Sample records for care provider strategies

  1. Involving private health care providers in delivery of TB care: global strategy. (United States)

    Uplekar, Mukund


    Most poor countries have a large and growing private medical sector. Evidence suggests that a large proportion of tuberculosis patients in many high TB- burden countries first approach a private health care provider. Further, private providers manage a significant proportion of tuberculosis cases. Surprisingly though, there is virtually no published evidence on linking private providers to tuberculosis programmes. As a part of global efforts to control tuberculosis through effective DOTS implementation, the World Health Organization has recently begun addressing the issue of private providers in TB control through an evolving global strategy. As a first step, a global assessment of private providers' participation in tuberculosis programmes was undertaken. The findings of the assessment were discussed and debated in a consultation involving private practitioners, TB programme managers and policy makers. Their recommendations have contributed to the evolving global strategy called Public-Private Mix for DOTS implementation (PPM DOTS). This paper presents the guiding principles of PPM DOTS and major elements of the global strategy. These include: informed advocacy; setting-up "learning projects"; scaling-up successful projects and formulation of regional, national and local strategies; developing practical tools to facilitate PPM DOTS and pursuing an operational research agenda to help better design and shape PPM DOTS strategies. Encouraging results from some ongoing project sites are discussed. The paper concludes that concerted global efforts and local input are required for a sustained period to help achieve productive engagement of private practitioners in DOTS implementation. Such efforts have to be targeted as much towards national tuberculosis programmes as towards private providers and their associations. Continued apathy in this area could not only potentially delay achieving global targets for TB control but also undo, in the long run, the hard

  2. Child Care Providers' Strategies for Supporting Healthy Eating: A Qualitative Approach (United States)

    Lynch, Meghan; Batal, Malek


    Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child care providers, this study aimed to develop a better understanding of the…

  3. Practical strategies for providing culturally sensitive, ethical care in developing nations. (United States)

    Crigger, Nancy J; Holcomb, Lygia


    Providing health care in developing nations results in cultural and ethical challenges for health care professionals. The authors' intent is to raise readers' awareness of how to maintain an ethical and culturally sensitive approach to practice in developing nations. Four practical approaches to ethical decision-making, developed from the literature and praxis, in conjunction with traditional moral theory and guidelines from professional and international organizations are discussed. Ethical multiculturalism, a view that combines universalism and multiculturalism undergirds culturally appropriate and ethically responsive decisions.

  4. Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial

    NARCIS (Netherlands)

    Vlemmix, F.; Rosman, A.N.; Rijnders, M.E.; Beuckens, A.; Opmeer, B.C.; Mol, B.W.J.; Kok, M.; Fleuren, M.A.H.


    Onjective: To determine the effectiveness of a client or care-provider strategy to improve the implementation of external cephalic version. Design: Cluster randomized controlled trial.Setting: Twenty-five clusters; hospitals and their referring midwifery practices randomly selected in the Netherland

  5. Humor as a Communication Strategy in Provider-Patient Communication in a Chronic Care Setting. (United States)

    Schöpf, Andrea C; Martin, Gillian S; Keating, Mary A


    Humor is a potential communication strategy to accomplish various and potentially conflicting consultation goals. We investigated humor use and its reception in diabetes consultations by analyzing how and why humor emerges and its impact on the interaction. We did this by using an interactional sociolinguistics approach. We recorded 50 consultations in an Irish diabetes setting. Analysis of the humor events drew on framework analysis and on concepts from Conversation Analysis and pragmatics. The study also comprised interviews using tape-assisted recall. We identified 10 humor functions and two umbrella functions. A key finding is that most humor is relationship-protecting humor initiated by patients, that is, they voice serious messages and deal with emotional issues through humor. Our findings imply that patients' and providers' awareness of indirect communication strategies needs to be increased. We also recommend that researchers employ varied methods to adequately capture the interactive nature of humor.

  6. Therapeutic strategies for pediatric non-alcoholic fatty liver disease: A challenge for health care providers

    Institute of Scientific and Technical Information of China (English)

    Valerio Nobili; Melania Manco


    Non-alcoholic steato-hepatitis (NASH) is related to insulin resistance and, thus, frequently occurs as part of the metabolic changes that accompany obesity, diabetes and hyperlipidemia. In childhood, the overwhelming boost of obesity and its co-morbidities have lead to the extraordinarily increased prevalence of NASH.Establishing effective therapeutic strategies to treat the disease represents the challenge for hepatologists and gastroenterologists in the next decade. Therapeutic approaches have aimed at treating associated conditions (obesity, insulin resistance, hyperlipemia, etc) or reducing liver oxidative damage (vitamin E).

  7. Perioperative Care of Prisoners: Providing Safe Care. (United States)

    Smith, Francis Duval


    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel.

  8. Babesiosis for Health Care Providers

    Centers for Disease Control (CDC) Podcasts


    This podcast will educate health care providers on diagnosing babesiosis and providing patients at risk with tick bite prevention messages.  Created: 4/25/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria.   Date Released: 4/25/2012.

  9. Strategies to reduce barriers in reporting herbal use to the health-care provider among women of childbearing age in two communities in Ogun state, Nigeria

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    Florence F Folami


    Full Text Available Background: The use of complementary and alternative medicine (CAM has increased tremendously in the past decades. Herbs in this study involved the use of plant products in their raw or cooked forms which have not been subjected to laboratory investigations for their safety and efficacy. Objective: To explore strategies to reduce barriers in reporting herbal use to the health-care provider among childbearing age women in two communities in Ogun state, Nigeria. Materials and Methods: A descriptive cross-sectional survey was used to explore strategies to reduce barriers in reporting herbal use to the health-care provider. The study population constitutes childbearing age women that attend two private hospitals and one comprehensive health center in two communities of Ogun state, Nigeria. Out of the 270 patients who were randomly sampled for the study, 250 agreed to participate (response rate: 92.6%. Results: The mean age of the participants was 29.3 years ± 5.5 and 77.6% were married. The majority (69% had used herbal medicines in the last 6 months before seeking medical care, and 66% did not disclose the use of herbal medicines to health-care providers. Conclusion: Health-care professionals should routinely include herbal remedy category in the list of drug history when asking about the patient's drug. This will help identify herbal remedy use and assist to take precautions relating to safety. Patients and traditional birth attendants should be educated through community mobilization and educational programs about alternative medicines particularly herbal. The disclosure of CAM use and its adverse outcomes should be encouraged by health-care professionals.

  10. Research based empathic knowledge for nursing: a translational strategy for disseminating phenomenological research findings to provide evidence for caring practice. (United States)

    Galvin, Kathleen T; Todres, Les


    We are interested in the kind of knowledge that is particularly relevant to caring practice and the way in which qualitative research findings can serve such knowledge. As phenomenological researchers we have been engaged with the question of how findings from such research can be re-presented and expressed more aesthetically. Such a movement towards a more aesthetic phenomenology may serve the communicative concern to express phenomena relevant to caring practice in ways that appeal to the 'head, hand and heart'. The paper first offers some thoughts about the complex kind of knowledge relevant to caring that is not only technical or propositional, but actionable and aesthetically moving as well. We call this kind of knowledge 'embodied relational understanding'. Further, the paper outlines the development of one way of serving a more aesthetic phenomenology whereby research findings can be faithfully and evocatively translated into more empathically impactful expressions. We call this process 'embodied interpretation'. It is guided by an epistemological framework grounded in the philosophies of Gadamer and Gendlin. We finally illustrate the process with reference to the experience of living after Stroke, and consider the value of this translational process for nursing education and practice.

  11. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program - IQIC

    Directory of Open Access Journals (Sweden)

    Adilia Maria Pires Sciarra


    Full Text Available Introduction: Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. Objective: To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. Methods: The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Results: Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. Conclusion: It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases.

  12. Choosing Your Prenatal Care Provider (United States)

    ... on midwives. A family nurse practitioner (also called FNP) is a nurse with special education and training ... care of every member of your family. An FNP can take care of you during pregnancy and ...

  13. Conjugal violence in the perspective of "Family Health Strategy" professionals: a public health problem and the need to provide care for the women

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    Nadirlene Pereira Gomes


    Full Text Available OBJECTIVE: to construct a theoretical matrix based on the meanings of the interactions and actions experienced by the professionals regarding the nursing care practices and the health of women in situations of conjugal violence in the ambit of the Family Health Strategy. METHODS: research based in Grounded Theory. Following approval by the Research Ethics Committee, 52 professionals were interviewed in Santa Catarina, Brazil. The analysis was based on open, axial and selective codifications. RESULTS: the theoretical model was delimited based on the phenomenon "Recognizing conjugal violence as a public health problem, and the need for management of the care for the woman", which reflects the experience of the professionals in relation to care for the woman, as well as the meanings attributed to this care. CONCLUSIONS: the phenomenon allows one to understand the movement of action and interaction regarding the care for the woman in a situation of conjugal violence.

  14. California's "Bridge to Reform": identifying challenges and defining strategies for providers and policymakers implementing the Affordable Care Act in low-income HIV/AIDS care and treatment settings.

    Directory of Open Access Journals (Sweden)

    Patrick T Hazelton

    Full Text Available In preparation for full Affordable Care Act implementation, California has instituted two healthcare initiatives that provide comprehensive coverage for previously uninsured or underinsured individuals. For many people living with HIV, this has required transition either from the HIV-specific coverage of the Ryan White program to the more comprehensive coverage provided by the county-run Low-Income Health Programs or from Medicaid fee-for-service to Medicaid managed care. Patient advocates have expressed concern that these transitions may present implementation challenges that will need to be addressed if ambitious HIV prevention and treatment goals are to be achieved.30 semi-structured, in-depth interviews were conducted between October, 2012, and February, 2013, with policymakers and providers in 10 urban, suburban, and rural California counties. Interview topics included: continuity of patient care, capacity to handle payer source transitions, and preparations for healthcare reform implementation. Study team members reviewed interview transcripts to produce emergent themes, develop a codebook, build inter-rater reliability, and conduct analyses.Respondents supported the goals of the ACA, but reported clinic and policy-level challenges to maintaining patient continuity of care during the payer source transitions. They also identified strategies for addressing these challenges. Areas of focus included: gaps in communication to reach patients and develop partnerships between providers and policymakers, perceived inadequacy in new provider networks for delivering quality HIV care, the potential for clinics to become financially insolvent due to lower reimbursement rates, and increased administrative burdens for clinic staff and patients.California's new healthcare initiatives represent ambitious attempts to expand and improve health coverage for low-income individuals. The state's challenges in maintaining quality care and treatment for people

  15. Insure Kids Now (IKN) (Dental Care Providers) (United States)

    U.S. Department of Health & Human Services — The Insure Kids Now (IKN) Dental Care Providers in Your State locator provides profile information for oral health providers participating in Medicaid and Children's...

  16. Development of an educational module on provider self-care. (United States)

    Meadors, Patrick; Lamson, Angela; Sira, Natalia


    Intensive care providers who care for traumatized populations often face multiple traumas for extended periods and are vulnerable to developing lasting symptoms of compassion fatigue and secondary traumatization. Symptoms are often not recognizable until compassion fatigue or secondary traumatization negatively affects the providers' ability to care for their patients. More attention needs to be given to the care of the provider to ensure high-quality patient care, decrease turnover in the profession, and increase productivity. This article provides a framework for the development of an educational module for healthcare providers' self-care. This educational module created the opportunity to share with providers (a) how to explore their own professional experience; (b) how to recognize the different symptoms of compassion fatigue, primary traumatization, and secondary traumatization; (c) factors related to grief reactions; and (d) personal and professional strategies to decrease compassion fatigue and secondary traumatization.

  17. Primary care patient and provider preferences for diabetes care managers

    Directory of Open Access Journals (Sweden)

    Ramona S DeJesus


    Full Text Available Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these.Methods: A 20-item questionnaire, asking for patients’ and providers’ preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers.Results: There were 254 (25.4% patient responders and 28 (66% provider responders. The majority of patients (>70% and providers (89% expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager.Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.Keywords: care manager, collaborative care, patient preference, diabetes care

  18. Elder Care for Alzheimer's: Choosing a Provider (United States)

    ... elder care center for a loved one with Alzheimer's. What should I look for when considering a ... provide an opportunity for your loved one with Alzheimer's to receive assistance and therapeutic activities in a ...

  19. Home care providers to the rescue

    DEFF Research Database (Denmark)

    Hansen, Steen Møller; Brøndum, Stig; Thomas, Grethe


    AIM: To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA......). METHODS: We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched...... providers. The study was conducted in a rural district in Denmark. RESULTS: Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases...

  20. Multicultural Nursing: Providing Better Employee Care. (United States)

    Rittle, Chad


    Living in an increasingly multicultural society, nurses are regularly required to care for employees from a variety of cultural backgrounds. An awareness of cultural differences focuses occupational health nurses on those differences and results in better employee care. This article explores the concept of culturally competent employee care, some of the non-verbal communication cues among cultural groups, models associated with completing a cultural assessment, and how health disparities in the workplace can affect delivery of employee care. Self-evaluation of the occupational health nurse for personal preferences and biases is also discussed. Development of cultural competency is a process, and occupational health nurses must develop these skills. By developing cultural competence, occupational health nurses can conduct complete cultural assessments, facilitate better communication with employees from a variety of cultural backgrounds, and improve employee health and compliance with care regimens. Tips and guidelines for facilitating communication between occupational health nurses and employees are also provided.

  1. Providing nursing care in a children's hospice. (United States)

    Day, Alison

    Children who are admitted to hospices need specialist treatment that enables them to enjoy their childhood as much as possible while they receive the care they require. Their parents also have particular needs. During Children's Hospice Week, which started on September 21, the Association of Children's Hospices aims to raise awareness of the work done by children's hospices and the services they provide.

  2. How Do Health Care Providers Diagnose Vaginitis? (United States)

    ... the treatments? Are there complications? Does it affect pregnancy? How is it prevented? NICHD Research Information Clinical Trials Resources and Publications How do health care providers diagnose vaginitis? Skip sharing on social media links Share this: Page Content To find out ...

  3. The effect of provider- and workflow-focused strategies for guideline implementation on provider acceptance

    Directory of Open Access Journals (Sweden)

    Ramanujam Rangaraj


    Full Text Available Abstract Background The effective implementation of clinical practice guidelines (CPGs depends critically on the extent to which the strategies that are deployed for implementing the guidelines promote provider acceptance of CPGs. Such implementation strategies can be classified into two types based on whether they primarily target providers (e.g., academic detailing, grand rounds presentations or the work context (e.g., computer reminders, modifications to forms. This study investigated the independent and joint effects of these two types of implementation strategies on provider acceptance of CPGs. Methods Surveys were mailed to a national sample of providers (primary care physicians, physician assistants, nurses, and nurse practitioners and quality managers selected from Veterans Affairs Medical Centers (VAMCs. A total of 2,438 providers and 242 quality managers from 123 VAMCs participated. Survey items measured implementation strategies and provider acceptance (e.g., guideline-related knowledge, attitudes, and adherence for three sets of CPGs--chronic obstructive pulmonary disease, chronic heart failure, and major depressive disorder. The relationships between implementation strategy types and provider acceptance were tested using multi-level analytic models. Results For all three CPGs, provider acceptance increased with the number of implementation strategies of either type. Moreover, the number of workflow-focused strategies compensated (contributing more strongly to provider acceptance when few provider-focused strategies were used. Conclusion Provider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies.

  4. Building a safe care-providing robot. (United States)

    Fotoohi, Leila; Gräser, Axel


    A service robot especially a care-providing robot, works in the vicinity of a human body and is sometimes even in direct contact with it. Conventional safety methods and precautions in industrial robotics are not applicable to such robots. This paper presents a safety approach for designing the safe care-providing robot FRIEND. The approach is applied in each step of design iteratively to identify and assess the potential hazards during design. The steps are explained briefly in this work. The main contribution of this paper is verification of safety requirements using the Ramadge-Wonham (RW) framework. The greater complexity of the tasks the robot will perform, the more complex is the identification of safety requirements. Use of this framework led us to analyze the requirements and verify them formally, systematically and on a modular basis. In our approach human-robot interaction (HRI) is also modeled by a set of uncontrolled events that may happen any time during operation. Subsequently the safety requirements are modified to consider these interactions. As a result the safety module behaves like a controller, running in parallel with the system, which maintains the system safe and works according to the safety requirements by enabling the admissible sequences of events.

  5. 29 CFR 825.125 - Definition of health care provider. (United States)


    ... 29 Labor 3 2010-07-01 2010-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only:...

  6. Special Sitters: Teenage Respite Care Providers. (United States)

    Reid, Penny; Legaz, Mary Ann


    Camp Fire's Special Sitters Project addresses the need for respite care experienced by parents of disabled children. The project trains teenagers to care for young handicapped children and links the teenagers with parents who call for babysitting service. The project has been successfully replicated in five communities. (Author/JDD)

  7. Teamwork: building healthier workplaces and providing safer patient care. (United States)

    Clark, Paul R


    A changing healthcare landscape requires nurses to care for more patients with higher acuity during their shift than ever before. These more austere working conditions are leading to increased burnout. In addition, patient safety is not of the quality or level that is required. To build healthier workplaces where safe care is provided, formal teamwork training is recommended. Formal teamwork training programs, such as that provided by the MedTeams group, TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), or participatory action research programs such as the Healthy Workplace Intervention, have decreased errors in the workplace, increased nurse satisfaction and retention rates, and decreased staff turnover. This article includes necessary determinants of teamwork, brief overviews of team-building programs, and examples of research programs that demonstrate how teamwork brings about healthier workplaces that are safer for patients. Teamwork programs can bring about these positive results when implemented and supported by the hospital system.

  8. Regulatory requirements for providing adequate veterinary care to research animals. (United States)

    Pinson, David M


    Provision of adequate veterinary care is a required component of animal care and use programs in the United States. Program participants other than veterinarians, including non-medically trained research personnel and technicians, also provide veterinary care to animals, and administrators are responsible for assuring compliance with federal mandates regarding adequate veterinary care. All program participants therefore should understand the regulatory requirements for providing such care. The author provides a training primer on the US regulatory requirements for the provision of veterinary care to research animals. Understanding the legal basis and conditions of a program of veterinary care will help program participants to meet the requirements advanced in the laws and policies.

  9. Buerger’s disease: providing integrated care (United States)

    Klein-Weigel, Peter; Volz, Theresa Sophie; Zange, Leonora; Richter, Jutta


    Buerger’s disease, also known as thromboangiitis obliterans (TAO), is a segmental inflammatory disease affecting small- and medium-sized vessels, which is strongly associated with tobacco use. Although the etiology is still unknown, recent studies suggest an immunopathogenesis. Diagnosis is based on clinical and angiomorphologic criteria, including age, history of smoking, clinical presentation with distal extremity ischemia, and the absence of other risk factors for atherosclerosis, autoimmune disease, hypercoagulable states, or embolic disease. Until now, no causative therapy exists for TAO. The most important therapeutic intervention is smoking cessations and intravenous prostanoid infusions (iloprost). Furthermore, effective analgesia is crucial for the treatment of ischemic and neuropathic pain and might be expanded by spinal cord stimulation. Revascularization procedures do not play a major role in the treatment of TAO due to the distal localization of arterial occlusion. More recently, immunoadsorption has been introduced eliminating vasoconstrictive G-protein-coupled receptor and other autoantibodies. Cell-based therapies and treatment with bosentan were also advocated. Finally, a consequent prevention and treatment of wounds and infections are essential for the prevention of amputations. To achieve better clinical results, integrated care in multidisciplinary and trans-sectoral teams with emphasis on smoking cessation, pain control, wound management, and social care by professionals, social workers, and family members is necessary. PMID:27785045

  10. The costs of providing antiretroviral therapy services to HIV-infected individuals presenting with advanced HIV disease at public health centres in Dar es Salaam, Tanzania: Findings from a randomised trial evaluating different health care strategies (United States)

    Kimaro, Godfather Dickson; Mfinanga, Sayoki; Simms, Victoria; Kivuyo, Sokoine; Bottomley, Christian; Hawkins, Neil; Harrison, Thomas S.; Jaffar, Shabbar; Guinness, Lorna


    Background Understanding the costs associated with health care delivery strategies is essential for planning. There are few data on health service resources used by patients and their associated costs within antiretroviral (ART) programmes in Africa. Material and methods The study was nested within a large trial, which evaluated screening for cryptococcal meningitis and tuberculosis and a short initial period of home-based adherence support for patients initiating ART with advanced HIV disease in Tanzania and Zambia. The economic evaluation was done in Tanzania alone. We estimated costs of providing routine ART services from the health service provider's perspective using a micro-costing approach. Incremental costs for the different novel components of service delivery were also estimated. All costs were converted into US dollars (US$) and based on 2012 prices. Results Of 870 individuals enrolled in Tanzania, 434 were enrolled in the intervention arm and 436 in the standard care/control arm. Overall, the median (IQR) age and CD4 cell count at enrolment were 38 [31, 44] years and 52 [20, 89] cells/mm3, respectively. The mean per patient costs over the first three months and over a one year period of follow up following ART initiation in the standard care arm were US$ 107 (95%CI 101–112) and US$ 265 (95%CI 254–275) respectively. ART drugs, clinic visits and hospital admission constituted 50%, 19%, and 19% of the total cost per patient year, while diagnostic tests and non-ART drugs (co-trimoxazole) accounted for 10% and 2% of total per patient year costs. The incremental costs of the intervention to the health service over the first three months was US$ 59 (p<0.001; 95%CI 52–67) and over a one year period was US$ 67(p<0.001; 95%CI 50–83). This is equivalent to an increase of 55% (95%CI 51%–59%) in the mean cost of care over the first three months, and 25% (95%CI 20%–30%) increase over one year of follow up. PMID:28234969

  11. Buerger’s disease: providing integrated care

    Directory of Open Access Journals (Sweden)

    Klein-Weigel P


    Full Text Available Peter Klein-Weigel,1 Theresa Sophie Volz,1 Leonora Zange,2 Jutta Richter,3 1Clinic of Angiology, 2Clinic of Cardiology and Nephrology, HELIOS Klinikum Berlin-Buch, Berlin, 3Medical Faculty, Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany Abstract: Buerger’s disease, also known as thromboangiitis obliterans (TAO, is a segmental inflammatory disease affecting small- and medium-sized vessels, which is strongly associated with tobacco use. Although the etiology is still unknown, recent studies suggest an immunopathogenesis. Diagnosis is based on clinical and angiomorphologic criteria, including age, history of smoking, clinical presentation with distal extremity ischemia, and the absence of other risk factors for atherosclerosis, autoimmune disease, hypercoagulable states, or embolic disease. Until now, no causative therapy exists for TAO. The most important therapeutic intervention is smoking cessations and intravenous prostanoid infusions (iloprost. Furthermore, effective analgesia is crucial for the treatment of ischemic and neuropathic pain and might be expanded by spinal cord stimulation. Revascularization procedures do not play a major role in the treatment of TAO due to the distal localization of arterial occlusion. More recently, immunoadsorption has been introduced eliminating vasoconstrictive G-protein-coupled receptor and other autoantibodies. Cell-based therapies and treatment with bosentan were also advocated. Finally, a consequent prevention and treatment of wounds and infections are essential for the prevention of amputations. To achieve better clinical results, integrated care in multidisciplinary and trans-sectoral teams with emphasis on smoking cessation, pain control, wound management, and social care by professionals, social workers, and family members is necessary. Keywords: Winiwater-Buerger's disease, Winiwarter–Buerger, thromboangiitis

  12. Non-dental primary care providers’ views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study


    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len


    Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experie...

  13. Medical Services: Nonphysician Health Care Providers (United States)


    of osteopathy ). (2) PAs may write routine orders on inpatients, using DA Form 4256 (Doctor’s Orders). (3) When required, inpatient treatment...of medicine or osteopathy , who are authorized and responsible for determining, starting, or altering the regimen of medical treatment provided to a

  14. Find Ryan White HIV/AIDS Medical Care Providers (United States)

    U.S. Department of Health & Human Services — The Find Ryan White HIV/AIDS Medical Care Providers tool is a locator that helps people living with HIV/AIDS access medical care and related services. Users can...

  15. Patients' satisfaction with the quality of nursing care provided: the Saudi experience. (United States)

    Atallah, Mohammad A; Hamdan-Mansour, Ayman M; Al-Sayed, Mohammad M; Aboshaiqah, Ahmad E


    Patient's satisfaction has emerged as a central focus of health-care delivery during the last decades, and nursing care became one significant component of patient's satisfaction. The purpose of this study is to examine patients' satisfaction with quality of nursing care provided in Saudi Arabia. Cross-sectional descriptive correctional design was used to recruit 100 patients from one regional hospital in Saudi Arabia. Data collected using structured interview from patients related to six dimensions of nursing care. Patients had a high level of satisfaction with nursing care provided (86% agreement rate). Language (56% disagreement rate), discharge information (56% disagreement rate) and availability (20% disagreement rate) have been identified with the lowest rates of patients satisfaction. Nursing leaders and health-care administrators need to maintain quality nursing care and develop strategies for improving nursing care emphasizing language as barrier and strategies of information dissemination.

  16. Veteran, Primary Care Provider, and Specialist Satisfaction With Electronic Consultation



    Background Access to specialty care is challenging for veterans in rural locations. To address this challenge, in December 2009, the Veterans Affairs (VA) Pittsburgh Healthcare System (VAPHS) implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients with enhanced specialty care access. Objective The aim of this quality improvement (QI) project evaluation was to: (1) assess satisfaction with the e-consult process, and (2) identify perceive...

  17. Spirituality in nursing: nurses' perceptions about providing spiritual care. (United States)

    Ruder, Shirley


    Providing spiritual care is an important foundation of nursing and is a requirement mandated by accreditation organizations. Spiritual care is essential in all clinical areas but particularly in home care and hospice. Clinicians may be unable to respond to spiritual needs because of inadequate education or the assumption that spiritual needs should be addressed by clergy, chaplains, or other "spiritual" care providers. In reality, clinicians in the home may be in the best position to offer spiritual support when caring for patients at home at end of life. The purpose of this pilot study was to examine relationships between spirituality and nurses' providing spiritual care. Professional nurses (n = 69) working in 2 large healthcare organizations completed the Perceptions of Spiritual Care Questionnaire. Approximately, 33% of the nurses worked in home care. Significant correlations were found among those nurses whose reported nursing education programs adequately prepared them to meet spiritual needs and taught ways to incorporate spiritual care into practice and those who did not.

  18. Attitudes regarding the safety of health care provider attire. (United States)

    Garvin, Kanishka W; Lipira, Lauren; Neradilek, Moni; Fox, Anna; Ali, Fatima; Pottinger, Paul S


    The majority of medical providers, nurses, and patients agree that appearance is important for patient care. However, at our institution, concerns regarding providers' white coats as fomites are expressed primarily by providers and nurses, not by patients. We provide a framework for approaching this important issue through a structured quality-improvement process.

  19. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers (United States)

    Roberts, James R.; McCurdy, Leyla Erk


    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

  20. Predictions of Children's Experiences with Latina Family Child Care Providers (United States)

    Zuniga, Stephen A.; Howes, Carollee


    Research Findings: Relatively little is known about the pre-academic experiences of Latino/a children in family child care. In this work we tested the extent to which previously established relations among provider characteristics, scaffolding and responsive behaviors, total quality (Family Day Care Rating Scale), and children's engagement in…

  1. Six health care trends that will reshape the patient-provider dynamic. (United States)

    Liao, Joshua M; Emanuel, Ezekiel J; Navathe, Amol S


    Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data. While these efforts can also improve the clinical relationship and create positive system redesign among health care organizations, they require alignment between organizational and physician incentives that can inadvertently harm the dynamic between patients and providers. Organizations can utilize several strategies to preserve the patient-physician relationship and advance the positive benefits of new organizational strategies while guarding against unintended consequences.

  2. How Do Health Care Providers Diagnose Bacterial Vaginosis (BV)? (United States)

    ... and Publications How do health care providers diagnose bacterial vaginosis (BV)? Skip sharing on social media links Share ... menstruating. Centers for Disease Control and Prevention. (2010). Bacterial vaginosis: CDC fact sheet . Retrieved May 10, 2012, from ...

  3. How Do Health Care Providers Diagnose Klinefelter Syndrome? (United States)

    ... and Publications How do health care providers diagnose Klinefelter syndrome (KS)? Skip sharing on social media links Share ... in 166 boys, adolescents and adults with nonmosaic Klinefelter syndrome: A Copenhagen experience. Acta Paediatrica , Jun;100(6), ...

  4. How Do Health Care Providers Diagnose Neural Tube Defects? (United States)

    ... and Publications How do health care providers diagnose neural tube defects? Skip sharing on social media links Share this: Page Content Neural tube defects are usually diagnosed before the infant is ...

  5. Using the National Provider Identifier for Health Care... (United States)

    U.S. Department of Health & Human Services — The establishment in recent years of a National Provider Identifier (NPI) offers a new method for counting and categorizing physicians and other health care...

  6. How Do Health Care Providers Diagnose Spina Bifida? (United States)

    ... and Publications How do health care providers diagnose spina bifida? Skip sharing on social media links Share this: Page Content Doctors diagnose spina bifida before or after the infant is born. Spina ...

  7. How Do Health Care Providers Diagnose Osteogenesis Imperfecta? (United States)

    ... ee-on-ik VILL-uhs ) sampling (CVS) or amniocentesis (pronounced am-nee-oh-sen-TEE-sis ). The ... tested for the presence of abnormal collagen. For amniocentesis, a health care provider takes a small amount ...

  8. Early Intervention Provider Use of Child Caregiver-Teaching Strategies (United States)

    Campbell, Philippa H.; Coletti, Catherine Ehret


    The purpose of this study was to identify the extent to which multidiscipline early intervention providers identified and demonstrated caregiver-teaching strategies. A total of 78 providers submitted 205 videotaped segments to illustrate 1 of 5 caregiver-teaching strategies (i.e., demonstration; caregiver practice with feedback; guided practice;…

  9. Female farmworkers' health during pregnancy: health care providers' perspectives. (United States)

    Kelley, Maureen A; Flocks, Joan D; Economos, Jeannie; McCauley, Linda A


    Pregnant farmworkers and their fetuses are at increased risk of negative health outcomes due to environmental and occupational factors at their workplaces. Health care providers who serve farm communities can positively affect workers' health through the informed care they deliver. Yet, interviews with rural health care providers reveal limited knowledge about agricultural work or occupational and environmental health risks during pregnancy. Professional associations, government organizations, academic institutions, and practice settings must renew their efforts to ensure that environmental and occupational health education, especially as it relates to women and their children, is incorporated into academic and practice environments.

  10. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives. (United States)

    Lin, Yung-Hsiu; Chen, Rong-Rong; Guo, Sophie Huey-Ming; Chang, Hui-Yu; Chang, Her-Kun


    Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and care providers' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs.

  11. Effective factors in providing holistic care: A qualitative study

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    Vahid Zamanzadeh


    Full Text Available Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses′ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  12. Human trafficking: the role of the health care provider. (United States)

    Dovydaitis, Tiffany


    Human trafficking is a major public health problem, both domestically and internationally. Health care providers are often the only professionals to interact with trafficking victims who are still in captivity. The expert assessment and interview skills of providers contribute to their readiness to identify victims of trafficking. The purpose of this article is to provide clinicians with knowledge on trafficking and give specific tools that they may use to assist victims in the clinical setting. Definitions, statistics, and common health care problems of trafficking victims are reviewed. The role of the health care provider is outlined through a case study and clinical practice tools are provided. Suggestions for future research are also briefly addressed.

  13. Providers' Perceptions of Challenges in Obstetrical Care for Somali Women

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    Jalana N. Lazar


    Full Text Available Background. This pilot study explored health care providers’ perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers’ experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC. Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement.

  14. Sex differences in health care provider communication during genital herpes care and patients' health outcomes. (United States)

    Ports, Katie A; Reddy, Diane M; Barnack-Tavlaris, Jessica L


    Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.

  15. Informal sector providers in Bangladesh: how equipped are they to provide rational health care? (United States)

    Ahmed, Syed Masud; Hossain, Md Awlad; Chowdhury, Mushtaque Raja


    In Bangladesh, there is a lack of knowledge about the large body of informal sector practitioners, who are the major providers of health care to the poor, especially in rural areas, knowledge which is essential for designing a need-based, pro-poor health system. This paper addresses this gap by presenting descriptive data on their professional background including knowledge and practices on common illnesses and conditions from a nationwide, population-based health-care provider survey undertaken in 2007. The traditional healers (43%), traditional birth attendants (TBAs, 22%), and unqualified allopathic providers (village doctors and drug sellers, 16%) emerged as major providers in the health care scenario of Bangladesh. Community health workers (CHWs) comprised about 7% of the providers. The TBAs/traditional healers had sector, instead of ignoring, recognize the importance of the informal providers for the health care of the poor. Consequently, their capacity should be developed through training, supportive supervision and regulatory measures so as to accommodate them in the mainstream health system until constraints on the supply of qualified and motivated health care providers into the system can be alleviated.

  16. Educating primary care providers about HIV disease: multidisciplinary interactive mechanisms.


    Macher, A; Goosby, E; Barker, L; Volberding, P; Goldschmidt, R.; Balano, K B; Williams, A; Hoenig, L; Gould, B; Daniels, E.


    As HIV-related prophylactic and therapeutic research findings continue to evolve, the Health Resources and Services Administration (HRSA) of the Public Health Service has created multidisciplinary mechanisms to disseminate new treatment options and educate primary care providers at rural and urban sites throughout our nation's health care system. HRSA has implemented (a) the International State-of-the-Art HIV Clinical Conference Call Series, (b) the national network of AIDS Education and Trai...

  17. A joint venture in providing home care and community service. (United States)

    Reifsteck, S


    General discussion of a joint venture providing home care and community service including future possibilities, business and financial aspects and demand is presented. The author then provides a group practice joint venture model including descriptions of operating structure, contract arrangements and management.

  18. Palliative care providers' perspectives on service and education needs. (United States)

    Sellick, S M; Charles, K; Dagsvik, J; Kelley, M L


    To obtain the information necessary for coordinated regional program development, we examined (a) the multidisciplinary viewpoint of palliative care service provision and (b) the continuing education needs reported by non-physician service providers. Of 146 surveys distributed to care providers from multiple settings, 135 were returned. Respondents cited these problems: fragmented services, poor pain and symptom control, lack of education for providers, lack of public awareness, problems with the continuity and coordination of care, lack of respite, and lack of hospice beds. Stress management for caregivers, pain management, communication skills, and symptom assessment were rated as priorities in continuing education. Lectures, small group discussions, practicum, and regular medical centre rounds were the preferred learning formats, while costs and staff shortages were cited as educational barriers.

  19. Human Trafficking: The Role of the Health Care Provider


    Dovydaitis, Tiffany


    Human trafficking is a major public health problem, both domestically and internationally. Health care providers are often the only professionals to interact with trafficking victims who are still in captivity. The expert assessment and interview skills of providers contribute to their readiness to identify victims of trafficking. The purpose of this article is to provide clinicians with knowledge on trafficking and give specific tools that they may use to assist victims in the clinical setti...

  20. Spirituality and spiritual evaluation, their role in providing spiritual care

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    Tzounis E.


    Full Text Available Introduction: Spiritual evaluation is the procedure in which health professionals are able to recognize the spiritual needs of the patients with the use of the right “tools”. The specific models of spirituality and their correlation to health and sickness are more and more attached and applied to medical-nursing care. This is why spiritual care is recognized by the bibliography as a significant factor which affects the biological and psycho – emotional needs of the people. Aim: This specific review is conducted in order to define the influence of spirituality and spiritual evaluation in providing spiritual care by the healthcare professionals. Μaterial and method: A bibliographic search on the data bases Pubmed using the terms: spirituality, spiritual care, spiritual evaluation, spiritual needs, spiritual pain, teaching on spirituality. Results: The last few years, more and more healing interventions include the patients’ thoughts and those of the health care professional in relation to spirituality and spiritual care. The patients desire discussions of spiritual content with the health professionals considering spiritual health as important as physical health. In order to evaluate and diagnose, both doctors and nurses should evaluate whether spirituality is important for a patient and whether the spiritual factors can actually help or prevent healing procedure. Moreover, health professionals who actually recognize their own spiritual needs, formulate the most important healing relationships.Conclusion: The spiritual area of the clinical care is important. The health care professionals have access to emotionally loaded moments of their patients. This is the reason why, any possible tendency for intervention in their patients’ belief system needs attention and should be limited. Because awareness of spiritual needs is best achieved through education, should at least be provided in the curriculum of medical and nursing schools in Greece.

  1. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

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    Sword Wendy


    Full Text Available Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of

  2. Care providers' needs and perspectives on suffering and care in Bosnia and Herzegovina and Cambodia. (United States)

    McDonald, Laura; Mollica, Richard F; Douglas Kelley, Susan; Tor, Svang; Halilovic, Majda


    This exploratory study aimed to obtain insight into field-level care providers' views on suffering and healing as well as existing obstacles and needs related to providing care to their clients. This research provides a "snapshot" for a better understanding of existing care systems in two post-conflict settings. By identifying existing approaches to care and the needs of the care provider community, this research might be useful in guiding psychosocial assistance programming in post-conflict settings. Utilizing a semi-structured questionnaire, 45 care providers were interviewed, including local health care practitioners, traditional/ spiritual healers, and humanitarian relief workers, in Bosnia and Herzegovina and Cambodia. This study found that the majority of care providers in both settings perceived poverty and violence as significant causes and consequences of human suffering and, at the same time, felt ill-equipped in addressing these issues and related problems. Other issues that hindered these healers in providing care included: limited government/institutional support; lack of training; material resources and funding. Study findings point to a new framework for developing effective interventions and the need for further emphasis on supporting care providers in their work, and most specifically, in identifying and responding to poverty and violence.

  3. Providing care for migrant farm worker families in their unique sociocultural context and environment. (United States)

    Connor, Ann; Layne, Laura; Thomisee, Karen


    This article highlights the Farm Worker Family Health Program's (FWFHP) strategies for providing care to migrant farm workers residing within a unique social and cultural context. The care provided by health professions students from a variety of disciplines extends and augments the work of the local migrant farm worker clinic that is pushed beyond capacity during peak growing and harvest times. Nursing's social responsibility to care for underserved populations is a guiding principle of the FWFHP and shapes how the work is translated into action. The FWFHP is a community-academic partnership that began in the rural southeastern United States in 1993. Challenges facing migrant farm worker families include access to health care, language, health literacy, housing and sanitation, family and community integrity, and workplace safety. The nursing practice strategies used to address these health challenges may be adapted to strengthen health programs serving other populations who live in poverty or reside in low-resource settings.

  4. How Do Health Care Providers Diagnose Fragile X Syndrome? (United States)

    ... These symptoms may include delays in speech and language skills, social and emotional difficulties, and being sensitive to certain sensations. Children may also be delayed in or have problems with motor skills such as learning to walk. A health care provider can perform ...

  5. Theory in Practice: Helping Providers Address Depression in Diabetes Care (United States)

    Osborn, Chandra Y.; Kozak, Cindy; Wagner, Julie


    Introduction: A continuing education (CE) program based on the theory of planned behavior was designed to understand and improve health care providers' practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods: Participants completed assessments of attitudes, confidence,…

  6. Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease (United States)

    Thompson, Megan R.; Stone, Ramona F.; Ochs, V. Dan; Litvan, Irene


    In order to determine primary health care providers' (PCPs) knowledge gaps on Parkinson's disease, data were collected before and after a one-hour continuing medical education (CME) lecture on early Parkinson's disease recognition and treatment from a sample of 104 PCPs participating at an annual meeting. The main outcome measure was the…

  7. Climate change & infectious diseases in India: implications for health care providers. (United States)

    Dhara, V Ramana; Schramm, Paul J; Luber, George


    Climate change has the potential to influence the earth's biological systems, however, its effects on human health are not well defined. Developing nations with limited resources are expected to face a host of health effects due to climate change, including vector-borne and water-borne diseases such as malaria, cholera, and dengue. This article reviews common and prevalent infectious diseases in India, their links to climate change, and how health care providers might discuss preventive health care strategies with their patients.

  8. Winning market positioning strategies for long term care facilities. (United States)

    Higgins, L F; Weinstein, K; Arndt, K


    The decision to develop an aggressive marketing strategy for its long term care facility has become a priority for the management of a one-hundred bed facility in the Rocky Mountain West. Financial success and lasting competitiveness require that the facility in question (Deer Haven) establish itself as the preferred provider of long term care for its target market. By performing a marketing communications audit, Deer Haven evaluated its present market position and created a strategy for solidifying and dramatizing this position. After an overview of present conditions in the industry, we offer a seven step process that provides practical guidance for positioning a long term care facility. We conclude by providing an example application.


    Directory of Open Access Journals (Sweden)

    Papagiannopoulou E.


    Full Text Available The term domestic violence describes a violent behaviour that ranges from verbal abuse, physical and sexual assault to rape and homicide. The vast majority of domestic violence incidents involve men being violent to women that they do not “break their silence”, as they usually do not know from whom they can ask help. Domestic violence against women has been defined as an important problem of public health with serious consequences for women, which it offends their physical and emotional integrity in short and long-term period and causes negative social impact. Studies, that have been conducted by researchers who come from different health care systems, have developed important evaluation methods, action kit and screening tools in order to support women that are victims of intimate partner violence. The potential use of these tools by health care providers could contribute in the effective confrontation of such incidents. The failure of health care providers to identify intimate partner violence incidents and offer support to its victims, constitutes an important problem for which various factors are incriminated, such as their lack of special education, their negative attitude towards the victims, and their difficulty to comprehend why women stay in violent relationships. In conclusion, it is noticed that the assistance and support of women victims of domestic violence is a moral obligation for the health care providers.

  10. Storytelling: A Strategy for Providing Context for Learning. (United States)

    Billings, Diane M


    Storytelling--a narrative of events related to nursing and linked to evidence--provides a context for learning, particularly for learners who require a rich context to understand and integrate concepts related to patient care. This article offers suggestions for developing and using stories in nursing education.

  11. What do consumers and healthcare providers in West Virginia think of long-term care? (United States)

    Chandra, Ashish; Smith, Lisa A; Paul, David P


    In recent years, the media has portrayed long-term care in a negative light, with exposè news stories on skilled nursing facilities, personal care homes, and hospitals that provide long-term care. There have been few positive news stories to counter the negative ones, and there is concern that the public perception of long-term care is inaccurate. The authors conducted the following study to evaluate how the West Virginia consumer perceives and defines long-term care and if there is a difference in that perception as compared with healthcare workers' perceptions and definitions of long-term care. The results of the study indicate that the respondents' education level, not occupation, has the most significant influence on respondents' definitions and perceptions of long-term care. Respondents felt that although media articles are informative, they are not accurate, and that long-term care is a needed service they would consider both for themselves and for a loved one. The results of the study suggest that current marketing strategies employed by nursing homes are working, as respondents largely believe that long-term care is provided in nursing homes and that they would likely seek care there if needed.

  12. Preventing Child Abuse and Neglect: Parent-Provider Partnerships in Child Care (United States)

    Seibel, Nancy; Britt, Donna; Gillespie, Linda Groves; Parlakian, Rebecca


    This book is an innovative approach to the primary prevention of child maltreatment. It focuses on the impact that child care providers can make in helping to reduce the risk of abuse and neglect in families with very young children. This research- and practice-based curriculum offers concepts, information, strategies, and practices focused on…

  13. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers. (United States)

    Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N


    Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

  14. Innovation spaces: six strategies to inform health care. (United States)

    Dhar, Michael; Griffin, Margaret; Hollin, Ilene; Kachnowski, Stan


    Innovation remains an understudied resource within health care. Furthermore, the goals of US health care reform make innovation vitally important, while the time and resource limitations characteristic of health care make new strategies for innovation both necessary and potentially highly meaningful. The purpose of this study was to examine strategies for innovation in various industries and draw lessons for improving innovation in health care. This qualitative study began with literature research that provided a framework for discussion and identified a recurrent challenge in innovation: balancing the freedom to be creative with the need for structured management of ideas. Researchers then identified leading innovative companies and conducted phone interviews with innovation officers and other experts about their strategies for addressing the major innovation challenge. This article breaks out innovation strategies into 6 categories (dedicated times, formal teams, outside ideas, idea-sharing platforms, company/job goals, and incentives) and evaluates them for levels of control, yield, and pervasiveness. Based on this analysis, recommendations are offered for improving innovation in health care, calling for employee time allocated to innovation, dedicated innovation teams, and the incorporation of outside ideas.

  15. Combat Injuries: Providing Medical Care for all Veterans (United States)


    honorably, the U.S. Government is morally responsible for providing basic health care for the treatment of combat related injuries . This obligation...the treatment of combat related injuries . This obligation extends to injuries incurred in the line of duty regardless of the service member’s...full medical benefits, but to ensure he or she gets treatment for combat injuries regardless of the discharge. If the injury occurred under

  16. The influence of culture on immigrant women's mental health care experiences from the perspectives of health care providers. (United States)

    O'Mahony, Joyce Maureen; Donnelly, Tam Truong


    It is well documented that serious mental health problems such as depression, schizophrenia, and post migration stress disorders exist among immigrant women. Informed by Kleinman's explanatory model, this qualitative exploratory study was conducted with seven health care providers who provided mental health services to immigrant women. Analysis of the data revealed that (a) immigrant women face many difficulties when accessing mental health care services due to cultural differences, social stigma, and unfamiliarity with Western biomedicine, (b) spiritual beliefs and practices that influence immigrant women's mental health care practices, and (c) the health care provider-client relationship, which exerts great influence on how immigrant women seek mental health care. The study also revealed that cultural background exerts both positive and negative influences on how immigrant women seek mental health care. We suggest that although cultural knowledge and practices influence immigrant women's coping choices and strategies, awareness of social and economic differences among diverse groups of immigrant women is necessary to improve the accessibility of mental health care for immigrant women.

  17. Deficiencies in culturally competent asthma care for ethnic minority children: a qualitative assessment among care providers

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    Seeleman Conny


    Full Text Available Abstract Background Asthma outcomes are generally worse for ethnic minority children. Cultural competence training is an instrument for improving healthcare for ethnic minority patients. To develop effective training, we explored the mechanisms in paediatric asthma care for ethnic minority patients that lead to deficiencies in the care process. Methods We conducted semi-structured interviews on care for ethnic minority children with asthma (aged 4-10 years with paediatricians (n = 13 and nurses (n = 3 in three hospitals. Interviews were analysed qualitatively with a framework method, using a cultural competence model. Results Respondents mentioned patient non-adherence as the central problem in asthma care. They related non-adherence in children from ethnic minority backgrounds to social context factors, difficulties in understanding the chronic nature of asthma, and parents’ language barriers. Reactions reported by respondents to patients’ non-adherence included retrieving additional information, providing biomedical information, occasionally providing referrals for social context issues, and using informal interpreters. Conclusions This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence. Care providers do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children (e.g. communicating mainly from a biomedical perspective and using mostly informal interpreters. Therefore, the learning objectives of cultural competence training should reflect issues that care providers are aware of as well as issues they are unaware of.

  18. Consumer satisfaction with primary care provider choice and associated trust

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    Balkrishnan Rajesh


    Full Text Available Abstract Background Development of managed care, characterized by limited provider choice, is believed to undermine trust. Provider choice has been identified as strongly associated with physician trust. Stakeholders in a competitive healthcare market have competing agendas related to choice. The purpose of this study is to analyze variables associated with consumer's satisfaction that they have enough choice when selecting their primary care provider (PCP, and to analyze the importance of these variables on provider trust. Methods A 1999 randomized national cross-sectional telephone survey conducted of United States residential households, who had a telephone, had seen a medical professional at least twice in the past two years, and aged ≥ 20 years was selected for secondary data analyses. Among 1,117 households interviewed, 564 were selected as the final sample. Subjects responded to a core set of questions related to provider trust, and a subset of questions related to trust in the insurer. A previously developed conceptual framework was adopted. Linear and logistic regressions were performed based on this framework. Results Results affirmed 'satisfaction with amount of PCP choice' was significantly (p Conclusion This study confirmed the association of 'satisfaction with amount of PCP choice' with provider trust. Results affirmed 'enough PCP choice' was a strong predictor of provider trust. 'Second opinion on PCP' may indicate distrust in the provider. Data such as 'trust in providers in general' and 'the role of provider performance information' in choice, though import in PCP choice, were not available for analysis and should be explored in future studies. Results have implications for rethinking the relationships among consumer choice, consumer behaviors in making trade-offs in PCP choice, and the role of healthcare experiences in 'satisfaction with amount of PCP choice' or 'provider trust.'

  19. Treatment essentials and training for health care providers

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    Sunil M Jain


    Full Text Available The lack of awareness among health care providers (HCPs is one of the biggest challenges for the management of patients with type 1 diabetes mellitus (T1DM in India. Major challenges faced by HCPs include lack of awareness about the disease among general physicians and inadequately trained staff to deal with children with T1DM. The changing diabetes in children (CDiC program is helping in overcoming these barriers faced by HCPs. CDiC provides treatment, monitoring tools, and education to children affected with T1DM and has been instrumental is developing various education and awareness tools.

  20. Misalignment between medicare policies and depression care in home health care: home health provider perspectives. (United States)

    Bao, Yuhua; Eggman, Ashley A; Richardson, Joshua E; Bruce, Martha L


    Semistructured interviews with nurses working for home health care agencies in five states raise serious questions about the deleterious effects of Medicare policies and procedures on depression care. The agencies have strong incentives to limit nursing time in a given payment episode and to increase volume, making it difficult to provide high-quality depression care for homebound patients. Some nurses felt forced to "abandon" many patients with depression. The authors call for incremental policy changes in several key areas.

  1. Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care



    Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need for various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technolog...

  2. [Strategies for improving care of oncologic patients: SHARE Project results]. (United States)

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio


    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  3. Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services. (United States)

    Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Wu, Amina; Lam, Annie


    The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.

  4. Getting what we pay for: innovations lacking in provider payment reform for chronic disease care. (United States)

    Tynan, Ann; Draper, Debra A


    Despite wide recognition that existing physician and hospital payment methods used by health plans and other payers do not foster high-quality and efficient care for people with chronic conditions, little innovation in provider payment strategies is occurring, according to a new study by the Center for Studying Health System Change (HSC) commissioned by the California HealthCare Foundation. This is particularly disconcerting because the nation faces an increasing prevalence of chronic disease, resulting in continued escalation of related health care costs and diminished quality of life for more Americans. To date, most efforts to improve care of patients with chronic conditions have focused on paying vendors, such as disease management firms, to intervene with patients or redesigning care delivery without reforming underlying physician and hospital payment methods. While there is active discussion and anticipation of physician and hospital payment reform, current efforts are limited largely to experimental or small-scale pilot programs. More fundamental payment reform efforts in practice are virtually nonexistent. Existing payment systems, primarily fee for service, encourage a piecemeal approach to care delivery rather than a coordinated approach appropriate for patients with chronic conditions. While there is broad agreement that existing provider payment methods are not well aligned with optimal chronic disease care, there are significant barriers to reforming payment for chronic disease care, including: (1) fragmented care delivery; (2) lack of payment for non-physician providers and services supportive of chronic disease care; (3) potential for revenue reductions for some providers; and (4) lack of a viable reform champion. Absent such reform, however, efforts to improve the quality and efficiency of care for chronically ill patients are likely to be of limited success.

  5. Providing surgical care in Somalia: A model of task shifting

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    Ford Nathan P


    Full Text Available Abstract Background Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. Methods In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Results Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65% were male and the median age was 22 (interquartile range, 17-30. 1460 (70% of interventions were emergent. Trauma accounted for 76% (1585 of all surgical pathology; gunshot wounds accounted for 89% (584 of violent injuries. Operative mortality (0.5% of all surgical interventions was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. Conclusions The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully

  6. Transforming care teams to provide the best possible patient-centered, collaborative care. (United States)

    Sevin, Cory; Moore, Gordon; Shepherd, John; Jacobs, Tracy; Hupke, Cindy


    Patient experience of care is now a crucial parameter in assessing the quality of healthcare delivered in the United States. Continuity, patient-driven access to care, and being "known" by a provider or practice, particularly for patients with chronic diseases, have been shown to enhance patient satisfaction with care and health outcomes. Healthcare systems are challenged to effectively meet the wants and needs of patients by tailoring interventions based on each person's unique set factors-his or her strengths, preferences, and personal and social context. Creating care teams, a coordinated multidisciplinary group of healthcare professionals, enables a practice to take advantage of the skill sets represented and redesign care delivery with the patient and community as the focal point. This article describes the attributes of highly functioning care teams, how to measure them, and guidance on creating them. A case example illustrates how these ideas work in practice.

  7. Spiritual Care Training Provided to Healthcare Professionals: A Systematic Review. (United States)

    Paal, Piret; Helo, Yousef; Frick, Eckhard


    This systematic review was conducted to assess the outcomes of spiritual care training. It outlines the training outcomes based on participants' oral/written feedback, course evaluation and performance assessment. Intervention was defined as any form of spiritual care training provided to healthcare professionals studying/working in an academic and/or clinical setting. An online search was conducted in MEDLINE, EMBASE, CINAHL, Web of Science, ERIC, PsycINFO, ASSIA, CSA, ATLA and CENTRAL up to Week 27 of 2013 by two independent investigators to reduce errors in inclusion. Only peer-reviewed journal articles reporting on training outcomes were included. A primary keyword-driven search found 4912 articles; 46 articles were identified as relevant for final analysis. The narrative synthesis of findings outlines the following outcomes: (1) acknowledging spirituality on an individual level, (2) success in integrating spirituality in clinical practice, (3) positive changes in communication with patients. This study examines primarily pre/post-effects within a single cohort. Due to an average study quality, the reported findings in this review are to be seen as indicators at most. Nevertheless, this review makes evident that without attending to one'the repeliefs and needs, addressing spirituality in patients will not be forthcoming. It also demonstrates that spiritual care training may help to challenge the spiritual vacuum in healthcare institutions.

  8. Quality of Care Provided by a Comprehensive Dementia Care Comanagement Program. (United States)

    Jennings, Lee A; Tan, Zaldy; Wenger, Neil S; Cook, Erin A; Han, Weijuan; McCreath, Heather E; Serrano, Katherine S; Roth, Carol P; Reuben, David B


    Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators (QIs) ranging from 18% to 42%. In response, the University of California at Los Angeles (UCLA) Health System created the UCLA Alzheimer's and Dementia Care (ADC) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers (DCM) working with primary care physicians and community-based organizations to provide comprehensive dementia care. The objective was to measure the quality of dementia care that nurse practitioner DCMs provide using the Assessing Care of Vulnerable Elders (ACOVE-3) and Physician Consortium for Performance Improvement QIs. Participants included 797 community-dwelling adults with dementia referred to the UCLA ADC program over a 2-year period. UCLA is an urban academic medical center with primarily fee-for-service reimbursement. The percentage of recommended care received for 17 dementia QIs was measured. The primary outcome was aggregate quality of care for the UCLA ADC cohort, calculated as the total number of recommended care processes received divided by the total number of eligible quality indicators. Secondary outcomes included aggregate quality of care in three domains of dementia care: assessment and screening (7 QIs), treatment (6 QIs), and counseling (4 QIs). QIs were abstracted from DCM notes over a 3-month period from date of initial assessment. Individuals were eligible for 9,895 QIs, of which 92% were passed. Overall pass rates of DCMs were similar (90-96%). All counseling and assessment QIs had pass rates greater than 80%, with most exceeding 90%. Wider variation in adherence was found among QIs addressing treatments for dementia, which patient-specific criteria triggered, ranging from 27% for discontinuation of medications associated with mental status changes to 86% for discussion about acetylcholinesterase inhibitors. Comprehensive


    Directory of Open Access Journals (Sweden)

    Olawale Ibrahim Olateju


    Full Text Available We examine the TQM Strategies and health care delivery in Nigeria, and the various means of measuring service quality. Nigeria continues to suffer outbreaks of various diseases cholera, malaria, cerebrospinal meningitis, measles, yellow fever, Bird flu e.t.c., all these diseases combine to cause high morbidity and mortality in the population. To assess the situation this paper looks at the relevant indicators like Annual Budgets by Government, Individual’s income, the role of Nigerian Medical Association (NMA and various health care agencies vested with the sole responsibility for elaborating standards for products and processes in Health care Delivery.The paper also examines the implication of Government Budget estimates on the Life expectancy of an average Nigerian. The findings necessitated the need for the government to seek support from WHO to assist in strengthening the health care system by advocating and providing technical support to health sector reforms.

  10. Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers. (United States)

    Harlan, Gregory A; Nkoy, Flory L; Srivastava, Rajendu; Lattin, Gena; Wolfe, Doug; Mundorff, Michael B; Colling, Dayvalena; Valdez, Angelika; Lange, Shay; Atkinson, Sterling D; Cook, Lawrence J; Maloney, Christopher G


    Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.

  11. Conflict across organizational boundaries: managed care organizations versus health care providers. (United States)

    Callister, R R; Wall, J A


    This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions.

  12. Push and pull strategies: applications for health care marketing. (United States)

    Kingsley, B R


    As health care markets mature and expand, strategies available in other industries become useful. This article examines how traditional push-pull strategies apply to health care. Marketers using a push strategy recognize that the sale of their services or goods is dependent upon the endorsement of a middleman and promote their product through the middleman. Those using a pull strategy market directly to the consumer. In this article, the author outlines the advantages and disadvantages of using each strategy.

  13. Health care providers' perspective of the gender influences on immigrant women's mental health care experiences. (United States)

    O'Mahony, Joyce M; Donnelly, Tamphd T


    The number of immigrants coming to Canada has increased in the last three decades. It is well documented that many immigrant women suffer from serious mental health problems such as depression, schizophrenia, and post migration stress disorders. Evidence has shown that immigrant women experience difficulties in accessing and using mental health services. Informed by the post-colonial feminist perspective, this qualitative exploratory study was conducted with seven health care providers who provide mental health services to immigrant women. In-depth interviews were used to obtain information about immigrant women's mental health care experiences. The primary goal was to explore how contextual factors intersect with race, gender, and class to influence the ways in which immigrant women seek help and to increase awareness and understanding of what would be helpful in meeting the mental health care needs of the immigrant women. The study's results reveal that (a) immigrant women face many difficulties accessing mental health care due to insufficient language skills, unfamiliarity/unawareness of services, and low socioeconomic status; (b) participants identified structural barriers and gender roles as barriers to accessing the available mental health services; (c) the health care relationship between health care providers and women had profound effects on whether or not immigrant women seek help for mental health problems.

  14. Self - care strategies among risky profession workers

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    Katarína Vasková


    colleagues, that can help in dealing with risky situations and therefore shouldn´t be overlooked. In comparison with non-risky professions professionals care significantly more about their physical and psychical health. Closer analysis showed some uniqueness with respect to a particular type of risky profession. Police officers and fire fighters are more interested in their physical condition, which is important for example in rescuing a person from an object in fire or in a situation where physical force needs to be used. In comparison with it, paramedics use more psychical self-care strategies, namely they are trying more to control their negative emotional state, to minimize risky situation and to preserve health. Lastly they are caring more about their personal improvement. This study has several limits. Equality of gender in sample should be taken to account in future researches. We also recommend to involve other risky professions to the analysis (for example soldiers. Results can be used as a basis for trainee or education programs, which could help professionals in dealing with traumatic situations.

  15. Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials

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    Allen Kelli D


    Full Text Available Abstract Background Osteoarthritis (OA of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care. Methods / Design One study is being conducted within the Department of Veterans Affairs (VA health care system and will compare a Combined Patient and Provider intervention relative to usual care among n = 300 patients (10 from each of 30 primary care providers. Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider interventions relative to usual care among n = 560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection, based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function, and

  16. Engaging primary care physicians in quality improvement: lessons from a payer-provider partnership. (United States)

    Lemak, Christy Harris; Cohen, Genna R; Erb, Natalie


    A health insurer in Michigan, through its Physician Group Incentive Program, engaged providers across the state in a collection of financially incentivized initiatives to transform primary care and improve quality. We investigated physicians' and other program stakeholders' perceptions of the program through semistructured interviews with more than 80 individuals. We found that activities across five areas contributed to successful provider engagement: (1) developing a vision of improving primary care, (2) deliberately fostering practice-practice partnerships, (3) using existing infrastructure, (4) leveraging resources and market share, and (5) managing program trade-offs. Our research highlights effective strategies for engaging primary care physicians in program design and implementation processes and creating learning communities to support quality improvement and practice change.

  17. Vietnamese Health Care Providers' Preferences Regarding Recommendation of HPV Vaccines. (United States)

    Asiedu, Gladys B; Breitkopf, Carmen Radecki; Kremers, Walter K; Ngo, Quang V; Nguyen, Nguyen V; Barenberg, Benjamin J; Tran, Vinh D; Dinh, Tri A


    Physician recommendation is an important predictor of HPV vaccine acceptance; however, physician willingness and preferences regarding HPV vaccination may be influenced by factors including patient age, vaccine type, and cost. A cross-sectional survey was administered to a convenience sample of health care providers in Da Nang, Vietnam, to evaluate awareness, perceptions about HPV and HPV vaccines, and willingness to vaccinate a female patient. Willingness to vaccinate was evaluated using a full-factorial presentation of scenarios featuring the following factors: vaccine cost (free vs 1,000,000 VND), patient age (12, 16, or 22 years), and HPV vaccine type (bivalent vs quadrivalent). Responses from 244 providers were analyzed; providers had a mean age of 34±11.9 years; a majority were female, married, and had children of their own. Thirty-six percent specialized in obstetrics/gynecology and 24% were providers in family medicine. Of the three factors considered in conjoint analysis, vaccine cost was the most important factor in willingness to vaccinate, followed by patient age, and vaccine type. The most favorable scenario for vaccinating a female patient was when the vaccine was free, the patient was 22 years of age, and the HPV4 vaccine was described. In multivariable analysis, older age, being a physician, being married, and having children were all associated with increased willingness to recommend HPV vaccination (p<0.05). Provider willingness is an important aspect of successful HPV vaccination programs; identifying preferences and biases in recommendation patterns will highlight potential areas for education and intervention.

  18. Strategies on Reducing Social Inequalitiesin Health Care

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    Sofia Zyga; Vasilios Kanellopoulos; Helen Bakola


    Full Text Available Health was and will always be the supreme good for human kind. From this scope, people should have equal opportunities for health and all healthcare systems must be build around the term of equity. The aim of this review article is to present, through extensive literature and relevant articles review from Internet, the main aspects of todays inequalities in healthcare provision and the strategies that must be followed so as different social-economical groups have the same access in health care. Also special credit is given on how the political systems must design their healthcare policies according to the facts (social-economical layers and status of their citizens (diseases.

  19. Supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking: views of antenatal care providers and pregnant indigenous women. (United States)

    Passey, Megan E; Sanson-Fisher, Rob W; Stirling, Janelle M


    To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85-90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.

  20. Pregnant at work: time for prenatal care providers to act. (United States)

    Karkowsky, Chavi Eve; Morris, Liz


    Fifty years ago, when a woman became pregnant, she was expected to stop working. Today, however, most women who work are the primary, sole, or co-breadwinner for their families, and their earnings during pregnancy are often essential to their families' economic well-being. Medical data about working during pregnancy are sparse but generally show that both low-risk and high-risk women can tolerate work-related duties well, although some work accommodations (eg, providing a chair for sitting, allowing snacks, or modifying the work schedule) may be necessary. However, some employers refuse to accommodate pregnant women who need adjustments. This can result in a woman being forced to make the choice between working without accommodations and losing her income and health insurance or even her job. Prenatal care providers can play an important role by implementing changes in their own practice, shaping public policy, and conducting research to increase protections for pregnant women and to ensure that they receive medically recommended accommodations while continuing to earn income for their growing families.


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    Ljaljević Agima


    Full Text Available Introduction: The aim of this study was to determine perceptions of service providers in the healthcare on their awareness and knowledge about HIV/AIDS, as well as the relationship of the above parameters and the existence of stigma and discrimination against people with HIV/AIDS. Method: The type of the study was a behavioral cross sectional study. The survey was conducted in 2012, on a representative sample of health workers in Montenegro. The main survey instrument was specifically designed questionnaire that consisted of six parts, out of which one was related to knowledge about HIV and AIDS. Data were analyzed by methods of inferential statistics. Results: More than four out of ten respondents have never attended educational workshops on HIV/AIDS. Research has shown that there is a highly significant statistical correlation between estimates of their own knowledge about HIV / AIDS and previous educations. Almost two-thirds of respondents, who attended some type of education in the field of HIV/AIDS, believe to have a satisfactory level of knowledge in the area. Conclusion: Health care service providers evaluate their knowledge of HIV/AIDS as insufficient.

  2. Qualitative evaluation of a Positive Prevention training for health care providers in Mozambique. (United States)

    Gutin, Sarah A; Cummings, Beverley; Jaiantilal, Prafulta; Johnson, Kelly; Mbofana, Francisco; Dawson Rose, Carol


    The rapid scale-up of HIV care and treatment in Mozambique has provided an opportunity to reach people living with HIV (PLHIV) with prevention interventions in HIV care and treatment settings. A three-day Positive Prevention (PP) training intervention for health care providers that focused on pressing issues for PLHIV in Mozambique was adapted and delivered at sites in three provinces. In-depth interviews were conducted with 31 providers trained in the PP curriculum. Qualitative data were used to assess the appropriateness of the training materials and approach, which lessons providers learned and were able to implement and which PP messages were still difficult to deliver. Providers reported gaining numerous insights from the training, including how to conduct a risk assessment and client-centered counseling, negotiating disclosure, partner testing, condom use, PMTCT, treatment adherence and approaches for positive living. Training topics not commonly mentioned included discordance counseling, STIs, family planning, alcohol and drug use, and frank sexual risk discussions. While areas for improvement exist, the PP training was useful in transferring skills to providers and is a viable component of HIV care. This evaluation helps identify areas where future PP trainings and specific strategies and messages can be refined for the Mozambican context.

  3. The human factor: the critical importance of effective teamwork and communication in providing safe care. (United States)

    Leonard, M; Graham, S; Bonacum, D


    Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

  4. Tuberculosis treatment managed by providers outside the Public Health Department: lessons for the Affordable Care Act.

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    Melissa Ehman

    Full Text Available INTRODUCTION: Tuberculosis (TB requires at least six months of multidrug treatment and necessitates monitoring for response to treatment. Historically, public health departments (HDs have cared for most TB patients in the United States. The Affordable Care Act (ACA provides coverage for uninsured persons and may increase the proportion of TB patients cared for by private medical providers and other providers outside HDs (PMPs. We sought to determine whether there were differences in care provided by HDs and PMPs to inform public health planning under the ACA. METHODS: We conducted a retrospective, cross-sectional analysis of California TB registry data. We included adult TB patients with culture-positive, pulmonary TB reported in California during 2007-2011. We examined trends, described case characteristics, and created multivariate models measuring two standards of TB care in PMP- and HD-managed patients: documented culture conversion within 60 days, and use of directly observed therapy (DOT. RESULTS: The proportion of PMP-managed TB patients increased during 2007-2011 (p = 0.002. On univariable analysis (N = 4,606, older age, white, black or Asian/Pacific Islander race, and birth in the United States were significantly associated with PMP care (p<0.05. Younger age, Hispanic ethnicity, homelessness, drug or alcohol use, and cavitary and/or smear-positive TB disease, were associated with HD care. Multivariable analysis showed PMP care was associated with lack of documented culture conversion (adjusted relative risk [aRR] = 1.37, confidence interval [CI] 1.25-1.51 and lack of DOT (aRR = 8.56, CI 6.59-11.1. CONCLUSION: While HDs cared for TB cases with more social and clinical complexities, patients under PMP care were less likely to receive DOT and have documented culture conversion. This indicates a need for close collaboration between PMPs and HDs to ensure that optimal care is provided to all TB patients and TB transmission is

  5. Primary Medical Care Provider Accreditation (PMCPA): pilot evaluation.

    NARCIS (Netherlands)

    Campbell, S.M.; Chauhan, U.; Lester, H.


    BACKGROUND: While practice-level or team accreditation is not new to primary care in the UK and there are organisational indicators in the Quality and Outcomes Framework (QOF) organisational domain, there is no universal system of accreditation of the quality of organisational aspects of care in the

  6. Culture and religion in nursing: providing culturally sensitive care. (United States)

    Mendes, Aysha

    Last month, Aysha Mendes discussed the impact on care of personal beliefs held by both nurses and patients. This month, she delves into the aspects of culture and religion, which form important pieces of this puzzle, as well as the importance of culturally appropriate care provision in nursing practice.

  7. Ghana's National Health Insurance Scheme: insights from members, administrators and health care providers. (United States)

    Barimah, Kofi Bobi; Mensah, Joseph


    The Ghana National Health Insurance Scheme (NHIS) was established as part of a poverty reduction strategy to make health care more affordable to Ghanaians. It is envisaged that it will eventually replace the existing cash-and-carry system. This paper examines the views of NHIS administrators, members/enrollees, and health care providers on how the Scheme operates in practice. It is part of a larger evaluation project on Ghana's NHIS, sponsored by the Bill and Melinda Gates Foundation and the Global Development Network as part of a two-year global research. We rely primarily on qualitative data from focus group discussion in the Brong Ahafo and the Upper East regions respectively. Our findings suggest that the NHIS has improved access to affordable health care services and prescription drugs to many people in Ghana. However, there are concerns about fraud and corruption that must be addressed if the Scheme is to be financially viable.

  8. 76 FR 9968 - Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws (United States)


    ... rights afforded to health care providers, including medical students, under the federal health care... regulatory enforcement scheme to protect the rights afforded to health care providers, including medical... beliefs. They were never intended to allow providers to refuse to ] provide medical care to an...

  9. Not Babysitting: Work Stress and Well-Being for Family Child Care Providers (United States)

    Gerstenblatt, Paula; Faulkner, Monica; Lee, Ahyoung; Doan, Linh Thy; Travis, Dnika


    Family child care providers contend with a number of work stressors related to the dual roles of operating a small business and providing child care in their home. Research has documented many sources of work related stress for family child care providers; however, research examining family child care providers' experiences outside of the…

  10. Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training. (United States)

    Green, Bonnie L; Saunders, Pamela A; Power, Elizabeth; Dass-Brailsford, Priscilla; Schelbert, Kavitha Bhat; Giller, Esther; Wissow, Larry; Hurtado de Mendoza, Alejandra; Mete, Mihriye


    Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma's effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.

  11. Strengths of primary healthcare regarding care provided for chronic kidney disease 1 (United States)

    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


    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

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

    Directory of Open Access Journals (Sweden)

    Elaine Amaral de Paula

    Full Text Available 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

  13. Can We Help Care Providers Communicate More Effectively With Persons Having Dementia Living in Long-Term Care Homes? (United States)

    Rochon, Elizabeth; Sidani, Souraya; Shaw, Alexander; Ben-David, Boaz M.; Saragosa, Marianne; Boscart, Veronique M.; Wilson, Rozanne; Galimidi-Epstein, Karmit K.


    Background: Effective communication between residents with dementia and care providers in long-term care homes (LTCHs) is essential to resident-centered care. Purpose: To determine the effects of a communication intervention on residents’ quality of life (QOL) and care, as well as care providers’ perceived knowledge, mood, and burden. Method: The intervention included (1) individualized communication plans, (2) a dementia care workshop, and (3) a care provider support system. Pre- and postintervention scores were compared to evaluate the effects of the intervention. A total of 12 residents and 20 care providers in an LTCH participated in the feasibility study. Results: The rate of care providers’ adherence to the communication plans was 91%. Postintervention, residents experienced a significant increase in overall QOL. Care providers had significant improvement in mood and perceived reduced burden. Conclusion: The results suggest that the communication intervention demonstrates preliminary evidence of positive effects on residents’ QOL and care providers’ mood and burden. PMID:27899433

  14. The Impact of Technology on Patients, Providers, and Care Patterns. (United States)

    Fagerhaugh, Shizuko; And Others


    Examines the problems technical innovation has brought to health care professionals, administrators, and patients from the standpoints of increased specialization, equipment obsolescence, bureaucracy, retraining, regulations, high costs of services, depersonalization, and ethical dilemmas. (CT)

  15. OIG’s Compliance Resources for Health Care Providers (United States)

    U.S. Department of Health & Human Services — OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing...

  16. Child Care Teachers' Strategies in Children's Socialization of Emotion (United States)

    Ahn, Hey Jun


    An observational study was conducted to examine teachers' emotional socialization strategies in three child care centers. Qualitative analysis of the data suggests that teachers in child care centers respond to children's emotional expressions with various strategies. Teachers clearly expressed a preference for positive emotion through verbal…

  17. Divorce and Childhood Chronic Illness: A Grounded Theory of Trust, Gender, and Third-Party Care Providers. (United States)

    Russell, Luke T; Coleman, Marilyn; Ganong, Lawrence H; Gayer, Debra


    Divorced parents face distinct challenges in providing care for chronically ill children. Children's residence in two households necessitates the development of family-specific strategies to ensure coparents' supervision of regimen adherence and the management of children's health care. Utilizing a risk and resilience perspective, a grounded theory study was conducted with 14 divorced parents of children with chronic illnesses. The importance of trust, gender, and relationships with third-party care providers emerged as key themes related to the development of effective coparenting relationships for maintaining children's health. Divorced parents were best able to support the management of their children's chronic conditions when care providers operated as neutral third parties and intermediaries. Collaborative family care may require health care practitioners to avoid being drawn into contentious inter-parental conflicts.

  18. The strategy, cost, and progress of primary health care. (United States)

    Boland, R G; Young, M E


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

  19. Antenatal and obstetric care in Afghanistan – a qualitative study among health care receivers and health care providers (United States)


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

  20. Improving breast care: providing, guiding, expertise, and leadership. (United States)

    Granai, Cornelius O; Orr, James W


    Optimal healthcare blends timeless doctor-patient values with state-of-the-art medical knowledge. The physician's role varies from delivering therapies to guiding patients through the healthcare maze to their best decisions. Breast care should not be parceling out of anatomic parts, as if biological relationships do not exist. Instead, it should stem from an understanding of the "total woman"--biological and otherwise--and how important that unity is for quality of life, even when confronting breast cancer. Breast fellowships for gynecologic and general surgeons create superior clinicians and better patient advocates -essential in advancing women-centric care and healthcare leadership.

  1. Care Transitions: Using Narratives to Assess Continuity of Care Provided to Older Patients after Hospital Discharge (United States)

    Wong, Carolyn; Hogan, David B.


    Background A common scenario that may pose challenges to primary care providers is when an older patient has been discharged from hospital. The aim of this pilot project is to examine the experiences of patients’ admission to hospital through to discharge back home, using analysis of patient narratives to inform the strengths and weaknesses of the process. Methods For this qualitative study, we interviewed eight subjects from the Sheldon M. Chumir Central Teaching Clinic (CTC). Interviews were analyzed for recurring themes and phenomena. Two physicians and two resident learners employed at the CTC were recruited as a focus group to review the narrative transcripts. Results Narratives generally demonstrated moderate satisfaction among interviewees with respect to their hospitalization and follow-up care in the community. However, the residual effects of their hospitalization surprised five patients, and five were uncertain about their post-discharge management plan. Conclusion Both secondary and primary care providers can improve on communicating the likely course of recovery and follow-up plans to patients at the time of hospital discharge. Our findings add to the growing body of research advocating for the implementation of quality improvement measures to standardize the discharge process. PMID:27729948

  2. Providing holistic care for women with chronic pelvic pain. (United States)

    Abercrombie, Priscilla D; Learman, Lee A


    Chronic pelvic pain (CPP) is one of the most common pain conditions affecting women and can have a significant impact on quality of life. Assessment of women with CPP is best approached in a comprehensive, systematic manner that includes exploration of physiological and psychological causes. A range of treatment options that draw from conventional medicine and complementary and alternative modalities should be offered. The women's health nurse plays a pivotal role in all aspects of care.

  3. Determinants of the Level of Care Provided for Various Types and Sizes of Dogs in New Providence, The Bahamas


    Fielding, William J.


    This paper reports the level of care offered 424 dogs, classified as small dogs, large dogs, pit bulls and potcakes (the colloquial name for the local mongrel) in New Providence, The Bahamas. Levels of care that meet the legal minimum –food water and shelter– as well as care considered essential and enriched in The Bahamas were less common for large dogs than small dogs. Small dogs tended to get more care than other dogs and so were at lowest risk of being neglected.It is suggested that the s...

  4. In the right words: addressing language and culture in providing health care. (United States)


    As part of its continuing mission to serve trustees, executives, and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from philanthropy, research, health care practice, and policy on April 4, 2003, to discuss the roles of language and culture in providing effective health care. During this Issue Dialogue, In the Right Words: Addressing Language and Culture in Providing Health Care, health grantmakers and experts from policy and practice participated in an open exchange of ideas and perspectives on language access and heard from fellow grantmakers who are funding innovative programs in this area. Together they explored ways to effectively support comprehensive language services, including the use of interpreters and translation of written materials. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It focuses on the challenges and opportunities involved with ensuring language access for the growing number of people who require it. Sections include: recent immigration trends and demographic changes; the effect of language barriers on health outcomes and health care processes; laws and policies regarding the provision of language services to patients, including an overview of public financing mechanisms; strategies for improving language access, including enhancing access in delivery settings, promoting advocacy and policy change, improving interpreter training, and advancing research; and roles for foundations in supporting improved language access, including examples of current activities. The Issue Dialogue focused mainly on activities and programs that ensure linguistic access to health care for all patients. Although language and culture are clearly inseparable, a full exploration of the field of cultural competence and initiatives that promote its application to the health care setting are beyond the scope

  5. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans. (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C


    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care.

  6. The Study of Frequency Self Care Strategies against Auditory Hallucinations

    Directory of Open Access Journals (Sweden)

    Mahin Nadem


    Full Text Available Background: In schizophrenic clients, self-care strategies against auditory hallucinations can decrease disturbances results in hallucination. This study was aimed to assess frequency of self-care strategies against auditory hallucinations in paranoid schizophrenic patients, hospitalized in Shafa Hospital.Materials and Method: This was a descriptive study on 201 patients with paranoid schizophrenia hospitalized in psychiatry unit with convenience sampling in Rasht. The gathered data consists of two parts, first unit demographic characteristic and the second part, self- report questionnaire include 38 items about self-care strategies.Results: There were statistically significant relationship between demographic variables and knowledg effect and self-care strategies against auditory hallucinaions. Sex with phisical domain p0.07, marriage status with cognitive domain (p>0.07 and life status with behavioural domain (p>0.01. 53.2% of reported type of our auditory hallucinations were command hallucinations, furtheremore the most effective self-care strategies against auditory hallucinations were from physical domain and substance abuse (82.1% was the most effective strategies in this domain.Conclusion: The client with paranoid schizophrenia used more than physical domain strategies against auditory hallucinaions and this result highlight need those to approprait nursing intervention. Instruction and leading about selection the effective self-care strategies against auditory ha

  7. Unanswered clinical questions: a survey of specialists and primary care providers* (United States)

    Gunn, Bridget; Shenoy, Anant M.; Blanchard, Rebecca


    Objective With the myriad of cases presented to clinicians every day at our integrated academic health system, clinical questions are bound to arise. Clinicians need to recognize these knowledge gaps and act on them. However, for many reasons, clinicians might not seek answers to these questions. Our goal was to investigate the rationale and process behind these unanswered clinical questions. Subsequently, we explored the use of biomedical information resources among specialists and primary care providers and identified ways to promote more informed clinical decision making. Methods We conducted a survey to assess how practitioners identify and respond to information gaps, their background knowledge of search tools and strategies, and their usage of and comfort level with technology. Results Most of the 292 respondents encountered clinical questions at least a few times per week. While the vast majority often or always pursued answers, time was the biggest barrier for not following through on questions. Most respondents did not have any formal training in searching databases, were unaware of many digital resources, and indicated a need for resources and services that could be provided at the point of care. Conclusions While the reasons for unanswered clinical questions varied, thoughtful review of the responses suggested that a combination of educational strategies, embedded librarian services, and technology applications could help providers pursue answers to their clinical questions, enhance patient safety, and contribute to patient-based, self-directed learning. PMID:28096740

  8. Providing support to doctors working in intensive care

    LENUS (Irish Health Repository)

    Murphy, JFA


    ‘Jading’ is a process of exhaustion in which apathy and cynicism replace the drive to be responsive and caring. ‘Burnout’ a term first coined in the psychology literature in 1974 was based on Graham Greene’s novel ‘A Burnt-Out Case1. It is the umbrella description for disengagement in the workplace setting characterised by withdrawal, denial and inefficiency. There is an alienation from the pressures of work. Marshall and Kasman2 defined it as ‘the loss of motivation for creative thought’. It is the opposite of engagement which is associated with energy and optimism. People who experience all 3 symptoms- emotional exhaustion, negative attitude towards patients, reduced sense of personal accomplishment- have the greatest degree of burnout. It doesn’t get better by being ignored. These processes have serious consequences for the individual involved and the hospital that they work in. The doctor underperforms and the Unit becomes dysfunctional There is decreased quality of care, increased absenteeism, and high staff turnover. There is an inability to make decisions and a failure to set priorities.

  9. Can we select health professionals who provide safer care. (United States)

    Firth-Cozens, J; Cording, H; Ginsburg, R


    In order to improve patient safety, health services are looking to other industries' experiences and as a result are adopting a systems approach to learning from error, rather than simply focusing the blame on the individual. However, in health care the individual will remain an important contributor to safety and this paper looks at other literatures besides health to consider a number of individual characteristics and the role they might play in terms of work practices that affect patient safety. It considers the effects of a variety of personality profiles including sensation seeking, Type A, and those with high self esteem; looks at our ability to select for psychological wellbeing; and discusses the ways that psychometrics have been used in medicine to predict performance. It concludes that although rarely used, psychometrics has been shown to be useful in predicting some aspects of performance in medicine and suggests that this is an area well worth further study for the benefit of patient care. Nevertheless, we are a long way away from being able to select safer staff and should instead be developing this knowledge to enable us to recognise and address potential difficulties.

  10. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    Directory of Open Access Journals (Sweden)

    Kimberly Ramsbottom


    Full Text Available Long term care (LTC homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide “resident-centred care”; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.

  11. Coping strategies of nurses in the care of patients with head and neck neoplasms

    Directory of Open Access Journals (Sweden)

    Naira Agostini Rodrigues dos Santos

    Full Text Available Abstract OBJECTIVE To understand and describe the experience of the development of coping strategies during the professional life of nurses providing care to patients with facial image alteration. METHOD Descriptive qualitative study with a hermeneutic-dialectic framework conducted in the head and neck ward of a reference hospital in Rio de Janeiro, with the participation of eight nurses and data produced through semi-structured interviews conducted between June and August 2013. RESULTS Three major impressions were found: initial estrangement and complexity, consisting in the care given to patients with facial image alteration; a threshold between estrangement and coping, corresponding to the emergence of coping strategies during care; and image-likeness as a (recognition of the individual with facial image alteration in the development and consolidation of coping strategies during care. CONCLUSION Among other contributions, the identification and understanding of coping strategies may contribute to better qualify nursing education and care.

  12. Whose Knowledge Counts? : A Study of Providers and Users of Antenatal Care in Rural Zimbabwe



    This thesis presents perspectives and experiences of different stakeholders and their ways of reasoning around pregnancy and pregnancy care. Data were generated from individual interviews with 25 health care providers, 18 women and 6 traditional birth attendants (TBAs) as well as 11 focus groups discussions with women, men and TBAs. The challenges experienced by health care providers in their provision of antenatal care, while attempting to change antenatal care through routines proven to ha...

  13. Better Together: Co-Location of Dental and Primary Care Provides Opportunities to Improve Oral Health. (United States)

    Pourat, Nadereh; Martinez, Ana E; Crall, James J


    Community Health Centers (CHCs) are one of the principal safety-net providers of health care for low-income and uninsured populations. Co-locating dental services in primary care settings provides an opportunity to improve access to dental care. Yet this study of California CHCs that provide primary care services shows that only about one-third of them co-located primary and dental care services on-site. An additional one-third were members of multisite organizations in which at least one other site provided dental care. The remaining one-third of CHC sites had no dental care capacity. Policy options to promote co-location include requiring on-site availability of dental services, providing infrastructure funding to build and equip dental facilities, and offering financial incentives to provide dental care and recruit dental providers.

  14. Physician Perspectives on Providing Primary Medical Care to Adults with Autism Spectrum Disorders (ASD) (United States)

    Warfield, Marji Erickson; Crossman, Morgan K.; Delahaye, Jennifer; Der Weerd, Emma; Kuhlthau, Karen A.


    We conducted in-depth case studies of 10 health care professionals who actively provide primary medical care to adults with autism spectrum disorders. The study sought to understand their experiences in providing this care, the training they had received, the training they lack and their suggestions for encouraging more physicians to provide this…

  15. Primary Care Providers' Perceptions of and Experiences with an Integrated Healthcare Model (United States)

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


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

  16. "Children's Play: An Introduction for Care Providers" by Vicki Mulligan. [Book Review]. (United States)

    LeMare, Lucy


    Notes the limited usefulness of Mulligan's book for student care-providers; its strengths lie in usability for students and instructors; its encouragement of care providers to be reflective, responsive professionals; and in the scope of topics discussed. Examines each book chapter in terms of usefulness for assisting care providers in assuming…

  17. Capital structure strategy in health care systems. (United States)

    Wheeler, J R; Smith, D G; Rivenson, H L; Reiter, K L


    The capital structures (the relative use of debt and equity to support assets) of leading health care systems are viewed as a strategic component of their financial plans. While not-for-profit hospitals as a group have maintained nearly constant levels of debt over the past decade, investor-owned hospitals and a group of leading health care systems have reduced their relative use of debt. Chief financial officers indicated that in addition to reducing debt because of less favorable reimbursement incentives, there was a focus on maintaining high bond ratings. Debt levels have not been reduced as sharply in these health care systems as they have in investor-owned hospitals, in part due to the use of debt to support investments in financial markets. Because these health care systems do not have easy access to equity, high bond ratings and solid investment earnings are central to their capital structure policies of preserving access to debt markets.

  18. Health Care Marketing: Opinions of Providers. North Dakota Economic Studies, Number 46. (United States)

    Anderson, Donald G.; And Others

    The health care industry in the United States has undergone tremendous change. Health care providers must view their health care delivery organizations as businesses and must use the tools of business, including marketing. Most research on health care marketing has focused on the practices of large, urban facilities. Little work has been…

  19. A pilot study: Reiki for self-care of nurses and healthcare providers. (United States)

    Brathovde, Angela


    The purpose of this study was to determine if Reiki energy therapy, level I, was taught as a self-care practice to healthcare providers, would their caring perceptions change? Methodological triangulation technique, including a self-report caring scale and interviews, was used, demonstrating positive changes in perceptions of participants' caring behaviors.

  20. Care management actions in the Family Health Strategy

    Directory of Open Access Journals (Sweden)

    Marcelo Costa Fernandes


    Full Text Available Objective: to identify, from nurses’ speeches, the actions that enable care management in the Family Health Strategy.Methods: descriptive study with a qualitative approach conducted with 32 nurses of primary care. It was used a semistructuredinterview as the data collection technique. The methodological process of the collective subject discourse wasused to organize the data Results: from the nurses’ speeches one identified the categories: complementary relationshipbetween care and management; meeting with community health agents, a care management strategy in nurses’ work;health education activities such as a care management action and a health information system as an essential tool forcare Conclusion: it was possible to observe that nurses understood the importance of coordination and complementaritybetween the activities of the working process of care and management.

  1. [Evaluation of the welcoming strategies in the Intensive Care Unit]. (United States)

    Maestri, Eleine; do Nascimento, Eliane Regina Pereira; Bertoncello, Kátia Cilene Godinho; de Jesus Martins, Josiane


    This qualitative study was performed at the adult Intensive Care Unit (ICU) of a public hospital in Southern Brazil with the objective to evaluate the implemented welcoming strategies. Participants included 13 patients and 23 relatives. Data collection was performed from July to October 2008, utilizing semi-structured interviews. All interviews were recorded. Data analysis was performed using the Collective Subject Discourse. The collected information yielded two discourses: the family recognized the welcoming strategies and the patients found the ICU team to be considerate. By including the family as a client of nursing care, relatives felt safe and confident. Results show that by committing to the responsibility of making changes in heath care practices, nurses experience a novel outlook towards ICU care, focused on human beings and associating the welcoming to the health care model that promotes the objectivity of care.

  2. Determinants of the Level of Care Provided for Various Types and Sizes of Dogs in New Providence, The Bahamas

    Directory of Open Access Journals (Sweden)

    Fielding, William J.


    Full Text Available This paper reports the level of care offered 424 dogs, classified as small dogs, large dogs, pit bulls and potcakes (the colloquial name for the local mongrel in New Providence, The Bahamas. Levels of care that meet the legal minimum –food water and shelter– as well as care considered essential and enriched in The Bahamas were less common for large dogs than small dogs. Small dogs tended to get more care than other dogs and so were at lowest risk of being neglected.It is suggested that the size of the dog is an important factor which determines the level of care provided. Pit bulls generally received similar care to potcakes which are often considered neglected. Large dogs were more likely to be kept outside and less likely to be allowed inside the home than small dogs. It is conjectured that in many instances the level of care offered constitutes partial abandonment due to a lack of interaction between caregivers and their dogs.

  3. Primary care referral management: a marketing strategy for hospitals. (United States)

    Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J


    With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

  4. Survival strategies in the era of managed care. (United States)

    Rudomin, M L; Spirakes, A S


    The era of managed care has forced an unprecedented restructuring of the health care environment. As hospitals downsize in response, materiel managers should consider adopting strategies that may help ensure their survival, including innovative approaches to supply management and the development of individual responses that will best position them to succeed in this new reality.

  5. Harm reduction interventions in HIV care: a qualitative exploration of patient and provider perspectives. (United States)

    Carlberg-Racich, Suzanne


    their HIV care providers, while provider receptiveness is mixed. The findings reveal critical implications for diffusion of harm reduction into HIV care, including the need to address cited barriers for both patients and providers to ensure feasibility of implementation. Strategies to address these barriers are discussed, and recommendations for further research are also shared.

  6. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider

    Directory of Open Access Journals (Sweden)

    Nidhi Mehrotra


    Full Text Available Ware G Kuschner, Sunayana Reddy, Nidhi Mehrotra, Harman S PaintalDivision of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USAAbstract: Primary care providers should be aware of two new developments in nicotine addiction and smoking cessation: 1 the emergence of a novel nicotine delivery system known as the electronic (e- cigarette; and 2 new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as “thirdhand smoke”. The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS. The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room

  7. [Internationalized medical care services increase need of health care providers to improve English communication skills]. (United States)

    Yang, Chia-Ling


    English is the most important language used in international communication. Nurses today have significantly more opportunities to come into contact with clients of different nationalities. Therefore, English communication abilities are a critical to the effective care of foreign clients. Miscommunication due to language barriers can endanger the health and safety of foreign clients and hinder their access to healthcare resources. Basic English communicate skills allow nurses to better understand the feelings of foreign clients and to affect their satisfaction with healthcare services provided. The majority of clinical nurses in Taiwan are inadequately prepared to communicate with foreign clients or use English when delivering nursing care services. Although English is not an official language in Taiwan, strengthening English communication skills is necessary for Taiwan's healthcare service system. Faced with increasing numbers of foreign clients in their daily work, first-line nursing staffs need more training to improve English proficiency. In order to do so, support from the hospital director is the first priority. The second priority is to motivate nursing staffs to learn English; the third is to incorporate different English classes into the medical system and schedule class times to meet nurse scheduling needs; and the fourth is to establish international medical wards, with appropriate incentives in pay designed to attract and retain nursing staff proficient in English communication.

  8. Channelrhodopsins provide a breakthrough insight into strategies for curing blindness

    Indian Academy of Sciences (India)

    Hiroshi Tomita; Eriko Sugano; Hitomi Isago; Makoto Tamai


    Photoreceptor cells are the only retinal neurons that can absorb photons. Their degeneration due to some diseases or injuries leads to blindness. Retinal prostheses electrically stimulating surviving retinal cells and evoking a pseudo light sensation have been investigated over the past decade for restoring vision. Currently, a gene therapy approach is under development. Channelrhodopsin-2 derived from the green alga Chlamydomonas reinhardtii, is a microbial-type rhodopsin. Its specific characteristic is that it functions as a light-driven cation-selective channel. It has been reported that the channelrhodopsin-2 transforms inner light-insensitive retinal neurons to light-sensitive neurons. Herein, we introduce new strategies for restoring vision by using channelrhodopsins and discuss the properties of adeno-associated virus vectors widely used in gene therapy.

  9. Patients' and providers' perspectives on bibliotherapy in primary care. (United States)

    McKenna, Grainne; Hevey, David; Martin, Elaine


    Bibliotherapy is a form of self-administered treatment in which structured materials provide a means to alleviate distress. Although the treatment has evidence of effectiveness, evaluations of bibliotherapy have typically focused on outcomes, and the perspectives of both the client and the service provider have been understudied. In the present study, eleven users of a bibliotherapy scheme were interviewed regarding their experiences of bibliotherapy. In addition, five referring practitioners to the scheme were also interviewed. Thematic analyses revealed three super-ordinate themes in the transcripts: participants' personal experiences of the bibliotherapy scheme factors that facilitate change and the influence of the professionals involved. The implications of these findings for bibliotherapy schemes are considered.

  10. Mental health provider perspectives regarding integrated medical care for patients with serious mental illness. (United States)

    Kilbourne, Amy M; Greenwald, Devra E; Bauer, Mark S; Charns, Martin P; Yano, Elizabeth M


    Integrated care for medical conditions is essential for persons with serious mental illness (SMI). This qualitative study describes mental health provider perspectives regarding barriers and facilitators of integrated care for patients with SMI. We interviewed providers from a national sample of Veterans Health Administration facilities that scored in the top or bottom percentile in medical care quality. Providers from high-performing sites reported substantial in-person contacts with general medical providers, while providers from low-performing sites reported stigma and limited communication with medical providers as major concerns. Interventions to improve mental health and medical provider communication may facilitate integrated care for persons with SMI.

  11. 78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers (United States)


    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care to Non-VA Providers... services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect home health and hospice care providers who do...

  12. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers (United States)


    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care by Non-VA Providers... methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing payment for other...

  13. The Effectiveness of a Brief Asthma Education Intervention for Child Care Providers and Primary School Teachers (United States)

    Neuharth-Pritchett, Stacey; Getch, Yvette Q.


    Limited information exists about management of asthma in child care settings and primary school classrooms. The goal of this study was to evaluate a brief asthma management intervention for child care providers and primary school teachers. Child care providers and primary school teachers were recruited to participate in two 3-h workshops on asthma…

  14. 77 FR 72738 - Contracts and Provider Agreements for State Home Nursing Home Care (United States)


    ... AFFAIRS 38 CFR Part 51 RIN 2900-AO57 Contracts and Provider Agreements for State Home Nursing Home Care... agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking is... 2900-AO57--Contracts and Provider Agreements for State Home Nursing Home Care.'' Copies of...

  15. Taking Care of the Kids: The Corporate Role in Providing Child Care. (United States)

    Friedman, Dana E.


    More and more people are beginning to look to their employers for a solution to the child care dilemma. Various types of employer supported child care are described, including day care centers, after school programs, summer day camps, financial assistance, flexible benefit plans, and information and referral services. (CB)

  16. Mutual Agreement Between Providers in Intensive Care Medicine on Patient Care After Interdisciplinary Rounds

    NARCIS (Netherlands)

    Ten Have, Elsbeth Cornelia Maria; Nap, Raoul Ernesto


    Purpose: Insights regarding the results of interdisciplinary communication about patient care are limited. We explored the perceptions of intensivists, junior physicians, and nurses about patient care directly after the interdisciplinary rounds (IDRs) in the intensive care unit (ICU) to determine mu

  17. Management of pain induced by exercise and mobilization during physical therapy programs: views of patients and care providers

    Directory of Open Access Journals (Sweden)

    Rannou François


    Full Text Available Abstract Background The expectations of patients for managing pain induced by exercise and mobilization (PIEM have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs. Methods We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women and 14 care providers (6 women: 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists. Results Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity. Conclusion PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers.

  18. Parents' and Providers' Views of Important Aspects of Child Care Quality. Publication #2015-13 (United States)

    Sosinsky, Laura; Halle, Tamara; Susman-Stillman, Amy; Cleveland, Jennifer; Li, Weilin


    The Maryland-Minnesota Child Care Research Partnership brought together two states committed to examining critical issues in early care and education and using research findings to inform policy with an interdisciplinary team of researchers experienced in conducting studies on (1) subsidy policy; (2) quality improvement strategies; and (3)…

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

    ... Gynecology Medical Conditions Nutrition & Fitness Emotional Health Choosing a Primary Health Care Provider (PCP): General Information Posted ... taking care of yourself. Why do I need a PCP? You need a PCP so that your ...

  20. Social inclusion of older adults in care: Is it just a question of providing activities?


    Knight, Tess; Mellor, David


    We investigated the experiences of older adults in residential care in relation to social activity and inclusion. We also examined the explored phenomenon of resident's social inclusion from the perspective of those providing care for the residents. Our participants were 25 care providers and 25 residents drawn from five low-level-care residential facilities in metropolitan Melbourne, Australia. We used one-to-one in-depth interviews which were aimed at tapping into themes related to social i...

  1. Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence (United States)

    Luoma, Jason B.; Martin, Catherine E.; Pearson, Jane L.


    Objective This study examined rates of contact with primary care and mental health care professionals by individuals before they died by suicide. Method The authors reviewed 40 studies for which there was information available on rates of health care contact and examined age and gender differences among the subjects. Results Contact with primary care providers in the time leading up to suicide is common. While three of four suicide victims had contact with primary care providers within the year of suicide, approximately one-third of the suicide victims had contact with mental health services. About one in five suicide victims had contact with mental health services within a month before their suicide. On average, 45% of suicide victims had contact with primary care providers within 1 month of suicide. Older adults had higher rates of contact with primary care providers within 1 month of suicide than younger adults. Conclusions While it is not known to what degree contact with mental health care and primary care providers can prevent suicide, the majority of individuals who die by suicide do make contact with primary care providers, particularly older adults. Given that this pattern is consistent with overall health-service-seeking, alternate approaches to suicide-prevention efforts may be needed for those less likely to be seen in primary care or mental health specialty care, specifically young men. PMID:12042175

  2. Human trafficking: Role of oral health care providers. (United States)

    Nuzzolese, E


    Trafficking in human beings is a modern form of slavery and is a well-known phenomenon throughout the European Union and beyond. After drug dealing and the weapons industry, human trafficking is the second largest criminal activity in the world today and it is a growing crime. The aim of governmental and non-governmental agencies, which are either directly or indirectly involved in combating trafficking in human beings, is the identification and referral of victims of trafficking and also to encourage self-referrals. Identification is the most important step to provide protection and assistance to victims of trafficking. Victims often have a variety of physical and mental health needs, including psychological trauma, injuries from violence, head and neck trauma, sexually transmitted infections and other gynaecological problems, dental/oral problems and have poor nutrition. The author's experience in the field of community dentistry in presented within. Volunteer dental services are offered to non-European Union patients held in a centre for asylum seekers in Bari (Italy). Dental professionals can, in fact, contribute to the identification, assistance and protection of trafficked persons, as well as offering forensic services to assist the police investigation in order to identify crimes and find the criminal organizations behind them. As for domestic violence and child abuse cases, there are ethical concerns involved in the identification and protection of the trafficked persons, as well as the need for interdisciplinary work and awareness. Adequate training in behavioural science and intercultural learning is paramount in order to avoid misunderstandings and increase sensitivity.

  3. Integrated opioid substitution therapy and HIV care: a qualitative systematic review and synthesis of client and provider experiences. (United States)

    Guise, Andy; Seguin, Maureen; Mburu, Gitau; McLean, Susie; Grenfell, Pippa; Islam, Zahed; Filippovych, Sergii; Assan, Happy; Low, Andrea; Vickerman, Peter; Rhodes, Tim


    People who use drugs in many contexts have limited access to opioid substitution therapy and HIV care. Service integration is one strategy identified to support increased access. We reviewed and synthesized literature exploring client and provider experiences of integrated opioid substitution therapy and HIV care to identify acceptable approaches to care delivery. We systematically reviewed qualitative literature. We searched nine bibliographic databases, supplemented by manual searches of reference lists of articles from the database search, relevant journals, conferences, key organizations and consultation with experts. Thematic synthesis was used to develop descriptive themes in client and provider experiences. The search yielded 11 articles for inclusion, along with 8 expert and policy reports. We identify five descriptive themes: the convenience and comprehensive nature of co-located care, contrasting care philosophies and their role in shaping integration, the limits to disclosure and communication between clients and providers, opioid substitution therapy enabling HIV care access and engagement, and health system challenges to delivering integrated services. The discussion explores how integrated opioid substitution therapy and HIV care needs to adapt to specific social conditions, rather than following universal approaches. We identify priorities for future research. Acceptable integrated opioid substitution therapy and HIV care for people who use drugs and providers is most likely through co-located care and relies upon attention to stigma, supportive relationships and client centred cultures of delivery. Further research is needed to understand experiences of integrated care, particularly delivery in low and middle income settings and models of care focused on community and non-clinic based delivery.

  4. Experiences of primary care professionals providing healthcare to recently arrived migrants: a qualitative study (United States)

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


    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

  5. Exploring the phenomenon of spiritual care between hospital chaplains and hospital based healthcare providers. (United States)

    Taylor, Janie J; Hodgson, Jennifer L; Kolobova, Irina; Lamson, Angela L; Sira, Natalia; Musick, David


    Hospital chaplaincy and spiritual care services are important to patients' medical care and well-being; however, little is known about healthcare providers' experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers' personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains' services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.

  6. Commentary: educating the present and future health care workforce to provide care to populations. (United States)

    Garr, David R; Margalit, Ruth; Jameton, Andrew; Cerra, Frank B


    The crisis of the rising cost of health care in the United States is stimulating major changes in the way care is being delivered. New models such as patient-centered medical homes and accountable care organizations are being developed with the expectation that health care professionals will address and improve the health of populations. Electronic health records and interprofessional teams will be critical to achieving the goal of better health. It is now time to bring together educators and clinicians at academic health centers, public health educators and practitioners, along with researchers, representatives from the health care delivery and financing systems, and community partners to reengineer health professions education to prepare health professions students for the health care system of the future.

  7. Nursing strategies for coping with the care of a potential organ donor

    Directory of Open Access Journals (Sweden)

    Silvia Silva Souza


    Full Text Available This work aimed to understand strategies that the nursing staff from an Intensive Care Unit applies to situations involving the care of a person with brain death as a potential donor. The study was conducted through qualitative, descriptive and exploratory research, carried out by 14 members of the nursing staff who work with the potential organ donor. Data were collected through semi-structured interviews, and a thematic context analysis was applied. The strategies of coping focused on emotion were: escape from reality, and reframe the event. And the strategies focused on the problem were: provide competent care, and search for other support. It is concluded that caring for a person with brain death is constituted as a very stressful event to the nursing professionals. These professionals need institutional support to better cope with these situations, because depending on how they manage their task, it may directly influence the assistance provided to patients.

  8. Provision of care to clients of migrant origin: the experiences of maternity care providers.


    Boerleider, A.W.; Francke, A.L.; Wiegers, T.A.; Manniën, J.; Devillé, W.L.J.M.


    Background: Women of non-western migrant origin comprise a substantial part of the client population in maternity care. According to Statistics Netherlands, mothers of non-western migrant origin contribute to 17% of all live births. This group is very diverse in origin which implies a variety in needs and expectations with regard to maternity care. Furthermore, clients of nonwestern migrant origin have been shown to make less adequate use of prenatal and postnatal care. This may add to the ch...

  9. Examining Health Care Costs: Opportunities to Provide Value in the Intensive Care Unit. (United States)

    Chang, Beverly; Lorenzo, Javier; Macario, Alex


    As health care costs threaten the economic stability of American society, increasing pressures to focus on value-based health care have led to the development of protocols for fast-track cardiac surgery and for delirium management. Critical care services can be led by anesthesiologists with the goal of improving ICU outcomes and at the same time decreasing the rising cost of ICU medicine.

  10. The Experiences of U.S. Army Primary Care Providers Meeting Sexual Health Care Needs During Post-Vietnam Deployments (United States)


    24 Difficult Patient Care Issues ............................................................... 26 Masturbation Issues...Difficult patient care issues Masturbation issues No sexual issues Therapeutic relationship issues Provider Experiences Dynamics change when...and had a hysterectomy. Masturbation issues. One of the providers was approached by an officer in his unit with concerns of masturbation . The

  11. An agent-based simulation model of patient choice of health care providers in accountable care organizations. (United States)

    Alibrahim, Abdullah; Wu, Shinyi


    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  12. Avaliação da assistência a pessoas com hipertensão arterial em Unidades de Estratégia Saúde da Família Evaluation of care provided for people with arterial hypertension in Family Health Strategy Services

    Directory of Open Access Journals (Sweden)

    Ernani Tiaraju de Santa Helena


    Full Text Available OBJETIVO: analisar a assistência a pessoas com hipertensão arterial sistêmica (HAS prestada por equipes de Estratégia Saúde da Família (ESF em Blumenau-SC. MÉTODOS: foram entrevistadas 595 pessoas com HAS moradoras da área de 10 ESF. As variáveis estudadas foram: características demográficas e socioeconômicas, estilo de vida, tratamento, comorbidades, adesão ao tratamento, satisfação com o serviço e níveis pressóricos. Na análise, utilizaram-se os testes de "t de Student" e Qui-quadrado. RESULTADOS: a idade média foi 60,6 anos. Houve predomínio do sexo feminino, cor branca, casadas, com até quatro anos de estudo, sem trabalhar, das classes C e D. A média de escolaridade foi maior em pessoas brancas e das classes A e B (p 140x90mmHg 69,3%. O descontrole pressórico mostrou-se associado a não adesão, sedentarismo e classes C/D/E. CONCLUSÕES: apesar do acesso a consultas e medicamentos e da satisfação dos usuários, os valores elevados de não adesão e dos níveis pressóricos colocam como desafio a melhoria da qualidade da assistência.BACKGROUND: to analyse the health care provided for people with arterial hypertension by family health strategy teams in Blumenau, state of Santa Catarina, Brazil. METHODS: overall, 595 people with arterial hypertension who live in the area of 10 family health teams were interviewed. The studied variables were: demographic and socio-economic characteristics, life style, treatment, co-morbidities, adherence to treatment, satisfaction with health service and blood pressure. Descriptive statistics and association tests (Student's t-test, ANOVA, chi-square were used. RESULTS: the mean age was 60.6 years old. Most are female, white, married, with four or less years of formal education, unemployed, and with low social status. White people and those with high social status had more years of schooling (p 140x90mmHg was presented by 69.3% and was associated to non-adherence, sedentariness and low

  13. Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study

    DEFF Research Database (Denmark)

    Peyrol, Mark; Rubin, Richard R.; Lauritzen, Torsten


    Aims/hypothesis We assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care. Methods The study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers in 13 countries from Asia, Australia......, Europe and North America. Participants were randomly selected adults with type 1 or type 2 diabetes (n=5,104), and randomly selected diabetes-care providers, including primary-care physicians (n=2,070), diabetes specialist physicians (n=635) and nurses (n=1,122). Multivariate analysis was used to examine...... the relationships between outcomes and both country and respondent characteristics, and the interaction between these two factors. Results Providers rated chronic-care systems and remuneration for chronic care as mediocre. Patients reported that ease of access to care was high, but not without financial barriers...

  14. Identifying Care Coordination Interventions Provided to Community-Dwelling Older Adults Using Electronic Health Records. (United States)

    Kim, Tae Youn; Marek, Karen D; Coenen, Amy


    Although care coordination is a popular intervention, there is no standard method of delivery. Also little is known about who benefits most, or characteristics that predict the amount of care coordination needed, especially with chronically ill older adults. The purpose of this study was to identify types and amount of nurse care coordination interventions provided to 231 chronically ill older adults who participated in a 12-month home care medication management program in the Midwest. For each participant, the nurse care coordinator spent an average of 134 min/mo providing in-person home care, 48 min/mo of travel, and 18 min/mo of indirect care occurring outside the home visit. This accounted for 67.2%, 23.8%, and 9.0% of nursing time, respectively, for home visits, travel, and indirect care. Four of 11 nursing interventions focused on medication management were provided to all participants. Seven of the 11 main interventions were individualized according to each person's special needs. Wide variations were observed in time provided with in-person home care and communications with multiple stakeholders. Study findings indicate the importance of individualizing interventions and the variability in the amount of nursing time needed to provide care coordination to chronically ill older adults.

  15. Forging partnerships between rural women with chronic conditions and their health care providers. (United States)

    Cudney, Shirley; Weinert, Clarann; Kinion, Elizabeth


    Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

  16. Living in institutional care: residents' experiences and coping strategies. (United States)

    Timonen, Virpi; O'Dwyer, Ciara


    Insights into daily living in residential care settings are rare. This article draws on a qualitative dataset (semi-structured interviews and recordings of residents' council meetings) that gives a glimpse of the experiences and coping strategies of (older) people living in residential care. The data highlight the range of unmet needs of the residents, similar to the categories of physiological, safety, love, esteem, and self-actualization needs in Maslow's hierarchy of needs theory. Our analysis indicates that "higher" and "lower" needs are closely intertwined and mutually reinforcing and should therefore be accorded equal emphasis by professionals (including social workers) employed within residential care settings.

  17. Vaccination for Group B Streptococcus during pregnancy: attitudes and concerns of women and health care providers. (United States)

    Patten, San; Vollman, Ardene Robinson; Manning, Shannon D; Mucenski, Melissa; Vidakovich, Jeanne; Davies, H Dele


    Group B Streptococcus (GBS) is the leading infectious cause of neonatal morbidity and mortality. Although intrapartum antibiotic prophylaxis (IAP) strategies are effective in preventing GBS transmission from mothers to newborns, there are growing concerns about adverse effects, and the development of antibiotic resistance. GBS vaccines targeting the most virulent neonatal disease serotypes are currently under development and may be used during pregnancy. The objective of this study was to explore the key issues and concerns that would be associated with GBS vaccination during pregnancy from the perspectives of pregnant women and health care providers. Twenty-two women and 25 health care professionals in Alberta, Canada participated in 10 focus groups, each group ranging from 2 to 20 participants. Valuable information emerged from the focus groups about the factors that would affect acceptance of a maternal GBS vaccine. This information will be essential for health systems to consider in the introduction, promotion and delivery of such a vaccine. The data may help optimize education about GBS and a putative vaccine to pregnant women.

  18. Mothers’ Satisfaction With Two Systems of Providing Care to Their Hospitalized Children


    Hosseinian, Masoumeh; Mirbagher Ajorpaz, Neda; Esalat Manesh, Soophia


    Background: Despite the paramount importance of the patient’s satisfaction, there are limited data on mothers’ satisfaction with the nursing care provided to their children in Iranian clinical settings. Objectives: This study aimed to evaluate mothers’ satisfaction with two systems of providing care to their hospitalized children. Patients and Methods: This research was a two-group quasi-experimental study. Primarily, the basics of the case method and the functional care delivery systems were...

  19. The "virtual" obstetrical intensive care unit: providing critical care for contemporary obstetrics in nontraditional locations. (United States)

    Leovic, Michael P; Robbins, Hailey N; Foley, Michael R; Starikov, Roman S


    Management of the critically ill pregnant patient presents a clinical dilemma in which there are sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness. The health care needs of the critically ill obstetric patient calls for clinicians to move beyond the traditional definition of the intensive care unit and develop a well-rounded, quickly responsive, and communicative interdisciplinary team that can provide high-quality, unique, and versatile care that best meets the needs of each particular patient. We propose a model in which a virtual intensive care unit team composed of preselected specialists from multiple disciplines (maternal-fetal medicine, neonatology, obstetric anesthesiology, cardiology, pulmonology, etc) participate in the provision of individualized, precontemplated care that is readily adapted to the specific patient's clinical needs, regardless of setting. With this team-based approach, an environment of trust and familiarity is fostered among team members and well thought-out patient care plans are developed through routine prebrief discussions regarding individual clinical care for parturients anticipated to required critical care services. Incorporating debriefings between team members following these intricate cases will allow for the continued evolution of care as the medical needs of this patient population change as well.

  20. Implementing a care coordination program for children with special healthcare needs: partnering with families and providers. (United States)

    Taylor, April; Lizzi, Michele; Marx, Alison; Chilkatowsky, Maryann; Trachtenberg, Symme W; Ogle, Sue


    Care coordination has been a key theme in national forums on healthcare quality, design, and improvement. This article describes the characteristics of a care coordination program aimed at supporting families in building care coordination competencies and providers in the coordination of care across multiple specialties. The program included implementation of a Care Coordination Counselor (CC Counselor) and several supporting tools-Care Binders, Complex Scheduling, Community Resources for Families Database, and a Care Coordination Network. Patients were referred by a healthcare provider to receive services from the CC Counselor or to receive a Care Binder organizational tool. To assess the impact of the counselor role, we compared patient experience survey results from patients receiving CC Counselor services to those receiving only the Care Binder. Our analysis found that patients supported by the CC Counselor reported greater agreement with accessing care coordination resources and identifying a key point person for coordination. Seventy-five percent of CC Counselor patients have graduated from the program. Our findings suggest that implementation of a CC Counselor role and supporting tools offers an integrative way to connect patients, families, and providers with services and resources to support coordinated, continuous care.

  1. Perceptions of vaginal microbicides as an HIV prevention method among health care providers in KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Mantell Joanne E


    Full Text Available Abstract Background The promise of microbicides as an HIV prevention method will not be realized if not supported by health care providers. They are the primary source of sexual health information for potential users, in both the public and private health sectors. Therefore, the aim of this study was to determine perceptions of vaginal microbicides as a potential HIV prevention method among health care providers in Durban and Hlabisa, South Africa, using a combination of quantitative and qualitative methods. Results During 2004, semi structured interviews with 149 health care providers were conducted. Fifty seven percent of hospital managers, 40% of pharmacists and 35% of nurses possessed some basic knowledge of microbicides, such as the product being used intra-vaginally before sex to prevent HIV infection. The majority of them were positive about microbicides and were willing to counsel users regarding potential use. Providers from both public and private sectors felt that an effective microbicide should be available to all people, regardless of HIV status. Providers felt that the product should be accessed over-the-counter in pharmacies and in retail stores. They also felt a need for potential microbicides to be available free of charge, and packaged with clear instructions. The media was seen by health care providers as being an effective strategy for promoting microbicides. Conclusion Overall, health care providers were very positive about the possible introduction of an effective microbicide for HIV prevention. The findings generated by this study illustrated the need for training health care providers prior to making the product accessible, as well as the importance of addressing the potential barriers to use of the product by women. These are important concerns in the health care community, and this study also served to educate them for the day when research becomes reality.

  2. The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'.

    Directory of Open Access Journals (Sweden)

    Stephan Brenner

    Full Text Available A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs, a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC, the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example.We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi.Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants' adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks.The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining

  3. 45 CFR 162.406 - Standard unique health identifier for health care providers. (United States)


    ... no intelligence about the health care provider in the number. (b) Required and permitted uses for the... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standard unique health identifier for health care providers. 162.406 Section 162.406 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  4. How do General Practitioners experience providing care for their psychotic patients?

    NARCIS (Netherlands)

    Oud, Marian J. T.; Schuling, Jan; Slooff, Cees J.; Meyboom-de Jong, Betty


    Background: In primary care, GPs usually provide care for patients with chronic diseases according to professional guidelines. However, such guidelines are not available in the Netherlands for patients with recurring psychoses. It seems that the specific difficulties that GPs experience in providing


    Directory of Open Access Journals (Sweden)

    Lana Kordić


    Full Text Available Health care systems face pressure to increase the quality of health care at the same time with pressure to reduce public spending. The attempt to overcome the gap between needs and opportunities can be resolved through the introduction of public-private partnerships. Goals of this study are to investigate variation of the number, form and efficiency of private providers of general/family medicine services in primary health care and the contribution of socioeconomic and demographic environment on those variations, among counties. Socioeconomic and demographic factors are identified as independent variables that influence the health care need and utilization and consequently the decision of private entities to engage in the provision of health care services. This study extended previous studies because it has introduced socioeconomic and demographic variables. This may shed same new lights on the relationship between private providers of health service and efficiency of providing health service in primary health care.

  6. Teaching Strategies for Primary Health Care. A Syllabus. (United States)

    Durana, Ines

    This book is intended to assist teachers, practitioners, and administrators to develop programs for training nonphysician, primary health care workers in Third World countries. It contains the instructional context of a comprehensive training program, organized into chapters and presented in outline form. Learning strategies follow each section of…

  7. Coping of health care providers with the death of a patient

    Directory of Open Access Journals (Sweden)

    Aleksander Mlinšek


    Full Text Available RQ: With an aging population, health care professionals are often faced with the death of a patient in acute hospitals. The experience of dying patients’ to health care professionals and to the health care system brings many challenges that need to be faced.Purpose: The present study was to determine how health care providers are faced with the death of a patient, what is the care needed for the dying patient and how to participate in interdisciplinary team care of among themselves and family members of dying patients.Method: We conducted a small-scale quantitative survey of nursing care in a Slovenian acute hospital. To analyze the results, we used frequency statistics and Pearson's correlation coefficient.Results: Health care providers need additional skills needed to care for a dying patient as well as to the family of the dying patient.They try to control distress of the dying experience reasonably and less with conversation. The effect on the loss of a patient affects work experience, but we did not notice any other effects. Theinvolvement of an interdisciplinary team in the care of the dying patient is satisfactory; family members are under-involved in the care.Organization: Health organizations that are more focused on acute treatment have to become aware of palliative care that needs to be included in nursing care as an integral process of care for the terminally ill. Health care staff need to communicate more with one another and go through additional training.Society: Attitudes to death in a broader cultural environment also affects the attitude of health workers towards death. Involvement of the social environment, especially family members, is very important.Originality: The survey was conducted on the basis of comparing two surveys.Limitations: The survey was conducted on a small sample size.

  8. Educational Needs of Health Care Providers Working in Long-Term Care Facilities with Regard to Pain Management

    Directory of Open Access Journals (Sweden)

    Yannick Tousignant-Laflamme


    Full Text Available BACKGROUND: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF, with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs.

  9. Provision of care to clients of migrant origin: the experiences of maternity care providers.

    NARCIS (Netherlands)

    Boerleider, A.W.; Francke, A.L.; Wiegers, T.A.; Manniën, J.; Devillé, W.L.J.M.


    Background: Women of non-western migrant origin comprise a substantial part of the client population in maternity care. According to Statistics Netherlands, mothers of non-western migrant origin contribute to 17% of all live births. This group is very diverse in origin which implies a variety in nee

  10. Providers' Perspectives of Survivorship Care for Young Adult Survivors of Childhood Cancer. (United States)

    Berg, Carla; Stratton, Erin; Esiashvili, Natia; Mertens, Ann; Vanderpool, Robin C


    We examined healthcare providers' perceptions of the goals of survivorship care and survivor programs, systems-level barriers and individual patient-level barriers to engaging patients in survivorship care, and potential resources for increasing engagement. In 2012, we recruited 21 healthcare providers of young adult survivors of childhood cancers from a children's hospital and a cancer center in the Southeastern USA to complete telephone-based semi-structured interviews. The sample was 45.95 years old (SD = 7.57) on average, 52.4 % female, and 81.0 % MDs. The major goals of survivorship programs identified were medical care management (e.g., addressing late and long-term effects, providing survivorship care plans (SCPs), assisting in transition of care) and holistic care including addressing psychosocial issues and promoting healthy lifestyles. Systems-level barriers to engagement in survivorship care included limited resources (e.g., time), role confusion (e.g., within cancer centers, from treatment team to survivorship care, role of primary care providers), communication challenges within the medical system (e.g., limited tracking of patients, lack of understanding of the role of survivorship clinic), communication challenges with patients (e.g., setting expectations regarding transition to survivorship care), and lack of insurance coverage. Perceived patient-level factors included psychological barriers (e.g., fear, avoidance), resistance to survivorship care, and physical barriers (e.g., distance from survivorship clinics). Resources to address these barriers included increased access to information, technology-based resources, and ensuring valuable services. There are several systems-level and patient-level barriers to survivorship care, thus requiring multilevel interventions to promote engagement in care among young adult survivors of childhood cancer.

  11. Seeking lower prices where providers are consolidated: an examination of market and policy strategies. (United States)

    Ginsburg, Paul B; Pawlson, L Gregory


    The ongoing consolidation between and among hospitals and physicians tends to raise prices for health care services, which poses increasing challenges for private purchasers and payers. This article examines strategies that these purchasers and payers can pursue to combat provider leverage to increase prices. It also examines opportunities for governments to either support or constrain these strategies. In response to higher prices, payers are developing new approaches to benefit and network design, some of which may be effective in moderating prices and, in some cases, volume. These approaches interact with public policy because regulation can either facilitate or constrain them. Federal and state governments also have opportunities to limit consolidation's effect on prices by developing antitrust policies that better address current market environments and by fostering the development of physician organizations that can increase competition and contract with payers under shared-savings approaches. The success of these private- and public-sector initiatives likely will determine whether governments shift from supporting competition to directly regulating payment rates.


    Directory of Open Access Journals (Sweden)

    Budi Hidayat


    Full Text Available Background: Indonesian's health care system is characterized by underutilized of the health-care infrastructure. One of the ways to improve the demand for formal health care is through health insurance. Responding to this potentially effective policy leads the Government of Indonesia to expand health insurance coverage by enacting the National Social Security Act in 2004. In this particular issue, understanding provider choice is therefore a key to address the broader policy question as to how the current low uptake of health care services could be turned in to an optimal utilization. Objective:To estimate a model of provider choice for outpatient care in Indonesia with specific attention being paid to the role of health insurance. Methods: A total of 16485 individuals were obtained from the second wave of the Indonesian Family Life survey. A multinomial logit regression model was applied to a estimate provider choice for outpatient care in three provider alternative (public, private and self-treatment. A policy simulation is reported as to how expanding insurance benefits could change the patterns of provider choice for outpatient health care services. Results: Individuals who are covered by civil servant insurance (Askes are more likely to use public providers, while the beneficiaries of private employees insurance (Jamsostek are more likely to use private ones compared with the uninsured population. The results also reveal that less healthy, unmarried, wealthier and better educated individuals are more likely to choose private providers than public providers. Conclusions: Any efforts to improve access to health care through health insurance will fail if policy-makers do not accommodate peoples' preferences for choosing health care providers. The likely changes in demand from public providers to private ones need to be considered in the current social health insurance reform process, especially in devising premium policies and benefit packages

  13. What matters most for end-of-life care? Perspectives from community-based palliative care providers and administrators (United States)

    Mistry, Bina; Bainbridge, Daryl; Bryant, Deanna; Tan Toyofuku, Sue; Seow, Hsien


    Objectives There has been little research conducted to understand the essential meaning of quality, community-based, end-of-life (EOL) care, despite the expansion of these services. The purpose of this study was to define what matters most for EOL care from the perspective of a diverse range of palliative care providers in the community who have daily encounters with death and dying. Methods We used interviews to explore the perceptions of providers and administrators from 14 specialised palliative care teams in Ontario, Canada. Participants were prompted with the question ‘What matters most for EOL care?’ Responses were analysed using a phenomenological approach to derive themes depicting the universal essence of EOL care. Results Data from 107 respondents were obtained and analysed, from which 40 formulated concepts emerged; these were further grouped into 9 themes. Of the respondents, 39% were nurses, 19% physicians, 27% were supervisors or executives and 15% other. The most predominate concept was that Patient's Wishes are Fulfilled, cited by almost half the respondents. The most prominent themes were Addressing the Non-physical Needs, Healthcare Teams’ Nature of Palliative Care Delivery, Patient Wishes are Honoured, Addressing the Physical Needs, Preparing for and Accepting Death, Communication and Relationship Development, and Involving and Supporting the Family. Conclusions 9 critical domains of EOL care evolved from the interviews, indicating that quality EOL care extends beyond managing physical pain, but includes a holistic perspective of care, a healthcare team dedicated to the EOL journey and a patient-centred pathway. Tailoring the provision of care to consider these important elements plays a critical role in supporting a positive EOL experience for patients and families. PMID:26124510

  14. Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia. (United States)

    Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim


    The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.

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

    Energy Technology Data Exchange (ETDEWEB)

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


    We developed this program for primary care providers (PCPs) and public health professionals (PHPs) who are interested in increasing their understanding of the genetics of common chronic diseases and of the implications of genetics and genomics for their fields. The program differs from virtually all previous educational efforts in genetics for health professionals in that it focuses on the genetics of common chronic disease and on the broad principles that emerge when one views disease from the perspectives of variation and individuality, which are at the heart of thinking genetically. The CD-ROM introduces users to content that will improve their understanding of topics such as: • A framework for genetics and common disease; • Basic information on genetics, genomics, genetic medicine, and public health genetics, all in the context of common chronic disease; • The status of research on genetic contributions to specific common diseases, including a review of research methods; • Genetic/environmental interaction as the new “central dogma” of public health genetics; • The importance of taking and analyzing a family history; • The likely impact of potential gene discovery and genetic testing on genetic counseling and risk assessment and on the practices of PCPs and PHPs; • Stratification of populations into low-, moderate-, and high-risk categories; • The potential role of PCPs and PHPs in identifying high-risk individuals and families, in providing limited genetics services, and in referring to clinical genetics specialists; the potential for standard referral algorithms; • Implications of genetic insights for diagnosis and treatment; • Ethical, legal, and social issues that arise from genetic testing for common chronic diseases; and • Specific prevention strategies based on understanding of genetics and genetic/ environmental interactions. The interactive content – developed by experts in genetics, primary care, and public health – is

  16. An interprofessional team approach to fall prevention for older home care clients ‘at risk’ of falling: health care providers share their experiences

    Directory of Open Access Journals (Sweden)

    Pamela Baxter


    Full Text Available Background: Providing care for older home care clients ‘at risk’ of falling requires the services of many health care providers due to predisposing chronic, complex conditions. One strategy to ensure that quality care is delivered is described in the integrated care literature; interprofessional collaboration. Engaging in an interprofessional team approach to fall prevention for this group of clients seems to make sense. However, whether or not this approach is feasible and realistic is not well described in the literature. As well, little is known about how teams function in the community when an interprofessional approach is engaged in. The barriers and facilitators of such an approach are also not known. Purpose: The purpose of this qualitative study was to describe the experiences of five different health care professionals as they participated in an interprofessional team approach to care for the frail older adult living at home and at risk of falling. Methodology: This study took place in Hamilton, ON, Canada and was part of a randomized controlled trial, the aim of which was to determine the effects and costs of a multifactorial and interdisciplinary team approach to fall prevention for older home care clients ‘at risk’ of falling. The current study utilized an exploratory descriptive design to answer the following research questions: how do interprofessional teams describe their experiences when involved in a research intervention requiring collaboration for a 9-month period of time? What are the barriers and facilitators to teamwork? Four focus groups were conducted with the care-provider teams (n=9 6 and 9 months following group formation. Results: This study revealed several themes which included, team capacity, practitioner competencies, perceived outcomes, support and time. Overall, care providers were positive about their experiences and felt that through an interprofessional approach benefits could be experienced by both

  17. Providing palliative care for the newly diagnosed cancer patient: concepts and resources. (United States)

    Gabriel, Michelle


    Palliative care has evolved from end-of-life care following exhaustion of curative therapy to care across the cancer-management continuum. Often initiated concurrently with curative care at the time of diagnosis, palliative care ensures both effective symptom management and the best possible quality of life in four key domains-physical, psychological, social, and spiritual. The significant growth and development of palliative care in the United States is evident in that one in four hospitals now has a palliative care program, palliative medicine is now recognized as an official medical subspecialty by the American Board of Medical Specialties, and national programs offer comprehensive continuing education in palliative care for nurses and physicians. The oncology nurse who provides palliative care does so as part of a multidisciplinary team that includes not only physicians but also can involve chaplains, massage therapists, pharmacists, nutritionists, and other specialists. This article provides resources and reviews and highlights pertinent palliative care issues to guide oncology nurses managing newly diagnosed cancer patients.

  18. Telehealth: seven strategies to successfully implement disruptive technology and transform health care. (United States)

    Schwamm, Lee H


    "Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.

  19. The Israeli Long-Term Care Insurance Law: selected issues in providing home care services to the frail elderly. (United States)

    Schmid, Hillel


    The paper describes and analyses selected issues related to the provision of home care services to frail elderly people following the Israeli Long-Term Care Insurance Law (1988). The goals and principles of the Law, which mandates the provision of home care services to frail elderly people, are presented. The paper also evaluates its contribution toward enhancing the well-being of elderly clients. Several major dilemmas that arose following implementation of the Law are analysed and evaluated in comparison with other countries that have enacted and implemented similar laws. These dilemmas are community vs institutional care; services in kind vs monetary allowances; service provision through contracting out with nongovernmental agencies; unstable and unskilled labour force; and service quality. Finally, policy implications are discussed, mainly in the following areas: investment in human resources as a condition for achieving high service quality, and the need for coordination between the agencies that provide long-term care services to elderly people.

  20. Characteristics of genomic test consumers who spontaneously share results with their health care provider. (United States)

    Darst, Burcu F; Madlensky, Lisa; Schork, Nicholas J; Topol, Eric J; Bloss, Cinnamon S


    The purpose of this study was to evaluate the characteristics of direct-to-consumer (DTC) genomic test consumers who spontaneously shared their test results with their health care provider. Utilizing data from the Scripps Genomic Health Initiative, we compared demographic, behavioral, and attitudinal characteristics of DTC genomic test consumers who shared their results with their physician or health care provider versus those who did not share. We also compared genomic risk estimates between the two groups. Of 2,024 individuals assessed at approximately 6 months post testing, 540 individuals (26.5%) reported sharing their results with their physician or health care provider. Those who shared were older (p consumers.

  1. A method to provide integrated care for complex medically ill patients : The INTERMED

    NARCIS (Netherlands)

    Latour, Cornelia H. M.; Huyse, Frederik J.; de Vos, Rien; Stalman, Wilhelmus A. B.


    A growing number of nursing subspecializations have been developed in recent decades. Topics of concern are that care is not tailored to cope with the growing number of patients with more than one chronic disease, there is an increase in co-ordination problems in the care that is provided for this g

  2. Attitudes of Health Care Providers toward Elderly Patients with Normal Aging and Disease-Related Symptoms. (United States)

    Baker, Rodney R.


    Examined preferences of 275 health care providers for working with elderly patients exhibiting symptoms of normal aging or diseases. In comparing descriptions of two hospitalized patients, physicians, nurses and social workers expressed a preference for working with patients with disease symptoms, raising concerns about geriatric care. (JAC)

  3. Teaching Child Care Providers to Reduce the Risk of SIDS (Sudden Infant Death Syndrome) (United States)

    Byington, Teresa; Martin, Sally; Reilly, Jackie; Weigel, Dan


    Keeping children safe and healthy is one of the main concerns of parents and child care providers. SIDS (Sudden Infant Death Syndrome) is the leading cause of death in infants 1 month to 12 months of age. Over 2,000 infants die from SIDS every year in the United States, and almost 15% of these deaths occur in child care settings. A targeted…

  4. The Relationship between Practices and Child Care Providers' Beliefs Related to Child Feeding and Obesity Prevention (United States)

    Lanigan, Jane D.


    Objective: To examine the association between child care practices and child care provider knowledge and beliefs about their role in supporting children's healthful eating. Design: Longitudinal design using survey and observation data from baseline and year 1 of the Encouraging Healthy Activity and Eating in Childcare Environments (ENHANCE) pilot…

  5. Providing Education to Child Care Instructors: Matching Children's Learning Activities to Cognitive Development. (United States)

    Desjardins, Margaret M.

    Child care instructors and their aides at the Good Shepherd Day Care Center, Punta Gorda, Florida, were taught skills needed to develop classroom activities matching the cognitive development of 3- and 4-year-old children. Through a program of in-service activity in child growth and development, instruction was provided to enable teachers to more…

  6. Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases (United States)

    Thackeray, Rosemary; Magnusson, Brianna M.


    Background: Child care facilities are prime locations for the transmission of infectious and communicable diseases. Children and child care providers are at high risk for cytomegalovirus (CMV) infection which causes severe birth defects and developmental delays. Objective: The goals of study were: (1) to determine the level of cytomegalovirus…

  7. HIV patient and provider feedback on a telehealth collaborative care for depression intervention. (United States)

    Drummond, Karen L; Painter, Jacob T; Curran, Geoffrey M; Stanley, Regina; Gifford, Allen L; Rodriguez-Barradas, Maria; Rimland, David; Monson, Thomas P; Pyne, Jeffrey M


    In the HIV Translating Initiatives for Depression into Effective Solutions project, we conducted a randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care in Veterans Health Administration HIV clinics in the US. An offsite HIV depression care team including a psychiatrist, a depression care manager (DCM), and a clinical pharmacist provided collaborative care using a stepped-care model of treatment and made recommendations to providers through the electronic health record system. The DCM delivered care management to HIV patients through phone calls, performing routine assessments and providing counseling in self-management and problem-solving. The DCM documented all calls in each patient's electronic medical record. In this paper we present results from interviews conducted with patients and clinical staff in a multi-stage formative evaluation (FE). We conducted semi-structured FE interviews with 26 HIV patients and 30 clinical staff at the three participating sites during and after the trial period to gather their experiences and perspectives concerning the intervention components. Interviews were transcribed verbatim and analyzed using rapid content analysis techniques. Patients reported high satisfaction with the depression care manager (DCM) phone calls. Both HIV and mental health providers reported that the DCM's chart notes in the electronic health record were very helpful, and most felt that a dedicated DCM for HIV patients is ideal to meet patient needs. Sites encountered barriers to achieving and maintaining universal depression screening, but had greater success when such screening was incorporated into routine intake processes. FE results demonstrated that depression care management via telehealth from an offsite team is acceptable and helpful to both HIV patients and their providers. Given that a centralized offsite depression care team can deliver effective, cost-effective, cost

  8. Criteria for clinical audit of women friendly care and providers' perception in Malawi

    Directory of Open Access Journals (Sweden)

    van den Broek Nynke


    Full Text Available Abstract Background There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. Objective We sought to (a establish standards for women friendly care and (b explore attitudinal barriers which could impede the proper implementation of clinical audit. Methods We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. Results The standards addressed different aspects of care given to women in maternity units, namely (i reception, (ii attitudes towards women, (iii respect for culture, (iv respect for women, (v waiting time, (vi enabling environment, (vii provision of information, (viii individualised care, (ix provision of skilled attendance at birth and emergency obstetric care, (x confidentiality, and (xi proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54 agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%, and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%. Conclusion Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers.

  9. The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit. (United States)

    Ismail, Ahmad


    Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels. These levels are informed by the Nursing Pain Management Model and include challenges (1) to be considered before pain assessment, (2) related to pain assessment, (3) related to pain treatment, and (4) related to post-treatment. This review mainly discusses the challenges of the first three levels because the fourth (post-treatment) relates to reassessment of pain, which shares the same challenges of level two, pain assessment. Key challenges of level one are related to health care provider's characteristics, patients and their families' factors, and PICU setting. The main challenges of the assessment and reassessment levels are the child's age and developmental level, ability to self-report, relying on behavioral and physiological indicators of pain, selecting the appropriate pain assessment scale, assessing pain while the patient is being treated with sedative and paralytic agents, mechanical ventilation, and changes in patients' level of consciousness. In the treatment level (level three), nonpharmacological interventions factors; alterations in the pharmacokinetics and pharmacodynamics of medications to be used for pain management in critically ill children; and the complexity of the administration of sedatives, analgesics, and paralytic agents in critically ill children are the main challenges. Health care providers can bear in mind such important challenges in order to provide effective pain management. Health care providers

  10. HIV health-care providers' burnout: can organizational culture make a difference? (United States)

    Ginossar, Tamar; Oetzel, John; Hill, Ricky; Avila, Magdalena; Archiopoli, Ashley; Wilcox, Bryan


    One of the major challenges facing those working with people living with HIV (PLWH) is the increased potential for burnout, which results in increased turnover and reduces quality of care provided for PLWH. The goal of this study was to examine the relationship among HIV health-care providers' burnout (emotional exhaustion and depersonalization) and organizational culture including teamwork, involvement in decision-making, and critical appraisal. Health-care providers for PLWH (N = 47) in federally funded clinics in a southwestern state completed a cross-sectional survey questionnaire about their perceptions of organizational culture and burnout. The results of multiple regression analysis indicated that positive organizational culture (i.e., teamwork) was negatively related to emotional burnout (p organizational culture (i.e., critical appraisal) was positively related to depersonalization (p < .005, R(2) = .18). These findings suggest that effective organizational communication interventions might protect HIV health-care providers from burnout.

  11. Fragile X-Associated Disorders (FXD): A Handbook for Families, Health Care Providers, Counselors, and Educators (United States)

    Fragile X-associated Disorders (FXD) A Handbook for Families, Health Care Providers, Counselors, and Educators For Personal Use Only ... contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Section 1: Genetics of Fragile X-Associated Disorders . . . . . . . . . . . . . . . 2 Case Scenario of a Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

  12. How Do Health Care Providers Diagnose Preeclampsia, Eclampsia, and HELLP Syndrome? (United States)

    ... and Publications How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome? Skip sharing on social ... weeks of pregnancy. Gestational hypertension can develop into preeclampsia. 1 Mild preeclampsia is diagnosed when a pregnant ...

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

    ... Health Medical Conditions Nutrition & Fitness Emotional Health Choosing a Primary Health Care Provider (PCP): General Information Posted ... help address your problems. Why do I need a PCP? You need a PCP so that your ...

  14. Talking about Complementary and Alternative Medicine with Health Care Provider: A Workbook and Tips (United States)

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  15. Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips (United States)

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  16. Talking about Complementary and Alternative Medicine with your Health Care Provider: A workbook and tips (United States)

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  17. Providing medical care for undocumented migrants in Denmark: what are the challenges for health professionals?

    DEFF Research Database (Denmark)

    Dræbel, Tania Aase; K Jensen, Natascha; Nørredam, Marie;


    Background: The rights of undocumented migrants are frequently overlooked. Denmark has ratified several international conventions recognizing the right to health care for all human beings, but has very scanty legislation and no existing policies for providing health care to undocumented migrants...... experience an unequal access to primary care facilities and that great uncertainties exist amongst health professionals as how to respond in such situations. The lack of official policies concerning the right to health care for undocumented migrants continue to pass on the responsibility to healt....... This study focuses on how health professionals navigate and how they experience providing treatment for undocumented migrants in the Danish health care system. Methods: The study was carried out as part of an EU-project on European Best Practices in Access, Quality and Appropriateness of Health Services...

  18. Analysis of an electronic consultation program at an academic medical centre: Primary care provider questions, specialist responses, and primary care provider actions. (United States)

    Wrenn, Katherine; Catschegn, Sereina; Cruz, Marisa; Gleason, Nathaniel; Gonzales, Ralph


    Introduction Electronic consultations (eConsults) increase access to specialty care, but little is known about the types of questions primary care providers (PCPs) ask through eConsults, and how they respond to specialist recommendations. Methods This is a retrospective descriptive analysis of the first 200 eConsults completed in the UCSF eConsult program. Participating PCPs were from eight adult primary care sites at the University of California, San Francisco (UCSF), USA. Medicine subspecialties participating were Cardiology, Endocrinology, Gastroenterology/hepatology, Hematology, Infectious diseases, Nephrology, Pulmonary medicine, Rheumatology, and Sleep medicine. We categorized eConsult questions into "diagnosis," "treatment," and/or "monitoring." We performed medical record reviews to determine the percentage of specialist recommendations PCPs implemented, and the proportion of patients with a specialist visit in the same specialty as the eConsult, emergency department visit, or hospital admission during the subsequent six months. Results PCP questions related to diagnosis in 71% of cases, treatment in 46%, and monitoring in 21%. Specialist responses related to diagnosis in 76% of cases, treatment in 64%, and monitoring in 40%. PCPs ordered 79% of all recommended laboratory tests, 86% of recommended imaging tests and procedures, 65% of recommended new medications, and 73% of recommended medication changes. In the six months after the eConsult, 14% of patients had a specialist visit within the UCSF system in the same specialty as the eConsult. Discussion eConsults provide guidance to PCPs across the spectrum of patient care. PCPs implement specialists' recommendations in the large majority of cases, and few patients subsequently require in-person specialty care related to the reason for the eConsult.

  19. Health care provider knowledge and routine management of pre-eclampsia in Pakistan.


    Sheikh, S; Qureshi, RN; Khowaja, AR; Salam, R; Vidler, M; Sawchuck, D.; von Dadelszen, P; Zaidi, S; Bhutta, Z; CLIP Working Group,


    Background Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagn...

  20. Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

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    Muhammad Ashraf Majrooh

    Full Text Available BACKGROUND: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. METHODS: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. RESULTS: The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. CONCLUSION: The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and

  1. [Nursing Experience With Providing Wound Care for a Newborn With Epidermolysis Bullosa]. (United States)

    Hsu, Hsiao-Hui; Zheng, Xin-Yi; Hsu, Mei-Yu


    Epidermolysis bullosa (EB) is a rare hereditary, chromosomal disease of the skin. Life-threatening septicemia may result if appropriate care is not provided to alleviate the extensive skin irritation that is the main symptom of this disease. This case report describes the experience of the author in nursing a wound area on a newborn that was suspected of being caused by EB. This wound area comprised blisters and peeling skin that covered 30% of the entire skin area of the infant. A holistic assessment conducted from December 1st, 2013 to January 7th, 2014 revealed that this large of an area of damage to the skin and mucosa considerably complicated the task of wound care and caused severe pain to the infant. In response to the special needs of this case, our medical team conducted a literature review of wound care for this rare disease. Based on the suggestions of previous empirical studies, nursing measures for the skin, mucosa, and wounds of the newborn were then administered through inter-team cooperation. These actions effectively reduced the pain, controlled the infection, and accelerated wound healing. In addition, progressive contact was used to guide the primary caregivers of the newborn, which alleviated their physical and psychological stresses effectively. The caregivers were educated systematically on wound care and guided to learn techniques for nursing and dressing wounds. Thus, these caregivers were better prepared to continue providing wound care at home. We suggest that healthcare professionals reference empirical studies when providing care to EB newborns during the acute-care period and provide wound care and supportive therapies to control the occurrence of complications using a multidisciplinary team-care model. In addition, social resources should be used effectively in nursing care plans to mitigate the effect of this rare disease on families.

  2. Home Care Providers to the Rescue: A Novel First-Responder Programme.

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    Steen M Hansen

    Full Text Available To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA.We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark.Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED.Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival.

  3. Incorporating human rights into reproductive health care provider education programs in Nicaragua and El Salvador. (United States)

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


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

  4. Critical Thinking in Critical Care: Five Strategies to Improve Teaching and Learning in the Intensive Care Unit. (United States)

    Hayes, Margaret M; Chatterjee, Souvik; Schwartzstein, Richard M


    Critical thinking, the capacity to be deliberate about thinking, is increasingly the focus of undergraduate medical education, but is not commonly addressed in graduate medical education. Without critical thinking, physicians, and particularly residents, are prone to cognitive errors, which can lead to diagnostic errors, especially in a high-stakes environment such as the intensive care unit. Although challenging, critical thinking skills can be taught. At this time, there is a paucity of data to support an educational gold standard for teaching critical thinking, but we believe that five strategies, routed in cognitive theory and our personal teaching experiences, provide an effective framework to teach critical thinking in the intensive care unit. The five strategies are: make the thinking process explicit by helping learners understand that the brain uses two cognitive processes: type 1, an intuitive pattern-recognizing process, and type 2, an analytic process; discuss cognitive biases, such as premature closure, and teach residents to minimize biases by expressing uncertainty and keeping differentials broad; model and teach inductive reasoning by utilizing concept and mechanism maps and explicitly teach how this reasoning differs from the more commonly used hypothetico-deductive reasoning; use questions to stimulate critical thinking: "how" or "why" questions can be used to coach trainees and to uncover their thought processes; and assess and provide feedback on learner's critical thinking. We believe these five strategies provide practical approaches for teaching critical thinking in the intensive care unit.

  5. Diagnostic characterization of services providing care to victims of accidents and violence in five Brazilian state capitals

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    Suely Ferreira Deslandes


    Full Text Available This article characterizes the services providing care to victims in five Brazilian regions with high violence and accident rates. It analyzes care activities and strategies, the profile of the teams, the conditions of installations, equipment and supplies, integrated care and registration services and the opinion of health managers with respect to the needs and requirements for a better care to the victims. The sample is composed by 103 services: 34 from Recife, 25 from Rio de Janeiro, 18 from Manaus, 18 from Curitiba and 8 from Brasília. The still preliminary results indicate: lower number of services focusing on the elderly; scarce investment in preventive actions; the principal actions carried out are social assistance, ambulatory and hospital care and psychological assistance; patients received from Basic Health Units require attention of the communities and families; need for investment in capacity building programs for professionals; precarious registries, data handled manually. The wording of the National Policy for Reduction of Morbidity and Mortality from Accidents and Violence is not well-known and there is a lack of articulation among and inside sectors and between prehospital and emergency care services. Rehabilitation services are insufficient in all cities.

  6. Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in home care. (United States)

    Hallberg, Ingalill Rahm; Cabrera, Ester; Jolley, David; Raamat, Katrin; Renom-Guiteras, Anna; Verbeek, Hilde; Soto, Maria; Stolt, Minna; Karlsson, Staffan


    Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor's level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor's degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.

  7. A qualitative exploration of how Canadian informal caregivers in medical tourism use experiential resources to cope with providing transnational care. (United States)

    Whitmore, Rebecca; Crooks, Valorie A; Snyder, Jeremy


    Canadians travelling abroad for privately arranged surgeries paid for out-of-pocket are engaging in what has come to be known as medical tourism. They are often accompanied by friends or family members, who we call caregiver-companions. Caregiver-companions provide care in and across a variety of formal and informal settings, such as in hotels, airplanes and at home. This qualitative study examines the experiences of informal caregivers in medical tourism to learn more about the lived experiences or 'experiential resources' they draw upon to cope with providing care and avoiding caregiver burden. The care-giving literature has demonstrated that such burden can negatively impact caregivers' well-being. The unique, transnational context of care-giving in medical tourism and recent growth in popularity of this practice means that there are few supports or resources currently in place to assist informal caregivers. In this article, we report on an analysis that sought to detail how caregiver-companions draw upon their previous lived experiences to cope with providing transnational care and to minimise or avoid the onset of caregiver burden. We conducted semi-structured telephone interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery between September 2013 and January 2014. Thematic analysis revealed the ways that participants had developed practical strategies to deal with the challenges they faced in medical tourism. The interviews revealed three important experiential resources drawn upon by participants: (i) previous experiences of international travel; (ii) previous experiences of informal care-giving; and (iii) dimensions of the existing relationship with the care recipient. Differences in access to and use of these experiential resources related to participants' perspectives on medical tourism and the outcomes of the trip. By identifying the experiential resources drawn upon by informal caregivers in medical tourism

  8. Managing organizational change: strategies for the female health care supervisor. (United States)

    Davies, G


    In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS)

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

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    Browne Annette J


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

  10. Differences in patient rating of care provided by BSN and ADN students. (United States)

    Davis-Martin, S; Skalak, C


    Nursing has discussed widely and with fervor the level of education required to provide quality nursing care for clients. No clear consensus has developed but studies tend to show that especially in the hospital setting, baccalaureate (BSN) and associate degree (ADN) nurses initially practice at a similar level. No studies identified compared patient ratings of BSN and ADN nurses. In this study ratings of care provided by BSN and ADN students were compared. Patients, students and instructors rated the student sample using Watson's Patient Satisfaction Rating Scale. Using Pearson correlations and t-tests, the overall satisfaction with care was assessed as "very positive" by patients, faculty and students alike. A significant correlation was found between faculty and patient ratings. Results support earlier findings and demonstrate similarities rather than differences in care provided by the two levels of students. Implications for nursing education and practice are discussed.

  11. Recruiting Quarterbacks: Strategies for Revitalizing Training in Primary Care Internal Medicine. (United States)

    Goroll, Allan H


    Current U.S. primary care workforce shortages and trainees' declining interest in primary care residency training, especially regarding primary care internal medicine, have many parallels with circumstances in the early 1970s, when modern adult primary care first emerged. Rediscovery of the lessons learned and the solutions developed at that time and applying them to the current situation have the potential to help engage a new generation of young physicians in the primary care mission.The author compares the internal medicine residency primary care track at the University of New Mexico, described by Brislen and colleagues in this issue, with the nation's first three-year primary care internal medicine residency track introduced at Massachusetts General Hospital in 1973. Strategies for addressing the challenges of primary care practice and improving learner attitudes toward the field are discussed. The author suggests that primary care physicians should be likened to "quarterbacks" rather than "gatekeepers" or "providers" to underscore the intensity of training, level of responsibility, degree of professionalism, and amount of compensation required for this profession. The advent of multidisciplinary team practice, modern health information technology, and fundamental payment reform promises to dramatically alter the picture of primary care, restoring its standing as one of the best job descriptions in medicine.

  12. Patient–Provider Rapport in the Health Care of People Who Inject Drugs

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    Ginetta Salvalaggio


    Full Text Available Little research has described determinants and consequences of patient–provider rapport among people who inject drugs (PWIDs. This mixed-method study (a qualitatively described facilitators, barriers, and consequences to rapport development between PWIDs and their health care providers and (b quantitatively tested the hypothesis that quality of rapport is associated with positive patterns of service use. Two exploratory focus groups with PWIDs and care providers were conducted. Subsequently, 89 PWIDs completed a survey interview; of those, eight completed a follow-up qualitative interview. Qualitative results indicated that rapport is influenced by drug-related behaviors, addiction severity, provider expertise, patient-centered care, and perceived discrimination and that rapport then influences patient compliance, timing of care, and criminal activity. Quantitative results indicated that rapport predicted PWID satisfaction with care as well as frequency and timing of emergency department presentations. Results suggest that PWID–provider rapport has several unique determinants and is associated with positive health care outcomes.

  13. Awareness, Interest, and Preferences of Primary Care Providers in Using Point-of-Care Cancer Screening Technology.

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    Chloe S Kim

    Full Text Available Well-developed point-of-care (POC cancer screening tools have the potential to provide better cancer care to patients in both developed and developing countries. However, new medical technology will not be adopted by medical providers unless it addresses a population's existing needs and end-users' preferences. The goals of our study were to assess primary care providers' level of awareness, interest, and preferences in using POC cancer screening technology in their practice and to provide guidelines to biomedical engineers for future POC technology development. A total of 350 primary care providers completed a one-time self-administered online survey, which took approximately 10 minutes to complete. A $50 Amazon gift card was given as an honorarium for the first 100 respondents to encourage participation. The description of POC cancer screening technology was provided in the beginning of the survey to ensure all participants had a basic understanding of what constitutes POC technology. More than half of the participants (57% stated that they heard of the term "POC technology" for the first time when they took the survey. However, almost all of the participants (97% stated they were either "very interested" (68% or "somewhat interested" (29% in using POC cancer screening technology in their practice. Demographic characteristics such as the length of being in the practice of medicine, the percentage of patients on Medicaid, and the average number of patients per day were not shown to be associated with the level of interest in using POC. These data show that there is a great interest in POC cancer screening technology utilization among this population of primary care providers and vast room for future investigations to further understand the interest and preferences in using POC cancer technology in practice. Ensuring that the benefits of new technology outweigh the costs will maximize the likelihood it will be used by medical providers and

  14. Awareness, Interest, and Preferences of Primary Care Providers in Using Point-of-Care Cancer Screening Technology. (United States)

    Kim, Chloe S; Vanture, Sarah; Cho, Margaret; Klapperich, Catherine M; Wang, Catharine; Huang, Franklin W


    Well-developed point-of-care (POC) cancer screening tools have the potential to provide better cancer care to patients in both developed and developing countries. However, new medical technology will not be adopted by medical providers unless it addresses a population's existing needs and end-users' preferences. The goals of our study were to assess primary care providers' level of awareness, interest, and preferences in using POC cancer screening technology in their practice and to provide guidelines to biomedical engineers for future POC technology development. A total of 350 primary care providers completed a one-time self-administered online survey, which took approximately 10 minutes to complete. A $50 Amazon gift card was given as an honorarium for the first 100 respondents to encourage participation. The description of POC cancer screening technology was provided in the beginning of the survey to ensure all participants had a basic understanding of what constitutes POC technology. More than half of the participants (57%) stated that they heard of the term "POC technology" for the first time when they took the survey. However, almost all of the participants (97%) stated they were either "very interested" (68%) or "somewhat interested" (29%) in using POC cancer screening technology in their practice. Demographic characteristics such as the length of being in the practice of medicine, the percentage of patients on Medicaid, and the average number of patients per day were not shown to be associated with the level of interest in using POC. These data show that there is a great interest in POC cancer screening technology utilization among this population of primary care providers and vast room for future investigations to further understand the interest and preferences in using POC cancer technology in practice. Ensuring that the benefits of new technology outweigh the costs will maximize the likelihood it will be used by medical providers and patients.

  15. Solvability of mental health care in the Family Health Strategy: social representation of professionals and users

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    Maria Salete Bessa Jorge


    Full Text Available Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, considering the words as units and providing context in the corpus. Results The representations emerge in two opposing poles: the users require satisfaction with care and the professionals realize the need for improvement of health actions. Although the matricial support in mental health and the home visits are developed, the barriers related to investment in health, continuing education and organization of care persist. Conclusion The different representations enable improvements in customer service, solvability of care and aggregate knowledge and practices in the expanded perspective of health needs in the family, social and therapeutic context.

  16. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study. (United States)

    Rix, Elizabeth F; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn


    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.

  17. Care coordination between specialty care and primary care: a focus group study of provider perspectives on strong practices and improvement opportunities

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    Kim B


    Full Text Available Bo Kim,1,2 Michelle A Lucatorto,3 Kara Hawthorne,4 Janis Hersh,5 Raquel Myers,6 A Rani Elwy,1,7 Glenn D Graham81Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, 2Department of Psychiatry, Harvard Medical School, Boston, MA, 3Office of Nursing Services, Department of Veterans Affairs, 4Chief Business Office, Purchased Care, Washington, DC, 5New England Veterans Engineering Resource Center, Boston, MA, 6SJ Quinney College of Law, University of Utah, Salt Lake City, UT, 7Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, 8Specialty Care Services (10P4E, Department of Veterans Affairs, Washington, DC, USAAbstract: Care coordination between the specialty care provider (SCP and the primary care provider (PCP is a critical component of safe, efficient, and patient-centered care. Veterans Health Administration conducted a series of focus groups of providers, from specialty care and primary care clinics at VA Medical Centers nationally, to assess 1 what SCPs and PCPs perceive to be current practices that enable or hinder effective care coordination with one another and 2 how these perceptions differ between the two groups of providers. A qualitative thematic analysis of the gathered data validates previous studies that identify communication as being an important enabler of coordination, and uncovers relationship building between specialty care and primary care (particularly through both formal and informal relationship-building opportunities such as collaborative seminars and shared lunch space, respectively to be the most notable facilitator of effective communication between the two sides. Results from this study suggest concrete next steps that medical facilities can take to improve care coordination, using as their basis the mutual understanding and respect developed between SCPs and PCPs through relationship-building efforts

  18. Review: Increasing Awareness and Education on Health Disparities for Health Care Providers. (United States)

    Nesbitt, Shawna; Palomarez, Rigo Estevan


    The focus of this review is to highlight health care disparities and trends in several common diseases in selected populations while offering evidence-based approaches to mitigating health care disparities. Health care disparities cross many barriers and affect multiple populations and diseases. Ethnic minorities, the elderly, and those of lower socioeconomic status (SES) are more at-risk than others. However, many low SES Whites and higher SES racial minorities have poorer health than their racial or SES peers. Also, recent immigrant groups and Hispanics, in particular, maintain high health ratings. The so-called Hispanic Paradox provides an example of how culture and social background can be used to improve health outcomes. These groups have unique determinants of disparity that are based on a wide range of cultural and societal factors. Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient's cultural background to promote healthy behaviors.

  19. Challenges in providing culturally-competent care to patients with metastatic brain tumours and their families. (United States)

    Longo, Lianne; Slater, Serena


    Being diagnosed with a metastatic brain tumour can be devastating as it is characterized by very low cure rates, as well as significant morbidity and mortality. Given the poor life expectancy and progressive disability that ensues, patients and family members experience much turmoil, which includes losses that bring about changes to family roles, routines and relationships. Crisis and conflict are common during such major disruptions to a family system, as individual members attempt to make sense of the illness experience based on cultural and spiritual beliefs, past experiences and personal philosophies. It is imperative health care providers strive towards increased awareness and knowledge of how culture affects the overall experience of illness and death in order to help create a mutually satisfactory care plan. Providing culturally-competent care entails the use of proper communication skills to facilitate the exploration of patient and family perspectives and allows for mutual decision making. A case study will illustrate the challenges encountered in providing culturally-competent care to a woman with brain cancer and her family. As the patient's health declined, the family entered into a state of crisis where communication between family members and health care professionals was strained; leading to conflict and sub-optimal outcomes. This paper will address the ethical dilemma of providing culturally-competent care when a patient's safety is at risk, and the nursing implications of upholding best practices in the context of differing beliefs and priorities.

  20. The Quality of Care Provided to Women with Urinary Incontinence in Two Clinical Settings (United States)

    Anger, Jennifer T.; Alas, Alexandriah; Litwin, Mark S.; Chu, Stephanie D.; Bresee, Catherine; Roth, Carol P.; Rashid, Rezoana; Shekelle, Paul; Wenger, Neil S.


    Purpose Our aim was to test the feasibility of a set of quality-of-care indicators for urinary incontinence (UI) and, at the same time, measure the care provided to women with UI in two different clinical settings. Materials and Methods This was a pilot test of a set of quality-of-care indicators (QIs). This was a pilot test of a set of quality-of-care indicators (QIs). Twenty QIs were previously developed using the RAND Appropriateness method. These QIs were used to measure care received for 137 women with a urinary incontinence (UI) diagnosis in a 120-physician hospital-based multi-specialty medical group (MSG). We also performed an abstraction of 146 patient records from primary care offices in Southern California. These charts were previously used as part of the Assessing Care of Vulnerable Elders Project (ACOVE). As a post-hoc secondary analysis, the two populations were compared with respect to quality, as measured by compliance with the QIs. Results In the ACOVE population, 37.7% of patients with UI underwent a pelvic examination, versus 97.8% in the MSG. Only 15.6% of cases in the MSG and 14.2% in ACOVE (p=0.86) had documentation that pelvic floor exercises were offered. Relatively few women with a body mass index (BMI) of >25 were counseled about weight loss in either population (20.9% MSG vs. 26.1% ACOVE, p=0.76). For women undergoing sling surgery, documentation of counseling about risks was lacking, and only 9.3% of eligible cases (MSG only) had documentation of the risks of mesh. Conclusions QIs are a feasible means to measure the care provided to women with UI. Care varied by population studied, yet deficiencies in care were prevalent in both patient populations studied. PMID:27164512

  1. Health care providers' readiness to screen for intimate partner violence in Northern Nigeria. (United States)

    John, I A; Lawoko, Stephen; Svanström, L; Mohammed, A Z


    Research on screening for intimate partner violence (IPV) within health care in a sub-Saharan African context is rare. This paper assessed factors associated with the readiness to screen for IPV among care providers (HCP, n = 274) at Kano hospital, Nigeria. Readiness was measured using the Domestic Violence Health Care Providers' survey instrument, which measures grade of perceived self-efficacy in screening for IPV, fear for victim/provider safety, access to system support to refer IPV victims, professional roles resistant/ fear of offending clients, and blaming the victim for being abused victim. Social workers perceived a higher self-efficacy and better access to system support networks to refer victims than peers in other occupation categories. Female care providers and doctors were less likely to blame the victim than males and social workers, respectively. Younger care providers of Yoruba ethnicity and social workers were less likely to perceive conflicting professional roles related to screening than older providers of Hausa ethnicity and doctors, respectively. Implications of our findings for interventions and further research are discussed.

  2. Medical provider attitudes about behavioral health consultants in integrated primary care: a preliminary study. (United States)

    Torrence, Nicole D; Mueller, Anne E; Ilem, Allison A; Renn, Brenna N; DeSantis, Brian; Segal, Daniel L


    Integrated behavioral health increases service utilization and treatment success, particularly with high-risk populations. This study assessed medical personnel's attitudes and perceptions of behavioral health clinicians (BHCs) in primary care using a brief self-report measure. A 6-item survey was given to medical providers (n = 45) from a health care system that includes integrated behavioral health services. Survey items assessed providers' attitudes and perceptions about BHCs. Attitudes about behavioral health were largely favorable. For all items, 73.3% to 100% of participants endorsed strongly agree or agree. Chi-square analyses revealed that those who interacted more frequently with BHCs were more comfortable discussing behavioral health issues with their patients, χ²(6, n = 45) = 13.43, p providers worked were not significantly related to any survey items. Medical providers surveyed believe that BHCs are valuable members of integrated health care, improving their abilities to provide care and to address their patients' physical and behavioral health problems. Although these preliminary results are promising, the setting surveyed has well-integrated behavioral health care services and thus might not be representative of other settings without such integration. Future studies should address medical providers' opinions of BHCs in a variety of settings with larger samples.

  3. Perceptions of misoprostol among providers and women seeking post-abortion care in Zimbabwe. (United States)

    Maternowska, M Catherine; Mashu, Alexio; Moyo, Precious; Withers, Mellissa; Chipato, Tsungai


    In Zimbabwe, abortions are legally restricted and complications from unsafe abortions are a major public health concern. This study in 2012 explored women's and providers' perspectives in Zimbabwe on the acceptability of the use of misoprostol as a form of treatment for complications of abortion in post-abortion care. In-depth interviews were conducted with 115 participants at seven post-abortion care facilities. Participants included 73 women of reproductive age who received services for incomplete abortion and 42 providers, including physicians, nurses, midwives, general practitioners and casualty staff. Only 29 providers had previously used misoprostol with their own patients, and only 21 had received any formal training in its use. Nearly all women and providers preferred misoprostol to surgical abortion methods because it was perceived as less invasive, safer and more affordable. Women also generally preferred the non-surgical method, when given the option, as fears around surgery and risk were high. Most providers favoured removing legal restrictions on abortion, particularly medical abortion. Approving use of misoprostol for post-abortion care in Zimbabwe is important in order to reduce unsafe abortion and its related sequelae. Legal, policy and practice reforms must be accompanied by effective reproductive health curricula updates in medical, nursing and midwifery schools, as well as through updated training for current and potential providers of post-abortion care services nationwide. Our findings support the use of misoprostol in national post-abortion care programmes, as it is an acceptable and potentially life-saving treatment option.

  4. Behavioral health providers' perspectives of delivering behavioral health services in primary care: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    Beehler Gregory P


    Full Text Available Abstract Background Co-located, collaborative care (CCC is one component of VA’s model of Integrated Primary Care that embeds behavioral health providers (BHPs into primary care clinics to treat commonly occurring mental health concerns among Veterans. Key features of the CCC model include time-limited, brief treatments (up to 6 encounters of 30 minutes each and emphasis on multi-dimensional functional assessment. Although CCC is a mandated model of care, the barriers and facilitators to implementing this approach as identified from the perspective of BHPs have not been previously identified. Methods This secondary data analysis used interview data captured as part of a quality improvement project in 2008. Fourteen BHPs (48% of providers in a regional VA network agreed to participate in a 30-minute, semi-structured phone interview. The interview included questions about their perceived role as a CCC provider, depiction of usual practice styles and behaviors, and perceptions of typical barriers and facilitators to providing behavioral healthcare to Veterans in CCC. Interviews were transcribed verbatim into a text database and analyzed using grounded theory. Results Six main categories emerged from the analysis: (a Working in the VA Context, (b Managing Access to Care on the Front Line, (c Assessing a Care Trajectory, (d Developing a Local Integrated Model, (e Working in Collaborative Teams, and (f Being a Behavioral Health Generalist. These categories pointed to system, clinic, and provider level factors that impacted BHP’s role and ability to implement CCC. Across categories, participants identified ways in which they provided Veteran-centered care within variable environments. Conclusions This study provided a contextualized account of the experiences of BHP’s in CCC. Results suggest that these providers play a multifaceted role in delivering clinical services to Veterans while also acting as an interdependent component of the larger VA

  5. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

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    Jensen Natasja Koitzsch


    Full Text Available Abstract Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE. Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy

  6. Examining the trajectories of children providing care for adults in rural Kenya

    DEFF Research Database (Denmark)

    Skovdal, Morten


    was adapted, with historical profiles, Photovoice and draw-and-write essays complementing 34 individual interviews and 2 group discussions. A thematic network analysis revealed that children's caregiving was not confined to a single experience. Children were observed to provide care for a number of different...... family and community members for varying periods of time and intensities. Although their living arrangements and life circumstances often gave them little choice but to care, a social recognition of children's capacity to provide care for fragile adults, helped the children construct an identity, which...... for many children in economically more advanced countries, this may not hold true in rural Africa, where poverty and AIDS can have significant knock-on effects on entire families and communities. This paper seeks to develop a more complex understanding of children's caring experiences by asking children...

  7. Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Maria Ellegård, Lina; Anell, Anders

    contribute more to the development of resistance, to less resistance-driving types. In the context of Swedish primary care, we study the introduction of P4P indicators encouraging substitution of narrow-spectrum antibiotics for broad-spectrum antibiotics in the treatment of children with respiratory tract......Resistance to antibiotics is a major threat to the eectiveness of modern health care. This study examines if pay-for-performance (P4P) to care providers stimulates the appropriate use of antibiotics; in particular, if P4P can induce a substitution away from broad-spectrum antibiotics, which...... infections (RTI). During 2006-2013, 8 out of 21 county councils introduced such P4P indicators in their reimbursement schemes for primary care providers. We employ municipality-level register data covering all purchases of RTI related antibiotics and exploit the staggered introduction of pay...

  8. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review (United States)

    Coast, Ernestina; Jones, Eleri; Lattof, Samantha R; Portela, Anayda


    Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations’ use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations’ access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated. PMID:27190222

  9. Health-care reforms in the People's Republic of China--strategies and social implications. (United States)

    Wong, V C; Chiu, S W


    Analyses the features, strategies and characteristics of health-care reforms in the People's Republic of China. Since the 14th Central Committee of the Chinese Communist Party held in 1992, an emphasis has been placed on reform strategies such as cost recovery, profit making, diversification of services, and development of alternative financing strategies in respect of health-care services provided in the public sector. Argues that the reform strategies employed have created new problems before solving the old ones. Inflation of medical cost has been elevated very rapidly. The de-linkage of state finance bureau and health service providers has also contributed to the transfer of tension from the state to the enterprises. There is no sign that quasi-public health-care insurance is able to resolve these problems. Finally, cooperative medicine in the rural areas has been largely dismantled, though this direction is going against the will of the state. Argues that a new balance of responsibility has to be developed as a top social priority between the state, enterprises and service users in China in order to meet the health-care needs of the people.

  10. Training providers on issues of race and racism improve health care equity. (United States)

    Nelson, Stephen C; Prasad, Shailendra; Hackman, Heather W


    Race is an independent factor in health disparity. We developed a training module to address race, racism, and health care. A group of 19 physicians participated in our training module. Anonymous survey results before and after the training were compared using a two-sample t-test. The awareness of racism and its impact on care increased in all participants. White participants showed a decrease in self-efficacy in caring for patients of color when compared to white patients. This training was successful in deconstructing white providers' previously held beliefs about race and racism.

  11. Financial health and customer satisfaction in private health care providers in Brazil. (United States)

    Schiozer, Rafael Felipe; Saito, Cristiana Checchia; Saito, Richard


    This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.

  12. Care provider perspectives on medical travel: A three-country study of destination hospitals. (United States)

    Garman, Andrew N; Johnson, Tricia J; Lynch, Elizabeth B; Satjapot, Siriporn


    Despite growing interest in the current and potential role of medical travel in U.S. patient care, very little research has been conducted on clinician and other provider organizations' perspectives on providing international patient care. The present study sought to gain formative insights about medical travel from the providers' perspectives, by conducting structured interviews and focus groups in six hospitals from three countries catering to patients traveling from the United States. Findings highlighted the surprising role of international events and policies in the evolution of medical travel, as well as both the desire and need for more transparent quality standards.

  13. The legal duty of physicians and hospitals to provide emergency care


    Walker, Anne F.


    ACCESSIBILITY OF HOSPITAL EMERGENCY SERVICES HAS BEEN an issue of increasing concern and was recently brought into public focus in Ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care ...

  14. Developing personal values: trainees' attitudes toward strikes by health care providers. (United States)

    Li, Su-Ting T; Srinivasan, Malathi; Der-Martirosian, Claudia; Kravitz, Richard L; Wilkes, Michael S


    Worldwide, health care providers use strikes and job actions to influence policy. For health care providers, especially physicians, strikes create an ethical tension between an obligation to care for current patients (e.g., to provide care and avoid abandonment) and an obligation to better care for future patients by seeking system improvements (e.g., improvements in safety, to access, and in the composition and strength of the health care workforce). This tension is further intensified when the potential benefit of a strike involves professional self-interest and the potential risk involves patient harm or death. By definition, trainees are still forming their professional identities and values, including their opinions on fair wages, health policy, employee benefits, professionalism, and strikes. In this article, the authors explore these ethical tensions, beginning with a discussion of reactions to a potential 2005 nursing strike at the University of California, Davis, Medical Center. The authors then propose a conceptual model describing factors that may influence health care providers' decisions to strike (including personal ethics, personal agency, and strike-related context). In particular, the authors explore the relationship between training level and attitudes toward taking a job action, such as going on strike. Because trainees' attitudes toward strikes continue to evolve during training, the authors maintain that open discussion around the ethics of health care professionals' strikes and other methods of conflict resolution should be included in medical education to enhance professionalism and systems-based practice training. The authors include sample case vignettes to help initiate these important discussions.

  15. Performance of the measures of processes of care for adults and service providers in rehabilitation settings

    Directory of Open Access Journals (Sweden)

    Bamm EL


    Full Text Available Elena L Bamm,1 Peter Rosenbaum,1,2 Seanne Wilkins,1 Paul Stratford11School of Rehabilitation Science, 2CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, CanadaIntroduction: In recent years, client-centered care has been embraced as a new philosophy of care by many organizations around the world. Clinicians and researchers have identified the need for valid and reliable outcome measures that are easy to use to evaluate success of implementation of new concepts.Objective: The current study was developed to complete adaptation and field testing of the companion patient-reported measures of processes of care for adults (MPOC-A and the service provider self-reflection measure of processes of care for service providers working with adult clients (MPOC-SP(A.Design: A validation studySettings: In-patient rehabilitation facilities.Main outcome measures: MPOC-A and measure of processes of care for service providers working with adult clients (MPOC-SP(A.Results: Three hundred and eighty-four health care providers, 61 patients, and 16 family members completed the questionnaires. Good to excellent internal consistency (0.71–0.88 for health care professionals, 0.82–0.90 for patients, and 0.87–0.94 for family members, as well as moderate to good correlations between domains (0.40–0.78 for health care professionals and 0.52–0.84 for clients supported internal reliability of the tools. Exploratory factor analysis of the MPOC-SP(A responses supported the multidimensionality of the questionnaire.Conclusion: MPOC-A and MPOC-SP(A are valid and reliable tools to assess patient and service-provider accounts, respectively, of the extent to which they experience, or are able to provide, client-centered service. Research should now be undertaken to explore in more detail the relationships between client experience and provider reports of their own behavior.Keywords: client-centered care, service evaluation, MPOC, models of

  16. Health Care Transformation: A Strategy Rooted in Data and Analytics. (United States)

    Koster, John; Stewart, Elizabeth; Kolker, Eugene


    Today's consumers purchasing any product or service are armed with information and have high expectations. They expect service providers and payers to know about their unique needs. Data-driven decisions can help organizations meet those expectations and fulfill those needs.Health care, however, is not strictly a retail relationship-the sacred trust between patient and doctor, the clinician-patient relationship, must be preserved. The opportunities and challenges created by the digitization of health care are at the crux of the most crucial strategic decisions for academic medicine. A transformational vision grounded in data and analytics must guide health care decisions and actions.In this Commentary, the authors describe three examples of the transformational force of data and analytics to improve health care in order to focus attention on academic medicine's vital role in guiding the needed changes.

  17. Keeping Kids Safe: A Guide for Safe Food Handling & Sanitation for Child Care Providers. (United States)

    Food Safety and Inspection Service (USDA), Washington, DC.

    Because children under age 5 are susceptible to food-borne illnesses and children in diapers present special sanitation and health problems, food safety and sanitation are emerging as important issues for child care providers. This booklet is designed to give providers and parents a quick and easy reference for food safety and sanitation. The…

  18. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians

    Directory of Open Access Journals (Sweden)

    Warmington K


    Full Text Available Kelly Warmington,1 Carol A Kennedy,2 Katie Lundon,3 Leslie J Soever,4 Sydney C Brooks,5 Laura A Passalent,6 Rachel Shupak,7 Rayfel Schneider,8 1Learning Institute, Hospital for Sick Children, 2Musculoskeletal Health and Outcomes Research, St Michael’s Hospital, 3Continuing Professional Development, Faculty of Medicine, University of Toronto, 4University Health Network, 5Ontario Division, Arthritis Society, 6Toronto Western Hospital, 7Division of Rheumatology, St Michael's Hospital, 8Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Objective: To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC program. Materials and methods: This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient–Doctor Interaction Scale, modified to capture patient–practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP services with previously received arthritis care. Results: A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%, female (72%, and living in urban areas (79%. The mean age of participants was 54 years (range 3–92 years, and 51% were not working. Patients with inflammatory (51% and noninflammatory conditions (31% were represented. Mean (standard deviation Patient–Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60 to 4.63 (0.48 (1 to 5 [greater satisfaction]. Overall satisfaction with the quality of care was high (4.39 [0.77], as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]. Ninety-eight percent of

  19. Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa

    Directory of Open Access Journals (Sweden)

    Orner Phyllis


    Full Text Available Abstract Background Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning. In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services. Methods Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. Results Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision. Conclusion This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of

  20. Client Factors Affect Provider Adherence to Clinical Guidelines during First Antenatal Care.

    Directory of Open Access Journals (Sweden)

    Mary Amoakoh-Coleman

    Full Text Available The first antenatal clinic (ANC visit helps to distinguish pregnant women who require standard care, from those with specific problems and so require special attention. There are protocols to guide care providers to provide optimal care to women during ANC. Our objectives were to determine the level of provider adherence to first antenatal visit guidelines in the Safe Motherhood Protocol (SMP, and assess patient factors that determine complete provider adherence.This cross-sectional study is part of a cohort study that recruited women who delivered in eleven health facilities and who had utilized antenatal care services during their pregnancy in the Greater Accra region of Ghana. A record review of the first antenatal visit of participants was carried out to assess the level of adherence to the SMP, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected using a questionnaire. Percentages of adherence levels and baseline characteristics were estimated and cluster-adjusted odds ratios (OR calculated to identify determinants.A total of 948 women who had delivered in eleven public facilities were recruited with a mean age (SD of 28.2 (5.4 years. Overall, complete adherence to guidelines pertained to only 48.1% of pregnant women. Providers were significantly more likely to completely adhere to guidelines when caring for multiparous women [OR = 5.43 (1.69-17.44, p<0.01] but less likely to do so when attending to women with history of previous pregnancy complications [OR = 0.50 (0.33-0.75, p<0.01].Complete provider adherence to first antenatal visit guidelines is low across different facility types in the Greater Accra region of Ghana and is determined by parity and history of previous pregnancy complication. Providers should be trained and supported to adhere to the guidelines during provision of care to all pregnant women.

  1. Ethical and professional considerations providing medical evaluation and care to refugee asylum seekers. (United States)

    Asgary, Ramin; Smith, Clyde L


    A significant number of asylum seekers who largely survived torture live in the United States. Asylum seekers have complex social and medical problems with significant barriers to health care access. When evaluating and providing care for survivors, health providers face important challenges regarding medical ethics and professional codes. We review ethical concerns in regard to accountability, the patient-physician relationship, and moral responsibilities to offer health care irrespective of patient legal status; competing professional responsibility toward society and the judiciary system; concerns about the consistency of asylum seekers' claims; ethical concerns surrounding involving trainees and researching within the evaluation setting; and the implication of broader societal views towards rights and social justice. We discuss contributing factors, including inadequate and insufficient provider training, varying and inadequate institutional commitment, asylum seekers' significant medical and social problems, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions.

  2. Personal values and attitudes toward people living with HIV among health care providers in Kazakhstan. (United States)

    Tartakovsky, Eugene; Hamama, Liat


    Our study investigates the relationship between health care providers' personal value preferences and their attitudes toward people living with HIV (PLWH). The study was conducted among nurses (n = 38) and physicians (n = 87) working in HIV Centers in Kazakhstan. Significant relationships were found between the providers' personal value preferences and their attitudes toward PLWH: higher preferences for tradition and power values and lower preferences for benevolence values were associated with more negative attitudes toward PLWH. In addition, more years of experience working with PLWH was associated with more positive attitudes toward this population. Age, gender, family status, religiosity, occupation, and number of years working in health care were not related to the health care providers' attitudes toward PLWH. Theoretical and practical implications of the results obtained are discussed.

  3. Older widows' speculations and expectancies concerning professional home-care providers. (United States)

    Porter, Eileen J; Ganong, Lawrence H


    Little is known about older persons' expectancies (or anticipations) about the possible actions of home-care professionals, although such data have implications for the ethics of home care and home-care policies. From a longitudinal study of older women's experience of home care, findings are reported concerning their expectancies of professional home-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from a series of interviews with 13 women aged 82 to 96 years. Among the five key structures of experience were 'finding that someone has the job of helping me here' and 'determining where the helper's field lies'. Two subsets within a category of expectancies were differentiated: speculations about helpers' possible actions and expectancies about outcomes of helpers' actions. As parameters of relational ethics, clients' speculations and expectancies are appropriate bases for dialogue about older widows' relationships with home-care professionals and the foci of home-care policies.

  4. Implementation of cancer clinical care pathways: a successful model of collaboration between payers and providers. (United States)

    Feinberg, Bruce A; Lang, James; Grzegorczyk, James; Stark, Donna; Rybarczyk, Thomas; Leyden, Thomas; Cooper, Joseph; Ruane, Thomas; Milligan, Scott; Stella, Philip; Scott, Jeffrey A


    Despite rising medical costs within the US health care system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of health care in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the health care cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology health care consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program.

  5. Public finance policy strategies to increase access to preconception care. (United States)

    Johnson, Kay A


    Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

  6. Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System. (United States)

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


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

  7. An Analysis of the Allocation of Funds for the Direct Health Care Provider Program (DHCPP) (United States)


    RENEWAL 15 __ OPTOMET 16 __ PREVMED 25 -REQ_$ 17 __ PA $ (000) 18 __ ENLISTED 26 --- REQ_$/WY $ (000) 27 _%_WORK 28 _AMEPFUND $ (000) 29 __ FY88 Other...Nutrition Care Provider NUTRI .5329 .0154 Optometry Provider OPTOMET .3439 .0544 Preventive Med. Provider PREVMED .33/2 .0024 z Physician Assistant Prov...RAD) + .6419 (PHYSMED) + .4350 (FAMPRAC) + .3190 (SOCIAL) + .4789 (PHARM) + .5329 (NUTRI) + .3439 ( OPTOMET ) + .3372 (PREVMED) + .3758 (PA) + .3331

  8. Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa


    Orner Phyllis; Stinson Kathryn; Harries Jane


    Abstract Background Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning. In South Africa, little is known about the personal and prof...

  9. What Obstetric Health Care Providers Need to Know About Measles and Pregnancy. (United States)

    Rasmussen, Sonja A; Jamieson, Denise J


    From January 1 to April 3, 2015, 159 people from 18 states and the District of Columbia were reported as having measles. Most cases are part of an outbreak linked to a California amusement park. Because measles was eliminated in the United States in 2000, most U.S. clinicians are unfamiliar with the condition. We reviewed information on the current outbreak, measles manifestations, diagnostic methods, treatment, and infection-control recommendations. To identify information on measles and pregnancy, we reviewed reports with 20 or more measles cases during pregnancy that included data on effects on pregnant women or pregnancy outcomes. These reports were identified through MEDLINE from inception through February 2015 using the following strategy: (((pregnan*) AND measles) AND English[Language]) NOT review[Publication Type]. Reference lists also were reviewed to identify additional articles. Pregnant women infected with measles are more likely to be hospitalized, develop pneumonia, and die than nonpregnant women. Adverse pregnancy outcomes, including pregnancy loss, preterm birth, and low birth weight, are associated with maternal measles; however, the risk of congenital defects does not appear to be increased. No antiviral therapy is available; treatment is supportive. Early identification of possible cases is needed so that appropriate infection control can be instituted promptly. The recent measles outbreak highlights the role that obstetric health care providers play in vaccine-preventable illnesses; obstetrician-gynecologists should ensure that patients are up to date on all vaccines, including measles-containing vaccines, and should recommend and ideally offer a measles-containing vaccine to women without evidence of measles immunity before or after pregnancy.

  10. Barriers to communication between HIV care providers (HCPs) and women living with HIV about child bearing

    DEFF Research Database (Denmark)

    Ddumba-Nyanzi, Ismael; Kaawa-Mafigiri, David; Johannessen, Helle


    Objectives: In the context of HIV clinical care, open discussion regarding sexual health and reproductive plans has become increasingly relevant. The aim of this paper is to explore barriers to communication between providers and women living with HIV regarding childbearing. Methods: In......) ‘accidental pregnancy’. Conclusion: Existing evidence regarding effective provider-patient communication should be considered for its application for reproductive counseling among HIV infected women. Practice implications: These data demonstrate the need for current counseling guidelines to explore approaches...... that encourage open, non-judgmental, non-directive discussions with HIV positive individuals around their reproductive desires and intentions in a health care setting...

  11. Do health care providers adhere to the revised malaria control guidelines? '

    Directory of Open Access Journals (Sweden)

    Sujoy Ray


    Full Text Available Introduction: Malaria is a public health problem worldwide with India contributing to 77% cases in the South East Asian region of World Health Organization (WHO. Karnataka is one of the project states under World Bank with API>2. Statistics from the district of Udupi, which is the setting for this study, shows a rise in malaria cases from January-May 2009. There were a total of 1189 malaria cases reported of which 103 were positive for P. falciparum. The National Programme to control malaria has recently revised its strategies, thus involved personnel need to be aware of it for the programme to be effective.Objectives: Keeping in mind the emergence of Choloroquine resistant malaria, The National Malaria Control Programme has revised its strategy. This cross-sectional study was conducted to assess the awareness and practice of National Guidelines for malaria among health care providers in Urban Udupi, Karnataka (which is one of the project states under the World Bank for malaria control and the problems in implementation of these guidelines.Settings and design: Cross sectional study, Udupi district.Methods: Data was collected by personal interview (structured questionnaire after obtaining due consent.Statistical analysis used: Data was analyzed by SPSS software.ObservationsResults: Most respondents were from both Manipal and Udupi and had been practicing for over 5 years. Chills and headache were used as main guiding symptoms for diagnosis, all insisted on lab diagnosis with QBC being the most preferred test followed by smear. Cases were treated on pure clinical diagnosis in case of typical signs, unresponsiveness to other therapy, unwillingness or non-affordability of tests. Both species of Plasmodium were prevalent, Chloroquine being first line treatment for P. Vivax and Artemisinin compounds for Falciparum. Clinical failure was encountered against Falciparum due to chloroquine resistance and quinine was mainly used to combat it. Medical

  12. Early childhood feeding: assessing knowledge, attitude, and practices of multi-ethnic child-care providers. (United States)

    Freedman, Marjorie R; Alvarez, Karina P


    Early childhood is a critical period for shaping and influencing feeding and lifestyle behaviors that have implications for future weight and health. With more women in the workforce, families have become reliant on child care. Thus, the child-feeding relationship has become a shared responsibility between the parent and child-care provider. Little is known about the impact of child-care providers on development of early childhood feeding behaviors and subsequent risk for obesity, especially in the Hispanic ethnic group. This research examined child-feeding attitudes, practices, and knowledge of multi-ethnic home-based and center-based child-care providers. Questionnaires were completed by a convenience sample of 72 providers, 50 of whom completed a pre- and post-test on child-feeding knowledge after receiving a 90-minute class based on Satter's division of responsibility feeding model during the spring of 2008. Results indicate many providers had practices consistent with this model. However, substantial differences were reported by Hispanic providers, who were statistically more likely to encourage children to finish meals before dessert, prepare foods they perceived as well-liked by children, coach children to eat foods perceived as appropriate, and not eat with children during meals. A substantial increase in knowledge from 73% correct at pretest to 82% at post-test was noted, with a substantial increase in knowledge on five of 13 questions. However, knowledge was not always congruent with behavior. This study points to differences among providers based on ethnicity, and strongly recommends recruiting Hispanic child-care providers to participate in educational programs and community efforts to prevent obesity.

  13. Group Medical Visits to Provide Gynecologic Care for Women Affected by Breast Cancer

    Directory of Open Access Journals (Sweden)

    Sally R. Greenwald


    Full Text Available Purpose: Women with breast cancer have complex and unique gynecologic needs that are challenging to effectively and comprehensively meet in a traditional gynecology visit format. Group medical visits are an effective and well-received model of care in other disease settings and can provide comprehensive health education as an adjunct to one-on-one evaluation and treatment. There are limited data regarding the use of this type of health care delivery in providing gynecology-focused care to women affected by breast cancer. Methods: A group medical visit model was created for gynecology providers to see new breast cancer patient consults. From May 2012 to February 2014, 148 patients (3–6 per group participated in a 1-hour informational session followed by a 15- to 30-minute individual visit with a physician that included history, physical examination and evaluation. We surveyed 101 women who attended these visits to evaluate a group model for providing gynecologic care and educational support to women with breast cancer. Results: Of those who responded to the survey question, 100% agreed or somewhat agreed that their expectations for an initial intake visit were met during the group visit; 81% agreed or somewhat agreed that they felt a group visit was preferable to an individual introductory visit. More than 95% agreed or somewhat agreed that the information was understandable and their questions were answered during the visit. Only 5 respondents expressed dissatisfaction with the additional time commitment for this type of visit. Conclusions: The majority of women surveyed expressed satisfaction with their experience with a group visit format. The women who participated preferred this format compared to an individual intake appointment when establishing gynecology care after breast cancer diagnosis/treatment, regardless of age, menopausal status, cancer stage or hormone receptor status. While further studies are warranted to directly compare and

  14. Providing supportive care to cancer patients: a study on inter-organizational relationships

    Directory of Open Access Journals (Sweden)

    Kevin Brazil


    Full Text Available Background: Supportive cancer care (SCC has historically been provided by organizations that work independently and possess limited inter-organizational coordination. Despite the recognition that SCC services must be better coordinated, little research has been done to examine inter-organizational relationships that would enable this goal. Objective: The purpose of this study was to describe relationships among programs that support those affected by cancer. Through this description the study objective was to identify the optimal approach to coordinating SCC in the community. Methods: Senior administrators in programs that provided care to persons and their families living with or affected by cancer participated in a personal interview. Setting: South-central Ontario, Canada. Study population: administrators from 43 (97% eligible programs consented to participate in the study. Results: Network analysis revealed a diffuse system where centralization was greater in operational than administrative activities. A greater number of provider cliques were present at the operational level than the administrative level. Respondents identified several priorities to improve the coordination of cancer care in the community including: improving standards of care; establishing a regional coordinating body; increasing resources; and improving communication between programs. Conclusion: Our results point to the importance of developing a better understanding on the types of relationships that exist among service programs if effective integrated models of care are to be developed.

  15. Knowledge and attitudes about intrauterine devices among women's health care providers in El Salvador. (United States)

    Hohmann, Heather Lyn; Cremer, Miriam L; Gonzalez, Enrique; Maza, Mauricio


    In order to gain an understanding of Salvadoran health care providers' clinical knowledge, attitudes, and practice toward the intrauterine device (IUD), Ministry of Health providers completed a self-administered, anonymous survey. Surveys were completed by 135 participants. The majority (94.7% and 97.0%) agreed the IUD is a safe and effective form of contraception. Only 46.6% of participants had ever received training in IUD placement, and 32.0% of them had ever inserted more than 10 IUDs. The majority of providers (54.2%) believed that the IUD was associated with a higher rate of infection than is described in the literature. Lack of formal training and knowledge about persistent infection rates associated with IUDs may contribute to low IUD placement by Salvadoran providers. Health care providers surveyed are open to learning more about the IUD and sharing the information with their patients.

  16. Ways of Doing: Restorative Practices, Governmentality, and Provider Conduct in Post-Apartheid Health Care. (United States)

    Harris, Bronwyn; Eyles, John; Goudge, Jane


    In this article, we consider the conduct of post-apartheid health care in a policy context directed toward entrenching democracy, ensuring treatment-adherent patients, and creating a healthy populace actively responsible for their own health. We ask how tuberculosis treatment, antiretroviral therapy, and maternal services are delivered within South Africa's health system, an institutional site of colonial and apartheid injustice, and democratic reform. Using Foucauldian and post-Foucauldian notions of governmentality, we explore provider ways of doing to, for, and with patients in three health subdistricts. Although restorative provider engagements are expected in policy, older authoritarian and paternalistic norms persist in practice. These challenge and reshape, even 'undo' democratic assertions of citizenship, while producing compliant, self-responsible patients. Alongside the need to address pervasive structural barriers to health care, a restorative approach requires community participation, provider accountability, and a health system that does with providers as much as providers who do with patients.

  17. Providing Palliative Care for a dying teen at home: Perspectives and challenges

    Directory of Open Access Journals (Sweden)

    Malathi Nayak


    Full Text Available Adolescents and young adults with cancer are a heterogeneous group. Management of this special group requires a broad-based interdisciplinary clinical team, which should include palliative care (PC, psychology, social work, oncology, and nursing representatives. The function of PC is to provide impeccable pain and other symptom control and to coordinate care as the disease progresses. The cure rate of cancer in adolescents is high but between 10% and 40% of them will develop incurable disease depending on tumor type and prognostic factors. PC in adolescents should also take care of the specific physical and psychosocial developmental changes in this age group. A 16-year old boy suffered with incurable disease and team has provided the PC at the door step taken as a case study.

  18. Interactional communication challenges in end-of-life care: dialectical tensions and management strategies experienced by home hospice nurses. (United States)

    Gilstrap, Cristina M; White, Zachary M


    This study examines the dialectical tensions experienced by home hospice nurses in interactions with patients, families, and health care providers. In-depth, semistructured interviews were conducted with 24 home hospice nurses from a mid-size for-profit hospice organization serving approximately 230 patients on an annual basis. Interviews revealed hospice nurses experience both interpersonal and organizational dialectics during hospice interactions: authoritative-nonauthoritative, revelation-concealment, independence-collaboration, and quality of care-business of care. Dialectics often resulted as a by-product of (a) responding to expectations and care choices of patients and families particular to the emotionally charged home context, (b) obtaining authorization from health care providers who are not members of the interdisciplinary team, and (c) pressures associated with providing quality patient care while fulfilling organizational role requirements. The praxis strategies used to negotiate tensions included segmentation, balance, recalibration, and spiraling inversion. Specifically, nurses employed strategies such as ascertaining family/patient acceptance, using persuasive tactics when communicating with external health care providers, relying on effective time management, and working off the clock to provide more in-person care. Although functional for patients and hospice organizations, nurses who continually rely on these strategies may experience job stress when their interpersonal commitments repeatedly conflict with organizational role demands.

  19. Trauma-informed care for children in the ambulance: international survey among pre-hospital providers (United States)

    Alisic, Eva; Tyler, Mark P.; Giummarra, Melita J.; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A.; Kassam-Adams, Nancy


    ABSTRACT Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers’ knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one

  20. Play as a care strategy for children with cancer

    Directory of Open Access Journals (Sweden)

    Kálya Yasmine Nunes de Lima

    Full Text Available OBJECTIVE: To understand the influence of play in the care process as perceived by children with cancer. METHOD: A descriptive, exploratory and qualitative study conducted in a children's cancer unit in Natal, Rio Grande do Norte, Brazil. Data were collected between October 2013 and January 2014 by means of photographic records and semi-structured interviews with eight children, and content analysis with emphasis on two categories: Auxiliary instruments during play; and The influence of play in the process of care. RESULTS: Recreational activities involve watching television, using computers, games and toys, drawing, the playroom and the clown, which provide fun, feelings of joy, distraction and interaction with other people. CONCLUSION: There are several activities at the hospital that are considered play-related and, for the children, they all benefit their care process.

  1. Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces. (United States)

    Acker, Peter; Newberry, Jennifer A; Hattaway, Leonard Bud F; Socheat, Phan; Raingsey, Prak P; Strehlow, Matthew C


    Despite significant improvements in health outcomes nationally, many Cambodians continue to experience morbidity and mortality due to inadequate access to quality emergency medical services. Over recent decades, the Cambodian healthcare system and civil infrastructure have advanced markedly and now possess many of the components required to establish a well functioning emergency medical system. These components include enhanced access to emergency transportation through large scale road development efforts, widspread availability of emergency communication channels via the spread of cellphone and internet technology, and increased access to health services for poor patients through the implementation of health financing schemes. However, the system still lacks a number of key elements, one of which is trained prehospital care providers. Working in partnership with local providers, our team created an innovative, Cambodia-specific prehospital care provider training course to help fill this gap. Participants received training on prehospital care skills and knowledge most applicable to the Cambodian healthcare system, which was divided into four modules: Basic Prehospital Care Skills and Adult Medical Emergencies, Traumatic Emergencies, Obstetric Emergencies, and Neonatal/Pediatric Emergencies. The course was implemented in nine of Cambodia's most populous provinces, concurrent with a number of overarching emergency medical service system improvement efforts. Overall, the course was administered to 1,083 Cambodian providers during a 27-month period, with 947 attending the entire course and passing the course completion exam.

  2. Naptime Data Meetings to Increase the Math Talk of Early Care and Education Providers (United States)

    Trawick-Smith, Jeffrey; Oski, Heather; DePaolis, Kim; Krause, Kristen; Zebrowski, Alyssa


    Classroom conversations about mathematics--math talk--between early care and education providers and young children have been associated with growth in mathematical thinking. However, professional development opportunities to learn about math teaching and learning are limited in many community-based child development centers. New approaches that…

  3. Planning and Providing End-of-life Care in Rural Areas (United States)

    Wilson, Donna M.; Justice, Christopher; Sheps, Sam; Thomas, Roger; Reid, Pam; Leibovici, Karen


    Context: Approximately 20% of North Americans and 25% of Europeans reside in rural areas. Planning and providing end-of-life (EOL) care in rural areas presents some unique challenges. Purpose: In order to understand these challenges, and other important issues or circumstances, a literature search was conducted to assess the state of science on…

  4. Make Time to Talk: Language Building Tips for Center-Based Child Care Providers (United States)

    National Institute for Literacy, 2010


    Everyone knows that it's important to talk every day with each child, using the kind of talk that builds language and thinking skills. The phrase MAKE TIME TO TALK is to help child care providers remember things they can do when talking to children to help them learn new vocabulary and how to use language to express their ideas and needs, and that…

  5. 42 CFR 433.56 - Classes of health care services and providers defined. (United States)


    ... organizations, preferred provider organizations); (9) Ambulatory surgical center services, as described for... defined. 433.56 Section 433.56 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...) Nursing facility services (other than services of intermediate care facilities for the mentally...

  6. Factors Predicting Oncology Care Providers' Behavioral Intention to Adopt Clinical Decision Support Systems (United States)

    Wolfenden, Andrew


    The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The…

  7. Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease (United States)

    Thompson, Megan R.; Stone, Ramona F.; Ochs, V. Dan; Litvan, Irene


    In order to determine primary health care providers' (PCPs) knowledge gaps on Parkinson's disease, data were collected before and after a one-hour continuing medical education (CME) lecture on early Parkinson's disease recognition and treatment from a sample of 104 PCPs participating at an annual meeting. The main outcome measure…

  8. The impact of child care providers' feeding on chidren's food consumption (United States)

    In young children, the eating environment is an important social context within which eating behaviors develop. Among many low-income young children, the responsibility for feeding may have shifted from family members to child care providers because these children spend the majority of their day in...

  9. How Do Health Care Providers Diagnose Precocious Puberty and Delayed Puberty? (United States)

    ... a health care provider to monitor organs and blood flow in real time An MRI (magnetic resonance imaging) scan of the brain and pituitary gland using an instrument that produces detailed images of organs ... 3 : Blood tests to measure hormone levels Blood tests to ...

  10. 76 FR 51381 - Supplemental Awards to Seven Unaccompanied Alien Shelter Care Providers (United States)


    ... HUMAN SERVICES Office of Refugee Resettlement Supplemental Awards to Seven Unaccompanied Alien Shelter... Resettlement announces the award of single-source expansion supplement grants to seven Unaccompanied Alien... supplement grants to seven unaccompanied alien shelter care providers for a total of $5,016,218....

  11. Health Care providers and Teen Driving Safety: Topics Discussed and Educational Resources Used in Practice. (United States)

    Dellinger, Ann M; West, Bethany A


    Traffic crashes are the leading cause of death among teens. Health care providers have an opportunity to address what works to keep teens safe on the road during the patient visit. An online survey was conducted of 1088 health care providers who saw patients at or near driving age. The survey assessed which road safety topics were discussed and which types of educational products were used most often. Family and general practice physicians represented 44.3% of the sample, followed by pediatricians (22.5%), nurse practitioners (17.6%), and internists (15.5%). Nearly all respondents (92.9%) reported addressing one or more driving safety factors (seat belt use, nighttime driving, fatigue, teen passengers, alcohol/drug use, speeding/reckless driving, and cell phone use/texting) with adolescent patients and/or their parents. Seat belt use was reported more often (83.7%) than other topics. The use of parent-teen driving agreements, a known effective intervention, was reported by less than 10% of respondents. Since health care providers expressed interest in receiving written resource materials, distribution of parent-teen driving agreements to health care providers might encourage greater uptake and use of this effective intervention.

  12. Child Care Providers' Competence and Confidence in Referring Children at Risk for Developmental Delays (United States)

    Branson, Diane; Bingham, Ann


    Despite the benefits of early intervention for children, the majority of children with developmental delays are not identified prior to the age of 5 years. Child care providers could aid in recognition of children at risk for developmental delays; however, there is little research on this topic. This article reports on a qualitative research study…

  13. Characteristics of Swedish Preschools That Provide Education and Care to Children with Special Educational Needs (United States)

    Lundqvist, Johanna; Westling, Mara Allodi; Siljehag, Eva


    In Sweden, preschool inclusion is embraced and preschools are open for children both with and without special educational needs. The purpose of this study was to examine the characteristics of a number of preschool units in Sweden that provide education and care to children with special educational needs with regard to organisation, resources and…

  14. The patient's perspective on "providing structure" in psychiatric inpatient care: an interview study

    NARCIS (Netherlands)

    Voogt, L.A.; Goossens, P.J.J.; Nugter, A.; Achterberg, T. van


    PURPOSE: To gain insight into the patients' experiences on providing structure (PS) as a nursing intervention during psychiatric inpatient care. DESIGN AND METHOD: Interviews were conducted with patients (n = 17) from two inpatient wards within a mental healthcare organization. For data analysis, a

  15. User and provider perspectives on emergency obstetric care in a Tanzanian rural setting

    DEFF Research Database (Denmark)

    Sorensen, Bjarke Lund; Nielsen, Birgitte Bruun; Rasch, Vibeke


    The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problem...... "actantial model is suggested for that purpose....

  16. Reaction Reading: A Tool for Providing Fantasy Imagery for Long-Term Care Facility Residents. (United States)

    Asmuth, M. Violet


    Describes a project utilizing reaction reading, the choral reading of poetry in small groups. Mentally alert long-term care residents are provided with an opportunity to react to the poetry, and the activity can be led by a nonprofessional. Residents are encouraged to share their memories and fantasies as inspired by poetic images. (JPS)

  17. Making Their Voices Heard: A Conversation with Two Child Care Providers Serving the Legislature (United States)

    Karolak, Eric


    This article presents an interview with two child care providers who are also legislators, Representative Shannon Erickson and Representative Mary Jane Wallner. Shannon Erickson is a Republican member of the South Carolina House of Representatives, representing District 124 in Beaufort County. While coming to office in a special election in…

  18. Providing palliative care to patients with cancer: Addressing the needs in Kenya

    Directory of Open Access Journals (Sweden)

    Pam Malloy


    Full Text Available Cancer is the third highest cause of death in Kenya, preceded by infectious and cardiovascular diseases, and in most cases, diagnosed in later stages. Nurses are the primary caregivers, assessing and managing these patients in the clinic, in inpatient settings, and in rural and remote communities. While cancer rates remain high, the burden to the patient, the caregiver, and society as a whole continues to rise. Kenya's poverty complicates cancer even further. Many Kenyans are unaware of cancer's signs and symptoms, and limited diagnostic and treatment centers are available. Despite these barriers, there is still hope and help for those in Kenya, who suffer from cancer. The World Health Organization has stated that palliative care is a basic human right and nurses providing this care in Kenya are making efforts to support cancer patients' ongoing needs, in order to promote compassionate palliative care and prevent suffering. The purpose of this paper is to address the palliative care needs of patients with cancer in Kenya by providing education to nurses and influencing health-care policy and education at micro and macro levels. A case study weaved throughout will highlight these issues.

  19. The benefits and challenges of providing nursing student clinical rotations in the intensive care unit. (United States)

    Swinny, Betsy; Brady, Melanie


    The goal of providing a clinical rotation in a basic nursing program is to integrate skills and knowledge from the classroom setting into the clinical practice setting. In the intensive care unit (ICU), nursing students have the ability to learn about the complex health issues of critically ill patients, practice selected technical skills, and develop communication skills. There are both benefits and challenges to having nursing students in the intensive care setting. With preparation, the student is able to immerse in the ICU environment, acquire new knowledge and skills, and participate alongside the nurse caring for critically ill patients. The staff nurse must balance patient care with the added responsibilities of helping the student meet the clinical goals. It is optimal to have faculty that are also intensive care clinically competent and can facilitate the clinical experience. The school, the hospital, and the ICU need to collaborate to provide a positive clinical experience that is safe for the patient. In return, the hospital can recruit student nurses and clinical faculty. Planned with thought and intention, rotations in the ICU can be an ideal clinical setting for upper-level student nurses to learn the role of the registered nurse.

  20. Global Strategies for International Education Providers in Australia: A Case Study of Tropical North Queensland TAFE (United States)

    Barker, Michelle; Haberman, Leigh


    The continuing growth of Australia's international education market is causing providers to consider moving from international business approaches to global strategies. This paper examines factors affecting a regional Australian educational provider's approach to the international student market, using Tropical North Queensland TAFE (TNQT) for…

  1. Maintenance of health care providers clinical proficiency: Transdisciplinary analysis, modeling and intervention (United States)


    Aids and Performance Support Systems  Visual aids – such as posters in exam rooms, checklists/flowcharts  Computerized clinical decision support...manikin  Scenario-based live exercises  Life- size immersive 3D visualization  Live demonstrations JOB AIDS AND PERFORMANCE SUPPORT SYSTEMS In...used during the actual performance of the task. A job aid provides a visual cue to provide concise, relevant information at the point of care to augment

  2. Uncompensated care provided by for-profit, not-for-profit, and government owned hospitals

    Directory of Open Access Journals (Sweden)

    Vaughan-Sarrazin Mary S


    Full Text Available Abstract Background There is growing concern certain not-for-profit hospitals are not providing enough uncompensated care to justify their tax exempt status. Our objective was to compare the amount of uncompensated care provided by not-for-profit (NFP, for-profit (FP and government owned hospitals. Methods We used 2005 state inpatient data (SID for 10 states to identify patients hospitalized for three common conditions: acute myocardial infarction (AMI, coronary artery bypass grafting (CABG, or childbirth. Uncompensated care was measured as the proportion of each hospital's total admissions for each condition that were classified as being uninsured. Hospitals were categorized as NFP, FP, or government owned based upon data obtained from the American Hospital Association. We used bivariate methods to compare the proportion of uninsured patients admitted to NFP, FP and government hospitals for each diagnosis. We then used generalized linear mixed models to compare the percentage of uninsured in each category of hospital after adjusting for the socioeconomic status of the markets each hospital served. Results Our cohort consisted of 188,117 patients (1,054 hospitals hospitalized for AMI, 82,261 patients (245 hospitals for CABG, and 1,091,220 patients for childbirth (793 hospitals. The percentage of admissions classified as uninsured was lower in NFP hospitals than in FP or government hospitals for AMI (4.6% NFP; 6.0% FP; 9.5% government; P Conclusions For the three conditions studied NFP and FP hospitals appear to provide a similar amount of uncompensated care while government hospitals provide significantly more. Concerns about the amount of uncompensated care provided by NFP hospitals appear warranted.

  3. 75 FR 44971 - Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children (United States)


    ... [CMS-2480-NC] Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care... recommendations for legislative changes to improve the quality of care provided to children under Medicaid and the... quality of care provided to children under Medicaid and the Children's Health Insurance Program....

  4. The legal duty of physicians and hospitals to provide emergency care. (United States)

    Walker, Anne F


    Accessibility of hospital emergency services has been an issue of increasing concern and was recently brought into public focus in Ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care on the existing standard of medical practice will be considered.

  5. Providing Children and Adolescents Opportunities for Social Interaction as a Standard of Care in Pediatric Oncology. (United States)

    Christiansen, Heather L; Bingen, Kristin; Hoag, Jennifer A; Karst, Jeffrey S; Velázquez-Martin, Blanca; Barakat, Lamia P


    Experiences with peers constitute an important aspect of socialization, and children and adolescents with cancer may experience reduced social interaction due to treatment. A literature review was conducted to investigate the evidence to support a standard of care evaluating these experiences. Sixty-four articles were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Moderate quality of evidence suggest that social interaction can be beneficial to increase knowledge, decrease isolation, and improve adjustment and constitute an important, unmet need. The evidence supports a strong recommendation for youth with cancer to be provided opportunities for social interaction following a careful assessment of their unique characteristics and preferences.

  6. Level of knowledge about anaphylaxis and its management among health care providers

    Directory of Open Access Journals (Sweden)

    H S Drupad


    Full Text Available Objectives: This study was conducted to assess the level of knowledge of health care providers regarding anaphylaxis and its management at a tertiary care teaching hospital. Materials and Methods: A pretested structured questionnaire was administered to interns, MBBS Phase II students, and nursing students. The subjects were asked to answer the questionnaire, which included questions regarding anaphylaxis and its management. Results: Of 265 subjects, 151 (56.9% of subjects answered correctly that adrenaline is the first line of drug for the treatment of anaphylaxis. Among 151 subjects, 40 (26.4% answered the correct dose of adrenaline, of which 25 (16.5% subjects selected intramuscular injection as the most appropriate route of administration. Medical students′ performance was better than interns and nursing students on questions regarding dose, route, and site of adrenaline administration. Conclusion: Knowledge regarding the management of anaphylaxis was inadequate in almost all the health care providers who were included in the study. Improved education and training of health care providers are necessary for better management of anaphylaxis.

  7. Do NHS walk-in centres in England provide a model of integrated care?

    Directory of Open Access Journals (Sweden)

    C. Salisbury


    Full Text Available Purpose: To undertake a comprehensive evaluation of NHS walk-in centres against criteria of improved access, quality, user satisfaction and efficiency. Context: Forty NHS walk-in centres have been opened in England, as part of the UK governments agenda to modernise the NHS. They are intended to improve access to primary care, provide high quality treatment at convenient times, and reduce inappropriate demand on other NHS providers. Care is provided by nurses rather than doctors, using computerised algorithms, and nurses use protocols to supply treatments previously only available from doctors. Data sources: Several linked studies were conducted using different sources of data and methodologies. These included routinely collected data, site visits, patient interviews, a survey of users of walk-in centres, a study using simulated patients to assess quality of care, analysis of consultation rates in NHS services near to walk-in centres, and audit of compliance with protocols. Conclusion & discussion: The findings illustrate many of the issues described in a recent WHO reflective paper on Integrated Care, including tensions between professional judgement and use of protocols, problems with incompatible IT systems, balancing users' demands and needs, the importance of understanding health professionals' roles and issues of technical versus allocative efficiency.

  8. Factors influencing the role of primary care providers as gatekeepers in the Malaysian public healthcare system. (United States)

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


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

  9. Anxiety in adolescents: Update on its diagnosis and treatment for primary care providers

    Directory of Open Access Journals (Sweden)

    Siegel RS


    Full Text Available Rebecca S Siegel, Daniel P DicksteinPediatric Mood, Imaging, and NeuroDevelopment Program, EP Bradley Hospital, East Providence, RI, USAAbstract: Anxiety disorders are the most prevalent mental health concern facing adolescents today, yet they are largely undertreated. This is especially concerning given that there are fairly good data to support an evidence-based approach to the diagnosis and treatment of anxiety, and also that untreated, these problems can continue into adulthood, growing in severity. Thus, knowing how to recognize and respond to anxiety in adolescents is of the utmost importance in primary care settings. To that end, this article provides an up-to-date review of the diagnosis and treatment of anxiety disorders geared towards professionals in primary care settings. Topics covered include subtypes, clinical presentation, the etiology and biology, effective screening instruments, evidence-based treatments (both medication and therapy, and the long-term prognosis for adolescents with anxiety. Importantly, we focus on the most common types of anxiety disorders, often known as phobias, which include generalized anxiety disorder, social anxiety/social phobia, separation anxiety disorder, panic disorder, and specific phobias. In summary, anxiety is a common psychiatric problem for adolescents, but armed with the right tools, primary care providers can make a major impact.Keywords: anxiety disorders, adolescents, presentation, etiology, assessment, treatment, primary care

  10. The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting : effects on patient outcomes

    NARCIS (Netherlands)

    Vrijhoef, HJM; Diederiks, JPM; Spreeuwenberg, C; Wolffenbuttel, BHR; van Wilderen, LJGP


    A solution to safeguard high quality diabetes care may be to allocate care to the nurse specialist. By using a one group pretest-posttest design with additional comparisons, this study evaluated effects on patient outcomes of a shared care model with the diabetes nurse as main care-provider for pati

  11. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration. (United States)

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A


    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation.

  12. Truth Telling and Treatment Strategies in End-of-Life Care in Physician-Led Accountable Care Organizations: Discrepancies Between Patients' Preferences and Physicians' Perceptions. (United States)

    Huang, Hsien-Liang; Cheng, Shao-Yi; Yao, Chien-An; Hu, Wen-Yu; Chen, Ching-Yu; Chiu, Tai-Yuan


    Providing patient-centered care from preventive medicine to end-of-life care in order to improve care quality and reduce medical cost is important for accountable care. Physicians in the accountable care organizations (ACOs) are suitable for participating in supportive end-of-life care especially when facing issues in truth telling and treatment strategy. This study aimed to investigate patients' attitudes toward truth telling and treatment preferences in end-of-life care and compare patients' attitudes with their ACOs physicians' perceptions.This nationwide study applied snowball sampling to survey physicians in physician-led ACOs and their contracted patients by questionnaire from August 2010 to July 2011 in Taiwan. The main outcome measures were beliefs about palliative care, attitudes toward truth telling, and treatment preferences.The data of 314 patients (effective response rate = 88.7%) and 177 physicians (88.5%) were analyzed. Regarding truth telling about disease prognosis, 94.3% of patients preferred to be fully informed, whereas only 80% of their physicians had that perception (P truth telling even when encountering terminal disease status (98.1% vs 85.3%). Regarding treatment preferences in terminal illness, nearly 90% of patients preferred supportive care, but only 15.8% of physicians reported that their patients had this preference (P truth telling and treatment strategies in end-of-life care. It is important to enhance physician-patient communication about end-of-life care preferences in order to achieve the goal of ACOs. Continuing education on communication about end-of-life care during physicians' professional development would be helpful in the reform strategies of establishing accountable care around the world.

  13. Informal Care Provided by Family Caregivers: Experiences of Older Adults With Multimorbidity. (United States)

    Lindvall, Agneta; Kristensson, Jimmie; Willman, Ania; Holst, Göran


    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at To obtain contact hours you must: 1. Read the article, "Informal Care Provided by Family Caregivers: Experiences of Older Adults With Multimorbidity" found on pages 24-31, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until July 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe how older adults with multimorbidity experience care provided from informal

  14. Translating sickle cell guidelines into practice for primary care providers with Project ECHO

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    Lisa M. Shook


    Full Text Available Background: Approximately 100,000 persons with sickle cell disease (SCD live in the United States, including 15,000 in the Midwest. Unfortunately, many patients experience poor health outcomes due to limited access to primary care providers (PCPs who are prepared to deliver evidence-based SCD care. Sickle Treatment and Outcomes Research in the Midwest (STORM is a regional network established to improve care and outcomes for individuals with SCD living in Indiana, Illinois, Michigan, Minnesota, Ohio, and Wisconsin. Methods: STORM investigators hypothesized that Project ECHO® methodology could be replicated to create a low-cost, high-impact intervention to train PCPs in evidence-based care for pediatric and young adult patients with SCD in the Midwest, called STORM TeleECHO. This approach utilizes video technology for monthly telementoring clinics consisting of didactic and case-based presentations focused on the National Heart, Lung and Blood Institute (NHLBI evidence-based guidelines for SCD. Results: Network leads in each of the STORM states assisted with developing the curriculum and are recruiting providers for monthly clinics. To assess STORM TeleECHO feasibility and acceptability, monthly attendance and satisfaction data are collected. Changes in self-reported knowledge, comfort, and practice patterns will be compared with pre-participation, and 6 and 12 months after participation. Conclusions: STORM TeleECHO has the potential to increase implementation of the NHLBI evidence-based guidelines, especially increased use of hydroxyurea, resulting in improvements in the quality of care and outcomes for children and young adults with SCD. This model could be replicated in other pediatric chronic illness conditions to improve PCP knowledge and confidence in delivering evidence-based care.

  15. Occupational exposure to sharps and splash: Risk among health care providers in three tertiary care hospitals in South India

    Directory of Open Access Journals (Sweden)

    Tetali S


    Full Text Available Occupational exposure to blood and body fluids places Health care providers at risk of infection with blood borne viruses including HIV. To understand Health Care Providers′ (HCPFNx01 perception of risk of occupational exposure to needles, blood and body fluids, to find out the correlates of exposure and to identify groups of HCP at high risk of sustaining maximum number of such exposures. A cross sectional survey was conducted on HCP in three tertiary care hospitals in Kerala, between August 20th and October 30th, 2004 Chi square test, independent-sample T test and one-way ANOVA was used for analysis. Overall, 74.5% (95% CI 71.3 to 78.2 of the respondents were exposed at least once in the last 12 months. Surgeons were exposed most frequently, with a mean of 3.8 injuries per person per year. Injection needles were responsible for 68% of the injuries. Those who underwent the in-service training program on needle safety were less injured ( P =0.001. Only 4% of surgeons had undergone needle safety training. Almost half the surgeons, anesthetists and medical students did not know the reporting procedure and only 10% of anesthetists knew about the provision of Post Exposure Prophylaxis (PEP. A considerable proportion of respondents (85% (95% CI- 81.2 to 88.5 were concerned about acquiring blood borne infections and 90% were immunized against Hepatitis B. Training of Health care providers is absolutely essential for injury reduction and should take into account the varying incidence of exposure across different occupation groups.

  16. Interactive video conferencing: a means of providing interim care to Parkinson's disease patients. (United States)

    Hubble, J P; Pahwa, R; Michalek, D K; Thomas, C; Koller, W C


    Inequity in health care delivery is attributable to a variety of factors including geographic isolation. Patients living far from major urban centers have limited access to medical specialists. In the instance of Parkinson's disease (PD), optimal assessment and care may depend upon availability of specialty health care providers. In order to broaden health care access, interactive video conference (IVC) units are being developed for medical use. IVC allows a patient at a distant site to be "seen and heard" by a hospital-based physician; simultaneously, the patient can "see and hear" the doctor. To establish the validity of this technology in the evaluation of PD, nine patients were independently examined and scored (UPDRS) by two movement disorder specialists. One examination was performed in-person by the usual physician. The other examination was performed on the same day via IVC over a distance of 350 miles by an examiner previously unfamiliar with the patients. Individual patient scores did not differ based on examiner (Spearman Rho Correlation Coefficients: UPDRS total scores r = 0.933, p video technology. Responses were favorable and virtually all patients viewed this as a means of accessing better health care. We conclude that valid motor assessments of PD patients can be made via IVC.

  17. Importance of healthcare utilization and multimorbidity level in choosing a primary care provider in Sweden

    DEFF Research Database (Denmark)

    Ranstad, Karin; Midlöv, Patrik; Halling, Anders


    OBJECTIVE: To study the associations between active choice of primary care provider and healthcare utilization, multimorbidity, age, and sex, comparing data from primary care and all healthcare in a Swedish population. DESIGN: Descriptive cross-sectional study using descriptive analyses including t.......30-1.32), multimorbidity level (OR 1.69, 95% CI 1.67-1.70), age (OR 1.03, 95% CI 1.03-1.03), and sex (OR for men 0.67, 95% CI 0.65-0.68) were all associated with registered active listing in primary care. Active listing was more strongly associated with number of consultations and multimorbidity level using primary care...... data (OR 2.11, 95% CI 2.08-2.15 and OR 2.14, 95% CI 2.11-2.17, respectively) than using data from all healthcare. Number of consultations and multimorbidity level were correlated and had similar associations with active listing in primary care. Modelling number of consultations, multimorbidity level...

  18. Maternal complications and women's behavior in seeking care from skilled providers in North Gondar, Ethiopia.

    Directory of Open Access Journals (Sweden)

    Abebaw Gebeyehu Worku

    Full Text Available BACKGROUND: Maternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women's experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study. METHODS: This study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders. RESULTS: Out of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7% reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6% sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider. CONCLUSION: Nearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved

  19. Ethno-cultural diversity in home care work in Canada: issues confronted, strategies employed

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    John Naslund


    Full Text Available Worldwide, immigrant workers are responsible for much of the care provided to elderly people who require assistance with personal care and with activities of daily living. This article examines the characteristics of immigrant home care workers, and the ways in which they differ from non-migrant care workers in Canada. It considers circumstances wherein the labor of care is framed by ethno-cultural diversity between client and worker, interactions that reflect the character of this ethno-cultural diversity, and the strategies employed by workers to address issues related to this diversity. Findings from a mixed methods study of 118 workers in the metropolitan area of Vancouver, British Columbia, Canada, indicate that while the discriminatory context surrounding migrant home care workers persists, issues of ethno-cultural diversity in relationships are complex, and can also involve non-foreign born workers. Multi-cultural home care is not always framed in a negative context, and there often are positive aspects.

  20. Zika Virus and Pregnancy: What Obstetric Health Care Providers Need to Know. (United States)

    Meaney-Delman, Dana; Rasmussen, Sonja A; Staples, J Erin; Oduyebo, Titilope; Ellington, Sascha R; Petersen, Emily E; Fischer, Marc; Jamieson, Denise J


    Zika virus is a flavivirus transmitted by Aedes (Stegomyia) species of mosquitoes. In May 2015, the World Health Organization confirmed the first local transmission of Zika virus in the Americas in Brazil. The virus has spread rapidly to other countries in the Americas; as of January 29, 2016, local transmission has been detected in at least 22 countries or territories, including the Commonwealth of Puerto Rico and the U.S. Virgin Islands. Zika virus can infect pregnant women in all three trimesters. Although pregnant women do not appear to be more susceptible to or more severely affected by Zika virus infection, maternal-fetal transmission has been documented. Several pieces of evidence suggest that maternal Zika virus infection is associated with adverse neonatal outcomes, most notably microcephaly. Because of the number of countries and territories with local Zika virus transmission, it is likely that obstetric health care providers will care for pregnant women who live in or have traveled to an area of local Zika virus transmission. We review information on Zika virus, its clinical presentation, modes of transmission, laboratory testing, effects during pregnancy, and methods of prevention to assist obstetric health care providers in caring for pregnant women considering travel or with a history of travel to areas with ongoing Zika virus transmission and pregnant women residing in areas with ongoing Zika virus transmission.

  1. Knowledge of Critical Care Provider on Prevention of Ventilator Associated Pneumonia

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    Passang Chiki Sherpa


    Full Text Available Background: Ventilator-associated pneumonia (VAP continues to be an important cause of morbidity and mortality in ventilated patient. Prevention of VAP in critically ill patient is significant concern for health care team in intensive care units (ICUs. Knowledge on prevention of VAP would have a significant impact on patient outcome. Aims and Objectives: To assess knowledge on prevention of VAP in critical care providers and to find the association between knowledge on prevention of VAP and educational qualification and years of experience in ICUs. Settings and Design: The study was conducted in 5 different ICUs of Kasturba Hospital, Manipal, and using descriptive study design. Material and Methods: The study involved a purposive sample of 138 critical care providers. Critical care providers who were willing to participate in the study were included. Tools on demographic proforma and self-administered structured knowledge questionnaire on prevention of VAP were developed and content validity was established. The reliability of the tools was established.The data was categorized and analyzed by using descriptive and inferential statistics. The SPSS 16.0 version was used for the analysis of the study. Result: Majority 89.1% of the participant were 20-29 years, 63% unmarried 51.4% had completed diploma course and majority 81.2% were from nursing discipline. The study revealed that only 55.80% of subjects were having adequate knowledge on prevention of VAP based on median score. There was no significant association between knowledge score and educational qualification (÷²=0, p=0.833, years of experience in ICU (÷²= 2.221, p=0.329.

  2. A situational analysis of training for behaviour change counselling for primary care providers, South Africa

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    Zelra Malan


    Full Text Available Background: Non-communicable diseases and associated risk factors (smoking, alcohol abuse, physical inactivity and unhealthy diet are a major contributor to primary care morbidity and the burden of disease. The need for healthcare-provider training in evidence-based lifestyle interventions has been acknowledged by the National Department of Health. However, local studies suggest that counselling on lifestyle modification from healthcare providers is inadequate and this may, in part, be attributable to a lack of training.Aim: This study aimed to assess the current training courses for primary healthcare providers in the Western Cape.Setting: Stellenbosch University and University of Cape Town.Methods: Qualitative interviews were conducted with six key informants (trainers of primary care nurses and registrars in family medicine and two focus groups (nine nurses and eight doctors from both Stellenbosch University and the University of Cape Town.Results: Trainers lack confidence in the effectiveness of behaviour change counselling and in current approaches to training. Current training is limited by time constraints and is not integrated throughout the curriculum – there is a focus on theory rather than modelling and practice, as well as a lack of both formative and summative assessment. Implementation of training is limited by a lack of patient education materials, poor continuity of care and record keeping, conflicting lifestyle messages and an unsupportive organisational culture.Conclusion: Revising the approach to current training is necessary in order to improve primary care providers’ behaviour change counselling skills. Primary care facilities need to create a more conducive environment that is supportive of behaviour change counselling.

  3. Malaria-related health-seeking behaviour and challenges for care providers in rural Ethiopia: implications for control. (United States)

    Deressa, Wakgari; Ali, Ahmed; Hailemariam, Damen


    A range of activities are currently underway to improve access to malaria prevention and control interventions. As disease control strategies change over time, it is crucial to understand the health-seeking behaviour and the local socio-cultural context in which the changes in interventions operate. This paper reflects on how people in an area of seasonal malaria perceive the causes and transmission of the disease, and what prevention and treatment measures they practise to cope with the disease. It also highlights some of the challenges of malaria treatment for health care providers. The study was undertaken in 2003 in Adami Tulu District in south-central Ethiopia, where malaria is a major health problem. Pre-tested structured questionnaires and focus group discussions were conducted among men and women. Malaria, locally known as busa, was perceived as the most important cause of ill health in the area. Respondent's perception and knowledge about the cause and transmission of the disease were relatively high. The newly introduced insecticide-treated nets were not popular in the area, and only 6.4% of households possessed at least one. The results showed that patients use multiple sources of health care for malaria treatment. Public health facilities, private clinics and community health workers were the main providers of malaria treatment. Despite higher treatment costs, people preferred to use private health care providers for malaria treatment due to the higher perceived quality of care they offer. In conclusion, effort in the prevention and control of malaria should be intensified through addressing not only public facilities, but also the private sector and community-based control interventions. Appropriate and relevant information on malaria should be disseminated to the local community. The authors propose the provision of effective antimalarial drugs and malaria prevention tools such as subsidized or free insecticide-treated nets.

  4. The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions (United States)

    Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.


    OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

  5. Patient and referring health care provider satisfaction with a physiotherapy spinal triage assessment service

    Directory of Open Access Journals (Sweden)

    Bath B


    Full Text Available Brenna Bath1, Bonnie Janzen21School of Physical Therapy, College of Medicine, University of Saskatchewan, 2Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaPurpose: To evaluate participant and referring care provider satisfaction associated with a spinal triage assessment service delivered by physiotherapists in collaboration with orthopedic surgeons.Methods: People with low back-related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists. Measures of patient and provider satisfaction were completed at approximately 4 weeks after the assessment. The satisfaction surveys were analyzed quantitatively with descriptive statistics and qualitatively with an inductive thematic approach of open and axial coding.Results: A total of 108/115 participants completed the posttest satisfaction survey. Sixty-six percent of participants were “very satisfied” with the service and 55% were “very satisfied” with the recommendations that were made. Only 18% of referring care providers completed the satisfaction survey and 90.5% of those were “very satisfied” with the recommendations. Sixty-one participants and 14 care providers provided comments which revealed a diverse range of themes which were coded into positive (ie, understanding the problem, communication, customer service, efficiency, and management direction, negative (ie, lack of detail, time to follow-up, cost and neutral related to the triage service, and an “other” category unrelated to the service (ie, chronic symptoms, comorbidities, and limited access to health care.Conclusion: The quantitative results of the participant survey demonstrated very high levels of satisfaction with the service and slightly less satisfaction with the recommendations that were made. Satisfaction of referring care providers with the recommendations and report was also high, but given

  6. Are doctor of pharmacy curricula in developing countries adequate to train graduates to provide pharmaceutical care?

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    Ramalingam Peraman


    Full Text Available Doctor of Pharmacy (PharmD program is a new dimension of pharmacy education in developing countries. The PharmD graduates are expected to participate in patient health care by providing pharmaceutical care. The graduates should have enough necessary clinical knowledge, competitiveness and skills in community, hospital and clinical pharmacy related services. There is a need of curriculum that fit into the program outcome that helps to attain graduate competency. Programs in India, Pakistan, Iran and Nepal were reviewed based on the available literature. Even though it is evident that the PharmD curriculum in developing countries has made an attempt to provide patient-oriented approach for pharmacists, the existing curriculum, training and orientation have several pitfalls. It needs assessment, evaluation and improvement.

  7. Balancing confidentiality and the information provided to families of patients in primary care (United States)

    Perez-Carceles, M; Pereniguez, J; Osuna, E; Luna, A


    Objectives: This study aimed to describe family doctors' attitudes to confidentiality and providing patient information to relatives as well as their justifications for sharing information. Method: A descriptive postal questionnaire was self-administered by family doctors. Results: Of 227 doctors, 95.1% provided information to a patient's family and over a third (35%) disclosed information to others without prior patient consent. Conclusions: The findings reveal that family doctors should pay more attention to their patients' rights to information, privacy, and confidentiality, and reflect very carefully on the fine balance between this and the occasional need for the support and collaboration of family members in delivery of care. Emphasis should be placed on ethics and legal problems during undergraduate education and in-service training of doctors. PMID:16131555

  8. Partnerships to provide care and medicine for chronic diseases: a model for emerging markets. (United States)

    Goroff, Michael; Reich, Michael R


    The challenge of expanding access to treatment and medicine for chronic diseases in emerging markets is both a public health imperative and a commercial opportunity. Cross-sector partnerships-involving a pharmaceutical manufacturer; a local health care provider; and other private, public, and nonprofit entities-could address this challenge. Such partnerships would provide integrated, comprehensive care and medicines for a specific chronic disease, with medicines directly supplied to the partnership at preferential prices by the manufacturer. The model discussed here requires additional specification, using real numbers and specific contexts, to assess its feasibility. Still, we believe that this model has the potential for public health and private business to cooperate in addressing the rising problem of chronic diseases in emerging markets.

  9. Role of primary care providers in dengue prevention and control in the community. (United States)

    Ang, K T; Rohani, I; Look, C H


    Dengue fever is a major public health threat in Malaysia, especially in the highly urbanized states of Selangor and the Federal Territory of Kuala Lumpur. It is believed that many seek treatment at the primary care clinics and are not admitted. This study aims at establishing the fact that primary care practitioners, as the first point of patient contacts, play a crucial role in advising patients suspected of having dengue to take early preventive measures to break the chain of dengue transmission. A total of 236 patients admitted to two government hospitals for suspected dengue fever were interviewed using a structured questionnaire over a one week period in December 2008. It was found that 83.9% of the patients had sought treatment at a Primary Care (PC) facility before admission to the hospital, with 68.7% of them seeking treatment on two or more occasions. The mean time period for seeking treatment at primary care clinic was one and a half (1.4) days of fever, compared to almost five (4.9) days for admission. The majority of patients (96-98%) reported that primary care practitioners had not given them any advice on preventive measures to be taken even though 51.9% of the patients had been told they could be having dengue fever. This study showed the need for primary care providers to be more involved in the control and prevention of dengue in the community, as these patients were seen very early in their illness compared to when they were admitted.

  10. 78 FR 68364 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date (United States)


    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care to Non-VA Providers... services and hospice care. The preamble of that final rule stated the effective date was November 15, 2013..., applicable to non-VA home health services and hospice care. Section 17.56 provides, among other things,...

  11. Association of family and health care provider opinion on infant feeding with mother's breastfeeding decision. (United States)

    Odom, Erika C; Li, Ruowei; Scanlon, Kelley S; Perrine, Cria G; Grummer-Strawn, Laurence


    In the United States, about 25% of women choose not to initiate breastfeeding, yet little is known about how opinions of individuals in a woman's support network influence her decision to breastfeed. In the 2005-2007 Infant Feeding Practices Study II, women completed questionnaires from the last trimester of pregnancy until 12 months postpartum. Mothers indicated prenatally their family members' and health care providers' opinion on how newborns should be fed: breastfed only, formula fed only, breast and formula fed, or no opinion/don't know. Breastfeeding initiation was determined by asking mothers around 4 weeks postpartum (n=2,041) whether they ever breastfed. Logistic regression was used to examine the association between mothers' perception of family members' and health care providers' opinion on how to feed the infant and the initiation of breastfeeding, adjusting for sociodemographic characteristics. Nearly 14% of mothers surveyed did not initiate breastfeeding. Mothers who believed their family members or health care providers preferred breastfeeding only were least likely not to initiate breastfeeding. Never breastfeeding was significantly associated with the following perceptions: the infant's father (odds ratio [OR]=110.4; 95% CI 52.0 to 234.4) or maternal grandmother (OR=15.9; 95% CI 7.0 to 36.0) preferred only formula feeding; the infant's father (OR=3.2; 95% CI 1.7 to 5.9) or doctor (OR=2.7; 95% CI 1.2 to 6.2) preferred both breast and formula feeding; and the infant's father (OR=7.6; 95% CI 4.5 to 12.7), maternal grandmother (OR=5.4; 95% CI 2.6 to 11.0), or doctor (OR=1.9; 95% CI 1.0 to 3.7) had no opinion/didn't know their feeding preference. The prenatal opinions of family members and health care providers play an important role in a woman's breastfeeding decisions after the infant's birth.

  12. Midwives' Experiences in Providing Care and Counselling to Women with Female Genital Mutilation (FGM) Related Problems


    Elisabeth Isman; Amina Mahmoud Warsame; Annika Johansson; Sarah Fried; Vanja Berggren


    Aim. The aim of this study was to elucidate midwives experiences in providing care and counselling to women with FGM related problems. Setting. The study was conducted at a maternity clinic in Hargeisa, Somaliland. Method. A qualitative, inductive study were performed with eight midwives living in Somaliland. The interviews had semi-structured questions. Content analysis was used for the analysis. Findings. The main findings of the present study were how midwives are challenged by culture and...

  13. Cultural Competence in Pediatrics: Health Care Provider Knowledge, Awareness, and Skills

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    Kirk Dabney


    Full Text Available The purpose of this study was to assess the effects of a cultural competence training (CCT program on pediatric health care providers’ self-reported ability to provide culturally competent care to a diverse pediatric patient population. This quantitative, nested ecologic level study design used a repeated measure in the form of pre-test and post-test data to assess percent change in providers’ cultural awareness, experience working or learning about different cultures, and preparedness and skills in working with different cultures before and after CCT. The study was conducted between 2011 and 2012 in a pediatric hospital and associated outpatient offices. The sample consisted of pediatric health care providers from various departments, mainly physicians and nurses (n = 69. Participants completed a pre-intervention cultural competence assessment and then were subjected to a cultural competence-training program, after which they completed the assessment a second time. The baseline and post-intervention data were collected in the form of Likert scales and transformed into a quintile or quartile scale as appropriate. Data were assessed using paired t-tests or Wilcoxon’s signed-rank tests. Providers indicated a 13% increase in knowledge (53.9% vs. 66.7%, t = 3.4, p = 0.001, 8.7% increase in awareness (46.7% vs. 55.4%, t = 3.0, p = 0.002, and 8% statistically marginal increase in skills (66.4% vs. 74.5%, z = 1.8, p = 0.06. Culturally competent training in a pediatric environment significantly enhances knowledge, awareness and to some extent skills in providing care to culturally diverse patient population.

  14. Health Care Provider Advice for African American Adults Not Meeting Health Behavior Recommendations



    Introduction Poor dietary habits and sedentary lifestyle contribute to excessive morbidity and mortality. Healthy People 2010 goals are for 85% of physicians to counsel their patients about physical activity and for 75% of physician office visits made by patients with cardiovascular disease, diabetes, or dyslipidemia to include dietary counseling. The purpose of this study was to 1) determine the rate of participant-reported health care provider advice for healthy lifestyle changes among Afr...

  15. Measuring the quality of care provided to women with pelvic organ prolapse (United States)

    Alas, Alexandriah N.; Bresee, Catherine; Eilber, Karyn; Toubi, Karen; Rashid, Rezoana; Roth, Carol; Shekelle, Paul; Wenger, Neil; Anger, Jennifer T.


    OBJECTIVE Health care providers are increasingly being evaluated by the quality of care they provide. Our aim was to assess the feasibility of recently developed quality indicators (QIs) for pelvic organ prolapse (POP) and identify possible deficits in care. STUDY DESIGN A panel ranked 14 QIs based on the RAND appropriateness method assessing screening and diagnosis, pessary management, and surgery for POP. Retrospective chart abstraction was performed after identifying patients with a diagnosis of POP evaluated within a hospital-based multispecialty group using International Classification of Diseases, ninth edition, diagnosis codes. RESULTS Of 283 patients identified, 98% of those with a new complaint of vaginal bulge had a pelvic examination. The POP was described but not staged in 6% and not documented at all in 25.1%. Among those managed with pessaries, 98% had vaginal examinations at least every 6 months. Forty-nine percent of the patients who had surgery had complete preoperative POP staging. Only 20% of women undergoing apical surgery had documentation of counseling regarding different surgical options, and of the women who underwent a hysterectomy for POP, only 48% had a concomitant vault suspension. Although 71% had documentation about the risk of postoperative stress incontinence, only 14.5% had documented counseling regarding risks of mesh. Only 37% of patients implanted with mesh for POP had documented follow-up at 1 year. An intraoperative cystoscopy was performed in 86% undergoing cystocele repair or apical surgery. CONCLUSION The quality of care for women with POP can be feasibly measured with QIs. Processes of care were deficient in many areas, and our findings can serve as a basis for quality improvement interventions. PMID:25448523

  16. Providing primary health care through integrated microfinance and health services in Latin America. (United States)

    Geissler, Kimberley H; Leatherman, Sheila


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

  17. Health care services provided to type 1 and type 2 diabetic patients in Saudi Arabia (United States)

    Al-Rubeaan, Khalid A.; Al-Manaa, Hamad A.; Khoja, Tawfik A.; Al-Sharqawi, Ahmad H.; Aburisheh, Khaled H.; Youssef, Amira M.; Alotaibi, Metib S.; Al-Gamdi, Ali A.


    Objectives: To assess health care services provided to type 1 and type 2 diabetic patients and diabetes health care expenditure in the Kingdom of Saudi Arabia (KSA). Methods: This study was part of a nationwide, household, population based cross-sectional survey conducted at the University Diabetes Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia between January 2007 and December 2009 covering 13 administrative regions of the Kingdom. Using patients’ interview questionnaires, health care services data were collected by trained staff. Results: A total of 5,983 diabetic patients were chosen to assess health care services and expenditure. Approximately 92.2% of health services were governmental and the remaining 7.8% were in private services. The mean annual number of visits to physicians was 6.5±3.9 and laboratories was 5.1±3.9. Diabetic patients required one admission every 3 years with a mean admission duration of 13.3±28.3 days. General practitioners managed 85.9% of diabetic cases alone, or shared with internists and/or endocrinologists. Health care expenditure was governmental in 90% of cases, while it was personal in 7.7% or based on insurance payment in 2.3%. Conclusion: Health services and its expenditure provided to diabetic citizens in Saudi Arabia are mainly governmental. Empowerment of the role of both the private sector and health insurance system is badly needed, aside from implementing proper management guidelines to deliver good services at different levels. PMID:26446334

  18. Tiering and Scaffolding: Two Strategies for Providing Access to Important Mathematics (United States)

    Williams, Lori


    Tiering and scaffolding are two differentiation strategies that teachers use to support access to a high-quality mathematics curriculum for all students. This article provides examples demonstrating a thinking process for planning tiered activities that focus on important mathematical understandings. Also described are possible scaffolds that can…

  19. Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India. (United States)

    Ahuja, Rajeev B; Goswami, Prasenjit


    There is an extreme paucity of studies examining cost of burn care in the developing world when over 85% of burns take place in low and middle income countries. Modern burn care is perceived as an expensive, resource intensive endeavour, requiring specialized equipment, personnel and facilities to provide optimum care. If 'burn burden' of low and middle income countries (LMICs) is to be tackled deftly then besides prevention and education we need to have burn centres where 'reasonable' burn care can be delivered in face of resource constraints. This manuscript calculates the cost of providing inpatient burn management at a large, high volume, tertiary burn care facility of North India by estimating all cost drivers. In this one year study (1st February to 31st January 2012), in a 50 bedded burn unit, demographic parameters like age, gender, burn aetiology, % TBSA burns, duration of hospital stay and mortality were recorded for all patients. Cost drivers included in estimation were all medications and consumables, dressing material, investigations, blood products, dietary costs, and salaries of all personnel. Capital costs, utility costs and maintenance expenditure were excluded. The burn unit is constrained to provide conservative management, by and large, and is serviced by a large team of doctors and nurses. Entire treatment cost is borne by the hospital for all patients. 797 patients (208 60% BSA burns. 258/797 patients died (32.37%). Of these deaths 16, 68 and 174 patients were from 0 to 30%, 31 to 60% and >60% BSA groups, respectively. The mean length of hospitalization for all admissions was 7.86 days (ranging from 1 to 62 days) and for survivors it was 8.9 days. There were 299 operations carried out in the dedicated burns theatre. The total expenditure for the study period was Indian Rupees (Rs) 46,488,067 or US$ 845,237. At 1 US$=Rs 55 it makes the cost per patient to be US$ 1060.5. Almost 70% of cost of burn management resulted from salaries, followed by

  20. Planning parenthood: Health care providers' perspectives on pregnancy intention, readiness, and family planning. (United States)

    Stevens, Lindsay M


    A major health care goal in the United States is increasing the proportion of pregnancies that are planned. While many studies examine family planning from the perspective of individual women or couples, few investigate the perceptions and practices of health care providers, who are gatekeepers to medicalized fertility control. In this paper, I draw on 24 in-depth interviews with providers to investigate how they interpret and enact the objective to "plan parenthood" and analyze their perspectives in the context of broader discourses about reproduction, family planning, and motherhood. Interviews reveal two central discourses: one defines pregnancy planning as an individual choice, that is as patients setting their own pregnancy intentions; the second incorporates normative expectations about what it means to be ready to have a baby that exclude poor, single, and young women. In the latter discourse, planning is a broader process of achieving middle-class life markers like a long-term relationship, a good job, and financial stability, before having children. Especially illuminating are cases where a patient's pregnancy intention and the normative expectations of "readiness" do not align. With these, I demonstrate that providers may prioritize normative notions of readiness over a patient's own intentions. I argue that these negotiations of intention and readiness reflect broader tensions in family planning and demonstrate that at times the seemingly neutral notion of "planned parenthood" can mask a source of stratification in reproductive health care.

  1. Helping the decision maker effectively promote various experts’ views into various optimal solutions to China’s institutional problem of health care provider selection through the organization of a pilot health care provider research system


    Tang, Liyang


    Background The main aim of China’s Health Care System Reform was to help the decision maker find the optimal solution to China’s institutional problem of health care provider selection. A pilot health care provider research system was recently organized in China’s health care system, and it could efficiently collect the data for determining the optimal solution to China’s institutional problem of health care provider selection from various experts, then the purpose of this study was to apply ...

  2. Facilitating communication about sexual health between aging women and their health care providers. (United States)

    Hughes, Anne K; Lewinson, Terri D W


    Many women experience changes in sexual health as they age, and discussing these changes with health care providers is an essential component of optimal health management. The purpose of this study was to understand aging women's perspectives about communicating with providers about sexual health. We used the integrative model of behavioral prediction as a theoretical lens to explore women's attitudes, perceived norms, and perceived self-efficacy that promote or inhibit the likelihood of communicating about sexual health. In this theory-based qualitative study, we interviewed 28 community-dwelling older women in the Midwestern United States. Through thematic analysis, we identified both positive and negative attitudes about communicating with providers. Women seemed most inclined to discuss sexual health if they perceived that important patient-provider conditions, such as trust and rapport, were in place. Despite situational obstacles and perceived norms, these women held strong beliefs about their abilities to discuss sexual health topics with providers.

  3. Providing specialty consultant expertise to primary care: an expanding spectrum of modalities. (United States)

    Kirsh, Susan R; Ho, P Michael; Aron, David C


    In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.

  4. Knowledge of Toxoplasmosis among Doctors and Nurses Who Provide Prenatal Care in an Endemic Region

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    Laura Berriel da Silva


    Full Text Available Congenital toxoplasmosis is a potentially severe infection and its prevention is most often based on serological screening in pregnant women. Many cases could be prevented by simple precautions during pregnancy. Aiming to assess the knowledge about toxoplasmosis among professionals working in antenatal care in a high prevalent region, a questionnaire was administered to 118 obstetric nurses and physicians attending at primary care units and hospitals. The questionnaire was self-completed and included questions on diagnosis, clinical issues, and prevention. Only 44% of total answers were corrected. Lower scores were observed among those with over 10 years of graduation, working in primary care units, and nurses. Errors were mainly observed in questions of prevention and diagnosis. As congenital toxoplasmosis is a mother-to-child (MTC transmitted disease, early diagnosis and treatment can prevent serious and irreversible fetal damage. Thus, doctors and nurses who provide prenatal care must be appropriately trained on prophylactic, diagnostic, and clinical aspects of toxoplasmosis. The authors suggest that measures should be taken for continuing education regarding toxoplasmosis in pregnancy.

  5. Knowledge of toxoplasmosis among doctors and nurses who provide prenatal care in an endemic region. (United States)

    da Silva, Laura Berriel; de Oliveira, Raquel de Vasconcelos Carvalhaes; da Silva, Marizete Pereira; Bueno, Wendy Fernandes; Amendoeira, Maria Regina Reis; de Souza Neves, Elizabeth


    Congenital toxoplasmosis is a potentially severe infection and its prevention is most often based on serological screening in pregnant women. Many cases could be prevented by simple precautions during pregnancy. Aiming to assess the knowledge about toxoplasmosis among professionals working in antenatal care in a high prevalent region, a questionnaire was administered to 118 obstetric nurses and physicians attending at primary care units and hospitals. The questionnaire was self-completed and included questions on diagnosis, clinical issues, and prevention. Only 44% of total answers were corrected. Lower scores were observed among those with over 10 years of graduation, working in primary care units, and nurses. Errors were mainly observed in questions of prevention and diagnosis. As congenital toxoplasmosis is a mother-to-child (MTC) transmitted disease, early diagnosis and treatment can prevent serious and irreversible fetal damage. Thus, doctors and nurses who provide prenatal care must be appropriately trained on prophylactic, diagnostic, and clinical aspects of toxoplasmosis. The authors suggest that measures should be taken for continuing education regarding toxoplasmosis in pregnancy.

  6. A new strategy for regulating long-term care facilities. (United States)

    Ruchlin, H S


    This study analyzes the failure of current regulatory efforts to elicit an acceptable level of performance in long-term care facilities and proposes a strategy for correcting that failure. Seven factors are identified as being responsible for the failure of current regulatory efforts: inadequate financing, inadequate knowledge, bureaucratic apathy, legal constraints, political constraints, a fragmentation of agency responsibility, and a shortage of conforming beds. Public utility status, market regulation, and non-profit control are reviewed and rejected as alternatives to the current approach. A new strategy aimed at improving the regulatory process and environment is proposed. The process can be improved by adopting a program rather than taking a functional approach to agency organization; linking the inspection and rate-setting processes; creating a role for consumer groups in the inspection process; and exposing the process and results of regulation to public scrutiny. Five proposals are offered for improving the regulatory environment. These focus on eliminating barriers to entry, supporting alternatives to institutionalization, federalizing the Medicaid program, abandoning exclusive reliance on the medical model as the guide for regulatory standards, and changing the focus of regulation from structure-process to out-come.

  7. Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care

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    Lyn J. Haskins


    Full Text Available Background: In South Africa, coverage of services for mothers and babies in the first year of life is suboptimal despite high immunisation coverage over the same time period. Integration of services could improve accessibility of services, uptake of interventions and retention in care.Aim: This study describes provision of services for mothers and babies aged under 1 year.Setting: Primary healthcare clinics in one rural district in KwaZulu-Natal, South Africa.Methods: All healthcare workers on duty and mothers exiting the clinic after attending well-child services were interviewed. Clinics were mapped to show the route through the clinic taken by mother–baby pairs receiving well-child services, where these services were provided and by whom.Results: Twelve clinics were visited; 116 health workers and 211 mothers were interviewed. Most clinics did not provide comprehensive services for mothers and children. Challenges of structural layout and deployment of equipment led to fragmented services provided by several different health workers in different rooms. Well-child services were frequently provided in public areas of the clinic or with other mothers present. In some clinics mothers and babies did not routinely see a professional nurse. In all clinics HIV-positive mothers followed a different route. Enrolled nurses led the provision of well-child services but did not have skills and training to provide comprehensive care.Conclusions: Fragmentation of clinic services created barriers in accessing a comprehensive package of care resulting in missed opportunities to provide services. Greater integration of services alongside immunisation services is needed.

  8. Internal marketing strategy: Focusing on staff orientation in health care in South Africa

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    J. W. De Jager


    Full Text Available Purpose: The purpose of the paper is to determine the levels of satisfaction in respect of pre identified internal marketing-related variables in a large provincial hospital in South Africa. Problem investigated: Low job satisfaction is often cited as a major cause of high turnover among health care providers worldwide. Likewise the Public Health Care Industry in South Africa is facing complex employee retention issues. In determining the reasons for high turnover an interest in evaluating employee satisfaction among health care providers has increased. Measuring components of job satisfaction will assist not only the health care organisations' management to understand hospital culture, but also to compile an effective internal marketing plan and strategy. Design/Methodology/Approach: A staff satisfaction survey was conducted amongst staff members at a provincial hospital in the Tshwane region, South Africa. Attitudes of staff on pre-identified staff satisfaction variables were assessed. These variables were employed to implement an internal marketing strategy. A list of variables was formulated after an extensive literature study had been conducted. A total of 416 staff members voluntarily completed a self-administered questionnaire. A five-point Likert type scale was used to measure the levels of satisfaction on staff-related issues, with a view to addressing issues in the internal marketing strategy. Findings : It was evident that the management principles currently employed by the management team were a cause for concern among staff members. Based on the analysis that identified the satisfaction variables best it was clear that management should take immediate steps to address the following issues : Clarification of hospital goals \\ objectives; Understanding the goals of the respective departments; The functioning of the Human resource department; Functioning of the overall hospital management; andImplications: This paper aims to present a

  9. Providing Nutritional Care in the Office Practice: Teams, Tools, and Techniques. (United States)

    Kushner, Robert F


    Provision of dietary counseling in the office setting is enhanced by using team-based care and electronic tools. Effective provider-patient communication is essential for fostering behavior change: the key component of lifestyle medicine. The principles of communication and behavior change are skill-based and grounded in scientific theories and models. Motivational interviewing and shared decision making, a collaboration process between patients and their providers to reach agreement about a health decision, is an important process in counseling. The stages of change, self-determination, health belief model, social cognitive model, theory of planned behavior, and cognitive behavioral therapy are used in the counseling process.

  10. The psychological effects of providing personal care to a partner: a multidimensional perspective

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    Thomas Hansen


    Full Text Available The expected increasing demand for informal care in aging societies underscores the importance of understanding the psychological implications of caregiving. This study explores the effect of providing regular help with personal care to a partner on different aspects of psychological well-being. We use cross-sectional data from the Norwegian Life Course, Ageing and Generation study (n. ~15,000; age 40-84 and two-wave panel data from the Norwegian study on Life Course, Ageing and Generation (n. ~3000; age 40-84. To separate the effects of providing care from those of the partner’s disability, caregivers are contrasted with non-caregivers with both disabled and nondisabled partners. We separate outcomes into cognitive well-being (life satisfaction, psychological functioning (self-esteem, mastery, and affective well-being (happiness, depression, loneliness. Findings show that caregiving has important cross-sectional and longitudinal detrimental psychological effects. These effects are fairly consistent across all aspects of well-being, demonstrating that caregiving has a broad-based negative impact. Among women, however, these effects are similar to if not weaker than the effects of a partner’s disability. Caregiving effects are constant by age, education, and employment status, but stronger among caregivers with health problems. Providing personal care to a partner is associated with marked adverse psychological effects for men and women irrespective of age and socio-economic status. Hence, no socio-demographic group is immune from caregiving stress, so programs should be targeted generally. The results also suggest that the health needs of caregivers demand more attention.

  11. A resource-based view of partnership strategies in health care organizations. (United States)

    Yarbrough, Amy K; Powers, Thomas L


    The distribution of management structures in health care has been shifting from independent ownership to interorganizational relationships with other firms. A shortage of resources has been cited as one cause for such collaboration among health care entities. The resource- based view of the firm suggests that organizations differentiate between strategic alliances and acquisition strategies based on a firm's internal resources and the types of resources a potential partner organization possesses. This paper provides a review of the literature using the resource-based theory of the firm to understand what conditions foster different types of health care partnerships. A model of partnership alliances using the resource-based view is presented, strategic linkages are presented, managerial implications are outlined, and directions for future research are given.

  12. Provider Documentation of Geriatric Issues among Older Adults Receiving Care in Safety Net (United States)

    Chodos, Anna H; Pierluissi, Edgar; Patel, Kanan; Ritchie, Christine S


    Background In a safety net setting, we evaluated primary care provider (PCP) documentation of geriatric issues and whether geriatric consultation influences subsequent documentation. Methods We performed a retrospective chart review of patients referred to an outpatient geriatric consult service at San Francisco General Hospital. The geriatrics service serves two primary care clinics and provides advice through an e-consult, an e-consult with care coordination services, or a comprehensive geriatrics assessment. We queried charts for patients ≥60 years of age, referred from October 2012 to November 2013, and received care for ≥ 6 months after the consult. For two primary care visits pre- and post-consult, we recorded documentation of geriatric issues, such as cognitive impairment, falls, and symptoms prevalent in older adults. Comparisons were analyzed using descriptive statistics and paired sample t-tests. Results Among 90 patients referred, mean age was 77.9 years (7.3) and 62.2% were female. Most patients (66.7%) were non-English speaking. Patients' race included 40% Hispanic, 32.2% Asian, 15.6% African-American, and 12.2% White. Many, 78.9%, were dual-eligible. The most common conditions included diabetes (43.3%), dementia (37.8%), and mental health disorders (31.1%). Pre-consult, PCPs documented screening for falls in 54.4%, cognitive impairment in 38.9%, mental health conditions in 35.6%, and activities of daily living in 28.9%. An advance directive or goals of care were documented in 45.6% of charts. Symptoms (pain, shortness of breath, insomnia, fatigue or anorexia) were often documented pre-consult (91.1%). The only difference in a pre-post comparison was that providers documented fewer screens post-consult for cognitive impairment (38.9 vs 21.1%). Conclusion Among PCPs in safety net clinics, less than half had documentation of common geriatrics issues, other than symptoms, prior to consulting a geriatrician. The consult did not affect post

  13. Team meetings in specialist palliative care: Asking questions as a strategy within interprofessional interaction


    Arber, A


    In this article, I explore what happens when specialist palliative care staff meet together to discuss patients under their care. Many studies (e.g., Atkinson) have discussed how health care practitioners in various settings use rhetorical strategies when presenting cases in situations such as ward rounds and team meetings. Strategies for arguing and persuading are central to medical practice in the interprofessional context. The context of specialist palliative care is an interesting place...

  14. The entrenchment strategy of logistics service providers: Towards a sequential cooperation-competition process?

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    Gilles Paché


    Full Text Available The logistics industry has been attracting the attention of researchers in management for several years. Their focus is increasingly on interorganisational relationships between logistics service providers and their customers, examining the modes of interaction occurring between them. An abundant literature emphasises the importance of cooperative strategies in the logistics industry, hinting that this is a dominant requirement, destined for inevitable development. This article presents a more qualified position and proposes that cooperative strategies are most likely a transition step between arm’s-length competition periods, and resorts to the entrenchment theory, imported from organisational finance, to propose a sequential cooperation-competition model.

  15. Multinational corporations and health care in the United States and Latin America: strategies, actions, and effects. (United States)

    Jasso-Aguilar, Rebeca; Waitzkin, Howard; Landwehr, Angela


    In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institutions and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector

  16. Health Care Provider Advice for African American Adults Not Meeting Health Behavior Recommendations

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    Elizabeth A. Fallon, PhD


    Full Text Available Introduction Poor dietary habits and sedentary lifestyle contribute to excessive morbidity and mortality. Healthy People 2010 goals are for 85% of physicians to counsel their patients about physical activity and for 75% of physician office visits made by patients with cardiovascular disease, diabetes, or dyslipidemia to include dietary counseling. The purpose of this study was to 1 determine the rate of participant-reported health care provider advice for healthy lifestyle changes among African Americans who do not meet recommendations for physical activity, fruit and vegetable consumption, and healthy weight; 2 examine correlates of provider advice; and 3 assess the association between provider advice and stage of readiness for change for each of these health behaviors. Methods Data for this study were collected as part of a statewide faith-based physical activity program for African Americans. A stratified random sample of 20 African Methodist Episcopal churches in South Carolina was selected to participate in a telephone survey of members aged 18 years and older. The telephone survey, conducted over a 5-month period, asked participants a series of questions about sociodemographics, health status, physical activity, and nutrition. Analyses for moderate to vigorous physical activity, fruit and vegetable consumption, and weight loss were conducted separately. For each of these behaviors, logistic regression analyses were performed to examine the independent association of sex, age, body mass index, education, number of diagnosed diseases, perceived health, and stage of change with health care provider advice for health behaviors. Results A total of 572 church members (407 women, 165 men; mean age, 53.9 years; range, 18–102 years completed the survey. Overall, participant-reported provider advice for lifestyle changes was 47.0% for physical activity, 38.7% for fruit and vegetable consumption, and 39.7% for weight. A greater number of diagnosed

  17. Providing Care for the People Who Walked out of the Institutions – Solidarity and Freedoom Therapy

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    Andreja Rafaelič


    Full Text Available After the Walk-out care had to be organised for the walkers that decided not to return to the institutions. Enabling public pressure and advocacy has been one of the tasks of the movement. Negotiations with the Ministry of labour, family and social affairs, special care homes, nongovernmental organizations and local authorities had started. Agency IN has been the only nongovernmental organization that has been willing to provide care for the walkers. The lives of the walkers have changed dramatically. The resettlement to Ljubljana has been a challenge for the walkers, their social workers and volunteers. The solidarity that has been created during the movement provided them with enough support and help to realise most of their goals. The movement enabled them to make friends and live in the community. While experiencing a lot of successes in their lives, obstacles have been encountered. Inadequate laws and the passivity of the ministry of social affairs has been one of the most oblivious.

  18. Drug Shortages: Patients and Health Care Providers Are All Drawing the Short Straw. (United States)

    Rinaldi, François; de Denus, Simon; Nguyen, Angela; Nattel, Stanley; Bussières, Jean-François


    Drug shortages have been reported for > 35 years. Attention to this problem increased recently after the Sandoz crisis, in which a warning letter by the Food and Drug Administration caused supply changes that suspended the availability of numerous medications. The frequency of drug shortages has increased recently. In 2011-2012 alone, Canadian supply shortages occurred for > 1000 drugs (including 150 for cardiovascular diseases). These shortages lasted for an average of 4-5 months, increasing the workload for health care providers, producing impaired health, stress, and anxiety for patients, and increasing the risk of errors. The critical importance of drug shortages is increasingly recognized by members of the public, and health care providers must sometimes make major efforts to minimize their adverse consequences. Although data are limited, such efforts come at a price that patients and the health care system should not have to bear; they divert pharmacists and physicians from their already busy clinical duties and often require complex and risky adjustments in medical regimens. If drug shortages are here to stay, clinicians, drug manufacturers, and relevant organizations should work together to increase accountability for drug availability and adaptation to shortages, and to create more effective tools with which to anticipate and respond to critical supply fluctuations.

  19. Structure of non-reimbursed and reimbursed therapeutic procedures provided at a general dental care office

    Directory of Open Access Journals (Sweden)

    Zgardzinska Sylwia


    Full Text Available Dental care in Poland is based both on the public system (reimbursement by the National Health Fund and on the private funding (non-reimbursed. The aim of the paper was an analysis of the structure of non-reimbursed and reimbursed therapeutic procedures provided at a general dental care office. The study material was medical documentation of 669 patients treated for 3 months (the third quarter of 2013 at a general dental care office. The structure of therapeutic procedures, with the exception of orthodontic and prosthetic treatment, was analyzed, taking into account the patients’ gender, age, place of residence, the kind of procedure, and the payment type they made. The procedures reimbursed by the National Health Fund constituted 60.1% of all the procedures provided to patients at a dental office. Both among the procedures reimbursed by the National Health Fund and non-reimbursed procedures, the therapeutic procedures prevailed significantly over the prophylactic ones; in all age groups conservative treatment was predominant. An increase in the number of extractions in patients over 40 years of age, in comparison to younger patients, was found. The number of the dental procedures reimbursed by the National Health Fund, compared to the number of the non-reimbursed ones, increased with the patients’ age.

  20. Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia

    Directory of Open Access Journals (Sweden)

    Oldenburg Brian


    Full Text Available Abstract Background Relatively little research attention has been given to the development of standardised and psychometrically sound scales for measuring influences relevant to the utilisation of health services. This study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia. Methods Relevant domains of influence were first identified from a literature review and formative research. Items were then generated by using and adapting previously developed scales and published findings from these. The new items and scales were pre-tested and qualitative feedback was obtained from a convenience sample of citizens from the community and a panel of experts. Principal Components Analyses (PCA and internal reliability testing (Cronbach's alpha were then conducted for all of the newly adapted or developed scales utilising data collected from a self-administered mailed survey sent to a randomly selected population-based sample of 381 individuals (response rate 65.6 per cent. Results The PCA identified five scales with acceptable levels of internal consistency were: (1 social support (ten items, alpha 0.86; (2 perceived interpersonal care (five items, alpha 0.87, (3 concerns about availability of health care and accessibility to health care (eight items, alpha 0.80, (4 value of good health (five items, alpha 0.79, and (5 attitudes towards health care (three items, alpha 0.75. Conclusion The five scales are suitable for further development and more widespread use in research aimed at understanding the determinants of preventive health services utilisation among adults in the general population.

  1. Should health care providers be forced to apologise after things go wrong? (United States)

    McLennan, Stuart; Walker, Simon; Rich, Leigh E


    The issue of apologising to patients harmed by adverse events has been a subject of interest and debate within medicine, politics, and the law since the early 1980s. Although apology serves several important social roles, including recognising the victims of harm, providing an opportunity for redress, and repairing relationships, compelled apologies ring hollow and ultimately undermine these goals. Apologies that stem from external authorities' edicts rather than an offender's own self-criticism and moral reflection are inauthentic and contribute to a "moral flabbiness" that stunts the moral development of both individual providers and the medical profession. Following a discussion of a recent case from New Zealand in which a midwife was required to apologise not only to the parents but also to the baby, it is argued that rather than requiring health care providers to apologise, authorities should instead train, foster, and support the capacity of providers to apologise voluntarily.

  2. Examining the trajectories of children providing care for adults in rural Kenya

    DEFF Research Database (Denmark)

    Skovdal, Morten


    Research on caregiving children tends to be limited to children's caregiving experiences of parents with a specific disease or disability. This has led to a common perception that children's caregiving is a single, uniform and often long-term experience. Whilst this is most certainly the case...... for many children in economically more advanced countries, this may not hold true in rural Africa, where poverty and AIDS can have significant knock-on effects on entire families and communities. This paper seeks to develop a more complex understanding of children's caring experiences by asking children...... was adapted, with historical profiles, Photovoice and draw-and-write essays complementing 34 individual interviews and 2 group discussions. A thematic network analysis revealed that children's caregiving was not confined to a single experience. Children were observed to provide care for a number of different...

  3. Does Male Care, Provided to Immature Individuals, Influence Immature Fitness in Rhesus Macaques?

    Directory of Open Access Journals (Sweden)

    Doreen Langos

    Full Text Available Among many mammals, maternal care strongly impacts infant survival; however, less is known about whether adult males also affect infant fitness. Paternal care is expected when providing care enhances offspring survival and reproduction, which likewise increases fathers' fitness. Males might also care for unrelated immature individuals to increase their mating probability with the immature individuals' mothers. Studies in multimale primate groups showed that sires enhance food access for offspring and provide protection in conflicts. Furthermore, fathers' presence during infancy has been suggested to accelerate offspring sexual maturation. However, no study has yet directly linked the degree of father-offspring bonds to offspring fitness in primates. We previously reported father-offspring affiliation in rhesus macaques, pronounced during early infancy and independent of mothers' presence. The present study aims at investigating whether affiliation with fathers or other males affects proxies of immature fitness (body mass gain, body fat and testis size. First, we combined behavioral, genetic and morphometric data from 55 subjects of one group. Second, using demographic and genetic data, we investigated for 92 individuals of the population whether mother- and father-offspring co-residence during immaturity influenced offspring lifetime reproductive success (LRS. Our results show that focal rank and higher amounts of affiliation with high-ranking males during infancy tend to positively impact body mass gain of female, but not male focal animals. In contrast, body mass gain of male focal individuals, but not females', appeared to be higher when affiliation of male immature individuals was evenly distributed across their adult male partners. Moreover, we found mothers', but not fathers', presence during immaturity to predict offspring LRS. Our results suggest that male-immature affiliation, but not father-offspring co-residence, potentially impacts

  4. Providing Basic Needs and Encouragement as Strategies in Managing Aggression in Dementia Clients

    Directory of Open Access Journals (Sweden)

    Retno Lestari


    Full Text Available Purpose: The experiences of caregivers in managing dementia clients with aggressive behaviour have been an issue in nursing homes. This study utilized the fact that there is no significant strategy for managing aggression effectively. The aim of the study is to explore the experiences of caregivers in managing dementia clients with aggressive behaviour in nursing home in Jakarta, Indonesia.Method: This study employed a hermeneutic phenomenological approach so that caregivers were able to explore the phenomenon of aggression by dementia residents in the nursing home. Six experienced caregivers were interviewed in this study to uncover caregivers’ strategies they use in managing aggression in dementia residents.Result: The findings in this study were several strategies that have been used by caregivers to manage aggressive behaviour among dementia residents in the nursing home: providing basic needs and encouragement.Conclusion: The findings suggested caregivers to implement the strategies for managing aggression in dementia residents. Due to a limited number of related studies in Indonesia, this study recommended for further research to other nursing homes in Indonesia to determine if other strategies to manage aggression exist.

  5. The attitudes of primary care providers towards screening for colorectal cancer

    Directory of Open Access Journals (Sweden)

    Jesús López-Torres Hidalgo


    Full Text Available Background and objective: the scientific community supports the appropriateness of colorectal cancer screening, and there is consensus on the need to raise awareness about the significance of prevention among both health care professionals and the population. The goal was to record the attitude of primary care providers towards colorectal cancer screening, as well as the main barriers to both patient and provider participation. Methods: a cross-sectional, observational study was performed of 511 professionals in Albacete Health District. Variables included views on screening effectiveness and cost-effectiveness, acceptance by providers and patients, barriers to participation, frequency of prevention recommendations, and education needs. Results: most (76 % considered screening was effective; 85 % said acceptance of fecal occult blood testing was intermediate or high, and 68.2 % this is also the case for colonoscopy when needed; 71.9 % would recommend screening should a population-based program be implemented (currently only 9.7 % recommends this. Correspondence analysis revealed that recommendation is more common when assigned populations are smaller. Conclusions: most providers consider screening is both effective and acceptable for patients. In today's situation, where screening is only performed in an opportunistic manner, the proportion of professionals who commonly recommend screening for the mid-risk population is low, especially when assigned populations are huge.

  6. Factors affecting the performance of maternal health care providers in Armenia

    Directory of Open Access Journals (Sweden)

    Voltero Lauren


    Full Text Available Abstract Background Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. Each of these factors should be supplied by the organization in which the provider works, and thus, organizational support is considered as an overarching element for analysis. Little research, domestically or internationally, has been conducted on the actual effects of each of the factors on performance outcomes and most PI practitioners assume that all the factors are needed in order for performance to improve. This study presents a unique exploration of how the factors, individually as well as in combination, affect the performance of primary reproductive health providers (nurse-midwives in two regions of Armenia. Methods Two hundred and eighty-five nurses and midwives were observed conducting real or simulated antenatal and postpartum/neonatal care services and interviewed about the presence or absence of the performance factors within their work environment. Results were analyzed to compare average performance with the existence or absence of the factors; then, multiple regression analysis was conducted with the merged datasets to obtain the best models of "predictors" of performance within each clinical service. Results Baseline results revealed that performance was sub-standard in several areas and several performance factors were deficient or nonexistent. The multivariate analysis showed that (a training in the use of the clinic tools; and (b receiving recognition from the employer or the client/community, are factors strongly associated with performance, followed by (c receiving performance feedback in postpartum care. Other – extraneous

  7. A sustainable training strategy for improving health care following a catastrophic radiological or nuclear incident. (United States)

    Blumenthal, Daniel J; Bader, Judith L; Christensen, Doran; Koerner, John; Cuellar, John; Hinds, Sidney; Crapo, John; Glassman, Erik; Potter, A Bradley; Singletary, Lynda


    The detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. Members throughout the health care delivery system, including medical first responders, hospital first receivers, and health care institution support personnel such as janitors, hospital administrators, and security personnel, lack radiation-related training. This lack of knowledge can lead to failure of these groups to respond appropriately after a nuclear detonation or other major radiation incident and limit the effectiveness of the medical response and recovery effort. Efficacy of the response can be improved by getting each group the information it needs to do its job. This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.

  8. Baccalaureate Nursing Faculty Competencies and Teaching Strategies to Enhance the Care of the Veteran Population: Perspectives of Veteran Affairs Nursing Academy (VANA) Faculty. (United States)

    Carlson, Judy


    It is critical that faculty competencies, teaching strategies, and the essential knowledge relating to the care of our veterans be delineated and taught to health care professionals in order for our Veterans to receive optimal care. The purpose of this qualitative study was to ascertain from nursing faculty members who have worked extensively with veterans, the necessary faculty competencies, essential knowledge, and teaching strategies needed to prepare baccalaureate level nurses to provide individualized, quality, and holistic care to veterans. Six Veteran Affairs Nursing Academy faculty members participated in two 2-hour focus group sessions. There were a total of 12 multidimensional major concepts identified: 5 faculty competencies, 4 essential knowledge areas, and 3 teaching strategies specifically related to veteran care. The information generated can be used for faculty, staff, and or nurse development. Having a comprehensive understanding of veteran health care needs enable effective patient-centered care delivery to veterans, which is the gold standard in health care our veterans deserve.

  9. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care. (United States)

    Fukui, Sadaaki; Salyers, Michelle P; Matthias, Marianne S; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C


    The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock's Informed Decision Making Scale (Braddock et al. 1997, 1999, 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was "exploration of consumer preference," with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM.

  10. Adverse Effects of Tattoos and Piercing on Parent/Patient Confidence in Health Care Providers. (United States)

    Johnson, Scarlett C; Doi, Maegan L M; Yamamoto, Loren G


    First impressions based on practitioner appearance often form the basis for preliminary assumptions regarding trust, confidence, and competence, especially in situations where patients or family members do not have an established relationship with the physician. Given their growing prevalence, we strove to further investigate whether visible tattoos or piercings on a medical provider affects a patient's perception of the provider's capabilities and their trust in the care that would be provided. A survey using photographs of simulated practitioners was administered to 314 participants split between rural and urban locations. Study volunteers rated tattooed practitioners with lower confidence ratings when compared with nontattooed practitioners and reported greater degrees of discomfort with greater degrees of facial piercing. We concluded that these factors adversely affect the clinical confidence ratings of practitioners, regardless of the gender, age group, or location of participants.

  11. Satisfaction of osteoarthritis patients with provided care is not related to the disease-specific quality of life.

    NARCIS (Netherlands)

    Rosemann, T.J.; Wensing, M.J.P.; Szecsenyi, J.; Grol, R.P.T.M.


    BACKGROUND: Osteoarthritis (OA) has a high prevalence in primary care. Patient satisfaction is an important indicator for the quality of care provided to OA patients. Little is known about satisfaction of patients with this condition in a primary care setting in Germany. The aim of the study was to

  12. Immunization of Health-Care Providers: Necessity and Public Health Policies (United States)

    Maltezou, Helena C.; Poland, Gregory A.


    Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered. PMID:27490580

  13. Intracerebral hemorrhage for the palliative care provider: what you need to know. (United States)

    Simmons, B Brent; Parks, Susan M


    Intracerebral hemorrhage (ICH) makes up 10%-30% of all strokes. Palliative care providers are often asked to get involved with ICH cases to aid with development of short-term and long-term goals. Prognosis can be calculated using the ICH score (based on Glasgow Coma Score score, ICH volume, presence of intraventricular hemorrhage, age, and location of origin) or the Essen score (based on age, NIH Stroke Scale [NIHSS], and level of consciousness). Do-not-resuscitate (DNR) status is important to discuss with families. Expert consensus states DNR is appropriate if the patient has two of the following: severe stroke, life-threatening brain damage, or significant comorbidities. The process of withdrawing ventilatory support can differ greatly from that of a medical intensive care unit (ICU) patient. Most ICH patients die within 24 hours following extubation. Symptoms of dyspnea and pain warrant use of opioids before and after terminal extubation. In addition, treating death rattle and postextubation stridor are important interventions. Family meetings are a vital intervention to help explain prognosis, establish a plan of care, and to get all family members on the same page. Family meetings can have a rapid effect, with 66% of families opting for withdrawal of life support to decide within 24 hours of such a meeting.

  14. Ending neglect: providing effective childhood tuberculosis training for health care workers in Tanzania (United States)

    Olotu, R.; Talbot, E. A.; Cronin, B. J.; Christopher, R.; Mkomwa, Z.


    Setting: Health care facilities in Dar es Salaam, Pwani, and Arusha, Tanzania. Objective: To assess health care worker (HCW) knowledge and practices 1 year after specialized training in childhood tuberculosis (TB). Design: Using a standardized survey, we interviewed a convenience sample of HCWs providing both general and specialized care to children. Results: We interviewed 117 HCWs in TB clinics, maternal and child health clinics, human immunodeficiency virus (HIV) clinics, out-patient departments, and pediatric in-patient wards at 12 facilities. A total of 81 HCWs (62% of nurses, 74% of clinicians) reported having attended the national childhood TB training course. Most HCWs responded correctly to questions on childhood TB diagnosis, treatment, and TB-HIV co-management, regardless of training history. Most HCWs reported that they routinely obtain chest radiographs, HIV testing, and a TB contact history when evaluating children for TB. Less than half of HCWs reported routinely obtaining sputum for mycobacterial culture or performing a tuberculin skin test. Three times as many trained as untrained HCWs reported having ever prescribed isoniazid preventive therapy (IPT) to a child (P < 0.05). Conclusion: In general, levels of childhood TB knowledge were high and practices were in accordance with national guidance. Specific gaps in diagnosis, treatment and use of IPT were identified for future focused training. PMID:26400701

  15. Immunization of Health-Care Providers: Necessity and Public Health Policies. (United States)

    Maltezou, Helena C; Poland, Gregory A


    Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered.

  16. Using an established telehealth model to train urban primary care providers on hypertension management. (United States)

    Masi, Christopher; Hamlish, Tamara; Davis, Andrew; Bordenave, Kristine; Brown, Stephen; Perea, Brenda; Aduana, Glen; Wolfe, Marcus; Bakris, George; Johnson, Daniel


    The objective of this study was to determine whether a videoconference-based telehealth network can increase hypertension management knowledge and self-assessed competency among primary care providers (PCPs) working in urban Federally Qualified Health Centers (FQHCs). We created a telehealth network among 6 urban FQHCs and our institution to support a 12-session educational program designed to teach state-of-the-art hypertension management. Each 1-hour session included a brief lecture by a university-based hypertension specialist, case presentations by PCPs, and interactive discussions among the specialist and PCPs. Twelve PCPs (9 intervention and 3 controls) were surveyed at baseline and immediately following the curriculum. The mean number of correct answers on the 26-item hypertension knowledge questionnaire increased in the intervention group (13.11 [standard deviation (SD)]=3.06) to 17.44 [SD=1.59], Phypertension management self-assessed competency scale increased in the intervention group (4.68 [SD=0.94] to 5.41 [SD=0.89], Phypertension care provided by urban FQHC providers.

  17. Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016. (United States)

    Oduyebo, Titilope; Igbinosa, Irogue; Petersen, Emily E; Polen, Kara N D; Pillai, Satish K; Ailes, Elizabeth C; Villanueva, Julie M; Newsome, Kim; Fischer, Marc; Gupta, Priya M; Powers, Ann M; Lampe, Margaret; Hills, Susan; Arnold, Kathryn E; Rose, Laura E; Shapiro-Mendoza, Carrie K; Beard, Charles B; Muñoz, Jorge L; Rao, Carol Y; Meaney-Delman, Dana; Jamieson, Denise J; Honein, Margaret A


    CDC has updated its interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure, to include the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. Possible exposures to Zika virus include travel to or residence in an area with active Zika virus transmission, or sex* with a partner who has traveled to or resides in an area with active Zika virus transmission without using condoms or other barrier methods to prevent infection.(†) Testing recommendations for pregnant women with possible Zika virus exposure who report clinical illness consistent with Zika virus disease(§) (symptomatic pregnant women) are the same, regardless of their level of exposure (i.e., women with ongoing risk for possible exposure, including residence in or frequent travel to an area with active Zika virus transmission, as well as women living in areas without Zika virus transmission who travel to an area with active Zika virus transmission, or have unprotected sex with a partner who traveled to or resides in an area with active Zika virus transmission). Symptomatic pregnant women who are evaluated possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women who live in areas without active Zika virus transmission and who are evaluated possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed 2-12 weeks after the exposure. Asymptomatic pregnant women who do not live in an area with active Zika virus transmission, who are first evaluated 2-12 weeks

  18. A practical guide about biosimilar data for health care providers treating inflammatory diseases


    Markenson J; Alvarez DF; Jacobs I; Kirchhoff C


    Joseph Markenson,1,2 Daniel F Alvarez,3 Ira Jacobs,4 Carol Kirchhoff5 1Department of Rheumatology, 2Department of Medicine, Hospital for Special Surgery, New York, NY, 3Pfizer Inc, Collegeville, PA, 4Pfizer Inc, New York, NY, 5Pfizer Inc, Chesterfield, MO, USA Abstract: To make informed decisions about the safety, efficacy, and clinical utility of a biosimilar, health care providers should understand the types and be able to analyze data generated from a biosimilar development program. T...

  19. Building an effective competitive intelligence system for health care service providers. (United States)

    Festervand, T A; Lumpkin, J R


    With the increasing competitiveness of the health care marketplace, the need for information by service providers has increased concomitantly. In response to this need, strategic and competitive intelligence systems have emerged as a vital source of information. This article establishes a basis for the development and operation of a competitive intelligence system. Initially, strategic and competitive intelligence systems are conceptualized, then followed by a discussion of the areas which are candidates for inclusion in the intelligence system. The remainder of the article focuses on system development and operation. Attention also is directed toward information utilization and integration.

  20. Acute Mallory-Weiss syndrome after cardiopulmonary resuscitation by health care providers in the emergency department

    Institute of Scientific and Technical Information of China (English)

    Dae Hee Kim; Dong Yoon Rhee; Seon Hee Woo; Woon Jeong Lee; Seung Hwan Seol; Won Jung Jeong


    A report of a 62-year-old female patient with severe Mallory-Weiss syndrome after successful cardiopulmonary resuscitation (CPR) by health care providers in the emergency department is presented. The bleeding continued for five days, and the patient’s total blood loss was estimated to be approximately 3 000 mL. After 7 days, the patient died due to respiratory distress syndrome. Severe Mallory-Weiss syndrome afterCPR may occur and should be considered as a potentially serious complication afterCPR.

  1. Creating a “Wellness Pathway” between health care providers and community-based organizations to improve the health of older adults

    Directory of Open Access Journals (Sweden)

    Maria A. Han, MD, MSHPM


    Full Text Available To effectively manage the health of older high-risk patients, health care organizations need to adopt strategies that go beyond the doctor's office and into patients' homes and communities. Community-based organizations (CBOs are important underutilized partners in activating and providing the resources necessary to deliver coordinated, culturally-tailored services to older individuals. This paper describes the process and preliminary results of creating and implementing a “Wellness Pathway” to improve the health of older individuals by coordinating care between health care providers and CBOs, such as senior centers. The Wellness Pathway provides a mechanism whereby health care providers refer patients to programs at the senior center, and senior center staff members refer patients for urgent or primary care services at the health care provider organization. The aim of the project was to determine whether the creation of the Wellness Pathway through the health care provider and CBO education and engagement is feasible and to identify challenges in scalability. During the 6 month study period, 25 patients were referred through the Wellness Pathway, and six patients acted on the referral. Stakeholders at both organizations were interviewed to obtain detailed information regarding their experiences with, and perceptions of, the Wellness Pathway. Patients and providers who participated in the pilot believe that it has the potential to positively impact the health of older patients and is worth continuing. The primary challenges that arose in the implementation of the Wellness Pathway resulted from inadequate levels of health care provider and staff engagement and from lagging patient recruitment.

  2. Primary care provider preferences for working with a collaborative support team

    Directory of Open Access Journals (Sweden)

    Flores Jennifer A


    Full Text Available Abstract Background Clinical interventions based on collaborative models require effective communication between primary care providers (PCPs and collaborative support teams. Despite growing interest in collaborative care, we have identified no published studies describing how PCPs prefer to communicate and interact with collaborative support teams. This manuscript examines the communication and interaction preferences of PCPs participating in an ongoing randomized clinical trial of a collaborative intervention for chronic pain and depression. Methods The trial is being conducted in five primary care clinics of a Veterans Affairs Medical Center. Twenty-one PCPs randomized to the study intervention completed a survey regarding preferences for interacting with the collaborative support team. Results A majority of PCPs identified email (95% and telephone calls (68% as preferred modes for communicating with members of the support team. In contrast, only 29% identified in-person communications as preferred. Most PCPs preferred that the care manager and physician pain specialist assess patients (76% and make initial treatment changes (71% without first conferring with the PCP. One-half wanted to be designated cosigners of all support team notes in the electronic medical record, one-half wanted to receive brief and focused information rather than in-depth information about their patients, and one-half wanted their practice nurses automatically included in communications. Panel size was strongly associated (p Conclusion The substantial variation in PCP communication preferences suggests the need for knowledge of these preferences when designing and implementing collaborative interventions. Additional research is needed to understand relationships between clinician and practice characteristics and interaction preferences.

  3. Association of child care providers breastfeeding support with breastfeeding duration at 6 months. (United States)

    Batan, Marilyn; Li, Ruowei; Scanlon, Kelley


    Many lactating mothers participate in the workforce and have their infants cared for outside of their home, yet little is known about their child care providers' (CCPs') support of breastfeeding. This study examines the association between CCPs' breastfeeding support as reported by mothers at 3 months and mother's breastfeeding at 6 months. Infant Feeding Practices Study II, a longitudinal study, followed mothers of infants via mail questionnaires almost monthly from late pregnancy throughout the first year. This study consisted of 183 mothers who breastfed and had their infant in child care at 3 months and answered 5 questions regarding CCPs' supports. Total number of CCPs' support was a summary of responses to individual items and categorized into 3 levels (0-2, 3-4, or 5 total supports). Multiple logistic regressions examined how each breastfeeding support and total number were associated with breastfeeding at 6 months. Breastfeeding at 6 months was significantly associated with CCP support to feed expressed breast milk (AOR = 4.55; 95% CI = 1.09, 18.95) and allow mothers to breastfeed at the child care place before or after work (AOR = 6.23; 95% CI = 1.33, 29.16). Compared to mothers who reported fewer than 3 total supports, mothers who reported 5 supports were 3 times as likely to be breastfeeding at 6 months (AOR = 3.00, 95% CI = 1.11, 8.13). Our findings suggest that CCPs' breastfeeding support at 3 months, particularly feeding expressed breast milk and allowing mothers to breastfeed before or after work, may help mothers maintain breastfeeding at 6 months.

  4. Employer strategies to combat health care plan fraud. (United States)

    Pflaum, B B; Rivers, J S


    Each year health care fraud drains millions of dollars from employer-sponsored health plans. Historically, employers have taken a rather tolerant view of fraud. As the pressure to manage health plan costs increases, however, many employers are beginning to see the detection and prosecution of fraud as an appropriate part of a cost management program. Fraud in medical insurance covers a wide range of activities in terms of cost and sophistication--from misrepresenting information on a claim, to billing for services never rendered, to falsifying the existence of an entire medical organization. To complicate matters, fraudulent activities can emanate from many, many sources. Perpetrators can include employees, dependents or associates of employees, providers and employees of providers--virtually anyone able to make a claim against a plan. This article addresses actions that employers can take to reduce losses from fraud. The first section suggests policy statements and administrative procedures and guidelines that can be used to discourage employee fraud. Section two addresses the most prevalent form of fraud--provider fraud. To combat provider fraud, employers should set corporate guidelines and should enlist the assistance of employees in identifying fraudulent provider activities. Section three suggests ways to improve fraud detection through the claims payment system--often the first line of defense against fraud. Finally, section four discusses the possibility of civil and criminal remedies and reviews the legal theories under which an increasing number of fraud cases have been prosecuted.

  5. Partner involvement in perinatal care and PMTCT services in Mbeya Region, Tanzania: the providers' perspective. (United States)

    Theuring, Stefanie; Nchimbi, Philo; Jordan-Harder, Brigitte; Harms, Gundel


    Partner involvement is considered to increase the effectiveness of female-oriented services for sexual and reproductive health (SRH), like those for antenatal care (ANC) or the prevention of mother-to-child transmission of HIV (PMTCT). However, male participation rates remain mostly low, and previous research has identified restrictive provider attitudes among barriers for partner participation in such services. Individual perspectives and experiences of healthcare providers are assumed to significantly influence the quality of delivered services. This study aimed at exploring providers' attitudes regarding partner involvement in ANC/PMTCT and other SRH services. A hundred interviews based on a semi-structured questionnaire were conducted among healthcare providers employed in an ANC-based PMTCT program in Mbeya Region, Tanzania. Interviewees expressed overall approval of male partner integration into the services, but this approval decreased when specifying for different service types, especially in those related to perinatal examinations or labor and delivery. Divergence between general attitudes and self-reported individual behavior was observed, querying the reliability of expressed attitudes. Among providers having at least one child, personally experienced partner attendance and approval of partner involvement were significantly associated for most service types. Although general views on partner involvement in SRH services seem to be mostly supportive, there is a need for health services to strengthen providers' positions toward male involvement, for example by communicating clear policies and job guidelines, and by encouraging partner service attendance among providers themselves.

  6. Market competition, ownership, payment systems and the performance of health care providers - a panel study among Finnish occupational health services providers. (United States)

    Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu


    Many health care reforms rely on competition although health care differs in many respects from the assumptions of perfect competition. Finnish occupational health services provide an opportunity to study empirically competition, ownership and payment systems and the performance of providers. In these markets employers (purchasers) choose the provider and prices are market determined. The price regulation of public providers was abolished in 1995. We had data on providers from 1992, 1995, 1997, 2000 and 2004. The unbalanced panel consisted of 1145 providers and 4059 observations. Our results show that in more competitive markets providers in general offered a higher share of medical care compared to preventive services. The association between unit prices and revenues and market environment varied according to the provider type. For-profit providers had lower prices and revenues in markets with numerous providers. The public providers in more competitive regions were more sensitive to react to the abolishment of their price regulation by raising their prices. Employer governed providers had weaker association between unit prices or revenues and competition. The market share of for-profit providers was negatively associated with productivity, which was the only sign of market spillovers we found in our study.

  7. Predictors of head start and child-care providers' healthful and controlling feeding practices with children aged 2 to 5 years. (United States)

    Dev, Dipti A; McBride, Brent A; Speirs, Katherine E; Donovan, Sharon M; Cho, Hyun Keun


    Few child-care providers meet the national recommendations for healthful feeding practices. Effective strategies are needed to address this disparity, but research examining influences on child-care providers' feeding practices is limited. The purpose of this study was to identify determinants of child-care providers' healthful and controlling feeding practices for children aged 2 to 5 years. In this cross-sectional study, child-care providers (n=118) from 24 center-based programs (six Head Start [HS], 11 Child and Adult Care Food Program [CACFP] funded, and seven non-CACFP) completed self-administered surveys during 2011-2012. Multilevel multivariate linear regression models were used to predict seven feeding practices. Working in an HS center predicted teaching children about nutrition and modeling healthy eating; that may be attributed to the HS performance standards that require HS providers to practice healthful feeding. Providers who reported being concerned about children's weight, being responsible for feeding children, and had an authoritarian feeding style were more likely to pressure children to eat, restrict intake, and control food intake to decrease or maintain children's weight. Providers with nonwhite race, who were trying to lose weight, who perceived nutrition as important in their own diet, and who had a greater number of nutrition training opportunities were more likely to use restrictive feeding practices. These findings suggest that individual- and child-care-level factors, particularly provider race, education, training, feeding attitudes and styles, and the child-care context may influence providers' feeding practices with young children. Considering these factors when developing interventions for providers to meet feeding practice recommendations may add to the efficacy of childhood obesity prevention programs.

  8. Providing High Quality Care in Low-Income Areas of Maryland: Definitions, Resources, and Challenges from Parents and Child Care Providers' Perspectives. Publication #2012-45 (United States)

    Forry, Nicole; Simkin, Shana; Wessel, Julia; Rodrigues, Katherine


    Early life experiences are critical to a child's development. Research has shown that, for a variety of reasons, children born into low-income families are at a disadvantage when compared to their higher-income peers. Fortunately, research has also shown a positive association between high quality child care and the academic and social-emotional…

  9. The expectations of fathers concerning care provided by midwives to the mothers during labour

    Directory of Open Access Journals (Sweden)

    Anna G.W. Nolte


    Full Text Available Midwives have been criticised for neglecting the expectations and needs of fathers. They either ignore the fathers or pressure them into becoming more involved than they would choose, if allowed to provide support to the mothers during labour. Whilst midwives are providing woman-centred care, it is important that they remember to involve the fathers in decision-making and to acknowledge their role, expectations and needs, because the birth of a child is one of the most important events in a person’s lifetime. This study focused on fathers’ expectations of the care provided to mothers by the midwives during labour. A qualitative, explorative, descriptive and contextual study design was utilised. In-depth qualitative interviews were conducted with fathers about the care provided to their partners or wives by midwives. Data were then analysed with an open descriptive method of coding that is appropriate for qualitative research. The results of the interviews were subsequently positioned within a holistic health-promotive nursing theory that encompassed body, mind and spirit. The results revealed that fathers saw the provision of comfort and support as the two main aspects for mothers in labour that they expected from midwives. The findings were that midwives should improve their communication skills with the mothers, as well as with the fathers if they are available. Fathers expected midwives to encourage them to accompany the mother during labour and to facilitate bonding between father, mother and baby. The results of this study should assist midwives to provide holistic quality care to mothers and fathers during labour.


    Vroedvroue word daarvan beskuldig dat hulle nie voldoen aan die verwagtinge en behoeftes van die vaders nie. Vaders word, óf deur hulle geïgnoreer, óf druk word op hulle uitgeoefen om meer betrokke te raak as waarmee hulle gemaklik is, indien hulle wel toegelaat word om moeders te

  10. Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey (United States)

    Singhal, Sonica; Figueiredo, Rafael; Dupuis, Sandy; Skellet, Rachel; Wincott, Tara; Dyer, Carolyn; Feller, Andrea; Quiñonez, Carlos


    Background: Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. Methods: Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. Results: Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. Interpretation: Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.

  11. Patient satisfaction with inpatient care provided by the Sydney Gynecological Oncology Group

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    Vivek Arora


    Full Text Available Vivek Arora, Shannon Philp, Kathryn Nattress, Selvan Pather, Christopher Dalrymple, Kenneth Atkinson, Sofia Smirnova, Stephen Cotterell, Jonathan CarterSydney Gynecological Oncology Group, Royal Prince Alfred Hospital, University of Sydney, Sydney, AustraliaPurpose: Patient satisfaction with the provision of hospital oncology services can have a significant impact on their overall treatment experience.Aims: To assess patient satisfaction with the inpatient hospital services in the gynecological oncology setting using the IN-PATSAT32 questionnaire developed by the European Organization for Research and Treatment of Cancer (EORTC.Methods: A modified version of the IN-PATSAT32 questionnaire with additional 16 items was administered to 52 adult surgical inpatients admitted with the Sydney Gynecological Oncology Group. All participants were provided with an information leaflet regarding the survey and written consent obtained.Results: A high response rate (100% from patients with varied social, ethnic, and educational backgrounds confirmed the acceptability of the survey. Standard of medical care provided, frequency of doctors’ visits, exchange of information with doctors, friendliness of the staff, and state of the room ranked highly (>95% on the patient satisfaction scales. Problems were identified with ease of access to and within the hospital, quality of food, and exchange of information with other hospital staff.Conclusions: Overall the satisfaction with inpatient care was rated very highly in most areas. Deficiencies in certain elements of provision of medical care to the patients were identified and steps have been taken to improve upon these shortcomings.Keywords: patient satisfaction, EORTC, IN-PATSAT32, gynecological oncology, survey

  12. What do primary care physicians and researchers consider the most important patient safety improvement strategies?

    NARCIS (Netherlands)

    Gaal, S.; Verstappen, W.H.J.M.; Wensing, M.J.P.


    BACKGROUND: Although it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by c

  13. Preferences for results from genomic microarrays: comparing parents and health care providers. (United States)

    Turbitt, E; Halliday, J L; Amor, D J; Metcalfe, S A


    Chromosomal microarray (CMA) testing is now performed frequently in paediatric care. Although CMAs improve diagnostic yields, they increase detection of variants of unknown and uncertain clinical significance (VUS). Understanding parents', paediatricians' and genetic health professionals' (GHPs) views regarding variant disclosure may reduce the potential for communication of unwanted information. A questionnaire was designed to compare disclosure preferences of these three groups in Australia. One hundred and forty-seven parents, 159 paediatricians and 69 GHPs hold similar views with at least 89% of respondents certainly or probably favouring disclosure of all categories of variants. However, some differences were observed between health care providers (HCPs: paediatricians and GHPs) and parents, who were less sure of their disclosure preferences. There was consensus among respondent groups that knowledge of a variant of certain clinical significance would provide more practical and emotional utility compared to VUS. Compared to HCPs, parents placed more emphasis on using knowledge of a VUS when considering future pregnancies (p exome/genome sequencing is integrated into clinical practice, the potential for differing views of parents and HCPs should be considered when developing guidelines for result disclosure.

  14. Implementation of cancer clinical care pathways: s successful model of collaboration between payers and providers. (United States)

    Feinberg, Bruce A; Lang, James; Grzegorczyk, James; Stark, Donna; Rybarczyk, Thomas; Leyden, Thomas; Cooper, Joseph; Ruane, Thomas; Milligan, Scott; Stella, Phillip; Scott, Jeffrey A


    Despite rising medical costs within the US healthcare system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of healthcare in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the healthcare cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology healthcare consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program.

  15. Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management

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    Monica Zolezzi


    Full Text Available Early assessment and management of risk factors is known to have significant impact in preventing cardiovascular disease (CVD and its associated burden. Cardiovascular disease risk assessment and management (CVDRAM is best approached by teamwork across health care professionals. This study aimed at assessing health care students’ (HCSs knowledge about the parameters needed for estimating CVD risk, their self-assessed preparedness/confidence and perceived barriers for the provision of CVDRAM services through a survey administered to third and fourth year pharmacy, medical, and nursing students in Qatar. Although all student cohorst achieved similar knowledge scores, less than half (n = 38, 47% were able to identify all of the six main risk factors necessary to estimate absolute CVD risk, and a third (32% were unable to identify total cholesterol as an independent risk factor necessary to estimate CVD risk. Training on the use of CVD risk assessment tools differed among the three student cohorts. All student cohorts also perceived similar levels of preparedness in CVDRAM. However, pharmacy students reported the highest preparedness/confidence with the use of the latest CVDRAM guidelines. The majority of statements listed under the barriers scale were perceived by the students as being moderate (median score = 3. Poor public acceptance or unawareness of importance of estimating CVD risk was the only barrier perceived as major by nursing students. Future integration of interprofessional educational (IPE activities in the CVDRAM curricula of HCSs may be a suitable strategy to minimize barriers and foster collaborative practice for the provision of CVDRAM services in Qatar.

  16. Recognition and perception of elder abuse by prehospital and hospital-based care providers. (United States)

    Rinker, Austin G


    The purposes of this study were to evaluate the extent of exposure, knowledge and attitudes of prehospital care providers (PCPs) and hospital care providers (HCPs) to elder abuse and neglect. A 20-question survey was designed to determine the providers' perception, knowledge and ability to identify patients that were potential victims of elder abuse and/or neglect. The surveys were distributed at four Maryland statewide conferences during 2006. A total of 645 surveys were distributed at the start of the individual conferences and 400 completed surveys were returned. Of the respondents, 272 (68.2%) were PCP (emergency medical services=EMSs) and 127 (31.8%) were HCP. During the past 12 months, 51.3% of those surveyed did not have reason to suspect any patients were exposed to abuse or neglect, although 60.5% admitted little or no contact with the elderly. In an attempt to determine respondent's ability to recognize potential abuse and neglect patients, scenario-type questions were used. Respondents believed a decubital ulcer (bedsore) was a positive indicator (83.5%) of abuse/neglect and 92.8% indicated that the elderly could suffer from injuries similar to "shaken-baby syndrome". When questioned about skin bruises as a possible indicator of abuse, only 69.3% of the respondents identified it as a possible sign of abuse. Seventy-one percent of respondents indicated that burns are not common in the elderly and could be another sign of elder abuse. One-in-three providers indicated they would suspect other reasons (dementia, depression, etc.) for the report of a sexual assault in an elderly patient. Eighty-nine percent of providers were aware that healthcare providers in the State of Maryland are required to report suspected elder and vulnerable patient abuse and/or neglect to law enforcement or social services' agencies. When asked to define elder abuse as a medical or social problem, 25.0% of providers stated that it was a social problem. Over 95% of the providers

  17. Emergency care and the national quality strategy: highlights from the Centers for Medicare & Medicaid Services. (United States)

    Venkatesh, Arjun K; Goodrich, Kate


    The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs.

  18. Transitions: A Guide to Teens Getting Older and Changing Health Care Providers (United States)

    ... have By age 17 or 18, you should: Work on managing your health care Learn about your health insurance ... health care to in an adult setting Actively work with your health care team to ensure that you receive optimal care Update ...

  19. Parents’ lived experience of providing kangaroo care to their preterm infants

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    Angela Leonard


    Full Text Available Premature and low birthweight infants pose particular challenges to health services in South Africa. While there is good evidence to demonstrate the benefits of kangaroo care in low birthweight infants, limited research has been conducted locally on the experiences of parents who provide kangaroo care to their preterm infants. This phenomenological study explores the lived experience of parents who provided their preterm infants with kangaroo care at a tertiary-level maternity centre in the Western Cape. In-depth interviews were conducted with six parents: four mothers and two fathers. Data was analysed using an adaptation of the approaches described by Colaizzi (1978:48-71 and Hycner (1985:280-294. To ensure trustworthiness, the trustworthiness criteria described by Guba and Lincoln (1989:242-243 were applied. Kangaroo care is a phased process, each phase bringing a unique set of experiences. The eight themes that emerged are described: unforeseen, unprepared and uncertain - the experience of birth; anxiety and barriers; an intimate connection; adjustments, roles and responsibilities; measuring success; a network of encouragement and support; living-in challenges; and living with the infant outside of hospital. Challenges facing health care providers are described and recommendations for information about kangaroo care and support for parents are made. Opsomming Vroeggebore babas en babas met ’n lae geboortegewig stel besondere uitdagings vir Suid-Afrikaanse gesondhiedsdienste. Daar bestaan goeie bewyse dat die kangaroesorgmetode voordelig is vir babas met ’n laegeboortegewig, dog is minimale plaaslike navorsing gedoen oor die ondervindinge van ouers wat hierdie metode gebruik om vir hul vroeggebore babas te sorg. Hierdie fenomenologiese studie verken die geleefde ervaringe van ouers wat vir hulle vroeggebore babas deur middel van die kangaroesorgmetode in ’n tersiêre kraamsentrum in die Weskaap gesorg het. Data is ingesamel deur in

  20. A practical guide about biosimilar data for health care providers treating inflammatory diseases (United States)

    Markenson, Joseph; Alvarez, Daniel F; Jacobs, Ira; Kirchhoff, Carol


    To make informed decisions about the safety, efficacy, and clinical utility of a biosimilar, health care providers should understand the types and be able to analyze data generated from a biosimilar development program. This article reviews the biosimilar guidelines, the biosimilar development process to provide education and context about biosimilarity, and uses examples from infliximab biosimilars to review the terminology and potential types of analyses that may be used to compare potential biosimilars to the originator biologic. A biosimilar is a biologic product that is highly similar to an approved (originator) biologic, notwithstanding minor differences in clinically inactive components, and with no clinically meaningful differences in terms of the safety, purity, and potency of the product. Due to their complex nature and production in living systems, it is not possible to exactly duplicate the approved originator biologic. To ensure biosimilars provide consistent, safe, and effective treatment comparable to the originator biologic, extensive analyses of the potential biosimilar are conducted, including side-by-side analytical, nonclinical, and clinical comparisons. A key goal is to determine whether there are sufficient relevant similarities in chemical composition, biologic activity, and pharmacokinetic aspects between the potential biosimilar and the originator. Regulatory approvals and marketing authorizations for biosimilars are made on a case-by-case and agency-by-agency basis after evaluating the totality of the evidence generated from the entire development program. Understanding how regulatory agencies review data for approval can help health care providers make appropriate decisions when biosimilars become available for use in the treatment of inflammatory diseases, and therefore they should review the literature to gain further information about specific biosimilars. PMID:28280299

  1. A practical guide about biosimilar data for health care providers treating inflammatory diseases

    Directory of Open Access Journals (Sweden)

    Markenson J


    Full Text Available Joseph Markenson,1,2 Daniel F Alvarez,3 Ira Jacobs,4 Carol Kirchhoff5 1Department of Rheumatology, 2Department of Medicine, Hospital for Special Surgery, New York, NY, 3Pfizer Inc, Collegeville, PA, 4Pfizer Inc, New York, NY, 5Pfizer Inc, Chesterfield, MO, USA Abstract: To make informed decisions about the safety, efficacy, and clinical utility of a biosimilar, health care providers should understand the types and be able to analyze data generated from a biosimilar development program. This article reviews the biosimilar guidelines, the biosimilar development process to provide education and context about biosimilarity, and uses examples from infliximab biosimilars to review the terminology and potential types of analyses that may be used to compare potential biosimilars to the originator biologic. A biosimilar is a biologic product that is highly similar to an approved (originator biologic, notwithstanding minor differences in clinically inactive components, and with no clinically meaningful differences in terms of the safety, purity, and potency of the product. Due to their complex nature and production in living systems, it is not possible to exactly duplicate the approved originator biologic. To ensure biosimilars provide consistent, safe, and effective treatment comparable to the originator biologic, extensive analyses of the potential biosimilar are conducted, including side-by-side analytical, nonclinical, and clinical comparisons. A key goal is to determine whether there are sufficient relevant similarities in chemical composition, biologic activity, and pharmacokinetic aspects between the potential biosimilar and the originator. Regulatory approvals and marketing authorizations for biosimilars are made on a case-by-case and agency-by-agency basis after evaluating the totality of the evidence generated from the entire development program. Understanding how regulatory agencies review data for approval can help health care providers make

  2. Filling the Gap for Early-Stage Breast Cancer Follow-Up: An Overview for Primary Care Providers. (United States)

    Bond-Bero, Stacy


    Earlier detection and newer treatments now make breast cancer highly survivable, and breast cancer survivors are the largest female cancer survivor group in the United States. With earlier detection, more women are being diagnosed with early-stage breast cancer and need follow-up care. With the increasing number of breast cancer survivors, there is a projected shortage in the workforce of oncology specialists to care for these women. The American Society of Clinical Oncology recommends that breast cancer follow-up care can be provided by an oncologist or primary care provider, as long as the primary care provider has spoken to the oncologist about appropriate follow-up care. Several studies have shown that primary care providers and oncologists have comparable outcomes for follow-up care of women with early-stage breast cancer. The National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) are considered the gold standard for breast cancer treatment and follow-up. These guidelines are clear and straightforward. Using knowledge of the NCCN Guidelines, primary care providers can fill the gap for follow-up care of women with early-stage breast cancer.

  3. Assessment of the Ability of the Health Care Provider to Detect Manifestations Indicative of TBI Management of care for TBI Through the Utilization of High Fidelity Simulation (United States)


    Ability of the medical health care provider to detect manifestations indicative of TBI and management of care for TBI through the utilization of High ...utilizing high fidelity simulation to identify the efficacy of the medics ability to assess and manage manifestations of TBI  Development of Evaluation...AWARD NUMBER: W81XWH-11-1-0837 TITLE: Assessment of the Ability of the medical health care provider to detect manifestations indicative of TBI and

  4. Intercultural communication between patients and health care providers: an exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety. (United States)

    Ulrey, K L; Amason, P


    Cultural diversity is becoming increasingly more important in the workplace. This is particularly true in health care organizations facing demographic shifts in the patients served and their families. This study serves to aid the development of intercultural communication training programs for health care providers by examining how cultural sensitivity and effective intercultural communication, besides helping patients, personally benefit health care providers by reducing their stress. Effective intercultural communication and cultural sensitivity were found to be related. Health care providers' levels of intercultural anxiety also were found to correlate with effective intercultural communication.

  5. Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers. (United States)

    Sinha, Anju; Chandhiok, Nomita; Sahay, Seema; Deb, Sibnath; Bharat, Shalini; Gupta, Abhilasha; Bhatt, Sripad; Kanthe, Vidisha; Kumar, Bijesh; Joglekar, Neelam; Paranjape, Ramesh; Mehendale, Sanjay


    A compelling case for promoting male circumcision (MC) as an intervention for reducing the risk of heterosexually acquired HIV infection was made by dissemination of the results of three studies in Africa. The WHO/UNAIDS recommendation for MC for countries like India, where the epidemic in concentrated in high-risk groups, advocates MC for specific population groups such as men at higher risk for HIV acquisition. A multicentre qualitative study was conducted in four geographically distinct districts (Belgaum, Kolkata, Meerut and Mumbai) in India during June 2009 to June 2011. Two categories of health care providers: Registered Healthcare Providers (RHCPs) and traditional circumcisers were interviewed by trained research staff who had received master's level education using interview guides with probes and open-ended questions. Respondents were selected using purposive sampling. A comparative analysis of the perspectives of the RHCP vs. traditional circumcisers is presented. Representatives of both categories of providers expressed the need for Indian data on MC. Providers feared that promoting circumcision might jeopardize/undermine the progress already made in the field of condom promotion. Reservation was expressed regarding its adoption by Hindus. Behavioural disinhibition was perceived as an important limitation. A contrast in the practice of circumcision was apparent between the traditional and the trained providers. MC should be mentioned as a part of comprehensive HIV prevention services in India that includes HIV counselling and testing, condom distribution and diagnosis and treatment of sexually transmitted infections. It should become an issue of informed personal choice rather than ethnic identity.

  6. Exploring Patient, Caregiver, and Healthcare Provider Perceptions of Caring for Patients With Heart Failure: What Are the Implications? (United States)

    Kennedy, Betty M.; Jaligam, Vijayendra; Conish, Beverly K.; Johnson, William D.; Melancon, Brian; Katzmarzyk, Peter T.


    Background: Heart failure (HF) is an incurable and frequently progressive disease. Symptoms of HF may impair the ability of patients to perform daily living activities. As HF progresses, patients typically increase their reliance on caregivers. The purpose of this study was to determine what roles patients and caregivers perceive and desire for themselves in managing HF and to compare and contrast these roles with those perceived by healthcare providers. Methods: A purposive sample (60 patients, 22 caregivers, and 11 healthcare providers) was enrolled in the study. Patients and caregivers individually participated in semistructured interviews, and healthcare providers participated in 1 of 2 focus groups. Results: Four key themes evolved from interviews with patients and caregivers—education on disease specifics, guidance to enhance quality of life, learning to cope with HF, and future outlook and care decisions—that may guide the development of caregiver interventions in HF. Healthcare providers in both structured focus groups regardless of rank order selected knowledge is powerful, adherence to treatment plan, and compliance with medication as the top 3 issues likely to have the greatest impact, and they identified education on the disease (knowledge is powerful) as the easiest strategy to implement for patients and caregivers in the management of HF. Conclusion: Interventions among caregivers of patients with HF are needed and should focus on education in family structures, family functioning, and skills training in family assessment and engagement. PMID:28331455

  7. Attitudes of Saudi Nursing Students on AIDS and Predictors of Willingness to Provide Care for Patients in Central Saudi Arabia

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    Mostafa A. Abolfotouh


    Full Text Available This study aimed to assess acquired immune deficiency syndrome (AIDS-related knowledge, attitudes, and risk perception among Saudi nursing students, and to identify predictors of their willingness to provide care for patients with AIDS. A cross-sectional study of 260 baccalaureate nursing students at King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, was done using a previously validated instrument. Students’ knowledge percentage mean score (PMS on AIDS was 72.93 ± 10.67 reflecting an average level of knowledge. There were many misconceptions about how AIDS is transmitted, for example, use of same toilets and bathrooms and washing clothes together (24.9%, swimming (53.7%, and coughing and sneezing (49.6%. Nursing students reported an overall negative attitude toward AIDS, with a PMS of 43.48 ± 9.21. The majority of students agreed that AIDS patients should be isolated from other patients (83%, and should not share the room with other noninfected patients (81.8%, and some reported that people living with AIDS deserve what has happened to them (24.7%. After controlling for confounders, students’ poor knowledge and negative attitude were associated only with having never been given nursing education as their primary university education “Stream 2 students” (p = .012 and p = .01, respectively. These findings have implications for development of teaching strategies and curricular approaches for nursing to address this health care issue.

  8. Learning and knowledge-integration strategies of nurses and client care workers serving homeless persons. (United States)

    Guirguis-Younger, Manal; McNeil, Ryan; Runnels, Vivien


    Health-care workers serving homeless persons often face difficulties in addressing the needs of this population due to the complexity of the health challenges and gaps in clinical knowledge. How can health-care workers enhance their ability to care for this population? The authors explore the learning and knowledge-integration strategies of nurses and client care workers employed by organizations targeting homeless persons in a Canadian city. Semi-structured qualitative interviews were conducted with 8 health-care workers.The data were examined using narrative analysis and constant comparative analysis. Three strategies were identified: integrating past experiences into clinical practice, interacting with clients to identify care needs and boundaries, and engaging in interprofessional knowledge exchange. A better understanding of these strategies may help nursing programs and health-services organizations to equip health-care workers with the skills they need to serve homeless persons.

  9. Feedback providing improvement strategies and reflection on feedback use: Effects on students' writing motivation, process, and performance

    NARCIS (Netherlands)

    H. Duijnhouwer; F.J. Prins; K.M. Stokking


    This study investigated the effects of feedback providing improvement strategies and a reflection assignment on students’ writing motivation, process, and performance. Students in the experimental feedback condition (n = 41) received feedback including improvement strategies, whereas students in the

  10. Provider-initiated HIV testing in rural Haiti: low rate of missed opportunities for diagnosis of HIV in a primary care clinic

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    Freedberg Kenneth A


    Full Text Available Abstract As HIV treatment is scaled-up in resource-poor settings, the timely identification of persons with HIV infection remains an important challenge. Most people with HIV are unaware of their status, and those who are often present late in the course of their illness. Free-standing voluntary counseling and testing sites often have poor uptake of testing. We aimed to evaluate a 'provider-initiated' HIV testing strategy in a primary care clinic in rural resource-poor Haiti by reviewing the number of visits made to clinic before an HIV test was performed in those who were ultimately found to have HIV infection. In collaboration with the Haitian Ministry of Health, a non-governmental organization (Partners In Health scaled up HIV care in central Haiti by reinforcing primary care clinics, instituting provider-initiated HIV testing and by providing HIV treatment in the context of primary medical care, free of charge to patients. Among a cohort of people with HIV infection, we assessed retrospectively for delays in or 'missed opportunities' for diagnosis of HIV by the providers in one clinic. Of the first 117 patients diagnosed with HIV in one clinic, 100 (85% were diagnosed at the first medical encounter. Median delay in diagnosis for the remaining 17 was only 62 days (IQR 19 – 122; range 1 – 272. There was no statistical difference in CD4 cell count between those with and without a delay. 3787 HIV tests were performed in the period reviewed. Provider-initiated testing was associated with high volume uptake of HIV testing and minimal delay between first medical encounter and diagnosis of HIV infection. In scale up of HIV care, provider-initiated HIV testing at primary care clinics can be a successful strategy to identify patients with HIV infection.

  11. Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

    Directory of Open Access Journals (Sweden)

    Macaulay Ann C


    Full Text Available Abstract Background Aboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies. Methods In Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated. Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities. Results the key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs. Conclusions Addressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services

  12. Research Needs Assessment in the Health Insurance Organization: Level of Health Care Provider

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    Mohammadkarim Bahadori


    Full Text Available Objective: Setting research priorities in the research management cycle is a key. It is important to set the research priorities to make optimal use of scarce resources. The aim of this research was to determine the research needs of Health Insurance Organization based on its health care centers research needs.Methods: This is a qualitative, descriptive and cross-sectional study that was conducted in 2011. A purposeful sample of 60 participants from 14 hospitals, seven dispensaries, five dental clinics, two rehabilitation centers, four radiology centers, six medical diagnostic laboratories, 12 pharmacies, and 20 medical offices that were contracted with the Health Insurance Organization in Iran was interviewed. The framework analysis method (a qualitative research method was used for analysis of interviews. Atlas-Ti software was used to analyze quantitative data, respectively. The topics were prioritized using the Analytical Hierarchy Process (AHP method through Expert Choice software.Results: Based on the problems extracted in our qualitative study, 12 research topics were proposed by the experts. Among these “Design of standard treatment protocols,” “Designing model of ranking the health care centers under contract,” and “Pathology of payment system” took the priority ranks of 1 to 3, earning the scores of 0.44, 0.42, and 0.37, respectively.Conclusion: Considering limited resources and unlimited needs and to prevent research resource wasting, conducting research related to health care providers in the Health Insurance Organization can help it achieve its goals.

  13. Radiation event medical management (REMM): website guidance for health care providers. (United States)

    Bader, Judith L; Nemhauser, Jeffrey; Chang, Florence; Mashayekhi, Bijan; Sczcur, Marti; Knebel, Ann; Hrdina, Chad; Coleman, Norman


    Planning for and exercising the medical response to potential chemical, biological, radiological, nuclear, and explosive (CBRNE) terrorist events are new responsibilities for most health care providers. Among potential CBRNE events, radiological and/or nuclear (rad/nuc) events are thought to have received the least attention from health care providers and planners. To assist clinicians, the U.S. Department of Health and Human Services (HHS) has created a new, innovative tool kit, the Radiation Event Medical Management (REMM) web portal ( Goals of REMM include providing (1) algorithm-style, evidence-based, guidance about clinical diagnosis and treatment during mass casualty rad/nuc events; (2) just-in-time, peer-reviewed, usable information supported by sufficient background material and context to make complex diagnosis and management issues understandable to those without formal radiation medicine expertise; (3) a zip-file of complete web portal files downloadable in advance so the site would be available offline without an Internet connection; (4) a concise collection of the printable, key documents that can be taken into the field during an event; (5) a framework for medical teams and individuals to initiate rad/nuc planning and training; and (6) an extensive bibliography of key, peer-reviewed, and official guidance documents relevant to rad/nuc responses. Since its launch, REMM has been well received by individual responders and teams across the country and internationally. It has been accessed extensively, particularly during training exercises. Regular content updates and addition of new features are ongoing. The article reviews the development of REMM and some of its key content areas, features, and plans for future development.

  14. An overview of patients' preference for, and satisfaction with, care provided by general practitioners and nurse practitioners.

    NARCIS (Netherlands)

    Laurant, M.G.H.; Hermens, R.P.M.G.; Braspenning, J.C.C.; Akkermans, R.P.; Sibbald, B.; Grol, R.P.T.M.


    AIM AND OBJECTIVES: To assess patients' views on the care provided by nurse practitioners compared with that provided by general practitioners and to determine factors influencing these views. BACKGROUND: Many countries have sought to shift aspects of primary care provision from doctors to nurses. I

  15. An Integrated Curriculum of Nursing, Nutrition, Exercise, and Drugs for Health Care Providers of the Elderly (Project NNED). (United States)

    Summit-Portage Area Health Education Network, Akron, OH.

    This document is intended to give health care providers interdisciplinary information concerning drugs, nutrition, and exercise to help them enhance health maintenance of the elderly. Prepared as part of Project NNED, (Nursing, Nutrition, Exercise, and Drugs), an integrated curriculum for health care providers of the elderly, the document includes…

  16. Communication between Asian American Adolescents and Health Care Providers about Sexual Activity, Sexually Transmitted Infections, and Pregnancy Prevention (United States)

    Zhao, Jessie; Lau, May; Vermette, David; Liang, David; Flores, Glenn


    Asian American adolescents have been reported to have the lowest amount of communication with health care providers regarding sexual health topics (sexual activity, contraception, sexually transmitted infections, and pregnancy prevention). This study identified Asian American adolescents' attitudes/beliefs regarding how health care providers can…

  17. Eliminating health disparities through culturally and linguistically centered integrated health care: consensus statements, recommendations, and key strategies from the field. (United States)

    Sanchez, Katherine; Chapa, Teresa; Ybarra, Rick; Martinez, Octavio N


    This report is the outcome of an expert consensus meeting sponsored by the United States Deparment of Health and Human Services Office of Minority Health, which was convened to formulate consensus statements, provide recommendations and identify key strategies from practice for implementing integrated health and behavioral health care intended to improve health status for underserved populations.

  18. Ventilation strategies in burn intensive care: A retrospective observational study

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    Stefano Palazzo


    Full Text Available Consensus regarding optimal burns intensive care (BICU patient management is lacking. This study aimed to assess whether ventilation strategies, cardiovascular support and sedation in BICU patients have changed over time, and whether this affects outcome. A retrospective observational study comparing two 12-patient BICU cohorts (2005/06 and 2010/11 was undertaken. Demographic and admission characteristics, ventilation parameters, sedation, fluid resuscitation, cardiovascular support and outcome (length of stay, mortality data were collected from patient notes. Data was analysed using T-tests, Fisher's exact and Mann-Whitney U tests. In our study cohort groups were equivalent in demographic and admission parameters. There were equal ventilator-free days in the two cohorts 10 ± 12.7 vs. 13.3 ± 12.2 ventilator free days; P = 0.447. The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort (568 ventilator days/1000 patient BICU days vs. 206 ventilator days/1000 patient BICU days; P = 0.001. The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous (17.8% vs. 26%; P = 0.001 and volume-controlled modes (34.4% vs. 40.8%; P = 0.001. Patients in 2010/11 cohort were more heavily sedated (P = 0.001 with more long-acting sedative drug use (P = 0.001 than the 2005/06 cohort, fluid administration was equivalent. Patient outcome did not vary. Inhalational injury patients were ventilated in volume-controlled (44.5% vs. 28.1%; P = 0.001 and pressure-controlled modes (18.2% vs. 9.5%; P = 0.001 more frequently than those without. Outcome did not vary. This study showed there has been shift away from mechanical ventilation, with increased use of tracheostomy/tracheal tube airway spontaneous ventilation. Inhalation injury patients require more ventilatory support though patient outcomes do not differ. Prospective trials are required to establish which strategies confer benefit.

  19. Primary Care Providers' Knowledge and Practices of Diabetes Management During Ramadan. (United States)

    Ali, Mujtaba; Adams, Alexandra; Hossain, Md Anwar; Sutin, David; Han, Benjamin Hyun


    There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan.

  20. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

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    Savanheimo Nora


    Full Text Available Abstract Background Dental general anaesthesia (DGA is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients’ overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care. Methods The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age ( Results The DGA patients (n=349 were aged 2.3 to 67.2 years. Immigrants predominated in the youngest age group (p Conclusions Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA.

  1. Professional quality of life of Japanese nurses/midwives providing abortion/childbirth care. (United States)

    Mizuno, Maki; Kinefuchi, Emiko; Kimura, Rumiko; Tsuda, Akiko


    This study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives. Between October 2011 and January 2012, questionnaires that included questions concerning eight stress factors, the Professional Quality of Life Scale, and the Japanese version of the Frankfurt Emotional Work Scale, were answered by 255 nurses and midwives working in abortion and childbirth services. Professional Quality of Life scores (compassion fatigue, compassion satisfaction, burnout) were significantly associated with stress factors and emotion work. Multiple regression analysis revealed that of all the evaluated variables, the Japanese version of the Frankfurt Emotional Work Scale score for negative emotions display was the most significant positive predictor of compassion fatigue and burnout. The stress factors "thinking that the aborted fetus deserved to live" and "difficulty in controlling emotions during abortion care" were associated with compassion fatigue. These findings indicate that providing abortion services is a highly distressing experience for nurses and midwives.

  2. A terrorist bomb blast, a real challenge for any tertiary care health provider. (United States)

    Singh, Shiv Kumar; Kumar, Amit; Katyal, Surabhi


    Multiple casualties and the complex set of injuries in survivors of a terrorist bomb blast poses a real challenge to health care providers. We are presenting three such cases, first case suffered a fracture of both bone lower limb bilaterally along with head injury (foreign bodies were impacted in the scalp and brain parenchyma). Following primary resuscitation, patient shifted to operation theatre after a quick computerized tomography scan and external fixator applied in general anesthesia using the rapid sequence induction. No active neurosurgical intervention was done. As this patient had acute post-traumatic stress response, he was subjected to low pressure hyperbaric oxygen therapy (pressure of 1.5 ATA for 60 min a day for 10 days) and group counseling. He had good recovery except one lost a limb because of extensive neurovascular damage due to blast. Second case had much more extensive damage involving multiple organ systems. He had blast lung, big cerebrovascular hemorrhage along with gut perforation. Despite best possible surgical and intensive care interventions, patent developed multiple organ failure and unfortunately we lost our patient. Third case was of a right sided globe rupture resulted from blast induced flying foreign bodies. After primary survey and initial resuscitation evisceration done for the damaged eye and patient later on discharged with necessary instruction (including warning signs) for follow-up.

  3. Effectiveness of Counseling Provided by Primary Care Doctors and Nurses in Increasing Glaucoma Screening Rates

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    Witold Rezner


    Full Text Available Introduction. An effective screening that can prevent glaucoma-related blindness largely depends on successful recruitment. This study was to assess the effectiveness of one-on-one counseling carried out by primary care doctors and nurses to increase glaucoma screening rates. Material and Methods. The study, carried out in an urban primary care center, involved 308 persons aged 35–87 years who were assigned to a doctor’s, nurse’s, or control group (N=109, 110, and 89, resp.. Interventions by doctors and nurses included a brief one-on-one counseling session, while only a screening history was taken from controls. The number of people in each group with a positive screening status was assessed by telephone interview three months after the visit. Results. The percentage of persons in the nurse’s counseling group who claimed being subjected to screening was more than four times higher than in the control group (20.9% versus 4.5%, P=0.002. The doctor’s interventions resulted in almost a tripled screening rate as compared to the control group (12.8% versus 4.5%, P=0.052. There was no significant difference between screening rates in doctor’s and nurse’s groups (P= 0.212. Conclusions. In the studied population, counseling provided by nurses proved to be an efficacious method to encourage patients to undergo glaucoma screening.

  4. Parents’ satisfaction with pediatric dental care provided by dental college, Riyadh (United States)

    AlMutairi, Manal A.


    Aims and Objectives: To evaluate the level of parents’ satisfaction with pediatric dental care provided by dental students at the College of Dentistry and explore the factors associated with various parents’ demographics. Materials and Methods: A cross-sectional study was conducted among parents (n = 150) whose children received dental care in dental colleges in King Saud University (KSU) in Riyadh. The parents were asked to fill a self-administered dental satisfaction questionnaire between Februry and April 2016. Data were recorded and analyses using the Statistical Package for the Social Sciences Version 20 (SPSS Inc., Chicago, IL, USA). Results: Results indicated that only 10.7% of the parents strongly agreed that before being seen they had to wait for a long time in the waiting area, and 36% strongly agreed that one of the causes for which they went to the KSU dental college is that there were inadequate pedodontics in their region. More than half of parents (60%) strongly agreed that the KSU dental clinic is up to date and very modern. Conclusions: The results indicate that the pediatric department has been successful in achieving parents’ satisfaction with dental students, their treatment, as well as operational aspects related to access. There was a strong degree of satisfaction from parents regarding the KSU dental college being modern and up to date. PMID:28032046

  5. Sun-care product advertising in parenting magazines: what information does it provide about sun protection? (United States)

    Kang, Hannah; Walsh-Childers, Kim


    This study analyzed the content of sun-care product advertisements in five major U.S. parenting magazines with high circulation: Family Circle, Parents, Family Fun, Parenting (Early Years), and Parenting (School Years). The study examined what information sun-care product advertisements tell parents about skin cancer prevention and about sunscreen use for themselves or for their children based on the Health Belief Model concepts of perceived benefits and perceived barriers. Results showed that the most commonly mentioned benefit of the product was that it blocks ultraviolet A (UVA) and ultraviolet B (UVB) rays. One-third of the ads promoted the product's effectiveness in overcoming four of the barriers that prevent people from using sunscreens: eye irritation, skin irritation, an unpleasant smell, and the need to reapply sunscreen too often or after physical activity. However, only a few of the ads provided information about the consequences of unprotected sun exposure or mentioned methods of sun protection or skin cancer prevention other than sunscreen use. We discuss the implications of these messages for parents' ability to understand correctly how to protect their children from damaging sun exposure.

  6. A terrorist bomb blast, a real challenge for any tertiary care health provider (United States)

    Singh, Shiv Kumar; Kumar, Amit; Katyal, Surabhi


    Multiple casualties and the complex set of injuries in survivors of a terrorist bomb blast poses a real challenge to health care providers. We are presenting three such cases, first case suffered a fracture of both bone lower limb bilaterally along with head injury (foreign bodies were impacted in the scalp and brain parenchyma). Following primary resuscitation, patient shifted to operation theatre after a quick computerized tomography scan and external fixator applied in general anesthesia using the rapid sequence induction. No active neurosurgical intervention was done. As this patient had acute post-traumatic stress response, he was subjected to low pressure hyperbaric oxygen therapy (pressure of 1.5 ATA for 60 min a day for 10 days) and group counseling. He had good recovery except one lost a limb because of extensive neurovascular damage due to blast. Second case had much more extensive damage involving multiple organ systems. He had blast lung, big cerebrovascular hemorrhage along with gut perforation. Despite best possible surgical and intensive care interventions, patent developed multiple organ failure and unfortunately we lost our patient. Third case was of a right sided globe rupture resulted from blast induced flying foreign bodies. After primary survey and initial resuscitation evisceration done for the damaged eye and patient later on discharged with necessary instruction (including warning signs) for follow-up. PMID:25886231

  7. Changing organisations: a study of the context and processes of mergers of health care providers in England. (United States)

    Fulop, Naomi; Protopsaltis, Gerasimos; King, Annette; Allen, Pauline; Hutchings, Andrew; Normand, Charles


    This paper presents findings from a study of the context and processes of provider mergers in the NHS in England. Mergers are an example of organisational restructuring, a key lever for change in the UK health care sector and elsewhere, although it is only one strategy for organisational change. The framework for the study is key themes from the organisational change literature: the complexity of the effects of change; the importance of context; and the role of organisational culture. The drivers for health care mergers and the evidence for these are analysed. Using documentary analysis and in-depth qualitative interviews with internal and external stakeholders, the first part of the paper reports on stated and unstated drivers in nine mergers. This provides the context for four in-depth case studies of the process of merger in the second and third years post-merger. Our study shows that the contexts of mergers, including drivers of change, are important. Merger is a process without clear boundaries, and this study shows problems persisting into the third year post-merger. Loss of management control and focus led to delays in service developments. Difficulties in the merger process included perceived differences in organisational culture and perceptions of 'takeover' which limited sharing of 'good practice' across newly merged organisations. Merger policy was based on simplistic assumptions about processes of organisational change that do not take into account the dynamic relationship between the organisation and its context and between the organisation and individuals within it. Understanding the process of merger better should lead to a more cautious approach to the likely gains, provide understanding of the problems that are likely in the period of change, and anticipate and avoid harmful consequences.

  8. Marketing environment dynamics and implications for pricing strategies: the case of home health care. (United States)

    Ponsford, B J; Barlow, D


    This research reviews the factors affecting the pricing or rate schedules of home health care agencies. A large number of factors affect costs and thus rate structures. The major factors include reimbursement structures with accompanying discount structures, administrative burdens, and risks. Channel issues include bargaining power, competition, and size. Staffing issues affect pricing and product through the provider level, productivity, and quality outcomes. Physician and patient issues include quality concerns and choices. These factors are discussed in light of overall marketing strategy and the interaction of pricing with other marketing controllables such as product, place/distribution, and promotion. Economic and accounting principles are also reviewed with consideration to understanding direct and indirect costs in order to enable negotiators to effectively price health care services.

  9. [Nursing fundamentals: critical incidents related to care provided in supervised training]. (United States)

    Valsecchi, Elizabeth Amâncio de Souza da Silva; Nogueira, Maria Suely


    The course of Nursing fundamentals introduces the students to supervised training and can result in anxiety and tension. Therefore, the purpose of this study was to identify positive/negative aspects related to the care provided during the supervised training, based on the critical incidents technique. The subjects were students of the 2 degrees, 3 degrees and 4 degrees years of the Nursing Undergraduate Program offered by the State University of Maringá-PR. Authors identified 95 reports: 48(50.5%) positive and 47(49.5) negative. The positive aspects were related to the faculty's presence mediating the teaching-learning process; and the negative ones were related to the professionals insensibility regarding pain and death.

  10. Male songbirds provide indirect parental care by guarding females during incubation (United States)

    Fedy, B.C.; Martin, T.E.


    Across many taxa, guarding of fertile mates is a widespread tactic that enhances paternity assurance. However, guarding of mates can also occur during the nonfertile period, and the fitness benefits of this behavior are unclear. Male songbirds, for example, sometimes guard nonfertile females during foraging recesses from incubation. We hypothesized that guarding postreproductive mates may have important, but unrecognized, benefits by enhancing female foraging efficiency, thereby increasing time spent incubating eggs. We tested the hypothesis in 2 songbird species by examining female behavior during natural and experimentally induced absences of males. Male absence caused increased vigilance in foraging females that decreased their efficiency and resulted in less time spent incubating eggs. Male guarding of nonfertile females can thus provide a previously unrecognized form of indirect parental care.

  11. Kinds of well-being: A conceptual framework that provides direction for caring

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    Kathleen T. Galvin


    Full Text Available This article offers a conceptual framework by which different kinds and levels of well-being can be named, and as such, provides a foundation for a resource-oriented approach in situations of illness and vulnerability (rather than a deficit-oriented approach. Building on a previous paper that articulated the philosophical foundations of an existential theory of well-being (“Dwelling-mobility”, we show here how the theory can be further developed towards practice-relevant concerns. We introduce 18 kinds of well-being that are intertwined and inter-related, and consider how each emphasis can lead to the formulation of resources that have the potential to give rise to well-being as a felt experience. By focusing on a much wider range of well-being possibilities, practitioners may find new directions for care that are not just literal but also at an existential level.

  12. The impact of organisational culture on the delivery of person-centred care in services providing respite care and short breaks for people with dementia. (United States)

    Kirkley, Catherine; Bamford, Claire; Poole, Marie; Arksey, Hilary; Hughes, Julian; Bond, John


    Ensuring the development and delivery of person-centred care in services providing respite care and short breaks for people with dementia and their carers has a number of challenges for health and social service providers. This article explores the role of organisational culture in barriers and facilitators to person-centred dementia care. As part of a mixed-methods study of respite care and short breaks for people with dementia and their carers, 49 telephone semi-structured interviews, two focus groups (N= 16) and five face-to-face in-depth interviews involving front-line staff and operational and strategic managers were completed in 2006-2007. Qualitative thematic analysis of transcripts identified five themes on aspects of organisational culture that are perceived to influence person-centred care: understandings of person-centred care, attitudes to service development, service priorities, valuing staff and solution-focused approaches. Views of person-centred care expressed by participants, although generally positive, highlight a range of understandings about person-centred care. Some organisations describe their service as being person-centred without the necessary cultural shift to make this a reality. Participants highlighted resource constraints and the knowledge, attitudes and personal qualities of staff as a barrier to implementing person-centred care. Leadership style, the way that managers' support and value staff and the management of risk were considered important influences. Person-centred dementia care is strongly advocated by professional opinion leaders and is prescribed in policy documents. This analysis suggests that person-centred dementia care is not strongly embedded in the organisational cultures of all local providers of respite-care and short-break services. Provider organisations should be encouraged further to develop a shared culture at all levels of the organisation to ensure person-centred dementia care.

  13. Endocrine check-up in adolescents and indications for referral: A guide for health care providers

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    Vincenzo De Sanctis


    Full Text Available The American Academy of Pediatrics recommends that young people between the ages of 11 and 21 years should be seen annually by their pediatricians, since annual checkups can be an important opportunity for health evaluation and anticipatory guidance. Parents of infants and young children are accustomed to regularly visiting a pediatrician for their child′s checkups. Unfortunately, when children reach the teen years, these annual checkups may decrease in frequency. In routine check-ups and medical office visits, particular attention should be paid to the possibility of a developmental or endocrine disorder. Early diagnosis and treatment may prevent medical complications in adulthood and foster age-appropriate development. Our purpose is to acquaint readers with the concept, based on current scientific understanding, that some endocrine disorders may be associated with a wide range of deleterious health consequences including an increased risk of hypertension and hyperlipidemia, increased risk of coronary artery disease, type 2 diabetes, significant anxiety and lack of self-esteem. Understanding the milestones and developmental stages of adolescence is essential for pediatricians and all other health providers who care for adolescents. Treating adolescents involves knowledge of a variety of medical, social and legal information; in addition, close working relationships must be established within the adolescent′s network to create an effective care system. In summary, we underline the importance of a periodic endocrine checkup in adolescents in order to identify endocrine problems early and develop an approach to treatment for those patients who need help during this time. Indications for endocrine referral for professional and other healthcare providers are also included. These lists are clearly not intended to be comprehensive, but will hopefully serve as a guide for specific clinical circumstances.

  14. Health facility environment as humanization strategy care in the pediatric unit: systematic review

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    Juliane Portella Ribeiro


    Full Text Available Objective: To identify and analyze the production of knowledge about the strategies that health care institutions have implemented to humanize care of hospitalized children. Method: This is a systematic review conducted in the Virtual Health Library - Nursing and SciELO, using the seven steps proposed by the Cochrane Handbook. Results: 15 studies were selected, and strategies that involved relationship exchanges were used between the health professional, the hospitalized child and their families, which may be mediated by leisure activities, music and by reading fairy tales. We also include the use of the architecture itself as a way of providing welfare to the child and his/her family, as well as facilitating the development of the work process of health professionals. Conclusion: Investments in research and publications about the topic are necessary, so that, the National Humanization Policy does not disappear and that the identified strategies in this study do not configure as isolated and disjointed actions of health policy.

  15. Emergency Preparedness and Professional Competency Among Health Care Providers During Hurricanes Katrina and Rita (United States)


    Hematology Hospice Internal Medicine Informatics Medical Genetics Long-Term Care Neonatology Medical/ Surgical Nephrology Neonatal...Internal Medicine Informatics Medical Genetics Long-Term Care Neonatology Medical/ Surgical Nephrology Neonatal Neurology Neurology...Hematology Hospice Internal Medicine Informatics Medical Genetics Long-Term Care Neonatology Medical/ Surgical Nephrology Neonatal

  16. 75 FR 2562 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the... (United States)


    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care Continuation... document announces the availability of the model health care continuation coverage notices required by...

  17. 75 FR 26276 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the... (United States)


    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care Continuation... announces the availability of the model health care continuation coverage notices required by ARRA,...

  18. 75 FR 13595 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the... (United States)


    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the availability of the Model Health Care Continuation... document announces the availability of the model health care continuation coverage notices required by...

  19. Primary Care Provider Perceptions of Colorectal Cancer Screening Barriers: Implications for Designing Quality Improvement Interventions (United States)

    Pickhardt, Perry J.; Schumacher, Jessica R.; Potvien, Aaron; Kim, David H.; Pfau, Patrick R.; Jacobs, Elizabeth A.; Smith, Maureen A.


    Aims. Colorectal cancer (CRC) screening is underutilized. Increasing CRC screening rates requires interventions targeting multiple barriers at each level of the healthcare organization (patient, provider, and system). We examined groups of primary care providers (PCPs) based on perceptions of screening barriers and the relationship to CRC screening rates to inform approaches for conducting barrier assessments prior to designing and implementing quality improvement interventions. Methods. We conducted a retrospective cohort study linking EHR and survey data. PCPs with complete survey responses for questions addressing CRC screening barriers were included (N = 166 PCPs; 39,430 patients eligible for CRC screening). Cluster analysis identified groups of PCPs. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for predictors of membership in one of the PCP groups. Results. We found two distinct groups: (1) PCPs identifying multiple barriers to CRC screening at patient, provider, and system levels (N = 75) and (2) PCPs identifying no major barriers to screening (N = 91). PCPs in the top half of CRC screening performance were more likely to identify multiple barriers than the bottom performers (OR, 4.14; 95% CI, 2.43–7.08). Conclusions. High-performing PCPs can more effectively identify CRC screening barriers. Targeting high-performers when conducting a barrier assessment is a novel approach to assist in designing quality improvement interventions for CRC screening.

  20. Private ownership of primary care providers associated with patient perceived quality of care: A comparative cross-sectional survey in three big Chinese cities. (United States)

    Wei, Xiaolin; Yin, Jia; Wong, Samuel Y S; Griffiths, Sian M; Zou, Guanyang; Shi, Leiyu


    Ownership of primary care providers varies in different cities in China. Shanghai represented the full public ownership model of primary providers; Shenzhen had public-owned but private-operated providers; and Hong Kong represented the full private ownership. The study aims to assess the association of primary care ownership and patient perceived quality of care in 3 Chinese megacities.We conducted multistage stratified random surveys in 2013 in the 3 cities. Quality scores of primary care were measured using the validated primary care assessment tools. Multivariate linear regression models were used to compare quality scores after controlling potential confounders of patient demographic, socioeconomic, and healthcare utilization factors.Overall, 797 primary care users in Shanghai, 802 in Shenzhen, and 1325 in Hong Kong participated in the study. The mean total quality scores were reported the highest in Shanghai (28.39), followed by Shenzhen (25.82) and then Hong Kong (25.21) (P quality and less equitable care distribution. In China, it suggests that it may be beneficial to promote public-owned and nonprofit providers. Promoting privatization in primary care may be at the cost of quality and equity of primary care.

  1. Knowledge of and attitudes toward mental illness among primary care providers in Saint Vincent and the Grenadines. (United States)

    Winer, Rachel A; Morris-Patterson, Amrie; Smart, Ynolde; Bijan, Inci; Katz, Craig L


    Saint Vincent and the Grenadines (SVG) is an Eastern Caribbean country with limited inpatient and outpatient resources to meet the country's mental health needs. In preparation for integrating mental health care into the primary care setting, we assessed knowledge of and attitudes toward mental illness among primary care providers in SVG. From October 24-November 11, 2011, we visited a convenience sample of District Health Centers in SVG. We gave a multiple-choice-answer, self-administered questionnaire to primary care providers and then administered a structured interview. Survey responses were analyzed for frequencies and interview transcripts qualitatively analyzed for major themes. We completed 53 surveys and interviews representing all nine SVG Health Districts. Results demonstrated a provider population with basic, but inadequate, knowledge of mental illness diagnosis and treatment. Results also revealed a curious and interested group of providers who felt mental illness should be a health priority and were willing and eager to receive further mental health training. Providers suggested strengthening resources in existing district clinics, providing additional staff training sessions, establishing positions with a dual health and mental health role, instituting annual mental health screening examinations, and creating weekly mental health clinics. Integrating mental health care into primary care necessitates involvement of primary care staff during the planning stages, and this study initiates an intensive effort to do so in SVG. Results have led to the development of a "mental health check-up" tool, which we hope will improve access to mental health care in this community.

  2. Migrant beer promoters' experiences accessing reproductive health care in Cambodia, Laos, Thailand, and Vietnam: lessons for planners and providers. (United States)

    Webber, Gail C; Spitzer, Denise L; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone


    Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services.

  3. Migrant Beer Promoters’ Experiences Accessing Reproductive Health Care in Cambodia, Laos, Thailand, and Vietnam: Lessons for Planners and Providers (United States)

    Webber, Gail C.; Spitzer, Denise L.; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone


    Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services. PMID:22743859

  4. Neither rain nor hail nor sleet nor snow: provider perspectives on the challenges of weather for home and community care. (United States)

    Skinner, Mark W; Yantzi, Nicole M; Rosenberg, Mark W


    This paper contributes to the literature on the geographies of care and caregiving by examining the implications of weather for providing home and community care for children and older adults. Integrating research from two previous qualitative studies of formal and informal care provisioning in Ontario, Canada, the authors re-analyzed semi-structured interviews with 83 directors, managers, paid staff, volunteers and family members to examine the challenges they faced when providing care during the winter season. Similar to other settings where winter conditions like snow, ice and cold temperatures are commonplace, the studies were set within a health policy context in which there is not enough recognition of the difficulties of weather for coordinating, managing and providing care to disabled, injured, chronically ill and frail individuals. The re-analysis focused on how winter conditions translate into geographical, administrative, economic, operational, physical, social and psychological barriers within and across different 'scales of care'. The findings indicate that the problems posed by weather are crucial yet often underestimated aspects of home and community care provided by formal and informal caregivers. The analysis of weather-related challenges for care provisioning needs to be extended to other seasonal conditions (e.g., the challenges of delivering care in extreme heat), to the developing world and even to the burgeoning debates on the health implications of global environmental change.

  5. The role of documentation and inter-provider information exchange in care continuity for older hip fracture patients. (United States)

    McMurray, Josephine; Stolee, Paul; Hicks, Elisabeth; Elliott, Jacobi; Johnson, Helen; Byrne, Kerry


    Maintaining continuity of patient care can be difficult during transitions between care settings, when quality of care and patient safety are at risk. We sought to understand the role of inter-provider documentation and information exchange across successive care settings for complex, older patients. Data were gathered as part of a multi-site ethnographic study that followed 23 older post-surgical hip fracture patients across multiple care transitions. Documentation and information exchange help build a "picture" of complex patients, but care continuity is challenged by late, missing or unnecessary information, duplicated assessments and lack of interoperability of electronic systems. This study demonstrates the importance of appropriate documentation in the transition process, but points to the need for comprehensive system-level solutions which standardize information collection and sharing along the continuum of care.

  6. Incarcerated adolescents. The need for the development of professional ethical standards for institutional health care providers. (United States)

    Jameson, E J


    Large numbers of children are incarcerated in juvenile correctional facilities each year in the United States. These children suffer from a wide range of physical and psychiatric illnesses and are in critical need of professional health care services. This article summarizes the health care needs of these children and documents the ethical problems faced by health care professionals who work in juvenile institutions. The adequacy of current ethical standards as a source of guidance and support for institutional health care professionals is reviewed and a series of recommendations for the development of comprehensive health care standards is set forth.

  7. USGS Environmental health science strategy: providing environmental health science for a changing world: public review release (United States)

    Bright, Patricia R.; Buxton, Herbert T.; Balistrieri, Laurie S.; Barber, Larry B.; Chapelle, Francis H.; Cross, Paul C.; Krabbenhoft, David P.; Plumlee, Geoffrey S.; Sleeman, Jonathan M.; Tillitt, Donald E.; Toccalino, Patricia L.; Winton, James R.


    and providing it to environmental, natural resource, agricultural, and public-health managers. The USGS is a Federal science agency with a broad range of natural science expertise relevant to environmental health. USGS provides scientific information and tools as a scientific basis for management and policy decision making. USGS specializes in science at the environment-health interface, by characterizing the processes that affect the interaction among the physical environment, the living environment, and people, and the resulting factors that affect ecological and human exposure to disease agents. This report describes a 10-year strategy that encompasses the portfolio of USGS environmental health science. It summarizes national environmental health priorities that USGS is best suited to address, and will serve as a strategic framework for USGS environmental health science goals, actions, and outcomes for the next decade. Implementation of this strategy is intended to aid coordination of USGS environmental health activities and to provide a focal point for disseminating information to stakeholders. The "One Health" paradigm advocated by the World Health Organization (WHO, 2011), and the American Veterinary Medicine Association (AVMA, 2008), among others, is based on a general recognition that the health of humans, animals, and the environment are inextricably linked. Thus, successful efforts to protect that health will require increased interdisciplinary research and increased communication and collaboration among the broader scientific and health community. This strategy is built upon that paradigm. The vision, mission, and five cornerstone goals of the USGS Environmental Health Science Strategy were developed with significant input from a wide range of stakeholders. Vision - The USGS is a premier source of the environmental health science needed to safeguard the health of the environment, fish, wildlife, and people. Mission - The mission of USGS in environmental

  8. Community interventions providing care and support to orphans and vulnerable children: a review of evaluation evidence. (United States)

    Schenk, Katie D


    Children affected by HIV in their families and communities face multiple risks to their health, education and psychosocial wellbeing. Community interventions for children who have been orphaned or rendered vulnerable take many forms, including educational assistance, home-based care, legal protection and psychosocial support. Despite a recent influx of funding for programme implementation, there exists little evidence to inform policymakers about whether their investments are improving the lives of vulnerable children and meeting key benchmarks including the Millennium Development Goals. This paper reviews the current evidence base on evaluations of community interventions for orphans and vulnerable children (OVC) in high HIV-prevalence African settings, focusing on studies' methodologies. Sources reviewed include published research studies and evidence from the unpublished programmatic "grey literature" located through database and internet searches. A total of 21 studies, varying in scope and generalisability, were identified. Interventions reviewed address children's wellbeing through various strategies within their communities. Evaluation methodologies reflect quantitative and qualitative approaches, including surveys (with and without baseline or comparison data), costing studies, focus groups, interviews, case studies, and participatory review techniques. Varied study methodologies reflect diverse research questions, various intervention types, and the challenges associated with evaluating complex interventions; highlighting the need to broaden the research paradigm in order to build the evidence base by including quasi-experimental and process evaluation approaches, and seeking further insights through participatory qualitative methodologies and costing studies. Although findings overall indicate the value of community interventions in effecting measurable improvements in child and family wellbeing, the quality and rigour of evidence is varied. A strategic

  9. Developing Indicators of Service Quality Provided for Cardiovascular Patients Hospitalized in Cardiac Care Unit

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash


    Full Text Available Introduction: Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU in Iran. Methods: In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic review articles in premier bibliographic databases, interview, performing two rounds of Delphi technique, and holding experts panel by attendance of experts in different fields was adopted. Finally, after recognizing relevant indicators in resources, these indicators were finalized during various stages using ideas of 27 experts in different fields. Results: Among 2800 found articles in the text reviewing phase, 21 articles, which had completely mentioned relevant indicators, were studied and 48 related indicators were extracted. After two interviews with a cardiologist and an epidemiologist, 32 items of the indicators were omitted and replaced by 27 indicators coping with the conditions of Iranian hospitals. Finally, 43 indicators were added into the Delphi phase and after 2 rounds of Delphi with 18 specialists, 7 cases were excluded due to their low scores of applicability. In the experts’ panel stage, 6 items were also omitted and 10 new indicators were developed to replace them. Eventually, 40 indicators were finalized. Conclusion: In this study, some proper indicators for evaluating provided service quality for CCU admissions in Iran were determined. Considering the informative richness of these indicators, they can be used by managers, policy makers, health service providers, and also insurance agencies in order to improve the quality of services, decisions, and policies.

  10. Communicating about eating behaviors. A qualitative study of Chilean women and their health-care providers. (United States)

    Gálvez, Patricia; Valencia, Alejandra; Palomino, Ana M; Cataldo, Marjorie; Schwingel, Andiara


    Good communication between health care providers (HCPs) and patients is critical in achieving positive health outcomes. The purpose of this article was to compare the perceptions of Chilean woman and their HCPs with respect to determinants of eating behaviors. Semi-structured interviews were conducted with women (n=15) visiting a public health care center in Chile and with their HCPs (n=8) who were in charge of promoting healthy eating behaviors among women. Data from the interviews indicated similarities and inconsistencies in determinants of eating behaviors between the groups. Both mentioned many important factors that influence women's eating behaviors, including food preferences, dietary knowledge, self-control and self-efficacy, family, food cost, and food availability. HCPs appeared to be less aware of the role that personality traits and past experiences play as potential determinants which women mentioned. In contrast, women were less aware of the influence of anxiety and low self-esteem on eating choices, which HCPs noted as key factors. Although it was encouraging to see agreement between women and their HCPs in some areas, it is important to work on increasing understanding among the groups with respect to the important role psychological factors play in influencing eating behavior. We suggest that HCPs should focus on the importance of women's personality traits and past eating behaviors, as well as work on improving women's self-esteem and helping to decrease their anxiety levels. HCPs should be encouraged to develop good communication with each person in order to help them understand the roles that external and internal factors play in eating behaviors.

  11. Investment in Open Innovation Service Providers: NASA's Innovative Strategy for Solving Space Exploration Challenges (United States)

    Fogarty, Jennifer A.; Rando, Cynthia; Baumann, David; Richard, Elizabeth; Davis, Jeffrey


    In an effort to expand routes for open communication and create additional opportunities for public involvement with NASA, Open Innovation Service Provider (OISP) methodologies have been incorporated as a tool in NASA's problem solving strategy. NASA engaged the services of two OISP providers, InnoCentive and, to test this novel approach and its feasibility in solving NASA s space flight challenges. The OISPs were chosen based on multiple factors including: network size and knowledge area span, established process, methodology, experience base, and cost. InnoCentive and each met the desired criteria; however each company s approach to Open Innovation is distinctly different. InnoCentive focuses on posting individual challenges to an established web-based network of approximately 200,000 solvers; viable solutions are sought and granted a financial award if found. Based on a specific technological need, acts as a talent scout providing a broad external network of experts as potential collaborators to NASA. A relationship can be established with these contacts to develop technologies and/or maintained as an established network of future collaborators. The results from the first phase of the pilot study have shown great promise for long term efficacy of utilizing the OISP methodologies. Solution proposals have been received for the challenges posted on InnoCentive and are currently under review for final disposition. In addition, has identified new external partners for NASA and we are in the process of understanding and acting upon these new opportunities. Compared to NASA's traditional routes for external problem solving, the OISP methodologies offered NASA a substantial savings in terms of time and resources invested. In addition, these strategies will help NASA extend beyond its current borders to build an ever expanding network of experts and global solvers.

  12. New mothers' perceptions regarding maternity care services provided in a prefecture of Northern Greece

    Directory of Open Access Journals (Sweden)

    Maria Tsiligiri


    Full Text Available Background: The use of health care services during pregnancy assists in decreasing neonatal deaths and improves the quality of life of pregnant women and their newborn children.Aim: To investigate the perceptions of new mothers in a prefecture of Northern Greece regarding the maternity services provided during pregnancy and childbirth.Methodology: The sample consists of 133 mothers of newborn babies who were hospitalised, after in-hospital delivery, between April and June 2008 in a prefecture of Northern Greece. The instrument used for the data collection was the Kuopio Instrument for Mothers (KIM.Results: 97% of participants were married, 42.2% had higher education and 23.3% were full-time employees. 42.9% of the mothers were primiparous and 57.1% were multiparous. 56.8% had vaginal delivery, while 42.9% had caesarean section. 84.2% of the participants stated that they would prefer to have their next delivery in a private maternity clinic, and 3% stated that they would prefer to give birth at home. 15.3% had participated in childbirth preparatory courses. Finally, the participants considered that maternity services, such as pregnancy monitoring, preventative examinations for foetal abnormalities, PAP-test and preventative examinations for breast cancer, should be provided by the state free of charge.Conclusions: It is necessary to further develop and modernize maternity services in such a way that they will correspond to pregnant women’s needs.

  13. Creating a Pediatric Digital Library for Pediatric Health Care Providers and Families (United States)

    D'Alessandro, Donna; Kingsley, Peggy


    The goal of this study was to complete a literature-based needs assessment with regard to common pediatric problems encountered by pediatric health care providers (PHCPs) and families, and to develop a problem-based pediatric digital library to meet those needs. The needs assessment yielded 65 information sources. Common problems were identified and categorized, and the Internet was manually searched for authoritative Web sites. The created pediatric digital library ( used a problem-based interface and was deployed in November 1999. From November 1999 to November 2000, the number of hyperlinks and authoritative Web sites increased 51.1 and 32.2 percent, respectively. Over the same time, visitors increased by 57.3 percent and overall usage increased by 255 percent. A pediatric digital library has been created that begins to bring order to general pediatric resources on the Internet. This pediatric digital library provides current, authoritative, easily accessed pediatric information whenever and wherever the PHCPs and families want assistance. PMID:11861631

  14. Midwives' Experiences in Providing Care and Counselling to Women with Female Genital Mutilation (FGM Related Problems

    Directory of Open Access Journals (Sweden)

    Elisabeth Isman


    Full Text Available Aim. The aim of this study was to elucidate midwives experiences in providing care and counselling to women with FGM related problems. Setting. The study was conducted at a maternity clinic in Hargeisa, Somaliland. Method. A qualitative, inductive study were performed with eight midwives living in Somaliland. The interviews had semi-structured questions. Content analysis was used for the analysis. Findings. The main findings of the present study were how midwives are challenged by culture and religion when providing FGM counselling. The most prominent challenge is the perception that FGM is an important part of the culture and from this point of view the midwives work is apprehended as interfering and subverting the Somali culture. Having personal experience of FGM emerged as a benefit when counselling women. Conclusion. There is a contradiction between the professional actions of performing FGM despite a personal belief against FGM. Midwives as a professional group could be important agents of change and further research is needed about the midwives role in this process.

  15. Relationship between low back pain, disability, MR imaging findings and health care provider

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    Arana, Estanislao; Molla, Enrique; Costa, Salvador; Montijano, Ruben [Clinica Quiron, Department of Radiology, Valencia (Spain); Marti-Bonmati, Luis [Clinica Quiron, Department of Radiology, Valencia (Spain); Hospital Universitario Dr. Peset, Department of Radiology, Valencia (Spain); Vega, Maria [Hospital Universitario Dr. Peset, Department of Radiology, Valencia (Spain); Bautista, Daniel [Hospital Universitario Dr. Peset, Department of Preventive Medicine, Valencia (Spain)


    To determine the association between the self-report of pain and disability and findings on lumbar MR images, and to compare two different health care providers in Spanish patients with low back pain (LBP). Cross-sectional A total of 278 patients, 137 men and 141 women aged 44{+-}14 years submitted with low back pain (LBP) were studied. One hundred and nine patients were from the National Health System (NHS) and 169 from private practice. Patients with previous discitis, surgery, neoplasm or traumatic episodes were excluded. Every patient completed a disability questionnaire with six core items, providing a score of disability from 2 to 28. All patients had sagittal spin-echo T1 and turbo spin-echo T2, axial proton-density and MR myelography weighted images. MR images of the two most affected disc levels were read, offering an MR imaging score from 0 to 30. Patients with a combination of LBP and sciatica showed the highest levels of disability (p=0.002). MR imaging scores only correlated with pain interference with normal work (p=0.04), but not with other disability questions. Patients from the NHS showed greater disability scores than private ones (p=0.001) and higher MR imaging scores (p=0.01). In patients with LBP, MR imaging only correlates with pain interference with work but not with other disability questions. Differences are found between private and NHS patients, the latter being more physically affected. (orig.)

  16. Health Care Provider Mobility Counseling Provision to Older Adults: A Rural/Urban Comparison. (United States)

    Huseth-Zosel, Andrea L; Sanders, Gregory; O'Connor, Melissa; Fuller-Iglesias, Heather; Langley, Linda


    The current study examined rural-urban differences in health care provider (HCP) perceptions, attitudes, and practices related to driving safety/cessation-related anticipatory guidance provision to older adults. A cross-sectional survey was conducted with HCPs in several north central states. Exploratory factor analysis was used to examine dimensions of HCP perceptions and attitudes related to mobility counseling. Binary logistic regression analyses were conducted to determine if HCP rurality was significantly predictive of HPC provision of mobility counseling by age. Rural HCPs were less likely than urban HCPs to provide mobility counseling to their patients aged 75 or older. Rural HCPs were less likely to refer patients to a driving fitness evaluation resource if they had questions related to driving issues, and were less likely to perceive there were adequate resources to help with driving issues. Rural-urban differences in HCP mobility counseling provision may contribute to potential health disparities between urban and rural patients. Both rural and urban HCPs need training about older driver issues, so they may educate their patients about driving safety/cessation. Future research should examine the association between rural-urban differences in HCP mobility counseling provision and rural older adult overrepresentation in motor vehicle injuries and fatalities statistics.

  17. Zika Virus Disease: A CDC Update for Pediatric Health Care Providers. (United States)

    Karwowski, Mateusz P; Nelson, Jennifer M; Staples, J Erin; Fischer, Marc; Fleming-Dutra, Katherine E; Villanueva, Julie; Powers, Ann M; Mead, Paul; Honein, Margaret A; Moore, Cynthia A; Rasmussen, Sonja A


    Zika virus is a mosquito-borne flavivirus discovered in Africa in 1947. Most persons with Zika virus infection are asymptomatic; symptoms when present are generally mild and include fever, maculopapular rash, arthralgia, and conjunctivitis. Since early 2015, Zika virus has spread rapidly through the Americas, with local transmission identified in 31 countries and territories as of February 29, 2016, including several US territories. All age groups are susceptible to Zika virus infection, including children. Maternal-fetal transmission of Zika virus has been documented; evidence suggests that congenital Zika virus infection is associated with microcephaly and other adverse pregnancy and infant outcomes. Perinatal transmission has been reported in 2 cases; 1 was asymptomatic, and the other had thrombocytopenia and a rash. Based on limited information, Zika virus infection in children is mild, similar to that in adults. The long-term sequelae of congenital, perinatal, and pediatric Zika virus infection are largely unknown. No vaccine to prevent Zika virus infection is available, and treatment is supportive. The primary means of preventing Zika virus infection is prevention of mosquito bites in areas with local Zika virus transmission. Given the possibility of limited local transmission of Zika virus in the continental United States and frequent travel from affected countries to the United States, US pediatric health care providers need to be familiar with Zika virus infection. This article reviews the Zika virus, its epidemiologic characteristics, clinical presentation, laboratory testing, treatment, and prevention to assist providers in the evaluation and management of children with possible Zika virus infection.

  18. Acculturation differences in communicating information about child mental health between Latino parents and primary care providers. (United States)

    Lê Cook, Benjamin; Brown, Jonathan D; Loder, Stephen; Wissow, Larry


    Significant Latino-white disparities in youth mental health care access and quality exist yet little is known about Latino parents' communication with providers about youth mental health and the role of acculturation in influencing this communication. We estimated regression models to assess the association between time in the US and the number of psychosocial issues discussed with the medical assistant (MA) and doctor, adjusting for child and parent mental health and sociodemographics. Other proxies of acculturation were also investigated including measures of Spanish and English language proficiency and nativity. Parent's length of time in the US was positively associated with their communication of: their child's psychosocial problems with their child's MA, stress in their own life with their child's MA, and their child's school problems with their child's doctor. These differences were especially apparent for parents living in the US for >10 years. Parent-child language discordance, parent and child nativity were also significantly associated with communication of psychosocial problems. Greater provider and MA awareness of variation in resistance to communicating psychosocial issues could improve communication, and improve the prevention, diagnosis and treatment of youth mental illness.

  19. Dynamic Pricing Strategy of Provider with Different QoS Levels in Web Service

    Directory of Open Access Journals (Sweden)

    Wei Pan


    Full Text Available In order to improve the service provider profit, the pricing strategies in service network have been studied, but primarily in static pricing setting without considering different quality of service (QoS levels. However, in real situation, providers usually dynamically adjust their prices and offer multiple class services to meet different customers. Moreover, because service provider will satisfy demands of customers on a specific future date, customers may cancel order. In this paper, we establish a new dynamic pricing model to consider order cancellation ration and different QoS levels for maximizing provider revenue. The analytical results from this new model reveal that the optimal capacity and prices are derived via closed-form solutions. Finally, a numerical example is presented to illustrate that the proposed method is effective for determining the optimal capacity and prices. In addition, sensitivity analysis of the optimal capacity and profit with respect to some important parameters are also conducted to illustrate the optimal decision characteristics.

  20. Population aging and its impacts: strategies of the health-care system in Taipei. (United States)

    Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung


    Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities.

  1. Home-based Palliative Care: A Strategy for Keeping Intensive Care Unit Beds Vacant

    Directory of Open Access Journals (Sweden)

    Heshmatolah Heydari


    the hospital and on the ICU beds, and to the last moments of life, they receive specialized cure, and occupy ICU beds, while the specialists are aware that this treatment is unfruitful, and this reality is supported by science. In the developed countries, the gap between death and specific cures is considered as an indicator of the quality of physician services and more length of time will be better indicator for physician services, while cancer patients in health system of Iran receive specific treatment and chemotherapy even to moment of death. To consider countless benefits of home care6 and the patients’ desire to receive services at home,7 if we can provide the conditions that at least 20% of end stage cancer patients in receive home based palliative care, 1000 deaths will occur at home yearly, and 1000 ICU beds will be released for use for other patients with better prognosis for survival. Therefore, health system authorities in Iran should considered home-based palliative care of cancer patients as a priority.

  2. 42 CFR 403.764 - Basis and purpose of religious nonmedical health care institutions providing home service. (United States)


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Basis and purpose of religious nonmedical health care institutions providing home service. 403.764 Section 403.764 Public Health CENTERS FOR MEDICARE... Religious Nonmedical Health Care Institutions-Benefits, Conditions of Participation, and Payment §...

  3. Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities : a Ghanaian cohort study

    NARCIS (Netherlands)

    Amoakoh-Coleman, Mary; Klipstein-Grobusch, Kerstin; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Ansah, Evelyn K


    BACKGROUND: Guideline utilization aims at improvement in quality of care and better health outcomes. The objective of the current study was to determine the effect of provider complete adherence to the first antenatal care guidelines on the risk of maternal and neonatal complications in a low resour

  4. Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making. (United States)

    Brown, Edwina A; Bekker, Hilary L; Davison, Sara N; Koffman, Jonathan; Schell, Jane O


    Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs.

  5. USGS Environmental health science strategy: providing environmental health science for a changing world: public review release (United States)

    Bright, Patricia R.; Buxton, Herbert T.; Balistrieri, Laurie S.; Barber, Larry B.; Chapelle, Francis H.; Cross, Paul C.; Krabbenhoft, David P.; Plumlee, Geoffrey S.; Sleeman, Jonathan M.; Tillitt, Donald E.; Toccalino, Patricia L.; Winton, James R.


    and providing it to environmental, natural resource, agricultural, and public-health managers. The USGS is a Federal science agency with a broad range of natural science expertise relevant to environmental health. USGS provides scientific information and tools as a scientific basis for management and policy decision making. USGS specializes in science at the environment-health interface, by characterizing the processes that affect the interaction among the physical environment, the living environment, and people, and the resulting factors that affect ecological and human exposure to disease agents. This report describes a 10-year strategy that encompasses the portfolio of USGS environmental health science. It summarizes national environmental health priorities that USGS is best suited to address, and will serve as a strategic framework for USGS environmental health science goals, actions, and outcomes for the next decade. Implementation of this strategy is intended to aid coordination of USGS environmental health activities and to provide a focal point for disseminating information to stakeholders. The "One Health" paradigm advocated by the World Health Organization (WHO, 2011), and the American Veterinary Medicine Association (AVMA, 2008), among others, is based on a general recognition that the health of humans, animals, and the environment are inextricably linked. Thus, successful efforts to protect that health will require increased interdisciplinary research and increased communication and collaboration among the broader scientific and health community. This strategy is built upon that paradigm. The vision, mission, and five cornerstone goals of the USGS Environmental Health Science Strategy were developed with significant input from a wide range of stakeholders. Vision - The USGS is a premier source of the environmental health science needed to safeguard the health of the environment, fish, wildlife, and people. Mission - The mission of USGS in environmental

  6. Political and cultural factors in achieving continuity with a primary health care provider at an Indian Health Service hospital. (United States)

    Dietrich, A J; Olson, A L


    A primary care system was established at Zuni-Ramah Indian Health Service Hospital and clinic in New Mexico. Continuity and coordination of care were added to a health care system that was already accountable, accessible, and comprehensive. The new system offered each patient a personal health care provider who worked as a member of a multidisciplinary team. In changing the health care system, special attention was given to its cultural and political setting, the village of Zuni. After thorough discussion with community and staff, community members' concerns about patients' privacy and free choice were better understood, and special efforts were made to safeguard them. Ongoing evaluation is essential to maintain continuity. Eight months after the primary care system was begun, 64 percent of patients who came for care had established a personal relationship with a health care provider. For 59 percent of the visits during the 1-month evaluation period, patients saw their regular provider and, for 82 percent, patients saw their provider or one of his or her team colleagues. These percentages include night and walk-in visits. The system required no extra funding or staff. The political process of planning and consultation helped anticipate and alleviate the community's concerns, but resistance from physician's assistants and some physicians was unexpected. A flexible approach has led to a gradual acceptance of this voluntary system. This experience with the people of Zuni village shows that a primary care system can be started in a rural Indian Health Service facility with minimal outside help. Apparent improvements in quality of care make the continuity of primary care worthy of further consideration in the IHS and similar health services systems.

  7. Nutrition and oral health considerations in children with special health care needs: implications for oral health care providers. (United States)

    Moursi, Amr M; Fernandez, Jill B; Daronch, Marcia; Zee, Lena; Jones, Cassandra L


    Children with special health care needs are at increased risk for oral diseases. The purpose of this article was to discuss: nutritional and oral health factors routinely observed in most chronic childhood disorders; dietary modifications associated with select systemic disorders and how they may impact oral health in children; and the following factors common to chronic disorders associated with diet modifications-decreased appetite and increased nutritional risk; frequency of food intake; parental overindulgence; long-term use of cariogenic medications; and xerostomia. Characteristics of childhood disorders that require dietary modifications (congenital heart disease, cystic fibrosis, cancer, AIDS/HIV, diabetes mellitus, and phenylketonuria) are summarized. In addition, healthy dietary modifications and oral health recommendations are suggested. Implementation of these recommendations can assist the dentist and dental team as they join physicians and nutritionists in delivering the best possible care to children with special health care needs.

  8. Diversification of health care services: the effects of ownership, environment, and strategy. (United States)

    Shortell, S M; Morrison, E M; Hughes, S L; Friedman, B S; Vitek, J L


    The present findings suggest that the trend toward greater diversification of hospital services is likely to be most strongly influenced by state Medicaid policies and certain hospital characteristics. Increasing Medicaid eligibility and payment levels is likely to have a positive effect on services diversification. Growth in the number of inpatient services provided and a more severe case mix are also likely to be involved with greater service diversification. Affiliation with a not-for-profit hospital system is likely to be associated with more diversified hospital services but not affiliation with an investor-owned system. There is also some indication that the overall portfolio of services which a hospital offers in regard to market share and market growth characteristics influences diversification. Specifically, a low market share portfolio is likely to be associated with less diversification. Competition is likely to be associated with more diversification; particularly for hospitals belonging to systems. The effect of competition on hospital strategy and services diversification is a particularly important area for further investigation. Increasing Medicaid payment and eligibility levels are also likely to have a positive effect on the provision of services which are usually unprofitable. Raising such levels is likely to be particularly beneficial to inner-city hospitals who are already providing a greater number of such services. However, the present data suggest that investor-owned hospitals are least likely to provide such services. Increasing Medicaid eligibility levels is also likely to be associated with fewer services for which charity care has to be provided. State regulation in the form of rate review and certificate of need is likely to be associated with more services for which hospitals provide some charity care. But such policies alone do not deal with the larger issue of how to finance care for the medically indigent. Present data suggest the

  9. Integrating early palliative care for patients with HIV: provider and patient perceptions of symptoms and need for services. (United States)

    Lofgren, Sarah; Friedman, Rachel; Ghermay, Rahwa; George, Maura; Pittman, John Richard; Shahane, Amit; Zeimer, Dorothy; Del Rio, Carlos; Marconi, Vincent C


    Increasingly clinicians are using palliative care to address the symptomatic and psychosocial effects of disease often missed by routine clinical care, termed "early" palliative care. Within an inner-city medical center, we began a program to integrate early palliative care into HIV inpatient care. Patient symptom burden and desired services were assessed and compared to provider perceptions of patient's needs. From 2010-2012, 10 patients, with a median CD4+ T-cell count of 32.5 cells/μL, and 34 providers completed the survey. Providers ranked their patients' fatigue, sadness, anxiety, sexual dysfunction, and body image significantly higher than patients it for themselves. Patients ranked medical care, pharmacy, social work, physical therapy, and housing as significantly more important to them than providers estimated them to be. These differences may reflect the fact that physicians often overlook patients' unmet basic needs. Early palliative care may narrow this gap between providers' and patients' perceptions of needs through good communication and targeting barriers, such as housing instability, which are vital to overcome for consistent long-term follow up.

  10. A pilot training programme for health and social care professionals providing oncological and palliative care to lesbian, gay and bisexual patients in Ireland.

    LENUS (Irish Health Repository)

    Reygan, Finn C G


    OBJECTIVE: The international literature points to the specific cancer risks and palliative care needs of lesbian, gay and bisexual (LGB) populations. However, with the exception of a programme in the USA, there is a lack of training internationally for health and social care professionals providing oncological and palliative care to LGB patients. In Ireland, a training project funded by the Irish Cancer Society, the Irish Hospice Foundation and the Health Service Executive developed a training pilot programme for health and social care professionals providing oncological and palliative care to LGB patients. METHODS: Over 200 (N = 201) oncology and palliative care staff participated in 17 brief, 50-min trainings in pilot sites. Evaluation of the training included self-report questionnaires at the end of each training and an evaluation interview with one participant from each of the four sites. RESULTS: The majority of participants reported that they would recommend the training to their colleagues, were interested in further training in the area and found the training useful for their practice. They also reported becoming more familiar with LGB-related language and terminology, became more knowledgeable of LGB health issues and reported becoming more confident in providing care to LGB patients. CONCLUSIONS: Recommendations are that the training be made available across the health services in Ireland and included in postgraduate courses for trainee health and social care professionals. Copyright © 2012 John Wiley & Sons, Ltd.

  11. Extending Our Understanding of Burnout and Its Associated Factors: Providers and Staff in Primary Care Clinics. (United States)

    Spinelli, William M; Fernstrom, Karl M; Galos, Dylan L; Britt, Heather R


    Burnout has been identified as an occupational hazard in the helping professions for many years and is often overlooked, as health-care systems strive to improve cost and quality. The Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS) are tools for assessing burnout prevalence and its associated factors. We describe how we used them in outpatient clinics to assess burnout for multiple job types. Traditional statistical techniques and seemingly unrelated regression were used to describe the sample and evaluate the association between work life domains and burnout. Of 838 eligible participants, 467 (55.7%) were included for analysis. Burnout prevalence varied across three job categories: providers (37.5%), clinical assistants (24.6%), and other staff (28.0%). It was not related to age, gender, or years of tenure but was lower in part-time workers (24.6%) than in full-time workers (33.9%). Analysis of the AWS subscales identified organizational correlates of burnout. Accurately identifying and defining the operative system factors associated with burnout will make it possible to create successful interventions. Using the MBI and the AWS together can highlight the relationship between system work experiences and burnout.

  12. Falls in the community-dwelling older adult: A review for primary-care providers

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    Theresa A Soriano


    Full Text Available Theresa A Soriano1, Linda V DeCherrie2, David C Thomas11The Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA; 2Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York, USAAbstract: Falls in the elderly are an important independent marker of frailty. Up to half of elderly people over 65 experience a fall every year. They are associated with high morbidity and mortality and are responsible for greater than 20 billion dollars a year in healthcare costs in the United States. This article presents a review and guide for the primary care provider of the predisposing and situational risk factors for falls; comprehensive assessment for screening and tailored intervention; and discussion of single and multicomponent measures for fall prevention and management in the older person living in the community. Interventions for the cognitively impaired and demented elderly will also be addressed.Keywords: falls, elderly, community-dwelling, review

  13. Pharmacists' perspective on providing care when patients engage in unhealthy behaviors. (United States)

    Lee, Christine; Segal, Richard; Kimberlin, Carole; Smith, W Thomas; Weiler, Robert M


    OBJECTIVE To assess the association between unhealthy lifestyle-related behaviors in patients and the pharmacist's professional obligation for providing care. DESIGN Repeated measures ANOVA was used to examine the effect of severity of lifestyle disease on professional obligation. SETTING Four live continuing education programs on law and management conducted in the state of Florida. PARTICIPANTS 488 Florida pharmacists were surveyed with 65% completing the survey. MAIN OUTCOME MEASURES Pharmacists' opinions based on lifestyle-related diseases classified as follows: low lifestyle-related disease (low LD): nonsmoker with asthma who is adherent with asthma medications; moderate (mod) LD: nonsmoker with asthma who is nonadherent with asthma medications; high LD: smoker with asthma who is adherent with asthma medications. RESULTS The difference between the scales for measuring professional obligation for low and mod LD was significant, with pharmacists reporting greater professional obligation for low versus mod LD. The difference between professional obligation for low and high LD was significant, with pharmacists reporting greater professional obligation for low than high LD. The difference between professional obligation for mod and high LD was significant, with pharmacists reporting a higher professional obligation for mod than high LD. CONCLUSION The differences in professional obligation between the three patient scenarios were small but statistically significant. The findings suggest that certain patient behaviors, such as smoking or medication nonadherence, can have a negative effect on pharmacists' sense of professional obligation to the patient.

  14. Pharmacist's management of drug-related problems: a tool for teaching and providing pharmaceutical care. (United States)

    Winslade, N E; Bajcar, J M; Bombassaro, A M; Caravaggio, C D; Strong, D K; Yamashita, S K


    During the development of education and practice models based on the philosophy of pharmaceutical care (PC), six pharmacists worked with the University of Toronto Faculty of Pharmacy to implement the PC model in their practice sites. These pharmacists found it necessary to modify existing tools to create one that explicitly guided them through the PC process, including the phase of monitoring patients for desired outcomes. This resulted in the development of the Pharmacist's Management of Drug Related Problems. This tool requires pharmacists to collect patient drug and medical data and write responses to specific questions about the data to interpret their significance. As proficiency in providing PC is attained, the questions and space for written responses can be eliminated, leaving a comprehensive documentation system of patient outcomes and the data collected, recommendations made, and monitoring completed by the pharmacist. This tool has been adopted by the University of Toronto Faculty of Pharmacy and is being used in various continuing education programs and by practicing pharmacists across Canada.

  15. Insufficient stocking of cyanide antidotes in US hospitals that provide emergency care

    Directory of Open Access Journals (Sweden)

    Lucas Gasco


    Full Text Available Objective: To identify the influence of catchment area, trauma center designation, hospital size, subspecialist employment, funding source, and other hospital characteristics on cyanide antidote stocking choice in US hospitals that provides emergency care. Materials and Methods: A web-based survey was sent out to pharmacy managers through two listservs; the American Society of Health-Systems Pharmacists and the American College of Clinical Pharmacy. A medical marketing company also broadcasted the survey to 2,659 individuals. We collected data on hospital characteristics (size, state, serving population, etc., to determine what influenced the hospital′s stocking choice. Results: The survey response rate was approximately 10% ( n = 286. Thirty-eight hospitals (16% stocked at least 4 antidote kits. Safety profile, recommendations from a poison control center, and ease of use had the strongest influence on stocking decisions. Conclusions: Survey of 286 US hospital pharmacy managers, 38/234 (16% hospitals had sufficient stocking of cyanide antidotes. Antidote preference was based on safety, ease of use, and recommendations by the local poison center, over cost.

  16. Validation of Single-Item Screening Measures for Provider Burnout in a Rural Health Care Network. (United States)

    Waddimba, Anthony C; Scribani, Melissa; Nieves, Melinda A; Krupa, Nicole; May, John J; Jenkins, Paul


    We validated three single-item measures for emotional exhaustion (EE) and depersonalization (DP) among rural physician/nonphysician practitioners. We linked cross-sectional survey data (on provider demographics, satisfaction, resilience, and burnout) with administrative information from an integrated health care network (1 academic medical center, 6 community hospitals, 31 clinics, and 19 school-based health centers) in an eight-county underserved area of upstate New York. In total, 308 physicians and advanced-practice clinicians completed a self-administered, multi-instrument questionnaire (65.1% response rate). Significant proportions of respondents reported high EE (36.1%) and DP (9.9%). In multivariable linear mixed models, scores on EE/DP subscales of the Maslach Burnout Inventory were regressed on each single-item measure. The Physician Work-Life Study's single-item measure (classifying 32.8% of respondents as burning out/completely burned out) was correlated with EE and DP (Spearman's ρ = .72 and .41, p burnout.

  17. Attitude about mental illness of health care providers and community leaders in rural Haryana, North India

    Directory of Open Access Journals (Sweden)

    Harshal Ramesh Salve


    Full Text Available Background: Attitude about mental illness determines health seeking of the people. Success of National Mental Health Programme (NMHP is dependent on attitude about mental illness of various stakeholders in the programme. Material & Methods: A community based cross-sectional study was carried out in Ballabgarh block of Faridabad district in Haryana. We aimed to study attitude about mental illness of various stakeholders of health care providers (HCP, community leaders in rural area of Haryana, north India. Study area consisting of five Primary Health Centers (PHCs serving 2,12,000 rural population. All HCP working at PHCs, Accredited Social Health Activist (ASHA and community leaders in study area were approached for participation. Hindi version of Opinion about Mental illness Scale for Chinese Community (OMICC was used to study attitude. Results: In total, 467 participants were participated in the study. Of which, HCP, ASHAs and community leaders were 81 (17.4%, 145 (31.0% and 241 (51.6% respectively. Community members reported socially restrictive, pessimistic and stereotyping attitude towards mentally ill person. ASHA and HCP reported stereotyping attitude about person with mental illness. None of the stakeholders reported stigmatizing attitude. Conclusion: Training programme focusing on spectrum of mental illness for HCP and ASHA working in rural area under NMHP programme is needed. Awareness generation of community leaders about bio-medical concept of mental illness is cornerstone of NMHP success in India.

  18. Comparative health care information: consumer quality index (CQI) information on differences between providers.

    NARCIS (Netherlands)

    Damman, O.C.; Stubbe, J.H.; Triemstra, A.H.M.; Spreeuwenberg, P.; Delnoij, D.M.J.


    Background: Public reporting on health care performances has become an important quality-improvement instrument. In the Netherlands, consumer quality index (CQI) questionnaires are currently being used to assess patients’ experiences with various domains of the health care system. An important quest

  19. Development and Evaluation of an Integrated Pest Management Toolkit for Child Care Providers (United States)

    Alkon, Abbey; Kalmar, Evie; Leonard, Victoria; Flint, Mary Louise; Kuo, Devina; Davidson, Nita; Bradman, Asa


    Young children and early care and education (ECE) staff are exposed to pesticides used to manage pests in ECE facilities in the United States and elsewhere. The objective of this pilot study was to encourage child care programs to reduce pesticide use and child exposures by developing and evaluating an Integrated Pest Management (IPM) Toolkit for…

  20. Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care. (United States)

    Dawson-Rose, Carol; Cuca, Yvette P; Webel, Allison R; Solís Báez, Solymar S; Holzemer, William L; Rivero-Méndez, Marta; Sanzero Eller, Lucille; Reid, Paula; Johnson, Mallory O; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Nicholas, Patrice K; Matshediso, Ellah; Mogobe, Keitshokile Dintle; Sabone, Motshedisi B; Ntsayagae, Esther I; Shaibu, Sheila; Corless, Inge B; Wantland, Dean; Lindgren, Teri


    Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

  1. Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda.

    Directory of Open Access Journals (Sweden)

    Agnes Nanyonjo

    Full Text Available OBJECTIVE: To compare caretakers' perceived quality of care (PQC for under-fives treated for malaria, pneumonia and diarrhoea by community health workers (CHWs and primary health facility workers (PHFWs. METHODS: Caretaker rated PQC for children aged (2-59 months treated by either CHWs or PHFWs for a bought of malaria, pneumonia or diarrhoea was cross-sectionally compared in quality domains of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust. Child samples were randomly drawn from CHW (419 and clinic (399 records from eight Midwestern Uganda districts. An overall PQC score was predicted through factor analysis. PQC scores were compared for CHWs and PHFWs using Wilcoxon rank-sum test. Multinomial logistic regression models were used to specify the association between categorized PQC and service providers for each quality domain. Finally, overall PQC was dichotomized into "high" and "low" based on median score and relative risks (RR for PQC-service provider association were modeled in a "modified" Poisson regression model. RESULTS: Mean (SD overall PQC was significantly higher for CHWs 0.58 (0 .66 compared to PHFWs -0.58 (0.94, p<0.0001. In "modified" Poisson regression, the proportion of caretakers reporting high PQC was higher for CHWS compared to PHFWs, RR=3.1, 95%CI(2.5-3.8. In multinomial models PQC was significantly higher for CHWs compared to PHFWs in all domains except for continuity. CONCLUSION: PQC was significantly higher for CHWs compared to PHFWs in this resource constrained setting. CHWs should be tapped human resources for universal health coverage while scaling up basic child intervention as PQC might improve intervention utilization.

  2. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers

    NARCIS (Netherlands)

    Hesselink, Gijs; Flink, Maria; Olsson, Mariann; Barach, Paul; Dudzik-Urbaniak, Ewa; Orrego, Carola; Toccafondi, Giulio; Kalkman, Cor; Johnson, Julie K.; Schoonhoven, Lisette; Vernooij-Dassen, Myrra; Wollersheim, Hub


    Background: Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. Objective: The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process. Methods: A qualitative st

  3. Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use


    Jones, AL; Cochran, SD; Leibowitz, A.; Wells, KB; Kominski, G; Mays, VM


    © 2015 Society of General Internal Medicine BACKGROUND: The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. OBJECTIVE: To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services...

  4. Implementation of patient portals: the perspective of the professional care provider (United States)

    Ros, Wynand J.G; ter Horst, Karin


    Introduction A few hospitals in the Netherlands have been introducing digital patient portals. Patient portals are secured internet environments for patients to log into from their homes to exchange information with their care provider. Such portals can be seen as an application of e-health that encourages patient’s self management. User acceptance is an important precondition for successful implementation. Research on patient user acceptance has already occurred. This project is about the user acceptance of the professional healthcare provider. The focus is on nurses, because in the Netherlands nurses play a crucial role in developing and implementing a portal, as well as in introducing the portal to the patient. Besides that, they have to integrate the portal tasks with their other work. Aim This qualitative research describes the extent to which and the manner in which nurses accept digital patient portals. It is investigated how the portals are developed and implemented, how nurses use and appreciate the portals and which factors are important for realizing user acceptance of professional health care providers. Method In-depth interviews were executed with 18 respondents of two University Medical Centers in the Netherlands. The group consisted of 12 nurses and nursing specialists, 2 doctors, 2 researchers, 1 communication officer and 1 manager. Interview topics were derived from the Technology Acceptance Model (TAM) and the Innovation Diffusion Theory (IDT). Results The results show that the degree of acceptance among nurses is great. Nurses see the introduction of patient portals as an inevitable development. Essential for nurses’ acceptance is the ‘perceived usefulness’, especially from patient’s perspective. Perceived usefulness from their own perspective (ease-to-use) also plays a role but this is of less importance. The e-consult is relevant. However, it will not substitute usual (face-to-face or telephone) contacts, unless e-consult is part of

  5. Prevention of unintended pregnancy and HIV/STIs among Latinos in rural communities: perspectives of health care providers. (United States)

    Branch, Meredith; Harvey, S Marie; Zukoski, Ann P; Warren, Jocelyn


    Latino women in the United States are disproportionately at risk for unintended pregnancy, HIV, and sexually transmitted infections (STIs). We conducted nine focus groups with health care practitioners who provide reproductive health care to Latinos in rural areas of the Northwest. From the practitioner perspective, we explored barriers and facilitators to the acquisition and use of contraceptives and to the prevention of HIV/STIs among rural Latinos. Suggestions for improving reproductive health care included Spanish-language resources/materials and convenient contraceptive methods. Findings provide context to the complex issues related to unintended pregnancy and disease prevention among Latinos residing in rural communities.

  6. [Leadership strategies--the Bible as a guide to management in the health care system]. (United States)

    Kudlacek, Stefan; Meran, Johannes G


    Management and leadership are an integral part of any organisation, to optimise procedures and increase efficiency. Aims, ideals and structures first need to be defined for tasks to be carried out successfully, particularly in difficult times. A good example for the way communities can effectively and with conviction pass on their values and standpoints from generation to generation, grow in strength and also influence their surroundings is provided by religion. This paper focuses leadership provided by charismatic personalities within the Jewish and Christian religions. Monasteries have run hospitals without governmental support ever since the Middle Ages. Leadership within today's health care system calls for a variety of strategies in the different phases of development. In times of limited resources and multifarious societies, leadership implies both a scientific as well as an ethical challenge.

  7. Effectiveness of the Rural Trauma Team Development Course for Educating Nurses and Other Health Care Providers at Rural Community Hospitals. (United States)

    Zhu, Thein Hlaing; Hollister, Lisa; Scheumann, Christopher; Konger, Jennifer; Opoku, Dazar


    The study evaluates (1) health care provider perception of the Rural Trauma Team Development Course (RTTDC); (2) improvement in acute trauma emergency care knowledge; and (3) early transfer of trauma patients from rural emergency departments (EDs) to a verified trauma center. A 1-day, 8-hour RTTDC was given to 101 nurses and other health care providers from nine rural community hospitals from 2011 to 2013. RTTDC participants completed questionnaires to address objectives (1) and (2). ED and trauma registry data were queried to achieve objective (3) for assessing reduction in ED time (EDT), from patient arrival to decision to transfer and ED length of stay (LOS). The RTTDC was positively perceived by health care providers (96.3% of them completed the program). Significant improvement in 13 of the 19 knowledge items was observed in nurses. Education intervention was an independent predictor in reducing EDT by 28 minutes and 95% confidence interval (CI) [-57, -0.1] at 6 months post-RTTDC, and 29 minutes and 95% CI [-53, -6] at 12 months post-RTTDC. Similar results were observed with ED LOS. The RTTDC is well-perceived as an education program. It improves acute trauma emergency care knowledge in rural health care providers. It promotes early transfer of severely injured patients to a higher level of care.

  8. Role of private sector in providing tuberculosis care: Evidence from a population-based survey in India

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    Indrajit Hazarika


    Full Text Available Background: In India, a large segment of the population seeks health care services from individual or institutional private health-care providers for health care. We analyzed a nationally representative data to identify the role of private providers in delivering health care for patients with tuberculosis. Materials and Methods: The primary data source for the present analysis was the 60 th round of the National Sample Survey. Distribution frequencies were used to analyze the distribution of key sociodemographic variables and multiple logistic regression was used to analyze the association between these variables and healthcare seeking behavior. Results: A sample of 2203 respondents who had received ambulatory care for tuberculosis, and 4568 respondents who had received inpatient treatment were analyzed. About half of the respondents had attended private facilities for TB care. Sociodemographic variables such as paediatric age group, females, higher level of education, and economic groups were associated with attendance at private sector. Dissatisfaction with services in government facilities was cited as the main reason for preferring private facilities. Conclusions: Private providers play an important role in providing health care services to a large proportion of patients with tuberculosis. There is a need for innovative measures to increase participation of the private sector in the national TB control program and to improve the quality of services in government facilities.

  9. Bridging the Gaps in Obstetric Care: Perspectives of Service Delivery Providers on Challenges and Core Components of Care in Rural Georgia. (United States)

    Pinto, Meredith; Rochat, Roger; Hennink, Monique; Zertuche, Adrienne D; Spelke, Bridget


    Objectives In 2011, a workforce assessment conducted by the Georgia Maternal and Infant Health Research Group found that 52 % of Primary Care Service Areas outside metropolitan Atlanta, Georgia, had an overburdened or complete lack of obstetric care services. In response to that finding, this study's aim was twofold: to describe challenges faced by providers who currently deliver or formerly delivered obstetric care in these areas, and to identify essential core components that can be integrated into alternative models of care in order to alleviate the burden placed on the remaining obstetric providers. Methods We conducted 46 qualitative in-depth interviews with obstetricians, maternal-fetal medicine specialists, certified nurse midwives, and maternal and infant health leaders in Georgia. Interviews were digitally recorded, transcribed verbatim, uploaded into MAXQDA software, and analyzed using a Grounded Theory Approach. Results Providers faced significant financial barriers in service delivery, including low Medicaid reimbursement, high proportions of self-pay patients, and high cost of medical malpractice insurance. Further challenges in provision of obstetric care in this region were related to patient's late initiation of prenatal care and lacking collaboration between obstetric providers. Essential components of effective models of care included continuity, efficient use of resources, and risk-appropriate services. Conclusion Our analysis revealed core components of improved models of care that are more cost effective and would expand coverage. These components include closer collaboration among stakeholder populations, decentralization of services with effective use of each type of clinical provider, improved continuity of care, and system-wide changes to increase Medicaid benefits.

  10. Nursing care provided to young people in two health centers compared with Watson Theory

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    María Alejandra Pichardo Meza


    Full Text Available This article has as objective to present the analysis of the care given by the nursing personnel to the young adult population in the Clinic of Pain Control and Palliative Care and in the Onco-hematology Service of the Max Peralta Hospital, related to Jean Watson’s theoretical proposal. The study corresponds to a joint research of parallel type with concurrent triangulation. The study populations were made up by twenty-six young adult people (who face morbid process health or chronic pain condition and four nursing professionals who worked in the Clinic of Pain Control and Palliative Care and in the Onco-hematology Service of the Max Peralta Hospital. A self-executed questionnaire and a semi-structured interview were used to collect the information, which was analyzed using the “SPSS” program and the qualitative categories, respectively. Results: The ten elements of the “Human Care Theory” can be included in the care given by the nursing personnel to the young adult population who faces morbid process health or chronic pain condition. The nursing care mainly focuses on the young adult population quality of life throughout education and pain management. The young adult population perceives a warm, pleasant and human nursing care. Conclusion: Nursing personnel put into practice elements of the Jean Watson’s theoretical proposal even when they do not know it.

  11. Association between change of health care providers and pregnancy exposure to FDA category C, D and X drugs

    Institute of Scientific and Technical Information of China (English)

    Yang Jianzhou; Xie Rihua; Daniel Krewski; Wang Yongjin; Mark Walker; Cao Wenjun; Shi Wu Wen


    Background Changing health care providers frequently breaks the continuity of care,which is associated with many health care problems.The purpose of this study was to examine the association between a change of health care providers and pregnancy exposure to FDA category C,D and X drugs.Methods A 50% random sample of women who gave a birth in Saskatchewan between January 1,1997 and December 31,2000 were chosen for this study.The association between the number of changes in health care providers and with pregnancy exposure to category C,D,and X drugs for those women with and without chronic diseases were evaluated using multiple logistical regression,with adjusted odds ratios (ORs) and its 95% confidence intervals (C/s) as the association measures.Results A total of 18 568 women were included in this study.Rates of FDA C,D,and X drug uses were 14.35%,17.07%,21.72%,and 31.14%,in women with no change of provider,1-2 changes,3-5 changes,and more than 5 changes of health care providers.An association between the number of changes of health care providers and pregnancy exposure to FDA C,D,and X drugs existed in women without chronic diseases but not in women with chronic disease.Conclusion Change of health care providers is associated with pregnancy exposure to FDA category C,D and X drugs in women without chronic diseases.

  12. Acculturation process: a collaborative strategy of integration in attaining culturally congruent nursing care. (United States)

    Nelson, Deborah B


    The author describes a strategic partnership effort in pursuit of culturally congruent care: the professional model of nursing practice. The organizing framework is an integrated strategy of acculturation based in cultural care theory. The professional health system's department of staff development and a vendor partnered to develop and implement the framework in acculturating Philippine nurses. The author also presents recommendations for future consideration.

  13. Improving communication between patients and providers using health information technology and other quality improvement strategies: focus on low-income children. (United States)

    Ngo-Metzger, Quyen; Hayes, Gillian R; Yunan Chen; Cygan, Ralph; Garfield, Craig F


    Effective communication between providers and patients has been linked to improved outcomes. Previous reviews of quality improvement strategies, including health information technology (health IT), have not focused on the needs of low-income children. The authors conducted a systematic review of the literature on studies of communication surrounding the care of low-income children, with an emphasis on interventions and health IT.The search yielded six studies that focused on low-income children; three of the studies used health IT. Key informant interviews provided insight to the current use of health IT for provider-patient communication in geographically diverse, underresourced settings.The authors identify gaps between existing literature and clinical practice. Future research should focus on the specific impact of health IT in pediatric medicine, particularly in underresourced and safety net settings. These efforts should focus on the use of technological innovations to improve care for low-income children and their families.

  14. The diffusion of innovation in nursing regulatory policy: removing a barrier to medication administration training for child care providers. (United States)

    Torre, Carolyn T; Crowley, Angela A


    Safe medication administration is an essential component of high-quality child care. Its achievement in New Jersey was impeded by a controversy over whether teaching child care providers medication administration involves registered nurses in the process of nursing delegation. Through the theoretical framework of the Diffusion of Innovation, this paper examines how the interpretation of regulatory policy related to nursing practice in New Jersey was adjusted by the Board of Nursing following a similar interpretation of regulatory policy by the Board of Nursing in Connecticut. This adjustment enabled New Jersey nurses to continue medication administration training for child care providers. National data supporting the need for training child care providers in medication administration is presented, the Diffusion of Innovation paradigm is described; the Connecticut case and the New Jersey dilemma are discussed; the diffusion process between the two states is analyzed and an assessment of the need for further change is made.

  15. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly. (United States)


    ... limits for up to a total of 24 hours: (A) 4 hours for adults 18 years of age or older; (B) 2 hours for... meals to each patient that are— (1) Consistent with the patient's plan of care, nutritional needs,...

  16. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. (United States)

    Yokoe, Deborah S; Anderson, Deverick J; Berenholtz, Sean M; Calfee, David P; Dubberke, Erik R; Ellingson, Katherine D; Gerding, Dale N; Haas, Janet P; Kaye, Keith S; Klompas, Michael; Lo, Evelyn; Marschall, Jonas; Mermel, Leonard A; Nicolle, Lindsay E; Salgado, Cassandra D; Bryant, Kristina; Classen, David; Crist, Katrina; Deloney, Valerie M; Fishman, Neil O; Foster, Nancy; Goldmann, Donald A; Humphreys, Eve; Jernigan, John A; Padberg, Jennifer; Perl, Trish M; Podgorny, Kelly; Septimus, Edward J; VanAmringe, Margaret; Weaver, Tom; Weinstein, Robert A; Wise, Robert; Maragakis, Lisa L


    Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).

  17. The use of interest rate swaps by nonprofit organizations: evidence from nonprofit health care providers. (United States)

    Stewart, Louis J; Trussel, John


    Although the use of derivatives, particularly interest rate swaps, has grown explosively over the past decade, derivative financial instrument use by nonprofits has received only limited attention in the research literature. Because little is known about the risk management activities of nonprofits, the impact of these instruments on the ability of nonprofits to raise capital may have significant public policy implications. The primary motivation of this study is to determine the types of derivatives used by nonprofits and estimate the frequency of their use among these organizations. Our study also extends contemporary finance theory by an empirical examination of the motivation for interest rate swap usage among nonprofits. Our empirical data came from 193 large nonprofit health care providers that issued debt to the public between 2000 and 2003. We used a univariate analysis and a multivariate analysis relying on logistic regression models to test alternative explanations of interest rate swaps usage by nonprofits, finding that more than 45 percent of our sample, 88 organizations, used interest rate swaps with an aggregate notional value in excess of $8.3 billion. Our empirical tests indicate the primary motive for nonprofits to use interest rate derivatives is to hedge their exposure to interest rate risk. Although these derivatives are a useful risk management tool, under conditions of falling bond market interest rates these derivatives may also expose a nonprofit swap user to the risk of a material unscheduled termination payment. Finally, we found considerable diversity in the informativeness of footnote disclosure among sample organizations that used interest rate swaps. Many nonprofits did not disclose these risks in their financial statements. In conclusion, we find financial managers in large nonprofits commonly use derivative financial instruments as risk management tools, but the use of interest rate swaps by nonprofits may expose them to other risks

  18. A study on corporate social responsibility for the health care of the elderly by private health care providers of Mangalore city: A health systems research

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    U Sudarshan Pai


    Full Text Available Introduction: Private sector is the largest provider of health care services in India. But it is expensive. Self-driven corporate social responsibility (CSR providing free or subsidised services will be useful to the elderly. There are no published data reporting the pattern or types of health care services provided to elderly by the private health care sector of India through CSR initiative. So this study was undertaken. Objectives: To know the pattern (Subsidised/free and type (Medical, Surgical etc., of Health care services received by the elderly people as a part of CSR. Materials and Methods: A questionnaire based cross-sectional study conducted among all private health care providers of Mangalore city. List of all private health care providers which included various types of hospitals (corporate hospitals, multispecialty hospitals etc... were obtained from the local chapter of Indian Medical Association. The data was collected form hospitals fulfilling the study criteria. The data was analysed using SPSS software for windows, version 16.0. Results are presented as frequencies and proportions in appropriate tables. Results: Totally 24 hospitals had participated in this study. Most (n = 16, 66.7% reported providing some free or subsidised services. Among them only 7 (29.2% were providing free services like: Health check-up camps, subsidised medical and surgical treatment. However most of them did not respond to the "criteria for selecting of the elderly for such free services." Conclusion: Most of the private hospitals in Mangalore do not provide free or subsidised health care services to the elderly through a self-driven CSR initiative

  19. Perception from Barrier and Facilitator for Providing of Early Rehabilitation Care for RTI Victims

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    Pashaei Sabet


    Full Text Available Background Road traffic injuries (RTIs are a major public health problem and the most important cause of disability, morbidity and mortality worldwide. Early rehabilitation can play a significant role in minimizing complications, morbidity and mortality. Objectives The aim of this study was to describe perceptions of barriers precluding provision of early rehabilitation care for RTI victims. Patients and Methods A qualitative content analysis was carried out on 15 nurses with at least one year experience caring for RTI victims. The nurses were selected from various wards (emergency, orthopedic, neurosurgery, and clinic of Sina and Imam Khomeini Hospitals via targeted sampling. Data were collected through semi-structured interviews and targeted sampling until data saturation. Data were analyzed and assessed. Results After continuous analysis and comparison of data, major causes precluding nurses from early rehabilitation of RTI patients were retrieved. These barriers included: (a lack of insight, (b lack of comprehensive care (c excessive costs; facilitating factors included (d training for cooperation and (e support for coping. Conclusions The findings of this study show that the need for early rehabilitation in the hospital phase of care for RTI victims is needed. Knowledge about the barriers precluding nurses from early rehabiltiation of RTI patients and facilitators that can help health care workers and policy makers eliminate the barriers precluding early rehabilitation can help health care workers, especially nurses enable patients get over their disability and gain social and family support.

  20. Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review

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    Duchin Jeffrey


    Full Text Available Abstract Background Health care providers (HCPs play an important role in public health emergency preparedness and response (PHEPR so need to be aware of public health threats and emergencies. To inform HCPs, public health issues PHEPR messages that provide guidelines and updates, and facilitate surveillance so HCPs will recognize and control communicable diseases, prevent excess deaths and mitigate suffering. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. We conducted a literature review to investigate the systems and tools used by public health to generate PHEPR communications to HCPs, and to identify specific characteristics of message delivery mechanisms and formats that may be associated with effective PHEPR communications. Methods A systematic review of peer- and non-peer-reviewed literature focused on the following questions: 1 What public health systems exist for communicating PHEPR messages from public health agencies to HCPs? 2 Have these systems been evaluated and, if yes, what criteria were used to evaluate these systems? 3 What have these evaluations discovered about characterizations of the most effective ways for public health agencies to communicate PHEPR messages to HCPs? Results We identified 25 systems or tools for communicating PHEPR messages from public health agencies to HCPs. Few articles assessed PHEPR communication systems or messaging methods or outcomes. Only one study compared the effectiveness of the delivery format, device or message itself. We also discovered that the potential is high for HCPs to experience "message overload" given redundancy of PHEPR messaging in multiple formats and/or through different delivery systems. Conclusions We found that detailed descriptions of PHEPR messaging from