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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.

  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.

  3. Healthcare and Social Assistance Sector (NAICS 62)

    EPA Pesticide Factsheets

    Environmental regulations and information for the Healthcare sector, including doctor's offices, hospitals, and medical laboratories. Includes information about dental amalgam wastewater, sterilizers, and medical waste.

  4. [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.

  5. Occupational Hazards in the Thai Healthcare Sector.

    PubMed

    Tipayamongkholgul, Mathuros; Luksamijarulkul, Pipat; Mawn, Barbara; Kongtip, Pornpimol; Woskie, Susan

    2016-05-01

    Healthcare personnel work in vulnerable conditions that can adversely impact physical and/or mental health. This paper aims to synthesize the state of knowledge on work-related illnesses, injuries, and risks experienced by Thai healthcare workers. We found that Thai healthcare personnel, like others worldwide, are at risk for injury related to needle sticks and sharp instruments; infectious diseases due to biological hazards exposure such as airborne pathogens and patient secretions; muscle pain due to workload and long duration of work; and psychological disorders related to stressful working conditions. Because detailed surveillance data are limited for the Thai healthcare workforce, we recommend that additional surveillance data on Thai healthcare workers' health outcomes be collected. Future research efforts should also focus on evidence-based interventions in order to develop methods to prevent and treat occupational health injuries and illnesses acquired in the workplace for Thai healthcare sector workers.

  6. 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.

  7. 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.

  8. Primary healthcare renewal in Canada: a glass half empty?

    PubMed

    van Soeren, Mary; Hurlock-Chorostecki, Christina; Pogue, Pamela; Sanders, Jane

    2008-01-01

    Primary healthcare renewal was an important government initiative arising in the early 21st century. This sector of the healthcare system in Canada had been under-resourced and ignored for decades. Recent changes include the development of salaried models for physician care, the use of other professionals in primary care, the integration of inter-professional teams, funding for information management systems and some incentives to provide directed primary care services. However, these changes are limited by a lack of overall policy direction to drive innovation, the absence of a shift in the locus of control of healthcare, a lack of education for healthcare providers to support inter-professional team-based practices and a failure to be more accountable to the Canadian public's needs. Without these innovations, the primary healthcare system will again be overwhelmed by future healthcare needs. Based on these limitations, we question whether this renewal represents lasting change in primary healthcare or a band-aid solution to the continued issue of primary healthcare delivery.

  9. 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.

  10. PAIR UP for primary care excellence: perspectives from a primary healthcare provider in Singapore

    PubMed Central

    Tan, Ngiap Chuan

    2014-01-01

    Singapore is facing an increasing noncommunicable disease burden due to its ageing population. Singapore’s primary healthcare services, provided by both polyclinic physicians and private general practitioners, are available to the public at differential fees for service. The resultant disproportionate patient loads lead to dissatisfaction for both healthcare providers and consumers. This article describes the ‘PAIR UP’ approach as a potential endeavour to facilitate primary care physicians (PCPs) in public and private sectors to collaborate to deliver enhanced primary care in Singapore. PAIR UP is an acronym referring to Policy, Academic development, Integration of healthcare information system, Research in primary care, Utility and safety evaluation, and Practice transformation. The current healthcare landscape is favourable to test out this multipronged approach. PCPs in both sectors can ride on it and work together synergistically to provide quality primary care in Singapore. PMID:24664374

  11. 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.

  12. 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.

  13. [Healthcare promotion in primary care: if Hippocrates were alive today…].

    PubMed

    Cabeza, Elena; March, Sebastià; Cabezas, Carmen; Segura, Andreu

    2016-11-01

    This article argues for the need to implement community healthcare promotion initiatives in medical practice. Some of the community initiatives introduced in primary care, as well as scientific evidence and associated implementation factors are described. The need for effective coordination between primary care and public health services, working with the community, is underlined. Two specific coordination initiatives are explained by way of example. The first is a project to develop healthcare plans in health centres in the Balearic Islands, by means of a participatory process with the collaboration of citizens, local organisations and the town council (urban planning, mobility, social services, etc.). The second is the Interdepartmental Public Health Plan of Catalonia, which was established to coordinate cross-sectoral healthcare. A specific part of this plan is the COMSalud project, the purpose of which is to introduce a community perspective to health centres and which is currently being piloted in 16 health areas. We review the proposals of a 2008 research study to implement healthcare promotion in primary care, assessing its achievements and shortfalls. The Disease Prevention and Health Promotion Strategy of the Spanish Ministry of Health is recognised as an opportunity to coordinate primary and public health. It is concluded that this change of mentality will require both financial and human resources to come to fruition.

  14. 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

  15. 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.

  16. Formation of Defence Primary Healthcare: a new way of delivering firm base primary healthcare.

    PubMed

    Burgess, John E; Gall, M; Orr, S; Kilbey, S

    2016-06-09

    Following the Strategic Defence and Security Review of 2010, the UK Surgeon General was directed to merge the delivery of primary healthcare from the three single Service organisations to a unified Defence Primary Healthcare. Although front line clinical staff were to be preserved, considerable savings were to be made in headquarters staff. This was one of the largest UK military medicine changes in delivery for a generation. The changes were completed on time with the transfer of UK and overseas general practice, specialist community services and dentistry, with a later requirement to add healthcare for the Reserves. The first years of this initiative have been remarkably successful, and Defence Primary Healthcare (DPHC) has progressively increased performance in all the QOF criteria measured by Defence Statistics.

  17. 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

  18. Standard Treatment Guidelines in Primary Healthcare Practice

    PubMed Central

    Gopalakrishnan, S.; Udayshankar, P.M.; Rama, R.

    2014-01-01

    In India, healthcare delivery is implemented at primary, secondary and tertiary levels. Of these, primary health care is the essential health care and is the first point of care for the public across the country. The primary health care system caters to nearly 70% of the population by treating about 90% of the common and locally prevailing problems. One of the integral elements of primary health care is provision of essential medicines, which should be available at all times in adequate amounts in appropriate dosage forms and at an affordable cost. It has an important bearing on the medical, economical and social outcomes of the healthcare delivery system. This situation mandates the need for rational use of medicines by standardizing the treatment of commonly occurring illness at the primary health care level. Standard Treatment Guidelines (STGs) have been in vogue in India only since recent times and is gaining popularity among practitioners. STGs have many advantages for the patients, healthcare providers, drug manufacturers and marketing agencies, and above all, the policy makers and the legislative system of the country. The drawback in STGs lies in the difficulties in implementation on a large scale. With due efforts to prioritize the health needs, comprehensive coverage of national health programs involving all the stakeholders including professional organizations, undergraduate medical curriculum planners and medical practitioners, STGs can be implemented effectively and thereby we can ensure a quality health care at the primary care level at an affordable cost as part of the now redefined Universal Health Coverage. This article is intended as a guide to understand the concept of STGs, prepared with the aim of capacity building for medical professionals in rationally treating patients in their day-to-day clinical practice. PMID:25657957

  19. Australian academic primary health-care careers: a scoping survey.

    PubMed

    Barton, Christopher; Reeve, Joanne; Adams, Ann; McIntyre, Ellen

    2016-01-01

    This study was undertaken to provide a snapshot of the academic primary health-care workforce in Australia and to provide some insight into research capacity in academic primary health care following changes to funding for this sector. A convenience sample of individuals self-identifying as working within academic primary health care (n=405) completed an anonymous online survey. Respondents were identified from several academic primary health-care mailing lists. The survey explored workforce demographics, clarity of career pathways, career trajectories and enablers/barriers to 'getting in' and 'getting on'. A mix of early career (41%), mid-career (25%) and senior academics (35%) responded. Early career academics tended to be female and younger than mid-career and senior academics, who tended to be male and working in 'balanced' (teaching and research) roles and listing medicine as their disciplinary background. Almost three-quarters (74%) indicated career pathways were either 'completely' or 'somewhat unclear', irrespective of gender and disciplinary backgrounds. Just over half (51%) had a permanent position. Males were more likely to have permanent positions, as were those with a medical background. Less than half (43%) reported having a mentor, and of the 57% without a mentor, more than two-thirds (69%) would like one. These results suggest a lack of clarity in career paths, uncertainty in employment and a large number of temporary (contract) or casual positions represent barriers to sustainable careers in academic primary health care, especially for women who are from non-medicine backgrounds. Professional development or a mentoring program for primary health-care academics was desired and may address some of the issues identified by survey respondents.

  20. 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

  1. Primary Healthcare Solo Practices: Homogeneous or Heterogeneous?

    PubMed Central

    Beaulieu, Marie-Dominique; Boivin, Antoine; Prud'homme, Alexandre

    2014-01-01

    Introduction. Solo practices have generally been viewed as forming a homogeneous group. However, they may differ on many characteristics. The objective of this paper is to identify different forms of solo practice and to determine the extent to which they are associated with patient experience of care. Methods. Two surveys were carried out in two regions of Quebec in 2010: a telephone survey of 9180 respondents from the general population and a postal survey of 606 primary healthcare (PHC) practices. Data from the two surveys were linked through the respondent's usual source of care. A taxonomy of solo practices was constructed (n = 213), using cluster analysis techniques. Bivariate and multilevel analyses were used to determine the relationship of the taxonomy with patient experience of care. Results. Four models were derived from the taxonomy. Practices in the “resourceful networked” model contrast with those of the “resourceless isolated” model to the extent that the experience of care reported by their patients is more favorable. Conclusion. Solo practice is not a homogeneous group. The four models identified have different organizational features and their patients' experience of care also differs. Some models seem to offer a better organizational potential in the context of current reforms. PMID:24523964

  2. Healthcare professionals' accounts of challenges in managing motor neurone disease in primary healthcare: a qualitative study.

    PubMed

    Lerum, Sverre Vigeland; Solbraekke, Kari Nyheim; Frich, Jan C

    2017-02-22

    Motor neurone disease (MND) is a progressive neurological disease causing muscle wasting, gradual paralysis and respiratory failure, with a life expectancy of 2-4 years. In order to better understand how MND is managed in the community, we conducted a qualitative study to explore the challenges healthcare professionals encounter when managing MND in primary healthcare. Based on data from 15 semi-structured interviews with primary healthcare professionals in Norway, we found that MND is viewed as a condition that requires exceptional effort and detailed planning. Healthcare professionals reported five main challenges in managing MND in primary healthcare: (i) building relationships with those giving and receiving care in the home; (ii) preventing caregiver burnout and breakdown; (iii) providing tailored care; (iv) ensuring good working conditions in patients' homes; and (v) recruiting and retaining qualified nursing assistants. Healthcare professionals reported needing working conditions that allow them to tailor their approach to the personal, emotional and existential nature of care preferences of those living with MND. However, people with MND and their families were sometimes perceived by healthcare professionals to prefer a strictly task-focused relationship with care providers. Such relationships limited the healthcare professionals' control over the MND trajectory and their capacity to prevent family caregiver burnout and breakdown. Adequate resources, along with training and support of nursing assistants, may increase the continuity of nursing assistants. Responsiveness to patient and family needs may enhance collaboration and promote tailored primary care and support for patients with MND and their families.

  3. Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia

    PubMed Central

    Masiye, Felix; Kaonga, Oliver

    2016-01-01

    Background: Access to appropriate and affordable healthcare is needed to achieve better health outcomes in Africa. However, access to healthcare remains low, especially among the poor. In Zambia, poor access exists despite the policy by the government to remove user fees in all primary healthcare facilities in the public sector. The paper has two main objectives: (i) to examine the factors associated with healthcare choices among sick people, and (ii) to assess the determinants of the magnitude of out-of-pocket (OOP) payments related to a visit to a health provider. Methods: This paper employs a multilevel multinomial logistic regression to model the determinants of an individual’s choice of healthcare options following an illness. Further, the study analyses the drivers of the magnitude of OOP expenditure related to a visit to a health provider using a two-part generalised linear model. The analysis is based on a nationally representative healthcare utilisation and expenditure survey that was conducted in 2014. Results: Household per capita consumption expenditure is significantly associated with increased odds of seeking formal care (odds ratio [OR] = 1.12, P = .000). Living in a household in which the head has a higher level of education is associated with increased odds of seeking formal healthcare (OR = 1.54, P = .000) and (OR = 1.55, P = .01), for secondary and tertiary education, respectively. Rural residence is associated with reduced odds of seeking formal care (OR = 0.706, P = .002). The magnitude of OOP expenditure during a visit is significantly dependent on household economic well-being, distance from a health facility, among other factors. A 10% increase in per capita consumption expenditure was associated with a 0.2% increase in OOP health expenditure while every kilometre travelled was associated with a K0.51 increase in OOP health expenditure. Conclusion: Despite the removal of user fees on public primary healthcare in Zambia, access to

  4. Universal Health Coverage and Primary Healthcare: Lessons From Japan

    PubMed Central

    Bloom, Gerald

    2017-01-01

    A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant.

  5. Civil society, third sector, and healthcare: the case of social cooperatives in Italy.

    PubMed

    Borzaga, Carlo; Fazzi, Luca

    2014-12-01

    In many European countries, the third sector is considered an actor able to improve both the efficiency and the efficacy of public healthcare systems afflicted by the crisis of the welfare state. Attributed to third-sector organizations is the role of a hybrid actor tasked with the professional supply of services, not for profit but rather for mutualistic purposes, and to serve the public interest. However, empirical evidence on the capacity of the third sector to pursue objectives of social inclusion in a phase of withdrawal by the public sector is almost entirely lacking in the European countries. The article describes the results of research on the transformation of the Italian healthcare system and on the emergence of a new third sector in Italy. The results of the inquiry highlight the strategies, characteristics, and governance processes which enable third-sector organizations operating in the healthcare sector to pursue objectives of inclusion, and to serve the needs of disadvantaged groups by assuming the form of social enterprises.

  6. Enhancing healthcare sector coordination through infrastructure and logistics support.

    PubMed

    Zoraster, Richard M

    2010-01-01

    The International Response to the 2004 Southeast Asia Tsunami was noted to have multiple areas of poor coordination, and in 2005, the "Health Cluster"approach to coordination was formulated. However, the 2010 Haiti response suggests that many of the same problems continue and that there are significant limitations to the cluster meetings. These limitations include the inconsistent attendance, poor dissemination of information, and perceived lack of benefit to providers. This article proposes that healthcare coordination would be greatly improved with logistical support, leading to improved efficiency and outcomes for those affected by disasters.

  7. 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.

  8. 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.

  9. 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.

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

    PubMed

    Montagu, Dominic; Goodman, Catherine

    2016-08-06

    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.

  11. 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

  12. 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.

  13. 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.

  14. Harmony in health sector: a requirement for effective healthcare delivery in Nigeria.

    PubMed

    Osaro, Erhabor; Charles, Adias Teddy

    2014-09-01

    Harmony is defined as the pleasing combination of elements of a system to form an all-inclusive, all involving and more productive team. The aim of this present review was to investigate the factors militating against harmony among healthcare professional in the Nigerian healthcare delivery system. This review was carried out by searching through literature on the topic that bother on harmony among health professions in the health sector. Literature search and reports from previous studies indicates that harmony among health workers is pivotal to improving the health indices. However, available evidence suggests that unlike in the developed world, health care professionals do not collaborate well together in Nigeria because of the claim of superiority of a particular health professional over others. This has often resulted in inter-professional conflict which is threatening to tear the health sector apart to the detriment of the patients. The Nigeria health system should be based on team work. Health professionals from a variety of disciplines should work together to deliver the best possible healthcare services to all Nigerians. All members of the team are equally valuable and essential to the smooth running of hospitals. Hospitals should ideally be headed by health administrators or by a qualified member of any of the professions in the health sector.

  15. 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.

  16. District nurses' views on quality of primary healthcare encounters.

    PubMed

    Nygren Zotterman, Anna; Skär, Lisa; Olsson, Malin; Söderberg, Siv

    2015-09-01

    Good encounters are fundamental for good and professional nursing care, and can be described as treating patients with respect and protecting their integrity and autonomy. This study describes district nurses' views on quality of healthcare encounters in primary healthcare. A purposive sample of 27 district nurses participated in five focus group interviews. The focus groups interviews were digitally recorded and transcribed verbatim. The interview texts were analysed using a thematic content analysis. The analysis resulted in four themes, including being aware of the importance and difficulties during encounters, being the patient's advocate, being attentive to the unique person and being informed when a meeting turned out poorly. The results show that district nurses believed that encounters formed the basis of their work and it was vital for them to be aware of any difficulties. District nurses found that acting in a professional manner during encounters is the most significant factor, but this type of interaction was sometimes difficult because of stress and lack of time. The district nurses considered themselves to be the patients' advocate in the healthcare system; in addition, the acts of seeing, listening, believing and treating the patient seriously were important for providing good quality care. If a poor encounter occurred between the district nurse and the patient, the district nurses found that it was necessary to arrange a meeting to properly communicate what problems arose during the interaction. The district nurses highlighted that providing an apology and explanation could improve future encounters and establish a better nurse-patient relationship. In conclusion, this study shows the importance of confirming and respecting patients' dignity as the fundamental basis for a good quality encounter in primary healthcare.

  17. 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

  18. 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…

  19. Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare?

    PubMed Central

    2013-01-01

    Background Over the past decade, in the province of Quebec, Canada, the government has initiated two consecutive reforms. These have created a new type of primary healthcare – family medicine groups (FMGs) – and have established 95 geographically defined local health networks (LHNs) across the province. A key goal of these reforms was to improve collaboration among healthcare organizations. The objective of the paper is to analyze the impact of these reforms on the development of collaborations among primary healthcare practices and between these organisations and hospitals both within and outside administrative boundaries of the local health networks. Methods We surveyed 297 primary healthcare practices in 23 LHNs in Quebec’s two most populated regions (Montreal & Monteregie) in 2005 and 2010. We characterized collaborations by measuring primary healthcare practices’ formal or informal arrangements among themselves or with hospitals for different activities. These collaborations were measured based on the percentage of clinics that identified at least one collaborative activity with another organization within or outside of their local health network. We created measures of collaboration for different types of primary healthcare practices: first- and second-generation FMGs, network clinics, local community services centres (CLSCs) and private medical clinics. We compared their situations in 2005 and in 2010 to observe their evolution. Results Our results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices. The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations

  20. General Satisfaction Among Healthcare Workers: Differences Between Employees in Medical and Mental Health Sector

    PubMed Central

    Papathanasiou, Ioanna V.; Kleisiaris, Christos F.; Tsaras, Konstantinos; Fradelos, Evangelos C.; Kourkouta, Lambrini

    2015-01-01

    Background: General satisfaction is a personal experience and sources of satisfaction or dissatisfaction vary between professional groups. General satisfaction is usually related with work settings, work performance and mental health status. Aim: The purpose of this research study was to investigate the level of general satisfaction of health care workers and to examine whether there were any differences among employees of medical and mental health sector. Methods: The sample consisted of employees from the medical and mental health sector, who were all randomly selected. A two-part questionnaire was used to collect data. The first section involved demographic information and the second part was a General Satisfaction Questionnaire (GSQ). The statistical analysis of data was performed using the software package 19.0 for Windows. Descriptive statistics were initially generated for sample characteristics. All data exhibited normal distributions and thus the parametric t-test was used to compare mean scores between the two health sectors. P values < 0.05 were defined as reflecting the acceptable level of statistical significance. Results: 457 healthcare workers completed the questionnaire. The mean age of the sample was 41.8 ± 7.9 years. The Cronbach alpha coefficient for GSQ was 0.79. The total mean score of general satisfaction for the employees in medical sector was 4.5 (5=very satisfied) and for the employees in mental health sector is 4.8. T-test showed that these results are statistical different (t=4.55, p<0.01) and therefore the two groups of healthcare workers feel different general satisfaction. Conclusions: Mental health employees appear to experience higher levels of general satisfaction and mainly they experience higher satisfaction from family roles, life and sexual life, emotional state and relations with patients. PMID:26543410

  1. 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…

  2. Healthy workplaces and effective teamwork: viewed through the lens of primary healthcare renewal.

    PubMed

    Jones, Linda; Way, Daniel

    2007-01-01

    This commentary reviews the content of the lead papers through the lens of primary healthcare renewal (PHCR). Although PHCR has been on the national agenda for decades, only since the turn of the century has real progress been made with emerging new practice models based on inter-professional team care. While much is expected, relatively little is known of the function and effectiveness of such teams in Canada. As well, information regarding healthy workplaces has focused on individual professional groups rather than an inter-professional workforce. Much of the knowledge currently available regarding team effectiveness and healthy workplaces comes from the hospital sector and may not be completely transferable. The work of the Interprofessional Education for Collaborative Patient-Centred Practice initiative and the results of the Health Transition Fund and Primary Health Care Transition Fund are additional key sources of research and knowledge transfer to guide the education, function and evaluation of inter-professional teamwork in these new primary healthcare practice models.

  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. Service quality and performance in the public health-care sector.

    PubMed

    Chahal, Hardeep; Kumari, Neetu

    2012-01-01

    The purpose of this article is to evaluate service quality and service performance relationship in the health-care sector using respective developed multidimensional scales. Data were collected from 400 inpatient respondents, using stratified sampling method from five departments, namely general medicine, surgery, pediatrics, orthopedics, gynecology, and ENT of a tertiary hospital (North India). The results confirm significant relationship among subdimensions of physical environment quality and interaction quality (service quality) and four service performance measures, namely waiting time, patient satisfaction, patient loyalty, and image in public hospitals.

  5. Examining Primary Healthcare Performance through a Triple Aim Lens

    PubMed Central

    Ryan, Bridget L.; Brown, Judith Belle; Glazier, Richard H.; Hutchison, Brian

    2016-01-01

    Purpose: This study sought to apply a Triple Aim framework to the measurement and evaluation of primary healthcare (PHC) team performance. Methods: Triple Aim components were populated with 10 dimensions derived from survey and health administrative data for 17 Family Health Teams (FHTs) in Ontario, Canada. Bivariate analyses and rankings of sites examined the relationships among dimensions and among Triple Aim components. Results: Readily available measures to fully populate the Triple Aim framework were lacking in FHTs. Within sites, there was little consistency in performance across the Triple Aim components (health, patient experience and cost). Conclusions: More and better measures are needed that can be readily used to examine the Triple Aim performance in PHC teams. FHTs, in this study, are partially achieving Triple Aim goals; however, there was a lack of consistency in performance. It is essential to collect appropriate measures and attend to performance across all components of the Triple Aim. PMID:27027790

  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. Incorporating Group Medical Visits into Primary Healthcare: Are There Benefits?

    PubMed Central

    Browne, Annette; Lavoie, Josée; Macleod, Martha L.P.; Chongo, Meck; Ulrich, Cathy

    2015-01-01

    Objective: Group medical visits (GMVs) have been touted as an innovation to effectively and efficiently provide primary healthcare (PHC) services. The purpose of this paper is to report whether GMVs have tangible benefits for providers and patients. Methods: This descriptive study included in-depth interviews with patients attending and providers facilitating GMVs and direct observation. Five primary care practices in rural towns and four First Nations communities participated. This paper reports on an analysis of interviews and observations. Results: Thirty-four providers and 29 patients were interviewed. Patient participants were an average of 62 years old, mostly female and married. The three most common chronic conditions reported by patients were diabetes (n = 9), high blood pressure (n = 8) and arthritis (n = 7). Three themes illustrated how GMVs: (1) can foster access to needed health services; (2) expand opportunities for collaboration and team-based care; and (3) improve patient and provider experiences. A fourth theme captured structural challenges in delivering GMVs. Discussion: There are tangible benefits in delivering GMVs in PHC. While whole patient panels can benefit from the integration of GMVs into practice, those who could gain the most are patients with complex medical and social needs. GMVs provide an opportunity to enhance PHC, strengthening the system particularly for patients with chronic conditions. PMID:26742114

  8. 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

  9. Constructing Taxonomies to Identify Distinctive Forms of Primary Healthcare Organizations

    PubMed Central

    Borgès Da Silva, Roxane; Pineault, Raynald; Hamel, Marjolaine; Levesque, Jean-Frédéric; Roberge, Danièle; Lamarche, Paul

    2013-01-01

    Background. Primary healthcare (PHC) renewal gives rise to important challenges for policy makers, managers, and researchers in most countries. Evaluating new emerging forms of organizations is therefore of prime importance in assessing the impact of these policies. This paper presents a set of methods related to the configurational approach and an organizational taxonomy derived from our analysis. Methods. In 2005, we carried out a study on PHC in two health and social services regions of Quebec that included urban, suburban, and rural areas. An organizational survey was conducted in 473 PHC practices. We used multidimensional nonparametric statistical methods, namely, multiple correspondence and principal component analyses, and an ascending hierarchical classification method to construct a taxonomy of organizations. Results. PHC organizations were classified into five distinct models: four professional and one community. Study findings indicate that the professional integrated coordination and the community model have great potential for organizational development since they are closest to the ideal type promoted by current reforms. Conclusion. Results showed that the configurational approach is useful to assess complex phenomena such as the organization of PHC. The analysis highlights the most promising organizational models. Our study enhances our understanding of organizational change in health services organizations. PMID:24959575

  10. Knowledge mobilisation in healthcare: a critical review of health sector and generic management literature.

    PubMed

    Ferlie, Ewan; Crilly, Tessa; Jashapara, Ashok; Peckham, Anna

    2012-04-01

    The health policy domain has displayed increasing interest in questions of knowledge management and knowledge mobilisation within healthcare organisations. We analyse here the findings of a critical review of generic management and health-related literatures, covering the period 2000-2008. Using 29 pre-selected journals, supplemented by a search of selected electronic databases, we map twelve substantive domains classified into four broad groups: taxonomic and philosophical (e.g. different types of knowledge); theoretical discourse (e.g. critical organisational studies); disciplinary fields (e.g. organisational learning and Information Systems/Information Technology); and organisational processes and structures (e.g. organisational form). We explore cross-overs and gaps between these traditionally separate literature streams. We found that health sector literature has absorbed some generic concepts, notably Communities of Practice, but has not yet deployed the performance-oriented perspective of the Resource Based View (RBV) of the Firm. The generic literature uses healthcare sites to develop critical analyses of power and control in knowledge management, rooted in neo-Marxist/labour process and Foucauldian approaches. The review generates three theoretically grounded statements to inform future enquiry, by: (a) importing the RBV stream; (b) developing the critical organisational studies perspective further; and (c) exploring the theoretical argument that networks and other alternative organisational forms facilitate knowledge sharing.

  11. Case Study: Primary Healthcare Clinical Placements during Nursing and Midwifery Education in Lesotho.

    PubMed

    Christensen, Alice; Phafoli, Semakaleng; Butler, Johannah; Nyangu, Isabel; Skolnik, Laura; Stender, Stacie C

    2015-01-01

    In Lesotho, primary healthcare is the main access point for health services. While nurses and midwives provide most of the care at this level, assessments of the clinical education programs have highlighted gaps in primary healthcare experiences for nursing and midwifery students. This case study examines placement of nursing and midwifery students in primary health clinics alongside preceptors. The placements provide students with varied clinical experience, better preparing them to practice in primary healthcare clinics. To date, more than 700 nursing and midwifery students have been placed in 40 rural health centres and 228 preceptors have been trained. The government is scaling up the program nationally.

  12. 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.

  13. 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.

  14. 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…

  15. 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…

  16. [Scientific medical forum as important source of scientific-information provision for innovation processes in the healthcare sector of Ukraine].

    PubMed

    Horban', A Ie; Zakrut'ko, L I; Uvarenko, S V; Prysiazhniuk, L V

    2013-12-01

    The article made a retrospective analysis of the scientific medical forums (congresses, symposia and scientific conferences) in the healthcare sector of Ukraine in 2008-2012, planned by higher medical schools and post-graduate medical education schools, scientific institutions of Ministry of Healthcare of Ukraine, National Academy of Medical Science of Ukraine, medical associations and scientific and medical societies. Quantitative and qualitative assessment was carried out of the effectiveness of their implementation, provided suggestions for improving the planning and conducting of medical research forums.

  17. 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.

  18. The retention of health human resources in primary healthcare centers in Lebanon: a national survey

    PubMed Central

    2012-01-01

    Background Critical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC) sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. Methods A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory). A total of 755 providers completed the questionnaire (60.5% response rate). Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. Results Two out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%), better job opportunities outside the country (35.1%) and lack of professional development (33.7%). A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. Conclusions The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits and allied health

  19. A baseline survey of the Primary Healthcare system in south eastern Nigeria.

    PubMed

    Chukwuani, Chinyere Mercellina; Olugboji, Akindeji; Akuto, Edward Erdorga; Odebunmi, Akim; Ezeilo, Ezenta; Ugbene, Emmanuel

    2006-07-01

    health tax among others. It was evident that poor funding, bad management practices and infrastructural decay is the bane of efficient PHC delivery. Consequently, we propose that cost determination studies, to establish the financial implication of the minimum package for provision of primary healthcare services, should be an essential prerequisite to the reform process. Some critical cross-cutting issues identified from the data obtained which could form the basis for major policy thrust include, development of strategies for sustainable promotion of public-private-partnership for enhanced community involvement in healthcare management, ensuring that interventional investment is proportional to the felt health needs of the populace and funding of healthcare through equitable integration of user fees/charges.

  20. Primary healthcare system and practice characteristics in Singapore.

    PubMed

    Khoo, Hwee Sing; Lim, Yee Wei; Vrijhoef, Hubertus Jm

    2014-01-01

    It is crucial to adapt and improve the (primary) health care systems of countries to prepare for future patient profiles and their related needs. The main aim of this study was to acquire a comprehensive overview of the perceptions of primary care experts in Singapore about the state of primary care in Singapore, and to compare this with the state of primary care in other countries. Notwithstanding ranked 2(nd) in terms of efficiency of health care, Singapore is facing significant health care challenges. Emails were sent to 85 experts, where they were asked to rate Singapore's primary care system based on nine internationally adopted health system characteristics and six practice characteristics (response rate = 29%). The primary care system in Singapore received an average of 10.9 out of 30 possible points. Lowest ratings were given to: earnings of primary care physicians compared to specialists, requirement for 24 hr accessibility of primary care services, standard of family medicine in academic departments, reflection of community served by practices in patient lists, and the access to specialists without needing to be referred by primary care physicians. Singapore was categorized as a 'low' primary care country according to the experts.

  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.

  2. 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.

  3. 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

  4. Primary healthcare NZ nurses' experiences of advance directives: understanding their potential role.

    PubMed

    Davidson, Raewyn; Banister, Elizabeth; de Vries, Kay

    2013-07-01

    Advance directives are one aspect of advance care planning designed to improve end of life care. The New Zealand Nurses Organisation released their first mission statement in 2010 concerning advance directives suggesting an increase in the use of these. A burgeoning older population, expected to rise over the next few years, places the primary healthcare nurse in a pivotal role to address the challenges in constructing advance directives. While literature supports the role for primary healthcare nurses in promoting advance directives, no research was found on this role in the New Zealand context. This paper presents results of a qualitative study conducted in New Zealand with 13 senior primary healthcare nurses with respect to their knowledge, attitudes, and experiences of advance directives. Results of the analysis revealed a dynamic process involving participants coming to understand their potential role in this area. This process included reflection on personal experience with advance directives; values and ethics related to end of life issues; and professional actions.

  5. 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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    Lord, J

    2003-01-01

    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

  8. 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…

  9. [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.

  10. 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.

  11. Is healthcare a 'Necessity' or 'Luxury'? an empirical evidence from public and private sector analyses of South-East Asian countries?

    PubMed

    Khan, Jahangir Am; Mahumud, Rashidul Alam

    2015-01-01

    South-East Asian Regional (SEAR) countries range from low- to middle-income countries and have considerable differences in mix of public and private sector expenditure on health. This study intends to estimate the income-elasticities of healthcare expenditure in public and private sectors separately for investigating whether healthcare is a 'necessity' or 'luxury' for citizens of these countries. Panel data from 9 SEAR countries over 16 years (1995-2010) were employed. Fixed- and random-effect models were fitted to estimate income-elasticity of public, private and total healthcare expenditure. Results showed that one percent point increase in GDP per capita increased private expenditure on healthcare by 1.128%, while public expenditure increased by only 0.412%. Inclusion of three-year lagged variables of GDP per capita in the models did not have remarkable influence on the findings. The citizens of SEAR countries consider healthcare as a necessity while provided through public sector and a luxury when delivered by private sector. By increasing the public provisions of healthcare, more redistribution of healthcare resources can be ensured, which can accelerate the journey of SEAR countries towards universal health coverage.

  12. 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…

  13. [Catalonia's primary healthcare accreditation model: a valid model].

    PubMed

    Davins, Josep; Gens, Montserrat; Pareja, Clara; Guzmán, Ramón; Marquet, Roser; Vallès, Roser

    2014-07-01

    There are few experiences of accreditation models validated by primary care teams (EAP). The aim of this study was to detail the process of design, development, and subsequent validation of the consensus EAP accreditation model of Catalonia. An Operating Committee of the Health Department of Catalonia revised models proposed by the European Foundation for Quality Management, the Joint Commission International and the Institut Català de la Salut and proposed 628 essential standards to the technical group (25 experts in primary care and quality of care), to establish consensus standards. The consensus document was piloted in 30 EAP for the purpose of validating the contents, testing standards and identifying evidence. Finally, we did a survey to assess acceptance and validation of the document. The Technical Group agreed on a total of 414 essential standards. The pilot selected a total of 379. Mean compliance with the standards of the final document in the 30 EAP was 70.4%. The standards results were the worst fulfilment percentage. The survey target that 83% of the EAP found it useful and 78% found the content of the accreditation manual suitable as a tool to assess the quality of the EAP, and identify opportunities for improvement. On the downside they highlighted its complexity and laboriousness. We have a model that fits the reality of the EAP, and covers all relevant issues for the functioning of an excellent EAP. The model developed in Catalonia is a model for easy understanding.

  14. Evaluation of spatial accessibility to primary healthcare using GIS

    NASA Astrophysics Data System (ADS)

    Jamtsho, S.; Corner, R. J.

    2014-11-01

    Primary health care is considered to be one of the most important aspects of the health care system in any country, which directly helps in improving the health of the population. Potential spatial accessibility is a very important component of the primary health care system. One technique for studying spatial accessibility is by computing a gravity-based measure within a geographic information system (GIS) framework. In this study, straight-line distances between the associated population clusters and the health facilities and the provider-to-population ratio were used to compute the spatial accessibility of the population clusters for the whole country. Bhutan has been chosen as the case study area because it is quite easy to acquire and process data for the whole country due to its small size and population. The spatial accessibility measure of the 203 sub-districts shows noticeable disparities in health care accessibility in this country with about only 19 sub-districts achieving good health accessibility ranking. This study also examines a number of different health accessibility policy scenarios which can assist in identifying the most effective health policy from amongst many probable planning scenarios. Such a health accessibility measuring system can be incorporated into an existing spatial health system in developing countries to facilitate the proper planning and equitable distribution of health resources.

  15. Implementing chronic disease management in the public healthcare sector in Singapore: the role of hospitals.

    PubMed

    Cheah, J; Heng, B H

    2001-01-01

    The public health care delivery system in Singapore faces the challenges of a rapidly ageing population, an increasing chronic disease burden, increasing healthcare cost, rising expectations and demand for better health services, and shortage of resources. It is also fragmented, resulting in duplication and lack of coordination between institutions. A disease management approach has been adopted by the National Healthcare Group (NHG) as a critical strategy to provide holistic, cost-effective, seamless and well-coordinated care across the continuum. The framework in the development of the disease management plan included identifying the diseases and defining the target population, organizing a multi-disciplinary team lead by a clinician champion, defining the core components, treatment protocols and evaluation methods, defining the goals, and measuring and managing the outcomes. As disease management and case management for chronic diseases are new approaches adopted in the healthcare delivery system, there is a lack of understanding by healthcare professionals. The leadership and participation of hospital physicians was sought in the planning, design and outcomes monitoring to ensure their 'buy-in' and the successful implementation and effectiveness of the program. The episodic diagnosis related group (DRG)-based framework of funding and subvention for healthcare, and the shortage of step-care care facilities, have been recognized by the Ministry of Health as an impediments to the implementation, and these are currently being addressed.

  16. 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

  17. 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.

  18. An analysis of the implementation and impact of speech-recognition technology in the healthcare sector.

    PubMed

    Parente, Ronaldo; Kock, Ned; Sonsini, John

    2004-06-18

    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.

  19. Mental health care: how can Family Health teams integrate it into Primary Healthcare?

    PubMed

    Gryschek, Guilherme; Pinto, Adriana Avanzi Marques

    2015-10-01

    Mental health is one of the responsibilities of Brazil's Family Health system. This review of literature sought to understand what position Mental Health occupies in the practice of the Family Health Strategy. A search was made of the scientific literature in the database of the Virtual Health Library (Biblioteca Virtual de Saúde), for the keywords: 'Mental Health'; 'Family Health'; 'Primary Healthcare'. The criteria for inclusion were: Brazilian studies from 2009 through 2012 that contributed to understanding of the following question: "How to insert Mental health care into the routine of the Family Health Strategy?" A total of 11 articles were found, which identified difficulties and strategies of the professionals in Primary Healthcare in relation to mental health. Referral, and medicalization, were common practices. Matrix Support is the strategy of training and skill acquisition for teams that enables new approaches in mental health in the context of Primary healthcare. It is necessary for Management of the Health System to take an active role in the construction of healthcare networks in mental health.

  20. 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…

  1. Clinical utility of the informant AD8 as a dementia case finding instrument in primary healthcare.

    PubMed

    Chan, Qun Lin; Xu, Xin; Shaik, Muhammad Amin; Chong, Steven Shih Tsze; Hui, Richard Jor Yeong; Chen, Christopher Li-Hsian; Dong, YanHong

    2016-01-01

    The informant AD8 has excellent discriminant ability for dementia case finding in tertiary healthcare settings. However, its clinical utility for dementia case finding at the forefront of dementia management, primary healthcare, is unknown. Therefore, we recruited participants from two primary healthcare centers in Singapore and measured their performance on the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and a local formal neuropsychological battery, in addition to the AD8. Logistic regression was conducted to examine the associations between demographic factors and dementia. Area under the receiver operating characteristics (ROC) curve analysis was used to establish the optimal cut-off points for dementia case finding. Of the 309 participants recruited, 243 (78.7%) had CDR = 0, 22 (7.1%) CDR = 0.5, and 44 (14.2%) CDR ≥1. Age was strongly associated with dementia, and the optimal age for dementia case finding in primary healthcare settings was ≥75 years. In this age group, the AD8 has excellent dementia case finding capability and was superior to the MMSE and equivalent to the MoCA [AD8 AUC (95% CI): 0.95 (0.91-0.99), cut-off: ≥3, sensitivity: 0.90, specificity: 0.88, PPV: 0.79 and NPV: 0.94; MMSE AUC (95% CI): 0.87 (0.79-0.94), p = 0.04; MoCA AUC (95% CI): 0.88 (0.82-0.95), p = 0.06]. In conclusion, the AD8 is well suited for dementia case finding in primary healthcare settings.

  2. 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

  3. Primary health-care network monitoring: a hierarchical resource allocation modeling approach.

    PubMed

    Pur, Aleksander; Bohanec, Marko; Lavrac, Nada; Cestnik, Bojan

    2010-01-01

    Management of a primary health-care network (PHCN) is a difficult task in every country. A suitable monitoring system can provide useful information for PHCN management, especially given a large quantity of health-care data that is produced daily in the network. This paper proposes a methodology for structured development of monitoring systems and a PHCN resource allocation monitoring model based on this methodology. The purpose of the monitoring model is to improve the allocation of health-care resources. The proposed methodology is based on modules that are organized into a hierarchy, where each module monitors a particular aspect of the system. This methodology was used to design a PHCN monitoring model for Slovenia. Specific aspects of the Slovenian PHCN were taken into account such as varying needs of patients from different municipalities, existence of small municipalities having less than 1000 residents, the fact that many patients visit physicians in other municipalities, and that physicians may work at more than one location or organization. The main modules in the model are focused on the overall assessment of the PHCN, monitoring of patients visits to health-care providers (HCPs), physical accessibility of health services, segment of patients in municipalities who have not selected a personal physician, assessment of the availability of HCPs for patients, physicians working on more than one location, and available human resources in the PHCN. Most of the model's components are general and can be adapted for other national health-care systems.

  4. 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.

  5. Implementation of ISO 9000 in the healthcare sector: a case study.

    PubMed

    Motwani, J G; Cheng, C H; Madan, M S

    1996-01-01

    In order to compete at the international level, companies are beginning to recognize ISO 9000 registration as a virtual necessity. As a result, the number of ISO certifications issued in the U.S. and Canada tripled between 1992 and 1994. By means of a case study, this paper describes how a large healthcare manufacturing organization recently achieved its ISO 9001 certification. Specifically, the strategies and the process used by the organization in obtaining the registration is explained.

  6. A systems-based partnership learning model for strengthening primary healthcare

    PubMed Central

    2013-01-01

    Background Strengthening primary healthcare systems is vital to improving health outcomes and reducing inequity. However, there are few tools and models available in published literature showing how primary care system strengthening can be achieved on a large scale. Challenges to strengthening primary healthcare (PHC) systems include the dispersion, diversity and relative independence of primary care providers; the scope and complexity of PHC; limited infrastructure available to support population health approaches; and the generally poor and fragmented state of PHC information systems. Drawing on concepts of comprehensive PHC, integrated quality improvement (IQI) methods, system-based research networks, and system-based participatory action research, we describe a learning model for strengthening PHC that addresses these challenges. We describe the evolution of this model within the Australian Aboriginal and Torres Strait Islander primary healthcare context, successes and challenges in its application, and key issues for further research. Discussion IQI approaches combined with system-based participatory action research and system-based research networks offer potential to support program implementation and ongoing learning across a wide scope of primary healthcare practice and on a large scale. The Partnership Learning Model (PLM) can be seen as an integrated model for large-scale knowledge translation across the scope of priority aspects of PHC. With appropriate engagement of relevant stakeholders, the model may be applicable to a wide range of settings. In IQI, and in the PLM specifically, there is a clear role for research in contributing to refining and evaluating existing tools and processes, and in developing and trialling innovations. Achieving an appropriate balance between funding IQI activity as part of routine service delivery and funding IQI related research will be vital to developing and sustaining this type of PLM. Summary This paper draws together

  7. The framework of the practice of innovation in primary healthcare: a case study.

    PubMed

    Nodari, Cristine Hermann; Camargo, Maria Emilia; Olea, Pelayo Munhoz; Dorion, Eric Charles Henri; Claus, Suzete Marchetto

    2015-10-01

    The objective of this study was to identify the practice of innovation in primary healthcare in the second-largest county, by population, in the state of Rio Grande do Sul, Brazil. The methodology employed case studies of multiple units of analysis, where various studies were simultaneously conducted. Forty-five semi-structured interviews were carried out with the directors of basic health clinics, followed by content analysis, beginning with the construction of a system of categories based on the literature. Fifty-six innovations in total were identified: Eighteen were innovations of products (goods and/or services), fifteen in processes, eleven in marketing, and twelve were organizational innovations. Studies that focus on and highlight innovation in primary healthcare facilitate changes, improvements, and alternatives in the form of services provided to the population, serving as a basis for the formulation of public health policy. Finally, we also highlight the limitations and opportunities of future research.

  8. Reforming Victoria's primary health and community service sector: rural implications.

    PubMed

    Alford, K

    2000-01-01

    In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.

  9. 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

  10. 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.

  11. Networks and social capital: a relational approach to primary healthcare reform

    PubMed Central

    Scott, Catherine; Hofmeyer, Anne

    2007-01-01

    Collaboration among health care providers and across systems is proposed as a strategy to improve health care delivery the world over. Over the past two decades, health care providers have been encouraged to work in partnership and build interdisciplinary teams. More recently, the notion of networks has entered this discourse but the lack of consensus and understanding about what is meant by adopting a network approach in health services limits its use. Also crucial to this discussion is the work of distinguishing the nature and extent of the impact of social relationships – generally referred to as social capital. In this paper, we review the rationale for collaboration in health care systems; provide an overview and synthesis of key concepts; dispel some common misconceptions of networks; and apply the theory to an example of primary healthcare network reform in Alberta (Canada). Our central thesis is that a relational approach to systems change, one based on a synthesis of network theory and social capital can provide the fodation for a multi-focal approach to primary healthcare reform. Action strategies are recommended to move from an awareness of 'networks' to fully translating knowledge from existing theory to guide planning and practice innovations. Decision-makers are encouraged to consider a multi-focal approach that effectively incorporates a network and social capital approach in planning and evaluating primary healthcare reform. PMID:17894868

  12. 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.

  13. 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.

  14. 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

  15. 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

  16. Expanding pharmacy roles and the interprofessional experience in primary healthcare: A qualitative study.

    PubMed

    Silvaggi, Andrea; Nabhani-Gebara, Shereen; Reeves, Scott

    2017-01-01

    The pharmacist role is undergoing significant changes which are reshaping the way primary healthcare is delivered throughout England. Due to increased physician workload and focus on primary healthcare, the pharmacist role has expanded to provide enhanced patient services, integrating into general practice (GP) settings and working more closely as a member of the healthcare team. However, the experiences of pharmacists and team members are yet to be explored. The proposed study aims to explore the experiences, thoughts, and perceptions of a purposive sample of pharmacists, physicians, and nurses working in 10 GP clinics throughout the southeast of England. Interprofessional relationships, power dynamics, changing professional roles, and barriers and facilitators to the integration of the pharmacist role will be explored. An exploratory multiple case study design will be used to investigate interprofessional experiences within and between clinics. In-depth interviews will be completed with each participant. A thematic analysis will identify themes and patterns from the interview data. Results are expected to produce recommendations to help facilitate the integration of pharmacists in their new role and will have implications for interprofessional collaboration and interprofessional education which are important for delivering safe and effective care.

  17. The integration of primary care and behavioral healthcare in northern California Kaiser-Permanente.

    PubMed

    Dea, R A

    2000-01-01

    Integration of behavioral healthcare and primary care has a number of presumed benefits, including better communication between providers and systems, leading to improved patient care. There are studies showing medical cost offsets, although they tend to be in circumscribed research settings. Northern California Kaiser-Permanente has designed a new primary care system providing mental health clinicians on a primary care team. Those clinicians evaluate patients, create treatment plans, provide brief interventions, coordinate care with specialty behavioral healthcare, and consult with primary care physicians. Those physicians also have an increased role in the detection and treatment of behavioral health problems via guidelines developed with behavioral health. Structural changes within the overall system, including regional call centers and computerized clinical information systems, support the integration. Quality programs also support the ongoing improvement of the integration process. There are investment expenses in this type of re-design, but also expected cost savings. An infrastructure is now in place to measure both clinical outcomes, and cost effects of the new model.

  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

    2014-12-17

    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.

  19. 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…

  20. 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.

  1. 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

  2. P4 medicine: how systems medicine will transform the healthcare sector and society

    PubMed Central

    Glusman, Gustavo; Brogaard, Kristin; Price, Nathan D; Hood, Leroy

    2014-01-01

    Ten years ago, the proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was regarded as highly speculative. Today, the core elements of that vision are widely accepted and have been articulated in a series of recent reports by the US Institute of Medicine. Systems approaches to biology and medicine are now beginning to provide patients, consumers and physicians with personalized information about each individual’s unique health experience of both health and disease at the molecular, cellular and organ levels. This information will make disease care radically more cost effective by personalizing care to each person’s unique biology and by treating the causes rather than the symptoms of disease. It will also provide the basis for concrete action by consumers to improve their health as they observe the impact of lifestyle decisions. Working together in digitally powered familial and affinity networks, consumers will be able to reduce the incidence of the complex chronic diseases that currently account for 75% of disease-care costs in the USA. PMID:25342952

  3. P4 medicine: how systems medicine will transform the healthcare sector and society.

    PubMed

    Flores, Mauricio; Glusman, Gustavo; Brogaard, Kristin; Price, Nathan D; Hood, Leroy

    2013-01-01

    Ten years ago, the proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was regarded as highly speculative. Today, the core elements of that vision are widely accepted and have been articulated in a series of recent reports by the US Institute of Medicine. Systems approaches to biology and medicine are now beginning to provide patients, consumers and physicians with personalized information about each individual's unique health experience of both health and disease at the molecular, cellular and organ levels. This information will make disease care radically more cost effective by personalizing care to each person's unique biology and by treating the causes rather than the symptoms of disease. It will also provide the basis for concrete action by consumers to improve their health as they observe the impact of lifestyle decisions. Working together in digitally powered familial and affinity networks, consumers will be able to reduce the incidence of the complex chronic diseases that currently account for 75% of disease-care costs in the USA.

  4. Healthy Lifestyle Medicine in the Traditional Healthcare Environment-Primary Care and Cardiac Rehabilitation.

    PubMed

    Williams, Mark A; Kaminsky, Leonard A

    There is unquestioned value of the need to incorporate Healthy Lifestyle Medicine (HLM) within the traditional models of healthcare. Primary care providers are well positioned to implement HLM as a routine aspect of their healthcare practice. Unfortunately, barriers for this to occur, including poor professional training in the components of HLM and limitations in the time they have available to spend with patients, result in inadequate delivery of HLM from primary care providers. Thus, new approaches for the delivery of HLM need to be developed that would allow primary care providers better, and more, opportunities to make patient referrals. Ideally, this would start with creating a culture change within communities that embraces the importance on living a healthy lifestyle. One opportunity which should be considered is expanding access to currently available options, such as cardiac rehabilitation programs and worksite wellness programs. Both types of programs already provide key elements of HLM within their existing structure. However, new models also need to be developed. Community-based HL centers comprising HL specialists including counselors, exercise physiologists, dietitians, and physical therapists, could be developed and become core locations for the promotion of HLM.

  5. A conversation on health in Canada: revisiting universality and the centrality of primary healthcare.

    PubMed

    White, Franklin; Nanan, Debra

    2009-01-01

    In 2006, British Columbia launched a public consultation on how to strengthen the health system. We report on the processes and the inputs and views submitted and examine the perceived importance of universality and primary healthcare (PHC). Public response revealed strong support for the Canada Health Act, which upholds 5 principles: public administration, comprehensiveness, universality, portability, and accessibility, and also a need for the system to be more open to innovation. It recognized that keys to improving population health and efficiency gains within the health system lie within the scope of PHC and that prevention, demand management, and self-management are all part of PHC.

  6. 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

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

    PubMed

    Robinson, Andrew Ken Lacey

    2015-09-21

    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.

  8. [Primary healthcare geared to the needs of the elderly: from theory to practice].

    PubMed

    Martins, Aline Blaya; D'Avila, Otávio Pereira; Hilgert, Juliana Balbinot; Hugo, Fernando Neves

    2014-08-01

    This article seeks to establish a confrontation between theory and practice with respect to healthcare for the elderly. The theory was evaluated by a study of documents that comprise the legal and theoretical framework related to the health of the elderly, which generated a matrix to assess universal access, equity, comprehensiveness and quality of care. However, the practice of healthcare was evaluated by a population-based study conducted on 862 elderly individuals and a census that assessed primary healthcare (PHC) units in two districts of Porto Alegre in the state of Rio Grande do Sul, Brazil. The variables chosen to verify the categories were type of care accessed, first contact attribute, wheelchair accessibility and availability of priority access. Other variables include comprehensive care and the presence of dental root remains, basic PHC score, the adequacy of health facilities and ongoing professional training, as well as cross-sectional categories, elderly groups and home care. A mismatch was found between recommendation and practice in some factors and advances were observed in the equity and quality of care regarding the ongoing training of professionals.

  9. At the interface of community and healthcare systems: a longitudinal cohort study on evolving health and the impact of primary healthcare from the patient's perspectiv

    PubMed Central

    2010-01-01

    Background Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the effect of patient-centred and effective primary healthcare on the evolution of chronic illness burden and health functioning in a population, and in particularly vulnerable groups: the multi-morbid and the poor. Methods/Design A randomly selected cohort of 2000 adults aged 25 to 75 years will be recruited within the geographic boundaries of four local healthcare networks in Quebec. At recruitment, cohort members will report on socio-demographic information, functional health and healthcare use. Two weeks, 12 months and 24 months after recruitment, cohort participants will complete a self-administered questionnaire on current health and health behaviours in order to evaluate primary healthcare received in the previous year. The dependent variables are calculated as change over time of functional health status, chronic illness burden, and health behaviours. Dimensions of patient-centred care and clinical processes are measured using sub-scales of validated instruments. We will use Poisson regression modelling to estimate the incidence rate of chronic illness burden scores and structural equation modelling to explore relationships between variables and to examine the impact of dimensions of patient-centred care and effective primary healthcare. Discussion Results will provide valuable information for primary healthcare clinicians on the course of chronic illness over time and the impact on health outcomes of accessible, patient-centred and effective care. A demonstration of impact will contribute to the promotion of continuous quality improvement activities at a clinical level. While considerable advances have been

  10. Pain measurement as part of primary healthcare of adult patients with sickle cell disease

    PubMed Central

    Signorelli, Andreza Aparecida Felix; Ribeiro, Sonia Beatriz Felix; Moraes-Souza, Helio; de Oliveira, Lucas Felix; Ribeiro, João Batista; da Silva, Sheron Hellen; de Oliveira, Daniel Fachinelli Felix; Ribeiro, Matheus Fernando Felix

    2013-01-01

    Objective The aim of this exploratory, cross-sectional study was to evaluate pain in sickle cell disease patients and aspects related to primary healthcare. Methods Data were obtained through home interviews. The assessment instruments (body diagram, Numerical Pain Scale, McGill Pain Questionnaire) collected information on the underlying disease and on pain. Data were analyzed using the Statistical Package for Social Sciences program for Windows. Associations between the subgroups of sickle cell disease patients (hemoglobin SS, hemoglobin SC, sickle β-thalassemia and others) and pain were analyzed using contingency tables and non-parametric tests of association (classic chi-square, Fisher's and Kruskal-Wallis) with a level of 5% (p-value < 0.05) being set for the rejection of the null hypothesis. Results Forty-seven over 18-year-old patients with sickle cell disease were evaluated. Most were black (78.7%) and female (59.6%) and the mean age was 30.1 years. The average number of bouts of pain annually was 7.02; pain was predominantly reported by individuals with sickle cell anemia (hemoglobin SS). The intensity of pain (Numeric Pain Scale) was 5.5 and the quantitative index (McGill) was 35.9. This study also shows that patients presented a high frequency of moderately painful crises in their own homes. Conclusion According to these facts, it is essential that pain related to sickle cell disease is properly identified, quantified, characterized and treated at the three levels of healthcare. In primary healthcare, accurate measurement of pain combined with better care may decrease acute painful episodes and consequently minimize tissue damage, thus improving the patient's overall health. PMID:24106446

  11. [Primary healthcare and underreporting and (in)visibility of violence against women].

    PubMed

    Kind, Luciana; Orsini, Maria de Lourdes Pereira; Nepomuceno, Valdênia; Gonçalves, Letícia; Souza, Gislaine Alves de; Ferreira, Monique Fernanda Félix

    2013-09-01

    This study aimed to map indicators of violence against women as recorded by primary healthcare services in Belo Horizonte, Minas Gerais State, Brazil, and to identify difficulties experienced by health professionals in reporting such violence. Epidemiological data on this type of notification were collected in the information system of the Municipal Health Department. Data were produced with a semi-structured questionnaire and three focus group sessions with participation by 270 primary care professionals. The data were submitted to content analysis and were coded, categorized, and discussed in light of a literature review. A central analytical axis was called (in)visibility of violence against women. The data revealed both the recognition of violence as a public health problem and the invisibility that prevents dealing with it properly. Notification of such violence is often viewed as a fuss or commotion, which hampers progress in discussing and acting on the problem.

  12. Public perspectives on health human resources in primary healthcare: context, choices and change.

    PubMed

    Regan, Sandra; Wong, Sabrina T; Watson, Diane E

    2010-02-01

    The purpose of this study was to examine factors identified by patients as relevant to health human resources (HHR) planning for primary healthcare (PHC). Eleven focus groups were conducted in British Columbia and a thematic analysis was undertaken, informed by a needs-based HHR planning framework. Three themes emerged: (a) the importance of geographic context, (b) change management at the practice level and (c) the need for choices and changes in delivery of PHC. Findings suggest that more attention could be focused on overcoming geographic barriers to providing services, change management within office-based practices, and providing support structures that allow primary care providers to work closer to their full scope of practice. That these factors align with many strategic directions set out by government and planners signals the readiness for change in how PHC is delivered and HHR planned.

  13. Primary healthcare in Portugal: 10 years of contractualization of health services in the region of Lisbon.

    PubMed

    Monteiro, Baltazar Ricardo; Pisco, Ana Maria Silva Azenha; Candoso, Fátima; Bastos, Sónia; Reis, Magda

    2017-03-01

    Contractualization consists in the development and implementation of a documented agreement whereby one party (payer) provides compensation to the other party (provider) in exchange for a set of health services to a targeted population. We describe, through a case study, the history and the process of implementation of primary health care contractualization (since 1992) in Portugal, emphasizing the consolidation and future challenges of the primary healthcare reform started in 2005. This article resorts to a case study to reflect on the results obtained in the Cluster of Health Centers of the Northern West, Regional Administration of Lisbon and Tagus Valley, between 2009 and 2015, following implementation of contractualization. It was found that the incentive-related payments will have to be weighted considering the results obtained, strongly influenced by epidemiological and socioeconomic change.

  14. 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.

  15. Australia's personally controlled electronic health record and primary healthcare: generating a framework for implementation and evaluation.

    PubMed

    Almond, H; Cummings, E; Turner, P

    2013-01-01

    The Australian Government launched a personally controlled electronic health record (PCEHR) system in July 2012 committing $466.7m. Currently Australia lacks a clearly articulated implementation and evaluation framework and there remains limited detail on how this system's success will be determined. These problems are especially visible in primary healthcare. The UK and US, have been advocated as models, however they have started to report points of failure arising from their approaches. Evidence suggests that alternatives need to be considered, if mistakes are not to be replicated. Insights from e-health record implementation and evaluation approaches in Denmark and the Netherlands provide Australia with other approaches. The PCEHR requires different and radical thinking around the delivery of health services. Drawing on a range of English language articles identified between 1996 and 2012, the paper generates a conceptual framework for implementation and evaluation of the PCEHR. The generation of a grounded implementation and evaluation framework in primary healthcare will reduce provider scepticism and facilitate complex changes associated with PCEHR uptake.

  16. 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.

  17. 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…

  18. 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

  19. 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

  20. 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

  1. 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

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

    PubMed Central

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

    2016-01-01

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

  3. [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.

  4. Strengths of primary healthcare regarding care provided for chronic kidney disease 1

    PubMed Central

    de Paula, Elaine Amaral; Costa, Mônica Barros; Colugnati, Fernando Antonio Basile; Bastos, Rita Maria Rodrigues; Vanelli, Chislene Pereira; Leite, Christiane Chaves Augusto; Caminhas, Márcio Santos; de Paula, Rogério Baumgratz

    2016-01-01

    ABSTRACT Objective: to assess the structure and results obtained by the "Chronic Renal Patients Care Program" in a Brazilian city. Method: epidemiological, cross-sectional study conducted in 14 PHC units and a secondary center from 2010 to 2013. The Donabedian Model was the methodological framework used. A total of 14 physicians, 13 supervisors, and 11 community health agents from primary healthcare were interviewed for the assessment of structure and process and 1,534 medical files from primary healthcare and 282 from secondary care were consulted to assess outcomes. Results: most units lacked sufficient offices for physicians and nurses to provide consultations, had incomplete staffing, and most professionals had not received proper qualification to provide care for chronic renal disease. Physicians from PHC units classified as capable more frequently referred patients to the secondary care service in the early stages of chronic renal disease (stage 3B) when compared to physicians of units considered not capable (58% vs. 36%) (p=0.049). Capable PHC units also more frequently presented stabilized glomerular filtration rates (51%) when compared to partially capable units (36%) and not capable units (44%) (p=0.046). Conclusion: patients cared for by primary healthcare units that scored higher in structure and process criteria presented better clinical outcomes. Objective: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables. Method: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. Results: the coping strategies most often used by family members

  5. 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

  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. 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.

  8. 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

  9. Contributions of the nursing intervention in primary healthcare for the promotion of breastfeeding.

    PubMed

    da Graça, Luís Carlos Carvalho; Figueiredo, Maria do Céu Barbiéri; Conceição, Maria Teresa Caetano Carreira

    2011-01-01

    This study aimed to analyze the contributions of the Primary Healthcare nursing interventions, with primiparae in the promotion of breastfeeding. This is a quasi-experimental, longitudinal study, with a sample consisting of 151 primiparae, who had less than 28 weeks of pregnancy, with the child living for at least six months after the birth, performed between 15 October 2007 and 29 February 2008. Almost all the women initiated breastfeeding, with a sharp decline verified in the prevalence at six months. The mean duration of breastfeeding was 123.8±68.9 days. The intervention that began in the prepartum and continued into the postpartum period, using various strategies (individual consultation, preparation courses for parenting/childbirth, and domicile visits) and intervention contexts (health services and domicile) had significant effects on the duration of breastfeeding, which was not verified in the prevalence.

  10. An Ethnographically Informed Participatory Design of Primary Healthcare Information Technology in a Developing Country Setting.

    PubMed

    Shidende, Nima Herman; Igira, Faraja Teddy; Mörtberg, Christina Margaret

    2017-01-01

    Ethnography, with its emphasis on understanding activities where they occur, and its use of qualitative data gathering techniques rich in description, has a long tradition in Participatory Design (PD). Yet there are limited methodological insights in its application in developing countries. This paper proposes an ethnographically informed PD approach, which can be applied when designing Primary Healthcare Information Technology (PHIT). We use findings from a larger multidisciplinary project, Health Information Systems Project (HISP) to elaborate how ethnography can be used to facilitate participation of health practitioners in developing countries settings as well as indicating the importance of ethnographic approach to participatory Health Information Technology (HIT) designers. Furthermore, the paper discusses the pros and cons of using an ethnographic approach in designing HIT.

  11. 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

  12. Satisfaction of Patients Attending in Primary Healthcare Centers in Riyadh, Saudi Arabia: A Random Cross-Sectional Study.

    PubMed

    Almutairi, Khalid M

    2017-06-01

    This study aims to determine the level of satisfaction of patients who visit primary healthcare centers in Riyadh, Saudi Arabia. The investigation was a cross-sectional study conducted in twenty randomly selected primary healthcare centers in Riyadh, Saudi Arabia from October to December 2014. A descriptive data analysis was performed. Eligible participants had visited at least one of the selected primary healthcare centers within the past 12 months. A total of 1741 participants completed the survey, providing a response rate of 87 % (43 % male, 57 % female). The highest satisfaction rates were in the following areas: comprehensiveness and coordination 76.2 % (95 % CI 74.8 ± 77.5), communication 72.7 % (95 % CI 71.3 ± 74) and attitude of staff 73.4 % (95 % CI 72.1 ± 74.8) The areas of greatest concern expressed by the participants were the length of the wait and the quality of the facility 55.4 % (95 % CI 53.3 ± 57.5), 50.5 % (95 % CI 48.3 ± 52.7), respectively. The majority of the patients attending primary healthcare centers in Riyadh showed high levels of satisfaction; however, there are still some factors that need to be considered and improved upon. These include the accessibility of primary healthcare centers as well as waiting time of patients. The results of the current study showed relative improvement in other factors such as comprehensiveness and coordination, communication and attitude of staff. The level of satisfaction of patients and stakeholders shows the progress of the quality of care in healthcare facilities in Riyadh, Saudi Arabia.

  13. Health-care providers' perception of knowledge, skills and preparedness for disaster management in primary health-care centres in Jordan.

    PubMed

    Al-Ali, N M; Ibaid, A H Abu

    2015-12-13

    This survey in primary health-care centres in north Jordan aimed to assess health-care providers' perceptions of their knowledge, skills and preparedness for disaster management. A multistage random sample was used to recruit nurses and physicians from 57 health centres. A total of 207 participants completed the Arabic version of the Disaster Preparedness Evaluation Tool. Participants perceived themselves as having moderate preparation for disaster management [mean score 74.9 (SD 21.6)], moderate knowledge [mean 49.9 (SD 12.3)] and moderate to weak skills in disaster management [mean 35.3 (SD 12.7)]. Significant differences were revealed in participants' perceptions of their disaster preparedness, knowledge and skills according to their sex, specialty and exposure to a real disaster situation. Further education and training courses are needed to enhance providers' preparedness for disaster management in Jordan.

  14. 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

  15. Juggling efficiency. An ethnographic study exploring healthcare seeking practices and institutional logics in Danish primary care settings.

    PubMed

    Andersen, Rikke Sand; Vedsted, Peter

    2015-03-01

    This article explores the mutually constituting relationship between healthcare seeking practices and the socio-political context of clinical encounters. On the basis of ethnographic fieldwork carried out in the context of Danish primary care (general practice) and inspired by recent writings on institutional logics, we illustrate how a logic of efficiency organise and give shape to healthcare seeking practices as they manifest in local clinical settings. Overall, patient concerns are reconfigured to fit the local clinical setting and healthcare professionals and patients are required to juggle efficiency in order to deal with uncertainties and meet more complex or unpredictable needs. Lastly, building on the empirical case of cancer diagnostics, we discuss the implications of the pervasiveness of the logic of efficiency in the clinical setting and argue that provision of medical care in today's primary care settings requires careful balancing of increasing demands of efficiency, greater complexity of biomedical knowledge and consideration for individual patient needs.

  16. 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

  17. A training intervention on child feeding among primary healthcare workers in Ibadan Municipality

    PubMed Central

    Olaolorun, Funmilola M.; Adeniyi, Joshua D.

    2016-01-01

    Introduction Health workers at the primary level are well positioned to provide health information and counselling on child feeding to mothers on antenatal visits. The study was designed to evaluate the effect of training on the knowledge, attitudes and provision of infant and young child feeding (IYCF) information and counselling among primary healthcare (PHC) workers. Methods A two-stage cluster sample was used to select health workers for training on IYCF in Ibadan, Nigeria. Baseline, immediate and 4-week post-training surveys were conducted to assess knowledge, attitudes and practices of health workers regarding IYCF. Paired t-tests were used to measure differences (p < 0.05) before and after the training. Results A total of 124 health workers were trained on current global IYCF recommendations. Participants included community health extension workers (59.7%), nurses (27.4%), community health officers (11.3%), and pharmacy technicians (1.6%). Mean age was 41.8 ± 8.2 years and 95.2% were women. Knowledge of health workers regarding IYCF, particularly complementary feeding, was low at baseline but improved significantly following the training intervention. Attitudes and practices regarding provision of IYCF were suboptimal among health workers at the PHC facilities, but this improved with training. Conclusion Health workers at the PHC level need regular retraining exercises to ensure effective counselling on IYCF. PMID:27796119

  18. 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.

  19. Wound care by district nurses at primary healthcare centres: a challenging task without authority or resources.

    PubMed

    Friman, Anne; Klang, Birgitta; Ebbeskog, Britt

    2011-09-01

    There is a lack of studies that describes how district nurses experience the care they provide in connection with wound care. The aim of this study was therefore to describe district nurses experiences of their nursing actions when treating patients with different kinds of wounds at primary healthcare centres and in the home care in order to increase understanding of this kind of care. A qualitative, descriptive study was conducted, with interviews of eight district nurses. Data were analysed using qualitative content analysis. Three themes and nine sub-themes were identified. The first theme included two sub-themes which revealed that in performing wound care district nurses feel responsible for administering wound care, and they feel confident in making independent assessments. The second theme included three sub-themes which revealed that district nurses endeavour to assess all aspects of their patient's situation and to maintain continuity in both their contact with the patient and the treatment. A treatment plan for wound care and regular reports were identified as being important in collaboration with other healthcare professionals. District nurses wanted their own procedure for referral to facilitate the patient's direct contact with a dermatologist. The third theme included four sub-themes which revealed difficulties associated with ambiguous organisation. Lack of time led to the dressing of wounds being delegated to nursing assistants. Limited access to treatment rooms and equipment made wound care difficult and inefficient. Wound care in the home care was regarded as challenging due to the lack of equipment, and poor lighting, ergonomics and hygiene. The results of this study thus identified the aspirations of district nurses to provide expert wound care while working independently. However, these aspirations were aggravated by organisational shortcomings, such as a lack of authority and the resources required to carry out their nursing actions optimally.

  20. 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

  1. 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.

  2. 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

  3. 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

  4. Primary health-care responses to methamphetamine use in Australian Indigenous communities.

    PubMed

    MacLean, Sarah; Harney, Angela; Arabena, Kerry

    2015-01-01

    Crystal methamphetamine (commonly known as 'ice') use is currently a deeply concerning problem for some Australian Indigenous peoples and can cause serious harms to individual, families and communities. This paper is intended to support best practice responses by primary health-care staff working with Australian Indigenous people who use methamphetamine. It draws on a systematic search of relevant databases to identify literature from January 1999 to February 2014, providing an overview of prevalence, treatment, education and harm reduction, and community responses. The prevalence of methamphetamine use is higher in Indigenous than non-Indigenous communities, particularly in urban and regional settings. No evidence was identified that specifically related to effective treatment and treatment outcomes for Indigenous Australians experiencing methamphetamine dependence or problematic use. While studies involving methamphetamine users in the mainstream population suggest that psychological and residential treatments show short-term promise, longer-term outcomes are less clear. Community-driven interventions involving Indigenous populations in Australia and internationally appear to have a high level of community acceptability; however, outcomes in terms of methamphetamine use are rarely evaluated. Improved national data on prevalence of methamphetamine use among Indigenous people and levels of treatment access would support service planning. We argue for the importance of a strength-based approach to addressing methamphetamine use, to counteract the stigma and despair that frequently accompanies it.

  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.

  6. [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.

  7. Supply and distribution of primary healthcare registered nurses in british columbia.

    PubMed

    Wong, Sabrina T; Watson, Diane E; Young, Ella; Mooney, Dawn

    2009-11-01

    WHAT DID WE DO?: This study uses an existing data source to (a) describe the population and geographic distribution of registered nurses (RNs) working in primary healthcare (PHC) in British Columbia, (b) compare this workforce to PHC physicians and (c) assess the distribution of PHC-RNs relative to population health status. WHAT DID WE LEARN?: Of the 27,570 practising RNs in British Columbia in 2000, there were 3,179 (12%) in the PHC workforce. This translates into 147 people per practising RN and 1,277 people per PHC-RN. In 2000, there were 990 people per PHC physician. PHC-RNs represented 43% of the combined PHC workforce of physicians and RNs. A large proportion (47%) of PHC-RNs worked in community health centres, whereas less than 2% worked in physicians' offices. Geographic distribution of PHC-RNs is similar to the distribution of PHC physicians and is not associated with population health status. WHAT ARE THE IMPLICATIONS?: There seem to be sufficient PHC-RNs to implement policy objectives in support of interdisciplinary PHC teams, but physicians and nurses will increasingly need to practice in the same location or have access to electronic information systems to support coordination, continuity and comprehensiveness of PHC. The PHC workforce could be better deployed to align with population health status.

  8. Falls among dizzy patients in primary healthcare: an intervention study with control group.

    PubMed

    Hansson, Eva Ekvall; Månsson, Nils-Ove; Ringsberg, Karin A; Håkansson, Anders

    2008-03-01

    The objective of this study is to investigate whether vestibular rehabilitation can improve balance, reduce self-perceived handicap because of dizziness and, if possible, reduce falls among dizzy patients in primary healthcare. The study also finds out which of the balance measures and measure of self-perceived handicap, if any, predicted the risk of falls. The design of this study is an intervention study with control group. Fifty-eight patients, 65 years and older, with multisensory dizziness were taken as participants. The intervention group trained vestibular rehabilitation twice a week for 9 weeks. All patients were assessed at baseline and after 3 months, with four different balance measures and the Dizziness Handicap Inventory. After 6, 9 and 12 months, a follow-up by telephone was performed and, at 12 months, the patients also filled out a Dizziness Handicap Inventory questionnaire. Statistically significant differences were found between the groups between baseline and 3 months in one static balance measure and in one dynamic measure (P=0.038 and 0.044). In total, 40 falls were reported, 31 were classified as intrinsic falls, 26 of them caused by vertigo and nine falls were classified as extrinsic. No difference was found between the two groups in proportions of patients who fell. Poor ability to stand in tandem stance doubled the risk for falls. Vestibular rehabilitation can improve balance in elderly patients with multisensory dizziness. Vertigo is a common cause of falls in this group of patients and vestibular rehabilitation is a feasible treatment.

  9. Are primary healthcare services culturally appropriate for Aboriginal people? Findings from a remote community.

    PubMed

    Smith, Kaye; Fatima, Yaqoot; Knight, Sabina

    2017-04-13

    This study explored the views of key stakeholders on cultural appropriateness of primary health care (PHC) services for Aboriginal people. A total of 78 participants, including healthcare providers, administrative team members (n=24, ~30% of study sample) and Aboriginal community members (n=54, ~70% of study sample) living in remote North West Queensland participated in the study. Outcome measures were assessed by administering survey questionnaires comprising qualitative questions and various subscales (e.g. provider behaviours and attitudes, communication, physical environment and facilities, and support from administrative staff). Descriptive statistics were used to present quantitative findings, whereas inductive thematic analysis was used for qualitative data. In contrast to the views of PHC providers, a significant number of Aboriginal people did not perceive that they were receiving culturally appropriate services. Although PHC providers acknowledged cultural awareness training for familiarising themselves with Aboriginal culture, they found the training to be general, superficial and lacking prospective evaluation. PHC providers should understand that culturally inappropriate clinical encounters generate mistrust and dissatisfaction. Therefore, a broad approach involving culturally respectful association between PHC providers, Aboriginal consumers and administrative staff is required to bring sustainable changes at the practice level to improve the health of Aboriginal people.

  10. 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

  11. 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

  12. 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.

  13. Development of a Mobile System Decision-support for Medical Diagnosis of Asthma in Primary Healthcare--InteliMED.

    PubMed

    Menezes, Júlio; Gusmão, Cristine

    2015-01-01

    The structure of public and primary healthcare in Brazil is organized in a way to provide decentralized services. In theory, this scenario could enable the usage of mobile devices integrated with information systems of several purposes. In addition, there is a need of decision-support tools that are based on collected evidences, once the professional of primary healthcare, which essentially has general knowledge (non-specialist). Therefore there is a need of information that support the decision-making process on more specific contexts. This paper presents the proposal, experience of development and application of the InteliMED, a decision-support system to asthma diagnosis of children and adolescents through decision-trees and mobile devices (smartphones and tablets).

  14. 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

  15. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: assessment and management of infertility at primary healthcare level.

    PubMed

    Loh, Seong Feei; Agarwal, Rachna; Chan, Jerry K; 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, P C; Yeong, Cheng Toh; Yu, Su Ling

    2014-02-01

    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.

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

    PubMed Central

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

    2016-01-01

    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

  17. Primary healthcare reform in the United Nations Relief and Works Agency for Palestine Refugees in the Near East.

    PubMed

    Santoro, A; Abu-Rmeileh, N; Khader, A; Seita, A; McKee, M

    2016-09-25

    Palestinian refugees served by the United Nation Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) are experiencing increasing rates of diagnosis of non-communicable diseases. In response, in 2011 UNRWA initiated an Agency-wide programme of primary healthcare reform, informed by the Chronic Care Model framework. Health services were reorganized following a family-centred approach, with delivery by multidisciplinary family health teams supported by updated technical advice. An inclusive clinical information system, termed e-Health, was implemented to collect a wide range of health information, with a focus on continuity of treatment. UNRWA was able to bring about these wide-ranging changes within its existing resources, reallocating finances, reforming its payment mechanisms, and modernizing its drug-procurement policies. While specific components of UNRWA's primary healthcare reform are showing promising results, additional efforts are needed to empower patients further and to strengthen involvement of the community.

  18. 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

  19. Impact of the Mais Médicos (More Doctors) Program in reducing physician shortage in Brazilian Primary Healthcare.

    PubMed

    Girardi, Sábado Nicolau; Stralen, Ana Cristina de Sousa van; Cella, Joana Natalia; Wan Der Maas, Lucas; Carvalho, Cristiana Leite; Faria, Erick de Oliveira

    2016-09-01

    The Mais Médicos (More Doctors) Program (PMM) was put in place in Brazil aiming to reduce inequalities in access to Primary Healthcare. Based on diverse evidence that pointed to a scenario of profound shortage of doctors in the country, one of its central thrusts was emergency provision of these professionals in vulnerable areas, referred to as the Mais Médicos para o Brasil (More Doctors for Brazil) Project. The article analyses the impact of the PMM in reducing shortage of physicians in Brazilian municipalities. To do this, it uses the Primary Healthcare Physicians Shortage Index, which identifies and measures the shortage in the periods of March 2003 and September 2015, before and after implementation of the program. The results show that there was a substantial increase in the supply of physicians in primary healthcare in the period, which helped reduce the number of municipalities with shortage from 1,200 to 777. This impact also helped reduce inequalities between municipalities, but the inequities in distribution persisted. It was also found that there was a reduction in the regular supply of doctors made by municipalities, suggesting that these were being simply substituted by the supply coming from the program. Thus, an overall situation of insecurity in care persists, reflecting the dependence of municipalities on the physician supply from the federal government.

  20. 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

  1. 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

  2. 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.

  3. Health care policy and community pharmacy: implications for the New Zealand primary health care sector.

    PubMed

    Scahill, Shane; Harrison, Jeff; Carswell, Peter; Shaw, John

    2010-06-25

    and other primary care providers. There are significant barriers to change. Some of these are financial but many are professional and organisational and require a genuine commitment from the whole primary health care sector.

  4. 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.

  5. 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

  6. 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

  7. [Primary healthcare and the construction of meanings for oral health: a social constructionist interpretation of discourses by the elderly].

    PubMed

    Bulgarelli, Alexandre Favero; Lorenzi, Carla Guanáes; Silva, Rosalina Carvalho da; Mestriner, Soraya Fernandes; Villa, Teresa Cristina Scatena; Pinto, Ione Carvalho

    2012-08-01

    Dentistry is nowadays open to new ideas about the constructions of meanings for oral health. This openness tallies with the social production of health and shows the need to contextualize the social, historical and sundry knowledge in the development of oral health for different communities. The scope of this research is to build meanings for oral health with a group of elderly people. With this in mind, we propose an approximation between the discourses of the elderly on oral health and the Social Constructionist discourse. Thus, we interviewed 14 elderly people registered with a Family Health Unit in Ribeirão Preto in the State of São Paulo in the first semester of 2010. This enabled us to identify two Interpretative Repertoires with the use of Discourse Analysis, which showed the relationship between: 1 - Lack of dental information and assistance in childhood; and 2 - Primary Healthcare constructing meaning for oral health. We concluded that Social Constructionism assists epistemologically for the construction of meaning for oral health and that Primary Healthcare is essential for valuing healthcare for the construction of meaning for oral health on the part of the elderly by fostering conditions for self care and healthy attitudes.

  8. Knowledge of and Attitudes to Influenza Vaccination in Healthy Primary Healthcare Workers in Spain, 2011-2012

    PubMed Central

    Domínguez, Angela; Godoy, Pere; Castilla, Jesús; Soldevila, Núria; Toledo, Diana; Astray, Jenaro; Mayoral, José María; Tamames, Sonia; García-Gutiérrez, Susana; González-Candelas, Fernando; Martín, Vicente; Díaz, José; Torner, Nuria

    2013-01-01

    Annual influenza vaccination is recommended for healthcare workers, but many do not follow the recommendation. The objective of this study was to investigate the factors associated with seasonal influenza vaccination in the 2011–2012 season. We carried out an anonymous web survey of Spanish primary healthcare workers in 2012. Information on vaccination, and knowledge and attitudes about the influenza vaccine was collected. Workers with medical conditions that contraindicated vaccination and those with high risk conditions were excluded. Multivariate analysis was performed using unconditional logistic regression. We included 1,749 workers. The overall vaccination coverage was 50.7% and was higher in workers aged ≥ 55 years (55.7%), males (57.4%) and paediatricians (63.1%). Factors associated with vaccination were concern about infection at work (aOR 4.93; 95% CI 3.72–6.53), considering that vaccination of heathcare workers is important (aOR 2.62; 95%CI 1.83–3.75) and that vaccination is effective in preventing influenza and its complications (aOR 2.40; 95% CI 1.56–3.67). No association was found between vaccination and knowledge of influenza or the vaccine characteristics. Educational programs should aim to remove the misconceptions and attitudes that limit compliance with recommendations about influenza vaccination in primary healthcare workers rather than only increasing knowledge about influenza and the characteristics of the vaccine. PMID:24260560

  9. Knowledge of and attitudes to influenza vaccination in healthy primary healthcare workers in Spain, 2011-2012.

    PubMed

    Domínguez, Angela; Godoy, Pere; Castilla, Jesús; Soldevila, Núria; Toledo, Diana; Astray, Jenaro; Mayoral, José María; Tamames, Sonia; García-Gutiérrez, Susana; González-Candelas, Fernando; Martín, Vicente; Díaz, José; Torner, Nuria

    2013-01-01

    Annual influenza vaccination is recommended for healthcare workers, but many do not follow the recommendation. The objective of this study was to investigate the factors associated with seasonal influenza vaccination in the 2011-2012 season. We carried out an anonymous web survey of Spanish primary healthcare workers in 2012. Information on vaccination, and knowledge and attitudes about the influenza vaccine was collected. Workers with medical conditions that contraindicated vaccination and those with high risk conditions were excluded. Multivariate analysis was performed using unconditional logistic regression. We included 1,749 workers. The overall vaccination coverage was 50.7% and was higher in workers aged ≥ 55 years (55.7%), males (57.4%) and paediatricians (63.1%). Factors associated with vaccination were concern about infection at work (aOR 4.93; 95% CI 3.72-6.53), considering that vaccination of heathcare workers is important (aOR 2.62; 95%CI 1.83-3.75) and that vaccination is effective in preventing influenza and its complications (aOR 2.40; 95% CI 1.56-3.67). No association was found between vaccination and knowledge of influenza or the vaccine characteristics. Educational programs should aim to remove the misconceptions and attitudes that limit compliance with recommendations about influenza vaccination in primary healthcare workers rather than only increasing knowledge about influenza and the characteristics of the vaccine.

  10. Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states.

    PubMed

    Mbachu, Chinyere; Onwujekwe, Obinna; Ezumah, Nkoli; Ajayi, Olayinka; Sanwo, Olusola; Uzochukwu, Benjamin

    2016-09-01

    Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players' capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players' support largely depends on how well the reform aligns with political structures and current institutional practices.

  11. 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

  12. 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…

  13. 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

  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.

  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. Healthcare technology and technology assessment.

    PubMed

    Herndon, James H; Hwang, Raymond; Bozic, K J; Bozic, K H

    2007-08-01

    New technology is one of the primary drivers for increased healthcare costs in the United States. Both physician and industry play important roles in the development, adoption, utilization and choice of new technologies. The Federal Drug Administration regulates new drugs and new medical devices, but healthcare technology assessment remains limited. Healthcare technology assessment originated in federal agencies; today it is decentralized with increasing private sector efforts. Innovation is left to free market forces, including direct to consumer marketing and consumer choice. But to be fair to the consumer, he/she must have free knowledge of all the risks and benefits of a new technology in order to make an informed choice. Physicians, institutions and industry need to work together by providing proven, safe, clinically effective and cost effective new technologies, which require valid pre-market clinical trials and post-market continued surveillance with national and international registries allowing full transparency of new products to the consumer--the patient.

  17. 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

  18. Recent trends in working with the private sector to improve basic healthcare: a review of evidence and interventions.

    PubMed

    Montagu, Dominic; Goodman, Catherine; Berman, Peter; Penn, Amy; Visconti, Adam

    2016-10-01

    The private sector provides the majority of health care in Africa and Asia. A number of interventions have, for many years, applied different models of subsidy, support and engagement to address social and efficiency failures in private health care markets. We have conducted a review of these models, and the evidence in support of them, to better understand what interventions are currently common, and to what extent practice is based on evidence. Using established typologies, we examined five models of intervention with private markets for care: commodity social marketing, social franchising, contracting, accreditation and vouchers. We conducted a systematic review of both published and grey literature, identifying programmes large enough to be cited in publications, and studies of the listed intervention types. 343 studies were included in the review, including both published and grey literature. Three hundred and eighty programmes were identified, the earliest having begun operation in 1955. Commodity social marketing programmes were the most common intervention type, with 110 documented programmes operating for condoms alone at the highest period. Existing evidence shows that these models can improve access and utilization, and possibly quality, but for all programme types, the overall evidence base remains weak, with practice in private sector engagement consistently moving in advance of evidence. Future research should address key questions concerning the impact of interventions on the market as a whole, the distribution of benefits by socio-economic status, the potential for scale up and sustainability, cost-effectiveness compared to relevant alternatives and the risk of unintended consequences. Alongside better data, a stronger conceptual basis linking programme design and outcomes to context is also required.

  19. School Sector Differences in Student Achievement in Australian Primary and Secondary Schools: A Longitudinal Analysis

    ERIC Educational Resources Information Center

    Marks, Gary N.

    2015-01-01

    This article examines school sector differences in student performance Years 3, 5, and 7 in numeracy, reading, writing, spelling and grammar using data from the Longitudinal Study of Australian Children and the national testing program (NAPLAN). At each of the 3 Year levels, there are sizable school sector differences with students from…

  20. 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

  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. 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.

  3. Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

    PubMed Central

    D'Amour, Danielle; Contandriopoulos, Damien; Chouinard, Véronique; Dubois, Carl-Ardy

    2014-01-01

    Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration. PMID:25692039

  4. [Latent tuberculosis infection in healthcare personnel at a primary level general hospital in Catalonia, Spain].

    PubMed

    Sol Vidiella, Josep; Catalán Gómez, Teresa; Callau Casanova, Cristina; Lejeune, Marylène

    2014-01-01

    The aim was to analyze the prevalence of latent tuberculosis infection and associated risk factors in healthcare personnel at the Hospital de Tortosa Verge de la Cinta (Tarragona, Spain). This was a cross-sectional study of 398 workers at this hospital who underwent tuberculin skin testing for latent tuberculosis infection (LTBI) between 2001 and 2012.We also analyzed the relationship between LTBI and age, sex, job and work area according to their risk of exposure to tuberculosis(high, low, uncertain). The total prevalence of LTBI in our sample was 11.1% (95%CI 8.3%-14.5%). LBTI was associated with age and work area. Multivariate analysis showed that the risk of LTBI increased by 6.4% per 1 year increase in age. The prevalence of LTBI in this population approximates that of the general population in Spain.

  5. 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

  6. Evaluation of academic detailing programme on childhood diarrhoea management by primary healthcare providers in Banke district of Nepal.

    PubMed

    Khanal, Saval; Ibrahim, Mohamed Izham B Mohamed; Shankar, Pathiyil Ravi; Palaian, Subish; Mishra, Pranaya

    2013-06-01

    Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children's Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p < 0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p < 0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal.

  7. Evaluation of Academic Detailing Programme on Childhood Diarrhoea Management by Primary Healthcare Providers in Banke District of Nepal

    PubMed Central

    Ibrahim, Mohamed Izham b. Mohamed; Shankar, Pathiyil Ravi; Palaian, Subish; Mishra, Pranaya

    2013-01-01

    Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children's Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p<0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p<0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal. PMID:23930342

  8. Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

    PubMed Central

    Mashamba-Thompson, Tivani P.; Jama, Ngcwalisa A.; Sartorius, Benn; Drain, Paul K.; Thompson, Rowan M.

    2017-01-01

    Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics. PMID:28075337

  9. 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

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

    PubMed

    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.

  11. 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

  12. Aligning provider incentives to improve primary healthcare delivery in the United States

    PubMed Central

    DeVoe, JE; Stenger, R

    2016-01-01

    Background The United States (US) is reforming primary care delivery systems, including the implementation of ‘patient-centered medical homes.’ Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms. Methods This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create ‘prisoner’s dilemmas’ that have stalled past reform efforts. It then uses this framework to illustrate, hypothetically, how advantages from different models could be blended together to encourage cooperation and improve the quality of primary care services delivered, thus providing an escape from current prisoner’s dilemmas faced by providers. Findings Improvements in primary care delivery will largely hinge on blended payment mechanisms that can effectively combine the advantageous elements of fee-for-service, capitation, and incentive payments into a balanced equation that enables providers to escape the perverse financial incentives of current payment mechanisms and overcome collective action problems. Conclusions If balanced appropriately, a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved. PMID:27942388

  13. 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

  14. Patients' Experiences with Specialist Care via Video Consultation in Primary Healthcare in Rural Areas

    PubMed Central

    Johansson, Annette M.; Lindberg, Inger; Söderberg, Siv

    2014-01-01

    Introduction. Video consultation (VC) can improve access to specialist care, especially for individuals who live in rural areas that are long distances from specialist clinics. Aim. The aim of this study was to describe patients' experiences with specialist care via VC encounters. Method. Interviews were conducted with 26 patients who had participated in a VC encounter. The data were analysed using thematic content analysis. Result. The analysis resulted in two themes. The theme “confident with the technology” was constructed from the categories “possibilities and obstacles in using VC encounters” and “advantages and disadvantages of the technology.” The theme “personal satisfaction with the VC encounters” was constructed from the categories “support from the healthcare personnel,” “perceived security,” and “satisfaction with the specialist consultation.” Conclusion. The patients who did not think that the VC was the best care still considered that the visit was adequate because they did not have to travel. An important finding was that the patients' perceived even short distances to specialty care as expensive journeys because many patients had low incomes. Among the patients who had more than one VC, the second encounter was perceived as safer. Additionally, good communication was essential for the patient's perception of security during the VC encounter. PMID:25243009

  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.

  16. 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

  17. Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations.

    PubMed

    Lane, Riki; Halcomb, Elizabeth; McKenna, Lisa; Zwar, Nicholas; Naccarella, Lucio; Davies, Gawaine Powell; Russell, Grant

    2016-04-21

    Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce.Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territoriesResults Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies.Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices.What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses' skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally

  18. Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China.

    PubMed

    Pan, Jay; Zhao, Hanqing; Wang, Xiuli; Shi, Xun

    2016-12-01

    In 2009, the Chinese government launched a new round of healthcare reform, which encourages development of private hospitals. Meanwhile, many public hospitals in China also became increasingly profit-oriented. These trends have led to concerns about social justice and regional disparity. However, there is a lack of empirical scientific analysis to support the debate. We started to fill this gap by conducting a regional-level analysis of spatial variation in spatial access to hospitals in the Sichuan Province. Such variation is an important indication of (in) equity in healthcare resource allocation. Using data of 2012, we intended to provide a snapshot of the situation that was a few years later since the new policies had set out. We employed two methods to quantify the spatial access: the nearest-neighbor method and the enhanced two-step floating catchment area (E2SFCA) method. We recognized two sub-regions of Sichuan: the rural West Sichuan and the well-developed East Sichuan. We classified the hospitals using both ownership and level. We applied the analysis to the resulting groups of hospitals and their combinations in the two sub-regions. The two sub-regions have a high contrast in the spatial access to hospitals, in terms of both quantity and spatial pattern. Public hospitals still dominated the service in the province, especially in the West Sichuan, which had been solely relying on public hospitals. Private hospitals only occurred in the East Sichuan, and at the primary level, they had surpassed public hospitals in terms of spatial accessibility. However, the governmental health expenditures seemed to be disconnected with the actual situation of the spatial access to hospitals. The government should continue carrying on its responsibility in allocating healthcare resources, be cautious about marketizing public hospitals, and encourage private hospitals to expand into rural areas. Methodologically, the results from the two methods are concurring but not

  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. 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…

  1. 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

  2. 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

  3. The power of r - pharmaceutical sales decomposition in Cyprus public healthcare sector and determinants of drug expenditure evolution: any lessons learned?

    PubMed

    Petrou, Panagiotis

    2014-04-01

    The pharmaceutical sector has been established as the primary cost driver in health. The scope of this paper is to explore the drivers of pharmaceutical expenditure in Cyprus by decomposing sales and assessing impact of prices, volumes and substitution effect. We used a statistical approach to decompose the growth of public pharmaceutical expenditure during 2005-2011 into three elements: 1) substitution effect; 2) price effect; and 3) increase of consumption. We further decomposed consumption into: 1) prescription/visits; 2) visits/beneficiaries; and 3) beneficiaries. Pharmaceutical expenditure grew by 31.4 % and volume of medicines dispensed increased by 55%. Prices declined by 11% and product-mix residual was -5.5%, indicating that Cyprus experienced a switch to cheaper medicines (generics) without compromising access of patients to innovative medicines. This was enhanced by guidelines, monitoring of prescribing behavior, generic substitution and efficient tendering. The increasing number of products per prescriptions should be monitored with caution.

  4. Interventions to improve care coordination between primary healthcare and oncology care providers: a systematic review

    PubMed Central

    Tomasone, Jennifer R; Brouwers, Melissa C; Vukmirovic, Marija; Grunfeld, Eva; O'Brien, Mary Ann; Urquhart, Robin; Walker, Melanie; Webster, Fiona; Fitch, Margaret

    2016-01-01

    Coordination of patient care between primary care and oncology care providers is vital to care quality and outcomes across the cancer continuum, yet it is known to be challenging. We conducted a systematic review to evaluate current or new models of care and/or interventions aimed at improving coordination between primary care and oncology care providers for patients with adult breast and/or colorectal cancer. MEDLINE, EMBASE, CINAHL, Cochrane Library Database of Systematic Reviews, and the Centre for Reviews and Dissemination were searched for existing English language studies published between January 2000 and 15 May 2015. Systematic reviews, meta-analyses, randomised controlled trials (RCTs) and non-randomised studies were included if they evaluated a specific model/intervention that was designed to improve care coordination between primary care and oncology care providers, for any stage of the cancer continuum, for patients with adult breast and/or colorectal cancer. Two reviewers extracted data and assessed risk of bias. Twenty-two studies (5 systematic reviews, 6 RCTs and 11 non-randomised studies) were included and varied with respect to the targeted phase of the cancer continuum, type of model or intervention tested, and outcome measures. The majority of studies showed no statistically significant changes in any patient, provider or system outcomes. Owing to conceptual and methodological limitations in this field, the review is unable to provide specific conclusions about the most effective or preferred model/intervention to improve care coordination. Imprecise results that lack generalisability and definitiveness provide limited evidence to base the development of future interventions and policies. Trial registration number CRD42015025006. PMID:27843639

  5. 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

  6. Comorbidities of HIV infection and health care seeking behavior among HIV infected patients attending public sector healthcare facilities in KwaZulu-Natal: A cross sectional study

    PubMed Central

    Nlooto, Manimbulu

    2017-01-01

    Background HIV-infected people may present with co-infections, comorbidities, and side effects associated with antiretroviral therapy. This study explored the prevalence of comorbid health problems and determined the extent of the use of traditional medicine for treatment of co-infections, comorbidities of HIV infection and side effects. Methods A cross sectional study, using researcher-administered questionnaires, was carried out among HIV-infected patients in eight public sector healthcare facilities in KwaZulu-Natal between April and October 1024. Self-reports of comorbidities, co-infections and side effects were analyzed with respect to factors such as age, gender, race, and health care seeking behavior including the use of traditional medicine. Cross-tabulations were conducted to test the association between factors and the use of traditional medicine, using Pearson chi-squared (χ2) test. Simple and multiple logistic regression models tested the association of the use of traditional medicine with age, gender, race, side effects and comorbidities. Odds ratios with 95% confidence intervals were estimated. Missing values were handled, defined and treated as missing values in the final analysis. Results Overall, 29.5% (n = 516) of the survey participants reported having other comorbidities and or co-infections besides their HIV condition. Same participants reported two or more comorbidities. Almost forty percent of participants (208/531, 39.17%) reported having hypertension as the most noninfectious comorbidity while 21.65% of participants (115/531) had tuberculosis accounting for the most infectious comorbidity. Almost eight percent of participants (142/1748, 8.12%) reported using traditional medicine after starting with cART. Sixty out of 142 participants (60/142, 42.25%) on cART resorted to the use of traditional medicine for the management of comorbidities and or co-infections of their HIV infection. Overall, 311 out of 1748 participants (17.80%) complained

  7. A Model for Good Governance of Healthcare Technology Management in the Public Sector: Learning from Evidence-Informed Policy Development and Implementation in Benin

    PubMed Central

    Houngbo, P. Th.; Zweekhorst, M.; De Cock Buning, Tj.; Medenou, D.; Bunders, J. F. G.

    2017-01-01

    Good governance (GG) is an important concept that has evolved as a set of normative principles for low- and middle-income countries (LMICs) to strengthen the functional capacity of their public bodies, and as a conditional prerequisite to receive donor funding. Although much is written on good governance, very little is known on how to implement it. This paper documents the process of developing a strategy to implement a GG model for Health Technology Management (HTM) in the public health sector, based on lessons learned from twenty years of experience in policy development and implementation in Benin. The model comprises six phases: (i) preparatory analysis, assessing the effects of previous policies and characterizing the HTM system; (ii) stakeholder identification and problem analysis, making explicit the perceptions of problems by a diverse range of actors, and assessing their ability to solve these problems; (iii) shared analysis and visioning, delineating the root causes of problems and hypothesizing solutions; (iv) development of policy instruments for pilot testing, based on quick-win solutions to understand the system’s responses to change; (v) policy development and validation, translating the consensus solutions identified by stakeholders into a policy; and (vi) policy implementation and evaluation, implementing the policy through a cycle of planning, action, observation and reflection. The policy development process can be characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. Interactive and analytical tools of action research were used to integrate knowledge amongst actor groups, identify consensus solutions and develop the policy in a way that satisfies criteria of GG. This model could be useful for other LMICs where resources are constrained and the majority of healthcare technologies are imported. PMID:28056098

  8. A Model for Good Governance of Healthcare Technology Management in the Public Sector: Learning from Evidence-Informed Policy Development and Implementation in Benin.

    PubMed

    Houngbo, P Th; Coleman, H L S; Zweekhorst, M; De Cock Buning, Tj; Medenou, D; Bunders, J F G

    2017-01-01

    Good governance (GG) is an important concept that has evolved as a set of normative principles for low- and middle-income countries (LMICs) to strengthen the functional capacity of their public bodies, and as a conditional prerequisite to receive donor funding. Although much is written on good governance, very little is known on how to implement it. This paper documents the process of developing a strategy to implement a GG model for Health Technology Management (HTM) in the public health sector, based on lessons learned from twenty years of experience in policy development and implementation in Benin. The model comprises six phases: (i) preparatory analysis, assessing the effects of previous policies and characterizing the HTM system; (ii) stakeholder identification and problem analysis, making explicit the perceptions of problems by a diverse range of actors, and assessing their ability to solve these problems; (iii) shared analysis and visioning, delineating the root causes of problems and hypothesizing solutions; (iv) development of policy instruments for pilot testing, based on quick-win solutions to understand the system's responses to change; (v) policy development and validation, translating the consensus solutions identified by stakeholders into a policy; and (vi) policy implementation and evaluation, implementing the policy through a cycle of planning, action, observation and reflection. The policy development process can be characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. Interactive and analytical tools of action research were used to integrate knowledge amongst actor groups, identify consensus solutions and develop the policy in a way that satisfies criteria of GG. This model could be useful for other LMICs where resources are constrained and the majority of healthcare technologies are imported.

  9. 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.

  10. Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need

    PubMed Central

    Hanssens, Lise; Vyncke, Veerle; De Maeseneer, Jan; Willems, Sara

    2017-01-01

    Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC) system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013) and the Primary Healthcare Activity Monitor for Europe (2010). The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country’s PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce) as this can influence inequity in unmet need. PMID:28046051

  11. Primary prevention of latex allergy in healthcare-spectrum of strategies including the European glove standardization.

    PubMed

    Wrangsjö, Karin; Boman, Anders; Lidén, Carola; Meding, Birgitta

    2012-04-01

    IgE-mediated allergy to natural rubber latex was first noted from rubber gloves in 1979. The initial reports in dermatological journals described contact urticarial reactions; later, severe generalized allergic reactions and asthma were documented. A considerable proportion of the people involved in medical and dental care were found to be sensitized to latex. This article describes and surveys a broad range of primary prevention measures at the local and national levels. Examples are given from paediatrics, dental education, and medical care. National strategies and position papers on latex allergy are presented in which medical professionals, manufacturers and public authorities have cooperated. Special reference is paid to the European work to standardize medical gloves, which led to document EN 455:3.

  12. Academisation, School Collaboration and the Primary School Sector in England: A Story of Six School Leaders

    ERIC Educational Resources Information Center

    Keddie, Amanda

    2016-01-01

    This paper presents data from a study of five English primary schools. It examines some of the challenges associated with school autonomy and collaboration for state primary schools amid the uncertainty and complexity of governance in the present English education context. The paper features the voices of six leaders gathered from interviews that…

  13. 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'.

  14. 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

  15. Experiences of primary care professionals providing healthcare to recently arrived migrants: a qualitative study

    PubMed Central

    Lindenmeyer, Antje; Redwood, Sabi; Griffith, Laura; Teladia, Zaheera; Phillimore, Jenny

    2016-01-01

    Objectives The main objectives of the study were to explore the experiences of primary care professionals providing care to recent migrants in a superdiverse city and to elicit barriers and facilitators to meeting migrants' care needs. This paper focuses on a strong emergent theme: participants' descriptions and understandings of creating a fit between patients and practices. Design An exploratory, qualitative study based on the thematic analysis of semistructured interviews. Setting and participants A purposive sample of 10 practices. We interviewed 6 general practitioners, 5 nurses and 6 administrative staff; those based at the same practice opted to be interviewed together. 10 interviewees were from an ethnic minority background; some discussed their own experiences of migration. Results Creating a fit between patients and practice was complex and could be problematic. Some participants defined this in a positive way (reaching out, creating rapport) while others also focused on ways in which patients did not fit in, for example, different expectations or lack of medical records. A small but vocal minority put the responsibility to fit in on to migrant patients. Some participants believed that practice staff and patients sharing a language could contribute to achieving a fit but others outlined the disadvantages of over-reliance on language concordance. A clearly articulated, team-based strategy to create bridges between practice and patients was often seen as preferable. Conclusions Although participants agreed that a fit between patients and practice was desirable, some aimed to adapt to the needs of recently arrived migrants, while others thought that it was the responsibility of migrants to adapt to practice needs; a few viewed migrant patients as a burden to the system. Practices wishing to improve fit might consider developing strategies such as introducing link workers and other ‘bridging’ people; however, they could also aim to foster a general stance

  16. [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.

  17. Prenatal exposure to antiepileptic drugs and use of primary healthcare during childhood: a population-based cohort study in Denmark

    PubMed Central

    Würtz, Anne Mette; Vestergaard, Claus Høstrup; Vestergaard, Mogens; Bech, Bodil Hammer

    2017-01-01

    Objective Prenatal exposure to antiepileptic drugs (AEDs) has been associated with adverse outcomes in the offspring such as congenital malformations and neuropsychiatric disorders. The objective of this study was to investigate whether prenatal exposure to AEDs is also associated with more frequent use of primary healthcare during childhood. Design Population-based cohort study. Setting Nationwide national registers in Denmark. Participants All live-born singletons in Denmark during 1997–2012 identified in the Danish National Patient Register and followed until 31 December 2013 (n=963 010). Information on prenatal exposure to AEDs for maternal indication of epilepsy and other neurological conditions was obtained from the Danish Register of Medicinal Product Statistics. Main outcome measures The primary outcome measure was the number and type of contacts with the general practitioner (GP), excluding routine well-child visits and vaccinations. The secondary outcome measure was specific services provided at the GP contact. The association between prenatal exposure to AEDs and contacts with the GP was estimated by using negative binomial regression adjusting for sex and date of birth of the child, maternal age, cohabitation status, income, education, substance abuse, depression, severe psychiatric disorders and use of antipsychotics, antidepressants and insulin. Results Children exposed prenatally to AEDs (n=4478) had 3% (95% CI 0 to 5%) more GP contacts during the study period than unexposed children. This was primarily accounted for by the number of phone contacts. Within each year of follow-up, exposed children tended to have more contacts than unexposed children, but the differences were small. We found no difference between exposed and unexposed children with regard to specific services provided at the GP contact. For the individual AEDs, we found that exposure to valproate or oxcarbazepine was associated with more GP contacts. Conclusions We found only minor

  18. Flexible design should be primary goal.

    PubMed

    2008-09-01

    At "Rebuilding the NHS", a recent Health Service Journal conference in London, Daryl Murphy, a partner at leading architect and health planning specialist for the primary and community care sectors Murphy Philipps, explained how the Department of Health's (DH's) forthcoming HBN 11-01 Health Building Note sets out a "less prescriptive approach" to the design of new primary care and community healthcare facilities.

  19. 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

  20. 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…

  1. 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

  2. Measuring the performance of primary healthcare: existing capacity and potential information to support population-based analyses.

    PubMed

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

    2009-11-01

    WHAT DID WE DO?: We reviewed the degree to which existing population-based data in Canada can be used to describe and report on primary healthcare (PHC) performance. We identified gaps in current data sources and made recommendations on how these gaps might be addressed to support quality improvement and public reporting for PHC. WHAT DID WE LEARN?: Population-based survey and administrative data are available to describe population characteristics and other contextual factors for PHC, as well as some aspects of the material, financial and human resources inputs, and selected activities and decisions at the policy, management and clinical levels. Existing data can also be used to describe some volumes and types of PHC outputs. However, we currently have limited population-based data to assess selected qualities of PHC services (e.g., coordination and interpersonal effectiveness) and most immediate outcomes of PHC. The ability to link data to assess outcomes and attribute changes in outcomes to PHC is limited. A full report describing more than 130 indicators from existing data sources and gaps in current data is available at www.chspr.ubc.ca. WHAT ARE THE IMPLICATIONS?: As we look to the future, there is a clear need to build on existing data sources to expand PHC data capacity in Canada. Data are needed to inform an understanding of PHC outputs, outcomes and the linkages among PHC dimensions. Commitment to a comprehensive PHC data collection strategy and information system is needed across Canadian provinces and territories to inform policy development and planning, to evaluate PHC redesign initiatives and to meet the accountability expectations of Canadians.

  3. 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

  4. 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.

  5. Optimising value and quality in general practice within the primary health care sector through relationship marketing: a conceptual framework.

    PubMed

    Bansal, Manjit K

    2004-01-01

    Discusses the rationale of applying relationship marketing and service quality concepts within the primary health care sector. The use of relational strategies in general practice, by modelling the relationships between practitioners and patients from a marketing perspective, could potentially lead to sustained high quality service being provided, and to more efficient use of resources. This essentially conceptually focused paper addresses an area that has not yet been researched in detail, and furthers understanding of the relationships that facilitate exchange within general practice and service delivery in non-profit, resource-constrained conditions. Deeper understanding of the needs and expectations of patients and the way these can be delivered by general practice can only lead to improvements for all parties involved. The relationship marketing paradigm presents itself as a potentially exciting way of addressing issues associated with ensuring that the highest level of quality is delivered in this area of the UK National Health Service.

  6. Effect of Positive Psychological Intervention on Posttraumatic Growth among Primary Healthcare Workers in China: A Preliminary Prospective Study

    PubMed Central

    Xu, Xin; Hu, Mu-li; Song, Yu; Lu, Zhang-xiu; Chen, You-qiao; Wu, Da-xing; Xiao, Tao

    2016-01-01

    Posttraumatic growth (PTG) is defined as positive psychological change in the wake of highly challenging circumstances. Healthcare workers in particular are more vulnerable to stressors and trauma than the general population. The current study examined the use and effectiveness of a novel positive psychological intervention based on Chinese traditional culture to improve PTG in hospital healthcare workers. The intervention was provided to 579 healthcare workers at hospitals in Guilin, Shenzhen and Xiangtan. Scores on the Posttraumatic Growth Inventory (PTGI) and its subscales were significantly higher after intervention than before (p < 0.001). Of the five aspects of PTG, the aspect of “new possibilities” benefited the most from intervention (Cohen’s d = 0.45). PTG in women, nurses and college graduates increased to a greater extent than other participants after intervention. It was concluded that our novel intervention is effective at improving PTG in medical staff. PMID:27995960

  7. The distribution of lung cancer across sectors of society in the United Kingdom: a study using national primary care data

    PubMed Central

    2011-01-01

    Background There is pressing need to diagnose lung cancer earlier in the United Kingdom (UK) and it is likely that research using computerised general practice records will help this process. Linkage of these records to area-level geo-demographic classifications may also facilitate case ascertainment for public health programmes, however, there have as yet been no extensive studies of data validity for such purposes. Methods To first address the need for validation, we assessed the completeness and representativeness of lung cancer data from The Health Improvement Network (THIN) national primary care database by comparing incidence and survival between 2000 and 2009 with the UK National Cancer Registry and the National Lung Cancer Audit Database. Secondly, we explored the potential of a geo-demographic social marketing tool to facilitate disease ascertainment by using Experian's Mosaic Public Sector ™ classification, to identify detailed profiles of the sectors of society where lung cancer incidence was highest. Results Overall incidence of lung cancer (41.4/100, 000 person-years, 95% confidence interval 40.6-42.1) and median survival (232 days) were similar to other national data; The incidence rate in THIN from 2003-2006 was found to be just over 93% of the national cancer registry rate. Incidence increased considerably with area-level deprivation measured by the Townsend Index and was highest in the North-West of England (65.1/100, 000 person-years). Wider variations in incidence were however identified using Mosaic classifications with the highest incidence in Mosaic Public Sector ™types 'Cared-for pensioners, ' 'Old people in flats' and 'Dignified dependency' (191.7, 174.2 and 117.1 per 100, 000 person-years respectively). Conclusions Routine electronic data in THIN are a valid source of lung cancer information. Mosaic ™ identified greater incidence differentials than standard area-level measures and as such could be used as a tool for public health

  8. 1992 healthcare business outlook.

    PubMed

    Wagner, L; Burda, D; Kenkel, P J; Nemes, J; Lutz, S; Weissenstein, E; Greene, J; Pallarito, K; Gardner, E; Wagner, M

    1992-01-06

    Whether it's with apprehension or expectation, most of us are wondering what the new year will hold. With that question in mind, Modern Healthcare staff writers and healthcare industry leaders offer their short- and long-range forecasts for all sectors and on a variety of all-encompassing issues. Some key questions: Will presidential politics pressure healthcare reform efforts? How will investor-owned companies fare under another year of regulatory scrutiny? What awaits hospitals and physicians under the new fee schedule and other Medicare rule changes?

  9. 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

  10. Primary Healthcare Provider Knowledge, Beliefs and Clinic-Based Practices Regarding Alternative Tobacco Products and Marijuana: A Qualitative Study

    ERIC Educational Resources Information Center

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

    2016-01-01

    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…

  11. Role of GIS in social sector planning: can developing countries benefit from the examples of primary health care (PHC) planning in Britain?

    PubMed

    Ishfaq, Mohammad; Lodhi, Bilal Khan

    2012-04-01

    Social sector planning requires rational approaches where community needs are identified by referring to relative deprivation among localities and resources are allocated to address inequalities. Geographical information system (GIS) has been widely argued and used as a base for rational planning for equal resource allocation in social sectors around the globe. Devolution of primary health care is global strategy that needs pains taking efforts to implement it. GIS is one of the most important tools used around the world in decentralization process of primary health care. This paper examines the scope of GIS in social sector planning by concentration on primary health care delivery system in Pakistan. The work is based on example of the UK's decentralization process and further evidence from US. This paper argues that to achieve benefits of well informed decision making to meet the communities' needs GIS is an essential tool to support social sector planning and can be used without any difficulty in any environment. There is increasing trend in the use of Health Management Information System (HMIS) in Pakistan with ample internet connectivity which provides well established infrastructure in Pakistan to implement GIS for health care, however there is need for change in attitude towards empowering localities especially with reference to decentralization of decision making. This paper provides GIS as a tool for primary health care planning in Pakistan as a starting point in defining localities and preparing locality profiles for need identification that could help developing countries in implementing the change.

  12. 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

  13. The ISTSS/Rand guidelines on mental health training of primary healthcare providers for trauma-exposed populations in conflict-affected countries.

    PubMed

    Eisenman, David; Weine, Stevan; Green, Bonnie; de Jong, Joop; Rayburn, Nadine; Ventevogel, Peter; Keller, Allen; Agani, Ferid

    2006-02-01

    Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations.

  14. Opportunistic screening for genital chlamydial infection. I: Acceptability of urine testing in primary and secondary healthcare settings

    PubMed Central

    Pimenta, J; Catchpole, M; Rogers, P; Perkins, E; Jackson, N; Carlisle, C; Randall, S; Hopwood, J; Hewitt, G; Underhill, G; Mallinson, H; McLean, L; Gleave, T; Tobin, J; Harindra, V; Ghosh, A

    2003-01-01

    Objectives: To determine the acceptability of opportunistic screening for Chlamydia trachomatis in young people in a range of healthcare settings. Design: An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples tested by ligase chain reaction (LCR). Data on uptake and testing were collected and in-depth interviews were used for programme evaluation. Setting: General practice, family planning, genitourinary medicine clinics, adolescent sexual health clinics, termination of pregnancy clinics, and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics) in two health authorities (Wirral and Portsmouth and South East Hampshire). Main participants: Sexually active women aged between 16 and 24 years attending healthcare settings for any reason. Main outcome measures: Uptake data: proportion of women accepting a test by area, healthcare setting, and age; overall population coverage achieved in 1 year. Evaluation data: participants' attitudes and views towards opportunistic screening and urine testing. Results: Acceptance of testing by women (16–24 years) was 76% in Portsmouth and 84% in Wirral. Acceptance was lower in younger women (Portsmouth only) and varied by healthcare setting within each site. 50% of the target female population were screened in Portsmouth and 39% in Wirral. Both the opportunistic offer of screening and the method of screening were universally acceptable. Major factors influencing a decision to accept screening were the non-invasive nature of testing and treatment, desire to protect future fertility, and the experimental nature of the screening programme. Conclusions: An opportunistic model of urine screening for chlamydial infection is a practical, universally acceptable method of screening. PMID:12576607

  15. 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

  16. [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.

  17. Mental Health of Refugees and Non-refugees from War-Conflict Countries: Data from Primary Healthcare Services and the Norwegian Prescription Database.

    PubMed

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

    2016-06-21

    High rates of mental health problems are consistently found among immigrants from refugee generating countries. While refugees and their family members may have experienced similar traumas, refugees are more likely to have undergone a stressful asylum period. This study aims to determine whether their mental health differs. Using national registry data, refugees and non-refugees from the same countries were compared on primary healthcare service use for mental health problems and purchase of psychotropic medicine. Refugees had higher odds of using primary health care services than non-refugees. Refugee women were more likely to purchase psychotropic medicine than non-refugee women. Refugee men were more likely to purchase anti-depressants. The findings suggest that refugees have poorer mental health than non-refugees. This may be due to a combination of greater pre-migration trauma and post-migration stressors such as enduring a difficult asylum period.

  18. [Physical inactivity among adults and elderly living in areas covered by primary healthcare units with and without the Family Health Program in Pernambuco State, Brazil].

    PubMed

    Alves, João Guilherme Bezerra; Siqueira, Fernando Vinholes; Figueiroa, José Natal; Facchini, Luiz Augusto; Silveira, Denise Silva da; Piccini, Roberto Xavier; Tomasi, Elaine; Thumé, Elaine; Hallal, Pedro C

    2010-03-01

    The epidemiological transition in Brazil has been explained partially by the low levels of physical activity. However, few studies have explored physical inactivity in low-income population groups. Within this context, primary healthcare units gain strategic importance. This article describes the prevalence of sedentary lifestyle and associated factors in a cross-sectional study, including 1,018 adults and 1,010 elderly adults in 10 cities in Pernambuco State. Prevalence of sedentary lifestyle was 37.8% (95%CI: 34.0-40.2) in adults and 68.3% (95%CI: 65.3-71.3) in the elderly. Identification of physical activity as the most important factor for good health was associated with sedentary lifestyle in elderly adults. A lower proportion of sedentary lifestyle among non-elderly adults was associated with good self-reported health status. We concluded that sedentary lifestyle prevalence is high in elderly and non-elderly people covered by primary healthcare units in Pernambuco State as compared to the South of Brazil.

  19. What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

    PubMed Central

    McKibbon, Kathleen Ann; Wilczynski, Nancy L; Haynes, Robert Brian

    2004-01-01

    Background We conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal. Methods We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health). Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. Results We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine), four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice), five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing), seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health), nine titles supplied 53.2% of the articles and 34 additional

  20. Lean healthcare in developing countries: evidence from Brazilian hospitals.

    PubMed

    Costa, Luana Bonome Message; Filho, Moacir Godinho; Rentes, Antonio Freitas; Bertani, Thiago Moreno; Mardegan, Ronaldo

    2017-01-01

    The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd.

  1. Healthcare for the poor and dispossessed: from Alma-Ata to the Millennium Development Goals.

    PubMed

    Maharaj, S R

    2011-07-01

    Healthcare models which recognize the equity principle have had to confront the challenge of providing healthcare for the poor and dispossessed. Healthcare premised on "human rights" strives to remove/ reduce barriers to access by a complete waiver of all fees in the public sector or various other subsidies to make healthcare more affordable. Social welfare programmes are held hostage to the vagaries of the economy and resource scarcity. The Alma-Ata's primary healthcare is inherently a health development strategy which embraces a wholistic approach to health and wellness. This strategy, by refocussing on the Millennium Development Goals, can therefore accommodate the innovations required to overcome the challenges posed by technological, financial, cultural and geographical factors to provide a better quality of life for all, but moreso for the poor and dispossessed.

  2. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?

    PubMed

    Freund, Tobias; Everett, Christine; Griffiths, Peter; Hudon, Catherine; Naccarella, Lucio; Laurant, Miranda

    2015-03-01

    World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries. Based on a framework of team organization across the care continuum, six national experts compare skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. Nurses are the main non-physician health professional working along with doctors in most countries although types and roles in primary care vary considerably between countries. However, the number of allied health professionals and support workers, such as medical assistants, working in primary care is increasing. Shifting from 'task delegation' to 'team care' is a global trend but limited by traditional role concepts, legal frameworks and reimbursement schemes. In general, remuneration follows the complexity of medical tasks taken over by each profession. Clear definitions of each team-member's role may facilitate optimally shared responsibility for patient care within primary care teams. Skill mix changes in primary care may help to maintain access to primary care and quality of care delivery. Learning from experiences in other countries may inspire policy makers and researchers to work on efficient and effective teams care models worldwide.

  3. Adaptive capacity of the Adjusted Clinical Groups Case-Mix System to the cost of primary healthcare in Catalonia (Spain): a observational study

    PubMed Central

    Velasco-Velasco, Soledad; Navarro-Artieda, Ruth; Prados-Torres, Alexandra; Bolibar-Ribas, Buenaventura; Violan-Fors, Concepción

    2012-01-01

    Objectives To describe the adaptive capacity of the Adjusted Clinical Groups (ACG) system to the cost of care in primary healthcare centres in Catalonia (Spain). Design Retrospective study (multicentres) conducted using computerised medical records. Setting 13 primary care teams in 2008 were included. Participants All patients registered in the study centres who required care between 1 January and 31 December 2008 were finally studied. Patients not registered in the study centres during the study period were excluded. Outcome measures Demographic (age and sex), dependent (cost of care) and case-mix variables were studied. The cost model for each patient was established by differentiating the fixed and variable costs. To evaluate the adaptive capacity of the ACG system, Pearson's coefficient of variation and the percentage of outliers were calculated. To evaluate the explanatory power of the ACG system, the authors used the coefficient of determination (R2). Results The number of patients studied was 227 235 (frequency: 5.9 visits per person per year), with a mean of 4.5 (3.2) episodes and 8.1 (8.2) visits per patient per year. The mean total cost was €654.2. The explanatory power of the ACG system was 36.9% for costs (56.5% without outliers). 10 ACG categories accounted for 60.1% of all cases and 19 for 80.9%. 5 categories represented 71% of poor performance (N=78 887, 34.7%), particularly category 0300-Acute Minor, Age 6+ (N=26 909, 11.8%), which had a coefficient of variation =139% and 6.6% of outliers. Conclusions The ACG system is an appropriate manner of classifying patients in routine clinical practice in primary healthcare centres in Catalonia, although improvements to the adaptive capacity through disaggregation of some categories according to age groups and, especially, the number of acute episodes in paediatric patients would be necessary to reduce intra-group variation. PMID:22734115

  4. [Resilience among the elderly cared for by the primary healthcare network in a city of northeast Brazil].

    PubMed

    Ferreira, Camomila Lira; Santos, Lúcia Maria Oliveira; Maia, Eulália Maria Chaves

    2012-04-01

    The objective of this study is to evaluate the capacity of resilience, self-esteem and social support among the elderly by means of an exploratory study. The convenience sample consisted of elderly users of the public healthcare network in Natal-RN, Brazil, who answered the questionnaire and the Resilience, Self-Esteem and Social Support Scales. Participants were 65 seniors, with a mean age of 71 years, 81% female, with poor socio-economic conditions. It was found that the elderly participants have resilient characteristics, positive self-esteem and social support perceived as satisfactory, despite their losses and decline due to aging. Furthermore, moderate and positive correlations were observed between resilience and self-esteem, because as one increased, the other also increased. Therefore, it appears that resilience, considered a resource that assists development, favors staying well through this critical period, as well as the protective factors, which are important health indicators.

  5. Choroidal area assessment in various fundus sectors of patients at different stages of primary open-angle glaucoma by using enhanced depth imaging optical coherence tomography

    PubMed Central

    Li, Mu; Yan, Xiao-Qin; Song, Yin-Wei; Guo, Jing-Min; Zhang, Hong

    2017-01-01

    Abstract To compare the choroidal area in different eye fundus sectors of subjects with normal eyes, early-stage primary open-angle glaucoma (POAG) eyes, and 10° tubular visual field POAG eyes using enhanced depth imaging optical coherence tomography. Twenty-five normal, 25 early-stage POAG, and 25 ten-degree tubular visual field POAG eyes were recruited. Enhanced depth imaging optical coherence tomography was used to measure the choroidal area in different fundus sectors (fovea; 10° superior, inferior, temporal, and 24° superior, inferior, temporal, nasal to the fovea) and the peripapillary sector. There were neither significant differences in the choroidal area at any of the 8 measured fundus sectors, nor significant differences in the percentage change between the choroidal area of the fovea and other 7 measured fundus sectors among the 3 groups (all P > 0.05). For the total peripapillary choroidal area, no significant difference was found among the 3 groups (P > 0.05); however, the temporal peripapillary choroidal area of 10° tubular visual field POAG eyes was significantly thicker than that of normal eyes (4,46,213 ± 1,16,267 vs 3,74,164 ± 1,21,658 μm2; P = 0.048). Our study showed that there was no significant difference in the choroidal area of the 8 measured fundus sectors among normal, early-stage POAG, and 10° tubular visual field POAG eyes, suggesting that there might be no blood redistribution from the peripheral choroid to the subfoveal choroid. However, the thicker temporal peripapillary choroidal area might play a role in the central visual acuity protection in patients with POAG. PMID:28272255

  6. [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.

  7. Primary healthcare usage and morbidity among immigrant children compared with non-immigrant children: a population-based study in Norway

    PubMed Central

    Møen, Kathy Ainul; Diaz, Esperanza

    2016-01-01

    Objectives Health status, disease spectrum and use of healthcare have been reported to vary across groups of migrants and according to the different phases of migration. However, most studies are conducted among adults. This study assesses usage of primary healthcare (PHC) by children with immigrant background compared with non-immigrant children in Norway and describes their relative morbidity burden. Design Population-based retrospective cohort study. Setting This study used 3 linked population-based registers in Norway for children under 18 years of age in 2008. Main exposure and outcome measures Immigrants were defined as children with both parents born abroad, and further classified into first and second generation, and according to the World Bank income categories of their parents' country of origin. Usage and morbidity were assessed with negative binomial regression and logistic regression analyses, respectively. Further, population-attributable fraction analyses on PHC visits were conducted to estimate the impact on the primary health system. Participants 1 168 365 children including 119 251 with immigrant background. Results The mean number of visits to PHC for non-immigrant children was 1.40 compared with 1.19 for immigrants from high-income countries (HIC) and 1.76 for immigrants from low-income countries (LIC). Compared with non-immigrants, first generation immigrants used PHC significantly less after adjusting for age and sex (incidence risk ratio (IRR) 0.70 (HIC) to 0.93 (LIC)) while second generation immigrant children generally used PHC more (IRR 1.03 (HIC) to 1.43 (LIC)); however, the median number of visits were similar between all groups. The morbidity spectrum also varied between the groups. Conclusions Compared with non-immigrants, the excess number of consultations attributable to immigrant groups corresponds to around 1.3% of PHC visits among children. PMID:27737883

  8. Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre

    PubMed Central

    Barnes, Emily R.; Theeke, Laurie A.; Mallow, Jennifer

    2015-01-01

    Rationale, aims and objectives Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Methods Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Results Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Conclusions Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. PMID:25558956

  9. 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.

  10. Lean healthcare.

    PubMed

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  11. Organization and functioning of primary healthcare for pre-school children in Croatia: a longitudinal study from 1995 to 2012.

    PubMed

    Buljan, Josip; Prljević, Gordana; Menegoni, Martina; Bralić, Irena

    2014-12-01

    Primary health care for children in Croatia are mostly provided by primary pediatricians (PP) in the urban and by family doctors in rural areas. During past decades, as apart of health care reforms, primary pediatric care experiences several changes. This study was undertaken in order to investigate the trends in organizational structure and functioning of the PPs, based on routinely collected data from Croatian Health Service Yearbooks, 1995 to 2012. The results have consistently shown a shortage of PPs in Croatia. The shortage obviously affects the average number of children per PP; number increased from 994 in 1995, to 1556 children in 2010, which was far above the standard. The shortage of PPs is also related to the high number of visits (30 to 40) per PP and per working day. The obtained results clearly show only the trends, therefore further research is needed for a full understanding of the PHC for pre-school children.

  12. 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.

  13. Electronic health records and information portability: a pilot study in a rural primary healthcare center in India.

    PubMed

    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.

  14. 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

  15. Evolution of Experience of Care of Patients with and without Chronic Diseases following a Québec Primary Healthcare Reform

    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

    Objectives. To assess the extent to which new primary healthcare (PHC) models implemented in two regions of Quebec have improved patient experience of care, unmet needs, and use of services for individuals with and without chronic diseases, compared with other forms of PHC practices. Methods. In 2005 and 2010, we carried out population and organization surveys. We divided PHC organizations into new model practices and other practices and followed the evolution over time of patient experience of care. Results. Patients with chronic diseases had better accessibility but worse continuity of care in the new model practices than in the other practices at both time periods. Through the reform, accessibility decreased evenly in both groups, but continuity and perceived outcomes improved more in the other practices. Use of primary care services decreased more in the new model practices. Among patients without chronic disease, accessibility decreased much less in the new models and responsiveness increased more. There was no significant change in ER attendance and hospitalization. Conclusion. The evolution of patient experience of care has been more favorable for patients without chronic diseases. These findings raise concerns about equity since the aim of the PHC reform was targeting in priority individuals with the greatest needs. PMID:27144222

  16. Evolution of Experience of Care of Patients with and without Chronic Diseases following a Québec Primary Healthcare Reform.

    PubMed

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

    2016-01-01

    Objectives. To assess the extent to which new primary healthcare (PHC) models implemented in two regions of Quebec have improved patient experience of care, unmet needs, and use of services for individuals with and without chronic diseases, compared with other forms of PHC practices. Methods. In 2005 and 2010, we carried out population and organization surveys. We divided PHC organizations into new model practices and other practices and followed the evolution over time of patient experience of care. Results. Patients with chronic diseases had better accessibility but worse continuity of care in the new model practices than in the other practices at both time periods. Through the reform, accessibility decreased evenly in both groups, but continuity and perceived outcomes improved more in the other practices. Use of primary care services decreased more in the new model practices. Among patients without chronic disease, accessibility decreased much less in the new models and responsiveness increased more. There was no significant change in ER attendance and hospitalization. Conclusion. The evolution of patient experience of care has been more favorable for patients without chronic diseases. These findings raise concerns about equity since the aim of the PHC reform was targeting in priority individuals with the greatest needs.

  17. Meeting the needs? Perceived support of a nurse-led lifestyle programme for young adults with mental illness in a primary health-care setting.

    PubMed

    Rönngren, Ylva; Björk, Annette; Kristiansen, Lisbeth; Haage, David; Enmarker, Ingela; Audulv, Åsa

    2017-04-04

    Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle-related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse-led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16-25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse-led programme provides health information-management strategies that could easily be integrated in a primary health-care setting.

  18. Mobile healthcare.

    PubMed

    Morgan, Stephen A; Agee, Nancy Howell

    2012-01-01

    Mobile technology's presence in healthcare has exploded over the past five years. The increased use of mobile devices by all segments of the US population has driven healthcare systems, providers, and payers to accept this new form of communication and to develop strategies to implement and leverage the use of mobile healthcare (mHealth) within their organizations and practices. As healthcare systems move toward a more value-driven model of care, patient centeredness and engagement are the keys to success. Mobile healthcare will provide the medium to allow patients to participate more in their care. Financially, mHealth brings to providers the ability to improve efficiency and deliver savings to both them and the healthcare consumer. However, mHealth is not without challenges. Healthcare IT departments have been reluctant to embrace this shift in technology without fully addressing security and privacy concerns. Providers have been hesitant to adopt mHealth as a form of communication with patients because it breaks with traditional models. Our healthcare system has just started the journey toward the development of mHealth. We offer an overview of the mobile healthcare environment and our approach to solving the challenges it brings to healthcare organizations.

  19. Primary healthcare usage and use of medications among immigrant children according to age of arrival to Norway: a population-based study

    PubMed Central

    Diaz, Esperanza

    2017-01-01

    Background Morbidity, use of healthcare and medication use have been reported to vary across groups of migrants and according to the different phases of migration, but little is known about children with immigrant background. In this study, we investigate whether the immigrant children's age of arrival predicts differences in usage of primary healthcare (PHC) and in use of prescribed medication. Methods This nationwide, population-based study used information for children under 18 years of age in 2008 from three linked registers in Norway. Use of medication was assessed with logistic regression analyses presented with ORs with 95% CIs. Results Of 1 168 365 children, 119 251 had immigrant background. The mean number of PHC visits among children aged 10–18 years, was 1.19 for non-immigrants, 1.17 among second generation immigrants, 1.12, 1.05 and 0.83 among first immigrant children who were <5, 5–9 and ≥10 years at arrival in Norway, respectively. Patterns were similar for younger immigrants, and were confirmed with regression models adjusting for age and sex. First generation immigrant children used less of nearly all groups of prescribed medication compared to non-immigrants when adjusting for age and sex (overall OR 0.48 (0.47 to 0.49)), and medication was also generally less used among second generation immigrant children (overall OR 0.92 (0.91 to 0.94)). Conclusions Age of arrival predicted PHC usage among children among first-generation children. First-generation immigrant children, particularly those arriving later in adolescence, used PHC less than age corresponding non-immigrant children. Immigrant children used less prescribed medication compared to non-immigrants after adjustment for age and sex. PMID:28148537

  20. Effects of climate change on the delivery of soil-mediated ecosystem services within the primary sector in temperate ecosystems: a review and New Zealand case study.

    PubMed

    Orwin, Kate H; Stevenson, Bryan A; Smaill, Simeon J; Kirschbaum, Miko U F; Dickie, Ian A; Clothier, Brent E; Garrett, Loretta G; van der Weerden, Tony J; Beare, Michael H; Curtin, Denis; de Klein, Cecile A M; Dodd, Michael B; Gentile, Roberta; Hedley, Carolyn; Mullan, Brett; Shepherd, Mark; Wakelin, Steven A; Bell, Nigel; Bowatte, Saman; Davis, Murray R; Dominati, Estelle; O'Callaghan, Maureen; Parfitt, Roger L; Thomas, Steve M

    2015-08-01

    Future human well-being under climate change depends on the ongoing delivery of food, fibre and wood from the land-based primary sector. The ability to deliver these provisioning services depends on soil-based ecosystem services (e.g. carbon, nutrient and water cycling and storage), yet we lack an in-depth understanding of the likely response of soil-based ecosystem services to climate change. We review the current knowledge on this topic for temperate ecosystems, focusing on mechanisms that are likely to underpin differences in climate change responses between four primary sector systems: cropping, intensive grazing, extensive grazing and plantation forestry. We then illustrate how our findings can be applied to assess service delivery under climate change in a specific region, using New Zealand as an example system. Differences in the climate change responses of carbon and nutrient-related services between systems will largely be driven by whether they are reliant on externally added or internally cycled nutrients, the extent to which plant communities could influence responses, and variation in vulnerability to erosion. The ability of soils to regulate water under climate change will mostly be driven by changes in rainfall, but can be influenced by different primary sector systems' vulnerability to soil water repellency and differences in evapotranspiration rates. These changes in regulating services resulted in different potentials for increased biomass production across systems, with intensively managed systems being the most likely to benefit from climate change. Quantitative prediction of net effects of climate change on soil ecosystem services remains a challenge, in part due to knowledge gaps, but also due to the complex interactions between different aspects of climate change. Despite this challenge, it is critical to gain the information required to make such predictions as robust as possible given the fundamental role of soils in supporting human well-being.

  1. Finding a balance between "value added" and feeling valued: revising models of care. The human factor of implementing a quality improvement initiative using Lean methodology within the healthcare sector.

    PubMed

    Deans, Rachel; Wade, Shawna

    2011-01-01

    Growing demand from clients waiting to access vital services in a healthcare sector under economic constraint, coupled with the pressure for ongoing improvement within a multi-faceted organization, can have a significant impact on the front-line staff, who are essential to the successful implementation of any quality improvement initiative. The Lean methodology is a management system for continuous improvement based on the Toyota Production System; it focuses on two main themes: respect for people and the elimination of waste or non-value-added activities. Within the Lean process, value-added is used to describe any activity that contributes directly to satisfying the needs of the client, and non-value-added refers to any activity that takes time, space or resources but does not contribute directly to satisfying client needs. Through the revision of existing models of service delivery, the authors' organization has made an impact on increasing access to care and has supported successful engagement of staff in the process, while ensuring that the focus remains on the central needs of clients and families accessing services. While the performance metrics continue to exhibit respectable results for this strategic priority, further gains are expected over the next 18-24 months.

  2. [Primary healthcare and the construction of meanings of oral health: a social constructionist interpretation of discourses of the elderly].

    PubMed

    Bulgarelli, Alexandre Favero; Pinto, Ione Carvalho; Lorenzi, Carla Guanaes; Villa, Teresa Cristina Scatena; Mestriner, Soraya Fernandes; Silva, Rosalina Carvalho da

    2012-05-01

    Dentistry currently reveals itself to be open to new ideas about the construction of meanings for oral health. This openness leads to the social production of health revealing the contextualization of the social and historical aspects of the sundry knowledge in the development of oral health for different communities. With this research, we seek to build meanings for oral health with a group of elderly people. With this objective in mind, we propose an approximation between discourses on oral health mentioned by the elderly and the Social Constructionist discourse. We interviewed 14 elderly people enrolled in a Family Health Unit in Ribeirão Preto, State of São Paulo, in the first semester of 2010, and identified two interpretative repertoires through Discourse Analysis, which showed the relationship between 1 - Lack of information and dental assistance in childhood, and 2 - Primary Health Care building the meaning of oral health. We concluded that Social Constructionism works epistemologically for the construction of meanings for oral health and that primary health is essential for appreciation and health care that enables the construction of meanings in oral health by the elderly that create conditions for self-care and healthy attitudes.

  3. The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries.

    PubMed Central

    Palmer, N.

    2000-01-01

    Contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient. This is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them. This review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries. PMID:10916919

  4. Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol

    PubMed Central

    Mukumbang, Ferdinand C; Van Belle, Sara; Marchal, Bruno; Van Wyk, Brian

    2016-01-01

    Introduction Suboptimal retention in care and poor treatment adherence are key challenges to antiretroviral therapy (ART) in sub-Saharan Africa. Community-based approaches to HIV service delivery are recommended to improve patient retention in care and ART adherence. The implementation of the adherence clubs in the Western Cape province of South Africa was with variable success in terms of implementation and outcomes. The need for operational guidelines for its implementation has been identified. Therefore, understanding the contexts and mechanisms for successful implementation of the adherence clubs is crucial to inform the roll-out to the rest of South Africa. The protocol outlines an evaluation of adherence club intervention in selected primary healthcare facilities in the metropolitan area of the Western Cape Province, using the realist approach. Methods and analysis In the first phase, an exploratory study design will be used. Document review and key informant interviews will be used to elicit the programme theory. In phase two, a multiple case study design will be used to describe the adherence clubs in five contrastive sites. Semistructured interviews will be conducted with purposively selected programme implementers and members of the clubs to assess the context and mechanisms of the adherence clubs. For the programme's primary outcomes, a longitudinal retrospective cohort analysis will be conducted using routine patient data. Data analysis will involve classifying emerging themes using the context-mechanism-outcome (CMO) configuration, and refining the primary CMO configurations to conjectured CMO configurations. Finally, we will compare the conjectured CMO configurations from the cases with the initial programme theory. The final CMOs obtained will be translated into middle range theories. Ethics and dissemination The study will be conducted according to the principles of the declaration of Helsinki (1964). Ethics clearance was obtained from the

  5. Protocol for determining primary healthcare practice characteristics, models of practice and patient accessibility using an exploratory census survey with linkage to administrative data in Nova Scotia, Canada

    PubMed Central

    Marshall, Emily Gard; Gibson, Richard J; Lawson, Beverley; Burge, Frederick

    2017-01-01

    Introduction There is little evidence on how primary care providers (PCPs) model their practices in Nova Scotia (NS), Canada, what services they offer or what accessibility is like for the average patient. This study will create a database of all family physicians and primary healthcare nurse practitioners in NS, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. Methods and analysis 3 census surveys of all family physicians, primary care nurse practitioners (ie, PCPs) and their practices in NS will be conducted. The first will be a telephone survey conducted during typical daytime business hours. At each practice, the person answering the telephone will be asked questions about the practice's accessibility and model of care. The second will be a telephone survey conducted after typical daytime business hours to determine what out-of-office services PCP practices offer their patients. The final will be a tailored fax survey that will collect information that could not be obtained in the first 2 surveys plus new information on scope of practice, practice model and willingness to participate in research. Survey data will be linked with billing data from administrative health databases. Multivariate regression analysis will be employed to assess whether access and availability outcome variables are associated with PCP and model of practice characteristics. Negative binomial regression analysis will be employed to assess the association between independent variables from the survey data and health system use outcomes from administrative data. Ethics and dissemination This study has received ethical approval from the Nova Scotia Health Authority and the Health Data Nova Scotia Data Access Committee. Dissemination approached will include stakeholder engagement at local and national levels, conference presentations, peer-reviewed publications and a public website. PMID

  6. The Sector-Wide Approach in Bangladesh Primary Education: A Critical View. CREATE Pathways to Access. Research Monograph No. 57

    ERIC Educational Resources Information Center

    Ahmed, Manzoor

    2011-01-01

    This monograph, in the CREATE Pathways to Access series, is about the modality of cooperation and programme management in primary education in Bangladesh, based specifically on the experience of the Second Primary Education Development Programme (PEDP II). It is not intended to be an assessment of PEDP II accomplishments, but key information and a…

  7. EDUCORE project: a clinical trial, randomised by clusters, to assess the effect of a visual learning method on blood pressure control in the primary healthcare setting

    PubMed Central

    2010-01-01

    Background High blood pressure (HBP) is a major risk factor for cardiovascular disease (CVD). European hypertension and cardiology societies as well as expert committees on CVD prevention recommend stratifying cardiovascular risk using the SCORE method, the modification of lifestyles to prevent CVD, and achieving good control over risk factors. The EDUCORE (Education and Coronary Risk Evaluation) project aims to determine whether the use of a cardiovascular risk visual learning method - the EDUCORE method - is more effective than normal clinical practice in improving the control of blood pressure within one year in patients with poorly controlled hypertension but no background of CVD; Methods/Design This work describes a protocol for a clinical trial, randomised by clusters and involving 22 primary healthcare clinics, to test the effectiveness of the EDUCORE method. The number of patients required was 736, all between 40 and 65 years of age (n = 368 in the EDUCORE and control groups), all of whom had been diagnosed with HBP at least one year ago, and all of whom had poorly controlled hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg). All personnel taking part were explained the trial and trained in its methodology. The EDUCORE method contemplates the visualisation of low risk SCORE scores using images embodying different stages of a high risk action, plus the receipt of a pamphlet explaining how to better maintain cardiac health. The main outcome variable was the control of blood pressure; secondary outcome variables included the SCORE score, therapeutic compliance, quality of life, and total cholesterol level. All outcome variables were measured at the beginning of the experimental period and again at 6 and 12 months. Information on sex, age, educational level, physical activity, body mass index, consumption of medications, change of treatment and blood analysis results was also recorded; Discussion The EDUCORE method could provide a

  8. Service providers' views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation.

    PubMed

    Freeman, Toby; Baum, Frances E; Jolley, Gwyneth M; Lawless, Angela; Edwards, Tahnia; Javanparast, Sara; Ziersch, Anna

    2016-01-01

    Community participation is a key principle of comprehensive primary health care (PHC). There is little literature on how community participation is implemented at Australian PHC services. As part of a wider study conducted in partnership with five South Australian PHC services, and one Aboriginal community controlled health service in the Northern Territory, 68 staff, manager, regional health executives, and departmental funders were interviewed about community participation, perceived benefits, and factors that influenced implementation. Additional data were collected through analysis of policy documents, service reports on activity, and a web-based survey completed by 130 staff. A variety of community participation strategies was reported, ranging from consultation and participation as a means to improve service quality and acceptability, to substantive and structural participation strategies with an emphasis on empowerment. The Aboriginal community controlled health service in our study reported the most comprehensive community participation. Respondents from all services were positive about the benefits of participation but reported that efforts to involve service users had to compete with a centrally directed model of care emphasising individual treatment services, particularly at state-managed services. More empowering substantive and structural participation strategies were less common than consultation or participation used to achieve prescribed goals. The most commonly reported barriers to community participation were budget and lack of flexibility in service delivery. The current central control of the state-managed services needs to be replaced with more local management decision making if empowering community participation is to be strengthened and embedded more effectively in the culture of services.

  9. A cross-sectional exploration of the clinical characteristics of disengaged (NEET) young people in primary mental healthcare

    PubMed Central

    O'Dea, Bridianne; Glozier, Nicholas; Purcell, Rosemary; McGorry, Patrick D; Scott, Jan; Feilds, Kristy-Lee; Hermens, Daniel F; Buchanan, John; Scott, Elizabeth M; Yung, Alison R; Killacky, Eoin; Guastella, Adam J; Hickie, Ian B

    2014-01-01

    Objective Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth. Design Cross-sectional data from a longitudinal cohort study. Setting Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate. Participants Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney. Measures Individuals ‘Not in any type of Education, Employment or Training’ in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning were assessed using clinical interview and self-report. Results A total of 19% (n=130/696) were NEET. NEETs were more likely to be male, older, have a history of criminal charges, risky cannabis use, higher level of depression, poorer social functioning, greater disability and economic hardship, and a more advanced stage of mental illness than those engaged in education, training or work. Demographics such as postsecondary education, immigrant background and indigenous background, were not significantly associated with NEET status in this sample. Conclusions One in five young people seeking help for mental health problems were not in any form of education, employment and training. The commonly observed risk factors did not appear to influence this association, instead, behavioural factors such as criminal offending and cannabis use appeared to require targeted intervention. PMID:25537785

  10. Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review

    PubMed Central

    Martín Cantera, Carlos; Puigdomènech, Elisa; Ballvé, Jose Luis; Arias, Olga Lucía; Clemente, Lourdes; Casas, Ramon; Roig, Lydia; Pérez-Tortosa, Santiago; Díaz-Gete, Laura; Granollers, Sílvia

    2015-01-01

    Objective The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. Design A systematic review of randomised and non-randomised controlled trials was undertaken. Eligibility criteria for included studies Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish. Methods We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. Results Of 1147 references identified, 9 studies were selected (10 204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose–response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. Conclusions Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected

  11. The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá – Colombia: an ecological analysis

    PubMed Central

    2012-01-01

    Background Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá. Methods An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007. Results In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also

  12. [Culture and health services: studying the participation of cultural traits of Brazilian society in the work process of primary healthcare services].

    PubMed

    Pinto, Alessandra Maria Silva; Najar, Alberto Lopes

    2011-11-01

    The analysis of institutions is a widely researched area of health. The culture of organizations is understood as a symbolic possibility contained in a larger dimension, called "national culture". This premise justifies the incorporation of the social anthropological approach to the study of organizational culture. This study sought to establish the perceptions of employees of two primary healthcare services in Niterói, State of Rio de Janeiro, regarding commonly used social navigation strategies from the theory developed by Roberto DaMatta. The results showed the relational character associated with the stereotype of the Brazilian people manifested by conflicts arising from the existence of values based on the `individual' and the `person'. Among them are the distortions observed between discourse and practice, and the mobilization strategies of social navigation like "making do" - to establish a mediation between the person and the impersonal law. The organization of the services of the Niterói Family Medical Program apparently sets its employees the concrete challenge of balancing the egalitarian principle that underpins the Unified Health System (SSU) with the set of values upon which personal relations are based in Brazilian society.

  13. A study on knowledge, attitude, and practice towards premarital carrier screening among adults attending primary healthcare centers in a region in Oman

    PubMed Central

    2014-01-01

    Background Despite that hereditary diseases are widespread among the Arab population due to high rates of consanguineous marriages, research regarding community awareness towards premarital carrier screening in some countries such as Oman, is extremely scarce. This study aimed to investigate knowledge and attitude towards premarital carrier screening (PMCS) in Oman. Methods A cross-sectional study was conducted using a self-administered questionnaire which was distributed to 400 Omani adults aged 20–35 who attended primary healthcare institutions at the South Batinah Governorate in Oman. Results The majority of the participants (84.5%) believed that PMCS was necessary, and about half of them (49.5%) supported the view of making PMCS compulsory. On the contrary, approximately one third (30.5%) of the participants reported that they were not in favor of taking the blood screening test. Overall, unwillingness to perform pre-marital testing was associated with female gender, younger age, being single, less education, and increased income. Conclusion Despite the relatively high level of knowledge, about one third of the participants were still reluctant to carry out premarital testing. Such attitude calls for immediate need for community-based campaigns to encourage the public to do premarital testing. PMID:24742222

  14. Factors associated with use of HIV primary care among persons recently diagnosed with HIV: examination of variables from the behavioural model of health-care utilization.

    PubMed

    Anthony, M N; Gardner, L; Marks, G; Anderson-Mahoney, P; Metsch, L R; Valverde, E E; Del Rio, C; Loughlin, A M

    2007-02-01

    The delay between testing positive for human immunodeficiency virus (HIV) and entering medical care can be better understood by identifying variables associated with use of HIV primary care among persons recently diagnosed with the virus. We report findings from 270 HIV-positive persons enrolled in the Antiretroviral Treatment Access Study (ARTAS). 74% had not seen an HIV care provider before enrollment; 26% had one prior visit only. Based on Andersen's behavioural model of health care utilization, several variables reflecting demographic, healthcare, illness, behavioural, and psychosocial dimensions were assessed and used to predict the likelihood that participants had seen an HIV care provider six months after enrollment. Overall, 69% had seen an HIV care provider by six months. In multivariate analysis, the likelihood of seeing a provider was significantly (p<.05) higher among men, Hispanics (vs. non-Hispanic Blacks), those with higher education, those who did not use injection drugs, those with three or more HIV-related symptoms, those with public health insurance (vs. no insurance), and those who received short-term case management (vs. passive referral). The findings support several conceptual categories of Andersen's behavioural model of health services utilization as applied to the use of HIV medical care among persons recently diagnosed with HIV.

  15. Experience of nurses with using eHealth in Gilgit-Baltistan, Pakistan: a qualitative study in primary and secondary healthcare

    PubMed Central

    2013-01-01

    Background To improve the quality of health care in remote parts of Pakistan, a research project was initiated in the mountainous region of Gilgit-Baltistan using information and communication technology to improve patient care and support continuing education of health providers (eHealth). This paper describes the experience of nurses in using eHealth in their routine practices. Methods All health centres of Gilgit-Baltistan, Pakistan using eHealth as part of this study, were taken as a single case. These include four primary healthcare centres, three secondary care centres and one medical centre. In-depth interviews were conducted using semi-structured interview guide to study nurses’ perspective about using eHealth, and its perceived impact on their professional lives. Results According to the respondents, eHealth enhanced access to care for remote communities, and improved quality of health services by providing opportunities for continuing learning. Nurses also appreciated eHealth for reducing their professional isolation, and providing exposure to new knowledge through teleconsultations and eLearning. The responses categorized under six major headings include: gaps in health services prior to eHealth; role of eHealth in addressing these gaps; benefits of eHealth; challenges in eHealth implementation; community’s perception about eHealth; and future recommendations. Conclusions Low-cost and simple eHealth solutions have shown to benefit nurses, and the communities in the remote mountainous regions of Pakistan. PMID:23452373

  16. Development and evaluation of information resources for patients, families, and healthcare providers addressing behavioral and cognitive sequelae among adults with a primary brain tumor.

    PubMed

    Wright, Kylie M; Simpson, Grahame K; Koh, Eng-Siew; Whiting, Diane L; Gillett, Lauren; Simpson, Teresa; Firth, Rochelle

    2015-06-01

    Behavioral and cognitive changes in patients with primary brain tumor (PBT) are common and may be distressing to patients and their family members. Healthcare professionals report a strong need for information, practical strategies, and training to assist consumers and better address management issues. A literature review by the current project found that 53% of the information resources currently available to consumers and health professionals contained minimal or no information about cognitive/behavioral changes after PBT, and 71% of the resources contained minimal or no information on associated strategies to manage these changes. This project aimed to develop an information resource for patients, carers, and health professionals addressing the behavioral and cognitive sequelae of PBT, including strategies to minimize the disabling impact of such behaviors. In consultation with staff and patient groups, 16 key information topics were identified covering cognitive and communication changes and challenging behaviors including executive impairment, behavioral disturbance, and social/emotional dysfunction. Sixteen fact sheets and 11 additional resource sheets were developed and evaluated according to established consumer communication guidelines. Preliminary data show that these resources have been positively received and well utilized. These sheets are the first of their kind addressing challenging behaviors in the neuro-oncology patient group and are a practical and useful information resource for health professionals working with these patients and their families. The new resource assists in reinforcing interventions provided to individual patients and their relatives who are experiencing difficulties in managing challenging behaviors after PBT.

  17. Primary Mainstream Teachers' Attitudes towards Inclusion of Students with Special Educational Needs in the Private Sector: A Perspective from Dubai

    ERIC Educational Resources Information Center

    Gaad, Eman; Khan, Lavina

    2007-01-01

    One of the main challenges facing primary mainstream teachers in Dubai in the United Arab Emirates (UAE) stems from the current educational movement towards inclusion. It is an international phenomenon, a process that emphasizes providing special education services to students with special educational needs within the regular classrooms. The…

  18. Circumferential or sectored beam arrangements for stereotactic body radiation therapy (SBRT) of primary lung tumors: Effect on target and normal-structure dose-volume metrics

    SciTech Connect

    Rosenberg, Mara W.; Kato, Catherine M.; Carson, Kelly M.P.; Matsunaga, Nathan M.; Arao, Robert F.; Doss, Emily J.; McCracken, Charles L.; Meng, Lu Z.; Chen, Yiyi; Laub, Wolfram U.; Fuss, Martin; Tanyi, James A.

    2013-01-01

    To compare 2 beam arrangements, sectored (beam entry over ipsilateral hemithorax) vs circumferential (beam entry over both ipsilateral and contralateral lungs), for static-gantry intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques with respect to target and organs-at-risk (OAR) dose-volume metrics, as well as treatment delivery efficiency. Data from 60 consecutive patients treated using stereotactic body radiation therapy (SBRT) for primary non–small-cell lung cancer (NSCLC) formed the basis of this study. Four treatment plans were generated per data set: IMRT/VMAT plans using sectored (-s) and circumferential (-c) configurations. The prescribed dose (PD) was 60 Gy in 5 fractions to 95% of the planning target volume (PTV) (maximum PTV dose ∼ 150% PD) for a 6-MV photon beam. Plan conformality, R{sub 50} (ratio of volume circumscribed by the 50% isodose line and the PTV), and D{sub 2} {sub cm} (D{sub max} at a distance ≥2 cm beyond the PTV) were evaluated. For lungs, mean doses (mean lung dose [MLD]) and percent V{sub 30}/V{sub 20}/V{sub 10}/V{sub 5} Gy were assessed. Spinal cord and esophagus D{sub max} and D{sub 5}/D{sub 50} were computed. Chest wall (CW) D{sub max} and absolute V{sub 30}/V{sub 20}/V{sub 10}/V{sub 5} {sub Gy} were reported. Sectored SBRT planning resulted in significant decrease in contralateral MLD and V{sub 10}/V{sub 5} {sub Gy}, as well as contralateral CW D{sub max} and V{sub 10}/V{sub 5} {sub Gy} (all p < 0.001). Nominal reductions of D{sub max} and D{sub 5}/D{sub 50} for the spinal cord with sectored planning did not reach statistical significance for static-gantry IMRT, although VMAT metrics did show a statistically significant decrease (all p < 0.001). The respective measures for esophageal doses were significantly lower with sectored planning (p < 0.001). Despite comparable dose conformality, irrespective of planning configuration, R{sub 50} significantly improved with IMRT

  19. [Healthcare expenditure].

    PubMed

    Huguier, Michel

    2012-10-01

    Healthcare expenditure is divided between medical infrastructure and individual patient management. Total healthcare costs in France amount to roughly 175 billion euros, financed through public health insurance (77%), private insurance (14%), and individual expenditure (9%). The principal expenditures are for hospitalization (44%), community medical, dental and paramedical care (28%), drugs (20%) and miscellaneous resources (8%). The main factors of rising costs are medical progress and aging. More controllable costs include healthcare provision, the level of reimbursement, public education and information, and physician training. France devotes 9.2% of its gross national product to healthcare, compared to 7-8% in Sweden, Germany and the United Kingdom, representing a diference of about 18 billion euros. In France there is a chronic imbalance between resources and expenditure, creating a cumulative budget deficit of about 100 billlion euros. Major efforts must be made to improve efficiency, and it will be necessary to choose between preserving our healthcare system or our financial system. If the latter is prioritized, healthcare will inevitably deteriorate.

  20. The 30-day prognosis of chronic-disease patients after contact with the out-of-hours service in primary healthcare

    PubMed Central

    Carlsen, Anders Helles; Moth, Grete; Christensen, Morten Bondo; Vestergaard, Mogens; Olesen, Frede; Vedsted, Peter

    2014-01-01

    Abstract Objective. Little is known about the prognosis of patients with chronic disease who contact the out-of-hours (OOH) service in primary care. The characteristics of contacts with the Danish out-of-hours service and daytime general practice, hospitalization, and death were studied during a 30-day follow-up period in patients with chronic heart diseases. Design. Cohort study. Setting and subjects. The study was based on data from 11 897 adults aged 18 + years from a Danish survey of OOH contacts, including information on consultation type. Reason for encounter (RFE) was categorized by OOH GPs at triage as either “exacerbation” or “new health problem”. Registry data were used to identify eligible patients, and the cohort was followed for 30 days after OOH contact through nationwide registries on healthcare use and mortality. Main outcome measures. The 30-day prognosis of chronic-disease patients after OOH contact. Results. Included patients with chronic disease had a higher risk of new OOH contact, daytime GP contact, and hospitalization than other patients during the 30-day follow-up period. OOH use was particularly high among patients with severe mental illness. A strong association was seen between chronic disease and risk of dying during follow-up. Conclusion. Patients with chronic disease used both daytime general practice and the out-of-hours service more often than others during the 30-day follow-up period; they were more often hospitalized and had higher risk of dying. The findings call for a proactive approach to future preventive day care and closer follow-up of this group, especially patients with psychiatric disease. PMID:25471829

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

    PubMed Central

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

    2015-01-01

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

  2. Bioethics and transnational medical travel: India,"medical tourism," and the globalisation of healthcare.

    PubMed

    Runnels, Vivien; Turner, Leigh

    2011-01-01

    Health-related travel, also referred to as "medical tourism" is historically well-known. Its emerging contemporary form suggests the development of a form of globalised for-profit healthcare. Medical tourism to India, the focus of a recent conference in Canada, provides an example of the globalisation of healthcare. By positioning itself as a low-cost, high-tech, fast-access and high-quality healthcare destination country, India offers healthcare to medical travellers who are frustrated with waiting lists and the limited availability of some procedures in Canada. Although patients have the right to travel and seek care at international medical facilities, there are a number of dimensions of medical tourism that are disturbing. The diversion of public investments in healthcare to the private sector, in order to serve medical travellers, perversely transfers public resources to international patients at a time when the Indian public healthcare system fails to provide primary healthcare to its own citizens. Further, little is known about patient safety and quality care in transnational medical travel. Countries that are departure points as well as destination countries need to carefully explore the ethical, social, cultural, and economic consequences of the growing phenomenon of for-profit international medical travel.

  3. Schooling, Child Labor, and the Returns to Healthcare in Tanzania

    ERIC Educational Resources Information Center

    Adhvaryu, Achyuta R.; Nyshadham, Anant

    2012-01-01

    We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work.…

  4. Business process modeling in healthcare.

    PubMed

    Ruiz, Francisco; Garcia, Felix; Calahorra, Luis; Llorente, César; Gonçalves, Luis; Daniel, Christel; Blobel, Bernd

    2012-01-01

    The importance of the process point of view is not restricted to a specific enterprise sector. In the field of health, as a result of the nature of the service offered, health institutions' processes are also the basis for decision making which is focused on achieving their objective of providing quality medical assistance. In this chapter the application of business process modelling - using the Business Process Modelling Notation (BPMN) standard is described. Main challenges of business process modelling in healthcare are the definition of healthcare processes, the multi-disciplinary nature of healthcare, the flexibility and variability of the activities involved in health care processes, the need of interoperability between multiple information systems, and the continuous updating of scientific knowledge in healthcare.

  5. The healthcare system and provision of oral healthcare in European Union member states. Part 4: Greece.

    PubMed

    Damaskinos, P; Koletsi-Kounari, H; Economou, C; Eaton, K A; Widström, E

    2016-03-11

    This paper presents a description of the healthcare system and how oral healthcare is organised and provided in Greece, a country in a deep economic and social crisis. The national health system is underfunded, with severe gaps in staffing levels and the country has a large private healthcare sector. Oral healthcare has been largely provided in the private sector. Most people are struggling to survive and have no money to spend on general and oral healthcare. Unemployment is rising and access to healthcare services is more difficult than ever. Additionally, there has been an overproduction of dentists and no development of team dentistry. This has led to under or unemployment of dentists in Greece and their migration to other European Union member states, such as the United Kingdom, where over 600 Greek dentists are currently working.

  6. Are patients who call a primary care office referred to the emergency department by non-healthcare personnel without the input of a physician?

    PubMed Central

    Hill, Russell; Gest, Albert; Smith, Cynthia; Guardiola, Jose H.; Apolinario, Michael; Ha, Joann; Gonzalez, Jose R.

    2016-01-01

    Objective. We hypothesized that a significant percentage of patients who are referred to the Emergency Department (ED) after calling their primary care physician’s (PCP) office receive such instructions without the input of a physician. Methods. We enrolled a convenience sample of stable adults at an inner-city ED. Patients provided written answers to structured questions regarding PCP contact prior to the ED visit. Continuous data are presented as means ± standard deviation; categorical data as frequency of occurrence. 95% confidence intervals were calculated. Results. The study group of 660 patients had a mean age of 41.7 ± 14.7 years and 72.6% had income below $20,000/year. 472 patients (71.51%; 67.9%–74.8%) indicated that they had a PCP. A total of 155 patients (23.0%; 19.9%–26.4%) called to contact their PCP prior to ED visit. For patients who called their PCP office and were directed by phone to the ED, the referral pattern was observed as follows: 31/98 (31.63%; 23.2%–41.4%) by a non-health care provider without physician input, 11/98 (11.2%; 6.2%–19.1%) by a non-healthcare provider after consultation with a physician, 12/98 (12.3%; 7.7%–20.3%) by a nurse without physician input, and 14/98 (14.3%; 8.6%–22.7%) by a nurse after consultation with physician. An additional 11/98, 11.2%; 6.2–19.1%) only listened to a recorded message and felt the message was directing them to the ED. Conclusion. A relatively small percentage of patients were referred to the ED without the consultation of a physician in our overall population. However, over half of those that contacted their PCP’s office felt directed to the ED by non-health care staff. PMID:27069780

  7. Effect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial

    PubMed Central

    Cardoso, Marly A.; Augusto, Rosangela A.; Bortolini, Gisele A.; Oliveira, Cristieli S. M.; Tietzman, Daniela C.; Sequeira, Leopoldina A. S.; Hadler, Maria Claret C. M.; Peixoto, Maria do Rosario G.; Muniz, Pascoal T.; Vitolo, Márcia R.; Lira, Pedro I. C.; Jaime, Patrícia C.

    2016-01-01

    Background Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce. Methods A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment. Results In CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 μg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children. Conclusions MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children. Trial Registration Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b PMID:26974146

  8. Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders

    PubMed Central

    Komaromy, Miriam; Duhigg, Dan; Metcalf, Adam; Carlson, Cristina; Kalishman, Summers; Hayes, Leslie; Burke, Tom; Thornton, Karla; Arora, Sanjeev

    2016-01-01

    ABSTRACT Background: Project ECHO (Extension for Community Healthcare Outcomes) trains and mentors primary care providers (PCPs) in the care of patients with complex conditions. ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning. This article describes a teleECHO clinic based at the University of New Mexico Health Sciences Center that is focused on treatment of substance use disorders (SUDs) and behavioral health disorders. Methods: Since 2005, specialists in treatment of SUDs and behavioral health disorders at Project ECHO have offered a weekly 2-hour Integrated Addictions and Psychiatry (IAP) TeleECHO Clinic focused on supporting PCP evaluation and treatment of SUDs and behavioral health disorders. We tabulate the number of teleECHO clinic sessions, participants, and CME/CEU (continuing medical education/continuing education unit) credits provided annually. This teleECHO clinic has also been used to recruit physicians to participate in DATA-2000 buprenorphine waiver trainings. Using a database of the practice location of physicians who received the buprenorphine waiver since 2002, the number of waivered physicians per capita in US states was calculated. The increase in waivered physicians practicing in underserved areas in New Mexico was evaluated and compared with the rest of the United States. Results: Since 2008, approximately 950 patient cases have been presented during the teleECHO clinic, and more than 9000 hours of CME/CEU have been awarded. Opioids are the substances discussed most commonly (31%), followed by alcohol (21%) and cannabis (12%). New Mexico is near the top among US states in DATA-2000 buprenorphine-waivered physicians per capita, and it has had much more rapid growth in waivered physicians practicing in traditionally underserved areas compared with the rest of the United States since the initiation of the teleECHO clinic focused on

  9. Availability and rational use of drugs in primary healthcare facilities following the national drug policy of 1982: is Bangladesh on right track?

    PubMed

    Ahmed, Syed Masud; Islam, Qazi Shafayetul

    2012-03-01

    In Bangladesh, the National Drug Policy (NDP) 1982 was instrumental in improving the supply of essential drugs of quality at an affordable price, especially in the early years. However, over time, evidence showed that the situation deteriorated in terms of both availability of essential drugs and their rational use. The study examined the current status of the outcome of the NDP objectives in terms of the availability and rational use of drugs in the primary healthcare (PHC) facilities in Bangladesh, including affordability by consumers. The study covered a random sample (n=30) of rural Upazila Health Complexes (UHCs) and a convenient sample (n=20) of urban clinics (UCs) in the Dhaka metropolitan area. Observations on prescribing and dispensing practices were made, and exit-interviews with patients and their attendants, and a mini-market survey were conducted to collect data on the core drug-use indicators of the World Health Organization from the health facilities. The findings revealed that the availability of essential drugs for common illnesses was poor, varying from 6% in the UHCs to 15% in the UCs. The number of drugs dispensed out of the total number of drugs prescribed was higher in the UHCs (76%) than in the UCs (44%). The dispensed drugs were not labelled properly, although >70% of patients/care-givers (n=1,496) reported to have understood the dosage schedule. The copy of the list of essential drugs was available in 55% and 47% of the UCs and UHCs respectively, with around two-thirds of the drugs being prescribed from the list. Polypharmacy was higher in the UCs (46%) than in the UHCs (33%). An antibiotic was prescribed in 44% of encounters (n=1,496), more frequently for fever (36-40%) and common cold (26-34%) than for lower respiratory tract infection, including pneumonia (10-20%). The prices of key essential drugs differed widely by brands (500% or more), seriously compromising the affordability of the poor people. Thus, the availability and rational

  10. Patient satisfaction with doctor-patient interaction and its association with modifiable cardiovascular risk factors among moderately-high risk patients in primary healthcare

    PubMed Central

    Masseni, Abd Aziz; Azlina, Ishak

    2017-01-01

    Background The outcomes of the physician-patient discussion intervene in the satisfaction of cardiovascular disease risk patients. Adherence to treatment, provision of continuous care, clinical management of the illness and patients’ adjustment are influenced by satisfaction with physician-patient interaction. This study aims to determine the patient satisfaction with doctor-patient interaction and over six months after following prevention counselling, its associations with modifiable cardiovascular risk factors amongst moderately-high risk patients in a primary healthcare clinic in Kelantan, Malaysia. Methods A prospective survey was conducted amongst patients with moderately-high cardiovascular risk. A total of 104 moderately-high risk patients were recruited and underwent structured prevention counselling based on the World Health Organization guideline, and their satisfaction with the doctor-patient interaction was assessed using ‘Skala Kepuasan Interaksi Perubatan-11,’ the Malay version of the Medical Interview Satisfaction Scale-21. Systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol were measured at baseline and at a follow-up visit at six months. Descriptive analysis, paired t test and linear regression analyses were performed. Results A total of 102 patients responded, giving a response rate of 98.1%. At baseline, 76.5% of the respondents were satisfied with the relation with their doctor, with the favourable domain of distress relief (85.3%) and rapport/confidence (91.2%). The unfavourable domain was interaction outcome, with satisfaction in only 67.6% of the respondents. Between the two visits, changes had occurred in total cholesterol (P = 0.022) and in systolic blood pressure (P < 0.001). Six months after the initial visits, no relationship existed between patient satisfaction scores and changes in modifiable cardiovascular risks. Discussion The ‘Skala Kepuasan Interaksi Perubatan-11’ which represents a

  11. Healthcare Lean.

    PubMed

    Long, John C

    2003-01-01

    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  12. Addressing healthcare.

    PubMed

    Daly, Rich

    2013-02-11

    Though President Barack Obama has rarely made healthcare references in his State of the Union addresses, health policy experts are hoping he changes that strategy this year. "The question is: Will he say anything? You would hope that he would, given that that was the major issue he started his presidency with," says Dr. James Weinstein, left, of the Dartmouth-Hitchcock health system.

  13. Agriculture Sectors

    EPA Pesticide Factsheets

    The Agriculture sectors comprise establishments primarily engaged in growing crops, raising animals, and harvesting fish and other animals. Find information on compliance, enforcement and guidance on EPA laws and regulations on the NAICS 111 & 112 sectors.

  14. The Relational-Behavior Survey as a Predictor of HIV-Related Parental Miscommunication: Implications for HIV, Prevention and Education at Primary Healthcare Service Facilities

    ERIC Educational Resources Information Center

    Chandler, Michele Denise; Chandler, Donald S.; Chandler, Donald S., Jr.; Race, James

    2012-01-01

    The study examined the relational-behavior survey (RBS) as a predictor of HIV-related parental miscommunication (HPM) among a voluntary sample 75 African American parents at a private healthcare facility located in the southwest region of the United States. A multiple regression analysis indicated that there was significant marginal prediction of…

  15. The Development of a New Master's of Science in Healthcare Quality Program

    ERIC Educational Resources Information Center

    Sears, Kim; Broderick, Briana; Stockley, Denise; Goldstien, D.; Egan, R.

    2014-01-01

    Working in silos or working within one discipline has not improved the delivery of healthcare. With a goal to advance the healthcare quality agenda and in response to an identified need within both the educational and healthcare sector, Queen's University has established a Master's degree in Healthcare Quality [MSc(HQ)]. The interprofessional…

  16. Current Trends and Healthcare Resource Usage in the Hospital Treatment of Primary Malignant Brain Tumor in Japan: A National Survey Using the Diagnostic Procedure Combination Database (J-ASPECT Study-Brain Tumor)

    PubMed Central

    YOSHIMOTO, Koji; KADA, Akiko; KUGA, Daisuke; HATAE, Ryusuke; MURATA, Hideki; AKAGI, Yojiro; NISHIMURA, Kunihiro; KUROGI, Ryota; NISHIMURA, Ataru; HATA, Nobuhiro; MIZOGUCHI, Masahiro; SAYAMA, Tetsuro; IIHARA, Koji

    2016-01-01

    We conducted this study to clarify the current trends and healthcare resource usage in the treatment of inpatients with primary malignant brain tumors. The Diagnostic Procedure Combination (DPC) data of all inpatients treated between 2013 and 2014 in the 370 core and branch hospitals enrolled in the Japanese Neurosurgical Society training program were collected. DPC is a discharge abstract and administrative claims database of inpatients. We assessed 6,142 primary, malignant brain tumor patients. Patient information, diagnostic information, treatment procedure, and healthcare resource usage were analyzed. Chemotherapy was the most frequent treatment (27% of cases), followed by surgery (13%) and surgery + chemo-radiotherapy (11%). Temozolomide (TMZ), the most frequently used chemotherapeutic drug, was administered to 1,236 patients. Concomitant TMZ and radiotherapy was administered to 816 patients, and was performed according to the Stupp regimen in many cases. The mean length of hospital stay (LOS) was 16 days, and the mean medical cost was 1,077,690 yen. The average medical cost of TMZ-only treatment was 1,138,620 yen whilst it was 4,424,300 yen in concomitant TMZ patients. The LOS was significantly shorter in high-volume than in low-volume hospitals, and the medical cost was higher in hospitals treating 21–50 patients compared to those treating 1–10 patients. However, the direct medical cost of TMZ treatment was the same across different volume hospitals. This is the first report of current trends and healthcare resource usage in the treatment of primary malignant brain tumor inpatients in the TMZ era in Japan. PMID:27680329

  17. Current Trends and Healthcare Resource Usage in the Hospital Treatment of Primary Malignant Brain Tumor in Japan: A National Survey Using the Diagnostic Procedure Combination Database (J-ASPECT Study-Brain Tumor).

    PubMed

    Yoshimoto, Koji; Kada, Akiko; Kuga, Daisuke; Hatae, Ryusuke; Murata, Hideki; Akagi, Yojiro; Nishimura, Kunihiro; Kurogi, Ryota; Nishimura, Ataru; Hata, Nobuhiro; Mizoguchi, Masahiro; Sayama, Tetsuro; Iihara, Koji

    2016-11-15

    We conducted this study to clarify the current trends and healthcare resource usage in the treatment of inpatients with primary malignant brain tumors. The Diagnostic Procedure Combination (DPC) data of all inpatients treated between 2013 and 2014 in the 370 core and branch hospitals enrolled in the Japanese Neurosurgical Society training program were collected. DPC is a discharge abstract and administrative claims database of inpatients. We assessed 6,142 primary, malignant brain tumor patients. Patient information, diagnostic information, treatment procedure, and healthcare resource usage were analyzed. Chemotherapy was the most frequent treatment (27% of cases), followed by surgery (13%) and surgery + chemo-radiotherapy (11%). Temozolomide (TMZ), the most frequently used chemotherapeutic drug, was administered to 1,236 patients. Concomitant TMZ and radiotherapy was administered to 816 patients, and was performed according to the Stupp regimen in many cases. The mean length of hospital stay (LOS) was 16 days, and the mean medical cost was 1,077,690 yen. The average medical cost of TMZ-only treatment was 1,138,620 yen whilst it was 4,424,300 yen in concomitant TMZ patients. The LOS was significantly shorter in high-volume than in low-volume hospitals, and the medical cost was higher in hospitals treating 21-50 patients compared to those treating 1-10 patients. However, the direct medical cost of TMZ treatment was the same across different volume hospitals. This is the first report of current trends and healthcare resource usage in the treatment of primary malignant brain tumor inpatients in the TMZ era in Japan.

  18. Effect of baseline HbA1c level on the development of diabetes by lifestyle intervention in primary healthcare settings: insights from subanalysis of the Japan Diabetes Prevention Program

    PubMed Central

    Sakane, Naoki; Sato, Juichi; Tsushita, Kazuyo; Tsujii, Satoru; Kotani, Kazuhiko; Tominaga, Makoto; Kawazu, Shoji; Sato, Yuzo; Usui, Takeshi; Kamae, Isao; Yoshida, Toshihide; Kiyohara, Yutaka; Sato, Shigeaki; Tsuzaki, Kokoro; Takahashi, Kaoru; Kuzuya, Hideshi

    2014-01-01

    Objectives To determine the effects of a lifestyle intervention on the development of type 2 diabetes mellitus (T2DM) among participants with impaired glucose tolerance (IGT), in particular in the subgroup with baseline glycated hemoglobin (HbA1c) levels ≥5.7%, in primary healthcare settings. Design Randomized controlled trial. Setting 32 healthcare centers in Japan. Participants Participants with IGT, aged 30–60 years, were randomly assigned to either an intensive lifestyle intervention group (ILG) or a usual care group (UCG). Interventions During the initial 6 months, participants in the ILG received four group sessions on healthy lifestyles by public health providers. An individual session was further conducted biannually during the 3 years. Participants in the UCG received usual care such as one group session on healthy lifestyles. Outcome measures The primary endpoint was the development of T2DM based on an oral glucose tolerance test. Results The mean follow-up period was 2.3 years. The annual incidence of T2DM were 2.7 and 5.1/100 person-years of follow-up in the ILG (n=145) and UCG (n=149), respectively. The cumulative incidence of T2DM was significantly lower in the ILG than in the UCG among participants with HbA1c levels ≥5.7% (log-rank=3.52, p=0.06; Breslow=4.05, p=0.04; Tarone-Ware=3.79, p=0.05), while this was not found among participants with HbA1c levels <5.7%. Conclusions Intensive lifestyle intervention in primary healthcare setting is effective in preventing the development of T2DM in IGT participants with HbA1c levels ≥5.7%, relative to those with HbA1c levels <5.7%. Trial registration number UMIN000003136. PMID:25452854

  19. A multifaceted strategy using mobile technology to assist rural primary healthcare doctors and frontline health workers in cardiovascular disease risk management: protocol for the SMARTHealth India cluster randomised controlled trial

    PubMed Central

    2013-01-01

    Background Blood Pressure related disease affected 118 million people in India in the year 2000; this figure will double by 2025. Around one in four adults in rural India have hypertension, and of those, only a minority are accessing appropriate care. Health systems in India face substantial challenges to meet these gaps in care, and innovative solutions are needed. Methods We hypothesise that a multifaceted intervention involving capacity strengthening of primary healthcare doctors and non-physician healthcare workers through use of a mobile device-based clinical decision support system will result in improved blood pressure control for individuals at high risk of a cardiovascular disease event when compared with usual healthcare. This intervention will be implemented as a stepped wedge, cluster randomised controlled trial in 18 primary health centres and 54 villages in rural Andhra Pradesh involving adults aged ≥40 years at high cardiovascular disease event risk (approximately 15,000 people). Cardiovascular disease event risk will be calculated based on World Health Organisation/International Society of Hypertension’s region-specific risk charts. Cluster randomisation will occur at the level of the primary health centres. Outcome analyses will be conducted blinded to intervention allocation. Expected outcomes The primary study outcome is the difference in the proportion of people meeting guideline-recommended blood pressure targets in the intervention period vs. the control period. Secondary outcomes include mean reduction in blood pressure levels; change in other cardiovascular disease risk factors, including body mass index, current smoking, reported healthy eating habits, and reported physical activity levels; self-reported use of blood pressure and other cardiovascular medicines; quality of life (using the EQ-5D); and cardiovascular disease events (using hospitalisation data). Trial outcomes will be accompanied by detailed process and economic

  20. Innovation Concepts in Healthcare

    SciTech Connect

    2011-01-06

    AbstractDemographic change and advances in medical science pose increased challenges to healthcare systems globally: The economic basis is aging and thus health is becoming more and more a productivity factor. At the same time, with today’s new communication possibilities the demand and expectations of effective medical treatment have been increased. This presentation will illustrate the need for the “industrialization” of healthcare in order to achieve highest results at limited budgets. Thereby, industrialization is not meaning the medical treatment based on the assembly line approach. Rather it is to recognize the cost of medical care as an investment with respective expectations on the return of the investment. Innovations in imaging and pharmaceutical products as well as in processes - that lead to similar medical results, but with lower efforts - are keys in such scenarios.BiographyProf. Dr. Hermann Requardt, 54, is a member of the Managing Board of Siemens AG and Chief Executive Officer of the Healthcare Sector. In addition he is the CTO of Siemens AG and Head of Corporate Technology, the central research department at Siemens.After completing his studies in physics and philosophy at the Darmstadt University of Technology and Johann Wolfgang Goethe University in Frankfurt and receiving a doctorate in biophysics, he worked at the Institute of Aerospace Medicine at the German Aerospace Center.In 1984 he joined the Medical Technology Group of Siemens AG, where he was responsible for projects in the Magnetic Resonance (MR) division. He was appointed head of the division in 1995. From 2001 to 2006, as a member of the Executive Management of the Medical Solutions Group, he was responsible for several areas, including technological development.In 2006 he became a Member of the Siemens’ Managing Board and head of Corporate Technology. He was additionally appointed as the Sector Healthcare CEO in 2008.Since 2006 he is an honorary professor in physics of the

  1. Development of a district mental healthcare plan in Uganda

    PubMed Central

    Kigozi, Fred N.; Kizza, Dorothy; Nakku, Juliet; Ssebunnya, Joshua; Ndyanabangi, Sheila; Nakiganda, Blandina; Lund, Crick; Patel, Vikram

    2016-01-01

    Background Evidence is needed for the integration of mental health into primary care advocated by the national health sector strategic investment plan in Uganda. Aims To describe the processes of developing a district mental healthcare plan (MHCP) in rural Uganda that facilitates integration of mental health into primary care. Method Mixed methods using a situational analysis, qualitative studies, theory of change workshops and partial piloting of the plan at two levels informed the MHCP. Results A MHCP was developed with packages of care to facilitate integration at the organisational, facility and community levels of the district health system, including a specified human resource mix. The partial embedding period supports its practical application. Key barriers to scaling up the plan were identified. Conclusions A real-world plan for the district was developed with involvement of stakeholders. Pilot testing demonstrated its feasibility and implications for future scaling up. PMID:26447171

  2. Self-reported oral health among a community sample of people experiencing social and health inequities: cross-sectional findings from a study to enhance equity in primary healthcare settings

    PubMed Central

    Wallace, Bruce; Browne, Annette J; Varcoe, Colleen; Ford-Gilboe, Marilyn; Wathen, Nadine; Long, Phoebe M; Parker, Joanne

    2015-01-01

    Objective To describe the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages. Methods As part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary healthcare intervention, we examined the oral health of a sample of 567 people receiving care at four clinics that serve marginalised populations in two Canadian provinces. Data collected included self-rated oral health and experiences accessing and receiving healthcare, standard self-report measures of health and quality of life, and sociodemographic information. Results The prevalence of self-rated poor oral health was high, with almost half (46.3%) of the participants reporting poor or fair oral health. Significant relationships were observed between poor oral health and vulnerabilities related to mental health, trauma and housing instability. Our findings suggest that the oral health of some Canadian populations may be dramatically worse than what is reported in existing population health surveys. Conclusions Our findings reinforce the importance of addressing oral health as part of health equity strategies. The health and oral health issues experienced by this client cohort highlight the need for interdisciplinary, team-based care that can address the intersections among people's health status, oral health and social issues. PMID:26700285

  3. Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie

    PubMed Central

    2010-01-01

    Background The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care. Objectives In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The goal of the present research project is to track the evolution of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance. Methods/Design This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year

  4. Integrating chronic care with primary care activities: enriching healthcare staff knowledge and skills and improving glycemic control of a cohort of people with diabetes through the First Line Diabetes Care Project in the Philippines

    PubMed Central

    Ku, Grace Marie V.; Kegels, Guy

    2014-01-01

    Background This study investigated the effects of integrating primary chronic care with current healthcare activities in two local government health units (LGHU) of the Philippines on knowledge and skills of the LGHU staff and clinical outcomes for people with diabetes. Design Integration was accomplished through health service reorganization, (re)distribution of chronic care tasks, and training of LGHU staff. Levels of the staff's pre- and post-training diabetes knowledge and of their self-assessment of diabetes care-related skills were measured. Primary diabetes care with emphasis on self-care development was provided to a cohort of people with diabetes. Glycosylated hemoglobin (HbA1c) and obesity measures were collected prior to and one year after full project implementation. Results The training workshop improved diabetes knowledge (p<0.001) and self-assessed skills (p<0.001) of the LGHU staff. Significant reductions in HbA1c (p<0.001), waist–hip ratio (p<0.001) and waist circumference (p=0.011) of the cohort were noted. Although the reduction in HbA1c was somewhat greater among those whose community-based care providers showed improvement in knowledge and self-assessed skills, the difference was not statistically significant. Conclusions Primary care for chronic conditions such as diabetes may be integrated with other healthcare activities in health services of low-to-middle-income countries such as the Philippines, utilizing pre-existing human resources for health, and may improve clinical endpoints. PMID:25361726

  5. What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland

    PubMed Central

    Parda, Natalia; Stępień, Małgorzata; Zakrzewska, Karolina; Madaliński, Kazimierz; Kołakowska, Agnieszka; Godzik, Paulina; Rosińska, Magdalena

    2016-01-01

    Objectives Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare. Design Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate. Setting This study was conducted in primary care units in selected provinces in Poland. Participants A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected. Results Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect. Conclusions Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed. PMID

  6. Metals Sector

    EPA Pesticide Factsheets

    Find environmental regulatory information about the metals sector (NAICS 331 & 332), including NESHAPs for metal coatings, effluent guidelines for metal products, combustion compliance assistance, and information about foundry sand recycling.

  7. Health sector responses to intimate partner violence: A literature review

    PubMed Central

    Zweigenthal, Virginia; Joyner, Kate

    2014-01-01

    Abstract Background Intimate partner violence (IPV) is a common and serious public health concern, particularly in South Africa, but it is not well managed in primary care. Aim This review aims to summarise the current state of knowledge regarding health sector-based interventions for IPV, their integration into health systems and services and the perspectives of service users and healthcare workers on IPV care, focusing on the South African context. Method PubMed, CINAHL, PsycINFO and Google Scholar were searched between January 2012 and May 2014. All types of study design were included, critically appraised and summarised. Results Exposure to IPV leads to wide-ranging and serious health effects. There is sufficient evidence that intervening in IPV in primary care can improve outcomes. Women who have experienced IPV have described an appropriate response by healthcare providers to be non-judgmental, understanding and empathetic. IPV interventions that are complex, comprehensive and utilise systems-wide approaches have been most effective, but system- and society-level barriers hamper implementation. Gender inequities should not be overlooked when responding to IPV. Conclusion Further evaluations of health sector responses to IPV are needed, in order to assist health services to determine the most appropriate models of care, how these can be integrated into current systems and how they can be supported in managing IPV. The need for this research should not prevent health services and healthcare providers from implementing IPV care, but rather should guide the development of rigorous contextually-appropriate evaluations. PMID:26245388

  8. Private sector contributions and their effect on physician emigration in the developing world.

    PubMed

    Loh, Lawrence C; Ugarte-Gil, Cesar; Darko, Kwame

    2013-03-01

    The contribution made by the private sector to health care in a low- or middle-income country may affect levels of physician emigration from that country. The increasing importance of the private sector in health care in the developing world has resulted in newfound academic interest in that sector's influences on many aspects of national health systems. The growth in physician emigration from the developing world has led to several attempts to identify both the factors that cause physicians to emigrate and the effects of physician emigration on primary care and population health in the countries that the physicians leave. When the relevant data on the emerging economies of Ghana, India and Peru were investigated, it appeared that the proportion of physicians participating in private health-care delivery, the percentage of health-care costs financed publicly and the amount of private health-care financing per capita were each inversely related to the level of physician expatriation. It therefore appears that private health-care delivery and financing may decrease physician emigration. There is clearly a need for similar research in other low- and middle-income countries, and for studies to see if, at the country level, temporal trends in the contribution made to health care by the private sector can be related to the corresponding trends in physician emigration. The ways in which private health care may be associated with access problems for the poor and therefore reduced equity also merit further investigation. The results should be of interest to policy-makers who aim to improve health systems worldwide.

  9. Clinical practice placements in the community: a survey to determine if they reflect the shift in healthcare delivery from secondary to primary care settings.

    PubMed

    Betony, Karen

    2012-01-01

    With the worldwide strategic shift of health care delivery from secondary to primary care settings, more newly qualified nurses are working in primary care, making exposure to the variety of roles available to nurses essential for future workforce development. The aim of this small research project was to explore whether English universities' programmes are providing clinical practice placement experiences which reflect the breadth and complexity of nursing roles available in primary care. A survey of academic staff highlighted that universities designed curricula based on local placement and mentor availability and while a variety of primary care teams are being used, district nursing teams continue to be used the most, particularly for substantive placements. The need for specified staff to work across university and placement settings was deemed essential for identifying and supporting community based clinical placements. Recommendations from the project include: an increasingly collaborative approach amongst clinical, academic and managerial staff to create a learning culture for all health professional students' practice experience; robust strategic systems to ensure clinical placements are offered by services on the periphery of a national health service; and focussing of resources on students with a desire to pursue a primary care career.

  10. Prevalence of post-traumatic stress symptoms and associated factors in tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa.

    PubMed

    Peltzer, Karl; Naidoo, Pamela; Matseke, Gladys; Louw, Julia; McHunu, Gugu; Tutshana, Bomkazi

    2013-01-01

    High rates of tuberculosis (TB) and TB/HIV co-infection is often linked with mental health issues such as post-traumatic stress disorder (PTSD) symptoms, which is further associated with poor health outcomes. In a country such as South Africa where rates of these infectious diseases are high, it is concerning that there is limited/no data on prevalence rates of mental disorders such as PTSD and its associated factors. Therefore, the aim of this study was to establish the prevalence of PTSD symptoms and associated factors in TB, TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa. Brief screening self-report tools were used to measure: PTSD symptoms, psychological distress (anxiety and depression) and alcohol misuse. Other relevant measures, such as adherence to medication, stressful life events and sexual risk-taking behaviours, were obtained through structured questions. A total of 4900 public primary care adult patients from clinics in high TB burden districts from three provinces in South Africa participated. All the patients screened positive for TB (either new or retreatment cases). The prevalence of PTSD symptoms was 29.6%. Patients who screened positive for PTSD symptoms and psychological distress were more likely to be on antidepressant medication. Factors that predicted PTSD symptoms were poverty, residing in an urban area, psychological distress, suicide attempt, alcohol and/or drug use before sex, unprotected sex, TB-HIV co-infected and the number of other chronic conditions. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of TB and HIV.

  11. Innovation Concepts in Healthcare

    ScienceCinema

    None

    2016-07-12

    AbstractDemographic change and advances in medical science pose increased challenges to healthcare systems globally: The economic basis is aging and thus health is becoming more and more a productivity factor. At the same time, with today’s new communication possibilities the demand and expectations of effective medical treatment have been increased. This presentation will illustrate the need for the “industrialization” of healthcare in order to achieve highest results at limited budgets. Thereby, industrialization is not meaning the medical treatment based on the assembly line approach. Rather it is to recognize the cost of medical care as an investment with respective expectations on the return of the investment. Innovations in imaging and pharmaceutical products as well as in processes - that lead to similar medical results, but with lower efforts - are keys in such scenarios.BiographyProf. Dr. Hermann Requardt, 54, is a member of the Managing Board of Siemens AG and Chief Executive Officer of the Healthcare Sector. In addition he is the CTO of Siemens AG and Head of Corporate Technology, the central research department at Siemens.After completing his studies in physics and philosophy at the Darmstadt University of Technology and Johann Wolfgang Goethe University in Frankfurt and receiving a doctorate in biophysics, he worked at the Institute of Aerospace Medicine at the German Aerospace Center.In 1984 he joined the Medical Technology Group of Siemens AG, where he was responsible for projects in the Magnetic Resonance (MR) division. He was appointed head of the division in 1995. From 2001 to 2006, as a member of the Executive Management of the Medical Solutions Group, he was responsible for several areas, including technological development.In 2006 he became a Member of the Siemens’ Managing Board and head of Corporate Technology. He was additionally appointed as the Sector Healthcare CEO in 2008.Since 2006 he is an honorary professor in

  12. Rules and Incentives: The Problem with American Healthcare.

    PubMed

    Baum, Neil

    2015-01-01

    There are very few within or outside of the American healthcare system who would argue that the current system of providing healthcare is badly broken and needs fixing. The cost of healthcare has outpaced every other sector of American life. We spend 2.5 times more on healthcare than do most developed countries in the world. Do we have the best healthcare in the world? The average life expectancy is 78.49 years, which ranks us 51st in the world. We spend more on healthcare than any other nation but get less for our hard-earned dollars. This article will provide suggestions for repairing the broken healthcare system with excerpts taken from the book Practical Wisdom, by Dr. Barry Schwartz and Kenneth Sharpe.

  13. Community College Nursing and Allied Health Education Programs, and Iowa's Healthcare Workforce

    ERIC Educational Resources Information Center

    McLaughlin, Michael P.

    2009-01-01

    As the nation's population ages and the Baby Boom generation nears retirement, the need for skilled healthcare workers in Iowa and across the nation grows. Healthcare is one of the fastest growing sectors of the U.S. economy, and one of the top industries for job growth and job creation in Iowa. The increase in the number of healthcare positions…

  14. Globalization, global health, and access to healthcare.

    PubMed

    Collins, Téa

    2003-01-01

    It is now commonly realized that the globalization of the world economy is shaping the patterns of global health, and that associated morbidity and mortality is affecting countries' ability to achieve economic growth. The globalization of public health has important implications for access to essential healthcare. The rise of inequalities among and within countries negatively affects access to healthcare. Poor people use healthcare services less frequently when sick than do the rich. The negative impact of globalization on access to healthcare is particularly well demonstrated in countries of transitional economies. No longer protected by a centralized health sector that provided free universal access to services for everyone, large segments of the populations in the transition period found themselves denied even the most basic medical services. Only countries where regulatory institutions are strong, domestic markets are competitive and social safety nets are in place, have a good chance to enjoy the health benefits of globalization.

  15. Social Responsibility and Healthcare in Finland.

    PubMed

    Ahola-Launonen, Johanna

    2016-07-01

    This article examines current trends and prospects in Finnish healthcare literature and discussion. The Finnish healthcare system was long considered to manifest an equal, universal, and solidaristic welfare scheme. However, recent data reveals structural inequalities in access to healthcare that result in health differences among socioeconomic groups. The political will aims at tackling these inequalities, but the ideological trend toward responsibilization of the individual taking place across political spheres elsewhere in Europe creates potential challenges to this goal. The applications of this trend have a theoretical background in the responsibility-sensitive egalitarian-or luck egalitarian-tradition. The theory, which is unfit for real-life policy applications, has explicit appeal in considerations aiming at the responsibilization of the individual within the healthcare sector. It remains to be seen in which direction the Finnish welfare schemes will continue to develop.

  16. Sri Lankan-born women who have given birth in Victoria: a survey of their primary postpartum health-care needs.

    PubMed

    Nilaweera, Irosha; Rowe, Heather; Nguyen, Hau; Burns, Joanna; Doran, Frances; Fisher, Jane

    2016-01-01

    Women who migrate are vulnerable after giving birth. Normal postpartum adaptive challenges are heightened by separation from family and lack of familiarity with local services. The aim was to investigate primary care needs among Sri Lankan-born women with at least one Victorian-born child aged under 2 years. Health care, information and support needs and unmet needs were assessed in a structured Sinhala or English survey offered in print, online or by telephone. Fifty women provided data. Most (80%) had at least one relative from Sri Lanka to stay for postpartum support. Despite this, many had difficulties settling (62%), feeding (58%) and soothing (42%) their babies. They used significantly fewer health services on average (2.3) than mothers in the general community (2.8) (P<0.004). Only 32% of primiparous women attended at least one First-Time Parents' group session. Of women experiencing infant care difficulties, only two-thirds accessed care from a Maternal and Child Health Nurse and only one-third from a General Practitioner. Sri Lankan-born mothers have significant unmet needs for primary care, which are not reduced by informal support. A two-pronged approach is indicated in which women are informed about primary care availability, and the cultural competence and client friendliness of services is strengthened.

  17. Healthcare financing: approaches and trends in India.

    PubMed

    Bajpai, Vikas; Saraya, Anoop

    2010-01-01

    Despite the importance of healthcare for the well-being of society, there is little public debate in India on issues relating to it. The 'human capital approach' to finance healthcare largely relies on private investment in health, while the 'human development approach' envisages the State as the guarantorof preventive as well as curative care to achieve universalization of healthcare. The prevailing health indices of India and challenges in the field of public health require a human developmentapproach to healthcare. On the eve of independence, India adopted the human development approach, with the report of the Bhore Committee emphasizing the role of the State in the development and provision of healthcare. However, more recently, successive governments have moved towards the human capital approach. Instead of increasing state spending on health and expanding the public health infrastructure, the government has been relying more and more on the private sector. The public-private partnership has been touted as the new-age panacea for the ills of the Indian healthcare system. This approach has led to a stagnation of public health indices and a decrease in the access of the poor to healthcare.

  18. Knowledge Discovery from Massive Healthcare Claims Data

    SciTech Connect

    Chandola, Varun; Sukumar, Sreenivas R; Schryver, Jack C

    2013-01-01

    The role of big data in addressing the needs of the present healthcare system in US and rest of the world has been echoed by government, private, and academic sectors. There has been a growing emphasis to explore the promise of big data analytics in tapping the potential of the massive healthcare data emanating from private and government health insurance providers. While the domain implications of such collaboration are well known, this type of data has been explored to a limited extent in the data mining community. The objective of this paper is two fold: first, we introduce the emerging domain of big"healthcare claims data to the KDD community, and second, we describe the success and challenges that we encountered in analyzing this data using state of art analytics for massive data. Specically, we translate the problem of analyzing healthcare data into some of the most well-known analysis problems in the data mining community, social network analysis, text mining, and temporal analysis and higher order feature construction, and describe how advances within each of these areas can be leveraged to understand the domain of healthcare. Each case study illustrates a unique intersection of data mining and healthcare with a common objective of improving the cost-care ratio by mining for opportunities to improve healthcare operations and reducing hat seems to fall under fraud, waste,and abuse.

  19. Understanding business intelligence in the context of healthcare.

    PubMed

    Mettler, Tobias; Vimarlund, Vivian

    2009-09-01

    In today's fast changing healthcare sector, decision makers are facing a growing demand for both clinical and administrative information in order to comply with legal and customer-specific requirements. The use of business intelligence (BI) is seen as a possible solution to this actual challenge. As the existing research about BI is primarily focused on the industrial sector, it is the aim of this contribution to translate and adapt the current findings for the healthcare context. For this purpose, different definitions of BI are examined and condensed in a framework. Furthermore, the sector-specific preconditions for the effective use and future role of BI are discussed.

  20. Schooling, Child Labor, and the Returns to Healthcare in Tanzania.

    PubMed

    Adhvaryu, Achyuta R; Nyshadham, Anant

    2012-01-01

    We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work. Children attend school for more days per week-but not for more hours per day-as a result of accessing better healthcare. There are no significant effects on child labor, but the results suggest that time spent in physically strenuous activities such as farming and herding increases.

  1. Schooling, Child Labor, and the Returns to Healthcare in Tanzania

    PubMed Central

    Adhvaryu, Achyuta R.; Nyshadham, Anant

    2013-01-01

    We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children’s allocation of time to school and work. Children attend school for more days per week—but not for more hours per day—as a result of accessing better healthcare. There are no significant effects on child labor, but the results suggest that time spent in physically strenuous activities such as farming and herding increases. PMID:24353348

  2. The Chinese healthcare challenge

    PubMed Central

    Fabre, Guilhem

    2015-01-01

    Investments in the extension of health insurance coverage, the strengthening of public health services, as well as primary care and better hospitals, highlights the emerging role of healthcare as part of China’s new growth regime, based on an expansion of services, and redistributive policies. Such investments, apart from their central role in terms of relief for low-income people, serve to rebalance the Chinese economy away from export-led growth toward the domestic market, particularly in megacity-regions as Shanghai and the Pearl River Delta, which confront the challenge of integrating migrant workers. Based on the paper by Gusmano and colleagues, one would expect improvements in population health for permanent residents of China’s cities. The challenge ahead, however, is how to address the growth of inequalities in income, wealth and the social wage. PMID:25774379

  3. Lean in healthcare: the unfilled promise?

    PubMed

    Radnor, Zoe J; Holweg, Matthias; Waring, Justin

    2012-02-01

    In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily 'professional' in origin but actually more 'organisational' and 'managerial' and, if not addressed could severely constrain Lean's impact on healthcare productivity at the systems level.

  4. [Cartography of healthcare for pregnant women].

    PubMed

    Silva, Raimunda Magalhães da; Costa, Milena Silva; Matsue, Regina Yoshie; Sousa, Girliani Silva de; Catrib, Ana Maria Fontenelle; Vieira, Luiza Jane Eyre de Souza

    2012-03-01

    This work uses cartography as a method for mapping the trajectory of primary healthcare provided to pregnant women. The scope of the study comprises 9 Basic Healthcare Units located in the city of Juazeiro do Norte in the State of Ceará. In all, fifteen women in the 37th to 39th week of pregnancy were selected. Interviews were conducted with these women during the period from January to June 2010. The cartographic findings were depicted in stages in the flowchart, which exposed lacunas in prenatal healthcare, such as the low number of oncotic cytology exams conducted and the lack of educational counseling. Nevertheless, in the interviews, a significant number of pregnant women expressed satisfaction with the prenatal care provided. The good relationships developed between the healthcare professionals and the pregnant women were the main reason that led them to continue the treatment. This fact reinforces the importance of dialogue between these two actors for the success of prenatal healthcare.

  5. Fraud Detection in Healthcare

    SciTech Connect

    Chandola, Varun; Schryver, Jack C; Sukumar, Sreenivas R

    2015-01-01

    We discuss the problem of fraud detection in healthcare in this chapter. Given the recent scrutiny of the ineciencies in the US healthcare system, identifying fraud has been on the forefront of the eorts towards reducing the healthcare costs. In this chapter we will focus on understanding the issue of healthcare fraud in detail, and review methods that have been proposed in the literature to combat this issue using data driven approach.

  6. A decade of occupational accidents due to direct or indirect electrical contact in the primary, secondary and tertiary sectors in Spain (2003-2012).

    PubMed

    Castillo-Rosa, Juan; Suárez-Cebador, Manuel; Rubio-Romero, Juan Carlos; Aguado, Jose Antonio

    2017-03-01

    Occupational accidents caused by electrical contact are a major concern worldwide due to their severe consequences. The study conducted is based on an analysis of the evolution of incidence rates and dependence between variables for 14,022 electrical accidents occurring in Spain between 2003 and 2012. The results show that electrical accidents as a whole are 3.6 times more likely to have severe consequences than the rest of the accidents in the country. This proportion is even nine times greater in the case of fatal accidents. They also confirm a significant relationship between the severity of this type of accidents and the economic sector in which they occur. On the other hand, there is a positive trend in the reduction of the incidence rate, especially in relation to direct contact, although unexpectedly the rate of accidents due to indirect contact is on the rise. Thus, preventing electrical occupational accidents requires efforts to guarantee adequate training adapted to the needs of workers in the various economic sectors. Furthermore, those responsible for safety should work to implement mechanisms to monitor and control compliance with efficient protective measures against electrical contact.

  7. Private sector contributions and their effect on physician emigration in the developing world

    PubMed Central

    Ugarte-Gil, Cesar; Darko, Kwame

    2013-01-01

    Abstract The contribution made by the private sector to health care in a low- or middle-income country may affect levels of physician emigration from that country. The increasing importance of the private sector in health care in the developing world has resulted in newfound academic interest in that sector’s influences on many aspects of national health systems. The growth in physician emigration from the developing world has led to several attempts to identify both the factors that cause physicians to emigrate and the effects of physician emigration on primary care and population health in the countries that the physicians leave. When the relevant data on the emerging economies of Ghana, India and Peru were investigated, it appeared that the proportion of physicians participating in private health-care delivery, the percentage of health-care costs financed publicly and the amount of private health-care financing per capita were each inversely related to the level of physician expatriation. It therefore appears that private health-care delivery and financing may decrease physician emigration. There is clearly a need for similar research in other low- and middle-income countries, and for studies to see if, at the country level, temporal trends in the contribution made to health care by the private sector can be related to the corresponding trends in physician emigration. The ways in which private health care may be associated with access problems for the poor and therefore reduced equity also merit further investigation. The results should be of interest to policy-makers who aim to improve health systems worldwide. PMID:23476095

  8. Healthcare. Executive Summary

    ERIC Educational Resources Information Center

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

    2012-01-01

    This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

  9. Prevalence of intimate partner violence and its associated risk factors among Saudi female patients attending the primary healthcare centers in Western Saudi Arabia

    PubMed Central

    Alzahrani, Turki A.; Abaalkhail, Bahaa A.; Ramadan, Iman K.

    2016-01-01

    Objectives: To estimate the prevalence of intimate partner violence (IPV) among female patients, age 18-60 years, attending primary health care centers (PHCCs) and to measure its determinants, and reporting behavior. Methods: A cross-sectional study design using validated, translated, and self-administered questionnaire among 497 Saudi female patients attending PHCCs in Taif, Kingdom of Saudi Arabia (KSA) from January to February 2015 was employed. A 2-stage probability sampling was adopted for selection of PHCCs in the first stage, and then participants in the second stage. Results: The estimated prevalence of IPV during the last year was 11.9%. Predictors of IPV related to abused women included divorced status and divorced parents; while those related to abusers (husbands) included widowed parents, exposure to violence in childhood, and alcohol or drugs addiction. Most of the abused wives (56%) talked regarding their IPV to their families, their husbands’ families (15.2%), or their friends (11.8%); while only a minority (3.3%) complained to the police or to a judge, and no one reported this to a family physician, or to women protection agency. Conclusion: One out of 10 women is a victim of IPV in Taif, KSA. Intimate partner violence is significantly associated with a number of victim and abuser-related psychosocial factors, the detection of which might help screening for individuals at risk. PMID:26739983

  10. Meeting patient expectations: healthcare professionals and service re-engineering.

    PubMed

    Laing, Angus

    2002-08-01

    A central theme underpinning the reform of healthcare systems in western economies since the 1980s has been the emphasis on reorienting service provision around the patient. Healthcare organizations have been forced to re-appraise the design of the service delivery process, specifically the service encounter, to take account of these changing patient expectations. This reorientation of healthcare services around the patient has fundamental implications for healthcare professionals, specifically challenging the dominance of service professionals in the design and delivery of health services. Utilizing a qualitative methodological framework, this paper explores the responses of healthcare professionals to service redesign initiatives implemented in acute NHS hospitals in Scotland and considers the implications of such professional responses for the development of patient-focused service delivery. Within this, it specifically examines evolving professional perspectives on the place of a service user focus in a publicly funded healthcare system, professional attitudes towards private sector managerial practices, and the dynamics of changing professional behaviour.

  11. A special report on India's biotech scenario: advancement in biopharmaceutical and health care sectors.

    PubMed

    Chakraborty, Chiranjib; Agoramoorthy, Govindasamy

    2010-01-01

    India's biotechnology industry has been growing towards new heights in conjunction with the recent economic outburst. The country has the potential to revolutionize biopharmaceutical and healthcare sectors. In this review, we have highlighted the achievements of India's biotechnology industry, especially biopharmaceutical and healthcare sectors that include therapeutics, diagnostics, stem cell research, human healthcare related bioinformatics and animal health care. We have also described regulatory mechanisms involved in India's health care biotech including manpower development.

  12. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

    PubMed

    Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

    2015-08-31

    In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of

  13. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns

    PubMed Central

    Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

    2015-01-01

    In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers’ concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of

  14. STD-related knowledge, beliefs and attitudes of Xhosa-speaking patients attending STD primary health-care clinics in South Africa.

    PubMed

    Reddy, P; Meyer-Weitz, A; van den Borne, B; Kok, G

    1999-06-01

    The primary aim of this study was to describe patients at sexually transmitted disease (STD) clinics in Cape Town, South Africa, in terms of gender, education and age differences relative to their STD knowledge and beliefs, their condom use, as well as their attitudes towards condom use and their condom-use behaviour. The information was collected with a view to developing a health education intervention. Structured interviews were conducted with 2978 randomly sampled Xhosa-speaking STD clinic attenders about their knowledge, beliefs and practices regarding STDs and related behaviours. More males (75%) than females (25%) presented for STD treatment. The majority of patients (92%) were younger than 35 years. Female patients were found to be more aware than male patients of the sexual nature of STD transmission, valued personal autonomy in sexual behaviour and expressed a greater need to use condoms. Males perceived STD symptoms to be more serious, had more misconceptions about the cause of STDs and also more negative beliefs and attitudes towards condom use. Only 34.9% of the patients reported using condoms in the last 6 months while only 24.5% reported regular use. Those who reported condom use were more knowledgeable about the sexual transmission of STDs and the effects of STDs on the neonate. They also had fewer misconceptions about the causes of STDs and perceived STD symptoms to be more serious, attached greater value to personal autonomy in sexual behaviour and condom use and had more positive outcome expectancies of refusing sex than those who never used condoms. The data suggest that targeted interventions directed at males will have to address their inadequate knowledge regarding STDs in terms of transmission, causes, consequences, prevention and cure. Their negative beliefs and attitudes towards condoms will need special attention, especially in view of their multiple partner behaviour. Interventions directed at females will need to improve their knowledge

  15. A collaborative clinical and population-based curriculum for medical students to address primary care needs of the homeless in New York City shelters : Teaching homeless healthcare to medical students.

    PubMed

    Asgary, Ramin; Naderi, Ramesh; Gaughran, Margaret; Sckell, Blanca

    2016-06-01

    Background Millions of Americans experience homelessness annually. Medical providers do not receive adequate training in primary care of the homeless.Methods Starting in 2012, a comprehensive curriculum was offered to medical students during their family medicine or ambulatory clerkship, covering clinical, social and advocacy, population-based, and policy aspects. Students were taught to: elicit specific social history, explore health expectations, and assess barriers to healthcare; evaluate clinical conditions specific to the homeless and develop plans for care tailored toward patients' medical and social needs; collaborate with shelter staff and community organizations to improve disease management and engage in advocacy efforts. A mixed methods design was used to evaluate students' knowledge, attitudes, and skills including pre- and post-curriculum surveys, debriefing sessions, and observed clinical skills.Results The mean age of the students (n = 30) was 26.5 years; 55 % were female. The overall scores improved significantly in knowledge, attitude, and self-efficacy domains using paired t‑test (p < 0.01). Specific skills in evaluating mental health, substance abuse, and risky behaviours improved significantly (p < 0.05). In evaluation of communication skills, the majority were rated as having 'outstanding rapport with patients.'Conclusions Comprehensive and ongoing clinical component in shelter clinics, complementary teaching, experienced faculty, and working relationship and collaboration with community organizations were key elements.

  16. The Effect of Volunteering at a Student-Run Free Healthcare Clinic on Medical Students' Self-Efficacy, Comfortableness, Attitude, and Interest in Working with the Underserved Population and Interest in Primary Care

    PubMed Central

    Kovalskiy, Aleksandr; Desai, Anand; Imran, Amna; Ismail, Rahim; Hernandez, Caridad

    2017-01-01

    Introduction The number of primary care physicians in the United States continues to lag behind the number of uninsured people. There has been a growing demand for medical students to improve their self-efficacy, comfortableness, attitude, and interest in working with the underserved and in primary care. This study aims to discern whether volunteering at a student-run, free healthcare clinic has a positive impact on these five variables of interest or not. Methods A 95-item survey was distributed through Qualtrics Survey Software (Qualtrics, Provo, UT, USA) to medical students from the Class of 2018 and Class of 2019 at the University of Central Florida College of Medicine. They were recruited via emails, Facebook, and in-classroom announcements. Mean responses on a Likert-like scale to different survey items were collected and compared between two study cohorts: Keeping Neighbors In Good Health Through Service (KNIGHTS) Clinic volunteers and non-volunteers. Results Results from 128 students showed no significant differences in the means between the two cohorts (p-values were not significant). When volunteers were asked the survey item, “KNIGHTS Clinic positively influenced my attitude towards working with underserved patients,” 62% strongly agreed, 26% agreed, 10% were neutral, and 2% disagreed. Discussion Based on the results, volunteering at KNIGHTS Clinic may not have a positive impact on the five variables of interest. However, the lack of significance may also be due to certain limitations of this study addressed elsewhere in this paper. With the majority of KNIGHTS Clinic volunteers agreeing that “KNIGHTS Clinic positively influenced […their] attitude towards working with underserved patients,” there may be a positive impact of volunteering on volunteers’ attitude towards working with the underserved.   PMID:28367389

  17. Policy Review of the Primary and Junior Secondary Education Sub-Sectors in East Java. Educational Policy and Planning Project. A Government of Indonesia-USAID Project.

    ERIC Educational Resources Information Center

    Soebagio, Retno L.; And Others

    Indonesian representatives and the Educational Research and Development Center studied East Javanese primary and junior secondary schools to develop a database for future planning and to identify deficiencies, constraints, and areas for fruitful reform. Issues of enrollment, personnel, curriculum, facilities and equipment, cost, and financing were…

  18. Development of a Knowledge Management Model for the Development of a Quality Public Sector Management System for the Office of the Primary Educational Service Area

    ERIC Educational Resources Information Center

    Khotbancha, Wijitra; Chantarasombat, Chalard; Sriampai, Anan

    2015-01-01

    The objectives of this research were: 1) to study the current situation and problem of Knowledge Management of the office of the primary education service area, 2) to develop a Knowledge Management model, 3) to study the success of the implementation of the Knowledge Management system. There were 25 persons in the target group. There were 2 kinds…

  19. Performance management in healthcare: a critical analysis.

    PubMed

    Hewko, Sarah J; Cummings, Greta G

    2016-01-01

    Purpose - The purpose of this paper is to explore the underlying theoretical assumptions and implications of current micro-level performance management and evaluation (PME) practices, specifically within health-care organizations. PME encompasses all activities that are designed and conducted to align employee outputs with organizational goals. Design/methodology/approach - PME, in the context of healthcare, is analyzed through the lens of critical theory. Specifically, Habermas' theory of communicative action is used to highlight some of the questions that arise in looking critically at PME. To provide a richer definition of key theoretical concepts, the authors conducted a preliminary, exploratory hermeneutic semantic analysis of the key words "performance" and "management" and of the term "performance management". Findings - Analysis reveals that existing micro-level PME systems in health-care organizations have the potential to create a workforce that is compliant, dependent, technically oriented and passive, and to support health-care systems in which inequalities and power imbalances are perpetually reinforced. Practical implications - At a time when the health-care system is under increasing pressure to provide high-quality, affordable services with fewer resources, it may be wise to investigate new sector-specific ways of evaluating and managing performance. Originality/value - In this paper, written for health-care leaders and health human resource specialists, the theoretical assumptions and implications of current PME practices within health-care organizations are explored. It is hoped that readers will be inspired to support innovative PME practices within their organizations that encourage peak performance among health-care professionals.

  20. Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health.

    PubMed

    Levin, Jeff

    2016-12-01

    Interconnections between the faith-based and medical sectors are multifaceted and have existed for centuries, including partnerships that have evolved over the past several decades in the U.S. This paper outlines ten points of intersection that have engaged medical and healthcare professionals and institutions across specialties, focusing especially on primary care, global health, and community-based outreach to underserved populations. In a time of healthcare resource scarcity, such partnerships-involving religious congregations, denominations, and communal and philanthropic agencies-are useful complements to the work of private-sector medical care providers and of federal, state, and local public health institutions in their efforts to protect and maintain the health of the population. At the same time, challenges and obstacles remain, mostly related to negotiating the complex and contentious relations between these two sectors. This paper identifies pressing legal/constitutional, political/policy, professional/jurisdictional, ethical, and research and evaluation issues that need to be better addressed before this work can realize its full potential.

  1. [Youth Healthcare guideline 'Skin disorders'].

    PubMed

    Deurloo, Jacqueline A; van Gameren-Oosterom, Helma B M; Kamphuis, Mascha

    2012-01-01

    There is a high incidence of skin disorders; these are also frequently encountered within Youth Healthcare (YHC). Some skin disorders are caused by an underlying disease, syndrome or child abuse. Therefore, detection of these causes in an early stage is important. Skin disorders can have a huge psychosocial impact on both child and parents. This is one of the reasons why prevention, detection, diagnosis, treatment, referral, and uniform advice and guidance are of great importance. The YHC Guideline examines counselling and advice, criteria for referral to primary or secondary healthcare, and skincare in general. It also describes the disorders that should be actively detected. The Guideline also looks at specific aspects of dark skins and ethnic diversity, and the impact of skin disorders on general wellbeing. The accompanying web-based tool includes argumentation and opinions from experts on more than 75 skin disorders, including illustrations and decision trees, to aid the drawing up of a treatment plan.

  2. Leadership and Cultural Competence of Healthcare Professionals

    PubMed Central

    Dauvrin, Marie; Lorant, Vincent

    2015-01-01

    Background International migration is a global phenomenon challenging healthcare professionals to provide culturally competent care. Objectives The purpose of this study was to investigate the influence of leaders on the cultural competence of healthcare professionals. Methods A cross-sectional survey was conducted from 2010 to 2012 to obtain data for a social network analysis in 19 inpatient services and five primary care services in Belgium. The Competences in Ethnicity and Health questionnaire was used. A total of 507 healthcare professionals, including 302 nurses, identified their social relationships with other healthcare professionals working in their service. Highest in-degree centrality was used to identify the leaders within each health service. Multiple regressions with the Huber sandwich estimator were used to link cultural competence of leaders with the cultural competence of the rest of the healthcare staff. Results Cultural competence of the healthcare staff was associated with the cultural competence of the leaders. This association remained significant for two specific domains of cultural competence—mediation and paradigm—after controlling for contextual and sociodemographic variables. Interaction analysis suggested that the leadership effect varied with the degree of cultural competence of the leaders. Discussion Cultural competence among healthcare professionals is acquired partly through leadership. Social relationships and leadership effects within health services should be considered when developing and implementing culturally competent strategies. This requires a cautious approach as the most central individuals are not always the same persons as the formal leaders. PMID:25871625

  3. An overview in healthcare information systems security.

    PubMed

    Bourka, A; Polemi, N; Koutsouris, D

    2001-01-01

    The scope of this paper is to present the current needs and trends in the field of healthcare systems security. The approach applied within the described review was based on three major steps. The first step was to define the point and ways of penetration and integration of security services in current healthcare related applications addressing technical, organisational and legal/regulatory issues. The second step was to specify and evaluate common security technologies applied in healthcare information systems pointing out gaps and efficient solutions, whereas the third was to draw conclusions for the present conditions and identify the future trends of healthcare information security. A number of EU RTD Projects were selected, categorised, analysed and comparatively evaluated in terms of security. The technical focus was on key security technologies, like Public Key Infrastructures (PKIs) based on Trusted Third Parties (TTPs) in conjunction with other state-of-the-art security components (programming tools, data representation formats, security standards and protocols, security policies and risk assessment techniques). The experience gained within this review will provide valuable input for future security applications in the healthcare sector, solving existing problems and addressing real user needs.

  4. [Lay agency and healthcare: producing healthcare maps].

    PubMed

    Cecilio, Luiz Carlos de Oliveira; Carapinheiro, Graça; Andreazza, Rosemarie; Souza, Ana Lúcia Medeiros de; Andrade, Maria da Graça Garcia; Santiago, Silvia Maria; Meneses, Consuelo Sampaio; Reis, Denizi Oliveira; Araújo, Eliane Cardoso; Pinto, Nicanor Rodrigues da Silva; Spedo, Sandra Maria

    2014-07-01

    This study aimed to characterize which regulatory logics (other than government regulation) result in healthcare output, using a two-stage qualitative study in two municipalities in the ABCD Paulista region in São Paulo State, Brazil. The first stage included interviews with strategic actors (managers and policymakers) and key health professionals. The second phase collected life histories from 18 individuals with high health-services utilization rates. An analysis of the researchers' involvement in the field allowed a better understanding of the narratives. Four regulatory systems were characterized (governmental, professional, clientelistic, and lay), indicating that regulation is a field in constant dispute, a social production. Users' action produces healthcare maps that reveal the existence of other possible health system arrangements, calling on us to test shared management of healthcare between health teams and users as a promising path to the urgent need to reinvent health.

  5. Patients' appraisals of public and private healthcare: a qualitative study of physiotherapy and osteopathy.

    PubMed

    Bradbury, Katherine J; Bishop, Felicity L; Yardley, Lucy; Lewith, George

    2013-10-01

    Patients have previously reported differences in their experiences of treatments received in the public and private sectors; it remains unclear whether such perceived differences are particular to or shared across different interventions. This study explored whether patients' appraisals of public and private treatments are similar when appraising a complementary therapy (osteopathy) compared to a mainstream therapy (physiotherapy). Thirty-five qualitative interviews were analysed thematically. Patients' appraisals varied by health-care sector and therapy type: physiotherapy was appraised more negatively in the National Health Service than the private sector but osteopathy was appraised similarly within both health-care sectors. Potential reasons for this are discussed.

  6. Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India

    PubMed Central

    Kroll, Mareike; Phalkey, Revati; Dutta, Sayani; Shukla, Sharvari; Butsch, Carsten; Bharucha, Erach; Kraas, Frauke

    2016-01-01

    Background Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results In total, 1,532 incident cases were recorded that mainly included hypertension (n=622, 41%) and diabetes (n=460, 30%). Dropout rate was 10% (n=13). The monthly reporting consistency was quite constant, with the majority (n=63, 50%) submitting 1–10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n=104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation

  7. Healthcare. State Report

    ERIC Educational Resources Information Center

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

    2012-01-01

    This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…

  8. The healthcare volunteer.

    PubMed

    Tuckman, H P; Chang, C F

    1994-01-01

    Every year, volunteers contribute billions of dollars worth of time to the healthcare industry. Despite their contributions, however, little is known about who these volunteers are, what they do, why they volunteer, as well as the costs and benefits they bring to institutions. This article examines these and other characteristics of the healthcare volunteer.

  9. Patient Education as an Information System, Healthcare Tool and Interaction

    ERIC Educational Resources Information Center

    Pirhonen, Antti; Silvennoinen, Minna; Sillence, Elizabeth

    2014-01-01

    Patient education (PE) has a crucial role in the function of a healthcare organisation. For the care process of a patient, it is essential to get the right information at the right moment and in the right form. This paper analyses PE as the primary mode of interaction between a patient and a healthcare organisation. The approach is illustrated…

  10. Ontario primary care reform and quality improvement activities: an environmental scan

    PubMed Central

    2013-01-01

    Background Quality improvement is attracting the attention of the primary health care system as a means by which to achieve higher quality patient care. Ontario, Canada has demonstrated leadership in terms of its improvement in healthcare, but the province lacks a structured framework by which it can consistently evaluate its quality improvement initiatives specific to the primary healthcare system. The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector (QI-PHC) in Ontario as a first step to developing a coordinated and sustainable framework of primary healthcare for the province. Methods Data were collected between January and July 2011 in collaboration with an advisory group of stakeholder representatives and quality improvement leaders in primary health care. Twenty participants were interviewed by telephone, followed by review of relevant websites and documents identified in the interviews. Data were systematically examined using Framework Analysis augmented by Prior’s approach to document analysis in an iterative process. Results The environmental scan identified many activities (n = 43) designed to strategically build QI-PHC capacity, identify promising QI-PHC practices and outcomes, scale up quality improvement-informed primary healthcare practice changes, and make quality improvement a core organizational strategy in health care delivery, which were grouped into clusters. Cluster 1 was composed of initiatives in the form of on-going programs that deliberately incorporated long-term quality improvement capacity building through province-wide reach. Cluster 2 represented activities that were time-limited (research, pilot, or demonstration projects) with the primary aim of research production. The activities of most primary health care practitioners, managers, stakeholder organizations and researchers involved in this scan demonstrated a

  11. Entrepreneurship Education: Towards an Industry Sector Approach

    ERIC Educational Resources Information Center

    Richardson, Ita; Hynes, Briga

    2008-01-01

    Purpose: The purpose of this paper is to consider the requirements for an industry sector approach to entrepreneurship education--the information and communications technology (ICT) sector. A modified Process Framework for Entrepreneurship Education is presented focusing specifically on ICT. The primary components of the Process Framework are…

  12. Results from a patient-based health education intervention in reducing antibiotic use for acute upper respiratory tract infections in the private sector primary care setting in Singapore.

    PubMed

    Lee, Magdalene Hui Min; Pan, Darius Shaw Teng; Huang, Joyce Huixin; Chen, Mark I-Cheng; Chong, Joash Wen Chen; Goh, Ee Hui; Jiang, Lili; Leo, Yee Sin; Lee, Tau Hong; Wong, Chia Siong; Loh, Victor Weng Keong; Lim, Fong Seng; Poh, Adrian Zhongxian; Tham, Tat Yean; Wong, Wei Mon; Yu, Yue

    2017-02-13

    We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) amongst adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at GP (general practitioner) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the aetiology of URTIs, role of antibiotics in treating URTIs, and consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared on proportions prescribed antibiotics and patients' post-consultation views. 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). Demographics in both arms were similar. 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR] 1.20, 95% confidence intervals [CI] 0.83-1.73) except in patients of Indian ethnicity (OR 0.28, 95% CI 0.09-0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs (p=0.047) and on being worried about the side effects of antibiotics (p=0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR 0.36, 95% CI 0.14 - 0.92), while certain inappropriate patient responses were associated with receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities, and to explore GP-targeted interventions, are recommended.

  13. Demonstration of Advanced Technologies for Multi-Load Washers in Hospitality and Healthcare -- Wastewater Recycling Technology

    SciTech Connect

    Boyd, Brian K.; Parker, Graham B.; Petersen, Joseph M.; Sullivan, Greg; Goetzler, W.; Foley, K. J.; Sutherland, T. A.

    2014-08-14

    The objective of this demonstration project was to evaluate market-ready retrofit technologies for reducing the energy and water use of multi-load washers in healthcare and hospitality facilities. Specifically, this project evaluated laundry wastewater recycling technology in the hospitality sector and ozone laundry technology in both the healthcare and hospitality sectors. This report documents the demonstration of a wastewater recycling system installed in the Grand Hyatt Seattle.

  14. Community College Healthcare Students' Conceptions of Empathy: A Program-Wide Mixed Methods Case Study

    ERIC Educational Resources Information Center

    Fields, Kellee M.

    2015-01-01

    Community colleges play a vital role in the education of our Nations healthcare professions. In order to respond to the rising economic and social needs of the healthcare sector, community colleges are meeting the challenge by providing health professions skills and training programs to meet these shortages. These crucial programs are charged with…

  15. Regulatory Information By Sector

    EPA Pesticide Factsheets

    Find environmental regulatory, compliance, & enforcement information for various business, industry and government sectors, listed by NAICS code. Sectors include agriculture, automotive, petroleum manufacturing, oil & gas extraction & other manufacturing

  16. Interventions to reduce corruption in the health sector

    PubMed Central

    Gaitonde, Rakhal; Oxman, Andrew D; Okebukola, Peter O; Rada, Gabriel

    2016-01-01

    Background Corruption is the abuse or complicity in abuse, of public or private position, power or authority to benefit oneself, a group, an organisation or others close to oneself; where the benefits may be financial, material or non-material. It is wide-spread in the health sector and represents a major problem. Objectives Our primary objective was to systematically summarise empirical evidence of the effects of strategies to reduce corruption in the health sector. Our secondary objective was to describe the range of strategies that have been tried and to guide future evaluations of promising strategies for which there is insufficient evidence. Search methods We searched 14 electronic databases up to January 2014, including: CENTRAL; MEDLINE; EMBASE; sociological, economic, political and other health databases; Human Resources Abstracts up to November 2010; Euroethics up to August 2015; and PubMed alerts from January 2014 to June 2016. We searched another 23 websites and online databases for grey literature up to August 2015, including the World Bank, the International Monetary Fund, the U4 Anti-Corruption Resource Centre, Transparency International, healthcare anti-fraud association websites and trial registries. We conducted citation searches in Science Citation Index and Google Scholar, and searched PubMed for related articles up to August 2015. We contacted corruption researchers in December 2015, and screened reference lists of articles up to May 2016. Selection criteria For the primary analysis, we included randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies that evaluated the effects of an intervention to reduce corruption in the health sector. For the secondary analysis, we included case studies that clearly described an intervention to reduce corruption in the health sector, addressed either our primary or secondary objective, and stated the methods that the study authors used to collect and

  17. Electronics for better healthcare.

    PubMed

    Wolf, Bernhard; Herzog, Karolin

    2013-06-01

    Microelectronics and microsystem technology have changed our daily lives considerably in the past 50 years. Countless everyday objects contain microelectronic components. In healthcare up to the present, however, it has not been possible to make major alterations in introducing electronics and information technology that would lead to innovative improvements and greater transparency. This paper describes initial steps in diagnostics and oncological therapy including telematic healthcare systems which can, for example, assist patients with cardiovascular diseases and shows, through these areas, how electronics and microsystems technology can contribute to better healthcare.

  18. Sectoral approaches to improve regional carbon budgets

    SciTech Connect

    Smith, Pete; Nabuurs, Gert-Jan; Marland, Gregg

    2008-06-01

    Humans utilise about 40% of the earth s net primary production (NPP) but the products of this NPP are often managed by different sectors, with timber and forest products managed by the forestry sector and food and fibre products from croplands and grasslands managed by the agricultural sector. Other significant anthropogenic impacts on the global carbon cycle include human utilization of fossil fuels and impacts on less intensively managed systems such as peatlands, wetlands and permafrost. A great deal of knowledge, expertise and data is available within each sector. We describe the contribution of sectoral carbon budgets to our understanding of the global carbon cycle. Whilst many sectors exhibit similarities for carbon budgeting, some key differences arise due to differences in goods and services provided, ecology, management practices used, landmanagement personnel responsible, policies affecting land management, data types and availability, and the drivers of change. We review the methods and data sources available for assessing sectoral carbon budgets, and describe some of key data limitations and uncertainties for each sector in different regions of the world. We identify the main gaps in our knowledge/data, show that coverage is better for the developed world for most sectors, and suggest how sectoral carbon budgets could be improved in the future. Research priorities include the development of shared protocols through site networks, a move to full carbon accounting within sectors, and the assessment of full greenhouse gas budgets.

  19. Efficacy of a strategy for implementing a guideline for the control of cardiovascular risk in a primary healthcare setting: the SIRVA2 study a controlled, blinded community intervention trial randomised by clusters

    PubMed Central

    2011-01-01

    This work describes the methodology used to assess a strategy for implementing clinical practice guidelines (CPG) for cardiovascular risk control in a health area of Madrid. Background The results on clinical practice of introducing CPGs have been little studied in Spain. The strategy used to implement a CPG is known to influence its final use. Strategies based on the involvement of opinion leaders and that are easily executed appear to be among the most successful. Aim The main aim of the present work was to compare the effectiveness of two strategies for implementing a CPG designed to reduce cardiovascular risk in the primary healthcare setting, measured in terms of improvements in the recording of calculated cardiovascular risk or specific risk factors in patients' medical records, the control of cardiovascular risk factors, and the incidence of cardiovascular events. Methods This study involved a controlled, blinded community intervention in which the 21 health centres of the Number 2 Health Area of Madrid were randomly assigned by clusters to be involved in either a proposed CPG implementation strategy to reduce cardiovascular risk, or the normal dissemination strategy. The study subjects were patients ≥ 45 years of age whose health cards showed them to belong to the studied health area. The main variable examined was the proportion of patients whose medical histories included the calculation of their cardiovascular risk or that explicitly mentioned the presence of variables necessary for its calculation. The sample size was calculated for a comparison of proportions with alpha = 0.05 and beta = 0.20, and assuming that the intervention would lead to a 15% increase in the measured variables. Corrections were made for the design effect, assigning a sample size to each cluster proportional to the size of the population served by the corresponding health centre, and assuming losses of 20%. This demanded a final sample size of 620 patients. Data were analysed

  20. Identifying Patients at Risk of High Healthcare Utilization

    PubMed Central

    Sheets, Lincoln; Popejoy, Lori; APRN, GCNS-BC; Khalilia, Mohammed; Petroski, Greg; Parker, Jerry C.

    2016-01-01

    Objective. To develop a systematic and reproducible way to identify patients at increased risk for higher healthcare costs. Methods. Medical records were analyzed for 9,581 adults who were primary care patients in the University of Missouri Health System and who were enrolled in Medicare or Medicaid. Patients were categorized into one of four risk tiers as of October 1, 2013, and the four tiers were compared on demographic characteristics, number of healthcare episodes, and healthcare charges in the year before and the year after cohort formation. Results. The mean number of healthcare episodes and the sum of healthcare charges in the year following cohort formation were higher for patients in the higher-risk tiers. Conclusions. Retrospective information that is easily extracted from medical records can be used to create risk tiers that provide highly useful information about the prospective risk of healthcare utilization and costs. PMID:28269910

  1. Coproduction of healthcare service

    PubMed Central

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-01-01

    Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. PMID:26376674

  2. Norovirus in Healthcare Settings

    MedlinePlus

    ... Evaluating Environmental Cleaning Appendices to the Conceptual Program Model for Environmental Evaluation Basic Infection Control and Prevention Plan for Outpatient Oncology Settings Appendices Outpatient Care Guide Tools for Protecting Healthcare Personnel PPE Training ...

  3. Coproduction of healthcare service.

    PubMed

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-07-01

    Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.

  4. Center for Healthcare Technologies

    SciTech Connect

    Carrano, A.V.

    1994-03-01

    In the U.S., we now spend about 13% of the gross domestic product (CDP) on healthcare. This figure represents nearly $3000 per year per man, woman, and child. Moreover, this expenditure is projected to grow to about 20% of the GDP by the year 2000. Medical research and development accounts for only about 3% of national healthcare spending, and technology development represents only a small fraction of that 3%. New technologies that are far more cost-effective than previous ones - such as minimally invasive surgical procedures, advanced automated diagnostics, and better information systems - could save the nation billions of dollars per year to say nothing of the potential reductions in pain and suffering. A center is described that will coordinate ongoing Laboratory research aimed at developing more cost-effective tools for use by the healthcare community. The new Center for Healthcare Technologies will have many long-term benefits for the region and the nation.

  5. Global implications of China's healthcare reform.

    PubMed

    Yan, Fei; Tang, Shenglan; Zhang, Jian

    2016-01-01

    The ongoing healthcare reform in China has a powerful spillover effect beyond the health sector and the borders of China. A successful completion of the Chinese reform will offer a new model for social justice development, shift the global economy toward sustainability and create a new hub for science and technology in medical and health science. However, reforming the healthcare system in the most populated country is a daunting task. China will not live up to its promise, and all the potentials may end with hype not hope if coherent national strategies are not constructed and state-of-the-art navigation is not achieved with staggering domestic and global challenges. The cost of failure will be immensely high, socioeconomic costs for Chinese and an opportunity cost for the world as a whole. A full appreciation of the global implications of China's healthcare reform is crucial in keeping China receptive toward good practices evidence-approved elsewhere and open minded to fulfill its international obligations. More critically, the appreciation yields constructive engagements from global community toward a joint development and global prosperity. The current report provides a multiple disciplinary assessment on the global implications of the healthcare reform in China.

  6. Crime and healthcare.

    PubMed

    Shinkman, R; Weissenstein, E

    1997-05-19

    When charges were made last summer against 12 men affiliated with a New Jersey-based third-party administrator firm, headlines trumpeted the arrests as the first major case of organized crime infiltrating the healthcare industry. While law enforcement experts don't believe the mob has established a major role in healthcare, they acknowledge the $1 trillion-a-year industry is a lucrative target for illicit activity.

  7. Healthcare Industry Study

    DTIC Science & Technology

    2003-01-01

    expenditure through measures of access, cost and quality . While the quality of the U.S. healthcare system is unparalleled in the areas of acute...system’s outcomes as measured by cost, access and quality , and makes recommendations targeted at government’s role in promoting the health of our...the system combine to produce an output that we call healthcare. That output can be measured in terms of access, cost and quality --the same market

  8. Faith-Based Organizations and the Affordable Care Act: Reducing Latino Mental Healthcare Disparities

    PubMed Central

    Villatoro, Alice P.; Dixon, Elizabeth; Mays, Vickie M.

    2014-01-01

    The Patient Protection and Affordable Care Act (ACA) is expected to increase access to mental healthcare through provisions aimed at increasing health coverage among the nation's uninsured, including 10.2 million eligible Latino non-elderly adults. The ACA will increase health coverage by expanding Medicaid eligibility to individuals living below 138% of the federal poverty level, subsidizing the purchase of private insurance among individuals not eligible for Medicaid, and requiring employers with 50 or more employees to offer health insurance. An anticipated result of this landmark legislation is improvement in the screening, diagnosis, and treatment of mental disorders in racial/ethnic minorities, particularly for Latinos, who traditionally have had less access to these services. However, these efforts alone may not sufficiently ameliorate mental healthcare disparities for Latinos. Faith-based organizations (FBOs) could play an integral role in the mental healthcare of Latinos by increasing help-seeking, providing religion-based mental health services, and delivering supportive services that address common access barriers among Latinos. Thus, in determining ways to eliminate Latino mental healthcare disparities under the ACA, examining pathways into care through the faith-based sector offers unique opportunities to address some of the cultural barriers confronted by this population. We examine how partnerships between FBOs and primary care patient-centered medical homes (PCMH) may help reduce the gap of unmet mental health needs among Latinos in this era of health reform. We also describe the challenges FBOs and PCMH providers need to overcome in order to be partners in integrated care efforts. PMID:26845492

  9. Improve processes on healthcare: current issues and future trends.

    PubMed

    Chen, Jason C H; Dolan, Matt; Lin, Binshan

    2004-01-01

    Information Technology (IT) is a critical resource for improving today's business competitiveness. However, many healthcare providers do not proactively manage or improve the efficiency and effectiveness of their services with IT. Survival in a competitive business environment demands continuous improvements in quality and service, while rigorously maintaining core values. Electronic commerce continues its development, gaining ground as the preferred means of business transactions. Embracing e-healthcare and treating IT as a strategic tool to improve patient safety and the quality of care enables healthcare professionals to benefit from technology formerly used only for management purposes. Numerous improvement initiatives, introduced by both the federal government and the private sector, seek to better the status quo in IT. This paper examines the current IT climate using an enhanced "Built to Last" model, and comments on future IT strategies within the healthcare industry.

  10. The Transformation of Behavioral Healthcare in New Mexico

    PubMed Central

    Willging, Cathleen E.; Lamphere, Louise; Rylko-Bauer, Barbara

    2014-01-01

    Since 1997, public-sector behavioral healthcare in New Mexico has remained under continual transition. We have conducted qualitative research to examine recent efforts in NM to establish a recovery-oriented behavioral healthcare system, focusing on comprehensive community support services, clinical homes, and core service agencies. We examine how decisions made in the outer context (e.g., the system level) shaped the implementation of each initiative within the inner context of service provision (e.g., provider agencies). We also clarify how sociopolitical factors, as exemplified in changes instituted by one gubernatorial administration and undone by its successor, can undermine implementation efforts and create crises within fragile behavioral healthcare systems. Finally, we discuss findings in relation to efforts to promote wraparound service planning and to establish medical home models under national healthcare reform. PMID:24980437

  11. Rethinking healthcare as a safety--critical industry.

    PubMed

    Lwears, Robert

    2012-01-01

    The discipline of ergonomics, or human factors engineering, has made substantial contributions to both the development of a science of safety, and to the improvement of safety in a wide variety of hazardous industries, including nuclear power, aviation, shipping, energy extraction and refining, military operations, and finance. It is notable that healthcare, which in most advanced societies is a substantial sector of the economy (eg, 15% of US gross domestic product) and has been associated with large volumes of potentially preventable morbidity and mortality, has heretofore not been viewed as a safety-critical industry. This paper proposes that improving safety performance in healthcare must involve a re-envisioning of healthcare itself as a safety-critical industry, but one with considerable differences from most engineered safety-critical systems. This has implications both for healthcare, and for conceptions of safety-critical industries.

  12. Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries.

    PubMed

    Hall, John J; Taylor, Richard

    2003-01-06

    Access to basic health services was affirmed as a fundamental human right in the Declaration of Alma-Ata in 1978. The model formally adopted for providing healthcare services was "primary health care" (PHC), which involved universal, community-based preventive and curative services, with substantial community involvement. PHC did not achieve its goals for several reasons, including the refusal of experts and politicians in developed countries to accept the principle that communities should plan and implement their own healthcare services. Changes in economic philosophy led to the replacement of PHC by "Health Sector Reform", based on market forces and the economic benefits of better health. It is time to abandon economic ideology and determine the methods that will provide access to basic healthcare services for all people.

  13. A vision for better healthcare in India.

    PubMed

    Baillie, Jonathan

    2013-10-01

    Ian Hinitt, until the Summer of 2012 deputy director of Estates at Bradford Teaching Hospitals NHS Foundation Trust, is spearheading an ambitious joint-venture project between Apex 4D, he and his business partner, Balbir Panesar's recently established Bradford-based outsourced FM company, and Leeds-headquartered architectural practice, Bowman Riley, which the project partners hope will initiate the construction of a new generation of modular buildings to improve healthcare provision throughout India, and, in the process, generate significant reciprocal trade opportunities for both UK and Indian suppliers to the sector. HEJ editor, Jonathan Baillie, reports.

  14. Healthcare Energy End-Use Monitoring

    SciTech Connect

    Sheppy, M.; Pless, S.; Kung, F.

    2014-08-01

    NREL partnered with two hospitals (MGH and SUNY UMU) to collect data on the energy used for multiple thermal and electrical end-use categories, including preheat, heating, and reheat; humidification; service water heating; cooling; fans; pumps; lighting; and select plug and process loads. Additional data from medical office buildings were provided for an analysis focused on plug loads. Facility managers, energy managers, and engineers in the healthcare sector will be able to use these results to more effectively prioritize and refine the scope of investments in new metering and energy audits.

  15. What ails India's two-tiered healthcare system? A philosophical enquiry.

    PubMed

    Ghoshal, Rakhi

    2015-01-01

    India's two-tiered healthcare system (viz the public and private sectors) has been suffering from various ailments, and each sector has been criticised for its own set of deficiencies. Against this backdrop, this article explores whether there is any possible commonality between the two sectors, and suggests that the "common logic", or common ground, is the model of biomedical knowledge, which forms the foundation of both sectors. It is to problems inherent in the "model of biomedical knowledge" that certain gaps in each sector can be traced. It is only when we have identified the lapses at the root of the structures of each sector that we can plug the gaps in healthcare. The author suggests that it would be best to analyse the gaps through a philosophical enquiry, and to offer a probable solution, turns to the methodologies of care ethics and feminist standpoint epistemology.

  16. [Clinical bioethics for primary health care].

    PubMed

    González-de Paz, L

    2013-01-01

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

  17. Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12)

    PubMed Central

    2012-01-01

    Background The oral administration of vitamin B12 offers a potentially simpler and cheaper alternative to parenteral administration, but its effectiveness has not been definitively demonstrated. The following protocol was designed to compare the effectiveness of orally and intramuscularly administered vitamin B12 in the treatment of patients ≥65 years of age with vitamin B12 deficiency. Methods/design The proposed study involves a controlled, randomised, multicentre, parallel, non-inferiority clinical trial lasting one year, involving 23 primary healthcare centres in the Madrid region (Spain), and patients ≥65 years of age. The minimum number of patients required for the study was calculated as 320 (160 in each arm). Bearing in mind an estimated 8-10% prevalence of vitamin B12 deficiency among the population of this age group, an initial sample of 3556 patients will need to be recruited. Eligible patients will be randomly assigned to one of the two treatment arms. In the intramuscular treatment arm, vitamin B12 will be administered as follows: 1 mg on alternate days in weeks 1 and 2, 1 mg/week in weeks 3–8,and 1 mg/month in weeks 9–52. In the oral arm, the vitamin will be administered as: 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. The main outcome variable to be monitored in both treatment arms is the normalisation of the serum vitamin B12 concentration at weeks 8, 26 and 52; the secondary outcome variables include the serum concentration of vitamin B12 (in pg/ml), adherence to treatment, quality of life (EuroQoL-5D questionnaire), patient 3satisfaction and patient preferences. All statistical tests will be performed with intention to treat and per protocol. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in analyses. Discussion The

  18. Pitfalls in Health Communication: Healthcare Policy, Institution, Structure, & Process

    PubMed Central

    Calderón, José L; Beltrán, Robert A

    2004-01-01

    The state of health communication for a given population is a function of several tiers of structure and process: government policy, healthcare directives, healthcare structure and process, and the ethnosocial realities of a multicultural society. Common yet specific to these tiers of health communication is the interpersonal and intergroup use of language in all its forms. Language is the most common behavior exhibited by humankind. Its use at all tiers determines quality of healthcare and quality of life for healthcare consumers: patients and their families. Of note, at the consumer end, mounting evidence demonstrates that barriers to health communication contribute to poorer access to care, quality of care, and health outcomes. The lack of comprehensible and usable written and spoken language is a major barrier to health communication targeting primary and secondary disease prevention and is a major contributor to the misuse of healthcare, patient noncompliance, rising healthcare costs. In this paper, we cursorily examine the relationship among government policy, institutional directives, and healthcare structure and process and its influence on the public health, especially vulnerable populations. We conclude that limited health communication in the context of changing healthcare environments and diverse populations is an important underpinning of rising healthcare costs and sustained health disparities. More research is needed to improve communication about health at all tiers and to develop health communication interventions that are usable by all population groups. PMID:15208522

  19. Priority-setting in Finnish healthcare.

    PubMed

    Rissanen, P; Häkkinen, U

    1999-12-01

    The characteristics which affect priority setting in the Finnish healthcare system include strong municipal (local) administration, no clear separation between producers and purchasers, a duality in funding, and the potential for physicians in public hospitals to practice in the private sector. This system has its strengths, such as the possibility to effectively co-ordinate social and healthcare services, and a strong incentive to take care of local needs, because of municipal responsibility to finance these services largely through local taxes. However, the municipalities are typically too small to take advantage of these potentials, their knowledge is scarce especially of secondary care and their negotiating power with respect to hospitals is low. Local politicians also have a dual role: they represent the needs of the local population but simultaneously they are decision-makers in hospitals. Full-time physicians are allowed to act in a dual role as well; they can run a private practice, which is paid for on a fee-for-service basis, while the hospital pays (mostly) a fixed monthly salary. The share of financing which flows from the National Sickness Insurance system to healthcare users may have adverse effects on the local use of resources. The broad national consensus statement on patient-level priorities did not reach any general rules on priorities. Strong support was given to citizens' equal right to access all healthcare services. In healthcare practice, this general rule has some exemptions. First, the reimbursement schemes for prescribed drugs vary depending on the severity and chronic nature of the disease. Secondly, the tax-financed dental services for the young are clearly prioritised over those of older citizens. In the consensus statement, emphasis was put on improving the efficiency of producing health services in order to avoid having to impose patient-level priorities.

  20. Understanding and coping with diversity in healthcare.

    PubMed

    Jhutti-Johal, J

    2013-09-01

    In the healthcare sector, race, ethnicity and religion have become an increasingly important factor in terms of patient care due to an increasingly diverse population. Health agencies at a national and local level produce a number of guides to raise awareness of cultural issues among healthcare professionals and hospitals may implement additional non-medical services, such as the provision of specific types of food and dress to patients or the hiring of chaplains, to accommodate the needs of patients with religious requirements. However, in an attempt to address the spiritual, cultural and religious needs of patients healthcare providers often assume that ethnic minority groups are homogenous blocks of people with similar needs and fail to recognize that a diverse range of views and practices exist within specific groups themselves. This paper describes the example of the Sikh community and the provision of palliative care in hospitals and hospices. Although, the majority of patients classifying themselves as Sikhs have a shared language and history, they can also be divided on a number of lines such as caste affiliation, degree of assimilation in the west, educational level and whether baptized or not, all of which influence their beliefs and practices and hence impact on their needs from a health provider. Given that it is unfeasible for health providers to have knowledge of the multitude of views within specific religious and ethnic communities and accounting for the tight fiscal constraints of healthcare budgets, this paper concludes by raising the question whether healthcare providers should step away from catering for religious and cultural needs that do not directly affect treatment outcomes, and instead put the onus on individual communities to provide resources to meet spiritual, cultural and religious needs of patients.

  1. Healthcare Software Assurance

    PubMed Central

    Cooper, Jason G.; Pauley, Keith A.

    2006-01-01

    Software assurance is a rigorous, lifecycle phase-independent set of activities which ensure completeness, safety, and reliability of software processes and products. This is accomplished by guaranteeing conformance to all requirements, standards, procedures, and regulations. These assurance processes are even more important when coupled with healthcare software systems, embedded software in medical instrumentation, and other healthcare-oriented life-critical systems. The current Food and Drug Administration (FDA) regulatory requirements and guidance documentation do not address certain aspects of complete software assurance activities. In addition, the FDA’s software oversight processes require enhancement to include increasingly complex healthcare systems such as Hospital Information Systems (HIS). The importance of complete software assurance is introduced, current regulatory requirements and guidance discussed, and the necessity for enhancements to the current processes shall be highlighted. PMID:17238324

  2. Characteristics of healthcare wastes

    SciTech Connect

    Diaz, L.F. Eggerth, L.L.; Enkhtsetseg, Sh.; Savage, G.M.

    2008-07-01

    A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23 kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65 kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly

  3. National healthcare capital project benchmarking--an owner's perspective.

    PubMed

    Kahn, Noah

    2009-01-01

    Few sectors of the economy have been left unscathed in these economic times. Healthcare construction has been less affected than residential and nonresidential construction sectors, but driven by re-evaluation of healthcare system capital plans, projects are now being put on hold or canceled. The industry is searching for ways to improve the value proposition for project delivery and process controls. In other industries, benchmarking component costs has led to significant, sustainable reductions in costs and cost variations. Kaiser Permanente and the Construction Industry Institute (CII), a research component of the University of Texas at Austin, an industry leader in benchmarking, have joined with several other organizations to work on a national benchmarking and metrics program to gauge the performance of healthcare facility projects. This initiative will capture cost, schedule, delivery method, change, functional, operational, and best practice metrics. This program is the only one of its kind. The CII Web-based interactive reporting system enables a company to view its information and mine industry data. Benchmarking is a tool for continuous improvement that is capable not only of grading outcomes; it can inform all aspects of the healthcare design and construction process and ultimately help moderate the increasing cost of delivering healthcare.

  4. Architectural approach for quality and safety aware healthcare social networks.

    PubMed

    López, Diego M; Blobel, Bernd; González, Carolina

    2012-01-01

    Quality of information and privacy and safety issues are frequently identified as main limitations to make most benefit from social media in healthcare. The objective of the paper is to contribute to the analysis of healthcare social networks (SN), and online healthcare social network services (SNS) by proposing a formal architectural analysis of healthcare SN and SNS, considering the complexity of both systems, but stressing on quality, safety and usability aspects. Quality policies are necessary to control the quality of content published by experts and consumers. Privacy and safety policies protect against inappropriate use of information and users responsibility for sharing information. After the policies are established and documented, a proof of concept online SNS supporting primary healthcare promotion is presented in the paper.

  5. Healthcare knowledge management through building and operationalising healthcare enterprise memory.

    PubMed

    Cheah, Y N; Abidi, S S

    1999-01-01

    In this paper we suggest that the healthcare enterprise needs to be more conscious of its vast knowledge resources vis-à-vis the exploitation of knowledge management techniques to efficiently manage its knowledge. The development of healthcare enterprise memory is suggested as a solution, together with a novel approach advocating the operationalisation of healthcare enterprise memories leading to the modelling of healthcare processes for strategic planning. As an example, we present a simulation of Service Delivery Time in a hospital's OPD.

  6. Factors influencing healthcare service quality

    PubMed Central

    Mosadeghrad, Ali Mohammad

    2014-01-01

    Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946

  7. [Photography, language and healthcare].

    PubMed

    Georgantelis, Cynthia

    2010-01-01

    Photography as an art is a way of accessing our emotions, naming them, understanding them and taking them into account in the healthcare relationship. A training session on the Photolangage method enables us not only to increase our knowledge but also to share our emotional experience and encourages reflection.

  8. Hygienic drainage for healthcare.

    PubMed

    Jennings, Peter

    2012-08-01

    Peter Jennings, technical director for ACO Building Drainage, which specialises in the development of corrosion-resistant drainage systems and building products, looks at the key issues to consider when specifying and installing pipework and drainage for hygiene-critical environments such as hospitals and other healthcare facilities.

  9. Mobile technology and healthcare: the adoption issues and systemic problems.

    PubMed

    Standing, Susan; Standing, Craig

    2008-01-01

    Although the benefits that are associated with mobile technology have been recognised as offering great potential in the healthcare sector, its widespread adoption has been lagging. We propose that fundamental systemic issues are likely to be the main barriers to adoption. We explain that the fragmented nature of the conservative healthcare system, the contradictory incentives and improper outcome measures conspire to make the innovative adoption of mobile technology problematic. Researchers can only gain a limited understanding of a technology's potential success by using technology adoption frameworks and need to supplement this with a 'systems' perspective that takes a more strategic view.

  10. Health Information Management System for Elderly Health Sector: A Qualitative Study in Iran

    PubMed Central

    Sadoughi, Farahnaz; Shahi, Mehraban; Ahmadi, Maryam; Davaridolatabadi, Nasrin

    2016-01-01

    Background: There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision. Objectives: The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran. Materials and Methods: This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them. Results: The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information. Conclusions: It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran. PMID:27186383

  11. Demonstration of Advanced Technologies for Multi-Load Washers in Hospitality and Healthcare -- Ozone Based Laundry Systems

    SciTech Connect

    Boyd, Brian K.; Parker, Graham B.; Petersen, Joseph M.; Sullivan, Greg; Goetzler, W.; Sutherland, T. A.; Foley, K. J.

    2014-08-14

    The objective of this demonstration project was to evaluate market-ready retrofit technologies for reducing the energy and water use of multi-load washers in healthcare and hospitality facilities. Specifically, this project evaluated laundry wastewater recycling technology in the hospitality sector and ozone laundry technology in both the healthcare and hospitality sectors. This report documents the demonstration of ozone laundry system installations at the Charleston Place Hotel in Charleston, South Carolina, and the Rogerson House assisted living facility in Boston, Massachusetts.

  12. Transformative leadership: an ethical stewardship model for healthcare.

    PubMed

    Caldwell, Cam; Voelker, Carolyn; Dixon, Rolf D; LeJeune, Adena

    2008-01-01

    The need for effective leadership is a compelling priority for those who would choose to govern in public, private, and nonprofit organizations, and applies as much to the healthcare profession as it does to other sectors of the economy (Moody, Horton-Deutsch, & Pesut, 2007). Transformative Leadership, an approach to leadership and governance that incorporates the best characteristics of six other highly respected leadership models, is an integrative theory of ethical stewardship that can help healthcare professionals to more effectively achieve organizational efficiencies, build stakeholder commitment and trust, and create valuable synergies to transform and enrich today's healthcare systems (cf. Caldwell, LeJeune, & Dixon, 2007). The purpose of this article is to introduce the concept of Transformative Leadership and to explain how this model applies within a healthcare context. We define Transformative Leadership and identify its relationship to Transformational, Charismatic, Level 5, Principle-Centered, Servant, and Covenantal Leadership--providing examples of each of these elements of Transformative Leadership within a healthcare leadership context. We conclude by identifying contributions of this article to the healthcare leadership literature.

  13. Building a Healthcare System's Innovation Program.

    PubMed

    Conger, Michelle D

    2016-01-01

    OSF HealthCare, based in Peoria, Illinois, has developed an innovative strategy to adapt to the changes and forces disrupting the healthcare environment. This strategy evolved organically from the performance improvement efforts we began more than 15 years ago, as well as from the lessons we learned from years of research into the innovative practices and platforms of other healthcare institutions and of companies in other industries. More important, the strategy reflects our mission "to serve persons with the greatest care and love."The OSF innovation model has three components: internal innovations, partnering with external entities, and validating innovations through simulation. OSF has an ongoing and comprehensive commitment to innovation. Examples include our initiative to transform our model of care in primary care clinics by expanding access, reducing costs, and increasing efficiency; our partnerships with outside entities to find revolutionary solutions and products in which we can invest; and our establishment of a world-class simulation and education center.OSF HealthCare could not do any of this if it lacked the support of its people. To that end, we continue to work on embedding a culture of innovation across all of our facilities. Ours is a culture in which everyone is encouraged to voice creative ideas and no one is afraid to fail-all for the betterment of our organization and the patients we serve.

  14. Burden of healthcare utilization and out-of-pocket costs among individuals with NCDs in an Indian setting.

    PubMed

    Joshi, Ashish; Mohan, Krishna; Grin, Gurmit; Perin, Douglas Marcel Puricelli

    2013-04-01

    Non communicable diseases (NCDs) are now the major cause of death and disability worldwide. It increasingly affects people from developing as well as developed countries. Over the coming decades the burden from NCDs is projected to rise particularly fast in the developing world. There is a lack of optimal data collection about the burden of risk factors related to NCDs especially in the developing countries. To assess the burden of healthcare utilization and out-of-pocket costs associated with NCDs in an Indian setting. A cross sectional study was performed to enroll a convenient sample of 166 participants aged 18 years and above from a tertiary hospital in Punjab, a Northern state of India. The data was gathered during the period of Feb 2010-April 2010. A mixed methods approach was used to assess the burden of diabetes, hypertension, high cholesterol, and their associated risk factors. Further we evaluated the burden of healthcare utilization and out-of-pocket costs associated with these conditions using self-reported assessments. Results showed the average age of the participants was 50 years, 63 % (n = 104) were females, 32 % (n = 53) had education less than high school and 20 % (n = 33) had no formal education. About 96 % of the study participants were living with a partner. Majority of the study participants were non-smokers and 17 % (n = 27) of them reported to have history of alcohol consumption. The majority of the participants had access to cell phones (94 %; n = 156) and about 40 % (n = 66) had computers at home. About 33 % (n = 55) of the study participants had some form of previous knowledge of computers. Majority of the study participants went to the private hospital (47.5 %) for seeking healthcare. About 32 % (n = 53) also sought healthcare from some kind of healthcare professional including a primary care doctor or a nurse or even a pharmacist in a village setting. Doctor visits related to diabetes were higher as compared

  15. Healthcare in Myanmar.

    PubMed

    Latt, Nyi Nyi; Myat Cho, Su; Htun, Nang Mie Mie; Yu Mon Saw; Myint, Myat Noe Htin Aung; Aoki, Fumiko; Reyer, Joshua A; Yamamoto, Eiko; Yoshida, Yoshitoku; Hamajima, Nobuyuki

    2016-05-01

    Myanmar transitioned to a civilian government in March, 2011. Although the democratic process has accelerated since then, many problems in the field of healthcare still exist. Since there is a limited overview on the healthcare in Myanmar, this article briefly describes the current states surrounding health services in Myanmar. According to the Census 2014, the population in the Republic of the Union of Myanmar was 51,410,000. The crude birth rate in the previous one year was estimated to be 18.9 per 1,000, giving the annual population growth rate of 0.89% between 2003 and 2014. The Ministry of Health reorganized into six departments. National non-governmental organizations and community-based organizations support healthcare, as well as international non-governmental organizations. Since hospital statistics by the government cover only public facilities, the information on private facilities is limited. Although there were not enough medical doctors (61 per 100,000 population), the number of medical students was reduced from 2,400 to 1,200 in 2012 to ensure the quality of medical education. The information on causes of death in the general population could not be retrieved, but some data was available from hospital statistics. Although the improvement was marked, the figures did not reach the levels set by Millennium Development Goals 4 and 5. A trial prepaid health insurance system started in July 2015, to be followed by evaluation one year later. There are many international donors, including the Japan International Cooperation Agency, supporting health in Myanmar. With these efforts and support, a marked progress is expected in the field of healthcare.

  16. [The healthcare democracy].

    PubMed

    Saout, Christian

    2015-06-01

    Thirteen years after the law of 4th March 2002, known as the "Kouchner law", what is the situation regarding the much talked about healthcare democracy? Individual and collective rights have been granted to the users of the health care system. In addition, a series of actions have been promoted in order to exert them. Finally, a number of places and processes favouring consultation have been put in place.

  17. Healthcare in Myanmar

    PubMed Central

    Latt, Nyi Nyi; Myat Cho, Su; Htun, Nang Mie Mie; Yu Mon Saw; Myint, Myat Noe Htin Aung; Aoki, Fumiko; Reyer, Joshua A.; Yamamoto, Eiko; Yoshida, Yoshitoku; Hamajima, Nobuyuki

    2016-01-01

    ABSTRACT Myanmar transitioned to a civilian government in March, 2011. Although the democratic process has accelerated since then, many problems in the field of healthcare still exist. Since there is a limited overview on the healthcare in Myanmar, this article briefly describes the current states surrounding health services in Myanmar. According to the Census 2014, the population in the Republic of the Union of Myanmar was 51,410,000. The crude birth rate in the previous one year was estimated to be 18.9 per 1,000, giving the annual population growth rate of 0.89% between 2003 and 2014. The Ministry of Health reorganized into six departments. National non-governmental organizations and community-based organizations support healthcare, as well as international non-governmental organizations. Since hospital statistics by the government cover only public facilities, the information on private facilities is limited. Although there were not enough medical doctors (61 per 100,000 population), the number of medical students was reduced from 2,400 to 1,200 in 2012 to ensure the quality of medical education. The information on causes of death in the general population could not be retrieved, but some data was available from hospital statistics. Although the improvement was marked, the figures did not reach the levels set by Millennium Development Goals 4 and 5. A trial prepaid health insurance system started in July 2015, to be followed by evaluation one year later. There are many international donors, including the Japan International Cooperation Agency, supporting health in Myanmar. With these efforts and support, a marked progress is expected in the field of healthcare. PMID:27303099

  18. Crisis as a serendipity for change in Cyprus' healthcare services.

    PubMed

    Petrou, Panagiotis

    2015-01-01

    As Cyprus signed a financial agreement with a team of international lenders, several reform measures were outlined as pre-requisites for disbursement of financial instalments. The health sector was massively reformed in order to enhance efficiency and reduce waste. The magnitude of reforms included introduction of guidelines and clinical algorithms, co-payments, and revision of criteria for public beneficiary status. In order to safeguard equity in access, solidarity in coverage and sustainability of its healthcare sector, reforms must continue unabated and, more importantly, the introduction of a universal health system should be the ultimate goal.

  19. Military Healthcare Battlefield Immunity.

    PubMed

    Kelly, J C

    2012-12-01

    The combatant soldier on the battlefield remains protected from any claim in negligence by the doctrine of combat immunity for any negligent act or omission they may make when fighting. In other words, the combatant soldier does not owe a fellow soldier a duty of care on the battlefield, as the duty of care is non-justiciable. However, the non-combatant Military Healthcare Professional, although sometimes operating in the same hostile circumstances as the fighting soldier, is unlikely to benefit from combat immunity for any clinical negligence on the battlefield. This is because they continue to owe their patient a duty of care, although this has not been tested in the courts. This paper considers if any military healthcare professional could ever benefit from combat immunity, which is unlikely due to their non-combatant status. Instead, this paper suggests that a modified form of immunity; namely, Military Healthcare Battlefield Immunity could be a new, unique and viable doctrine, however, this could only be granted in rare circumstances and to a much lesser degree than combat immunity.

  20. Advanced technology program: information infrastructure for healthcare focused program.

    PubMed

    Spivack, Richard N

    2002-01-01

    This paper describes an initiative begun by the Advanced Technology Program in 1994 referred to as the Information Infrastructure for Healthcare (IIH) focused program. The IIH focus program began with an initial exchange of ideas among members of the private and public sectors (industry's submission of "white papers"; workshops conducted by the ATP; meetings held between individuals from both groups) to identify those technologies necessary for the development of a national information infrastructure in healthcare. A discussion of the development of the focus program through a "white paper" process notes differences that existed between what the ATP had hoped to gain through this method and how the private sector responded. A statistical description of the participants as well as a brief discussion of the ATP review and selection process is included.

  1. Demystifying first-cost green building premiums in healthcare.

    PubMed

    Houghton, Adele; Vittori, Gail; Guenther, Robin

    2009-01-01

    This study assesses the extent of "first-cost green building construction premiums" in the healthcare sector based on data submitted by and interviews with 13 current LEED-certified and LEED-registered healthcare project teams, coupled with a literature survey of articles on the topics of actual and perceived first-cost premiums associated with green building strategies. This analysis covers both perceived and realized costs across a range of projects in this sector, leading to the following conclusions: Construction first-cost premiums may be lower than is generally perceived, and they appear to be independent of both building size and level of "green" achievement; projects are using financial incentives and philanthropy to drive higher levels of achievement; premiums are decreasing over time; and projects are benefiting from improvements in health and productivity which, although difficult to monetize, are universally valued.

  2. Management of healthcare waste: developments in Southeast Asia in the twenty-first century.

    PubMed

    Kühling, Jan-Gerd; Pieper, Ute

    2012-09-01

    In many Southeast Asian countries, significant challenges persist with regard to the proper management and disposal of healthcare waste. The amount of healthcare waste in these countries is continuously increasing as a result of the expansion of healthcare systems and services. In the past, healthcare waste, if it was treated at all, was mainly incinerated. In the last decade more comprehensive waste management systems were developed for Southeast Asian countries and implementation started. This also included the establishment of alternative healthcare waste treatment systems. The developments in the lower-middle-income countries are of special interest, as major investments are planned. Based upon sample projects, a short overview of the current development trends in the healthcare waste sector in Laos, Indonesia and Vietnam is provided. The projects presented include: (i) Lao Peoples Democratic Republic (development of the national environmental health training system to support the introduction of environmental health standards and improvement of healthcare waste treatment in seven main hospitals by introducing steam-based treatment technologies); (ii) Indonesia (development of a provincial-level healthcare waste-management strategy for Province Nanggroe Aceh Darussalam (NAD) and introduction of an advanced waste treatment system in a tertiary level hospital in Makassar); and (iii) Vietnam (development of a healthcare waste strategy for five provinces in Vietnam and a World Bank-financed project on healthcare waste in Vietnam).

  3. Healthscape role towards customer satisfaction in private healthcare.

    PubMed

    Sahoo, Debajani; Ghosh, Tathagata

    2016-07-11

    Purpose - The purpose of this paper is to identify the motives that enforce consumers to find out the major determinants that frame healthscape in private healthcare service that leads to their satisfaction in a developing country like India. Design/methodology/approach - The generic motive dimensions are identified using an exploratory factor analysis. Next the reliability and validity of the factors are established followed by regression analysis using SPSS 20.0 s/w. Findings - This paper identifies six healthscape motives in the private healthcare sector named as service personnel conduct and cleanliness, service delivery and facilities, ambience, location and look, appealing decoration, and upgraded safety service, out of which only service delivery, ambience, location, and decorations contribute the most to build customer satisfaction as per their significance value. Research limitations/implications - The various dimensions of healthcare motives should be viewed as the levers of improving hospitals' service quality in the minds of its present and future customers. This finding can offer valuable insight to the forthcoming as well as existing developer who are planning to have their healthcare service presence in India. Practical implications - This study suggests some important strategic guidelines for service positioning and market segmentation of healthcare services as per customer requirements. In the recent past, availing services from hospitals were purely utilitarian in nature. Customers were more inclined to get proper and timely services and cared more about the service quality of the healthcare service provider. Originality/value - This paper is among the few works done on understanding private healthcare service delivery process in India and customer satisfaction level from those Hospitals. This study addresses the gap by identifying a set of dimensions that are relevant to customers for a unique healthcare experience.

  4. A Theoretical Approach to Information Needs Across Different Healthcare Stakeholders

    NASA Astrophysics Data System (ADS)

    Raitoharju, Reetta; Aarnio, Eeva

    Increased access to medical information can lead to information overload among both the employees in the healthcare sector as well as among healthcare consumers. Moreover, medical information can be hard to understand for consumers who have no prerequisites for interpreting and understanding it. Information systems (e.g. electronic patient records) are normally designed to meet the demands of one professional group, for instance those of physicians. Therefore, the same information in the same form is presented to all the users of the systems regardless of the actual need or prerequisites. The purpose of this article is to illustrate the differences in information needs across different stakeholders in healthcare. A literature review was conducted to collect examples of these different information needs. Based on the findings the role of more user specific information systems is discussed.

  5. Service planning in the Victorian community health sector.

    PubMed

    Roussy, Véronique; Livingstone, Charles

    2015-01-01

    Until now, comprehensive service planning has been uncommon in the Victorian community health sector. Where it has occurred, it has primarily been undertaken by community health services embedded within larger, hospital-based health services. Reflections on the utility and efficacy of community health service planning are largely absent from the Australian peer-reviewed literature. Using a case study focussed on a specific centre in Melbourne's outer suburbs, this paper explores how community health service planning is shaped by the current policy context, the legal status of registered community health services, and the data and methodologies available to inform planning. It argues that regular and systematic service planning could support registered community health centres to better understand their unique position within the primary health-care landscape, having regard to their inherent opportunities and vulnerabilities. Furthermore, consistent and effective service planning is proposed to benefit agencies in establishing themselves as critical players in promoting local population health initiatives and driving improved health outcomes.

  6. Mineral Processing Sector

    EPA Pesticide Factsheets

    Find environmental regulatory and compliance information for the nonmetallic mineral processing sector (NAICS 327), including NESHAPs for asbestos and hazardous waste, and wastewater permit information.

  7. Key Aspects of Providing Healthcare Services in Disaster Response Stage

    PubMed Central

    POURHOSSEINI, Samira Sadat; ARDALAN, Ali; MEHROLHASSANI, Mohammad Hossien

    2015-01-01

    Abstract Background Health care management in disasters is one of the main parts of disaster management. Health in disasters is affected by performance of various sectors, and has an interactive impact on various aspects of disaster management. The aim of this study was to identify the most important themes affecting the healthcare management in disaster. Method In this qualitative study with a content analysis approach, in-depth interviews in two steps with 30 disaster experts and managers were conducted to collect the data. Results Eleven themes affecting healthcare management in disasters were identified. These themes were related to human resources management, resources management, victims’ management transfer, environmental hygiene monitoring, nutrition management, mental health control, inter-agency coordination, training, technology management, information and communication management, and budget management. Conclusion Providing effective health care service in disasters requires a comprehensive look at the various aspects of disaster management. Effective factors on the success of healthcare in disaster are not limited to the scope of healthcare. There should be a close relationship and interaction between different sectors of disaster management. PMID:26060782

  8. Data mining applications in healthcare.

    PubMed

    Koh, Hian Chye; Tan, Gerald

    2005-01-01

    Data mining has been used intensively and extensively by many organizations. In healthcare, data mining is becoming increasingly popular, if not increasingly essential. Data mining applications can greatly benefit all parties involved in the healthcare industry. For example, data mining can help healthcare insurers detect fraud and abuse, healthcare organizations make customer relationship management decisions, physicians identify effective treatments and best practices, and patients receive better and more affordable healthcare services. The huge amounts of data generated by healthcare transactions are too complex and voluminous to be processed and analyzed by traditional methods. Data mining provides the methodology and technology to transform these mounds of data into useful information for decision making. This article explores data mining applications in healthcare. In particular, it discusses data mining and its applications within healthcare in major areas such as the evaluation of treatment effectiveness, management of healthcare, customer relationship management, and the detection of fraud and abuse. It also gives an illustrative example of a healthcare data mining application involving the identification of risk factors associated with the onset of diabetes. Finally, the article highlights the limitations of data mining and discusses some future directions.

  9. Healthcare-associated Pneumonia and Aspiration Pneumonia

    PubMed Central

    Komiya, Kosaku; Ishii, Hiroshi; Kadota, Jun-ichi

    2015-01-01

    Healthcare-associated pneumonia (HCAP) is a new concept of pneumonia proposed by the American Thoracic Society/Infectious Diseases Society of America in 2005. This category is located between community-acquired pneumonia and hospital-acquired pneumonia with respect to the characteristics of the causative pathogens and mortality, and primarily targets elderly patients in healthcare facilities. Aspiration among such patients is recognized to be a primary mechanism for the development of pneumonia, particularly since the HCAP guidelines were published. However, it is difficult to manage patients with aspiration pneumonia because the definition of the condition is unclear, and the treatment is associated with ethical aspects. This review focused on the definition, prevalence and role of aspiration pneumonia as a prognostic factor in published studies of HCAP and attempted to identify problems associated with the concept of aspiration pneumonia. PMID:25657850

  10. The Coming Primary Care Revolution.

    PubMed

    Ellner, Andrew L; Phillips, Russell S

    2017-04-01

    The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.

  11. Air Traffic Sector Configuration Change Frequency

    NASA Technical Reports Server (NTRS)

    Chatterji, Gano B.; Drew, Michael

    2010-01-01

    A Mixed Integer Linear Programming method is used for creating sectors in Fort Worth, Cleveland, and Los Angeles centers based on several days of good-weather traffic data. The performance of these sectors is studied when they are subjected to traffic data from different days. Additionally, the advantage of using different sector designs at different times of day with varying traffic loads is examined. Specifically, traffic data from 10 days are used for design, and 47 other days are played back to test if the traffic-counts stay below the design values used in creating the partitions. The primary findings of this study are as follows. Sectors created with traffic from good-weather days can be used on other good-weather days. Sector configurations created with two hours of traffic can be used for 6 to 12 hours without exceeding the peak-count requirement. Compared to using a single configuration for the entire day, most of the sector-hour reduction is achieved by using two sector configurations -one during daytime hours and one during nighttime hours.

  12. Benefits Assessment of Algorithmically Combining Generic High Altitude Airspace Sectors

    NASA Technical Reports Server (NTRS)

    Bloem, Michael; Gupta, Pramod; Lai, Chok Fung; Kopardekar, Parimal

    2009-01-01

    In today's air traffic control operations, sectors that have traffic demand below capacity are combined so that fewer controller teams are required to manage air traffic. Controllers in current operations are certified to control a group of six to eight sectors, known as an area of specialization. Sector combinations are restricted to occur within areas of specialization. Since there are few sector combination possibilities in each area of specialization, human supervisors can effectively make sector combination decisions. In the future, automation and procedures will allow any appropriately trained controller to control any of a large set of generic sectors. The primary benefit of this will be increased controller staffing flexibility. Generic sectors will also allow more options for combining sectors, making sector combination decisions difficult for human supervisors. A sector-combining algorithm can assist supervisors as they make generic sector combination decisions. A heuristic algorithm for combining under-utilized air space sectors to conserve air traffic control resources has been described and analyzed. Analysis of the algorithm and comparisons with operational sector combinations indicate that this algorithm could more efficiently utilize air traffic control resources than current sector combinations. This paper investigates the benefits of using the sector-combining algorithm proposed in previous research to combine high altitude generic airspace sectors. Simulations are conducted in which all the high altitude sectors in a center are allowed to combine, as will be possible in generic high altitude airspace. Furthermore, the algorithm is adjusted to use a version of the simplified dynamic density (SDD) workload metric that has been modified to account for workload reductions due to automatic handoffs and Automatic Dependent Surveillance Broadcast (ADS-B). This modified metric is referred to here as future simplified dynamic density (FSDD). Finally

  13. "Cloud" health-care workers.

    PubMed Central

    Sherertz, R. J.; Bassetti, S.; Bassetti-Wyss, B.

    2001-01-01

    Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the existence of cloud health-care workers. PMID:11294715

  14. Health governance and healthcare reforms in China.

    PubMed

    Ramesh, M; Wu, Xun; He, Alex Jingwei

    2014-09-01

    This article examines the role of health governance in shaping the outcomes of healthcare reforms in China. The analysis shows that the failure of reforms during the 1980s and 1990s was in part due to inadequate attention to key aspects in health governance, such as strategic interactions among government, providers and users, as well as incentive structures shaping their preferences and behaviour. Although more recent reforms seek to correct these flaws, they are insufficiently targeted at the fundamental governance problems that beset the sector. The article suggests that the Chinese government needs to heighten its efforts to enhance health governance and change the ways providers are paid if it is to succeed in achieving its goal of providing health care to all at affordable cost.

  15. Parallel Education and Defining the Fourth Sector.

    ERIC Educational Resources Information Center

    Chessell, Diana

    1996-01-01

    Parallel to the primary, secondary, postsecondary, and adult/community education sectors is education not associated with formal programs--learning in arts and cultural sites. The emergence of cultural and educational tourism is an opportunity for adult/community education to define itself by extending lifelong learning opportunities into parallel…

  16. Palliative Care Partnership: a successful model of primary/secondary integration.

    PubMed

    Stewart, Bruce; Allan, Simon; Keane, Barry; Marshall, Bridget; Ayling, Jane; Luxford, Tai

    2006-09-22

    The health reforms of the 1990s and early 21st century have seen unheralded change in the delivery of health services in New Zealand, and the concept of integration of primary and specialist or secondary services into a seamless health delivery service is one of the key planks of national and regional healthcare planning in New Zealand. This paper reports on a successful primary secondary integration project. Starting with commentary on the historical difficulties that acted as a catalyst to this initiative, it reports on the development process, how the model works in practice, and outlines some initial evaluation work done as part of its quality improvement component. Given the collaborative nature of this project and its scope across primary and specialist care sectors, the authors believe this model has implications and relevance across a wide spectrum of the New Zealand health service.

  17. Trends in Worker Hearing Loss by Industry Sector, 1981–2010

    PubMed Central

    Masterson, Elizabeth A.; Deddens, James A.; Themann, Christa L.; Bertke, Stephen; Calvert, Geoffrey M.

    2015-01-01

    Background The purpose of this study was to estimate the incidence and prevalence of hearing loss for noise-exposed U.S. workers by industry sector and 5-year time period, covering 30 years. Methods Audiograms for 1.8 million workers from 1981–2010 were examined. Incidence and prevalence were estimated by industry sector and time period. The adjusted risk of incident hearing loss within each time period and industry sector as compared with a reference time period was also estimated. Results The adjusted risk for incident hearing loss decreased over time when all industry sectors were combined. However, the risk remained high for workers in Healthcare and Social Assistance, and the prevalence was consistently high for Mining and Construction workers. Conclusions While progress has been made in reducing the risk of incident hearing loss within most industry sectors, additional efforts are needed within Mining, Construction and Healthcare and Social Assistance. PMID:25690583

  18. Interventions for physical activity promotion applied to the primary healthcare settings for people living in regions of low socioeconomic level: study protocol for a non-randomized controlled trial

    PubMed Central

    2014-01-01

    Background Regular physical activity practice has been widely recommended for promoting health, but the physical activity levels remain low in the population. Therefore, the study of interventions to promote physical activity is essential. Objective: To present the methodology of two physical activity interventions from the “Ambiente Ativo” (“Active Environment”) project. Methods 12-month non-randomized controlled intervention trial. 157 healthy and physically inactive individuals were selected: health education (n = 54) supervised exercise (n = 54) and control (n = 49). Intervention based on health education: a multidisciplinary team of health professionals organized the intervention in group discussions, phone calls, SMS and educational material. Intervention based on supervised exercise program: consisted of offering an exercise program in groups supervised by physical education professionals involving strength, endurance and flexibility exercises. The physical activity level was assessed by the International Physical Activity Questionnaire (long version), physical activities recalls, pedometers and accelerometers over a seven-day period. Result This study described two different proposals for promoting physical activity that were applied to adults attended through the public healthcare settings. The participants were living in a region of low socioeconomic level, while respecting the characteristics and organization of the system and its professionals, and also adapting the interventions to the realities of the individuals attended. Conclusion Both interventions are applicable in regions of low socioeconomic level, while respecting the social and economic characteristics of each region. Trial registration ClinicalTrials.gov NCT01852981 PMID:24624930

  19. Integrating healthcare for older populations.

    PubMed

    Boult, C; Pacala, J T

    1999-01-01

    The complex array of needs posed by older adults has frequently produced fragmentation of care in traditional fee-for-service systems. Integration of care components in newer health systems will maximize patient benefits and organizational efficiency. This article outlines the major issues involved in integration of care for older populations. A health system must integrate its care of older adults in many ways: among providers, both in primary care and specialty services; with community-based sources of care; and across sites of care (clinic, hospital, emergency department, and nursing home). Integrating reimbursement structures for various services will serve to create a client-oriented system, as opposed to a finance-centered system, thereby enhancing coordination of care. The extent to which two experimental comprehensive systems, PACE (Program of All-inclusive Care of the Elderly) and SHMO II (Social Health Maintenance Organization), have achieved clinical and financial integration are discussed in detail. Healthcare organizations are encouraged to create integrated models of care and to study the effects of integration on patient outcomes.

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

    PubMed

    LaVeist, Thomas A; Pierre, Geraldine

    2014-01-01

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

  1. Health-care providers' perceptions, attitudes towards and recommendation practice of cervical cancer screening.

    PubMed

    Hweissa, N Ab; Lim, J N W; Su, T T

    2016-09-01

    In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women.

  2. Testing a model of facilitated reflection on network feedback: a mixed method study on integration of rural mental healthcare services for older people

    PubMed Central

    Fuller, Jeffrey; Oster, Candice; Muir Cochrane, Eimear; Dawson, Suzanne; Lawn, Sharon; Henderson, Julie; O'Kane, Deb; Gerace, Adam; McPhail, Ruth; Sparkes, Deb; Fuller, Michelle; Reed, Richard L

    2015-01-01

    Objective To test a management model of facilitated reflection on network feedback as a means to engage services in problem solving the delivery of integrated primary mental healthcare to older people. Design Participatory mixed methods case study evaluating the impact of a network management model using organisational network feedback (through social network analysis, key informant interviews and policy review). Intervention A model of facilitated network reflection using network theory and methods. Setting A rural community in South Australia. Participants 32 staff from 24 services and 12 senior service managers from mental health, primary care and social care services. Results Health and social care organisations identified that they operated in clustered self-managed networks within sectors, with no overarching purposive older people's mental healthcare network. The model of facilitated reflection revealed service goal and role conflicts. These discussions helped local services to identify as a network, and begin the problem-solving communication and referral links. A Governance Group assisted this process. Barriers to integrated servicing through a network included service funding tied to performance of direct care tasks and the lack of a clear lead network administration organisation. Conclusions A model of facilitated reflection helped organisations to identify as a network, but revealed sensitivity about organisational roles and goals, which demonstrated that conflict should be expected. Networked servicing needed a neutral network administration organisation with cross-sectoral credibility, a mandate and the resources to monitor the network, to deal with conflict, negotiate commitment among the service managers, and provide opportunities for different sectors to meet and problem solve. This requires consistency and sustained intersectoral policies that include strategies and funding to facilitate and maintain health and social care networks in rural

  3. Pay Premiums for Economic Sector and Race: A Decomposition.

    ERIC Educational Resources Information Center

    Daymont, Thomas N.

    Using data from the older men's file of the National Longitudinal Surveys, two issues related to the labor market implications of dual economy theory were examined: variations in rates of pay among economic sectors (competitive, monopoly, and public) and variation in relative opportunities for blacks across sectors. The primary analytical problem…

  4. Workplace Bullying in Healthcare: Part 3.

    PubMed

    Lamberth, By Becky

    2015-01-01

    As many as 53.5 million American workers have experienced workplace bullying, which can cost organizations an estimated $200 billion annually in lost productivity, increased sick d ays, increased med ical claims, legal costs, and staff turnover. Bullying can occur in any profession, but for many reasons it is most prevalent in healthcare. Bullying behavior in healthcare has been reported and documented in literature for over 35 years. Although physicians are often considered to be the primary culprit of bullying, healthcare bullies can be one any one of the professionals who work in the organization including nurses, radiology technologists, pharmacists, ancillary staff personnel, administrators, or other non-physician staff members. The first installment of the series focused on defining bullying and its impact on the organization. Part 2 discussed three legal protections for the bully to include at-will laws, unions, and bylaws related to physician privileging. The final installment in this series will evaluate specific bully types and implementing processes to address inappropriate behavior.

  5. Three Dimensional Sector Design with Optimal Number of Sectors

    NASA Technical Reports Server (NTRS)

    Xue, Min

    2010-01-01

    In the national airspace system, sectors get overloaded due to high traffic demand and inefficient airspace designs. Overloads can be eliminated in some cases by redesigning sector boundaries. This paper extends the Voronoi-based sector design method by automatically selecting the number of sectors, allowing three-dimensional partitions, and enforcing traffic pattern conformance. The method was used to design sectors at Fort-Worth and Indianapolis centers for current traffic scenarios. Results show that new designs can eliminate overloaded sectors, although not in all cases, reduce the number of necessary sectors, and conform to major traffic patterns. Overall, the new methodology produces enhanced and efficient sector designs.

  6. Burnout among healthcare professionals.

    PubMed

    Wood, Ben D; Killion, Jeffrey B

    2007-01-01

    *From many accounts healthcare professionals are at increased risk for professional burnout. Professional burnout is generally described as prolonged stress that impairs one's ability to perform his or her job in demanding situations. *Precursors to professional burnout include, but are not limited to, employee workload, chronic fatigue, compassion fatigue, balance between family and career, sickness absence, and loss of confidence. *Administrators must watch for early signs of professional burnout to improve retention and promote employee morale. To reduce professional burnout, administrators must implement strategies to reduce burnout while also promoting productivity. *When professional burnout occurs, management must consider each employee's generational differences. All generations have differing values, beliefs, and opinions that influence his or her work ethic in regard to employee productivity.

  7. Globalization of healthcare.

    PubMed

    2012-05-01

    Globalization-the increasing transnational circulation of money, goods, people, ideas, and information worldwide-is generally recognized as one of the most powerful forces shaping our current and future history. How is it affecting healthcare, and in that context, what is the purpose and significance of Global Advances in Health and Medicine (GAHM), publisher of this journal? Our goal is not homogenization but rather to provide an opportunity for integration, convergence, and collaboration across cultures. By respecting and conserving the richness and diversity of each new medicine, we embrace globalization. Globalization is of course not new; it began in the Renaissance and particularly with the 15th- and 16th-century voyages of exploration by Columbus, Magellan, and others. Since the beginning of time, there have been interactions and exchanges among different peoples and cultures. However, the current magnitude of globalization is unprecedented and yet still expanding rapidly.

  8. Technology and healthcare costs

    PubMed Central

    Kumar, R Krishna

    2011-01-01

    Medicine in the 21st century is increasingly dependent on technology. Unlike in many other areas, the cost of medical technology is not declining and its increasing use contributes to the spiraling healthcare costs. Many medical professionals equate progress in medicine to increasing use of sophisticated technology that is often expensive and beyond the reach of the average citizen. Pediatric heart care is very technology-intensive and therefore very expensive and beyond the reach of the vast majority of children in the developing world. There is an urgent need to address this situation through development and use of appropriate technology in accordance with the needs and priorities of the society. A number of simple and inexpensive quality measures that have the potential of improving outcomes substantially without the need for expensive equipment should be instituted before embracing high-end technology. Innovations to reduce costs that are commonly used in limited resource environments should be tested systematically. PMID:21677816

  9. Consumer reaction to healthcare advertising.

    PubMed

    Klein, R F

    1998-07-01

    How do consumers view healthcare advertising? This question, along with many others, was addressed in a national survey conducted by Market Strategies for The Alliance For Healthcare Strategy And Marketing, and presented during The Alliance's annual advertising and promotion conference last June.

  10. [Health promotion and prevention in the economic crisis: the role of the health sector. SESPAS report 2014].

    PubMed

    Márquez-Calderón, Soledad; Villegas-Portero, Román; Gosalbes Soler, Victoria; Martínez-Pecino, Flora

    2014-06-01

    This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts' opinions are divided on the need for some preventive activities. Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions.

  11. Buildings Sector Analysis

    SciTech Connect

    Hostick, Donna J.; Nicholls, Andrew K.; McDonald, Sean C.; Hollomon, Jonathan B.

    2005-08-01

    A joint NREL, ORNL, and PNNL team conducted market analysis to help inform DOE/EERE's Weatherization and Intergovernmental Program planning and management decisions. This chapter presents the results of the market analysis for the Buildings sector.

  12. Construction Sector (NAICS 23)

    EPA Pesticide Factsheets

    Find environmental regulatory information for the construction sector, including the construction of buildings or engineering projects. This includes RCRA information for hazardous waste, refrigeration compliance, asbestos, effluent guidelines & lead laws

  13. How does retiree health insurance influence public sector employee saving?

    PubMed

    Clark, Robert L; Mitchell, Olivia S

    2014-12-01

    Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers.Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not.

  14. How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

    PubMed Central

    2013-01-01

    Background Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in

  15. National Healthcare Reform: Implications for the Military Healthcare System

    DTIC Science & Technology

    2010-05-16

    healthcare for certain non-active duty reservists and extended chiropractic care to active duty members placing yet additional pressures on defense health...coalition of lobbyists and elected representatives to implement reforms. The recent passage of the Patient Protection and Affordable Care Act (PPACA... Care Act (PPACA), Capitation, Health Savings Accounts (HAS), AHLTA, VistA, TRICARE, Military Healthcare System (MHS). 16. SECURITY CLASSIFICATION

  16. [Healthcare patient loyalty].

    PubMed

    Ameri, Cinzia; Fiorini, Fulvio

    2016-01-01

    If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty.

  17. Healthcare financing in Yemen.

    PubMed

    Holst, Jens; Gericke, Christian A

    2012-01-01

    Yemen is a low-middle-income country where more than half of the population live in rural areas and lack access to the most basic health care. At US$40 per capita, Yemen's annual total health expenditure (THE) is among the lowest worldwide. This study analyses the preconditions and options for implementing basic social health protection in Yemen. It reveals a four-tiered healthcare system characterised by high geographic and financial access barriers mainly for the poor. Out-of-pocket payments constitute 55% of THE, and cost-sharing exemption schemes are not well organised. Resource-allocation practices are inequitable because about 30% of THE gets spent on treatment abroad for a small number of patients, mainly from better-off families. Against the background of a lack of social health protection, a series of small-scale and often informal solidarity schemes have developed, and a number of public and private companies have set up health benefit schemes for their employees. Employment-based schemes usually provide reasonable health care at an average annual cost of YR44 000 (US$200) per employee. In contrast, civil servants contribute to a mandatory health-insurance scheme without receiving any additional health benefits in return. A number of options for initiating a pathway towards a universal health-insurance system are discussed.

  18. Refugee perceptions of the quality of healthcare: findings from a participatory assessment in Ngara, Tanzania.

    PubMed

    Rutta, Edmund; Williams, Holly; Mwansasu, Andwele; Mung'ong'o, Fredrick; Burke, Heather; Gongo, Ramadhani; Veneranda, Rwegasira; Qassim, Mohamed

    2005-12-01

    This article describes the findings of a participatory assessment of Burundian and Rwandan refugees' perceptions of the quality of health services in camps in Ngara, Tanzania. Taking a beneficiary-centred approach, it examines a collaborative effort by several agencies to develop a generic field guide to analyse refugees' views of healthcare services. The objective was to gather information that would contribute to significant improvements in the care offered in the camps. Although the primary focus was on healthcare, several broader questions considered other general apprehensions that might influence the way refugees perceive their healthcare. Findings indicated that while refugees in Ngara were generally satisfied with the quality of healthcare provided and healthcare promotion activities, recognition of some key refugee concerns would assist healthcare providers in enhancing services. With increasing need for refugee community participation in evaluating humanitarian assistance, this assessment has relevance both in the context of Ngara and beyond.

  19. Shifting from glucose diagnosis to the new HbA1c diagnosis reduces the capability of the Finnish Diabetes Risk Score (FINDRISC) to screen for glucose abnormalities within a real-life primary healthcare preventive strategy

    PubMed Central

    2013-01-01

    Background To investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria. Methods A cross-sectional primary-care study was conducted as the first part of an active real-life lifestyle intervention to prevent type 2 diabetes within a high-risk Spanish Mediterranean population. Individuals without diabetes aged 45-75 years (n = 3,120) were screened using the FINDRISC. Where feasible, a subsequent 2-hour oral glucose tolerance test and HbA1c test were also carried out (n = 1,712). The performance of the risk score was calculated by applying the area under the curve (AUC) for the receiver operating characteristic, using three sets of criteria (2-hour glucose, fasting glucose, HbA1c) and three diagnostic categories (normal, pre-diabetes, diabetes). Results Defining diabetes by a single HbA1c measurement resulted in a significantly lower diabetes prevalence (3.6%) compared with diabetes defined by 2-hour plasma glucose (9.2%), but was not significantly lower than that obtained using fasting plasma glucose (3.1%). The FINDRISC at a cut-off of 14 had a reasonably high ability to predict diabetes using the diagnostic criteria of 2-hour or fasting glucose (AUC = 0.71) or all glucose abnormalities (AUC = 0.67 and 0.69, respectively). When HbA1c was used as the primary diagnostic criterion, the AUC for diabetes detection dropped to 0.67 (5.6% reduction in comparison with either 2-hour or fasting glucose) and fell to 0.55 for detection of all glucose abnormalities (17.9% and 20.3% reduction, respectively), with a relevant decrease in sensitivity of the risk score. Conclusions A shift from glucose-based diagnosis to HbA1c-based diagnosis substantially reduces the ability of the FINDRISC to screen for glucose abnormalities when applied in this real-life primary-care preventive strategy. PMID

  20. Negotiating and managing partnership in primary care.

    PubMed

    Charlesworth, J

    2001-09-01

    In the UK public service organisations are increasingly working together in new partnerships, networks and alliances, largely stimulated by government legislation, which aims to encourage 'joined-up' policy-making. This is particularly prevalent in health-care where local government, health authorities and trusts, voluntary and community groups are extending existing, and developing new, forms of partnership, particularly around Health Improvement Programmes and new primary care organisations. This paper explores two main aspects of how these new interorganizational relationships are being developed and managed and is based on research conducted in one case study locality. First, the new structures of partnership in primary care are mapped out, together with discussion on why these particular patterns of relationship between statutory and voluntary sector organisations have emerged, exploring both centrally and locally determined influences. Secondly, the paper explores the tensions associated with working within new policy-making and management structures, and how the additional demands of audit, performance measurement and the sheer pace of change, pose a potential threat to the partnership process.

  1. Healthcare-financing reforms in transitional society: a Shanghai experience.

    PubMed

    Dong, Weizhen

    2003-09-01

    Since the 1950s, China has had a very wide coverage of healthcare service at the local level. In urban areas, the employment-based healthcare-insurance schemes (Government Insurance Scheme and Labour Insurance Scheme) worked hand in hand with the full employment policy of the Government, which guaranteed basic care for almost every urban resident. However, since the economic reforms of the early 1980s, China's healthcare system has met great challenges. Some came from the reform of the labour system, and other challenges came from the introduction of market forces in the healthcare sector. The new policy of the Chinese Government on the Urban Employees' Basic Health Care Insurance is to introduce a cost-sharing plan in urban China. Like other major social policy changes, this new health policy also has a great impact on the lives of the Chinese people. Affordability has been the major concern among urban residents. Shanghai implemented the cost-sharing healthcare policy in the spring of 2001. It may be too early to assess the pros and cons of the new policy, but evidence shows that the employment-based health-insurance scheme excludes those at high risk and in most need. It is argued that the cost-sharing healthcare system will limit access by some people, especially those who are most vulnerable to the consequences of ill health and those in low-income groups, unless the deductibles vary according to income and unless low-income groups are exempt from paying premiums and deductibles.

  2. Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector

    PubMed Central

    Chandra, Amitabh; Finkelstein, Amy; Sacarny, Adam; Syverson, Chad

    2016-01-01

    The conventional wisdom for the healthcare sector is that idiosyncratic features leave little scope for market forces to allocate consumers to higher performance producers. However, we find robust evidence - across several different conditions and performance measures - that higher quality hospitals have higher market shares and grow more over time. The relationship between performance and allocation is stronger among patients who have greater scope for hospital choice, suggesting that patient demand plays an important role in allocation. Our findings suggest that healthcare may have more in common with “traditional” sectors subject to market forces than often assumed. PMID:27784907

  3. 75 FR 38819 - National Advisory Council for Healthcare Research and Quality: Request for Nominations for Public...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-06

    ... the Agency in light of private sector activity and opportunities for public private partnerships... Advisory Council for Healthcare Research and Quality: Request for Nominations for Public Members AGENCY... public members. SUMMARY: Section 921 (now Section 941 of the Public Health Service Act (PHS Act)), 42...

  4. A national study on nurses’ retention in healthcare facilities in underserved areas in Lebanon

    PubMed Central

    2013-01-01

    Background Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. Methods This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student’s t-test and ANOVA) tests to describe the respondents and examine the significance between nurses’ characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses’ intent to stay in underserved areas. Results A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to

  5. Securing Information Technology in Healthcare

    PubMed Central

    Anthony, Denise; Campbell, Andrew T.; Candon, Thomas; Gettinger, Andrew; Kotz, David; Marsch, Lisa A.; Molina-Markham, Andrés; Page, Karen; Smith, Sean W.; Gunter, Carl A.; Johnson, M. Eric

    2014-01-01

    Dartmouth College’s Institute for Security, Technology, and Society conducted three workshops on securing information technology in healthcare, attended by a diverse range of experts in the field. This article summarizes the three workshops. PMID:25379030

  6. Healthcare information technology and economics.

    PubMed

    Payne, Thomas H; Bates, David W; Berner, Eta S; Bernstam, Elmer V; Covvey, H Dominic; Frisse, Mark E; Graf, Thomas; Greenes, Robert A; Hoffer, Edward P; Kuperman, Gil; Lehmann, Harold P; Liang, Louise; Middleton, Blackford; Omenn, Gilbert S; Ozbolt, Judy

    2013-01-01

    At the 2011 American College of Medical Informatics (ACMI) Winter Symposium we studied the overlap between health IT and economics and what leading healthcare delivery organizations are achieving today using IT that might offer paths for the nation to follow for using health IT in healthcare reform. We recognized that health IT by itself can improve health value, but its main contribution to health value may be that it can make possible new care delivery models to achieve much larger value. Health IT is a critically important enabler to fundamental healthcare system changes that may be a way out of our current, severe problem of rising costs and national deficit. We review the current state of healthcare costs, federal health IT stimulus programs, and experiences of several leading organizations, and offer a model for how health IT fits into our health economic future.

  7. Control of corruption in healthcare.

    PubMed

    Ahmed, Armin; Azim, Afzal

    2015-01-01

    A recently published article on corruption in Indian healthcare in the BMJ has triggered a hot debate and numerous responses (1, 2, 3, 4). We do agree that corruption in Indian healthcare is a colossal issue and needs to be tackled urgently (5). However, we want to highlight that corruption in healthcare is not a local phenomenon confined to the Indian subcontinent, though India does serve as a good case study and intervention area due to the magnitude of the problem and the country's large population (6). Good governance, strict rules, transparency and zero tolerance are some of the strategies prescribed everywhere to tackle corruption. However, those entrusted with implementing good governance and strict rules in India need to go through a process of introspection to carry out their duties in a responsible fashion. At present, it looks like a no-win situation. In this article, we recommend education in medical ethics as the major intervention for dealing with corruption in healthcare.

  8. Enhancing Health-Care Services with Mixed Reality Systems

    NASA Astrophysics Data System (ADS)

    Stantchev, Vladimir

    This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

  9. Applying the balanced scorecard in healthcare provider organizations.

    PubMed

    Inamdar, Noorein; Kaplan, Robert S; Bower, Marvin

    2002-01-01

    Several innovative healthcare executives have recently introduced a new business strategy implementation tool: the Balanced Scorecard. The scorecard's measurement and management system provides the following potential benefits to healthcare organizations: It aligns the organization around a more market-oriented, customer-focused strategy It facilitates, monitors, and assesses the implementation of the strategy It provides a communication and collaboration mechanism It assigns accountability for performance at all levels of the organization It provides continual feedback on the strategy and promotes adjustments to marketplace and regulatory changes. We surveyed executives in nine provider organizations that were implementing the Balanced Scorecard. We asked about the following issues relating to its implementation and effect: 1. The role of the Balanced Scorecard in relation to a well-defined vision, mission, and strategy 2. The motivation for adopting the Balanced Scorecard 3. The difference between the Balanced Scorecard and other measurement systems 4. The process followed to develop and implement the Balanced Scorecard 5. The challenges and barriers during the development and implementation process 6. The benefits gained by the organization from adoption and use. The executives reported that the Balanced Scorecard strategy implementation and performance management tool could be successfully applied in the healthcare sector, enabling organizations to improve their competitive market positioning, financial results, and customer satisfaction. This article concludes with guidelines for other healthcare provider organizations to capture the benefits of the Balanced Scorecard performance management system.

  10. Pediatric home healthcare: a paradox.

    PubMed

    Krepper, R; Young, A; Cummings, E

    1994-01-01

    Although parents may welcome having their ill child cared for at home, they are not prepared to compromise privacy and family rituals, nor share control of their child. The purpose of this article is to provide a snapshot of problems that parents have encountered with pediatric home healthcare. Home care parents offer suggestions for other parents and home healthcare nurses and agencies, encouraging them to be proactive in preventing potential problems.

  11. Trust and Privacy in Healthcare

    NASA Astrophysics Data System (ADS)

    Singleton, Peter; Kalra, Dipak

    This paper considers issues of trust and privacy in healthcare around increased data-sharing through Electronic Health Records (EHRs). It uses a model structured around different aspects of trust in the healthcare organisation’s reasons for greater data-sharing and their ability to execute EHR projects, particularly any associated confidentiality controls. It reflects the individual’s personal circumstances and attitude to use of health records.

  12. Patient-centered healthcare design.

    PubMed

    Stichler, Jaynelle F

    2011-12-01

    Patient-centered care focuses on the patient's and family's experience in the hospital, and the design of the healthcare environment should support the patient-centered care concept. The purpose of this facility design department is to expand nurse leaders' knowledge and competencies in health facility design and enable them to take leadership roles in design efforts. This article focuses on healthcare design guiding principles and features to support organizational cultural initiatives such as patient- and family-centered care and Planetree.

  13. Strategies to Improve Healthcare Websites

    PubMed Central

    Johnson, Constance; Peterson, Susan K.; Turley, James P.; Ensor, Joe; Amos, Christopher; Spitz, Margaret; Levin, Bernard; Berry, Donald

    2006-01-01

    Healthcare websites that are influential in healthcare decision-making must be evaluated for accuracy, readability and understandability by the average population. Most existing frameworks for designing and evaluating interactive websites focus on the utility and usability of the site. Although these are significant to the design of the basic site, they are not sufficient. We have developed an iterative framework that considers additional attributes. PMID:17238588

  14. Campaign 2008: healthcare reform revisited.

    PubMed

    Wilensky, Gail R

    2008-10-01

    *An important lesson to be learned from the failed efforts at healthcare reform of the early 1990s is that successful reform cannot be an all-or-nothing proposition. *The McCain and Obama healthcare plans have some elements in common, but they also have important differences. *Whoever wins the election will face the challenge of persuading Congress to go along with his proposal.

  15. Sector-scanning echocardiography

    NASA Technical Reports Server (NTRS)

    Henry, W. L.; Griffith, J. M.

    1975-01-01

    The mechanical sector scanner is described in detail, and its clinical application is discussed. Cross sectional images of the heart are obtained in real time using this system. The sector scanner has three major components: (a) hand held scanner, (b) video display, and (c) video recorder. The system provides diagnostic information in a wide spectrum of cardiac diseases, and it quantitates the severity of mitral stenosis by measurement of the mitral valve orifice area in diagnosing infants, children and adults with cyanotic congenital heart disease.

  16. LEAN thinking in Finnish healthcare.

    PubMed

    Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

    2016-01-01

    Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

  17. Designing the future of healthcare.

    PubMed

    Fidsa, Gianfranco Zaccai

    2009-01-01

    This paper describes the application of a holistic design process to a variety of problems plaguing current healthcare systems. A design process for addressing complex, multifaceted problems is contrasted with the piecemeal application of technological solutions to specific medical or administrative problems. The goal of this design process is the ideal customer experience, specifically the ideal experience for patients, healthcare providers, and caregivers within a healthcare system. Holistic design is shown to be less expensive and wasteful in the long run because it avoids solving one problem within a complex system at the cost of creating other problems within that system. The article applies this approach to the maintenance of good health throughout life; to the creation of an ideal experience when a person does need medical care; to the maintenance of personal independence as one ages; and to the enjoyment of a comfortable and dignified death. Virginia Mason Medical Center is discussed as an example of a healthcare institution attempting to create ideal patient and caregiver experiences, in this case by applying the principles of the Toyota Production System ("lean manufacturing") to healthcare. The article concludes that healthcare is inherently dedicated to an ideal, that science and technology have brought it closer to that ideal, and that design can bring it closer still.

  18. Serial murder by healthcare professionals.

    PubMed

    Yorker, Beatrice Crofts; Kizer, Kenneth W; Lampe, Paula; Forrest, A R W; Lannan, Jacquetta M; Russell, Donna A

    2006-11-01

    The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.

  19. Current issues in German healthcare.

    PubMed

    Graf von der Schulenburg, J M; Uber, A

    1997-11-01

    Germany has developed a model of social health insurance for financing healthcare. The basic characteristics of this model are compulsory membership, income-dependent contributions paid by employers and employees, a comprehensive package of healthcare entitlements, stringent government regulation and implementation by not-for-profit health insurers--the sickness funds--which operate under public law. Since the mid-1970s, when health care cost containment gradually evolved as a new issue in German healthcare policy-making, a long series of reform programmes have been initiated. Two recent development can be noted: the introduction of market competition in health insurance and the introduction of fixed budgets. Market competition in health insurance is now an explicit policy tool in Germany. This article analyses the German healthcare system, the history of healthcare reforms and the current healthcare acts. Special emphasis is given to the German drug market and its regulation. The paper describes the present cost-containment policy for pharmaceutical products, especially the global budget concept which was introduced for medicines and patients' copayments.

  20. Health effects of work schedules in healthcare professions.

    PubMed

    Poissonnet, C M; Véron, M

    2000-01-01

    Increasing variety in working patterns and the appearance of new forms of shift schedules in the different occupational sectors, including health services, have raised great concern about the quality of working life and job performance. The aim of this paper is to present a systematic review of the literature on the effects on health of irregular schedules in healthcare professionals. Computer and manual searches of databases, and discussion with experts, were used to identify relevant studies. No conclusive evidence was found to favour any particular work system, although there is evidence that extended workdays (9-12 h) should be avoided as much as possible. There is need for carefully designed studies in order to evaluate the long-term consequences of work schedules in healthcare workers.

  1. Taming Healthcare Costs: Promise and Pitfalls for Women's Health

    PubMed Central

    Glynn, Amy; MacKenzie, Rose

    2016-01-01

    Abstract When it comes to healthcare, women are often the primary decision makers for their families. Therefore, focusing on women and their health needs can have a profound effect on health reform efforts to control costs and improve quality for all segments of the population. The promise and pitfalls of cost containment reform in Massachusetts can serve as an informative case study for policymakers at the local, state, and federal levels as they attempt to reduce costs while maintaining quality of care. Massachusetts cost containment law, Chapter 224, seeks to control the healthcare cost growth through innovative approaches to increase efficiency and transparency including the adoption of new delivery system models, investments in wellness and prevention programs, and implementation of standard quality and evaluation measures. In this paper, we outline four approaches to delivering on the promise of cost containment reform to maximize women's access to comprehensive, quality healthcare while avoiding the pitfalls of cost containment's adverse impact on women's health. PMID:26488183

  2. Redefining Health: Implication for Value-Based Healthcare Reform

    PubMed Central

    2017-01-01

    Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care. To implement value-based healthcare, transformations need to be done by both health providers and patients: establishing true health outcomes, strengthening primary care, building integrated health systems, implementing appropriate health payment schemes that promote value and reduce moral hazards, enabling health information technology, and creating a policy that fits well with a community.

  3. [Social medicine and healthcare economics. The framework for future forms of healthcare].

    PubMed

    Rebscher, Herbert

    2008-05-01

    In the political debate, even in academia, the concepts of "profitability" or "efficiency" are thrown around very robustly and freely with no regard for the players themselves. Economically speaking there can be no efficiency without a definition of targets in terms of outcomes and their level of quality. If even the government's Council of Economic Experts itself finds in its assessment of hospital funding that the "reform's target parameters - improving the profitability of service provision - have developed positively", but adds that "whether this also applies to the quality of services provided or to the realisation of healthcare outcomes remains to be seen due to the lack of evidence" [21], this indicates a one-sided and problematic curtailment of the concept even by highly competent bodies. Economic control of new forms of healthcare by means of prices and fees for clearly defined services is a complex problem that has not been dealt with adequately. All pricing is based on classification models aimed at ensuring cost and benefit clusters that are as homogeneous as possible. Classification models in healthcare as a basis for price control targets need constant adjusting to ensure accuracy of mapping and appropriateness to performance. A prerequisite for the methodology behind price control models of this kind is presupposing a responsible, rule-bound and criteria-based handling of "variance" and "coincidence" by means of risk-adjusted quality and price systems. They will define the character of a wide range of steering tools and have an effect that goes beyond the narrow formal confines of the sector. That is why the regulatory framework will need first and foremost to define a qualitative framework for the political "security infrastructure" by means of deregulated economic processes in which price control becomes accountable and is justified in terms of content.

  4. [Do healthcare insurers have too much power?

    PubMed

    Schut, F T; Varkevisser, M

    2016-01-01

    In the Dutch healthcare system, healthcare insurers act as purchasers of care on behalf of their insured clients. To this end, the insurers form contractual agreements with healthcare providers. In the interest of balanced negotiations regarding price and quality, it is important that neither of the two parties has a disproportionate position of power. This paper discusses whether healthy power relationships exist between healthcare insurers and healthcare providers.

  5. The Puerto Rico Healthcare Crisis.

    PubMed

    Roman, Jesse

    2015-12-01

    The Commonwealth of Puerto Rico is an organized nonincorporated territory of the United States with a population of more than 3.5 million U.S. citizens. The island has been the focus of much recent attention due to the recent default on its debt (estimated at more than $70 billion), high poverty rates, and increasing unemployment. Less attention, however, has been given to the island's healthcare system, which many believe is on the verge of collapsing. Healthcare makes up 20% of the Puerto Rican economy, and this crisis affects reimbursement rates for physicians while promoting the disintegration of the island's healthcare infrastructure. A major contributor relates to a disparity in federal funding provided to support the island's healthcare system when compared with that provided to the states in the mainland and Hawaii. Puerto Rico receives less federal funding for healthcare than the other 50 states and the District of Columbia even though it pays its share of social security and Medicare taxes. To make matters worse, the U.S. Center for Medicaid and Medicare Services is planning soon to implement another 11% cut in Medical Advantage reimbursements. This disparity in support for healthcare is considered responsible for ∼$25 billion of Puerto Rico's total debt. The impact of these events on the health of Puerto Ricans in the island cannot be entirely predicted, but the loss of healthcare providers and diminished access to care are a certainty, and quality care will suffer, leading to serious implications for those with chronic medical disorders including respiratory disease.

  6. [E-med: illustration and vector of globalization in healthcare].

    PubMed

    Dixneuf, M

    2006-12-01

    Destined for healthcare professionals interested in public health policy in developing countries, E-med is one of the few francophone forums on essential medicines. Bringing together users with diverse backgrounds, discussion groups illustrate the effects of globalization on health policy: disappearance of distance, convergence of political and sanitary issues, enhanced cooperation between public and private sectors, coalitions of heterogeneous players and destruction of national and international barriers. Having benefited from the development of the Internet in recent years, as a secondary tool, E-med, must now evolve with this tool that is now ubiquitous in international health policy.

  7. Impact of information technology on human resources in healthcare.

    PubMed

    Anvari, Mehran

    2007-01-01

    Incorporation of advances in information communications technology (ICT) into the workplace has had a major impact in human resource utilization in sectors of the economy where it has occurred in a substantial manner, such as manufacturing and financial services. While some benefits of ICT have been realized in healthcare, the full impact of its benefits will only be realized if it is incorporated in a systematic form, rather than in the current patchy and uneven manner seen around the province and across the country to date.

  8. Behavioral economics perspectives on public sector pension plans.

    PubMed

    Beshears, John; Choi, James J; Laibson, David; Madrian, Brigitte C

    2011-04-01

    We describe the pension plan features of the states and the largest cities and counties in the U.S. Unlike in the private sector, defined benefit (DB) pensions are still the norm in the public sector. However, a few jurisdictions have shifted toward defined contribution (DC) plans as their primary savings plan, and fiscal pressures are likely to generate more movement in this direction. Holding fixed a public employee's work and salary history, we show that DB retirement income replacement ratios vary greatly across jurisdictions. This creates large variation in workers' need to save for retirement in other accounts. There is also substantial heterogeneity across jurisdictions in the savings generated in primary DC plans because of differences in the level of mandatory employer and employee contributions. One notable difference between public and private sector DC plans is that public sector primary DC plans are characterized by required employee or employer contributions (or both), whereas private sector plans largely feature voluntary employee contributions that are supplemented by an employer match. We conclude by applying lessons from savings behavior in private sector savings plans to the design of public sector plans.

  9. Behavioral economics perspectives on public sector pension plans

    PubMed Central

    BESHEARS, JOHN; CHOI, JAMES J.; LAIBSON, DAVID; MADRIAN, BRIGITTE C.

    2011-01-01

    We describe the pension plan features of the states and the largest cities and counties in the U.S. Unlike in the private sector, defined benefit (DB) pensions are still the norm in the public sector. However, a few jurisdictions have shifted toward defined contribution (DC) plans as their primary savings plan, and fiscal pressures are likely to generate more movement in this direction. Holding fixed a public employee’s work and salary history, we show that DB retirement income replacement ratios vary greatly across jurisdictions. This creates large variation in workers’ need to save for retirement in other accounts. There is also substantial heterogeneity across jurisdictions in the savings generated in primary DC plans because of differences in the level of mandatory employer and employee contributions. One notable difference between public and private sector DC plans is that public sector primary DC plans are characterized by required employee or employer contributions (or both), whereas private sector plans largely feature voluntary employee contributions that are supplemented by an employer match. We conclude by applying lessons from savings behavior in private sector savings plans to the design of public sector plans. PMID:21789032

  10. Exploring corruption in the South African health sector.

    PubMed

    Rispel, Laetitia C; de Jager, Pieter; Fonn, Sharon

    2016-03-01

    Recent scholarly attention has focused on weak governance and the negative effects of corruption on the provision of health services. Employing agency theory, this article discusses corruption in the South African health sector. We used a combination of research methods and triangulated data from three sources: Auditor-General of South Africa reports for each province covering a 9-year period; 13 semi-structured interviews with health sector key informants and a content analysis of print media reports covering a 3-year period. Findings from the Auditor-General reports showed a worsening trend in audit outcomes with marked variation across the nine provinces. Key-informants indicated that corruption has a negative effect on patient care and the morale of healthcare workers. The majority of the print media reports on corruption concerned the public health sector (63%) and involved provincial health departments (45%). Characteristics and complexity of the public health sector may increase its vulnerability to corruption, but the private-public binary constitutes a false dichotomy as corruption often involves agents from both sectors. Notwithstanding the lack of global validated indicators to measure corruption, our findings suggest that corruption is a problem in the South African healthcare sector. Corruption is influenced by adverse agent selection, lack of mechanisms to detect corruption and a failure to sanction those involved in corrupt activities. We conclude that appropriate legislation is a necessary, but not sufficient intervention to reduce corruption. We propose that mechanisms to reduce corruption must include the political will to run corruption-free health services, effective government to enforce laws, appropriate systems, and citizen involvement and advocacy to hold public officials accountable. Importantly, the institutionalization of a functional bureaucracy and public servants with the right skills, competencies, ethics and value systems and whose

  11. Comprehensibility of universal healthcare symbols for wayfinding in healthcare facilities.

    PubMed

    Lee, Seunghae; Dazkir, Sibel Seda; Paik, Hae Sun; Coskun, Aykut

    2014-07-01

    Healthcare facilities are often complex and overwhelming for visitors, and wayfinding in healthcare facilities can be challenging. As there is an increasing number of global citizens who travel to seek medical care in another country, it is critical to make wayfinding easy for visitors who are not familiar with the language in a foreign country. Among many wayfinding aids, symbols are helpful for those visitors who have limited ability to understand written language. This study tested universal healthcare symbols in the United States, South Korea, and Turkey to compare the comprehension of symbols cross-country and identify predictors of the correct comprehension. To explore statistically significant relationships between symbol comprehension and countries, Pearson's Chi-square tests, logistic regression, and ANOVA were conducted. The test results showed that ten symbols among 14 tested have significant relationship with countries. Results of this study demonstrate that symbol comprehension can be varied significantly in different countries.

  12. Harnessing the privatisation of China's fragmented health-care delivery.

    PubMed

    Yip, Winnie; Hsiao, William

    2014-08-30

    Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals.

  13. 30 years after Alma-Ata: has primary health care worked in countries?

    PubMed

    Rohde, Jon; Cousens, Simon; Chopra, Mickey; Tangcharoensathien, Viroj; Black, Robert; Bhutta, Zulfiqar A; Lawn, Joy E

    2008-09-13

    We assessed progress for primary health care in countries since Alma-Ata. First we analysed life expectancy relative to national income and HIV prevalence to identify overachieving and underachieving countries. Then we focused on the 30 low-income and middle-income countries with the highest average yearly reduction of mortality among children less than 5 years of age, describing coverage and equity of primary health care as well as non-health sector actions. These 30 countries have scaled up selective primary health care (eg, immunisation, family planning), and 14 have progressed to comprehensive primary health care, marked by high coverage of skilled attendance at birth. Good governance and progress in non-health sectors are seen in almost all of the 14 countries identified with a comprehensive primary health care system. However, these 30 countries include those that are making progress despite very low income per person, political instability, and high HIV/AIDS prevalence. Thailand has the highest average yearly reduction in mortality among children less than 5 years of age (8.5%) and has achieved universal coverage of immunisation and skilled birth attendance, with low inequity. Lessons learned from all these countries include the need for a nationally agreed package of prioritised and phased primary health care that all stakeholders are committed to implementing, attention to district management systems, and consistent investment in primary health-care extension workers linked to the health system. More detailed analysis and evaluation within and across countries would be invaluable in guiding investments for primary health care, and expediting progress towards the Millennium Development Goals and "health for all".

  14. Healthcare waste management in Asia

    SciTech Connect

    Prem Ananth, A.; Prashanthini, V.; Visvanathan, C.

    2010-01-15

    The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

  15. The Microbiome and Sustainable Healthcare

    PubMed Central

    Dietert, Rodney R.; Dietert, Janice M.

    2015-01-01

    Increasing prevalences, morbidity, premature mortality and medical needs associated with non-communicable diseases and conditions (NCDs) have reached epidemic proportions and placed a major drain on healthcare systems and global economies. Added to this are the challenges presented by overuse of antibiotics and increased antibiotic resistance. Solutions are needed that can address the challenges of NCDs and increasing antibiotic resistance, maximize preventative measures, and balance healthcare needs with available services and economic realities. Microbiome management including microbiota seeding, feeding, an