 (range, 20-54 years). The healthcare workers who practiced breast self-examination had significantly higher knowledge level (P = 0.001) than those who had not. The respondents had high knowledge level of breast self-examination; however, the knowledge level of breast cancer and mammography screen was low. Conclusions. While the female primary healthcare workers in this study had adequate knowledge of breast self-examination, this is not reflected in their attitudes and practices. Emphasis should be laid on breast self-examination in undergraduate and postgraduate courses for primary healthcare workers, since they are mostly involved in patient education. PMID:27123449

  19. Knowledge, Attitudes, and Behaviors about Breast Self-Examination and Mammography among Female Primary Healthcare Workers in Diyarbakır, Turkey

    PubMed Central

    Erdem, Özgür; Toktaş, İzzettin

    2016-01-01

    Aim. This study aims to determine the knowledge level of the female primary healthcare workers about breast cancer and to reveal their attitude and behaviors about breast self-examination and mammography. Methods. This cross-sectional study was conducted on female primary healthcare workers who work in family health centres. 91% (n = 369) of female primary healthcare workers agreed to participate in the study. The questionnaire consisted of three parts: sociodemographic characteristics, knowledge about breast self-examination, and actual practice of breast self-examination. Results. The mean (SD) age of the female primary healthcare workers was 33.1 ± 6.8 (range, 20–54 years). The healthcare workers who practiced breast self-examination had significantly higher knowledge level (P = 0.001) than those who had not. The respondents had high knowledge level of breast self-examination; however, the knowledge level of breast cancer and mammography screen was low. Conclusions. While the female primary healthcare workers in this study had adequate knowledge of breast self-examination, this is not reflected in their attitudes and practices. Emphasis should be laid on breast self-examination in undergraduate and postgraduate courses for primary healthcare workers, since they are mostly involved in patient education. PMID:27123449

  20. Job Satisfaction Differences between Primary Health Care and Treatment Sectors: An Experience from Iran

    PubMed Central

    Bagheri, Shokoufe; Janati, Ali; Kousha, Ahmad; Sadeghi-Bazargani, Homayoun; Asghari-Jafarabadi, Mohammad; Farahbakhsh, Mostafa

    2013-01-01

    Background: The aim of this study was to compare the levels of job satisfaction and its predictors among primary health care and treatment sectors' staff in East Azerbaijan Province, Iran. Methods: This comparative study was conducted in East Azerbaijan Province,Iran in 2011. A questionnaire survey was performed on 420 staff from health care and treatment sectors using multi-stage proportional cluster sampling method. Job satisfaction was measured in five aspects namely: structural and managerial; individual; social; work-itself; environmental and welfare job satisfaction factors.The job satisfaction measurement score was normalized to fall into a range of zero to 100. Statistical analyses were performed using Friedman and independent sample t-tests. Results: Overall satisfaction in health and treatment sectors was moderate with a mean score above 50. Hospital General Practitioners reported significantly higher job satisfaction score (mean ± SD=57.34 ± 17.02) compared to health care center General Practitioners (mean ± SD= 31.74±14.99). The highest satisfaction scores belonged to individual factors both in health care sector staff (64.83±18.50) and treatment sector staff (63.55±17.44). The lowest job satisfaction was observed with environmental and welfare factors (38.47±19.86 and 36.83±19.86, respectively). Conclusion: The job satisfaction significantly differs between primary health care and treatment sectors. Based on the results, environmental and welfare factors may be targeted to improve the job satisfaction in public health care system. PMID:24688957

  1. The Impact of Trauma Exposure and Post-Traumatic Stress Disorder on Healthcare Utilization Among Primary Care Patients

    PubMed Central

    Kartha, Anand; Brower, Victoria; Saitz, Richard; Samet, Jeffrey H.; Keane, Terence M.; Liebschutz, Jane

    2009-01-01

    Background Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain. Objectives To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients. Research Design Cross-sectional study. Subjects English speaking patients at an academic, urban primary care clinic. Measures Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities. Results Among 592 subjects, 80% had ≥1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1–14.1] but no other increased utilization. After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9–11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4–3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4–5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1–4.1) but no increase in outpatient and emergency department visits. Conclusions PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association. PMID:18362818

  2. Health sector reforms and changes in prevalence of untreated morbidity, choice of healthcare providers among the poor and rural population in India

    PubMed Central

    Ghosh, Soumitra

    2014-01-01

    Background: India’s health sector witnessed some major policy changes in 1990s that aimed at making health services more accessible to the population. Methods: In this paper, I tried to present some preliminary results of the significant changes that occurred between 1995/6 and 2004, especially in relation to the question of access to healthcare for the poor and rural population using data from 52nd (1995–6) and 60th round (2004) of National Sample Survey Organization on ‘morbidity and healthcare’. Results: The analysis suggests that overall utilization of healthcare services have declined and the odds of not seeking care due to financial inability has further increased among the poor and rural population during the period of reforms. Results of the multivariate logit regression model indicate that the non-poor, middle and above educated people were having greater likelihood of using services from private health care provider. Conclusion: Interestingly, poor and rural residents were more likely to have used healthcare from public facilities in 2004 than in 1995–6, suggesting that the shift from private to public sector is encouraging, provided they receive good quality health care services at public facilities and do not face catastrophic health expenditures. PMID:24757689

  3. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana.

    PubMed

    Ahiabu, Mary-Anne; Tersbøl, Britt P; Biritwum, Richard; Bygbjerg, Ib C; Magnussen, Pascal

    2016-03-01

    Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and 'no malaria drug' on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance

  4. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

    PubMed Central

    Ahiabu, Mary-Anne; Tersbøl, Britt P; Biritwum, Richard; Bygbjerg, Ib C; Magnussen, Pascal

    2016-01-01

    Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and ‘no malaria drug’ on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health

  5. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India

    PubMed Central

    Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh

    2016-01-01

    Background With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. Methods We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. Results The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630–10,294,065) and INR 26.9 million (95% CI: 22,225,159.3–32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6–208.3) and INR162.1 (95% CI: 112–219

  6. Impact of Québec’s healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up

    PubMed Central

    2014-01-01

    Background Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change achieved following these reforms. Methods We conducted two surveys of PHC organizations, in 2005 and 2010, in two regions of the province of Québec, Canada. From the responses to these surveys, we derived a measure of organizational change based on an index of conformity to an ideal type (ICIT). One set of explanatory variables was contextual, related to coercive, normative and mimetic influences; the other consisted of organizational variables that measured receptivity towards new PHC models. Multilevel analyses were performed to examine the relationships between ICIT change in the post-reform period and the explanatory variables. Results Positive results were attained, as expressed by increase in the ICIT score in the post-reform period, mainly due to implementation of new types of PHC organizations (Family Medicine Groups and Network Clinics). Organizational receptivity was the main explanatory variable mediating the effect of coercive and mimetic influences. Normative influence was not a significant factor in explaining changes. Conclusion Changes were modest at the system level but important with regard to new forms of PHC organizations. The top-down decreed reform was a determining factor in initiating change whereas local coercive and normative influences did not play a major role. The exemplar role played by certain PHC organizations through mimetic influence was more important. Receptivity of individual organizations was both a necessary condition and a mediating factor in influencing change. This supports the view that a combination of top-down and bottom-up strategy is best suited for achieving substantial changes in PHC local

  7. Collaboration across private and public sector primary health care services: benefits, costs and policy implications.

    PubMed

    McDonald, Julie; Powell Davies, Gawaine; Jayasuriya, Rohan; Fort Harris, Mark

    2011-07-01

    Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations. PMID:21554068

  8. A structural equation modeling approach for the adoption of cloud computing to enhance the Malaysian healthcare sector.

    PubMed

    Ratnam, Kalai Anand; Dominic, P D D; Ramayah, T

    2014-08-01

    The investments and costs of infrastructure, communication, medical-related equipments, and software within the global healthcare ecosystem portray a rather significant increase. The emergence of this proliferation is then expected to grow. As a result, information and cross-system communication became challenging due to the detached independent systems and subsystems which are not connected. The overall model fit expending over a sample size of 320 were tested with structural equation modelling (SEM) using AMOS 20.0 as the modelling tool. SPSS 20.0 is used to analyse the descriptive statistics and dimension reliability. Results of the study show that system utilisation and system impact dimension influences the overall level of services of the healthcare providers. In addition to that, the findings also suggest that systems integration and security plays a pivotal role for IT resources in healthcare organisations. Through this study, a basis for investigation on the need to improvise the Malaysian healthcare ecosystem and the introduction of a cloud computing platform to host the national healthcare information exchange has been successfully established. PMID:24957398

  9. Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China

    PubMed Central

    2013-01-01

    Background The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented. Methods Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China’s Health Statistics Yearbook. By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment. Results Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was

  10. Web-Based Training for Primary Healthcare Workers in Rural China: A Qualitative Exploration of Stakeholders’ Perceptions

    PubMed Central

    Zhang, Zhixia; Zhan, Xingxin; Li, Yingxue; Hu, Rong; Yan, Weirong

    2015-01-01

    Background Equitable access to basic public health services is a priority in China. However, primary healthcare workers’ competence to deliver public health services is relatively poor because they lack professional training. Since the availability of web-based training has increased in China, the current study explored stakeholders’ perceptions of a web-based training program on basic public health services to understand their thoughts, experiences, and attitudes about it. Methods Six focus group discussions with primary healthcare workers and three with directors of township hospitals, county-level Health Bureaus, and county-level Centers for Disease Control and Prevention were conducted in Yichang City during 2013. Semi-structured topic guides were used to facilitate qualitative data collection. Audio recordings of the sessions were transcribed verbatim and theme analysis was performed. Results Most of the study’s participants, especially the village doctors, had insufficient knowledge of basic public health services. The existing training program for primary healthcare workers consisted of ineffective traditional face-to-face sessions and often posed accessibility problems for the trainees. Most of the study’s participants had a positive attitude about web-based learning and expressed a strong desire to receive this novel training approach because of its flexibility and convenience. The perceived barriers to utilizing the web-based training method included poor computer literacy, lack of personal interaction, inadequate infrastructure, and lack of time and motivation. The facilitators of this approach included the training content applicability, the user-friendly and interactive learning format, and policy support. Conclusions Web-based training on basic public health services is a promising option in rural China. The findings of the study will contribute knowledge to implementation of web-based training in similar settings. PMID:25961727

  11. Burnout Subtypes and Absence of Self-Compassion in Primary Healthcare Professionals: A Cross-Sectional Study

    PubMed Central

    Montero-Marin, Jesus; Zubiaga, Fernando; Cereceda, Maria; Piva Demarzo, Marcelo Marcos; Trenc, Patricia; Garcia-Campayo, Javier

    2016-01-01

    Background Primary healthcare professionals report high levels of distress and burnout. A new model of burnout has been developed to differentiate three clinical subtypes: ‘frenetic’, ‘underchallenged’ and ‘worn-out’. The aim of this study was to confirm the validity and reliability of the burnout subtype model in Spanish primary healthcare professionals, and to assess the explanatory power of the self-compassion construct as a possible protective factor. Method The study employed a cross-sectional design. A sample of n = 440 Spanish primary healthcare professionals (214 general practitioners, 184 nurses, 42 medical residents) completed the Burnout Clinical Subtype Questionnaire (BCSQ-36), the Maslach Burnout Inventory General Survey (MBI-GS), the Self-Compassion Scale (SCS), the Utrecht Work Engagement Scale (UWES) and the Positive and Negative Affect Schedule (PANAS). The factor structure of the BCSQ-36 was estimated using confirmatory factor analysis (CFA) by the unweighted least squares method from polychoric correlations. Internal consistency (R) was assessed by squaring the correlation between the latent true variable and the observed variables. The relationships between the BCSQ-36 and the other constructs were analysed using Spearman’s r and multiple linear regression models. Results The structure of the BCSQ-36 fit the data well, with adequate CFA indices for all the burnout subtypes. Reliability was adequate for all the scales and sub-scales (R≥0.75). Self-judgement was the self-compassion factor that explained the frenetic subtype (Beta = 0.36; p<0.001); isolation explained the underchallenged (Beta = 0.16; p = 0.010); and over-identification the worn-out (Beta = 0.25; p = 0.001). Other significant associations were observed between the different burnout subtypes and the dimensions of the MBI-GS, UWES and PANAS. Conclusions The typological definition of burnout through the BCSQ-36 showed good structure and appropriate internal consistence

  12. Recommendations for Undergraduate Training in the Primary Care Sector – Position Paper of the GMA-Primary Care Committee

    PubMed Central

    Huenges, Bert; Gulich, Markus; Böhme, Klaus; Fehr, Folkert; Streitlein-Böhme, Irmgard; Rüttermann, Viktor; Baum, Erika; Niebling, Wilhelm-Bernhard; Rusche, Herbert

    2014-01-01

    During their studies to become medical professionals, all students are obliged to become familiar with various aspects of primary care. The aim is to provide all students with a high quality training which ensures the best possible cooperation across all sectors of the medical system. Primary care comprises the primary use of the medical service by an unfiltered set of patients as well as continued patient care – including home-care. This position paper was developed together with representatives of the German Society of University Teachers of General Practice (GHA), the German Society for Ambulatory General Paediatrics (DGAAP), the German Society of General Practice and Family Medicine (DEGAM) and the German Society for Internal Medicine (DGIM). It includes recommendations for teaching in the field of primary care in four different types of internships such as preclinical work experience (“Hospitation”), 4-week clinical traineeships of a casual nature (“Famulatur”) and 2-week courses of structured and assessed clinical training (“Blockpraktikum”) as well as a broad-based 4-month elective clinical placement in the final year (known as a practical year, “PJ”). The recommendations encompass structural and process criteria for internships in different general practices. In addition, for the first time recommendations for teaching on campus – in the fields of general medicine, paediatrics, numerous cross-sectional areas and other clinical fields, but also for clinical skills training – are set down here. In this position paper the intention is to demonstrate the possible ways in which more aspects of primary care could be integrated into undergraduate medical training. PMID:25228937

  13. Predicting the learning and consultation time in a computerized primary healthcare clinic.

    PubMed

    Blignaut, P J; McDonald, T; Tolmie, C J

    2001-01-01

    Managers would like to know how long it takes healthcare service providers to achieve the same throughput of patients per day that they were used to with a pen-and-paper system. This study has been undertaken to derive a model for predicting the time it takes a service provider from a previously disadvantaged community to enter a patient's record in terms of his or her experience and the number of data units that have to be captured. A model was also derived to predict the average consultation time in terms of the number of data units that are captured by an experienced service provider. It can be inferred that healthcare service providers should be allowed at least 6 months of computerized system experience before any decisions about the success of the technology introduction can be made. PMID:11391885

  14. Telehealth: the backbone of healthcare financing.

    PubMed

    Suleiman, Abu Bakar

    2004-01-01

    Malaysia, like many other countries faces major challenges in meeting increasing demands with limited resources. Changes in demography, life-style diseases, increasing consumer expectations, new medical technologies and rapid economic growth all fuel demand for more healthcare services. There are problems related to the distribution and delivery of healthcare services, and there is inadequate integration of healthcare delivery and continuity of care is a major concern. Resources tend to be concentrated in the very expensive hospital sector, although services would be cost-effectively and conveniently delivered at primary care level. There is no ideal healthcare system, and how healthcare is supported and organized for service delivery influences the country's social, economic and political well-being. Like many other countries, Malaysia is undergoing health reform in meeting these challenges, and is becoming more reliant on telemedicine and telehealth. PMID:15747978

  15. How to create more supportive supervision for primary healthcare: lessons from Ngamiland district of Botswana: co-operative inquiry group

    PubMed Central

    Nkomazana, Oathokwa; Mash, Robert; Wojczewski, Silvia; Kutalek, Ruth; Phaladze, Nthabiseng

    2016-01-01

    Background Supportive supervision is a way to foster performance, productivity, motivation, and retention of health workforce. Nevertheless there is a dearth of evidence of the impact and acceptability of supportive supervision in low- and middle-income countries. This article describes a participatory process of transforming the supervisory practice of district health managers to create a supportive environment for primary healthcare workers. Objective The objective of the study was to explore how district health managers can change their practice to create a more supportive environment for primary healthcare providers. Design A facilitated co-operative inquiry group (CIG) was formed with Ngamiland health district managers. CIG belongs to the participatory action research paradigm and is characterised by a cyclic process of observation, reflection, planning, and action. The CIG went through three cycles between March 2013 and March 2014. Results Twelve district health managers participated in the inquiry group. The major insights and learning that emerged from the inquiry process included inadequate supervisory practice, perceptions of healthcare workers’ experiences, change in the managers’ supervision paradigm, recognition of the supervisors’ inadequate supervisory skills, and barriers to supportive supervision. Finally, the group developed a 10-point consensus on what they had learnt regarding supportive supervision. Conclusion Ngamiland health district managers have come to appreciate the value of supportive supervision and changed their management style to be more supportive of their subordinates. They also developed a consensus on supportive supervision that could be adapted for use nationally. Supportive supervision should be prioritised at all levels of the health system, and it should be adequately resourced. PMID:27345024

  16. Cost-Efficiency of Indigenously Fabricated Mobile-Portable Dental Unit in Delivery of Primary Healthcare in Rural India

    PubMed Central

    Goel, Ashok; Torwane, Nilesh Arjun

    2014-01-01

    Aim: Innovation in primary oral healthcare delivery is a potential yet relatively unexplored area in Dental literature. Aim of the present study was to assess the economic gains that can be made by designing and operating an indigenously fabricated portable dental unit in rural areas. Materials and Methods: Cost-efficiency was determined by comparing total revenue (number of patients treated) with total costs (direct – capital cost of fabrication; and indirect – dental materials, disposables, transport, miscellaneous) over a period of seven years (2005 to 2012). Operational efficiency of portable dental units was also compared with dental vans on various categories of performance indicators. Data analysis was based on institutional records of Rajasthan Dental College (RDC), Jaipur, India. Results: Results show that a total of 52,900 patients who attended 223 camps during this period were provided various primary oral healthcare services using four such portable dental units that were developed @ Rs. 24,000 ($ 417) per unit. Based on a cost-efficiency of Rs 35.53 ($ 0.65) per person, which is among the lowest reported from any part of the world, the authors conclude that indigenously fabricated portable dental units provide a cost-efficient service. The other aspects most relevant to portable equipment were ease of transportation and feasibility in domiciliary care provision. Conclusion: The Limitations of productivity due to time spent in setting up the unit and need for additional space/equipment was their main drawbacks vis-à-vis dental vans. PMID:25177627

  17. Staphylococcus aureus skin and soft tissue infections in primary healthcare in Denmark: a 12-year population-based study.

    PubMed

    Dalager-Pedersen, M; Søgaard, M; Schønheyder, H C

    2011-08-01

    A rise in community-onset Staphylococcus aureus infections has been observed in European countries. To ascertain secular trends of S. aureus infections in primary healthcare in Denmark, we conducted this register-based study in the North Denmark region, during the period 1997-2008. We identified all skin and mucosa specimens obtained by general practitioners and all prescriptions for the preferred oral anti-staphylococcal antibiotic, dicloxacillin. Repeat observations within a 12-month period were excluded prior to the calculation of age and gender standardised incidence rates per 100,000 person-years. We included 108,758 specimens, of which 42,778 (39%) yielded S. aureus. The annual incidence rate of specimens doubled during the study period, reaching 2,399 in 2008. The overall rate of S. aureus isolates increased 2-fold to a stable rate at about 850, but for isolates from children and for impetigo specimens, the increase was steeper, with a peak in 2002. A total of 156,462 dicloxacillin prescriptions had been redeemed and the annual prescription rate increased 2.5-fold, peaking at 3,714 in 2007. In conclusion, the annual rates of specimens, S. aureus infections and dicloxacillin prescriptions more than doubled in primary healthcare during the 12-year study period. A major impetigo epidemic and calls for antibiotic stewardship with increased utilisation of specimens were contributing factors. PMID:21279531

  18. Developmental Screening Tools: Feasibility of Use at Primary Healthcare Level in Low- and Middle-income Settings

    PubMed Central

    Morris, Jodi; Martines, José

    2014-01-01

    ABSTRACT An estimated 150 million children have a disability. Early identification of developmental disabilities is a high priority for the World Health Organization to allow action to reduce impairments through Gap Action Program on mental health. The study identified the feasibility of using the developmental screening and monitoring tools for children aged 0-3 year(s) by non-specialist primary healthcare providers in low-resource settings. A systematic review of the literature was conducted to identify the tools, assess their psychometric properties, and feasibility of use in low- and middle-income countries (LMICs). Key indicators to examine feasibility in LMICs were derived from a consultation with 23 international experts. We identified 426 studies from which 14 tools used in LMICs were extracted for further examination. Three tools reported adequate psychometric properties and met most of the feasibility criteria. Three tools appear promising for use in identifying and monitoring young children with disabilities at primary healthcare level in LMICs. Further research and development are needed to optimize these tools. PMID:25076668

  19. How much does it cost to achieve coverage targets for primary healthcare services? A costing model from Aceh, Indonesia.

    PubMed

    Abdullah, Asnawi; Hort, Krishna; Abidin, Azwar Zaenal; Amin, Fadilah M

    2012-01-01

    Despite significant investment in improving service infrastructure and training of staff, public primary healthcare services in low-income and middle-income countries tend to perform poorly in reaching coverage targets. One of the factors identified in Aceh, Indonesia was the lack of operational funds for service provision. The objective of this study was to develop a simple and transparent costing tool that enables health planners to calculate the unit costs of providing basic health services to estimate additional budgets required to deliver services in accordance with national targets. The tool was developed using a standard economic approach that linked the input activities to achieving six national priority programs at primary healthcare level: health promotion, sanitation and environment health, maternal and child health and family planning, nutrition, immunization and communicable diseases control, and treatment of common illness. Costing was focused on costs of delivery of the programs that need to be funded by local government budgets. The costing tool consisting of 16 linked Microsoft Excel worksheets was developed and tested in several districts enabled the calculation of the unit costs of delivering of the six national priority programs per coverage target of each program (such as unit costs of delivering of maternal and child health program per pregnant mother). This costing tool can be used by health planners to estimate additional money required to achieve a certain level of coverage of programs, and it can be adjusted for different costs and program delivery parameters in different settings. PMID:22887349

  20. Links among high-performance work environment, service quality, and customer satisfaction: an extension to the healthcare sector.

    PubMed

    Scotti, Dennis J; Harmon, Joel; Behson, Scott J

    2007-01-01

    Healthcare managers must deliver high-quality patient services that generate highly satisfied and loyal customers. In this article, we examine how a high-involvement approach to the work environment of healthcare employees may lead to exceptional service quality, satisfied patients, and ultimately to loyal customers. Specifically, we investigate the chain of events through which high-performance work systems (HPWS) and customer orientation influence employee and customer perceptions of service quality and patient satisfaction in a national sample of 113 Veterans Health Administration ambulatory care centers. We present a conceptual model for linking work environment to customer satisfaction and test this model using structural equations modeling. The results suggest that (1) HPWS is linked to employee perceptions of their ability to deliver high-quality customer service, both directly and through their perceptions of customer orientation; (2) employee perceptions of customer service are linked to customer perceptions of high-quality service; and (3) perceived service quality is linked with customer satisfaction. Theoretical and practical implications of our findings, including suggestions of how healthcare managers can implement changes to their work environments, are discussed. PMID:17447538

  1. Primary Care for Adults with Down Syndrome: Adherence to Preventive Healthcare Recommendations

    ERIC Educational Resources Information Center

    Jensen, K. M.; Taylor, L. C.; Davis, M. M.

    2013-01-01

    Background: Due to significant medical improvements, persons with Down syndrome now live well into adulthood. Consequently, primary care for adults with Down syndrome needs to incorporate routine care with screening for condition-specific comorbidities. This study seeks to evaluate the adherence of primary care physicians to age- and…

  2. The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon

    PubMed Central

    2014-01-01

    Background In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. Methods The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. Results The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. Conclusions To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well. PMID:24568632

  3. Impacts of Québec Primary Healthcare Reforms on Patients' Experience of Care, Unmet Needs, and Use of Services

    PubMed Central

    Pineault, Raynald; Borgès Da Silva, Roxane; Provost, Sylvie; Breton, Mylaine; Tousignant, Pierre; Fournier, Michel; Prud'homme, Alexandre; Levesque, Jean-Frédéric

    2016-01-01

    Introduction. Healthcare reforms launched in the early 2000s in Québec, Canada, involved the implementation of new forms of primary healthcare (PHC) organizations: Family Medicine Groups (FMGs) and Network Clinics (NCs). The objective of this paper is to assess how the organizational changes associated with these reforms have impact on patients' experience of care, use of services, and unmet needs. Methods. We conducted population and organization surveys in 2005 and 2010 in two regions of the province of Québec. The design was a before-and-after natural experiment. Changes over time between new models and other practices were assessed using difference-in-differences statistical procedures. Results. Accessibility decreased between 2003 and 2010, but less so in the treatment than in the comparison group. Continuity of care generally improved, but the increase was less for patients in the treatment group. Responsiveness also increased during the period and more so in the treatment group. There was no other significant difference between the two groups. Conclusion. PHC reform in Québec has brought about major organizational changes that have translated into slight improvements in accessibility of care and responsiveness. However, the reform does not seem to have had an impact on continuity, comprehensiveness, perceived care outcomes, use of services, and unmet needs. PMID:26977318

  4. A Primary Healthcare Screening Tool to Identify Depression and Anxiety Disorders among People with Epilepsy in Zambia

    PubMed Central

    Mbewe, Edward K; Uys, Leana R; Nkwanyana, Ntombifikile M; Birbeck, Gretchen L

    2013-01-01

    Among the 50 million people with epilepsy (PWE) worldwide, ~15 to 60% also likely suffer from depression and/or anxiety disorders and 80% reside in low-income regions where these comorbidities are often under-recognised and undertreated. We developed a 10-item screening tool for the detection of depression and anxiety disorders for use in Zambian primary care clinics where the baseline detection rate of depression and/or anxiety disorders among PWE is ~1%. Consenting adults (n=595) completed the screening tool and 53.7% screened positive. The screen was validated by a Psychiatric Clinical Officer using DMS-IV criteria. Cronbach’s Alpha was 0.77 overall, and 0.67 and 0.57 for the depression and anxiety components, respectively. Other test characteristics included sensitivity 56.63%, specificity 68.05%, positive predictive value 67.3%, and negative predictive value 57.5%. Interrater reliability (kappa) was 0.85. The psychometric qualities of the tool are inadequate. Development of further, better quality instruments is needed though this will likely require a longer tool which the healthcare workers delivering epilepsy care services have previously deemed non-feasible for routine use. As we work toward development and acceptability of a more optimal instrument, use of this initial screening tool which healthcare workers are willing to use may increase the identification of comorbid depression and anxiety in the low resource setting described in the study. PMID:23510742

  5. A primary healthcare screening tool to identify depression and anxiety disorders among people with epilepsy in Zambia.

    PubMed

    Mbewe, Edward K; Uys, Leana R; Nkwanyana, Ntombifikile M; Birbeck, Gretchen L

    2013-05-01

    Among the 50 million people with epilepsy (PWE) worldwide, ~15 to 60% also likely suffer from depression and/or anxiety disorders, and 80% reside in low-income regions where these comorbidities are often underrecognized and undertreated. We developed a 10-item screening tool for the detection of depression and anxiety disorders for use in Zambian primary care clinics where the baseline detection rate of depression and/or anxiety disorders among PWE is ~1%. Consenting adults (n=595) completed the screening tool, and 53.7% screened positive. The screen was validated by a psychiatric clinical officer using DMS-IV criteria. Cronbach's alpha was 0.77 overall and 0.67 and 0.57 for the depression and anxiety components, respectively. Other test characteristics included sensitivity 56.6%, specificity 68.1%, positive predictive value 67.3%, and negative predictive value 57.5%. Interrater reliability (kappa) was 0.85. The psychometric qualities of the tool are inadequate. Development of further, better quality instruments is needed though this will likely require a longer tool which the healthcare workers delivering epilepsy care services have previously deemed nonfeasible for routine use. As we work toward development and acceptability of a more optimal instrument, use of this initial screening tool which healthcare workers are willing to use may increase the identification of comorbid depression and anxiety in the low resource setting described in the study. PMID:23510742

  6. Food-based dietary guidelines and nutrition interventions for children at primary healthcare facilities in South Africa.

    PubMed

    Hendricks, Michael K; Goeiman, Hilary; Dhansay, Ali

    2007-10-01

    Existing dietary recommendations and nutrition counselling provided to mothers/caregivers at primary healthcare (PHC) facilities are reviewed and analysed to be consistent with food-based dietary guidelines (FBDGs) that are being developed for preschool children. Recommendations provided by the Integrated Management of Childhood Illness and the provincial Paediatric Case Management Guidelines, which are currently implemented at PHC facilities were reviewed. For FBDGs to be consistent with nutrition counselling that is provided to mothers/caregivers at these facilities, various principles need to be promoted. These include among others, exclusive and on-demand breastfeeding in the HIV-negative mother; exclusive breastfeeding with abrupt cessation preferably at 6 months or exclusive, safe and adequate formula feeding in the HIV-infected mother; the introduction of complementary feeds in all infants at 6 months; the provision of energy-dense and micronutrient-enriched (particularly, iron, zinc, calcium and vitamin A) complementary feeds; frequent visits to the healthcare facility; and physical activity aimed at encouraging a healthy lifestyle and preventing overweight and obesity in childhood. The FBDGs should be incorporated into nutrition and child health programmes and be reviewed and modified regularly. PMID:17824853

  7. Wait and consult times for primary healthcare services in central Mozambique: a time-motion study

    PubMed Central

    Wagenaar, Bradley H.; Gimbel, Sarah; Hoek, Roxanne; Pfeiffer, James; Michel, Cathy; Cuembelo, Fatima; Quembo, Titos; Afonso, Pires; Gloyd, Stephen; Lambdin, Barrot H.; Micek, Mark A.; Porthé, Victoria; Sherr, Kenneth

    2016-01-01

    Background We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. Design We observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors. Results Mean wait times (in minutes) were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes) were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248) of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers. Discussion The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness. PMID:27580822

  8. Gaps in primary healthcare electronic medical record research and knowledge: findings of a pan-Canadian study.

    PubMed

    Terry, Amanda L; Stewart, Moira; Fortin, Martin; Wong, Sabrina T; Kennedy, Maureen; Burge, Fred; Birtwhistle, Richard; Grava-Gubins, Inese; Webster, Greg; Thind, Amardeep

    2014-01-01

    While the barriers to electronic medical record (EMR) adoption by physicians are well-known, we have much less knowledge about the broader challenges regarding EMR use faced by primary healthcare (PHC) EMR stakeholders in Canada. Therefore, we conducted interviews (from June 2009 to September 2010) and consultation sessions (in October and November 2009) with these stakeholders, as well as carrying out a research capacity assessment, to identify, describe and prioritize gaps in PHC EMR knowledge and research. Twelve thematic gaps emerged; four were identified as the most important: the need to ascertain the value of EMRs, the need to better understand elements of EMR implementation and adoption, the need to develop innovative data entry and extraction procedures, and a lack of agreement and understanding of data sharing. To advance EMR use, Canada needs to address these gaps; yet, we currently have a lack of research capacity with which to accomplish this. PMID:25410695

  9. Involvement of family nurses in home visits during an 8-year period encompassing primary healthcare reforms in Poland.

    PubMed

    Marcinowicz, Ludmiła; Chlabicz, Sławomir; Konstantynowicz, Jerzy; Gugnowski, Zbigniew

    2009-07-01

    Home visits by doctors and nurses are considered an important indicator of the quality of healthcare. Published data are scarce regarding the role of family nurses in providing professional home care in Central and Eastern European countries that have recently introduced reforms to their primary care systems. The objective of the present study was to describe the involvement of family nurses in home visits in the context of organizational and legal changes in service provision, that is, to analyse the role of the family nurses employed by family doctors (1998) versus family nurses working in autonomous positions (2002 and 2006). The proportion of patients in the community receiving a home visit from a family nurse, the purpose of the family nurse's home visit and patient expectations towards the family nurse were studied. A series of cross-sectional studies were conducted in a small town in northeastern Poland, based on three consecutive surveys taken at 4-year intervals (1998, 2002, 2006, surveys I, II and III, respectively). During each survey, 1000 patients were interviewed (face to face) with structured questionnaires. In 1998, family nurses were employed by family doctors, but by 2002, nurses had established their own practices and held direct contracts with the National Health Fund. A significant increase in the percentage of patients receiving home visits from a family nurse was observed between surveys I and II (12.8% and 30.0%); however, the number of respondents reporting a home visit in survey III decreased to 23.9%. Patients over 75 years of age were the major demographic group receiving family nursing at home. This study suggests that reform of the primary healthcare system in Poland has produced changes in the family nursing system. Independence, contractual obligations and self-employment of Polish family nurses have resulted in their greater participation in home visits. PMID:19054138

  10. Prolonged Sitting Time: Barriers, Facilitators and Views on Change among Primary Healthcare Patients Who Are Overweight or Moderately Obese

    PubMed Central

    Martínez-Ramos, Elena; Martín-Borràs, Carme; Trujillo, José-Manuel; Giné-Garriga, Maria; Martín-Cantera, Carlos; Solà-Gonfaus, Mercè; Castillo-Ramos, Eva; Pujol-Ribera, Enriqueta; Rodríguez, Dolors; Puigdomenech, Elisa; Beltran, Angela-Maria; Serra-Paya, Noemi; Gascón-Catalán, Ana; Puig-Ribera, Anna

    2015-01-01

    Background and Objectives Prolonged sitting time has negative consequences on health, although the population is not well aware of these harmful effects. We explored opinions expressed by primary care patients diagnosed as overweight or moderately obese concerning their time spent sitting, willingness to change, and barriers, facilitators, goals and expectations related to limiting this behaviour. Methods A descriptive-interpretive qualitative study was carried out at three healthcare centres in Barcelona, Spain, and included 23 patients with overweight or moderate obesity, aged 25 to 65 years, who reported sitting for at least 6 hours a day. Exclusion criteria were inability to sit down or stand up from a chair without help and language barriers that precluded interview participation. Ten in-depth, semi-structured interviews (5 group, 5 individual) were audio recorded from January to July 2012 and transcribed. The interview script included questions about time spent sitting, willingness to change, barriers and facilitators, and the prospect of assistance from primary healthcare professionals. An analysis of thematic content was made using ATLAS.Ti and triangulation of analysts. Results The most frequent sedentary activities were computer use, watching television, and motorized journeys. There was a lack of awareness of the amount of time spent sitting and its negative consequences on health. Barriers to reducing sedentary time included work and family routines, lack of time and willpower, age and sociocultural limitations. Facilitators identified were sociocultural change, free time and active work, and family surroundings. Participants recognized the abilities of health professionals to provide help and advice, and reported a preference for patient-centred or group interventions. Conclusions Findings from this study have implications for reducing sedentary behaviour. Patient insights were used to design an intervention to reduce sitting time within the frame of

  11. Physician user satisfaction with an electronic medical records system in primary healthcare centres in Al Ain: a qualitative study

    PubMed Central

    Al Alawi, Shamma; Al Dhaheri, Aysha; Al Baloushi, Durra; Al Dhaheri, Mouza; Prinsloo, Engela A M

    2014-01-01

    Objectives To explore physician satisfaction with an electronic medical records (EMR) system, to identify and explore the main limitations of the system and finally to submit recommendations to address these limitations. Design A descriptive qualitative study that entailed three focus group interviews was performed among physicians using open-ended questions. The interviews were audiotaped, documented and transcribed verbatim. The themes were explored and analysed in different categories. Setting The study was conducted in primary healthcare centres (PHC) in Al Ain, United Arab Emirates (UAE). Participants A total of 23 physicians, all using the same EMR system, attended one of three focus groups held in PHC in Al Ain Medical District. Each focus group consisted of 7–9 physicians working in PHC as family medicine specialists, residents or general practitioners. Primary outcome measure Physician satisfaction with the EMR system. Results Key themes emerged and were categorised as physician-dependent, patient-related and system-related factors. In general, physicians were satisfied with the EMR system in spite of initial difficulties with implementation. Most participants identified that the long time required to do the documentation affected their practice and patient communication. Many physicians expressed satisfaction with the orders and results of laboratory and radiology functions and they emphasised that this was the strongest point in the EMR. They were also satisfied with the electronic prescription function, stating that it reduced errors and saved time. Conclusions Physicians are satisfied with the EMR and have a positive perception regarding the application of the system. Several themes emerged during this study that need to be considered to enhance the EMR system. Further studies need to be conducted among other healthcare practitioners and patients to explore their attitude and perception about the EMR. PMID:25377010

  12. Strengthening Intersectoral Collaboration for Primary Health Care in Developing Countries: Can the Health Sector Play Broader Roles?

    PubMed Central

    Adeleye, Omokhoa Adedayo; Ofili, Antoinette Ngozi

    2010-01-01

    Many strategic challenges impeding the success of primary health care are rooted in weak strategic inputs, including intersectoral collaboration. Some encouraging evidence from programmes, projects, and studies suggests that intersectoral collaboration is feasible and useful. The strategy has the potential to fast-track the attainment of Millenium Development Goals. However, the strategy is not commonly utilised in developing countries. The health sector expects inputs from other sectors which may not necessarily subscribe to a shared responsibility for health improvement, whereas the public expects ‘‘health” from the health sector. Yet, the health sector rarely takes on initiatives in that direction. The sector is challenged to mobilise all stakeholders for intersectoral collaboration through advocacy and programming. Pilot projects are advised in order to allow for cumulative experience, incremental lessons and more supportive evidence. PMID:20454703

  13. Are pricing and reimbursement decision-making criteria aligned with public preferences regarding allocation principles in the Polish healthcare sector?

    PubMed

    Kolasa, Katarzyna

    2014-10-01

    Given growing interest in multicriteria decision making and multiple cost-effectiveness thresholds' approach, it was decided to investigate its usefulness in Poland. The pricing and reimbursement (P&R) regulations were reviewed and a cross-sectional survey was conducted amongst nurses. The study investigated whether P&R rules are aligned with the preferences of healthcare professional towards the concept of equity. The references to aversion to inequalities in health and capacity to benefit were recognized as the most and least important principle respectively by the group of nurses. Different weightings of health gain dependent on disease severity were accepted by half of the study's population. In the review of legal acts, references to capacity to benefit were frequently found. The opposite was registered for other concepts of equity. There is room for further improvement with respect to the alignment between the Polish P&R decision making criteria and public preferences regarding allocation principles. PMID:25052370

  14. RFID-enabled traceability system for consignment and high value products: a case study in the healthcare sector.

    PubMed

    Bendavid, Ygal; Boeck, Harold; Philippe, Richard

    2012-12-01

    This paper presents a case study of a hospital operating room that evaluated a Radio-Frequency Identification (RFID)-enabled traceability system for the management of consignment and high value products requiring item level traceability. Results indicate that the traceability system in conjunction with the redesign of replenishment processes facilitates item level traceability, improves financial controls and case costing, upgrades service levels and reduces inventory shrinkage. Other benefits include time saved from non-value-added activities that can be transferred to patient care activities. The solution can be considered (i) as an alternative to RFID-enabled cabinets used in the replenishment of consignment and high value supplies in certain operating rooms, cardiac catheterization laboratories and interventional radiology departments, or (ii) as a complementary solution facilitating the tracking of medical devices removed from RFID-enabled cabinets. In short, the end-to-end traceability of medical products in the healthcare supply chain can be significantly enhanced. PMID:22105627

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

    PubMed

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

    2016-03-01

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

  16. The US healthcare workforce and the labor market effect on healthcare spending and health outcomes.

    PubMed

    Pellegrini, Lawrence C; Rodriguez-Monguio, Rosa; Qian, Jing

    2014-06-01

    The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided [Formula: see text] significance of [Formula: see text] .05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status ([Formula: see text] .01), and mortality for males ([Formula: see text] .05) and females ([Formula: see text] .001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines ([Formula: see text] .001); whereas, the private healthcare spending share decreases ([Formula: see text] .001). Public and private healthcare spending also

  17. An assessment of primary care attributes from the perspective of female healthcare users1

    PubMed Central

    Lima, Eliane de Fátima Almeida; Sousa, Ana Inês; Primo, Cândida Caniçali; Leite, Francielie Marabotti Costa; Lima, Rita de Cassia Duarte; Maciel, Ethel Leonor Nóia

    2015-01-01

    OBJECTIVE: this study sought to assess the quality of the Family Health Strategy (FHS) and investigated the association between primary care attributes (PCAs) and the sociodemographic characteristics of users. METHOD: a total of 215 female FHS users were interviewed for this descriptive and cross-sectional study. The Primary Care Assessment Tool (PCATool), Adult Edition was used, and the results were analyzed using Fisher's exact tests, Pearson's chi-square tests and logistic regressions. RESULTS: the lowest average score corresponded to the dimension "accessibility" (1.80), and the highest score corresponded to "access" (8.76). The results corresponding to the attributes "longitudinality", "coordination", "comprehensiveness", and "orientation" were not significant. No association was found between the participants' sociodemographic characteristics and the essential, derivative, and general attributes (p>0.05). CONCLUSION: several attributes must be improved across all the investigated services from the perspective of female FHS users. PMID:26155006

  18. Creating a 'reverse' integrated primary and mental healthcare clinic for those with serious mental illness.

    PubMed

    Maragakis, Alexandros; Siddharthan, Ragavan; RachBeisel, Jill; Snipes, Cassandra

    2016-09-01

    Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement 'reverse' integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed. PMID:26586369

  19. Group motivational intervention in overweight/obese patients in primary prevention of cardiovascular disease in the primary healthcare area

    PubMed Central

    2010-01-01

    Background The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. Methods This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. Discussion By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting. Trial Registration ClinicalTrials.gov Identifier: NCT01006213 PMID:20298557

  20. Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial

    PubMed Central

    Bendtsen, Preben; Müssener, Ulrika; Karlsson, Nadine; López-Pelayo, Hugo; Palacio-Vieira, Jorge; Colom, Joan; Gual, Antoni; Reynolds, Jillian; Wallace, Paul; Segura, Lidia; Anderson, Peter

    2016-01-01

    Objectives The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice. Design The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking. Setting A total of 120 primary healthcare centres from 5 jurisdictions in Europe. Participants 746 individual providers (general practitioners, nurses or other professionals) participated in the study. Primary outcome Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period. Results The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%. Conclusions Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI. Trial registration number NCT01501552; Post-results. PMID:27311902

  1. How do public child healthcare professionals and primary school teachers identify and handle child abuse cases? A qualitative study

    PubMed Central

    2013-01-01

    Background Public child healthcare doctors and nurses, and primary school teachers play a pivotal role in the detection and reporting of child abuse, because they encounter almost all children in the population during their daily work. However, they report relatively few cases of suspected child abuse to child protective agencies. The aim of this qualitative study was to investigate Dutch frontline workers’ child abuse detection and reporting behaviors. Methods Focus group interviews were held among 16 primary school teachers and 17 public health nurses and physicians. The interviews were audio recorded, transcribed, and thematically analyzed according to factors of the Integrated Change model, such as knowledge, attitude, self-efficacy, skills, social influences and barriers influencing detection and reporting of child abuse. Results Findings showed that although both groups of professionals are aware of child abuse signs and risks, they are also lacking specific knowledge. The most salient differences between the two professional groups are related to attitude and (communication) skills. Conclusion The results suggest that frontline workers are in need of supportive tools in the child abuse detection and reporting process. On the basis of our findings, directions for improvement of child abuse detection and reporting are discussed. PMID:24007516

  2. One-Year Results of the BeweegKuur Lifestyle Intervention Implemented in Dutch Primary Healthcare Settings

    PubMed Central

    Schutte, Bianca A. M.; Haveman-Nies, Annemien; Preller, Liesbeth

    2015-01-01

    Background. Lifestyle interventions focusing on healthy diet and physical activity (PA) are effective in reducing health risks in controlled research settings. The aim of this study was to investigate the one-year results of the BeweegKuur lifestyle intervention implemented nationwide in Netherlands for people with a weight-related health risk. Materials and Methods. Data were requested from all 160 locations participating in the BeweegKuur. In a one group pretest/posttest study, one-year changes in health outcome variables and time spent on physical activity were tested with dependent t-tests. Associations between one-year changes in weight and waist circumference and sociodemographic factors and uptake of the program were analysed with ANOVA. Results. Data for 517 participants from 47 locations were available for analysis. One year after the intervention, weight reduced by 2.9 kg (95% CI −3.3;, −2.5), waist circumference by 4.3 cm (−4.9; −3.7), and blood glucose by 0.5 mmol/L (−0.8; −0.3). Physical activity increased significantly. Higher uptake of the program was associated with a larger decrease in waist circumference. Conclusion. The results of the study suggest that lifestyle interventions implemented in real-life primary healthcare settings with tailor-made supervision can contribute meaningfully to primary prevention. PMID:26380276

  3. Assessment of medical waste management at a primary health-care center in São Paulo, Brazil.

    PubMed

    Moreira, A M M; Günther, W M R

    2013-01-01

    According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of São Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized. Total waste generation increased 9.8%, but it was possible to reduce the volume of non-recyclable materials (11%) and increase the volume of recyclable materials (4%). It was also possible to segregate organic waste (7%), which was forwarded for production of compost. The rate of infectious waste generation in critical areas decreased from 0.021 to 0.018 kg/procedure. Many improvements have been observed, and now the PHC complies with most of legal requirements

  4. Health-care cost reduction resulting from primary-care allergy testing in children in Italy

    PubMed Central

    2010-01-01

    Background Allergy places a considerable cost burden on society. Specific immunoglobulin E (spIgE) testing may improve the management of allergy patients. There is therefore a reason to quantify the economic consequences of the use of spIgE testing in the diagnosis of allergic conditions. Methods The expected costs of spIgE testing versus no-testing were calculated using a clinical decision model based on a prospective clinical trial performed in primary care. Results The expected costs per patient over 2 years decreased from 802 euros in the "no-test strategy" to 560 euros in the spIgE "test strategy". Cost savings persisted even after assumptions about the prevalence of allergy and the prices of medications were changed. The "test strategy" increased the percentage of patients correctly diagnosed from 54 to 87%. Conclusions spIgE testing of children with respiratory and/or skin problems in primary care in Italy reduces overall costs to society. These cost savings mostly result from a reduction in the use of medications, particularly corticosteroids. The study indicates that spIgE testing of all children with respiratory and/or skin symptoms would be a cost-effective strategy. PMID:20836868

  5. Burnout syndrome in professionals of the primary healthcare network in Aracaju, Brazil.

    PubMed

    Silva, Salvyana Carla Palmeira Sarmento; Nunes, Marco Antonio Prado; Santana, Vanessa Rocha; Reis, Francisco Prado; Machado Neto, José; Lima, Sonia Oliveira

    2015-10-01

    The Burnout Syndrome (SB) stems from the chronic emotional stress experienced by the worker, characterized by emotional exhaustion, depersonalization and low personal accomplishment. May involve professionals whose work relates directly to the public. Aims to assess the prevalence of SB and associated factors in higher education professionals, linked to the Primary Care Network Health in the city of Aracaju / SE, who answered the sociodemographic questionnaire and the Maslach Inventory for Burnout. The average age was 44.9 years, most nurses, women, married with children and graduate. The prevalence of SB was 6.7% to 10.8%, associated factors were younger age, excessive hours of work and job dissatisfaction. There was no difference between the categories evaluated and the majority does not have the SB. However, 54.1% had a high and moderate risk of developing this syndrome, reflecting a process of illness that threatens the welfare of top-level professionals from the Primary Care Network Health Aracaju - SE. These findings point to the importance of adopting preventive and interventional measures as collateral for a better working environment. PMID:26465844

  6. [Use of evaluation by primary healthcare managers: a case study in southern Brazil].

    PubMed

    Nickel, Daniela Alba; Natal, Sonia; Hartz, Zulmira Maria de Araújo; Calvo, Maria Cristina Marino

    2014-12-01

    This article reports on a meta-evaluation, focused on utilization, in a state in southern Brazil. This was a single case study with primary data collection using semi-structured interviews with health department administrators and staff. Content analysis used categories defined in the evaluation matrix: political and organizational context and implementation of evaluation. The political and organizational context revealed weaknesses in the items on experience, evaluation team, and time and space for reflection. Technical autonomy was verified in the State and in one municipality. In the implementation of evaluation, evaluative quality met the established criteria, but there was no prior definition of the uses and users of evaluation. One report referred to use for planning actions and political use. The study concluded that evaluation produced important information for stakeholders, with the political and organizational context as the principal limiting factor for use. PMID:26247991

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

    PubMed

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

    2016-02-01

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

  8. Longitudinal cohort study describing persistent frequent attenders in Australian primary healthcare

    PubMed Central

    Pymont, Carly; Butterworth, Peter

    2015-01-01

    Objectives To describe patterns of frequent attendance in Australian primary care, and identify the prospective risk factors for persistent frequent attendance. Design, setting and participants This study draws on data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study of residents from the Canberra region of Australia. Participants were assessed on 3 occasions over 8 years. The survey assessed respondents’ experience of chronic physical conditions, self-reported health, symptoms of common mental disorders, personality, life events, sociodemographic characteristics and self-reported medication use. A balanced sample was used in analysis, comprising 1734 respondents with 3 waves of data. The survey data for each respondent were individually linked to their administrative health service use data which were used to generate an objective measure of general practitioner (GP) consultations in the 12 months surrounding their interview date. Main outcome measures Respondents in the (approximate) highest decile of attenders on number of GP consultations over a 12-month period at each time point were defined as frequent attenders (FAs). Results Baseline FAs (8.4%) were responsible for 33.4% of baseline consultations, while persistent FAs (3.6%) for 15.5% of all consultations over the 3 occasions. While there was considerable movement between FA status over time, consistency was greater than expected by chance alone. While there were many factors that differentiated non-FAs from FAs in general, persistent frequent attendance was specifically associated with gender, baseline reports of depression, self-reported physical conditions and disability, and medication use. Conclusions The degree of persistence in GP consultations was limited. The findings of this study contribute to our understanding of the risk factors that predict subsequent persistent frequent attendance in primary care. However, further detailed

  9. Autochthonous Minority Languages in Public-Sector Primary Education: Bilingual Policies and Politics in Brittany and Scotland

    ERIC Educational Resources Information Center

    Rogers, Vaughan; McLeod, Wilson

    2006-01-01

    This paper examines the relationship between policy and politics in relation to the development of public-sector primary education through Breton and Gaelic, considering closely the patterns of power through which such provision is delivered. Brittany and Scotland present many similarities as culturally distinctive territories, contained within…

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

    PubMed Central

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

    2016-01-01

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

  11. Primary healthcare worker knowledge related to prenatal and immediate newborn care: a cross sectional study in Masindi, Uganda

    PubMed Central

    2014-01-01

    Background Global neonatal mortality remains unacceptably high. Health workers who attend to prenatal and postnatal mothers need to be knowledgeable in preventive and curative care for pregnant women and their newborn babies. This study aimed to determine the level of knowledge related to prenatal and immediate newborn care among primary healthcare workers in Masindi, Uganda. Methods A cross-sectional study was conducted. Interviews comprised of 25 multiple-choice questions were administered to health workers who were deployed to offer prenatal and postnatal care in Masindi in November 2011. Questions were related to four domains of knowledge: prenatal care, immediate newborn care, management of neonatal infections and identifying and stabilizing Low-Birth Weight (LBW) babies. Corresponding composite variables were derived; level of knowledge among health workers dichotomized as ‘adequate’ or ‘inadequate’. The chi-square statistic test was used to examine associations with independent variables including level of training (nursing assistant, general nurse or midwife), level of care (hospital/health centre level IV or health centre level III/II) and years of service (five years or less, six years or more). Results 183 health workers were interviewed: general nurses (39.3%), midwives (21.9%) and nursing assistants (38.8%). Respectively, 53.6%, 46.5%, 7.1% and 56.3% were considered to have adequate knowledge in prenatal care, newborn care, management of neonatal infections and identifying/stabilizing LBW babies. Being a general nurse was significantly associated with having adequate knowledge in identifying and stabilizing LBW babies (p < 0.001) compared to being a nursing assistant. Level of care being hospital/health centre level IV was not significantly associated with having adequate knowledge in prenatal or newborn care with reference to health centres of level III/II. Conclusion Knowledge regarding prenatal and newborn care among primary healthcare

  12. Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols. A prospective randomized study.

    PubMed

    Soegaard, Rikke; Christensen, Finn B; Lauerberg, Ida; Lauersen, Ida; Bünger, Cody E

    2006-05-01

    Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patient-articulated demands to the primary health care sector following lumbar spinal fusion and three different in-hospital rehabilitation regimens in a prospective, randomized study with a 2-year follow-up. Ninety patients were randomized 3 months post lumbar spinal fusion to either a 'video' group (one-time oral instruction by a physiotherapist and patients were then issued a video for home exercise), or a 'café' group (video regimen with the addition of three café meetings with other fusion-operated patients) or a 'training' group (exercise therapy; physiotherapist-guided; two times a week for 8 weeks). Register data of service utilization in the primary health care sector were collected from the time of randomization through 24 months postsurgery. Costs of in-hospital protocols were estimated and the service utilization in the primary health care sector and its cost were analyzed. A significant difference (P=0.023) in number of contacts was found among groups at 2-year follow-up. Within the periods of 3-6 months and 7-12 months postoperatively, the experimental groups required less than half the amount of care within the primary health care sector as compared to the video group (P=0.001 and P=0.008). The incremental costs of the café regimen respectively, the training regimen were compensated by cost savings in the primary health care sector, at ratios of 4.70 (95% CI 4.64; 4.77) and 1.70 (95% CI 1.68; 1.72). This study concludes that a low-cost biopsychosocial rehabilitation regimen significantly reduces service utilization in the primary health care sector as compared to the usual regimen and a training exercise regimen. The results stress the importance of a cognitive

  13. Aging and primary care: an overview of organizational and behavioral issues in the delivery of healthcare services to older Americans.

    PubMed Central

    Sofaer, S

    1998-01-01

    An overview of (1) key trends shaping the healthcare environment and market; (2) ways in which these environmental trends are reflected in changes in the organization and delivery of healthcare; (3) the implications of environmental and organizational changes for older Americans; and (4) the research issues that can be addressed using organizational and behavioral theories. This introductory article sets the healthcare scene for the articles that follow. PMID:9618673

  14. Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector

    PubMed Central

    2013-01-01

    Background Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. Methods An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers’ knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. Results The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer’s costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic

  15. The significance of socially-assigned ethnicity for self-identified Māori accessing and engaging with primary healthcare in New Zealand.

    PubMed

    Reid, Jennifer; Cormack, Donna; Crowe, Marie

    2016-03-01

    Despite increased focus in New Zealand on reducing health inequities between Māori and New Zealand European ethnic groups, research on barriers and facilitators to primary healthcare access for Māori remains limited. In particular, there has been little interrogation of the significance of social-assignment of ethnicity for Māori in relation to engagement with predominantly non-Māori primary healthcare services and providers. A qualitative study was undertaken with a subsample (n = 40) of the broader Hauora Manawa Study to examine experiences of accessing and engaging with primary healthcare among adult urban Māori. Thematic analysis of in-depth interviews identified that participants perceived social-assignment as New Zealand European as an efficacious form of capital when interacting with predominantly non-Māori health professionals. Skin colour that was 'white' or was perceived to identify Māori as belonging to the 'dominant' New Zealand European ethnic group was reported as broadly advantageous and protective. In contrast, social-assignment as Māori was seen to be associated with risk of exposure to differential and discriminatory healthcare. Reducing the negative impacts of racialisation in a (neo)colonial society where 'White' cultural capital dominates requires increased recognition of the health-protective advantages of 'White' privilege and concomitant risks associated with socially-assigned categorisation of ethnicity as non-'White'. PMID:25645659

  16. Primary gastrointestinal lymphomas - A study of 81 Cases from a Tertiary Healthcare Centre.

    PubMed

    Shirsat, H S; Vaiphei, K

    2014-01-01

    Purpose: Retrospective analysis of 81 routinely diagnosed gastrointestinal (GI) lymphoma to illustrate clinicopathological and immunohistochemical characteristics with predisposing condition. Materials and Methods: Age, sex, site, tumour stage, associated pathological features like lympho-epithelial lesion (LEL), atrophic gastritis (AG), intestinal metaplasia (IM) and enteropathy changes were analysed. Requisite immunohistochemical panel was applied wherever needed. Results: There were 55 male and 26 female patients with median age of 54.5 years. Site wise distributions were stomach 40, small intestine 22, colon 4, cecum 2, ileocecum 3, esophagus 1 and multiple sites 9. Histological subtypes were mucosa associated lymphoid tissue lymphoma (MALTOMA) 48, diffuse large B cell lymphoma (DLBL) 21, T cell lymphoma 9 [5 anaplastic large cell lymphoma (ALCL) and 4 enteropathy associated T cell lymphoma (EATL)], immunoproliferative small intestinal disease (IPSID) 2 and follicular lymphoma 1. LEL was present in 31 cases. Of the 19 AG, 8 had associated IM, and 1 case each had associated H Pylori infection and neuroendocrine tumor. Enteropathy was observed in 4 EATL, and one case each of DLBL and high grade MALTOMA. Giardia infection was present in 1 low grade duodenal MALTOMA. Of the 24 resected specimens, 16 were stage IE, 7 stage IIE and 1 stage IV (Mushoff's staging). Conclusion: Primary GI lymphoma was frequently observed in 6 th decade of life with male preponderance. Stomach was the commonest site and high grade MALTOMA being the commonest histological variant. Isolated colonic involvement and intestinal perforations were not infrequent. Rare variants like ALCL and follicular lymphomas were also observed. PMID:25494124

  17. Educational resources used by medical students in primary healthcare rotation: A cross sectional study

    PubMed Central

    Al-Hazmi, Ali

    2016-01-01

    Objective: To identify what educational resources are used by medical students for their personal study during Primary health care (PHC) clinical rotation and the reasons for making these choices at King Saud University in Riyadh, Saudi Arabia. Methods: A survey of 176 male and female medical students was conducted during PHC rotation. A self-administered questionnaire ascertained the type of educational source with reason and preferred type of teaching method. Responses by male and female students were compared by using Pearson’s Chi-square tests. Results: Of the 176 students, 85.8% used handouts, 77.3% used the internet, and 46.6% used textbooks. Of the three types of resources, 14.8% used one, 31.8% used all three sources, and 53.4% used two sources. Reasons for selecting a resource were; educational materials are up to the point (88.6%), convenient (85.2%), reliable (77.3%) fit the learning style (77.3%), exam focus (60.8%), recommended by seniors (57.4%), recommended by department (56.8%). The preferred teaching method was lecture (79.5%), and least preferred was student presentations (55.1%). Female medical students used internet related material greater than the males (86.9% versus 68.5%; p value <0.001), and tended to utilize more than one educational resource than male students. Conclusion: Medical students used multiple resources for relevance and convenience. Female students used network resources more than male students. PMID:27182240

  18. LIS-lnterlink-connecting laboratory information systems to remote primary health-care centres via the Internet.

    PubMed

    Clark, B; Wachowiak, B; Crawford, E W; Jakubowski, Z; Kabata, J

    1998-01-01

    A pilot study was performed to evaluate the feasibility of using the Internet to securely deliver patient laboratory results, and the system has subsequently gone into routine use in Poland. The system went from design to pilot and then to live implementation within a four-month period, resulting in the LIS-Interlink software product. Test results are retrieved at regular intervals from the BioLink(TM) LIS (Laboratory Information System), encrypted and transferred to a secure area on the Web server. The primary health-care centres dial into the Internet using a local-cell service provided by Polish Telecom (TP), obtain a TCP/IP address using the TP DHCP server, and perform HTTP 'get' and 'post' operations to obtain the files by secure handshaking. The data are then automatically inserted into a local SQL database (with optional printing of incoming reports)for cumulative reporting and searching functions. The local database is fully multi-user and can be accessed from different clinics within the centres by a variety of networking protocols. PMID:18924820

  19. [Primary healthcare: a multidimensional study on challenges and potential in the São Paulo Metropolitan Region (SP, Brazil)].

    PubMed

    Heimann, Luiza Sterman; Ibanhes, Lauro Cesar; Boaretto, Roberta Cristina; Castro, Iracema Ester do Nascimento; Telesi Júnior, Emilio; Cortizo, Carlos Tato; Fausto, Márcia Cristina Rodrigues; do Nascimento, Vânia Barbosa; Kayano, Jorge

    2011-06-01

    This paper presents some results of a case study in the Metropolitan Region of São Paulo (SP, Brazil) as part of a multicentric study conducted in Argentina, Brazil, Paraguay and Uruguay. The aim is to evaluate Primary Health Care (PHC) as a strategy to achieve integrated and universal healthcare systems. The methodological approach was based on five analytical dimensions: stewardship capability; financing; provision; comprehensiveness and intersectoral approach. The techniques included literature review, document analysis and interviews with key informants: policy makers; managers, experts, users and professionals. The results were organized in response to the challenges and possibilities of PHC as a structural system according to the five dimensions. The following emerged from the interviews: different interpretations on the concept and role of PHC and a consensus as the gateway to the system; weaknesses in funding; challenges in health workforce administration and the need for new legal-institutional design for regional management. The potential aspects were: broader coverage/universality, PHC as the basis for the organization of the system; connection with the territory and understanding specific population needs. PMID:21709984

  20. Validation of an instrument to assess factors associated with adherence to standard precautions among dentists in primary healthcare.

    PubMed

    Ribeiro, Patrícia H V; Gir, Elucir; Santos, Claudia B; Ribeiro, Renata P; Hayashida, Miyeko; Malaguti-Toffano, Silmara E; da Silva, Adriana M

    2014-01-01

    Accidents with biological material are a reality in dental practice. The use of preventive measures such as the adoption of Standard Precautions (SP) is essential, thus this study aims to validate an instrument to check factors associated with adherence to SP among dentists. The scales of psychosocial and organizational factors that influence adherence to SP were the starting point. These scales have already been nationally validated for doctors and nurses. The instrument consisted of 49 items divided into five dimensions. The process of instrument validation involved the following steps: its adaptation for situations that pose risks to dentists; content and semantic analysis by a committee of judges, and application to dentists. The adapted instrument was applied to 224 dentists who provided primary healthcare in the north region of Paraná State. After the application of scales, the psychometric properties were analyzed using the factor analysis technique and a reliability test. The factor analysis confirmed three domains: Obstacles to following standard precautions; Knowledge of occupational transmission of HIV and Safety climate. The reliability of the domains was considered adequate (Cronbach's alpha between 0.73 and 0.88.). The instrument demonstrated adequate psychometric properties to assess factors that influence adherence to SP among dentists. PMID:25335360

  1. Compilation and application of a primary PM 2.5 emissions inventory with high sectoral resolution in Japan

    NASA Astrophysics Data System (ADS)

    Sugiyama, Toshiharu; Nansai, Keisuke; Tohno, Susumu; Yamamoto, Kouhei

    To elucidate the macro-structure of the PM 2.5 emissions generated by Japan's economic activities, this paper presents an emission inventory of primary particles of PM 2.5 with high sectoral resolution based on the Japanese Input-Output Tables, comprising some 400 sectors. These primary PM 2.5 emissions were estimated by multiplying the estimated energy consumption associated with each fuel type by a PM 10 emission factor incorporating the technological level of dust collection in each sector and the mass ratio of PM 2.5 to PM 10. Non-energy emissions from agricultural open burning were also determined. Total PM 2.5 emissions in 2000 were 252 kt, 49% of which were due to mobile emission sources. Changes in total PM 2.5 emissions between 1990 and 2000 were also calculated. This showed that a substantial increase in energy sector emissions due to rising coal consumption was offset by a sharp decline in emissions from road vehicles and shipping vessels, resulting in an overall decrease in total emissions. In addition, the emissions induced by economic demand in each sector were quantified by means of input-output analysis, which revealed that demand for construction, foods and communications and services constituted the principal causes of real domestic emissions. An assessment of sectoral contributions to PM 2.5 emissions that takes into account the effects of human exposure, expressed as external costs, suggests that the contribution of transportation is greater than indicated on the grounds of direct emissions alone.

  2. Early Experience of the Contribution of an Information Specialist within a Primary Healthcare Team: A Partnership Venture between Library and Healthcare Services

    ERIC Educational Resources Information Center

    Wilson, Diane; Bateman, Hilarie; Bailey, Peter

    2004-01-01

    This article describes the early experience of an Information Officer appointed within a newly formed primary health care team in the new township of Cambourne, west of Cambridge. The post was jointly defined and funded through a partnership between Cambridgeshire Libraries, the Primary Care Trust and Monkfield Medical Practice. The article…

  3. Audit and comprehensive health assessment programme in the primary healthcare of adults with intellectual disability: a pilot study.

    PubMed

    Lennox, N G; Green, M; Diggens, J; Ugoni, A

    2001-06-01

    International research has demonstrated significant shortcomings in the health of adults with intellectual disability (ID). Because general practitioners (GPs) are the main providers of primary healthcare for this population, strategies to improve general practice care are an important aspect of rectifying these shortcomings. The present pilot study aimed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs, with a view to informing larger scale studies. The GPs were recruited through an earlier questionnaire-based postal survey. The GPs identified all their adult patients with ID, then obtained consent for participation from three patients randomly selected by the investigators. The GPs completed two self-evaluation forms and case note audits 12 months apart, read a synopsis of the relevant literature provided by the researchers, and completed a comprehensive health assessment (CHA) of their three patients. Forty-five GPs agreed to participate in the CHA programme (CHAP), and 15 completed the project. Thirty-eight patients completed the project. The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time. The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice. The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise. The CHAP appeared to provide a superior review process compared to the other interventions used in the present study. The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable. The CHAP served as a communication tool and an educative instrument, providing a basis for future studies and strategies to improve the general practice care of adults

  4. Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs

    PubMed Central

    2010-01-01

    Background Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such judgment. This study aimed to understand issues for primary care health practitioners in relation to prescription drug misuse (PDM), by exploring the attitudes and experiences of healthcare professionals with respect to PDM. Methods Tape-recorded interviews were conducted with a purposive sample of general practitioners (17), community pharmacists (16) and 'key experts' (18) in New Zealand. Interviews were transcribed verbatim and a thematic analysis undertaken. Participants were offered vouchers to the value of NZ$30 for their participation. Results A major theme that was identified was that of two different types of patients involved in PDM, as described by participants - the 'abuser' and the 'overuser'. The 'abuser' was believed to acquire prescription medicines through deception for their own use or for selling on to the illicit market, to use the drugs recreationally, for a 'high' or to stave off withdrawal from illicit drugs. 'Overusers' were characterised as having become 'addicted' through inadvertent overuse and over prescribing, and were generally viewed more sympathetically by practitioners. It also emerged that practitioners' attitudes may have impacted on whether any harm reduction interventions might be offered. Furthermore, whilst practitioners might be more willing to offer help to the 'over-user', it seemed that there is a lack of appropriate services for this group, who may also lack a peer support network. Conclusions A binary view of PDM may not be helpful in understanding the issues surrounding PDM, nor in providing appropriate interventions. There is a need for further exploration of 'over users’ whose needs may not be being met by mainstream drug services, and issues of stigma in relation to

  5. A Comparative Evaluation of Public Health Centers with Private Health Training Centers on Primary Healthcare Parameters in India: a Study by Data Envelopment Analysis Technique

    PubMed Central

    Davey, Sanjeev; Raghav, Santosh Kumar; Singh, Jai Vir; Davey, Anuradha; Singh, Nirankar

    2015-01-01

    Background: The evaluation of primary healthcare services provided by health training centers of a private medical college has not been studied in comparison with government health facilities in Indian context. Data envelopment analysis (DEA) is one such technique of operations research, which can be used on health facilities for identifying efficient operating practices and strategies for relatively efficient or inefficient health centers by calculating their efficiency scores. Materials and Methods: This study was carried out by DEA technique by using basic radial models (constant ratio to scale (CRS)) in linear programming via DEAOS free online Software among four decision making units (DMUs; by comparing efficiency of two private health centers of a private medical college of India with two public health centers) in district Muzaffarnagar of state Uttar Pradesh. The input and output records of all these health facilities (two from private and two from Government); for 6 months duration from 1st Jan 2014 to 1st July 2014 was taken for deciding their efficiency scores. Results: The efficiency scores of primary healthcare services in presence of doctors (100 vs 30%) and presence of health staff (100 vs 92%) were significantly better from government health facilities as compared to private health facilities (P < 0.0001). Conclusions: The evaluation of primary healthcare services delivery by DEA technique reveals that the government health facilities group were more efficient in delivery of primary healthcare services as compared to private training health facilities group, which can be further clarified in by more in-depth studies in future. PMID:26435598

  6. Visualizing desirable patient healthcare experiences.

    PubMed

    Liu, Sandra S; Kim, Hyung T; Chen, Jie; An, Lingling

    2010-01-01

    High healthcare cost has drawn much attention and healthcare service providers (HSPs) are expected to deliver high-quality and consistent care. Therefore, an intimate understanding of the most desirable experience from a patient's and/or family's perspective as well as effective mapping and communication of such findings should facilitate HSPs' efforts in attaining sustainable competitive advantage in an increasingly discerning environment. This study describes (a) the critical quality attributes (CQAs) of the experience desired by patients and (b) the application of two visualization tools that are relatively new to the healthcare sector, namely the "spider-web diagram" and "promotion and detraction matrix." The visualization tools are tested with primary data collected from telephone surveys of 1,800 patients who had received care during calendar year 2005 at 6 of 61 hospitals within St. Louis, Missouri-based, Ascension Health. Five CQAs were found by factor analysis. The spider-web diagram illustrates that communication and empowerment and compassionate and respectful care are the most important CQAs, and accordingly, the promotion and detraction matrix shows those attributes that have the greatest effect for creating promoters, preventing detractors, and improving consumer's likelihood to recommend the healthcare provider. PMID:20155554

  7. Medication regimen complexity in adults and the elderly in a primary healthcare setting: determination of high and low complexities

    PubMed Central

    Ferreira, Juliana M.; Galato, Dayani; Melo, Angelita C.

    2015-01-01

    Background: The complexity of a medication regimen is related to the multiple characteristics of the prescribed regimen and can negatively influence the health outcomes of patients. Objective: To propose cut-off points in the complexity of pharmacotherapy to distinguish between patients with low and high complexities seen in a primary health care (PHC) setting to enable prioritization of patient management. Methods: This is a cross-sectional study, which included 517 adult and elderly patients, analyzing different cut-off points to define the strata of low and high pharmacotherapy complexities based on percentiles of the population evaluated. Data collection began with the solicitation of prescriptions, followed by a questionnaire that was administered by an interviewer. The complexity of a medication regimen was estimated from the Medication Regimen Complexity Index (MRCI). High complexity pharmacotherapy scores were analyzed from patient profiles, the use of health services, and pharmacotherapy. The criteria for subject inclusion in the sample population were as follows: inhabitant of the area covered by the municipality, 18 years or older, and being prescribed at least one drug during the collection period. Exclusion criteria at the time of collection were the use of any medication whose prescription was not available. All medications were accessed through the Primary Healthcare Service (PHS). Results: The median total pharmacotherapy complexity score was 8.5. High MRCI scores were correlated with age, medications taken with in the Brazilian PHS, having at least one potential drug-related problem, receiving up to eight years of schooling, number of medications and polypharmacy (five or more medicines), number of medical conditions, number of medical appointments, and number of cardiovascular diseases and endocrine metabolic diseases. We suggest different complexity tracks according to age (e.g., adult or elderly) that consider the pharmacotherapy and population

  8. Attributes of patient-centered primary care associated with the public perception of good healthcare quality in Brazil, Colombia, Mexico and El Salvador.

    PubMed

    Doubova, Svetlana V; Guanais, Frederico C; Pérez-Cuevas, Ricardo; Canning, David; Macinko, James; Reich, Michael R

    2016-09-01

    This study evaluated primary care attributes of patient-centered care associated with the public perception of good quality in Brazil, Colombia, Mexico and El Salvador. We conducted a secondary data analysis of a Latin American survey on public perceptions and experiences with healthcare systems. The primary care attributes examined were access, coordination, provider-patient communication, provision of health-related information and emotional support. A double-weighted multiple Poisson regression with robust variance model was performed. The study included between 1500 and 1503 adults in each country. The results identified four significant gaps in the provision of primary care: not all respondents had a regular place of care or a regular primary care doctor (Brazil 35.7%, Colombia 28.4%, Mexico 22% and El Salvador 45.4%). The communication with the primary care clinic was difficult (Brazil 44.2%, Colombia 41.3%, Mexico 45.1% and El Salvador 56.7%). There was a lack of coordination of care (Brazil 78.4%, Colombia 52.3%, Mexico 48% and El Salvador 55.9%). Also, there was a lack of information about healthy diet (Brazil 21.7%, Colombia 32.9%, Mexico 16.9% and El Salvador 20.8%). The public's perception of good quality was variable (Brazil 67%, Colombia 71.1%, Mexico 79.6% and El Salvador 79.5%). The primary care attributes associated with the perception of good quality were a primary care provider 'who knows relevant information about a patient's medical history', 'solves most of the health problems', 'spends enough time with the patient', 'coordinates healthcare' and a 'primary care clinic that is easy to communicate with'. In conclusion, the public has a positive perception of the quality of primary care, although it has unfulfilled expectations; further efforts are necessary to improve the provision of patient-centered primary care services in these four Latin American countries. PMID:26874326

  9. 'There's only one enabler; come up, help us': staff perspectives of barriers and enablers to continuous quality improvement in Aboriginal primary health-care settings in South Australia.

    PubMed

    Newham, Jo; Schierhout, Gill; Bailie, Ross; Ward, Paul R

    2016-01-01

    This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding. PMID:25719603

  10. Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study

    PubMed Central

    Abdulhadi, Nadia; Al-Shafaee, Mohammed Ali; Östenson, Claes-Göran; Vernby, Åsa; Wahlström, Rolf

    2006-01-01

    Background A good patient-physician interaction is particularly important in chronic diseases like diabetes. There are so far no published data regarding the interaction between the primary health-care providers and patients with type 2 diabetes in Oman, where diabetes is a major and growing health problem. This study aimed at exploring how health-care providers interact with patients with type 2 diabetes at primary health-care level in Muscat, Oman, focusing on the consultation environment, and some aspects of care and information. Methods Direct observations of 90 consultations between 23 doctors and 13 diabetes nurses concerned with diabetes management during their consultations with type 2 diabetes patients in six primary health-care centres in the Muscat region, using checklists developed from the National Diabetes Guidelines. Consultations were assessed as optimal if more than 75% of observed aspects were fulfilled and sub-optimal if less than 50% were fulfilled. Results Overall 52% of the doctors' consultations were not optimal. Some important aspects for a positive consultation environment were fulfilled in only about half of the doctors' consultations: ensuring privacy of consultation (49%), eye contact (49%), good attention (52%), encouraging asking questions (47%), and emphasizing on the patients' understanding of the provided information (52%). The doctors enquired about adverse effects of anti-diabetes drugs in less than 10% of consultations. The quality of the nurses' consultations was sub-optimal in about 75% of 85 consultations regarding aspects of consultation environment, care and information. Conclusion The performance of the primary health-care doctors and diabetes nurses needs to be improved. The role of the diabetes nurses and the teamwork should be enhanced. We suggest a multidisciplinary team approach, training and education to the providers to upgrade their skills regarding communication and care. Barriers to compliance with the guidelines

  11. Adoption of Innovation from the Business Sector by Post-Primary Education Organizations

    ERIC Educational Resources Information Center

    Hazzan, Orit; Zelig, Dafna

    2016-01-01

    Business organizations adopt innovation with the objective of meeting competition and improving their business performance; education organizations, likewise, operate in a competitive environment, are evaluated by stakeholders, and adopt innovation. The research presented here links these two sectors; its objective was to characterize the process…

  12. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

    PubMed Central

    Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F.

    2015-01-01

    Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. Purpose To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. Methods This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman’s rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Results Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to

  13. Integration of mental health into primary care in low- and middle-income countries: the PRIME mental healthcare plans

    PubMed Central

    Lund, Crick; Tomlinson, Mark; Patel, Vikram

    2016-01-01

    This supplement outlines the development and piloting of district mental healthcare plans from five low- and middle-income countries, together with the methods for their design, evaluation and costing. In this editorial we consider the challenges that these programmes face, highlight their innovations and draw conclusions. PMID:26447177

  14. The relevance of unrelated costs internal and external to the healthcare sector to the outcome of a cost-comparison analysis of secondary prevention: the case of general colorectal cancer screening in the German population.

    PubMed

    Tscheulin, Dieter K; Drevs, Florian

    2010-04-01

    The potential of secondary prevention measures, such as cancer screening, to produce cost savings in the healthcare sector is a controversial issue in healthcare economics. Potential savings are calculated by comparing treatment costs with the cost of a prevention program. When survivors' subsequent unrelated health care costs are included in the calculation, however, the overall cost of disease prevention rises. What have not been studied to date are the secondary effects of fatal disease prevention measures on social security systems. From the perspective of a policy maker responsible for a social security system budget, it is not only future healthcare costs that are relevant for budgeting, but also changes in the contributions to, and expenditures from, statutory pension insurance and health insurance systems. An examination of the effect of longer life expectancies on these insurance systems can be justified by the fact that European social security systems are regulated by the state, and there is no clear separation between the financing of individual insurance systems due to cross-subsidisation. This paper looks at how the results of cost-comparison analyses vary depending on the inclusion or exclusion of future healthcare and non-healthcare costs, using the example of colorectal cancer screening in the German general population. In contrast to previous studies, not only are future unrelated medical costs considered, but also the effects on the social security system. If a German colorectal cancer screening program were implemented, and unrelated future medical care were excluded from the cost-benefit analysis, savings of up to 548 million euros per year would be expected. The screening program would, at the same time, generate costs in the healthcare sector as well as in the social security system of 2,037 million euros per year. Because the amount of future contributions and expenditures in the social security system depends on the age and gender of the

  15. Why healthcare providers merge.

    PubMed

    Postma, Jeroen; Roos, Anne-Fleur

    2016-04-01

    In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities. PMID:26055501

  16. Work related characteristics, work-home and home-work interference and burnout among primary healthcare physicians: A gender perspective in a Serbian context

    PubMed Central

    2011-01-01

    Background Little information exists on work and stress related health of medical doctors in non-EU countries. Filling this knowledge gap is needed to uncover the needs of this target population and to provide information on comparability of health related phenomena such as burnout across countries. This study examined work related characteristics, work-home and home-work interference and burnout among Serbian primary healthcare physicians (PHPs) and compared burnout levels with other medical doctors in EU countries. Methods Data were collected via surveys which contained Maslach Burnout Inventory and other validated instruments measuring work and home related characteristics. The sample consisted of 373 PHPs working in 12 primary healthcare centres. Data were analysed using t-tests and Chi square tests. Results No gender differences were detected on mean scores of variables among Serbian physicians, who experience high levels of personal accomplishment, workload, job control and social support, medium to high levels of emotional exhaustion, medium levels of depersonalisation and work-home interference, and low levels of home-work interference. There were more women than men who experienced low job control and high depersonalisation. Serbian physicians experienced significantly higher emotional exhaustion and lower depersonalisation than physicians in some other European countries. Conclusions To diminish excessive workload, the number of physicians working in primary healthcare centres in Serbia should be increased. Considering that differences between countries were detected on all burnout subcomponents, work-related interventions for employees should be country specific. The role of gender needs to be closely examined in future studies as well. PMID:21943328

  17. Trends in number of consultations and antibiotic prescriptions for respiratory tract infections between 1999 and 2005 in primary healthcare in Kalmar County, Southern Sweden

    PubMed Central

    Neumark, Thomas; Brudin, Lars; Engström, Sven; Mölstad, Sigvard

    2009-01-01

    Background Respiratory tract infections (RTIs) comprise the most common indication for consulting a general practitioner and obtaining an antibiotic prescription. Objective To study changes in the number of visits, diagnoses, and antibiotic prescriptions for RTI in primary healthcare during the period 1999–2005. Design A retrospective, descriptive, population-based study of electronic patient records. Setting County of Kalmar in southeastern Sweden. Patients Patients visiting primary healthcare units in Kalmar County for an RTI between 1 July 1999 and 31 December 2005. Main outcome measures. RTI diagnoses, antibiotic prescriptions, age groups. Results A total of 240 447 visits for RTI made between 1999 and 2005 were analysed. The yearly consultation rates for the diagnoses acute tonsillitis and AOM decreased by 12% and 10%, respectively (p = 0.001). Of all patients consulting for an RTI diagnosis, 45% received antibiotics. Of all prescribed antibiotics, 60% were for phenoxymethylpenicillin (PcV) and 18% doxycycline. Amoxicillin or amoxicillin + clavulanic acid was prescribed to a lesser extent. The proportion of patients obtaining an antibiotic prescription was almost constant over time (44–46%). The prescriptions of doxycycline showed increasing values (NS). The prescriptions of remaining antibiotics decreased significantly especially for patients up to middle age. Conclusion This large population study, comprising more than six years of observations, showed the number of primary healthcare patients receiving an RTI diagnosis decreased during the period 1999–2005, but the proportion of patients receiving an antibiotic prescription remained the same. The large seasonal variations indicate a need for further interventions to decrease antibiotic use for RTIs. PMID:19085427

  18. Health-care utilization for primary headache disorders in China: a population-based door-to-door survey

    PubMed Central

    2013-01-01

    Background In order to know the status quo of health care for primary headache disorders in China, questions about headache consultation and diagnosis were included in a nationwide population-based survey initiated by Lifting The Burden: the Global Campaign against Headache. Methods Throughout China, 5,041 unrelated respondents aged 18–65 years were randomly sampled from the general population and visited unannounced at their homes. After basic sociodemographic and headache diagnostic questions, respondents with headache answered further questions about health-care utilization in the previous year. Results Significantly higher proportions of respondents with migraine (239/452; 52.9%) or headache on ≥15 days per month (23/48; 47.9%) had consulted a physician for headache than of those with tension-type headache (TTH) (218/531; 41.1%; P < 0.05). Multivariate analysis showed associations between disability and probability of consultation in those with migraine (mild vs. minimal: AOR 3.4, 95% CI: 1.6–7.4; moderate vs. minimal: 2.5, 1.2–5.4; severe vs. minimal: 3.9, 1.9–8.1) and between rural habitation and probability of consulting in those with TTH (AOR: 3.5; 95% CI: 1.9–6.3, P < 0.001). Married respondents with TTH were less likely than unmarried to have consulted (AOR: 0.26; 95% CI: 0.07–0.93; P = 0.038). About half of consultations (47.8–56.5%) for each of the headache disorders were at clinic level in the health system. Consultations in level-3 hospitals were relatively few for migraine (5.9%) but more likely for headache on ≥15 days/month (8.7%) and, surprisingly, for TTH (13.3%). Under-diagnosis and misdiagnosis were common in consulters. More than half with migraine (52.7%) or headache on ≥15 days/month (51.2%), and almost two thirds (63.7%) with TTH, reported no previous diagnosis. Consulters with migraine were as likely (13.8%) to have been diagnosed with “nervous headache” as with migraine. “Nervous headache” (9

  19. Increased utilisation of primary healthcare in persons exposed to severe stress in prenatal life: a national population-based study in Denmark

    PubMed Central

    Li, Jiong; Yang, Hu; Guldin, Mai-Britt; Vedsted, Peter; Vestergaard, Mogens

    2015-01-01

    Objective Recent studies have suggested that stress in a pregnant mother may affect the future health of the unborn child negatively. An excellent proxy for health problems is the use of healthcare resources. Using nationwide data, we examined whether persons born to mothers who lost a close relative during pregnancy have more contacts to general practice. Design Population-based cohort study. Setting Denmark. Participants We included all children born in Denmark from 1973 to 2002 (N=2 032 528). Exposure of prenatal stress was defined as maternal bereavement by the death of a close relative during the antenatal period. The outcome of interest was contact with general practice between 2003 and 2009 when the participants were between 1 and 35 years of age. Poisson regression was used to assess the association between exposure and outcome. Outcome measures Contacts to general practitioner. Results Overall, persons exposed to prenatal stress had 2% more GP contacts than those not exposed, primarily due to increased utilisation of healthcare services during late adolescence and early adulthood. The exposed persons born to mothers who had lost a spouse had a higher risk (relative risk (RR) 1.12, 95% CI 1.10 to 1.14) and so did those born to mothers who had lost a close relative due to unexpected death (RR 1.06, 95% CI 1.05 to 1.06). Exposed persons had more contacts to general practice in daytime and more psychometric tests, talk therapies and C reactive protein tests than unexposed persons. Conclusions Prenatal stress following maternal bereavement was associated with a slightly increased utilisation of primary healthcare, mainly due to increased healthcare needs related to mental health and infections. Understanding how stress during pregnancy influences the future health of the child is an important aspect of prenatal care. PMID:25573520

  20. How to change organisational culture: Action research in a South African public sector primary care facility

    PubMed Central

    De Sa, Angela; Christodoulou, Maria

    2016-01-01

    Background Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision. Aim To explore how to transform the organisational culture in line with the desired values. Setting Retreat Community Health Centre, Cape Town, South Africa. Methods Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA) survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA) and had 6 months of coaching. Results Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability. Conclusion Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group. PMID:27608671

  1. Unregulated access to health-care services is associated with overutilization—lessons from Austria

    PubMed Central

    Maier, Manfred

    2015-01-01

    The Austrian health-care system is characterized by free provider choice and uncontrolled access to all levels of care. Using primary data, the ECOHCARE study shows that hospitalization rates for the secondary and tertiary care levels in Austria are both 4.4 times higher than those reported from the USA using a similar methodology. At the same time, essential functions of the primary care sector are weak. We propose that regulating access to secondary and tertiary care and restricting free provider choice to the primary care level would both reverse over utilization and strengthen the primary care sector. PMID:25417940

  2. [Healthcare value chain: a model for the Brazilian healthcare system].

    PubMed

    Pedroso, Marcelo Caldeira; Malik, Ana Maria

    2012-10-01

    This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information. PMID:23099762

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

    PubMed Central

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

    2016-01-01

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

  4. Use of community-based participatory research in primary care to improve healthcare outcomes and disparities in care

    PubMed Central

    Tapp, Hazel; White, Lauren; Steuerwald, Mark; Dulin, Michael

    2014-01-01

    Community-based participatory research (CBPR) has emerged to bridge the gap between research and primary-care practice through community engagement and social action to increase health equity. It is widely acknowledged that access to high-quality primary care services is important to the overall health of a community. Here, CBPR studies in a primary care setting are reviewed to assess the use of CBPR associated with common health problems seen in primary care such as access to care and disparities in chronic disease management across vulnerable populations. CBPR involves building relationships with local communities, determining areas of need and establishing priorities for health concerns. Studies showing improved access to care for a Hispanic population, reduced asthma symptoms and weight loss are highlighted. PMID:24236682

  5. [Conceptions and typology of conflicts between workers and managers in the context of primary healthcare in the Brazilian Unified National Health System (SUS)].

    PubMed

    Carvalho, Brígida Gimenez; Peduzzi, Marina; Ayres, José Ricardo de Carvalho Mesquita

    2014-07-01

    This study aimed to analyze perceptions of conflict between workers and managers in primary healthcare units and to present a typology of conflicts on the job. This was a comprehensive interpretive case study with a critical hermeneutic approach. Data collection techniques included: focus group with managers, workplace observation, and worker interviews, conducted from April to November 2011. The results were triangulated and indicated the coexistence of distinct concepts of conflict, typified in six modalities: lack of collaboration at work; disrespect resulting from asymmetrical relations between workers; problematic employee behavior; personal problems; asymmetry with other management levels; and inadequate work infrastructure. The relevance of (non)mutual recognition, as proposed by Axel Honneth, stood out in the interpretation of the causes and practical implications of these conflicts. PMID:25166942

  6. Enhancing decolonization and knowledge transfer in nursing research with non-western populations: examining the congruence between primary healthcare and postcolonial feminist approaches.

    PubMed

    Racine, Louise; Petrucka, Pammla

    2011-03-01

    This article is a call for reflection from two distinct programs of research which converge on common interests pertaining to issues of health, social justice, and globalization. One of the authors has developed a research program related to the health and well-being of non-western populations, while the other author has expanded the field of Aboriginal and international research in Canada and abroad. Based on examples drawn from our respective programs of research, we suggest conciliating the philosophy of primary healthcare to postcolonial feminism for decolonizing research and enhancing knowledge transfer with non-western populations. We contend that applying the theoretical and methodological strengths of these two approaches is a means to decolonize nursing research and to avoid western neocolonization. In conciliating primary health care and postcolonial feminism, the goal is to enhance the pragmatic relevance of postcolonial feminism to generate resistance through transformative research for achieving social justice. In tapping into the synergistic and complementary epistemological assumptions of the philosophy of primary health care and postcolonial 'feminisms', nurse researchers reinforce the anti-oppresive goals of postcolonial feminist research. Consequently, this approach may enhance both decolonization and knowledge transfer through strategies like photovoice. PMID:21281391

  7. A primary healthcare approach to the management of chronic disease in Ethiopia: an example for other countries.

    PubMed

    Mamo, Yoseph; Seid, Etalem; Adams, Sarah; Gardiner, Amy; Parry, Eldryd

    2007-06-01

    Chronic non-communicable diseases such as epilepsy, diabetes, cardiac disease and hypertension represent a growing but neglected burden in developing countries. Rural sufferers, distant from health facilities, bear this most acutely. In response, a community care programme has been developed at Jimma University Hospital and its allied health centres in rural southwest Ethiopia. This involves general duty nurses at rural health centres being trained to provide care for chronic disease patients, with regular supervision from the hospital physicians. The programme allows treatment to be provided away from the main hospital so that those who cannot afford to travel can access care near their homes. Improved access increases the request for care, and helps to address the large unmet need for chronic disease treatment. This is a good model in which rural healthcare delivery through a team can bring widespread benefit. In this article chronic disease care is discussed with a particular focus on diabetes and epilepsy. The model can be replicated in more or less developed countries and may also be relevant for HIV care. PMID:17633941

  8. SOA governance in healthcare organisations.

    PubMed

    Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilakopoulos, Georgios

    2013-01-01

    Service Oriented Architecture (SOA) is increasingly adopted by many sectors, including healthcare. Due to the nature of healthcare systems there is a need to increase SOA adoption success rates as the non integrated nature of healthcare systems is responsible for medical errors that cause the loss of tens of thousands patients per year. Following our previous research [1] we propose that SOA governance is a critical success factor for SOA success in healthcare. Literature reports multiple SOA governance models that have limitations and they are confusing. In addition to this, there is a lack of healthcare specific SOA governance models. This highlights a literature void and thus the purpose of this paper is to proposed a healthcare specific SOA governance framework. PMID:23823423

  9. Electronic Health Records and Information Portability: A Pilot Study in a Rural Primary Healthcare Center in India

    PubMed Central

    Radhakrishna, Kedar; Goud, B. Ramakrishna; Kasthuri, Arvind; Waghmare, Abijeet; Raj, Tony

    2014-01-01

    Clinical documentation and health information portability pose unique challenges in urban and rural areas of India. This article presents findings of a pilot study conducted in a primary health center in rural India. In this article, we focus on primary care in rural India and how a portable health record system could facilitate the availability of medical information at the point of care. We followed a geriatric cohort and a maternal cohort of 308 participants over a nine-month period. Physician encounters were entered into a web-based electronic health record. This information was made available to all study participants through a short messaging service (SMS). Additionally, 135 randomly selected participants from the cohort were issued a USB-based memory card that contained their detailed health records and could be viewed on most computers. The dual portability model implemented in the pilot study demonstrates the utility of the concept. PMID:25214819

  10. The promotion of private health insurance and its implications for the social organisation of healthcare: a case study of private sector obstetric practice in Chile.

    PubMed

    Murray, Susan F; Elston, Mary Ann

    2005-09-01

    This paper examines some of the implications of the process of privatisation of a national healthcare system for the delivery, organisation and, ultimately, the outcome of services. Through a case study of obstetric care in Chile, we illuminate the relationships between the macro-level of political decisions, the meso-level of the organisations through which government reforms were enacted, and the micro-level of clinical practice. We show that, for a significant proportion of Chilean women seeking maternity care, privatisation has led to expanded access and to ostensibly highly-personalised relationships with specialists. However, because of the fragmentation of maternity services, the altered work patterns for obstetricians occasioned by changes in healthcare financing and the relatively weak market position of most obstetricians, this personalised care is dependent on highly technologised obstetric practices. By examining the specific organisational arrangements under which private maternity care is conducted in Chile we shed light on the connection between privately-funded maternity care and high caesarean section rates in this setting. PMID:16283895