WorldWideScience

Sample records for effective health care

  1. Effect of Health Care Professionals' Continuing Education ...

    African Journals Online (AJOL)

    Purpose: To evaluate the impact of educational intervention by health care providers on clinical outcomes in type 2 diabetes patients in a Yemeni health facility. Methods: A prospective, one-group and pre- and post-test design to assess the effects of health care providers' education on clinical patient outcomes was ...

  2. Redistributive effects in public health care financing.

    Science.gov (United States)

    Honekamp, Ivonne; Possenriede, Daniel

    2008-11-01

    This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.

  3. Primary health care services for effective health care development in ...

    African Journals Online (AJOL)

    This is an empirical study of 7 communities among the O-kun Yoruba of Ijumu, Kogi State, Nigeria. The general objective of the study was to investigate the prioritizing pattern of the various Primary Health Care services (PHC) in the study area. Data for the study were generated mainly through multi-stage sampling ...

  4. Access to effective health care

    DEFF Research Database (Denmark)

    Høy, Bente

    2015-01-01

    Access to effective healthcare is in particular challenging for vulnerable and socially disadvantaged patients. Patients with chronic conditions are over-represented in these lower socioeconomic (LSES) groups. No generic review integrating the evidence on Self-Management support interventions...

  5. Effect of Health Care Professionals' Continuing Education ...

    African Journals Online (AJOL)

    with physicians, nurses and other health care providers. Clinical ... general medical practitioners, four nurses, one pharmacist and one ..... disease and stroke. This study found that the lipid levels of the subjects were within the recommended levels. The HDL cholesterol (36.8 mg/dl) was lower than the recommended level ...

  6. Veterans Health Administration Timely and Effective Care Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of VHA hospitals with timely and effective care (process of care) measure data. VHA collects this information through a Quality Improvement Organization...

  7. Health Care Satisfaction: Effects of Immigration, Acculturation, Language.

    Science.gov (United States)

    Schutt, Russell K; Mejía, Camila

    2017-12-01

    Differences in health care satisfaction can alter patterns of health care utilization and so affect health outcomes, but little is known about variation in satisfaction in relation to immigration status. Health care satisfaction is analyzed with survey data from state public health program patients. Overall health care satisfaction is higher for first generation Hispanic immigrants and lower among those in the second generation compared to white Americans-consistent with the pattern termed the "healthy migrant effect." This pattern is more pronounced for Portuguese-speaking immigrants and is not explained by self-reported health, communication ability or acculturation. Satisfaction with specific aspects of health care follows different patterns that may be explained by differences in experiences and culture. As anticipated by segmented assimilation theory, we find variation in cross-generational patterns of health care satisfaction both within and between ethnic groups. This variation indicates the importance of distinguishing Portuguese-speakers from Spanish-speakers and of taking into account differences in the ways they are able to communicate with health care providers as well as differences in their orientations toward health care. Our disparate findings with other immigrant groups also reinforce limiting expectations of a "healthy migrant effect" to Latinos. Finally, the variable influences on different satisfaction measures indicate the importance of considering the relative influence of culturally-based orientations and health care experiences on the specific outcomes measured, with particular sensitivity to acceptance of individualized standards of care.

  8. Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health

    OpenAIRE

    Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela

    2017-01-01

    The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-difference-in-differences models that exploit variation in treat...

  9. Low health literacy: a barrier to effective patient care.

    Science.gov (United States)

    Seurer, Andrea C; Vogt, H Bruce

    2013-02-01

    Health literacy is defined in the U.S. Department of Health and Human Services initiative Healthy People 2010 as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." It is estimated that 48.8 million Americans are functionally illiterate, making health literacy a major obstacle for providing health care. Although communicating with physicians is a small component of the tasks that are incorporated in a definition of health literacy, it remains the most important aspect of this concept contributing to personal health. Primary care clinics within the Sioux Falls area were provided with both English and Spanish patient education brochures on communicating with physicians. A survey was then distributed to determine how low health literacy was affecting physician practices and what they were doing to remove the obstacles that health literacy presented. Physicians were asked to evaluate the multiple skills and competencies required by patients to access health care services and resources they use to assist patients. A total of 77 surveys were distributed. Twenty-two (28.6 percent) were returned. Of the physicians who returned the survey, the majority (77 percent) thought that low health literacy is a moderate obstacle in their practices. Several physicians stated that their offices had at least one method in place to assist those with low health literacy, but none of them were using a formal test of health literacy. Only six physicians could name a community resource to assist patients with low health literacy. Low health literacy is an unavoidable barrier to effective patient care for physicians across the country. If the full spectrum definition of health literacy is understood by physicians and carefully considered in the context of their own practices, it is likely they would come to the realization that health literacy is a greater obstacle to

  10. Cost-effectiveness Analysis of Health Care Interventions in ...

    African Journals Online (AJOL)

    Background: Decisions concerning the implementation of health programs are usually made on the basis of descriptive assessment. There are only few attempts to review whether returns from investment on these programs worth the effort. Objectives: To analyze and evaluate the cost-effectiveness of health care ...

  11. Health care input constraints and cost effectiveness analysis decision rules.

    Science.gov (United States)

    van Baal, Pieter; Morton, Alec; Severens, Johan L

    2018-01-27

    Results of cost effectiveness analyses (CEA) studies are most useful for decision makers if they face only one constraint: the health care budget. However, in practice, decision makers wishing to use the results of CEA studies may face multiple resource constraints relating to, for instance, constraints in health care inputs such as a shortage of skilled labour. The presence of multiple resource constraints influences the decision rules of CEA and limits the usefulness of traditional CEA studies for decision makers. The goal of this paper is to illustrate how results of CEA can be interpreted and used in case a decision maker faces a health care input constraint. We set up a theoretical model describing the optimal allocation of the health care budget in the presence of a health care input constraint. Insights derived from that model were used to analyse a stylized example based on a decision about a surgical robot as well as a published cost effectiveness study on eye care services in Zambia. Our theoretical model shows that applying default decision rules in the presence of a health care input constraint leads to suboptimal decisions but that there are ways of preserving the traditional decision rules of CEA by reweighing different cost categories. The examples illustrate how such adjustments can be made, and makes clear that optimal decisions depend crucially on such adjustments. We conclude that it is possible to use the results of cost effectiveness studies in the presence of health care input constraints if results are properly adjusted. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  12. Effect of visual impairment upon oral health care: a review.

    Science.gov (United States)

    Mahoney, E K; Kumar, N; Porter, S R

    2008-01-26

    The incidence of visual impairment is increasing globally and in the United Kingdom due to local and systemic disease, medical advances, and the increasing age of population groups. Despite there being a large number of people resident in the UK with a visual impairment, there is little information available regarding the dental health care and needs of such individuals. As reported in other groups of patients with special needs, many individuals with a visual impairment may only seek oral health care when a problem arises, such as pain. Visual impairment may have a negative effect upon oral hygiene with many blind and partially sighted individuals having worse oral hygiene than sighted peers. This review article was undertaken to examine the literature relating to visual impairment, oral health and dental care. This article will discuss the dental aspects of visual impairment, its implications for obtaining dental care, associated oral conditions and medical complications.

  13. Price and quality transparency: how effective for health care reform?

    Science.gov (United States)

    Nyman, John A; Li, Chia-Hsuan W

    2009-07-01

    Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed.

  14. Effects and side-effects of integrating care: the case of mental health care in the Netherlands

    NARCIS (Netherlands)

    Hutschemaekers, Giel J.M.; Tiemens, Bea G.; Winter, M. de

    2007-01-01

    Purpose Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. Context of case Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of

  15. Effects and side-effects of integrating care: The case of mental health care in the Netherlands

    NARCIS (Netherlands)

    Hutschemaekers, G.J.M.; Tiemens, B.G.; Winter, M. de

    2007-01-01

    Purpose: Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. Context of case: Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of

  16. Corruption in health-care systems and its effect on cancer care in Africa.

    Science.gov (United States)

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

    2015-08-01

    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Implementing a self care program. Effect on employee health care utilization.

    Science.gov (United States)

    Powell, D R; Sharp, S L; Farnell, S D; Smith, P T

    1997-05-01

    1. One way to reduce health care costs is to reduce the demand for health care services. This can be accomplished by teaching employees to make better decisions about when they should see the health care provider or go to the emergency department versus treating themselves at home using self care. 2. In an effort to reduce health care costs, a manufacturing company implemented a self care program using a publication called the HealthyLife Self Care Guide. The guide was distributed to employees during a 50 minute workshop. 3. Analysis of claims data 1 year prior to distribution of the Guide and 1 year after distribution showed a savings of $39.65 per employee (a 24.4% decrease in costs) due to reduced health care provider and emergency department visits. This amounted to a return on investment of 2.6:1. 4. It appears that implementing a self care program in a worksite setting can be an effective way to reduce employer health care costs.

  18. Effects of decentralized health care financing on maternal care in Indonesia

    NARCIS (Netherlands)

    R. Hartwig (Renate); R.A. Sparrow (Robert); S. Budiyati (Sri); A. Yumna (Athia); N. Warda (Nila); A. Suryahadi (Asep); A.S. Bedi (Arjun Singh)

    2015-01-01

    textabstractWe exploit variation in the design of sub-national health care financing initiatives in Indonesian districts to assess the effects of these local schemes on maternal care from 2004 to 2010. The analysis is based on a district pseudo-panel, combining data from a unique survey among

  19. A review on the analysis of ingredients with health care effects in health food in Taiwan

    Directory of Open Access Journals (Sweden)

    Pai-Wen Wu

    2015-09-01

    Full Text Available This review article discusses the analysis of ingredients with health care effects in health food in Taiwan. The top 10 items on the list of registered health food products up to 2014 in Taiwan are described, including monocolin K, ω-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid, β-glucans, inulin, catechins, oligosaccharides, resistant maltodextrin, amino acids, medium chain fatty acids, and polysaccharides. Some analytical methods for the analysis of ingredients with health care effects are announced to the public on the website of health food section of the Taiwan Food and Drug Administration for the application and the postmarket surveillance of health food. Each application of health food should include the appropriate analytical method for the analysis of the ingredient or specific compound that has the health care effect, for the sake of quality assurance. Self-management of each applicant is required for regulation, the reputation of its own, and social responsibility to the consumers.

  20. Health care operations management

    NARCIS (Netherlands)

    Carter, M.W.; Hans, Elias W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

  1. Effects of Health-Care Services and Commodities Cost on the ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... cross-sectional survey of six primary health-care facilities in Zaria metropolis, namely Baban dodo, Tudun ... Adegboyega and Abioye: Effect of Health-Care services and commodities cost in North western Nigeria. 1028. Nigerian ..... Integrating primary health care governance-primary health care under one.

  2. Effects of professional oral health care on elderly: randomized trial.

    Science.gov (United States)

    Morino, T; Ookawa, K; Haruta, N; Hagiwara, Y; Seki, M

    2014-11-01

    To better understand the role of the professional oral health care for elderly in improving geriatric oral health, the effects of short-term professional oral health care (once per week for 1 month) on oral microbiological parameters were assessed. Parallel, open-labelled, randomize-controlled trial was undertaken in a nursing home for elderly in Shizuoka, Japan. Thirty-four dentate elderly over 74 years were randomly assigned from ID number to the intervention (17/34) and control (17/34) groups. The outcomes were changes in oral microbiological parameters (number of bacteria in unstimulated saliva; whole bacteria, Streptococcus, Fusobacterium and Prevotella: opportunistic pathogens detection: and index of oral hygiene evaluation [Dental Plaque Index, DPI]) within the intervention period. Each parameter was evaluated at before and after intervention period. Four elderly were lost from mortality (1), bone fracture (1), refused to participate (1) and multi-antibiotics usage (1). Finally, 30 elderly were analysed (14/intervention and 16/control). At baseline, no difference was found between the control and intervention groups. After the intervention period, the percentage of Streptococcus species increased significantly in the intervention group (Intervention, 86% [12/14]; Control, 50% [8/16]: Fisher's, right-tailed, P oral health care can improve oral conditions in the elderly. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. The effect of mergers and acquisitions on behavioral health care.

    Science.gov (United States)

    Lazarus, A

    1995-01-01

    The consolidation of America's managed health care industry rivals any corporate raider scenario. Unlike previous merger booms, however, health care unions in the 1990s have been strategically planned. Particular attention is paid to merger activity in the behavioral health care field. Ultimately, the author writes, mergers will bring greater efficiency and lower costs to health care but also less choice for patients. Unless providers and payers pay close attention to the human side of mergers and acquisitions, new alliances are likely to fall short of their goals.

  4. Potential Effects of Health Care Policy Decisions on Physician Availability

    Science.gov (United States)

    Garcia, Christopher; Goodrich, Michael

    2011-01-01

    Many regions in America are experiencing downward trends in the number of practicing physicians and the number of available physician hours, resulting in a worrisome decrease in the availability of health care services. Recent changes in American health care legislation may induce a rapid change in the demand for health care services, which in turn will result in a new supply-demand equilibrium . In this paper we develop a system dynamics model linking physician availability to health care demand and profitability. We use this model to explore scenarios based on different initial conditions and describe possible outcomes for a range of different policy decisions.

  5. Health Care Accessibility Modeling: Effects of Change in Spatial Representation of Demand for Primary Health Care Services

    Directory of Open Access Journals (Sweden)

    Jankowski Piotr

    2014-09-01

    Full Text Available Health care accessibility can be measured by the number of prospective patients who could reach a medical facility within a prescribed time limit. The representation of health care demand in estimating accessibility is an important consideration since different spatial aggregations of demand have different consequences with regard to accessibility estimates. This article examines the effects of aggregating population demand for primary health care, ranging from census tract to aggregated census block, on estimates of primary health care accessibility. Spatial representations of aggregated demand were incorporated into a location-allocation model in order to determine a measure of accessibility represented by the unmet demand for primary health care services. The model was implemented for the U.S. State of Idaho, based on the allocation of Idaho residents’ demand for primary health care to the state’s existing primary health care facilities. The results confirm a relationship between the level of demand aggregation and the level of potential accessibility. In case of a rural state such as Idaho the relationship is positive; higher levels of aggregation result in higher measures of accessibility.

  6. Organizational leadership for building effective health care teams.

    Science.gov (United States)

    Taplin, Stephen H; Foster, Mary K; Shortell, Stephen M

    2013-01-01

    The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.

  7. The effect of health care expenditure on patient outcomes: Evidence from English neonatal care.

    Science.gov (United States)

    Watson, Samuel; Arulampalam, Wiji; Petrou, Stavros

    2017-12-01

    The relationship between health care expenditure and health outcomes has been the subject of recent academic inquiry in order to inform cost-effectiveness thresholds for health technology assessment agencies. Previous studies in public health systems have relied upon data aggregated at the national or regional level; however, there remains debate about whether the supply side effect of changes to expenditure are identifiable using data at this level of aggregation. We use detailed patient data derived from electronic neonatal records across England along with routinely available cost data to estimate the effect of changes to patient expenditure on clinical health outcomes in a well-defined patient population. A panel of 32 neonatal intensive care units for the period 2009-2013 was constructed. Accounting for the potential endogeneity of expenditure a £100 increase in the cost per intensive care cot day (sample average cost: £1,127) is estimated to reduce the risk of mortality of 0.38 percentage points (sample average mortality: 11.0%) in neonatal intensive care. This translates into a cost per life saved in neonatal intensive care of approximately £420,000. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Interactive telemedicine: effects on professional practice and health care outcomes.

    Science.gov (United States)

    Flodgren, Gerd; Rachas, Antoine; Farmer, Andrew J; Inzitari, Marco; Shepperd, Sasha

    2015-09-07

    Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3

  9. The effect of complementary private health insurance on the use of health care services.

    Science.gov (United States)

    Kiil, Astrid; Arendt, Jacob Nielsen

    2017-03-01

    This study estimates the effect of complementary private health insurance (PHI) on the use of health care. The empirical analysis focuses on an institutional setting in which empirical findings are still limited; namely on PHI covering co-payment for treatments that are only partly financed by a universal health care system. The analysis is based on Danish data recently collected specifically for this purpose, which makes identification strategies assuming selection on observables only, and on both observables and unobservables also, both plausible and possible. We find evidence of a substantial positive and significant effect of complementary PHI on the use of prescription medicine and chiropractic care, a smaller but significant effect on dental care, weaker indications of effects for physiotherapy and general practice, and finally that the use of hospital-based outpatient care is largely unaffected. This implies that complementary PHI is generally not simply a marker of a higher propensity to use health care but induces additional use of some health care services over and above what would be used in the absence of such coverage.

  10. Effectiveness of oral health education among primary health care workers at the primary health center in Nellore district, Andhra Pradesh

    Directory of Open Access Journals (Sweden)

    Muthyala Pavana Sandhya

    2014-01-01

    Full Text Available Background: Primary dental care can be a way of achieving good oral health for the community. This can be achieved by integration of oral health care with the existing primary health care activities through training of primary health care workers on aspects of oral health. Objective: To assess the effectiveness of oral health education among primary health care workers at the primary health center (PHC in Nellore district, Andhra Pradesh. Materials and Methods: Descriptive longitudinal study was conducted from June 2010 to August 2010 at a PHC. Knowledge about oral health among primary health care workers was pretested using a self-administered questionnaire prepared in local language (Telugu. Later after a month health education was provided to the health workers, and pamphlets with information on oral health were distributed. Posttest assessment was done 1-month after providing health education using the same questionnaire. Statistical analysis was performed using the SPSS 12.0 software, Student′s t-test was used to compare knowledge scores between pre and posttests. Results: A total of 118 Primary Health Care Workers with the majority in the 20-30 years age group participated in the study. Posttest assessment showed a change in knowledge level with an overall increase in knowledge level of primary health care workers with a mean difference of 12.56 ± 3.23, which was highly significant (P < 0.001. Conclusion: The knowledge about oral health was poor, and it improved after providing health education to primary health care workers. Change in knowledge was appreciable and may play a key role in oral health promotion of the vast majority of the rural population.

  11. Effect of social media in health care and orthopedic surgery.

    Science.gov (United States)

    Saleh, Jenine; Robinson, Brooke S; Kugler, Nathan W; Illingworth, Kenneth D; Patel, Pranay; Saleh, Khaled J

    2012-04-01

    With the growth of social media platforms, their potential to affect health care, and orthopedics specifically, continues to expand. We reviewed the literature to obtain all pertinent information on social media in health care and examined its strengths and weaknesses from patient and physician perspectives. Health care professionals have slowly begun to use social media to stay connected with patients. The recent use of networking sites aims to improve education, provide a forum to discuss relevant medical topics, and allow for improved patient care. The use of social media, with the understanding of its limitations, may help promote patient happiness and safety and serve as an educational platform. Copyright 2012, SLACK Incorporated.

  12. Effect of Progressive Muscle Relaxation in Female Health Care ...

    African Journals Online (AJOL)

    Background: Increasing population, fast paced industrialization, increased, competitiveness, unanticipated problems in the work place have increased the stress among the females working in health care in recent times. Aim: The aim of the following study is to detect the stress levels among female health care professionals ...

  13. Augmenting health care failure modes and effects analysis with simulation

    DEFF Research Database (Denmark)

    Staub-Nielsen, Ditte Emilie; Dieckmann, Peter; Mohr, Marlene

    2014-01-01

    This study explores whether simulation plays a role in health care failure mode and effects analysis (HFMEA); it does this by evaluating whether additional data are found when a traditional HFMEA is augmented with simulation. Two multidisciplinary teams identified vulnerabilities in a process...... by brainstorming, followed by simulation. Two means of adding simulation were investigated as follows: just simulating the process and interrupting the simulation between substeps of the process. By adding simulation to a traditional HFMEA, both multidisciplinary teams identified additional data that were relevant...

  14. [A health promotion programme's effectiveness in reducing medical care costs].

    Science.gov (United States)

    Martínez-López, Elkin; Grajales, Isabel C

    2010-12-01

    Regularly engaging in physical activity should enable disease incidence to become reduced and may result in reducing healthcare costs. Exploring possible health care cost reduction in active people. An active group of people's medical costs were contrasted with those of a control group of people taken at random from the rest of the population so covered in a health-care providing institution. Medical costs were lower for active people in areas such as emergency room visits, hospitalization and providing medication; a reduction was observed in the frequency of cases and the average cost per patient and per service. Regular physical activity reduces health care requirements and thereby leads to significant savings in health-care costs. This leads to promising perspectives for implementing health promotion programmes amongst the population and rationalising health sector financial resources.

  15. Effect of Progressive Muscle Relaxation in Female Health Care ...

    African Journals Online (AJOL)

    Keywords: Female stress, relaxation techniques, health care professionals. Original Article ... Stress management programs such as meditation, yoga, hypnosis ..... stress in undergraduate medical students at S. N. Medical College,. Bagalkot ...

  16. Environmental Impacts of the U.S. Health Care System and Effects on Public Health.

    Directory of Open Access Journals (Sweden)

    Matthew J Eckelman

    Full Text Available The U.S. health care sector is highly interconnected with industrial activities that emit much of the nation's pollution to air, water, and soils. We estimate emissions directly and indirectly attributable to the health care sector, and potential harmful effects on public health. Negative environmental and public health outcomes were estimated through economic input-output life cycle assessment (EIOLCA modeling using National Health Expenditures (NHE for the decade 2003-2013 and compared to national totals. In 2013, the health care sector was also responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%, greenhouse gas emissions (10%, smog formation (10% criteria air pollutants (9%, stratospheric ozone depletion (1%, and carcinogenic and non-carcinogenic air toxics (1-2%. The largest contributors to impacts are discussed from both the supply side (EIOLCA economic sectors and demand side (NHE categories, as are trends over the study period. Health damages from these pollutants are estimated at 470,000 DALYs lost from pollution-related disease, or 405,000 DALYs when adjusted for recent shifts in power generation sector emissions. These indirect health burdens are commensurate with the 44,000-98,000 people who die in hospitals each year in the U.S. as a result of preventable medical errors, but are currently not attributed to our health system. Concerted efforts to improve environmental performance of health care could reduce expenditures directly through waste reduction and energy savings, and indirectly through reducing pollution burden on public health, and ought to be included in efforts to improve health care quality and safety.

  17. Cultural competence and perceptions of community health workers' effectiveness for reducing health care disparities.

    Science.gov (United States)

    Mobula, Linda M; Okoye, Mekam T; Boulware, L Ebony; Carson, Kathryn A; Marsteller, Jill A; Cooper, Lisa A

    2015-01-01

    Community health worker (CHW) interventions improve health outcomes of patients from underserved communities, but health professionals' perceptions of their effectiveness may impede integration of CHWs into health care delivery systems. Whether health professionals' attitudes and skills, such as those related to cultural competence, influence perceptions of CHWs, is unknown. A questionnaire was administered to providers and clinical staff from 6 primary care practices in Maryland from April to December 2011. We quantified the associations of self-reported cultural competence and preparedness with attitudes toward the effectiveness of CHWs using logistic regression adjusting for respondent age, race, gender, provider/staff status, and years at the practice. We contacted 200 providers and staff, and 119 (60%) participated. Those reporting more cultural motivation had higher odds of perceiving CHWs as helpful for reducing health care disparities (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 3.48-28.80). Those reporting more frequent culturally competent behaviors also had higher odds of believing CHWs would help reduce health disparities (OR = 3.58, 95% CI = 1.61-7.92). Attitudes toward power and assimilation were not associated with perceptions of CHWs. Cultural preparedness was associated with perceived utility of CHWs in reducing health care disparities (OR = 2.33, 95% CI = 1.21-4.51). Providers and staff with greater cultural competence and preparedness have more positive expectations of CHW interventions to reduce healthcare disparities. Cultural competency training may complement the use of CHWs and support their effective integration into primary care clinics that are seeking to reduce disparities. © The Author(s) 2014.

  18. Effectiveness of screening for diabetes mellitus in dental health care.

    Science.gov (United States)

    Engström, S; Berne, C; Gahnberg, L; Svärdsudd, K

    2013-02-01

      The aim of the present study was to test the effectiveness of opportunistic blood glucose screening in a cooperational framework between dental and primary health care.   Altogether, 1568 subjects, age 20-75 years, with no previous history of diabetes, who came for a regular dental examination, had their non-fasting blood glucose measured with a portable blood glucose meter. Subjects with a concentration of ≥ 6.7 mmol/l (121 mg dl(-1) ) were referred to their primary healthcare centre for follow-up. The outcome, a diagnosis of diabetes mellitus, was obtained from primary healthcare centre and hospital patient records, during 3 years after screening.   Of the 155 (9.9%) subjects who screened positive, 139 (89.7%) came to their primary healthcare centre within the 3-year follow-up period and nine (5.8%) were diagnosed as having diabetes mellitus according to the World Health Organization criteria. Of the 1413 subjects who screened negative, 1137 (80.5%) came to the primary healthcare centre and eight (0.6%) were found to have diabetes mellitus. Screening sensitivity was 52.9%, specificity 90.6% and positive predictive value 5.8%. The number of subjects needed to screen to find one case of diabetes was 196. Delineating the study population to those 40- to 75-year-olds with a BMI ≥ 25 kg/m(2) , and 30-to 75-year-olds with a BMI ≥ 30 kg/m(2) , the numbers needed to screen was reduced to 96.   Cooperation between dental and primary care for high blood glucose screening and follow-up appears to be a feasible method for early diagnosis of diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

  19. The effects of health care reforms on health inequalities: a review and analysis of the European evidence base.

    Science.gov (United States)

    Gelormino, Elena; Bambra, Clare; Spadea, Teresa; Bellini, Silvia; Costa, Giuseppe

    2011-01-01

    Health care is widely considered to be an important determinant of health. The health care systems of Western Europe have recently experienced significant reforms, under pressure from economic globalization. Similarly, in Eastern Europe, health care reforms have been undertaken in response to the demands of the new market economy. Both of these changes may influence equality in health outcomes. This article aims to identify the mechanisms through which health care may affect inequalities. The authors conducted a literature review of the effects on health inequalities of European health care reforms. Particular reference was paid to interventions in the fields of financing and pooling, allocation, purchasing, and provision of services. The majority of studies were from Western Europe, and the outcomes most often examined were access to services or income distribution. Overall, the quality of research was poor, confirming the need to develop an appropriate impact assessment methodology. Few studies were related to pooling, allocation, or purchasing. For financing and purchasing, the studies showed that publicly funded universal health care reduces the impact of ill health on income distribution, while insurance systems can increase inequalities in access to care. Out-of-pocket payments increase inequalities in access to care and contribute to impoverishment. Decentralizing health services can lead to geographic inequalities in health care access. Nationalized, publicly funded health care systems are most effective at reducing inequalities in access and reducing the effects on health of income distribution.

  20. Occupational health care system and its effectiveness in Lithuania.

    Science.gov (United States)

    Januskevicius, Vidmantas; Telksniene, Ruta

    2002-01-01

    The Ministry of Labor and Social Affairs in collaboration with the Ministry of Health Care carries out the activities aimed at solving occupational health and safety problems in Lithuania. Occupational health care system in Lithuania consists of three levels: 1) primary occupational health centers in the industry; 2) general practitioners taking care of employees' health; and 3) the State Labor Inspectorate. The second level includes regional occupational medicine centers that are located in the three major cities of Lithuania: Vilnius, Kaunas and Klaipeda. Hygiene investigations of workplaces and prophylaxis of occupational diseases are performed by regional Public Health Center Departments of Occupational Medicine. The third level is provided by the Lithuanian Center of Occupational Medicine in Vilnius and the State Commission of Medical and Social Examination. The complicated cases of occupational diseases are treated in specialized departments of the University clinics. The real situation of work safety is not good. About 600 cases of occupational diseases and over 2500 accidents, including 60 fatal causalities are registered annually.

  1. The Effects of Prenatal Care Utilization on Maternal Health and Health Behaviors.

    Science.gov (United States)

    Yan, Ji

    2017-08-01

    While many economic studies have explored the role of prenatal care in infant health production, the literature is sporadic on the effects of prenatal care on the mother. This research contributes to this understudied but important area using a unique large dataset of sibling newborns delivered by 0.17 million mothers. We apply within-mother estimators to find robust evidence that poor prenatal care utilization due to late onset of care, low frequency of care visits, or combinations of the two significantly increases the risks of maternal insufficient gestational weight gain, prenatal smoking, premature rupture of membranes, precipitous labor, no breastfeeding, postnatal underweight, and postpartum smoking. The magnitude of the estimates relative to the respective sample means of the outcome variables ranges from 3% to 33%. The results highlight the importance of receiving timely and sufficient prenatal care in improving maternal health and health behaviors during pregnancy as well as after childbirth. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Effect of Progressive Muscle Relaxation in Female Health Care ...

    African Journals Online (AJOL)

    University of Health Sciences), West Bengal, 2Department of Psychiatry, D.Y. Patil Medical College, Pune, harashtra, India. Abstract ... a need to adopt early life‑style modification by practicing relaxation exercises to ameliorate stress and to improve not only their quality‑of‑life in general, but patient care in particular.

  3. The effect of restructuring of health care services on caesarean ...

    African Journals Online (AJOL)

    Objective. To review the anticipated changes in caesarean section (CS) rates following the restructuring of maternity health care services from regional to district level. Hypothesis. A change in provision of maternity services from regional to district level results in a decline in the CS rates. Method. A retrospective audit was ...

  4. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

  5. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months.Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files.Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis.Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required

  6. Effects of a sexual health care nursing record on the attitudes and practice of oncology nurses.

    Science.gov (United States)

    Jung, Dukyoo; Kim, Jung-Hee

    2016-10-01

    A nursing record focused on sexual health care for patients with cancer could encourage oncology nurses to provide sexual health care for oncology patients in a simple and effective manner. However, existing electronic information systems focus on professional use and not sexual health care, which could lead to inefficiencies in clinical practice. To examine the effects of a sexual health care nursing record on the attitudes and practice of oncology nurses. Twenty-four full-time registered nurses caring for oncology patients were randomly assigned to the intervention and control groups in Korea. The researchers developed a sexual health care record and applied it to the intervention group for one month. Data were analyzed by Mann-Whitney U test and chi-square test. Content analysis was used to analyze interviews. Oncology nurses using the sexual health care record had significantly higher levels of sexual health care practice at 4 weeks post-intervention as compared to those who provided usual care to patients with cancer. A sexual health care record may have the potential to facilitate oncology nurses' practice of sexual health care. This study highlighted the importance of using SHC records with oncology patients to improve nursing practice related to sexuality issues. A nursing record focused on SHC for patients with cancer could make it easier and more effective for oncology nurses to provide such care to their patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. The effect of financial incentives on the quality of health care provided by primary care physicians.

    Science.gov (United States)

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris

    2011-09-07

    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome

  8. [Cost-effectiveness in Dutch mental health care: future because of ROM?].

    Science.gov (United States)

    van Agthoven, M; van der Kolk, A; Knegtering, H; Delespaul, Ph A E G; Arends, J; Jeurissen, P P T; Krabbe, P F M; Huijsman, R; Luijk, R; De Beurs, E; Hakkaart-Van Roijen, L; Bruggeman, R

    2015-01-01

    The document reporting Dutch mental health care negotiations for 2014-2017 calls for a cost decrease based on cost-effectiveness. Thanks to ROM, the Dutch mental health care seems well prepared for cost-effectiveness research. Evaluate how valid cost-effectiveness research should be established in mental health care and the role of rom therein. Evaluation of requirements of cost-effectiveness research, trends, and a translation to Dutch mental health care. Valid cost-effectiveness research in mental health care requires the application of a societal perspective, a long time-horizon and an adequate evaluation of quality of life of patients. Healthcare consumption, outcome of care and characterisation of the patient population should be measured systematically and continuously. Currently, rom-data are not suitable to serve as a basis for cost-effectiveness research, although a proper basis is present. Further development of rom could lead to a situation in which mental health care is purchased on the basis of cost-effectiveness. However, cost-effectiveness will only really be improved if quality of care is rewarded, rather than rewarding activities that are not always related to outcome of care. Cost-effectiveness research in mental health care should focus on societal costs and benefits, quality of life and a long time-horizon. If developed further, rom has the potential to be a basis for cost-effectiveness research in the future.

  9. Effect of progressive muscle relaxation in female health care professionals.

    Science.gov (United States)

    Chaudhuri, A; Ray, M; Saldanha, D; Bandopadhyay, Ak

    2014-09-01

    Increasing population, fast paced industrialization, increased, competitiveness, unanticipated problems in the work place have increased the stress among the females working in health care in recent times. The aim of the following study is to detect the stress levels among female health care professionals in the age group of 25-35 years and its impact on health. A prospective cross-sectional pilot project was conducted in a tertiary care hospital in Eastern part of India, after receiving approval from the Institutional Ethics Committee and informed consent form was taken from the subjects. Stress level in the subjects was assessed according to the presumptive life event stress scale. Females with scores above 200 were selected. For these, initial assessment of anthropometric measurement, electrocardiogram and lipid profile analysis, resting pulse rate, blood pressure, physical fitness index (PFI), breath holding time (BHT), isometric hand grip (IHG) test results were evaluated and recorded. All subjects were given training of progressive muscle relaxation (PMR) for 3 months. After 3 months, the lipid profile and vital parameters, Perceived Stress Scale values were re-evaluated and subjects were asked to repeat the same exercises and data thus recorded were analyzed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). Significant decrease in resting heart rate, blood pressure and Perceived Stress Scale levels was seen after PMR training in the subjects. Results of BHT, IHG tests and PFI were significantly increased after PMR training. There was a significant decrease in total cholesterol, triglyceride and low-density lipoprotein cholesterol in subjects after practicing PMR for 3 months. Increasing stress among female health care professionals is a cause for concern and there is a need to adopt early life-style modification by practicing relaxation exercises to ameliorate

  10. [Cost-effectiveness in Dutch mental health care: future because of ROM?

    NARCIS (Netherlands)

    Agthoven, M. van; Kolk, A. van der; Knegtering, H.; Delespaul, P.A.; Arends, J.; Jeurissen, P.P.T.; Krabbe, P.F.M.; Huijsman, R.; Luijk, R.; Beurs, E. de; Hakkaart-van Roijen, L.; Bruggeman, R.

    2015-01-01

    BACKGROUND: The document reporting Dutch mental health care negotiations for 2014 - 2017 calls for a cost decrease based on cost-effectiveness. Thanks to rom, the Dutch mental health care seems well prepared for cost-effectiveness research.
    AIM: Evaluate how valid cost-effectiveness

  11. Effectiveness of the Health Complex Model in Iranian primary health care reform: the study protocol.

    Science.gov (United States)

    Tabrizi, Jafar Sadegh; Farahbakhsh, Mostafa; Sadeghi-Bazargani, Homayoun; Hassanzadeh, Roya; Zakeri, Akram; Abedi, Leili

    2016-01-01

    Iranian traditional primary health care (PHC) system, although proven to be successful in some areas in rural populations, suffers major pitfalls in providing PHC services in urban areas especially the slum urban areas. The new government of Iran announced a health reform movement including the health reform in PHC system of Iran. The Health Complex Model (HCM) was chosen as the preferred health reform model for this purpose. This paper aims to report a detailed research protocol for the assessment of the effectiveness of the HCM in Iran. An adaptive controlled design is being used in this research. The study is planned to measure multiple endpoints at the baseline and 2 years after the intervention. The assessments will be done both in a population covered by the HCM, as intervention area, and in control populations covered by the traditional health care system as the control area. Assessing the effectiveness of the HCM, as the Iranian PHC reform initiative, could help health system policy makers for future decisions on its continuation or modification.

  12. Effects of Health Education Programs for the Elders in Community Care Centers – Evaluated by Health Promotion Behaviors

    Directory of Open Access Journals (Sweden)

    Kuo-Song Chang

    2017-06-01

    Conclusion: The health education programs specifically for elders and middle age adults in community care centers were effective in raising the awareness of health promotion behaviors. The success could provide a reference for future studies developing health promotion and education programs and holistic care for community elders and middle age adults in Taiwan.

  13. Turnover in health care: the mediating effects of employee engagement.

    Science.gov (United States)

    Collini, Stevie A; Guidroz, Ashley M; Perez, Lisa M

    2015-03-01

    This study aimed to understand the interaction between interpersonal respect, diversity climate, mission fulfilment and engagement to better predict turnover in health care. Registered nurse turnover has averaged 14% and current nursing shortages are expected to spread. Few studies have studied employee engagement as a mediator between organisational context and turnover. Study participants were employees working within 185 departments across ten hospitals within a large healthcare organisation in the USA. Although a total of 5443 employees work in these departments, employee opinion survey responses were aggregated by department before being linked to turnover rates gathered from company records. Engagement fully mediated the relationship between respect and turnover and the relationship between mission fulfilment and turnover. Diversity climate was not related to turnover. Turnover in health care poses a significant threat to the mission of creating a healing environment for patients and these results demonstrate that workplace respect and connection to the mission affect turnover by decreasing engagement. The findings demonstrated that to increase engagement, and improve turnover rates in health care, it would be beneficial for organisations, and nurse management to focus on improving mission fulfilment and interpersonal relationships. © 2013 John Wiley & Sons Ltd.

  14. effectiveness of an oral health care training workshop for school ...

    African Journals Online (AJOL)

    a large number of children thereby play major role in the planning and implementation of oral health ... for the poor oral hygiene among them and their students. Objectives: To evaluate the effectiveness of an oral ... teachers who attended a two day oral health training workshop at. Eruwa, headquarters of Ibarapa East Local ...

  15. Partnership-Based Health Care: Suggestions for Effective Application

    Directory of Open Access Journals (Sweden)

    Teddie M Potter

    2015-06-01

    Full Text Available Societal transformation often starts with one visionary and a compelling idea. However, if there are no followers, the idea quickly becomes marginalized. It “takes a village” to build a movement, and the more system layers that can be addressed, the more likely the transformation will take hold. This article describes the framework for creating the necessary changes for partnership-based health care. It also makes suggestions for ensuring successful application of partnership-based systems change. This article is for all readers seeking to apply partnership principles in their own fields of influence.

  16. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    Science.gov (United States)

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2014-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  17. Extensions to decomposition of the redistributive effect of health care finance.

    Science.gov (United States)

    Zhong, Hai

    2009-10-01

    The total redistributive effect (RE) of health-care finance has been decomposed into vertical, horizontal and reranking effects. The vertical effect has been further decomposed into tax rate and tax structure effects. We extend this latter decomposition to the horizontal and reranking components of the RE. We also show how to measure the vertical, horizontal and reranking effects of each component of the redistributive system, allowing analysis of the RE of health-care finance in the context of that system. The methods are illustrated with application to the RE of health-care financing in Canada.

  18. Effect of primary health care reforms in Turkey on health service utilization and user satisfaction.

    Science.gov (United States)

    Hone, Thomas; Gurol-Urganci, Ipek; Millett, Christopher; Başara, Berrak; Akdağ, Recep; Atun, Rifat

    2017-02-01

    Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilization and user satisfaction.The effect of health system reforms, that introduced family medicine, on utilization was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services was explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (P care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30, respectively, a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8%, respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (P < 0.001) in PHC settings, but remained higher among urban, low-income and working-age populations. © The Author 2016. Published by Oxford University Press in association with

  19. Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs.

    Science.gov (United States)

    Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth

    2012-04-01

    To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide.

  20. Effects of home-based long-term care services on caregiver health according to age.

    Science.gov (United States)

    Chen, Ming-Chun; Kao, Chi-Wen; Chiu, Yu-Lung; Lin, Tzu-Ying; Tsai, Yu-Ting; Jian, Yi-Ting Zhang; Tzeng, Ya-Mei; Lin, Fu-Gong; Hwang, Shu-Ling; Li, Shan-Ru; Kao, Senyeong

    2017-10-23

    Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The

  1. Effect of training intervention on primary health care workers ...

    African Journals Online (AJOL)

    Design: A quasi experimental design, used multi stage sampling technique to select participants. Self-administered ... Conclusion: Training of PHC workers is an effective strategy of improving the level of knowledge and the quality of primary healthcare delivery services in Nigeria. Keywords: Primary healthcare, Oral health, ...

  2. Challenges to the effective delivery of health care to people with chronic hepatitis B in Australia.

    Science.gov (United States)

    Wallace, Jack; McNally, Stephen; Richmond, Jacqui; Hajarizadeh, Behzad; Pitts, Marian

    2012-05-01

    The complexity of the hepatitis B natural history and its prevalence in specific populations in Australia challenges the capacity of the health system to deliver health care effectively to affected people. This study explores the challenges in delivering health care to people with chronic hepatitis B (CHB) in Australia. We conducted a grounded theory based qualitative study in which data were gathered from 70 in-depth interviews with government program officers, clinicians and health and community workers across Australia, and four focus group discussions with 40 health and community workers from the communities most at risk of CHB. A systematic approach to screening populations at risk, including people born in countries with intermediate or high prevalence of CHB; consensus on clinical guidelines; development of a shared care framework for CHB involving general practitioners; and effective communication between patients and health professionals were identified as essential. Workforce development, particularly for primary health care professionals, and developing the knowledge and capacity of health professionals to communicate effectively with people with HBV were described as other major factors in reducing the barriers to CHB treatment in Australia. To improve the clinical management of people with CHB in Australia, the health system needs to encourage the screening of people at risk, improve access to clinical services, and the knowledge and communication skills of primary health care and community health service providers. This study supported developing a shared care model and related infrastructures including training programs, referral pathways and clinical guidelines.

  3. Portals to Wonderland: health portals lead to confusing information about the effects of health care.

    Science.gov (United States)

    Glenton, Claire; Paulsen, Elizabeth J; Oxman, Andrew D

    2005-03-15

    The Internet offers a seemingly endless amount of health information of varying quality. Health portals, which provide entry points to quality-controlled collections of websites, have been hailed as a solution to this problem. The objective of this study is to assess the extent to which government-run health portals provide access to relevant, valid and understandable information about the effects of health care. We selected eight clinically relevant questions for which there was a systematic review, searched four portals for answers, and compared the answers we found to the results of the systematic reviews. Our searches resulted in 3400 hits, 155 of which mentioned both the condition and the intervention in one of the eight questions. Sixty-three of the 155 web pages did not give any information about the effect of the intervention. Seventy-seven qualitatively described the effects of the intervention. Twenty-six of these had information that was too unclear to be categorised; 15 were not consistent with the systematic review; and 36 were consistent with the review, but usually did not mention what happens without the intervention, what outcomes have been measured or when they were measured. Fifteen web pages quantitatively described effects. Four of these were abstracts from the systematic review, nine had information that was incomplete and potentially misleading because of a lack of information about people not receiving the intervention and the length of follow-up; one had information that was consistent with the review, but only referred to three trials whereas the review included six; and one was consistent with the review. Information accessible through health portals is unlikely to be based on systematic reviews and is often unclear, incomplete and misleading. Portals are only as good as the websites they lead to. Investments in national health portals are unlikely to benefit consumers without investments in the production and maintenance of relevant

  4. Portals to Wonderland: Health portals lead to confusing information about the effects of health care

    Directory of Open Access Journals (Sweden)

    Oxman Andrew D

    2005-03-01

    Full Text Available Abstract Background The Internet offers a seemingly endless amount of health information of varying quality. Health portals, which provide entry points to quality-controlled collections of websites, have been hailed as a solution to this problem. The objective of this study is to assess the extent to which government-run health portals provide access to relevant, valid and understandable information about the effects of health care. Methods We selected eight clinically relevant questions for which there was a systematic review, searched four portals for answers, and compared the answers we found to the results of the systematic reviews. Results Our searches resulted in 3400 hits, 155 of which mentioned both the condition and the intervention in one of the eight questions. Sixty-three of the 155 web pages did not give any information about the effect of the intervention. Seventy-seven qualitatively described the effects of the intervention. Twenty-six of these had information that was too unclear to be categorised; 15 were not consistent with the systematic review; and 36 were consistent with the review, but usually did not mention what happens without the intervention, what outcomes have been measured or when they were measured. Fifteen web pages quantitatively described effects. Four of these were abstracts from the systematic review, nine had information that was incomplete and potentially misleading because of a lack of information about people not receiving the intervention and the length of follow-up; one had information that was consistent with the review, but only referred to three trials whereas the review included six; and one was consistent with the review. Conclusion Information accessible through health portals is unlikely to be based on systematic reviews and is often unclear, incomplete and misleading. Portals are only as good as the websites they lead to. Investments in national health portals are unlikely to benefit consumers

  5. Effects of different broiler production systems on health care costs in the Netherlands.

    Science.gov (United States)

    Gocsik, É; Kortes, H E; Lansink, A G J M Oude; Saatkamp, H W

    2014-06-01

    This study analyzed the effects of different broiler production systems on health care costs in the Netherlands. In addition to the conventional production system, the analysis also included 5 alternative animal welfare systems representative of the Netherlands. The study was limited to the most prevalent and economically relevant endemic diseases in the broiler farms. Health care costs consisted of losses and expenditures. The study investigated whether higher animal welfare standards increased health care costs, in both absolute and relative terms, and also examined which cost components (losses or expenditures) were affected and, if so, to what extent. The results show that health care costs represent only a small proportion of total production costs in each production system. Losses account for the major part of health care costs, which makes it difficult to detect the actual effect of diseases on total health care costs. We conclude that, although differences in health care costs exist across production systems, health care costs only make a minor contribution to the total production costs relative to other costs, such as feed costs and purchase of 1-d-old chicks. Poultry Science Association Inc.

  6. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, Nigeria. 1. 2. Adam V.Y , Iseh A.E. ABSTRACT. Introduction. The level of accurate knowledge adolescents have about HIV/AIDS, is important to enhance effective preventive actions, which ultimately result in a decrease in the incidence of ...

  7. The Effect of Health Information Technology on Health Care Provider Communication: A Mixed-Method Protocol.

    Science.gov (United States)

    Manojlovich, Milisa; Adler-Milstein, Julia; Harrod, Molly; Sales, Anne; Hofer, Timothy P; Saint, Sanjay; Krein, Sarah L

    2015-06-11

    Communication failures between physicians and nurses are one of the most common causes of adverse events for hospitalized patients, as well as a major root cause of all sentinel events. Communication technology (ie, the electronic medical record, computerized provider order entry, email, and pagers), which is a component of health information technology (HIT), may help reduce some communication failures but increase others because of an inadequate understanding of how communication technology is used. Increasing use of health information and communication technologies is likely to affect communication between nurses and physicians. The purpose of this study is to describe, in detail, how health information and communication technologies facilitate or hinder communication between nurses and physicians with the ultimate goal of identifying how we can optimize the use of these technologies to support effective communication. Effective communication is the process of developing shared understanding between communicators by establishing, testing, and maintaining relationships. Our theoretical model, based in communication and sociology theories, describes how health information and communication technologies affect communication through communication practices (ie, use of rich media; the location and availability of computers) and work relationships (ie, hierarchies and team stability). Therefore we seek to (1) identify the range of health information and communication technologies used in a national sample of medical-surgical acute care units, (2) describe communication practices and work relationships that may be influenced by health information and communication technologies in these same settings, and (3) explore how differences in health information and communication technologies, communication practices, and work relationships between physicians and nurses influence communication. This 4-year study uses a sequential mixed-methods design, beginning with a

  8. Silver in health care: antimicrobial effects and safety in use.

    Science.gov (United States)

    Lansdown, Alan B G

    2006-01-01

    Silver has a long and intriguing history as an antibiotic in human health care. It has been developed for use in water purification, wound care, bone prostheses, reconstructive orthopaedic surgery, cardiac devices, catheters and surgical appliances. Advancing biotechnology has enabled incorporation of ionizable silver into fabrics for clinical use to reduce the risk of nosocomial infections and for personal hygiene. The antimicrobial action of silver or silver compounds is proportional to the bioactive silver ion (Ag(+)) released and its availability to interact with bacterial or fungal cell membranes. Silver metal and inorganic silver compounds ionize in the presence of water, body fluids or tissue exudates. The silver ion is biologically active and readily interacts with proteins, amino acid residues, free anions and receptors on mammalian and eukaryotic cell membranes. Bacterial (and probably fungal) sensitivity to silver is genetically determined and relates to the levels of intracellular silver uptake and its ability to interact and irreversibly denature key enzyme systems. Silver exhibits low toxicity in the human body, and minimal risk is expected due to clinical exposure by inhalation, ingestion, dermal application or through the urological or haematogenous route. Chronic ingestion or inhalation of silver preparations (especially colloidal silver) can lead to deposition of silver metal/silver sulphide particles in the skin (argyria), eye (argyrosis) and other organs. These are not life-threatening conditions but cosmetically undesirable. Silver is absorbed into the human body and enters the systemic circulation as a protein complex to be eliminated by the liver and kidneys. Silver metabolism is modulated by induction and binding to metallothioneins. This complex mitigates the cellular toxicity of silver and contributes to tissue repair. Silver allergy is a known contra-indication for using silver in medical devices or antibiotic textiles.

  9. Strategic information technology alliances for effective health-care supply chain management.

    Science.gov (United States)

    Shih, Stephen C; Rivers, Patrick A; Hsu, H Y Sonya

    2009-08-01

    To gain and sustain competitive advantage, health-care providers have to continuously review and renovate their operational and information technology (IT) strategies through collaborative and cooperative endeavour with their supply chain channel members. This paper explores new ways of enhancing a health-care organization's responsiveness to changes and increasing its competitiveness through implementing strategic information technology alliances among channel members in a health-care supply chain network. An overview of issues and problems (e.g. bullwhip effect, negative externalities and free-riding phenomenon in multichannel supply chains) presented in the health-care supply chains is first delineated. This paper further goes over the issues of health-care supply chain coordination and integration for strategic IT alliances, followed by the discussion of the spillover effect of IT investments. A number of viable IT practices (such as information sharing and Internet-enabled supply chain portal) for effective health-care supply chain collaboration and coordination are then examined in this research. Finally, the paper discusses how strategic IT alliances can help improve the effectiveness of health-care supply chain management.

  10. Mental health care and average happiness: strong effect in developed nations.

    Science.gov (United States)

    Touburg, Giorgio; Veenhoven, Ruut

    2015-07-01

    Mental disorder is a main cause of unhappiness in modern society and investment in mental health care is therefore likely to add to average happiness. This prediction was checked in a comparison of 143 nations around 2005. Absolute investment in mental health care was measured using the per capita number of psychiatrists and psychologists working in mental health care. Relative investment was measured using the share of mental health care in the total health budget. Average happiness in nations was measured with responses to survey questions about life-satisfaction. Average happiness appeared to be higher in countries that invest more in mental health care, both absolutely and relative to investment in somatic medicine. A data split by level of development shows that this difference exists only among developed nations. Among these nations the link between mental health care and happiness is quite strong, both in an absolute sense and compared to other known societal determinants of happiness. The correlation between happiness and share of mental health care in the total health budget is twice as strong as the correlation between happiness and size of the health budget. A causal effect is likely, but cannot be proved in this cross-sectional analysis.

  11. [Humanization in health care].

    Science.gov (United States)

    Oliveira, Beatriz Rosana Gonçalves de; Collet, Neusa; Viera, Cláudia Silveira

    2006-01-01

    This study aims to reflect on humanization in health care, recovering the history of understanding about mankind, the human and humanity, until humanization in humanity and health. We discuss the national humanization program in hospital care and reflect on this proposal and on the issue of humanization in Brazilian health care nowadays. Communication is indispensable to establish humanization, as well as technical and material conditions. Both users and health professionals need to be heard, building a network of dialogues to think and promote singular humanization actions. For this process to take effect, there is a need to involve the whole that makes up the health service. This group involves different professionals, such as managers, public policy makers, professional councils and education institutions.

  12. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    vaccine for their children. journal of. COMMUNITY HEALTH. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 46-58. Correspondence to: Ijadunola M.Y. Department of Community Health, Faculty of Clinical Sciences,. College of Health Sciences, Obafemi Awolowo University,.

  13. Aligning health information technologies with effective service delivery models to improve chronic disease care.

    Science.gov (United States)

    Bauer, Amy M; Thielke, Stephen M; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-09-01

    Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care, have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Health care technology assessment

    Science.gov (United States)

    Goodman, Clifford

    1994-12-01

    The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.

  15. An investigation into the effect of alcohol consumption on health status and health care utilization in Ireland.

    Science.gov (United States)

    Ormond, Gillian; Murphy, Rosemary

    2017-03-01

    This paper presents a study of the effect of alcohol consumption on individual health status and health care utilization in Ireland using the 2007 Slán National Health and Lifestyle Survey, while accounting for the endogenous relationship between alcohol and health. Drinkers are categorized as those who never drank, non-drinkers, moderate drinkers, or heavy drinkers, based on national recommended weekly drinking levels in Ireland. The drinking-status equation is estimated using an ordered probit model. Predicted values for the inverse mills ratio are generated, which are then included in the health and health-care utilization equations. Differences in health status for each category of drinker are examined, and the relationship between both alcohol consumption and health with a host of other personal and socio-economic variables is also identified. Given that the measure of health status available is self-assessed, the effect of alcohol consumption on health-care utilization is also analyzed as an alternative measure of health. Findings show that in Ireland, moderate drinkers enjoy the best health status. More moderate drinkers report having very good or excellent health compared with heavy drinkers, non-drinkers, or those who never drank. While heavy drinkers do not report having as good a health status as moderate drinkers, they are better off in terms of health when compared with non-drinkers and those who are lifetime abstainers. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Effective CKD care in European countries: challenges and opportunities for health policy.

    Science.gov (United States)

    Bello, Aminu K; Levin, Adeera; Manns, Braden J; Feehally, John; Drueke, Tilman; Faruque, Labib; Hemmelgarn, Brenda R; Kernahan, Charles; Mann, Johannes; Klarenbach, Scott; Remuzzi, Giuseppe; Tonelli, Marcello

    2015-01-01

    Chronic kidney disease (CKD) is an important global public health problem that is associated with adverse health outcomes and high health care costs. Effective and cost-effective treatments are available for slowing the progression of CKD and preventing its complications, including cardiovascular disease. Although wealthy nations have highly structured schemes in place to support the care of people with kidney failure, less consideration has been given to health systems and policy for the much larger population of people with non-dialysis-dependent CKD. Further, how to integrate such strategies with national and international initiatives for control of other chronic noncommunicable diseases (NCDs) merits attention. We synthesized the various approaches to CKD control across 17 European countries and present our findings according to the key domains suggested by the World Health Organization framework for NCD control. This report identifies opportunities to strengthen CKD-relevant health systems and explores potential mechanisms to capitalize on these opportunities. Across the 17 countries studied, we found a number of common barriers to the care of people with non-dialysis-dependent CKD: limited work force capacity, the nearly complete absence of mechanisms for disease surveillance, lack of a coordinated CKD care strategy, poor integration of CKD care with other NCD control initiatives, and low awareness of the significance of CKD. These common challenges faced by diverse health systems reflect the need for international cooperation to strengthen health systems and policies for CKD care. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  17. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    COMMUNITY HEALTH. & PRIMARY HEALTH CARE. KEYWORDS ABSTRACT. Correspondence to: Journal of Community Medicine and Primary Health Care. 26 (2) 1-6. Facility User's Preference between the Free and the Bamako. Initiative (Drug Revolving Fund-Based) Health Services in Iwajowa Local Government, Oyo ...

  18. Towards the effective introduction of physical activity interventions in primary health care

    NARCIS (Netherlands)

    Huijg, Johanna Maria

    2014-01-01

    Despite the promising findings related to the efficacy of primary health care-based physical activity interventions and recommendations for primary health care professionals to promote physical activity, the introduction of physical activity interventions in routine daily primary health care

  19. The painful effects of the financial crisis on Spanish health care.

    Science.gov (United States)

    Bosch, Xavier; Moreno, Pedro; López-Soto, Alfonso

    2014-01-01

    Spain has an advanced, integrated health care system that has achieved remarkable results, including substantially improved health outcomes, over a relatively short time. Measures introduced by central and regional governments to combat the financial crisis may be severely affecting the health sector, with proposed changes potentially threatening the principles of equity and social cohesion underlying the welfare state. This article examines recent developments in Spanish health care, focusing on the austerity measures introduced since 2010. In Spain, as in other countries, evaluation of health care changes is difficult due to the paucity of data and because the effects of measures often lag well behind their introduction, meaning the full effects of changes on access to care or health outcomes only become apparent years later. However, some effects are already clear. With exceptions, Spain has not used the crisis as an opportunity to increase efficiency and quality, rationalize and reorganize health services, increase productivity, and regain public trust. We argue that immediate health care cuts may not be the best long-term answer and suggest evidence-driven interventions that involve the portfolio of free services and the private sector, while ensuring that the most vulnerable are protected.

  20. The effects of public and private health care expenditure on health status in sub-Saharan Africa: New evidence from panel data analysis

    OpenAIRE

    Novignon, Jacob; Olakojo, Solomon A.; Nonvignon, Justice

    2012-01-01

    Background: Health care expenditure has been low over the years in developing regions of the world. A majority of countries in these regions, especially sub-Saharan Africa (SSA), rely on donor grants and loans to finance health care. Such expenditures are not only unsustainable but also inadequate considering the enormous health care burden in the region. The objectives of this study are to determine the effect of health care expenditure on population health status and to examine the effect b...

  1. Health care utilization

    DEFF Research Database (Denmark)

    Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren

    An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... containment measures affect the utilization of health services, and how these measures interact with the number of patients per provider. Based on very valid register data, this is investigated for 9.556 Danish physiotherapists between 2001 and 2008. We find that higher (relative) fees for a given service...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...

  2. Effective Interpersonal Health Communication for Linkage to Care After HIV Diagnosis in South Africa.

    Science.gov (United States)

    Mabuto, Tonderai; Charalambous, Salome; Hoffmann, Christopher J

    2017-01-01

    Early in the global response to HIV, health communication was focused toward HIV prevention. More recently, the role of health communication along the entire HIV care continuum has been highlighted. We sought to describe how a strategy of interpersonal communication allows for precision health communication to influence behavior regarding care engagement. We analyzed 1 to 5 transcripts from clients participating in longitudinal counseling sessions from a communication strategy arm of a randomized trial to accelerate entry into care in South Africa. The counseling arm was selected because it increased verified entry into care by 40% compared with the standard of care. We used thematic analysis to identify key aspects of communication directed specifically toward a client's goals or concerns. Of the participants, 18 of 28 were female and 21 entered HIV care within 90 days of diagnosis. Initiating a communication around client-perceived consequences of HIV was at times effective. However, counselors also probed around general topics of life disruption-such as potential for child bearing-as a technique to direct the conversation toward the participant's needs. Once individual concerns and needs were identified, counselors tried to introduce clinical care seeking and collaboratively discuss potential barriers and approaches to overcome to accessing that care. Through the use of interpersonal communication messages were focused on immediate needs and concerns of the client. When effectively delivered, it may be an important communication approach to improve care engagement.

  3. Effectiveness of an Oral Health Care Training Workshop for School ...

    African Journals Online (AJOL)

    date knowledge to pupils and students. However, most teachers in developing countries like Nigeria have poor knowledge and motivation about oral health which may be due to inadequate training in the area of oral health. This might be one of ...

  4. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    healthcare providers in south-east Nigerian. Malaria. National population commission and ORC Macro. Journal.2009;8:22. 6. Amaghionyeodiwe LA. Determinants of the. 15. World Health Organisation. The African choice of health care provider in Nigeria. Health malaria report 2003. Available at. Care Management Science.

  5. The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis.

    Science.gov (United States)

    Novignon, Jacob; Olakojo, Solomon A; Nonvignon, Justice

    2012-12-11

    Health care expenditure has been low over the years in developing regions of the world. A majority of countries in these regions, especially sub-Saharan Africa (SSA), rely on donor grants and loans to finance health care. Such expenditures are not only unsustainable but also inadequate considering the enormous health care burden in the region. The objectives of this study are to determine the effect of health care expenditure on population health status and to examine the effect by public and private expenditure sources. The study used panel data from 1995 to 2010 covering 44 countries in SSA. Fixed and random effects panel data regression models were fitted to determine the effects of health care expenditure on health outcomes. The results show that health care expenditure significantly influences health status through improving life expectancy at birth, reducing death and infant mortality rates. Both public and private health care spending showed strong positive association with health status even though public health care spending had relatively higher impact. The findings imply that health care expenditure remains a crucial component of health status improvement in sub-Saharan African countries. Increasing health care expenditure will be a significant step in achieving the Millennium Development Goals. Further, policy makers need to establish effective public-private partnership in allocating health care expenditures.

  6. Measuring the effects of reducing subsidies for private insurance on public expenditure for health care.

    Science.gov (United States)

    Cheng, Terence Chai

    2014-01-01

    This paper investigates the effects of reducing subsidies for private health insurance on public sector expenditure for hospital care. An econometric framework using simultaneous equation models is developed to analyse the interrelated decisions on the intensity and type of health care use and private insurance. The framework is applied to the context of the mixed public-private system in Australia. The simulation projections show that reducing premium subsidies is expected to generate net cost savings. This arises because the cost savings achieved from reducing subsidies are larger than the potential increase in public expenditure on hospital care. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Long-term effects of oral clefts on health care utilization

    DEFF Research Database (Denmark)

    Pedersen, Morten Saaby; Wehby, George L; Pedersen, Dorthe Almind

    2015-01-01

    Oral clefts are among the most common birth defects affecting thousands of newborns each year, but little is known about their potential long-term consequences. In this paper, we explore the impact of oral clefts on health care utilization over most of the lifespan. To account for time...... clefts use more health services than their unaffected siblings. Additional results show that the effects are driven primarily by congenital malformation-related hospitalizations and intake of anti-infectives. Although the absolute differences in most health care utilization diminish over time, affected...... individuals have slightly higher utilization of some health care services in adulthood (particularly for diseases of the nervous and respiratory system). These results have important implications for affected individuals, their families, and their health professionals....

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

    Science.gov (United States)

    Fuller, Jeffrey D; Perkins, David; Parker, Sharon; Holdsworth, Louise; Kelly, Brian; Roberts, Russell; Martinez, Lee; Fragar, Lyn

    2011-03-25

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

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

    Directory of Open Access Journals (Sweden)

    Parker Sharon

    2011-03-01

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

  10. Vacation health care

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Vacation health care URL of this page: //medlineplus.gov/ency/article/001937.htm Vacation health care To use the ...

  11. National Health Care Survey

    Science.gov (United States)

    This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.

  12. Changing disease profile and preventive health care in India: Issues of economy, equity and effectiveness

    Directory of Open Access Journals (Sweden)

    Salma Kaneez

    2015-01-01

    Full Text Available The importance of preventive health care practices has increasingly been recognized in the wake of changing disease profile in India. The disease burden has been shifting from communicable to non-communicable diseases as a result of greater focus on achieving competitiveness in a fast globalizing economy. The rapid pace of social and technological changes has led to adverse life style choices resulting in higher incidence of heart diseases, diabetes, obesity, cancer, and deteriorating inter-personal relations and psychological well-being among individuals. Most of these health risks can considerably be reduced through disseminating science-based information on health promotion and disease prevention including exercise, nutrition, smoking and tobacco cessation, immunization, counseling, fostering good habits of health and hygiene, disease screening and preventive medicine. Prior evidences indicate that preventive health interventions can improve health outcomes in a great deal. In a regressive health delivery system of India where major health expenses on curative health is met by out-of-pocket money, preventive health services hold promise to be cost efficient, clinically effective and equity promoting. This article, therefore, examines in depth the issues and prospects of preventive and promotive health care services in realizing optimum health care needs of the people.

  13. Practicing effectively in today's health system: teaching systems-based care.

    Science.gov (United States)

    Rivo, Marc L; Keller, Dean R; Teherani, Arianne; O'Connell, Mark T; Weiss, Bruce A; Rubenstein, Simeon A

    2004-01-01

    The Institute of Medicine and the new Accreditation Council for Graduate Medical Education General Essentials have focused attention on the Undergraduate Medical Education for the 21st Century (UME-21) core content area of systems-based care. Through teaching systems-based care, medical students can learn how physicians effectively deliver and coordinate care within the health system. While medical students can be introduced to the organization, financing, and delivery of the health care system through lectures, the principles and practice of systems-based care must be reinforced through structured learning experiences during the clinical (ie, third and fourth) years. The purpose of this article is to define the undergraduate clinical content and experiences in systems-based care offered by the eight UME-21 partner schools. The eight partner UME-21 schools exposed third- and fourth-year medical students to a variety of clinical experiences outside the traditional teaching hospital in such settings as physician offices, skilled nursing facilities, the patient's home, hospice, and public health departments. They also taught systems-based care skills such as care coordination, performance assessment, and quality improvement. Based on surveys of graduating students, the UME-21 programs were successful in exposing students to the aforementioned topics, though there was variability among schools. The experiences of the UME-21 schools in teaching about systems-based care, as discussed in this paper, may be useful to those involved in medical school curricula planning.

  14. Creonization of health care.

    Science.gov (United States)

    Bulger, R J

    1990-01-01

    As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals.

  15. Pre-school wheeze: determinants and health care effects

    NARCIS (Netherlands)

    van der Gugten, A.C.

    2012-01-01

    Wheezing illnesses are an important health problem in children and are a threat to the quality of life of children and their families and account for a large number of primary healthcare consultations in the first years of life. Pre-school wheeze is a symptom that can precede the development of

  16. Public health care funding modifies the effect of out-of-pocket spending on maternal, infant, and child mortality.

    Science.gov (United States)

    Noel, Jonathan K

    2017-03-01

    Increased out-of-pocket (OOP) health care spending has been associated with increased maternal, infant, and child mortality, but the effect of public health care spending on mortality has not been studied. I identified a statistically significant interaction between public health care expenditure and OOP health care spending for maternal, infant, and child mortality. Generally, increases in public expenditure coincide with decreased rates of mortality, regardless of OOP spending levels. Specifically, higher levels of public expenditure with moderate levels of OOP spending may result in the lowest mortality rates. Increased public health care spending may improve health outcomes better than efforts to reduce OOP expenditure alone.

  17. Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol.

    Science.gov (United States)

    Yi Mohammadi, Joanna Jin; Franks, Kay; Hines, Sonia

    2015-10-01

    The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia.More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth. Dementia poses a significant challenge for health and social policy in Australia. The quality of life of individuals, their families and friends is impacted by dementia. Older people with dementia often have other health comorbidities resulting in the need for a higher level of care. From 2009 to 2010, 53% of permanent residents in Residential Aged Care Facilities (RACFs) had dementia on admission. Older Australians are retaining more of their natural teeth, therefore residents entering RACFs will have more of their natural teeth and require complex dental work than they did in previous generations. Data from the Australian Institute of Health and Welfare showed that more than half the residents in RACFs are now partially dentate with an average of 12 teeth each. Furthermore, coronal and root caries are significant problems, especially in older Australians who are cognitively impaired.Residents in aged care facilities frequently have poor oral health and hygiene with moderate to high levels of oral disease and overall dental neglect. This is reinforced by aged care staff who acknowledge that the demands of feeding, toileting and behavioral issues amongst residents often take precedence over oral health care regimens. Current literature shows that there is a general reluctance on the part of aged care staff to prioritize oral care due to limited knowledge as well as existing psychological barriers to working on another person's mouth. Although staff routinely deal with residents' urinary and faecal incontinence, deep psychological barriers exist when working on someone

  18. Personalised Health Care, the need for reassessment. A HTA perspective far beyond cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Iñaki Gutiérrez-Ibarluzea

    2012-11-01

    Full Text Available

    Background: personalised health care has been claimed to play an outstanding role in the future health services. In fact, health care systems will have to face changes in their work flows and processes due to the implementation of personalised technologies. Health Technology Assessment provides information to decision makers at any level on the introduction and exclusion of health technologies from the health care systems.

    Methods: the definition of Health Technology Assessment (HTA and the concepts and questions raised in the EUnetHTA core model, were used as a framework to analyse the impact of these new services in health care provision.

    Results: personalised health care services and products are health technologies, mainly diagnostics that have a broad impact in the health care systems. Although, safety, clinical effectiveness and economical aspects and consequences have been described, ethical, social and organisational issues raised questions that should be answered before considering their implementation in the health systems. Special attention should be paid on new requirements for regulation, data protection and the empowerment of citizen and health professionals.

    Conclusions: the benefits and harms of personalised health-care technologies should be decided on a “case by case” rather than a “one size fits all” basis and has to be analysed under its many aspects. The combination of genetic, clinical and environmental factors is crucial for the correct understanding of personalised medicine and

  19. Effect of child marriage on use of maternal health care services in Pakistan.

    Science.gov (United States)

    Nasrullah, Muazzam; Zakar, Rubeena; Krämer, Alexander

    2013-09-01

    To assess the association between child marriage (before 18 years of age) and maternal health care services use in Pakistan. We limited the data from Pakistan Demographic and Health Survey, 2006-2007, to ever-married females aged 15-24 years with at least one childbirth (n=1,404) to identify differences in prenatal care provision (skilled or unskilled medical care provider), antenatal care (antenatal visits; care at home or a hospital), care at delivery (assistance by unskilled medical care provider), and place of birth by early (younger than 18 years) compared with adult (18 years or older) age at marriage. Associations between child marriage and health care services use were assessed by calculating adjusted odds ratios (OR) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, rural residence), employment status, and partners' education. Overall, 66.1% of ever-married respondents aged 15-24 years in Pakistan with at least one childbirth were married before the age of 18 years. More than half (61.9%) of females married as children had no formal education, and the majority (71.0%) resided in rural areas. Child marriage was significantly associated with decreased likelihood of any prenatal care (adjusted OR 0.73, 95% confidence interval [CI] 0.534-0.993) and prenatal care by skilled medical care providers (adjusted OR 0.64, 95% CI 0.476-0.871) and increased likelihood of delivery assistance by unskilled medical providers (adjusted OR 1.90, 95% CI 1.435-2.518) and delivery at home (adjusted OR 2.17, 95% CI 1.617-2.915). Efforts to increase the age of marriage and delay childbearing may have population-level effects on reducing disparities between females married as children and adults and improving maternal and child health in Pakistan. II.

  20. Women's access to health care in Ghana: effects of education, residence, lineage and self-determination.

    Science.gov (United States)

    Boateng, John; Flanagan, Constance

    2008-01-01

    Women's physical and psychological access to health care was analyzed using the 2003 Ghana Demographic and Health Survey (GDHS), a nationally representative study for monitoring population and health in Ghana. Female respondents from the 2133 cases in the couple's data set were used in this study. Women's level of education was positively related to physical but not to psychological access to health care. Residing in an urban area was positively related to both types of access. Matriliny consistently showed positive effects on physical access. In addition to these demographic factors, both physical and psychological access were positively related to women's self-determination, i.e., women's right and ability to make real choices about their lives including their health, fertility, sexuality, childcare and all areas where women are denied autonomy and dignity in their identities as women. Self-determination factors both mediated the effects of background factors on access and added explanatory power to the models.

  1. The effect of kangaroo mother care on mental health of mothers with low birth weight infants

    Directory of Open Access Journals (Sweden)

    Zohreh Badiee

    2014-01-01

    Full Text Available Background: The mothers of premature infants are at risk of psychological stress because of separation from their infants. One of the methods influencing the maternal mental health in the postpartum period is kangaroo mother care (KMC. This study was conducted to evaluate the effect of KMC of low birth weight infants on their maternal mental health. Materials and Methods: The study was conducted in the Department of Pediatrics of Isfahan University of Medical Sciences, Isfahan, Iran. Premature infants were randomly allocated into two groups. The control group received standard caring in the incubator. In the experimental group, caring with three sessions of 60 min KMC daily for 1 week was practiced. Mental health scores of the mothers were evaluated by using the 28-item General Health Questionnaire. Statistical analysis was performed by the analysis of covariance using SPSS. Results: The scores of 50 infant-mother pairs were analyzed totally (25 in KMC group and 25 in standard care group. Results of covariance analysis showed the positive effects of KMC on the rate of maternal mental health scores. There were statistically significant differences between the mean scores of the experimental group and control subjects in the posttest period (P < 0.001. Conclusion: KMC for low birth weight infants is a safe way to improve maternal mental health. Therefore, it is suggested as a useful method that can be recommended for improving the mental health of mothers.

  2. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    debut (20.8%), 40.8% had multiple sexual partners, 23.3% had sex under the influence of alcohol while. 34.2% didn't use ... PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 97-106. KEYWORDS. Risky sexual behaviour, young people, ..... 2010;15(1): Art. #505[cited consistent with ...

  3. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Up to 11 (7.2%) respondents in the non-BI LGA were not satisfied with the drug services in the health centers, compared ... improvement in primary health care services,. 8 ..... Naves J O, Silver LD. Evaluation of pharmaceutical assistance in public primary care in Brasilia, Brazil. Rev. Saude Publica. 2005; 39(2): 223-30. 21.

  4. Testing an Adapted Modified Delphi Method: Synthesizing Multiple Stakeholder Ratings of Health Care Service Effectiveness.

    Science.gov (United States)

    Escaron, Anne L; Chang Weir, Rosy; Stanton, Petra; Vangala, Sitaram; Grogan, Tristan R; Clarke, Robin M

    2016-03-01

    The Affordable Care Act incentivizes health systems for better meeting patient needs, but often guidance about patient preferences for particular health services is limited. All too often vulnerable patient populations are excluded from these decision-making settings. A community-based participatory approach harnesses the in-depth knowledge of those experiencing barriers to health care. We made three modifications to the RAND-UCLA appropriateness method, a modified Delphi approach, involving patients, adding an advisory council group to characterize existing knowledge in this little studied area, and using effectiveness rather than "appropriateness" as the basis for rating. As a proof of concept, we tested this method by examining the broadly delivered but understudied nonmedical services that community health centers provide. This method created discrete, new knowledge about these services by defining 6 categories and 112 unique services and by prioritizing among these services based on effectiveness using a 9-point scale. Consistent with the appropriateness method, we found statistical convergence of ratings among the panelists. Challenges include time commitment and adherence to a clear definition of effectiveness of services. This diverse stakeholder engagement method efficiently addresses gaps in knowledge about the effectiveness of health care services to inform population health management. © 2015 Society for Public Health Education.

  5. Effect of the California tobacco control program on personal health care expenditures.

    Directory of Open Access Journals (Sweden)

    James M Lightwood

    2008-08-01

    Full Text Available Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state.Cointegrating regressions were used to predict (1 the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2 the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started and 2004, the California program was associated with $86 billion (2004 US dollars (95% confidence interval [CI] $28 billion to $151 billion lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%-12.1% of total health care expenditures in 2004.A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.

  6. The health and welfare effects of day-care: a systematic review of randomised controlled trials.

    Science.gov (United States)

    Zoritch, B; Roberts, I; Oakley, A

    1998-08-01

    Day-care has long been a controversial aspect of social policy in countries such as the U.K. What evidence is there about the effects of out-of-home day-care on educational, health and welfare outcomes for children and their families? This paper applies to day-care studies, the methodology of the systematic review as pioneered in the health care field, in order to establish the evidence-base for day-care provision. Randomised controlled trials of day-care for pre-school children were identified using electronic databases, hand searches of relevant literature and contacts with authors. A total of 8 trials were identified after examining 920 abstracts and 19 books. All the trials were carried out in the U.S.A. European research on this topic is extensive but we did not identify any studies using trial design. Instead observational, case controlled and cohort studies were prominent. The trials were assessed for methodological quality. Results showed that day-care promotes children's intelligence, development and school achievement. Long-term follow up demonstrates increased employment, lower teenage pregnancy rates, higher socio-economic status and decreased criminal behaviour. There are positive effects on mothers' education, employment and interaction with children. Effects on fathers have not been examined. Few studies look at a range of outcomes spanning the health, education and welfare domains. Most of the trials combined non-parental day-care with some element of parent training or education (mostly targeted at mothers); they did not disentangle the possible effects of these two interventions. The trials had other significant methodological weaknesses, pointing to the importance of improving on study design in this field. There is a need for well designed research on day-care to provide an evidence-base for British social policy.

  7. Health Care in China.

    Science.gov (United States)

    Younger, David S

    2016-11-01

    China has recently emerged as an important global partner. However, like other developing nations, China has experienced dramatic demographic and epidemiologic changes in the past few decades. Population discontent with the health care system has led to major reforms. China's distinctive health care system, including its unique history, vast infrastructure, the speed of health reform, and economic capacity to make important advances in health care, nonetheless, has incomplete insurance coverage for urban and rural dwellers, uneven access, mixed quality of health care, increasing costs, and risk of catastrophic health expenditures. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Health Care in India.

    Science.gov (United States)

    Younger, David S

    2016-11-01

    Although a stated right for all Indians, equal access to health care in India is impeded by socioeconomic barriers. With its 3-tier system of public health care centers in villages, district hospitals, and tertiary care hospitals, government expenditure in India is inordinately low, with a disproportionate emphasis on private health spending. Accordingly, the poorest receive a minority of the available subsidies, whereas the richest obtain more than a third, fostering a divide in health care infrastructure across the rich and poor in urban and rural settings. This paradigm has implications for domestic Indian public health and global public health. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Multinational Corporations and Health Care in the United States and Latin America: Strategies, Actions, and Effects*

    Science.gov (United States)

    JASSO-AGUILAR, REBECA; WAITZKIN, HOWARD; LANDWEHR, ANGELA

    2010-01-01

    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. PMID:15779471

  10. Multinational corporations and health care in the United States and Latin America: strategies, actions, and effects.

    Science.gov (United States)

    Jasso-Aguilar, Rebeca; Waitzkin, Howard; Landwehr, Angela

    2004-01-01

    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

  11. Managing Cancer Care - Finding Health Care Services

    Science.gov (United States)

    ... Caregivers Questions to Ask about Advanced Cancer Research Managing Cancer Care Finding Health Care Services Costs & Medical ... Feelings Planning for Advanced Cancer Advanced Cancer & Caregivers Managing Cancer Care Finding Health Care Services Managing Costs ...

  12. Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.

    Science.gov (United States)

    Baggaley, Rebecca F; Irvine, Michael A; Leber, Werner; Cambiano, Valentina; Figueroa, Jose; McMullen, Heather; Anderson, Jane; Santos, Andreia C; Terris-Prestholt, Fern; Miners, Alec; Hollingsworth, T Déirdre; Griffiths, Chris J

    2017-10-01

    Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK), a borough with high HIV prevalence (≥0·2% adult prevalence). We constructed a dynamic, compartmental model representing incidence of infection and the effect of screening for HIV in general practices in Hackney. We assessed cost-effectiveness of the RHIVA2 trial by fitting model diagnosis rates to the trial data, parameterising with epidemiological and behavioural data from the literature when required, using trial testing costs and projecting future costs of treatment. Over a 40 year time horizon, incremental cost-effectiveness ratios were £22 201 (95% credible interval 12 662-132 452) per quality-adjusted life-year (QALY) gained, £372 207 (268 162-1 903 385) per death averted, and £628 874 (434 902-4 740 724) per HIV transmission averted. Under this model scenario, with UK cost data, RHIVA2 would reach the upper National Institute for Health and Care Excellence cost-effectiveness threshold (about £30 000 per QALY gained) after 33 years. Scenarios using cost data from Canada (which indicate prolonged and even higher health-care costs for patients diagnosed late) suggest this threshold could be reached in as little as 13 years. Screening for HIV in primary care has important public health benefits as well as clinical benefits. We predict it to be cost-effective in the UK in the medium term. However, this intervention might be cost-effective far sooner, and even cost-saving, in settings where long-term health-care costs of late-diagnosed patients in high

  13. The effect of centralization of health care services on travel time and its equality.

    Science.gov (United States)

    Kobayashi, Daisuke; Otsubo, Tetsuya; Imanaka, Yuichi

    2015-03-01

    To analyze the regional variations in travel time between patient residences and medical facilities for the treatment of ischemic heart disease and breast cancer, and to simulate the effects of health care services centralization on travel time and equality of access. We used medical insurance claims data for inpatients and outpatients for the two target diseases that had been filed between September 2008 and May 2009 in Kyoto Prefecture, Japan. Using a geographical information system, patient travel times were calculated based on the driving distance between patient residences and hospitals via highways and toll roads. Locations of residences and hospital locations were identified using postal codes. We then conducted a simulation analysis of centralization of health care services to designated regional core hospitals. The simulated changes in potential spatial access to care were examined. Inequalities in access to care were examined using Gini coefficients, which ranged from 0.4109 to 0.4574. Simulations of health care services centralization showed reduced travel time for most patients and overall improvements in equality of access, except in breast cancer outpatients. Our findings may contribute to the decision-making process in policies aimed at improving the potential spatial access to health care services. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. The effect of health insurance coverage and the doctor-patient relationship on health care utilization in high poverty neighborhoods

    Directory of Open Access Journals (Sweden)

    Destini A. Smith

    2017-09-01

    Full Text Available African Americans have higher rates of mortality than whites who are the same age and sex. We hypothesize that in low socioeconomic status neighborhoods, having health insurance coverage and a regular health care provider increases the likelihood of receiving diagnostic tests for cardiovascular disease and diabetes. We use data from a random two-stage cluster sample of 230 adults living in high poverty census tracts to examine the effects of insurance coverage and having a regular doctor on the likelihood receiving diagnostic tests for high cholesterol, high blood sugar, and blood pressure. We find that health insurance coverage increases the odds of having a regular health care provider (p < 0.05 and of receiving the diagnostic tests (p < 0.05. Having a regular doctor mediates the effect of insurance coverage on the likelihood of receiving the tests, especially when the participant can report the physician's name.

  15. The effect of health insurance coverage and the doctor-patient relationship on health care utilization in high poverty neighborhoods.

    Science.gov (United States)

    Smith, Destini A; Akira, Alan; Hudson, Kenneth; Hudson, Andrea; Hudson, Marcellus; Mitchell, Marcus; Crook, Errol

    2017-09-01

    African Americans have higher rates of mortality than whites who are the same age and sex. We hypothesize that in low socioeconomic status neighborhoods, having health insurance coverage and a regular health care provider increases the likelihood of receiving diagnostic tests for cardiovascular disease and diabetes. We use data from a random two-stage cluster sample of 230 adults living in high poverty census tracts to examine the effects of insurance coverage and having a regular doctor on the likelihood receiving diagnostic tests for high cholesterol, high blood sugar, and blood pressure. We find that health insurance coverage increases the odds of having a regular health care provider (p < 0.05) and of receiving the diagnostic tests (p < 0.05). Having a regular doctor mediates the effect of insurance coverage on the likelihood of receiving the tests, especially when the participant can report the physician's name.

  16. Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol).

    Science.gov (United States)

    Lawal, Adegboyega K; Rotter, Thomas; Kinsman, Leigh; Sari, Nazmi; Harrison, Liz; Jeffery, Cathy; Kutz, Mareike; Khan, Mohammad F; Flynn, Rachel

    2014-09-19

    Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. PROSPERO CRD42014008853.

  17. Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews.

    Science.gov (United States)

    Mickan, Sharon; Tilson, Julie K; Atherton, Helen; Roberts, Nia Wyn; Heneghan, Carl

    2013-10-28

    Handheld computers and mobile devices provide instant access to vast amounts and types of useful information for health care professionals. Their reduced size and increased processing speed has led to rapid adoption in health care. Thus, it is important to identify whether handheld computers are actually effective in clinical practice. A scoping review of systematic reviews was designed to provide a quick overview of the documented evidence of effectiveness for health care professionals using handheld computers in their clinical work. A detailed search, sensitive for systematic reviews was applied for Cochrane, Medline, EMBASE, PsycINFO, Allied and Complementary Medicine Database (AMED), Global Health, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. All outcomes that demonstrated effectiveness in clinical practice were included. Classroom learning and patient use of handheld computers were excluded. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A previously published conceptual framework was used as the basis for dual data extraction. Reported outcomes were summarized according to the primary function of the handheld computer. Five systematic reviews met the inclusion and quality criteria. Together, they reviewed 138 unique primary studies. Most reviewed descriptive intervention studies, where physicians, pharmacists, or medical students used personal digital assistants. Effectiveness was demonstrated across four distinct functions of handheld computers: patient documentation, patient care, information seeking, and professional work patterns. Within each of these functions, a range of positive outcomes were reported using both objective and self-report measures. The use of handheld computers improved patient documentation through more complete recording, fewer documentation errors, and increased efficiency. Handheld computers provided easy access to clinical decision support systems and

  18. Effectiveness of the implementation of guidelines for anxiety disorders in specialized mental health care

    NARCIS (Netherlands)

    Dijk, M.K. van; Oosterbaan, D.B.; Verbraak, M.J.P.M.; Hoogendoorn, A.W.; Penninx, B.W.J.H.; Balkom, A.J.L.M. van

    2015-01-01

    Objective To examine the effect of implementing anxiety disorders guidelines on guideline adherence and patient outcomes in specialized mental health care. Method A treatment setting in which guidelines were implemented (intervention condition) was compared with one in which guidelines were only

  19. Effectiveness of the implementation of guidelines for anxiety disorders in specialized mental health care

    NARCIS (Netherlands)

    Dijk, M.K. van; Oosterbaan, D.B.; Verbraak, M.J.; Hoogendoorn, A.W.; Penninx, B.W.; Balkom, A.J. van

    2015-01-01

    OBJECTIVE: To examine the effect of implementing anxiety disorders guidelines on guideline adherence and patient outcomes in specialized mental health care. METHOD: A treatment setting in which guidelines were implemented (intervention condition) was compared with one in which guidelines were only

  20. The Effects of Health Care and Father Support for Mother on the Children's Emotions

    Science.gov (United States)

    Lestari, Tri Riana; Suwandi, Tjipto; Nursalam; Narendra, Moersintowarti B.

    2015-01-01

    Toddler stage is referred to as the golden era (golden age period), especially at the age of 0-2 years, the brain development reach 80%. This study examines the effects of health care support and father support for mother on the emotions of children aged less than 2 years. This study was observational, with cross-sectional design. The sampling…

  1. A 3-year assessment of the effects of a self-administered health risk assessment on health care utilization, costs, and health risks.

    Science.gov (United States)

    Sieck, Cynthia J; Dembe, Allard E

    2014-12-01

    This study examines the effect of taking a health risk assessment (HRA) on health care costs, utilization, and member health risks over a 3-year period. This retrospective cohort study examined changes utilization, costs, and health risks among a random sample of 500 employees completing an HRA compared with a matched group of 500 employees who did not complete an HRA. The HRA group accessed services more frequently and at a lower overall cost, was more likely to utilize primary care and preventive services after the HRA, and improved on seven out of eight health risk measures. This study demonstrates that significant and sustained improvement in health risks and lower health care costs may be achievable with efforts such as an HRA that seeks to engage employees in health improvement efforts.

  2. Health, behavior, and health care disparities: disentangling the effects of income and race in the United States.

    Science.gov (United States)

    Dubay, Lisa C; Lebrun, Lydie A

    2012-01-01

    The literature on health disparities in the United States typically focuses on race/ethnicity or on socioeconomic status (SES) separately, but not often together. The purpose of the study was to assess the separate effects of race/ethnicity and SES on health status, health behaviors, and health care utilization. Cross-sectional analyses were conducted using the 2008 National Health Interview Survey (n = 17,337 non-elderly adults). SES disparities within specific racial groups were examined, as were race disparities within high and low SES groups. Within each racial/ethnic group, a greater proportion of low versus high SES individuals were in poor health, a lower proportion had healthy behaviors, and a lower proportion had access to care. In both SES groups, blacks and Hispanics had poorer health outcomes than whites. While whites were more likely to exercise than blacks and Hispanics, they are more likely to be smokers and less likely to have no or moderate alcohol consumption. Blacks had similar or better health care use than whites, especially for cancer screening; Hispanics had lower use within each SES group. Race/ethnicity disparities among adults of similar incomes, while important, were dwarfed by the disparities identified between high- and low-income populations within each racial/ethnic group.

  3. Evaluating the Effect of Software Quality Characteristics on Health Care Quality Indicators

    Directory of Open Access Journals (Sweden)

    Sakineh Aghazadeh

    2015-07-01

    Full Text Available Introduction: Various types of software are used in health care organizations to manage information and care processes. The quality of software has been an important concern for both health authorities and designers of Health Information Technology. Thus, assessing the effect of software quality on the performance quality of healthcare institutions is essential. Method: The most important health care quality indicators in relation to software quality characteristics are provided via an already performed literature review. ISO 9126 standard model is used for definition and integration of various characteristics of software quality. The effects of software quality characteristics and sub-characteristics on the healthcare indicators are evaluated through expert opinion analyses. A questionnaire comprising of 126 questions of 10-point Likert scale was used to gather opinions of experts in the field of Medical/Health Informatics. The data was analyzed using Structural Equation Modeling. Results: Our findings showed that software Maintainability was rated as the most effective factor on user satisfaction (R2 =0.89 and Functionality as the most important and independent variable affecting patient care quality (R2 =0.98. Efficiency was considered as the most effective factor on workflow (R2 =0.97, and Maintainability as the most important factor that affects healthcare communication (R2 =0.95. Usability and Efficiency were rated as the most effectual factor affecting patient satisfaction (R2 =0.80, 0.81. Reliability, Maintainability, and Efficiency were considered as the main factors affecting care costs (R2 =0.87, 0.74, 0.87. Conclusion: We presented a new model based on ISO standards. The model demonstrates and weighs the relations between software quality characteristics and healthcare quality indicators. The clear relationships between variables and the type of the metrics and measurement methods used in the model make it a reliable method to assess

  4. Intercultural communication between patients and health care providers: an exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety.

    Science.gov (United States)

    Ulrey, K L; Amason, P

    2001-01-01

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

    Science.gov (United States)

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

    2013-01-01

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

  6. The effect of health insurance coverage and the doctor-patient relationship on health care utilization in high poverty neighborhoods

    National Research Council Canada - National Science Library

    Destini A. Smith; Alan Akira; Kenneth Hudson; Andrea Hudson; Marcellus Hudson; Marcus Mitchell; Errol Crook

    2017-01-01

    .... We hypothesize that in low socioeconomic status neighborhoods, having health insurance coverage and a regular health care provider increases the likelihood of receiving diagnostic tests for cardio...

  7. [Earthquakes--a historical review, environmental and health effects, and health care measures].

    Science.gov (United States)

    Nola, Iskra Alexandra; Doko Jelinić, Jagoda; Žuškin, Eugenija; Kratohvil, Mladen

    2013-06-01

    Earthquakes are natural disasters that can occur at any time, regardless of the location. Their frequency is higher in the Circum-Pacific and Mediterranean/Trans-Asian seismic belt. A number of sophisticated methods define their magnitude using the Richter scale and intensity using the Mercani-Cancani-Sieberg scale. Recorded data show a number of devastating earthquakes that have killed many people and changed the environment dramatically. Croatia is located in a seismically active area, which has endured a series of historical earthquakes, among which several occurred in the Zagreb area. The consequences of an earthquake depend mostly on the population density and seismic resistance of buildings in the affected area. Environmental consequences often include air, water, and soil pollution. The effects of this kind of pollution can have long-term health effects. The most dramatic health consequences result from the demolition of buildings. Therefore, quick and efficient aid depends on well-organized health professionals as well as on the readiness of the civil defence, fire department, and Mountain Rescue Service members. Good coordination among these services can save many lives Public health interventions must include effective control measures in the environment as secondary prevention methods for health problems caused by unfavourable environmental factors. The identification and control of long-term hazards can reduce chronic health effects. The reduction of earthquake-induced damages includes setting priorities in building seismically safe buildings.

  8. Effect of US Health Policies on Health Care Access for Marshallese Migrants

    Science.gov (United States)

    Hallgren, Emily; Yamada, Seiji

    2015-01-01

    The Republic of the Marshall Islands is a sovereign nation previously under the administrative control of the United States. Since 1986, the Compacts of Free Association (COFA) between the Republic of the Marshall Islands and the United States allows Marshall Islands citizens to freely enter, lawfully reside, and work in the United States, and provides the United States exclusive military control of the region. When the COFA was signed, COFA migrants were eligible for Medicaid and other safety net programs. However, these migrants were excluded from benefits as a consequence of the Personal Responsibility and Work Opportunity Reconciliation Act. Currently, COFA migrants have limited access to health care benefits in the United States, which perpetuates health inequalities. PMID:25713965

  9. Preventive health care

    Science.gov (United States)

    ... medicines or supplements that you are taking WHY PREVENTIVE HEALTH CARE IS IMPORTANT Even if you feel ... want to schedule a visit . Another part of preventive health is learning to recognize changes in your ...

  10. Timely and Effective Care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - national data. This data set includes national-level data for measures of heart attack care, heart failure care, pneumonia care,...

  11. Timely and Effective Care - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - state data. This data set includes state-level data for measures of heart attack care, heart failure care, pneumonia care,...

  12. Timely and Effective Care - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of heart attack care, heart failure care, pneumonia care,...

  13. Translational educational research: a necessity for effective health-care improvement.

    Science.gov (United States)

    McGaghie, William C; Issenberg, S Barry; Cohen, Elaine R; Barsuk, Jeffrey H; Wayne, Diane B

    2012-11-01

    Medical education research contributes to translational science (TS) when its outcomes not only impact educational settings, but also downstream results, including better patient-care practices and improved patient outcomes. Simulation-based medical education (SBME) has demonstrated its role in achieving such distal results. Effective TS also encompasses implementation science, the science of health-care delivery. Educational, clinical, quality, and safety goals can only be achieved by thematic, sustained, and cumulative research programs, not isolated studies. Components of an SBME TS research program include motivated learners, curriculum grounded in evidence-based learning theory, educational resources, evaluation of downstream results, a productive research team, rigorous research methods, research resources, and health-care system acceptance and implementation. National research priorities are served from translational educational research. National funding priorities should endorse the contribution and value of translational education research.

  14. Foster Care and Child Health.

    Science.gov (United States)

    McDavid, Lolita M

    2015-10-01

    Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. [Health economics of oncology care: financial effect of performance volume limit (PVL)].

    Science.gov (United States)

    Boncz, Imre; Donkáné Verebes, Eva; Oberfrank, Ferenc; Kásler, Miklós

    2010-03-01

    The aim of our study is to analyze the effect of performance volume limit (PVL) on the performance indicators of acute oncology care, with special respect to the health insurance reimbursement not paid to health care providers. Data were derived from the nationwide administrative dataset of the National Health Insurance Fund Administration (OEP) covering the period of 2006-2008. We analyzed the effect of PVL according to medical specialities. We calculated the average annual reimbursement rate of DRG cost-weight with and without the application of PVL. The loss due to PVL was calculated both by monetary terms and as the % of annual revenue. The loss of medical specialities measured by monetary units (Hungarian forint, HUF) and as a percent of their revenues was the following in 2008: oncology 1327 million HUF (4.7%), cardiology 791 million HUF (3.0%), gynecology and obstetrics 772 million HUF (3.0%), internal medicine 708 million HUF (3.3%), intensive care 661 million HUF (2.5%), surgery 637 million HUF (3.2%), pediatrics 614 million HUF (3.9%), traumatology 545 million HUF (2.5%), radiotherapy 438 million HUF (3.1%). The application of performance volume limit had significantly different effect on the different medical specialities. Oncology care can be considered as one of the largest losers of the application of performance volume limit.

  16. Cost-effectiveness of health promotion targeting physical activity and healthy eating in mental health care.

    Science.gov (United States)

    Verhaeghe, Nick; De Smedt, Delphine; De Maeseneer, Jan; Maes, Lea; Van Heeringen, Cornelis; Annemans, Lieven

    2014-08-18

    There is a higher prevalence of obesity in individuals with mental disorders compared to the general population. The results of several studies suggested that weight reduction in this population is possible following psycho-educational and/or behavioural weight management interventions. Evidence of the effectiveness alone is however inadequate for policy making. The aim of the current study was to evaluate the cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders. A Markov decision-analytic model using a public payer perspective was applied, projecting the one-year results of a 10-week intervention over a time horizon of 20 years, assuming a repeated yearly implementation of the programme. Scenario analysis was applied evaluating the effects on the results of alternative modelling assumptions. One-way sensitivity analysis was performed to assess the effects on the results of varying key input parameters. An incremental cost-effectiveness ratio of 27,096€/quality-adjusted life years (QALY) in men, and 40,139€/QALY in women was found in the base case. Scenario analysis assuming an increase in health-related quality of life as a result of the body mass index decrease resulted in much better cost-effectiveness in both men (3,357€/QALY) and women (3,766€/QALY). The uncertainty associated with the intervention effect had the greatest impact on the model. As far as is known to the authors, this is the first health economic evaluation of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders. Such research is important as it provides payers and governments with better insights how to spend the available resources in the most efficient way. Further research examining the cost-effectiveness of health promotion targeting physical activity and healthy eating in individuals with mental disorders is required.

  17. [Effectiveness of interventions for improving drug prescribing in Primary Health Care].

    Science.gov (United States)

    Zavala-González, Marco Antonio; Cabrera-Pivaral, Carlos Enrique; Orozco-Valerio, María de Jesús; Ramos-Herrera, Igor Martín

    2017-01-01

    To determine the effectiveness of interventions for improving drug prescribing in Primary Health Care units. Systematic review and meta-analysis. Searches were made in MedLine©, ScienceDirect©, Springer©, SciELO©, Dialnet©, RedALyC© and Imbiomed©, in Spanish, English and Portuguese, using keywords "drug prescribing", "intervention studies" and "primary health care", indexed in each data base up to August 2014. Experimental and quasi-experimental studies were included that had a CASP-score>5 and that evaluated effect of any type intervention on the quality of drug prescription in Primary Health Care. A total of 522 articles were found, and an analysis was performed on 12 that reported 17 interventions: 64.7% educational, 23.5% incorporating pharmacists into the health team, and 11.8% on the use of computer applications. The strong "intervention/improvement" associations were educational interventions OR=2.47 (95% CI; 2.28 - 2.69), incorporation of pharmacists OR=3.28 (95% CI; 2.58 4.18), and use of computer applications OR=10.16 (95% CI; 8.81 -11.71). The use of interventions with computer applications showed to be more effective than educational interventions and incorporation pharmacists into the health team. Future studies are required that include economic variables such as, implementation costs, drug costs and other expenses associated with health care and treatment of diseases. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    Early detection and treatment of these morbidities could prevent deterioration. The aim of the survey was to determine and compare the prevalence of ..... interventions. Increasing the detection rate of mental morbidity in the community is fundamental. The inclusion of mental health care as a component of primary health ...

  19. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    large extent can reduce financial barriers to options; including government budgetary health care access ..... managers and demand-side factors, such as. International Health Conference. New adverse selection in ... patients in the scheme, and patient demand for. Information Centre. 1995. insured services. Many previous ...

  20. Mental health training for primary health care workers and implication for success of integration of mental health into primary care: evaluation of effect on knowledge, attitude and practices (KAP).

    Science.gov (United States)

    Ayano, Getinet; Assefa, Dawit; Haile, Kibrom; Chaka, Asrat; Haile, Kelemua; Solomon, Melat; Yohannis, Kalkidan; Awoke, Akilew; Jemal, Kemal

    2017-01-01

    Mental disorders are always remained a neglected public health problems in low and middle-income countries (LMICs), most people with mental disorders never receive effective care and there is a large treatment gap. In order to solve the problem integration of mental health into primary health care is recommended and in Ethiopia implementation of the scale of mental health services at primary health care level was started in 2014. For the success of the integration of mental health into primary health care, primary care health professionals are the key personnel who are responsible for the management of mental, neurologic and substance use disorders. However, proper training and education of primary care health professionals is mandatory for an optimal performance and success of integration. This interventional study was conducted to assess the effectiveness of mental health training course for scale up of mental health services at primary health care level in Ethiopia. This quasi-experimental pre- and post-study design was conducted in Ethiopia from October to December 2016 using quantitative data collection methods. A total of 94 primary health care professionals were included in the study. The intervention was conducted by psychiatry professionals using standardized World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) guide prepared for scaling up of mental health care through integration into primary health care (PHC) and general medical services. Pre- and post intervention assessment was done for knowledge, attitude and practice (KAP); and statistically analyzed. A paired sample t test with p values was performed to test the differences between the pre- and post-test. In additions mean and standard deviation of the responses were calculated. Overall the response rate was 100% at the end of the intervention. The study resulted in a significant improvement in knowledge, attitude and practice (KAP) of PHC workers about all the four mental

  1. Effectiveness of nutritional intervention in overweight women in Primary Health Care

    OpenAIRE

    Ferreira, Nathália Luíza; Mingoti, Sueli Aparecida; Jaime, Patrícia Constante; Lopes, Aline Cristine Souza

    2014-01-01

    Objective: To assess the effectiveness of nutritional intervention in overweight women undergoing Primary Health Care.Methods: An intervention study was conducted with overweight adult and elderly women aged 20 years or older (body mass index ≥25.0 kg/m² and ≥27.0 kg/m², respectively) who were subjected to 12 months of individual nutritional monitoring. The effectiveness of the intervention was assessed by dietary, health, and anthropometric indicators.Results: Most of the 71 individuals were...

  2. Family dental health care service

    Directory of Open Access Journals (Sweden)

    Riana Wardani

    2008-07-01

    Full Text Available The Family Dental Health Care Service is a new approach that includes efforts to serve oral and dental patients that focuses on maintenance, improvement and protection. This oral and dental health approach uses basic dentistry science and technology. The vision of the Family Dental Health Care Service is the family independences in the effort of dental health maintenance and to achieve the highest oral and dental health degree as possible through family dentist care that is efficient, effective, fair, evenly distributed, safe and has a good quality. To support this effort, the Ministry of Health has issued Health Care Policy and Implementation Guideline as well as the licensing standard for family dentist practice.

  3. Who deserves health care? The effects of causal attributions and group cues on public attitudes about responsibility for health care costs.

    Science.gov (United States)

    Gollust, Sarah E; Lynch, Julia

    2011-12-01

    This research investigates the impact of cues about ascriptive group characteristics (race, class, gender) and the causes of ill health (health behaviors, inborn biological traits, social systemic factors) on beliefs about who deserves society's help in paying for the costs of medical treatment. Drawing on data from three original vignette experiments embedded in a nationally representative survey of American adults, we find that respondents are reluctant to blame or deny societal support in response to explicit cues about racial attributes--but equally explicit cues about the causal impact of individual behaviors on health have large effects on expressed attitudes. Across all three experiments, a focus on individual behavioral causes of illness is associated with increased support for individual responsibility for health care costs and lower support for government-financed health insurance. Beliefs about social groups and causal attributions are, however, tightly intertwined. We find that when groups suffering ill health are defined in racial, class, or gender terms, Americans differ in their attribution of health disparities to individual behaviors versus biological or systemic factors. Because causal attributions also affect health policy opinions, varying patterns of causal attribution may reinforce group stereotypes and undermine support for universal access to health care.

  4. The effectiveness of allied health care in patients with ataxia: a systematic review.

    Science.gov (United States)

    Fonteyn, Ella M R; Keus, Samyra H J; Verstappen, Carla C P; Schöls, Ludger; de Groot, Imelda J M; van de Warrenburg, Bart P C

    2014-02-01

    Many patients with cerebellar ataxia have serious disabilities in daily life, while pharmacological treatment options are absent. Therefore, allied health care is considered to be important in the management of these patients. The goal of this review is to evaluate scientific evidence for allied health care in cerebellar ataxia, to identify effective treatment strategies, and to give recommendations for clinical practice and further research. A systematic search for clinical trials concerning allied health care in cerebellar ataxias was conducted using the electronic databases of PubMed, Medline, Embase, Cinahl and Pedro, and references lists of articles, in the time period from 1980 up to and including December 2011 in English and Dutch. We identified 14 trials, of which the four best studies were formally of moderate methodological quality. There was a wide variation in disease entities and interventions. The combined data indicate that physical therapy may lead to an improvement of ataxia symptoms and daily life functions in patients with degenerative cerebellar ataxia (level 2), and in other diseases causing cerebellar ataxia (level 3). When added to physical therapy, occupational therapy might improve global functional status, and occupational therapy alone may diminish symptoms of depression (level 3). There are insufficient data for speech and language therapy. Despite the widespread use of allied health care interventions in cerebellar ataxia, there is a lack of good quality studies that have evaluated such interventions. We found some support for the implementation of physical therapy and occupational therapy, but more research is needed to develop recommendations for clinical practice.

  5. Assembled Products: The Key to More Effective Competition And Antitrust Oversight in Health Care.

    Science.gov (United States)

    Sage, William M

    2016-01-01

    This Article argues that recent calls for antitrust enforcement to protect health insurers from hospital and physician consolidation are incomplete. The principal obstacle to effective competition in health care is not that one or the other party has too much bargaining power, but that they have been buying and selling the wrong things. Vigorous antitrust enforcement will benefit health care consumers only if it accounts for the competitive distortions caused by the sector's long history of government regulation. Because of regulation, what pass for products in health care are typically small process steps and isolated components that can be assigned a billing code, even if they do little to help patients. Instead of further entrenching weakly competitive parties engaged in artificial commerce, antitrust enforcers and regulators should work together to promote the sale of fully assembled products and services that can be warranted to consumers for performance and safety. As better products emerge through innovation and market entry, competition may finally succeed at lowering medical costs, increasing access to treatment, and improving quality of care.

  6. Effective presentation of health care performance information for consumer decision making: A systematic review.

    Science.gov (United States)

    Kurtzman, Ellen T; Greene, Jessica

    2016-01-01

    This systematic review synthesizes what is known about the effective presentation of health care performance information for consumer decision making. Six databases were searched for articles published in English between September 2003 and April 2014. Experimental studies comparing consumers' responses to performance information when one or more presentation feature was altered were included. A thematic analysis was performed and practical guidelines derived. All 31 articles retained, the majority which tested responses to various presentations of health care cost and/or quality information, found that consumers better understand and make more informed choices when the information display is less complex. Simplification can be achieved by reducing the quantity of choices, displaying results in a positive direction, using non-technical language and evaluative elements, and situating results in common contexts. While findings do not offer a prescriptive design, this synthesis informs approaches to enhancing the presentation of health care performance information and areas that merit additional research. Guidelines derived from these results can be used to enhance health care performance reports for consumer decision making including using recognizable, evaluative graphics and customizable formats, limiting the amount of information presented, and testing presentation formats prior to use. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Postpartum home care and its effects on mothers' health: A clinical trial

    Directory of Open Access Journals (Sweden)

    Hourieh Shamshiri Milani

    2017-01-01

    Full Text Available Background: Postpartum home care plays an important role in prevention of postpartum complications. Regular visits of mothers during this period are imperative. This study aimed to provide postpartum home care for mothers to assess its effects on mothers' health in Iran. Materials and Methods: This study was carried out in two phases. First, a comprehensive postpartum home care program was compiled by performing a comparative study, using the available guidelines in this regard in different countries and based on the opinions of the experts. Next, a clinical trial was carried out on 276 women who gave birth in the university hospitals affiliated to Shahid Beheshti University of Medical Sciences. There were 92 mothers in the intervention and 184 in the control group. The intervention group mothers were provided with postpartum home care service while the control group did not receive such a service. Results: Outcome assessment at 60 days' postpartum revealed a significant difference between the two groups in terms of the use of supplements, birth control methods, postpartum depression, breastfeeding problems, constipation, and fatigue (P 0.05. Conclusion: The postpartum home care program had a positive effect on some aspects of the mothers' health status and their satisfaction in our society.

  8. Quality of primary health care and autonomous motivation for effective diabetes self-management among patients with type 2 diabetes

    OpenAIRE

    Anne M Koponen; Nina Simonsen; Sakari Suominen

    2017-01-01

    This study showed, in line with self-determination theory, that of the six central quality dimensions of primary health care (access to care, continuity of care, diabetes counseling, autonomy support from one’s physician, trust, patient-centered care), autonomy support from one’s physician was most strongly associated with autonomous motivation (self-regulation) for effective diabetes self-management among patients with type 2 diabetes ( n  = 2866). However, overall support for diabetes care ...

  9. VA Health Care Facilities Locator

    Science.gov (United States)

    ... map [a-z] More VA More VA Health Health Care Information A-Z Health Topic Finder My Health ... General QUICK LIST Apply for Benefits Apply for Health Care Prescriptions My Health e Vet eBenefits Life Insurance ...

  10. Promoting health and improving health care in a cost-effective manner through a military digital library.

    Science.gov (United States)

    Stoloff, Peter H; D'Alessandro, Michael P; D'Alessandro, Donna M; Bakalar, Richard S

    2006-01-01

    The Virtual Naval Hospital (VNH) is a digital library designed to meet the information needs of U.S. Navy medical professionals. The goal of this study was to determine whether the VNH promoted health and improved patient care in a cost-effective manner. An economic analysis determining the costs and benefits from the perspective of the U.S. Navy was conducted. As part of this analysis, medical professionals were surveyed from February to August 2000. Respondents used the VNH for a variety of professional activities (average, 8.2 h/wk). Respondents (70%) thought that VNH usage improved patient care. Medical providers thought it improved their diagnosis (70%) and treatment (60%). Respondents stated that the VNH affected 81 medical evacuations and 668 sick-in-quarter days. Overall content satisfaction was 94%. The VNH had a net savings of $143,848/yr and a cost/benefit ratio of 55.9%. The VNH has a beneficial impact on the Navy's health care system by improving health promotion and patient care and by being economically cost-effective.

  11. Health care decision makers' use of comparative effectiveness research: report from a series of focus groups.

    Science.gov (United States)

    Villa, Lorenzo; Warholak, Terri L; Hines, Lisa E; Taylor, Ann M; Brown, Mary; Hurwitz, Jason; Brixner, Diana; Malone, Daniel C

    2013-01-01

    Comparative effectiveness research (CER) is a helpful approach to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision makers about the most effective interventions. To (a) identify the factors necessary to increase the use of the Agency for Healthcare Research and Quality's (AHRQ) CER reviews in hospitals and managed care organizations; (b) assess current awareness and implementation of CER materials in these facilities and organizations; and (c) inform development of content for a workshop on CER. Pharmacy and therapeutics (PT) committee members and supportive personnel were recruited to participate in focus groups conducted at national health professional meetings. Prior to the sessions, each participant completed a prefocus group questionnaire evaluating the organization and process of the respondent's PT committee, as well as the respondent's role in the PT committee and awareness of AHRQ CER reports. Each session consisted of a focused discussion about CER and sources of evidence for PT monographs, and each participant completed a ballot to rank topics of importance for inclusion in a CER workshop for health care professionals involved in the PT process. Overarching themes were later identified using qualitative analysis of the transcripts of the focus group sessions. Thirty-nine (68%) pharmacists and 18 (32%) physicians involved in the PT process participated in 1 of 7 focus groups. Almost half of the participants had 6-15 years experience with the PT process. Participants represented health plans, hospitals, and health care systems. Two-thirds indicated they were aware of AHRQ's Effective Health Care Program's CER reviews, yet only 26% reported using the reviews in their organizations. The overarching themes reflected the need for timely and conclusive CER information; the role of the pharmacist as central to evidence synthesis for the PT process; and the need for educational programs

  12. The mental vitality @ work study: effectiveness of a mental module for workers' health surveillance for nurses and allied health care professionals on their help-seeking behavior

    NARCIS (Netherlands)

    Gärtner, Fania R.; Nieuwenhuijsen, Karen; Ketelaar, Sarah M.; van Dijk, Frank J. H.; Sluiter, Judith K.

    2013-01-01

    To study the effectiveness of a mental module for workers' health surveillance for health care workers. Nurses and allied health care professionals from one organization were cluster-randomized at ward level to an intervention or control group. The intervention included screening for work

  13. The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review.

    Science.gov (United States)

    Morton, Katie; Beauchamp, Mark; Prothero, Anna; Joyce, Lauren; Saunders, Laura; Spencer-Bowdage, Sarah; Dancy, Bernadette; Pedlar, Charles

    2015-01-01

    Motivational interviewing (MI) is a patient-centred approach to behaviour change that was originally developed in the addiction field but has increasingly been applied to public health settings with a focus on health promotion. The purpose of this review was to examine the evidence base for MI interventions in primary care settings with non-clinical populations to achieve behaviour change for physical activity, dietary behaviours and/or alcohol intake. We also sought to explore the specific behaviour change techniques included in MI interventions within primary care. Electronic databases were searched for relevant articles and 33 papers met inclusion criteria and were included. Approximately 50% of the included studies (n = 18) demonstrated positive effects in relation to health behaviour change. The efficacy of MI approaches is unclear given the inconsistency of MI descriptions and intervention components. Furthermore, research designs that do not isolate the effects of MI make it difficult to determine the effectiveness of such approaches. We offer a number of recommendations for researchers and practitioners seeking to include MI within behaviour change interventions to help improve the quality of the research and the effectiveness of MI-based interventions within primary care settings.

  14. Effectiveness of Primary Health Care Services in Addressing Mental Health Needs of Minority Refugee Population in New Zealand.

    Science.gov (United States)

    Shrestha-Ranjit, Jagamaya; Patterson, Elizabeth; Manias, Elizabeth; Payne, Deborah; Koziol-McLain, Jane

    2017-04-01

    Many people are displaced from their country of origin and become refugees, mostly due to armed conflicts, political violence and human rights abuse. Refugees have complex mental, physical, and social health problems related to their traumatic background and the experiences they have endured during their refugee journey. The aim of this qualitative exploratory study was to examine the effectiveness of primary health care services in addressing mental health needs of Bhutanese refugee women resettled in New Zealand. This study included focus group discussion with Bhutanese women and men followed by interviews with health service providers. The findings of this study highlighted inadequacies and constraints in addressing Bhutanese refugee women's mental health needs in New Zealand and provided evidence for recommendations to address these inadequacies.

  15. Quality of primary health care and autonomous motivation for effective diabetes self-management among patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Anne M Koponen

    2017-05-01

    Full Text Available This study showed, in line with self-determination theory, that of the six central quality dimensions of primary health care (access to care, continuity of care, diabetes counseling, autonomy support from one’s physician, trust, patient-centered care, autonomy support from one’s physician was most strongly associated with autonomous motivation (self-regulation for effective diabetes self-management among patients with type 2 diabetes ( n  = 2866. However, overall support for diabetes care received from friends, family members, other patients with diabetes, and health care professionals may even play a greater role.

  16. Quality of primary health care and autonomous motivation for effective diabetes self-management among patients with type 2 diabetes.

    Science.gov (United States)

    Koponen, Anne M; Simonsen, Nina; Suominen, Sakari

    2017-01-01

    This study showed, in line with self-determination theory, that of the six central quality dimensions of primary health care (access to care, continuity of care, diabetes counseling, autonomy support from one's physician, trust, patient-centered care), autonomy support from one's physician was most strongly associated with autonomous motivation (self-regulation) for effective diabetes self-management among patients with type 2 diabetes (n = 2866). However, overall support for diabetes care received from friends, family members, other patients with diabetes, and health care professionals may even play a greater role.

  17. The impact of mindfulness on leadership effectiveness in a health care setting: a pilot study.

    Science.gov (United States)

    Wasylkiw, Louise; Holton, Judith; Azar, Rima; Cook, William

    2015-01-01

    The purpose of this paper is to examine the impact of mindfulness awareness practice (MAP) on mid-level health-care managers' leadership. In total, 11 mid-level health-care managers in eastern Canada took part in an intensive weekend retreat and a follow-up webinar on mindfulness awareness. Perceived stress and leadership effectiveness were assessed pre- and post-intervention (i.e. four and eight weeks). A control group (n=10) also completed the same measures twice. Additionally, informants (n=28) provided assessments of participants' leadership pre- and post-intervention. Follow-up interviews were carried out with eight participants 12-16 weeks post-intervention. In comparison to controls, retreat participants showed significant increases in mindfulness and corresponding decreases in stress that were sustained across eight weeks post-retreat; retreat participants reported significant positive changes in their leadership effectiveness that were corroborated by informants. Qualitative data, however, suggest that sustaining a mindfulness practice presents significant challenges to middle managers in a health care setting. The findings are useful to management working in health services that are plagued by increasing demands and changes. Despite the small sample and lack of random assignment, the pilot data support the efficacy of MAP in improving leadership. Little empirical research supports the claim that MAP enhances leadership. The present study employed a mixed methods approach to address this gap and demonstrates the potential benefits of MAP among mid-level managers.

  18. [Amenable mortality as indicator of effectiveness of health care services in Spain before and after transferences].

    Science.gov (United States)

    Barrasa Villar, J I; Castán Ruiz, S; Estupiñán Romero, F R; Valderrama Rodríguez, M; Moliner Lahoz, F J

    2013-01-01

    To describe the evolution of amenable mortality (MRASS) in Spain and to evaluate differences in trend patterns before and after health care services were transferred to local authorities. MRASS was defined from a list of causes of death used in other studies. We analyzed the change in sex-age-standardized death rates of MRASS in two periods: 1999-2001 and 2006-2008, just before, and five years after, the health care transfers were completed. MRASS represented 24% of deaths in persons from 0 to 74 years old. MRASS has seen a reduction (19.4%) between the two periods over and above other causes of mortality (14.5%). The group of causes of mortality which showed most reduction: ischemic heart disease (28%), other vascular disease (27%), surgical conditions and surgical-medical errors (26%), and diabetes (22.5%). Although there were differences between the districts, health care transfers have not created significant variations in MRASS. Navarra and Madrid showed lower rates of MRASS, and the Canary Islands, Asturias, Andalusia, Ceuta and Melilla had higher rates. The Balearic Islands showed the greatest reduction in MRASS. MRASS constitutes an important proportion of trends of mortality in persons between 0-74 years. It has declined in all districts. Even though there were large differences between districts, there does not appear to be any direct influence due to health care transfer in amenable mortality trends. In spite of limitations, MRASS is an indicator to be considered when monitoring and detecting weaknesses in the effectiveness of health care systems. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

  19. Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo).

    Science.gov (United States)

    Ciccone, Marco Matteo; Aquilino, Ambrogio; Cortese, Francesca; Scicchitano, Pietro; Sassara, Marco; Mola, Ernesto; Rollo, Rodolfo; Caldarola, Pasquale; Giorgino, Francesco; Pomo, Vincenzo; Bux, Francesco

    2010-05-06

    Project Leonardo represented a feasibility study to evaluate the impact of a disease and care management (D&CM) model and of the introduction of "care manager" nurses, trained in this specialized role, into the primary health care system. Thirty care managers were placed into the offices of 83 general practitioners and family physicians in the Apulia Region of Italy with the purpose of creating a strong cooperative and collaborative "team" consisting of physicians, care managers, specialists, and patients. The central aim of the health team collaboration was to empower 1,160 patients living with cardiovascular disease (CVD), diabetes, heart failure, and/or at risk of cardiovascular disease (CVD risk) to take a more active role in their health. With the support of dedicated software for data collection and care management decision making, Project Leonardo implemented guidelines and recommendations for each condition aimed to improve patient health outcomes and promote appropriate resource utilization. Results show that Leonardo was feasible and highly effective in increasing patient health knowledge, self-management skills, and readiness to make changes in health behaviors. Patient skill-building and ongoing monitoring by the health care team of diagnostic tests and services as well as treatment paths helped promote confidence and enhance safety of chronic patient management at home. Physicians, care managers, and patients showed unanimous agreement regarding the positive impact on patient health and self-management, and attributed the outcomes to the strong "partnership" between the care manager and the patient and the collaboration between the physician and the care manager. Future studies should consider the possibility of incorporating a patient empowerment model which considers the patient as the most important member of the health team and care managers as key health care collaborators able to enhance and support services to patients provided by physicians in

  20. Differential effects of professional leaders on health care teams in chronic disease management groups.

    Science.gov (United States)

    Wholey, Douglas R; Disch, Joanne; White, Katie M; Powell, Adam; Rector, Thomas S; Sahay, Anju; Heidenreich, Paul A

    2014-01-01

    Leadership by health care professionals is likely to vary because of differences in the social contexts within which they are situated, socialization processes and societal expectations, education and training, and the way their professions define and operationalize key concepts such as teamwork, collaboration, and partnership. This research examines the effect of the nurse and physician leaders on interdependence and encounter preparedness in chronic disease management practice groups. The aim of this study was to examine the effect of complementary leadership by nurses and physicians involved in jointly producing a health care service on care team functioning. The design is a retrospective observational study based on survey data. The unit of analysis is heart failure care groups in U.S. Veterans Health Administration medical centers. Survey and administrative data were collected in 2009 from 68 Veterans Health Administration medical centers. Key variables include nurse and physician leadership, interdependence, psychological safety, coordination, and encounter preparedness. Reliability and validity of survey measures were assessed with exploratory factor analysis and Cronbach alphas. Multivariate analyses tested hypotheses. Professional leadership by nurses and physicians is related to encounter preparedness by different paths. Nurse leadership is associated with greater team interdependence, and interdependence is positively associated with respect. Physician leadership is positively associated with greater psychological safety, respect, and shared goals but is not associated with interdependence. Respect is associated with involvement in learning activities, and shared goals are associated with coordination. Coordination and involvement in learning activities are positively associated with encounter preparedness. By focusing on increasing interdependence and a constructive climate, nurse and physician leaders have the opportunity to increase care coordination

  1. Effect of heartfulness meditation on burnout, emotional wellness, and telomere length in health care professionals

    OpenAIRE

    Thimmapuram, Jayaram; Pargament, Robert; Sibliss, Kedesha; Grim, Rodney; Risques, Rosana; Toorens, Erik

    2017-01-01

    ABSTRACT Background: Burnout poses significant challenges during training years in residency and later in the career. Meditation is a tool to treat stress-related conditions and promote wellness. Telomere length may be affected by burnout and stress. However, the benefits of meditation have not been fully demonstrated in health care professionals. Objective: We assessed the effects of a 12-week ?Heartfulness Meditation? program on burnout, emotional wellness, and telomere length in residents,...

  2. Effectiveness of Dietetic Consultations in Primary Health Care: A Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Mitchell, Lana J; Ball, Lauren E; Ross, Lynda J; Barnes, Katelyn A; Williams, Lauren T

    2017-12-01

    A dietetic consultation is a structured process aimed at supporting individual patients to modify their dietary behaviors to improve health outcomes. The body of evidence on the effectiveness of nutrition care provided by dietitians in primary health care settings has not previously been synthesized. This information is important to inform the role of dietitians in primary health care service delivery. The aim of this systematic review was to evaluate the evidence of the effectiveness of individual consultations provided exclusively by dietitians in primary care to support adult patients to modify dietary intake and improve health outcomes. ProQuest Family Health, Scopus, PubMed Central, Medline, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for English language systematic reviews or randomized controlled trials published before October 2016. The key terms used identified the provision of nutrition care exclusively by a dietitian in a primary health care setting aimed at supporting adult patients to modify dietary behaviors and/or improve biomarkers of health. Interventions delivered to patients aged younger than 18 years, in hospital, via telephone only, in a group or lecture setting, or by a multidisciplinary team were excluded. The methodologic quality of each study was appraised using the Cochrane Risk of Bias tool and the body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual. Outcomes included the effectiveness of dietetic interventions in terms of anthropometry, clinical indicators, and dietary intake. A statistically significant between-group difference was used to indicate intervention effectiveness (P<0.05). Twenty-six randomized controlled studies met eligibility criteria, representing 5,500 adults receiving dietetic consultations in a primary care setting. Eighteen of 26 included studies showed statistically significant differences in dietary

  3. Spiritual Care Education of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Donia Baldacchino

    2015-05-01

    Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.

  4. Benchmarking HIV health care

    DEFF Research Database (Denmark)

    Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda

    2012-01-01

    ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care were...... assessed: Compliance with current guidelines on initiation of 1) combination antiretroviral therapy (cART), 2) chemoprophylaxis, 3) frequency of laboratory monitoring, and 4) virological response to cART (proportion of patients with HIV-RNA 90% of time on cART). RESULTS: 7097 Euro...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p HIV health care utilization...

  5. The effect of physical fitness and physical exercise training on work productivity among health care workers

    DEFF Research Database (Denmark)

    Kongstad, Malte Bue; Christensen, Jeanette Reffstrup; Sjøgaard, Gisela

    THE EFFECT OF PHYSICAL FITNESS AND PHYSICAL EXERCISE TRAINING ON WORK PRODUCTIVITY AMONG HEALTH CARE WORKERS Kongstad, M. 1, Sjøgaard, G. 1, Søgaard, K. 1, Christensen, JR. 1 1: SDU (Odense, Denmark) Introduction Workplace health promotion involving physical exercise training may negate lifestyle...... diseases and improve work productivity (WP) mediated by physiological variables such as BMI, cardiorespiratory fitness (CRF), and maximal voluntary contraction (MVC). The aim of this paper was to examine 1) the relationship between WP and the physiological variables BMI, CRF, and MVC in a cross...

  6. Health-Care Hub

    Science.gov (United States)

    Bowman, Darcia Harris

    2004-01-01

    The Broad Acres clinic is one of 1,500 school-based health centers nationwide that bring a wide range of medical, nutritional, and mental-health care to millions of students and their families. The centers provide an important safety net for children and adolescents--particularly the more than 10 million today who lack health insurance, according…

  7. Organizing Rural Health Care

    DEFF Research Database (Denmark)

    Bunkenborg, Mikkel

    2012-01-01

    The liberalization of health care in the course of three decades of ‘reform and opening up’ has given people in rural China access to a diverse range of treatment options, but the health care system has also been marred by accusations of price hikes, fake pharmaceuticals, and medical malpractice...... roads to healing. The recent introduction of new rural cooperative medicine in the township represents an attempt to bring the state back in and address popular concern with the cost and quality of health care. While superficially reminiscent of the traditional socialist system, this new state attempt...

  8. Effective strategies for global health research, training and clinical care: a narrative review.

    Science.gov (United States)

    Walker, Rebekah J; Campbell, Jennifer A; Egede, Leonard E

    2014-09-29

    The purpose of this narrative review was to synthesize the evidence on effective strategies for global health research, training and clinical care in order to identify common structures that have been used to guide program development. A Medline search from 2001 to 2011 produced 951 articles, which were reviewed and categorized. Thirty articles met criteria to be included in this review. Eleven articles discussed recommendations for research, 8 discussed training and 11 discussed clinical care. Global health program development should be completed within the framework of a larger institutional commitment or partnership. Support from leadership in the university or NGO, and an engaged local community are both integral to success and sustainability of efforts. It is also important for program development to engage local partners from the onset, jointly exploring issues and developing goals and objectives. Evaluation is a recommended way to determine if goals are being met, and should include considerations of sustainability, partnership building, and capacity. Global health research programs should consider details regarding the research process, context of research, partnerships, and community relationships. Training for global health should involve mentorship, pre-departure preparation of students, and elements developed to increase impact. Clinical care programs should focus on collaboration, sustainability, meeting local needs, and appropriate process considerations.

  9. Effect of Health Insurance on Demand for Outpatient Medical Care in ...

    African Journals Online (AJOL)

    In the 2000's the Government of Rwanda initiated health sector reforms aiming at increasing health care access. Despite these reforms there has not been a corresponding increase in demand for health services, as only about 30 percent of the sick persons use modern care (NISR, 2011). The objective of this paper is to ...

  10. Effect of routine mental health screening in a low-resource pediatric primary care population.

    Science.gov (United States)

    Berger-Jenkins, Evelyn; McCord, Mary; Gallagher, Trish; Olfson, Mark

    2012-04-01

    Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting. Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc. Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change. Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services.

  11. [Current Status and Effectiveness of Perioperative Oral Health Care Management for Lung Cancer and Esophageal Cancer Patients].

    Science.gov (United States)

    Nishino, Takeshi; Takizawa, Hiromitsu; Yoshida, Takahiro; Inui, Tomohiro; Takasugi, Haruka; Matsumoto, Daisuke; Kawakita, Naoya; Inoue, Seiya; Sakiyama, Shoji; Tangoku, Akira; Azuma, Masayuki; Yamamura, Yoshiko

    2016-01-01

    The effectiveness of perioperative oral health care management to decrease the risk of postoperative pneumonia have been reported lately. Since 2014, we introduced perioperative oral health care management for lung cancer and esophageal cancer patients. We report current status and effectiveness of perioperative oral health care management for lung cancer and esophageal cancer patients. Every 100 cases of lung cancer and esophageal cancer patients treated by surgery were classified 2 group with or without perioperative oral health care management and compared about postoperative complications retrospectively. In the lung cancer patients, the group with oral health care management could prevent postoperative pneumonia significantly and had shorter length of hospital stay than the group without oral health care management. In the esophageal cancer patients, there was little occurrence of postoperative pneumonia without significant difference between both group with or without oral health care management. A large number of esophageal cancer patients received neo-adjuvant chemotherapy and some patients developed oral mucositis and received oral care treatment before surgery. Treatment for oral mucositis probably improved oral environment and affected prevention of postoperative pneumonia. Perioperative oral health care management can prevent postoperative pneumonia of lung cancer and esophageal cancer patients by improvement of oral hygiene.

  12. HRM and its effect on employee, organizational and financial outcomes in health care organizations.

    Science.gov (United States)

    Vermeeren, Brenda; Steijn, Bram; Tummers, Lars; Lankhaar, Marcel; Poerstamper, Robbert-Jan; van Beek, Sandra

    2014-06-17

    One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. This study uses a unique dataset, based on the 'ActiZ Benchmark in Healthcare', a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the 'black box' between HRM and performance. The results underscore the importance of HRM in the health care sector, especially for HR and organizational outcomes. Further analyses of HRM

  13. HRM and its effect on employee, organizational and financial outcomes in health care organizations

    Science.gov (United States)

    2014-01-01

    Background One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. Methods This study uses a unique dataset, based on the ‘ActiZ Benchmark in Healthcare’, a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. Results It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the ‘black box’ between HRM and performance. Conclusion The results underscore the importance of HRM in the health care sector, especially for HR and

  14. Effect of an Internet-based system for doctor-patient communication on health care spending.

    Science.gov (United States)

    Baker, Laurence; Rideout, Jeffrey; Gertler, Paul; Raube, Kristiana

    2005-01-01

    We studied the effect of a structured electronic communication service on health care spending, comparing doctor office and laboratory spending for a group of patients before and after the service became available to them relative to changes in a control group. In the treatment group, doctor office spending and laboratory spending fell in the period after the service became available, relative to the control group (p < 0.05). A rough estimate is that average doctor office spending per treatment group member per month fell $1.71 after availability of the service, and laboratory spending fell roughly $0.12. Spending associated with use of the electronic service was $0.29 per member per month. We conclude that use of structured electronic visits can reduce health care spending.

  15. The effects of health information technology on the costs and quality of medical care.

    Science.gov (United States)

    Agha, Leila

    2014-03-01

    Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998 to 2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals' adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3% increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates. Copyright © 2013 Elsevier B.V. All rights reserved.

  16. An approach to develop effective health care decision making for women in prison.

    Science.gov (United States)

    Enders, Sheila R; Paterniti, Debora A; Meyers, Frederick J

    2005-04-01

    Decision making about medical treatment, advance care planning and end-of-life care often is limited or influenced by a patient's capacity to read or comprehend crucial information. Ineffective communication between patient and physician, and the complex nature of serious illness and dying also affect these decisions. America's incarcerated have virtually no autonomy in decision making, especially with regard to medical care and treatment. For the nearly 100,000 incarcerated women in the United States, medical issues differ significantly from those of male prisoners. Many women enter prison with chronic illnesses or are diagnosed with such illnesses while in prison. In addition, America's prison population reflects our country's unsolved literacy problems with almost two thirds of aging inmates lacking basic literacy skills. Maintaining a balance between the Eighth Amendment rights of prisoners and their status as wards of the state is a concern for inmates and for those responsible for their care. The purpose of this study was to identify informational barriers to people making medical care and treatment decisions, particularly those with low literacy. Findings were used to in the development of a tool to assist patients to initiate discussion and become active participants in their own care. Female inmates of diverse ethnicity and literacy levels were recruited through self-selection from the Central California Women's Facility near Sacramento to participate in focus group discussions. The focus groups were guided by a set of research questions and were facilitated by the first author to identify informational barriers to medical care needs. The female prison setting was identified as an appropriate setting for the development of a new approach to stimulate effective decision making by introducing basic information on medical care and treatment, advance care planning, and end-of-life care. A total of 113 inmates participated in 16 focus group, each 2 hours in

  17. VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans

    Science.gov (United States)

    2016-12-01

    that VA medical centers complied with requirements related to the environment of care for women veterans and VHA’s oversight of that compliance; (2...VHA’s oversight of medical facilities’ compliance with these requirements; 2. what is known about the availability of VHA medical providers who can...site visits cannot be generalized to other VAMCs. To examine VHA’s oversight of medical facilities’ compliance with requirements related to the

  18. Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children: a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Evelyn Korkor Ansah

    2009-01-01

    Full Text Available Delays in accessing care for malaria and other diseases can lead to disease progression, and user fees are a known barrier to accessing health care. Governments are introducing free health care to improve health outcomes. Free health care affects treatment seeking, and it is therefore assumed to lead to improved health outcomes, but there is no direct trial evidence of the impact of removing out-of-pocket payments on health outcomes in developing countries. This trial was designed to test the impact of free health care on health outcomes directly.2,194 households containing 2,592 Ghanaian children under 5 y old were randomised into a prepayment scheme allowing free primary care including drugs, or to a control group whose families paid user fees for health care (normal practice; 165 children whose families had previously paid to enrol in the prepayment scheme formed an observational arm. The primary outcome was moderate anaemia (haemoglobin [Hb] < 8 g/dl; major secondary outcomes were health care utilisation, severe anaemia, and mortality. At baseline the randomised groups were similar. Introducing free primary health care altered the health care seeking behaviour of households; those randomised to the intervention arm used formal health care more and nonformal care less than the control group. Introducing free primary health care did not lead to any measurable difference in any health outcome. The primary outcome of moderate anaemia was detected in 37 (3.1% children in the control and 36 children (3.2% in the intervention arm (adjusted odds ratio 1.05, 95% confidence interval 0.66-1.67. There were four deaths in the control and five in the intervention group. Mean Hb concentration, severe anaemia, parasite prevalence, and anthropometric measurements were similar in each group. Families who previously self-enrolled in the prepayment scheme were significantly less poor, had better health measures, and used services more frequently than those in

  19. Towards Sustainable Health Care Organizations

    Directory of Open Access Journals (Sweden)

    Mauro ROMANELLI

    2017-09-01

    Full Text Available Health care organizations have to develop a sustainable path for creating public value by seeking legitimacy for building and maintaining public trust with patients as social and economic institutions creating value and sustaining both health and wealth for people and communities within society. Health care organizations having at disposal decreasing resources and meeting increasing demands of citizens are following an unsustainable path. Designing sustainable health care systems and organizations is emerging as a strategic goal for developing the wealth of people and communities over time. Building sustainable organizations relies on valuing human resources, designing efficient and effective processes, using technology for better managing the relationships within and outside organizations. Sustainable health care organizations tend to rediscover the importance of human resource management and policies for effectively improving communication with patients and building trust-based relationships. While processes of accreditation contribute to legitimizing effectiveness and quality of health care services and efficient processes, introducing and using new information and communication technologies (ICTs and informatics helps communication leading to restore trust-based relationships between health care institutions and patients for value creation within society.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Enterobacter spp. 1. 0.6. Table V: Proportion of Respondent that enter the Ward with Handheld Device. Table VI: Proportion of Respondent that Disinfect Phones and what they Disinfect with. Table VII: Hand Hygiene Practices. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH ...

  1. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    globally, (Ischaemic heart diseases, Convention on Tobacco Control (FCTC), which. 5 cerebrovascular diseases, lower ... tract infections, chronic obstructive than 86% of the world's population. Tobacco pulmonary diseases ... and delivery of smoking cessation services among health care workers in Abuja. A cross sectional ...

  2. The effect of non-response on estimates of health care utilisation

    DEFF Research Database (Denmark)

    Gundgaard, Jens; Ekholm, Orla; Hansen, Ebba Holme

    2008-01-01

    BACKGROUND: Non-response in health surveys may lead to bias in estimates of health care utilisation. The magnitude, direction and composition of the bias are usually not well known. When data from health surveys are merged with data from registers at the individual level, analyses can reveal non......-response bias. Our aim was to estimate the composition, direction and magnitude of non-response bias in the estimation of health care costs in two types of health interview surveys. METHODS: The surveys were (1) a national personal interview survey of 22 484 Danes (2) a telephone interview survey of 5000 Danes...... living in Funen County. Data were linked with register information on health care utilisation in hospitals and primary care. Health care utilisation was estimated for respondents and non-respondents, and the difference was explained by a decomposition method of bias components. RESULTS: The surveys...

  3. Sustained effects of integrated COPD management on health status and exercise capacity in primary care patients

    Directory of Open Access Journals (Sweden)

    Annemarije L Kruis

    2010-11-01

    Full Text Available Annemarije L Kruis1, Joan van Adrichem2, Magda R Erkelens2, Huub Scheepers3, Hans in ’t Veen4, Jean WM Muris5, Niels H Chavannes11Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2Physiotherapy Center De Beweging, Rotterdam, 3Well-being Medical Center, Bocholtz-Simpelveld, 4Department of Pulmonary Diseases, Sint Franciscus Gasthuis, Rotterdam, 5Department of General Practice, Maastricht University Medical Center, The NetherlandsBackground: Chronic obstructive pulmonary disease (COPD constitutes a growing health care problem worldwide. Integrated disease management (IDM of mild to moderate COPD patients has been demonstrated to improve exercise capacity and health status after one year, but long-term results are currently lacking in primary care.Methods: Long-term data from the Bocholtz study, a controlled clinical trial comparing the effects of IDM versus usual care on health status in 106 primary care COPD patients during 24 months of follow-up, were analyzed using the Clinical COPD Questionnaire (CCQ. In addition, the Kroonluchter IDM implementation program has treated 216 primary care patients with mild to moderate COPD since 2006. Longitudinal six-minute walking distance (6MWD results for patients reaching 24 months of follow-up were analyzed using paired-sample t-tests. In prespecified subgroup analyses, the differential effects of baseline CCQ score, Medical Research Council (MRC dyspnea score, and 6MWD were investigated.Results: In the Bocholtz study, subjects were of mean age 64 years, with an average postbronchodilator forced expiratory volume in one second (FEV1 of 63% predicted and an FEV1/forced vital capacity (FVC ratio of 0.56. No significant differences existed between groups at baseline. CCQ improved significantly and in a clinically relevant manner by 0.4 points over 24 months; effect sizes were doubled in patients with CCQ > 1 at baseline and tripled in patients with MRC dyspnea score

  4. Resilient health care

    DEFF Research Database (Denmark)

    Hollnagel, E.; Braithwaite, J.; Wears, R. L.

    Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have...... engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering...

  5. Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders

    Directory of Open Access Journals (Sweden)

    Seekles Wike

    2009-06-01

    Full Text Available Abstract Background Mood and anxiety disorders are highly prevalent and have a large impact on the lives of the affected individuals. Therefore, optimal treatment of these disorders is highly important. In this study we will examine the effectiveness of a stepped care program for primary care patients with mood and anxiety disorders. A stepped care program is characterized by different treatment steps that are arranged in order of increasing intensity. Methods This study is a randomised controlled trial with two conditions: stepped care and care as usual, whereby the latter forms the control group. The stepped care program consists of four evidence based interventions: (1 Watchful waiting, (2 Guided self-help, (3 Problem Solving Treatment and (4 Medication and/or specialized mental health care. The study population consists of primary care attendees aged 18–65 years. Screeners are sent to all patients of the participating general practitioners. Individuals with a Diagnostic and Statistical Manual of mental disorders (DSM diagnosis of major depression, dysthymia, panic disorder (with or without agoraphobia, generalized anxiety disorder, or social phobia are included as well as individuals with minor depression and anxiety disorders. Primary focus is the reduction of depressive and anxiety symptoms. Both conditions are monitored at 8, 16 and 24 weeks. Discussion This study evaluates the effectiveness of a stepped care program for patients with depressive and anxiety disorder. If effective, a stepped care program can form a worthwhile alternative for care as usual. Strengths and limitations of this study are discussed. Trial Registration Current Controlled Trails: ISRCTN17831610.

  6. Health care engineering management.

    Science.gov (United States)

    Jarzembski, W B

    1980-01-01

    Today, health care engineering management is merely a concept of dreamers, with most engineering decisions in health care being made by nonengineers. It is the purpose of this paper to present a rationale for an integrated hospital engineering group, and to acquaint the clinical engineer with some of the salient features of management concepts. Included are general management concepts, organization, personnel management, and hospital engineering systems.

  7. The effect of interprofessional education on interprofessional performance and diabetes care knowledge of health care teams at the level one of health service providing

    Directory of Open Access Journals (Sweden)

    Nikoo Yamani

    2014-01-01

    Conclusion: It seems that inter-professional education can improve the quality of health care to some extent through influencing knowledge and collaborative performance of health care teams. It also can make the health-related messages provided to the covered population more consistent in addition to enhancing self-confidence of the personnel.

  8. Determination of Cost-Effectiveness Threshold for Health Care Interventions in Malaysia.

    Science.gov (United States)

    Lim, Yen Wei; Shafie, Asrul Akmal; Chua, Gin Nie; Ahmad Hassali, Mohammed Azmi

    2017-09-01

    One major challenge in prioritizing health care using cost-effectiveness (CE) information is when alternatives are more expensive but more effective than existing technology. In such a situation, an external criterion in the form of a CE threshold that reflects the willingness to pay (WTP) per quality-adjusted life-year is necessary. To determine a CE threshold for health care interventions in Malaysia. A cross-sectional, contingent valuation study was conducted using a stratified multistage cluster random sampling technique in four states in Malaysia. One thousand thirteen respondents were interviewed in person for their socioeconomic background, quality of life, and WTP for a hypothetical scenario. The CE thresholds established using the nonparametric Turnbull method ranged from MYR12,810 to MYR22,840 (~US $4,000-US $7,000), whereas those estimated with the parametric interval regression model were between MYR19,929 and MYR28,470 (~US $6,200-US $8,900). Key factors that affected the CE thresholds were education level, estimated monthly household income, and the description of health state scenarios. These findings suggest that there is no single WTP value for a quality-adjusted life-year. The CE threshold estimated for Malaysia was found to be lower than the threshold value recommended by the World Health Organization. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  9. The effect of aerobic exercise training on work ability of midwives working in health care centers

    Directory of Open Access Journals (Sweden)

    Zahra Abedian

    2017-01-01

    Full Text Available Background & aim: Maintaining and improving the work ability are important social goals, which challenge the health care and rehabilitation systems as well as health providers. The physical and mental health status affect the work ability. Regarding this, the current study aimed to investigate the effect of aerobic training on the work ability of the midwives in the health care centers of Mashhad, Iran in 2013. Methods: This randomized clinical trial was conducted on 60 midwives working in the health centers of Mashhad, Iran, using purposeful sampling method. The health care centers were selected randomly, and then assigned into the intervention and control groups. Subsequently, the intervention group performed aerobic exercise for 24 sessions. Data collection was performed using the work ability index and the Bruce test (to compare the fitness of the participants at the pre- and post-intervention stages. For data analysis, the two-way ANOVA, Mann-Whitney U, and Chi-square tests as well as independent and paired sample t-tests were employed, using SPSS version 19. The P-value less than 0.05 was considered statistically significant. Results: According to the results of the study, the mean score of work ability was significantly higher in the intervention group than that in the control group (40.5±4.9 vs. 36.4± 5.3, respectively; P=0.004. Furthermore, there was a significant difference between the two groups regarding the two variables including work ability compared with life time best (P

  10. Effectiveness of an intervention for prevention and treatment of burnout in primary health care professionals.

    Science.gov (United States)

    Gómez-Gascón, Tomás; Martín-Fernández, Jesús; Gálvez-Herrer, Macarena; Tapias-Merino, Ester; Beamud-Lagos, Milagros; Mingote-Adán, José Carlos

    2013-11-17

    Burnout syndrome is an important health problem that affects many professionals and must be addressed globally, with both organizational measures and personal interventions. Burnout of health professionals can be prevented in order to avoid personal, familial, and social consequences, as well as repercussions for patients. This work describes a protocol for a controlled, pragmatic, randomized clinical trial in 2 parallel groups: intervention and control. All health professionals from 7 health care centers will form the intervention group, and all health professionals from 7 different health care centers will form the control group. The intervention group will receive 16 hours of training at their work place. The Maslach's burnout inventory, the Cuestionario de Desgaste Profesional Médico or the Cuestionario de Desgaste Profesional de Enfermería, and the 28-item Goldberg's General Health Questionnaire, validated for our setting, will be used as measurement tools. Change in the average scores from the Maslach's burnout inventory emotional exhaustion scale will be compared between the intervention and control groups, measured as intention-to-treat, and the intervention will be considered effective if a minimum decrease of 20% is achieved. Due to the deleterious consequences of burnout syndrome for people suffering from it and for the organization where they work, it is necessary to evaluate the effectiveness of certain interventions for its prevention. Organizational measures are important for preventing burnout syndrome, but so is providing professionals with coping strategies, as this group intervention intends to do. ClinicalTrials.gov processed this record on June 10, 2013. ClinicalTrials.gov Identifier: NCT01870154.

  11. Effectiveness of an intervention for prevention and treatment of burnout in primary health care professionals

    Science.gov (United States)

    2013-01-01

    Background Burnout syndrome is an important health problem that affects many professionals and must be addressed globally, with both organizational measures and personal interventions. Burnout of health professionals can be prevented in order to avoid personal, familial, and social consequences, as well as repercussions for patients. Methods/design This work describes a protocol for a controlled, pragmatic, randomized clinical trial in 2 parallel groups: intervention and control. All health professionals from 7 health care centers will form the intervention group, and all health professionals from 7 different health care centers will form the control group. The intervention group will receive 16 hours of training at their work place. The Maslach's burnout inventory, the Cuestionario de Desgaste Profesional Médico or the Cuestionario de Desgaste Profesional de Enfermería, and the 28-item Goldberg's General Health Questionnaire, validated for our setting, will be used as measurement tools. Change in the average scores from the Maslach's burnout inventory emotional exhaustion scale will be compared between the intervention and control groups, measured as intention-to-treat, and the intervention will be considered effective if a minimum decrease of 20% is achieved. Discussion Due to the deleterious consequences of burnout syndrome for people suffering from it and for the organization where they work, it is necessary to evaluate the effectiveness of certain interventions for its prevention. Organizational measures are important for preventing burnout syndrome, but so is providing professionals with coping strategies, as this group intervention intends to do. Trial registration ClinicalTrials.gov processed this record on June 10, 2013. ClinicalTrials.gov Identifier: NCT01870154. PMID:24237937

  12. [Health care systems and aspects of health care economics. Sector ophthalmology - part 1: development of the German health care system].

    Science.gov (United States)

    Kern, T; Kohnen, T

    2010-11-01

    Although many health care reforms have been enacted in the last few years in Germany, many of the key points in the current social health care system have been retained from former times. All those introductions for an effective health care system from the last 150 years beginning with mandatory guild membership via Bismarck's social laws to the modern health care systems in Germany with the current problems of financing the heavy burden in the German budget are reported. Data and facts on the current health care system are provided. In the following two articles of this series ambulatory and inpatient treatment in the light of economic aspects of health care are reported.

  13. [Cost-effectiveness of needs-oriented discharge planning in high utilizers of mental health care].

    Science.gov (United States)

    Puschner, Bernd; Baumgartner, Ildiko; Loos, Sabine; Völker, Kathleen A; Ramacher, Meike; Sohla, Katja; Grempler, Julia; Becker, Thomas; Kilian, Reinhold

    2012-11-01

    To establish the cost-effectiveness of needs-oriented discharge planning in high utilizers of mental health services. As part of a multicenter RCT (n = 458), costs were measured via the German version of the "Client Sociodemographic and Service Receipt Inventory" (CSSRI-EU), and the EQ-5 D was used to ascertain QALYs. Cost-effectiveness analysis included deriving incremental cost-effectiveness ratios (ICERs) and plotting them onto the cost-effectiveness plane as well as examining cost-effectiveness acceptability taking into account willingness-to-pay. During an 18-month period after discharge from inpatient psychiatric treatment, neither total direct and indirect costs (44,278 € vs. 43,302 €) nor quality-adjusted life years (0.960 vs. 0.958 QALYs) significantly differed by participant allocation to intervention or control groups. Also inspection of ICERs showed that the intervention had no economic advantage over standard care. The intervention is no cost-effective alternative to standard care. Future studies aiming to improve organization of mental care should be considerate of institutional context. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Cost-Effectiveness of Physical Therapy Only and of Usual Care for Various Health Conditions: Systematic Review.

    Science.gov (United States)

    Bürge, Elisabeth; Monnin, Dominique; Berchtold, André; Allet, Lara

    2016-06-01

    Given continually rising health care costs, interventions of health care providers should be cost-effective. This review aimed to summarize current cost-effectiveness of physical therapy. Specific aims were: (1) to analyze cost-effectiveness of physical therapy only compared with usual care only, (2) to analyze cost-effectiveness of physical therapy added to usual care compared with usual care only, and (3) to specify in which health conditions physical therapy only or physical therapy added to usual care was cost-effective. Topic-related systematic reviews were searched in MEDLINE, CINAHL, PEDro, and Cochrane Library and manually. Studies published between 1998 and 2014 that investigated the cost-effectiveness of interventions carried out by physical therapists were reviewed. The methodological quality was assessed with the Cochrane risk of bias assessment for intervention studies and with the Quality of Health Economic Analyses Scale. Effectiveness and cost data for calculating incremental cost-effectiveness ratios (ICERs) and the original authors' conclusions were extracted. The 18 included studies presented low risk of bias and contained 8 comparisons of physical therapy only with usual care only and 11 comparisons of physical therapy added to usual care with usual care only. Based on ICERs, physical therapy only or added to usual care was cost-effective in 9 out of the 19 comparisons and in 10 comparisons according to the original authors' conclusions. Physical therapy only or added to usual care implies improved health in almost all studies. The cost-effectiveness of such interventions was demonstrated in half of the studies. This result might have been influenced by the fact that different definitions of the notion of "cost-effectiveness" exist. © 2016 American Physical Therapy Association.

  15. Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal.

    Science.gov (United States)

    Legido-Quigley, Helena; Karanikolos, Marina; Hernandez-Plaza, Sonia; de Freitas, Cláudia; Bernardo, Luís; Padilla, Beatriz; Sá Machado, Rita; Diaz-Ordaz, Karla; Stuckler, David; McKee, Martin

    2016-07-01

    Although Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troika's austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR=2.41, 95% CI 2.01-2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR=1.68, 95% CI 1.32-2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20-3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR=13.98, 95% CI 6.51-30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Effect of socioeconomic conditions on health care utilization in marital violence: a cross-sectional investigation from the Japanese Study on Stratification, Health, Income, and Neighborhood.

    Science.gov (United States)

    Umeda, Maki; Kawakami, Norito; Miller, Elizabeth

    2017-02-28

    The health-care-seeking process while experiencing marital violence can be significantly influenced by one's socioeconomic status, which limits the availability of resources and opportunities for accessing those resources. This study exploratorily examined the effects of socioeconomic factors on the association between marital violence and health care utilization in Japan. Cross-sectional data on 2,984 male and female community residents aged 25 to 50 years was obtained from the first wave of Japanese Study of Stratification, Health, Income, and Neighborhood (J-SHINE) conducted between 2010 and 2011. Multiple logistic regression analysis was conducted to examine the association between marital violence and health care utilization. Interaction terms were used to examine the moderating effect of educational attainment, household income, and employment status on the association. Mediation analysis was conducted to estimate the magnitude of mediating effects of mastery, social support, and health literacy in relation to the moderating effect of socioeconomic factors. Health care utilization in Japan was more prevalent among those who experienced marital violence (69.4 vs. 65.1%). The association between marital violence and health care utilization differed by employment status at a 0.10 level, while educational attainment and household income did not have substantial influence on health care utilization in the presence of marital violence. None of the psychosocial resources (mastery, health literacy, instrumental support, and informational support) explained the differential association by employment status. This study highlights the increased health care needs of those experiencing marital violence in Japan. The health care needs of the unemployed are potentially unmet in the presence of marital violence. Removing barriers to health care experienced by the unemployed may be an effective strategy for connecting survivors to needed supports and care.

  17. The effectiveness of health literacy interventions on the informed consent process of health care users: a systematic review protocol.

    Science.gov (United States)

    Perrenoud, Beatrice; Velonaki, Venetia-Sofia; Bodenmann, Patrick; Ramelet, Anne-Sylvie

    2015-10-01

    The aim of this systematic review is to establish the best available evidence of the effectiveness of health literacy interventions on the informed consent process for health care users. The specific review question is:What is the effectiveness of health literacy interventions on health care users' informed consent to health procedures processes? Informed consent is a fundamental principal in the health care context which nowadays includes the patient's capacity to judge and to be involved in the decision making concerning their care that ensures that the care received reflects their goals, preferences and values. The importance of obtaining a valid consent before any medical procedure is well-established. In a US court case in 1914, it was stated that it is the right of any adult with the capability of making decisions concerning his own body, and that any surgical operation without the patient's consent could be considered as an assault. In another US court case, the court stated that it is a doctor's duty to make a reasonable disclosure to his patient of the nature, probable consequences and dangers of the proposed treatment to the patient. The application of the doctrine of informed consent as a legal procedure may slightly differ from country to country or from state to state, and may have different forms even within the same country. For example in the UK, consent can be written, verbal or non-verbal/implied, and a written consent form is not the actual consent itself but merely serves as evidence that consent has been given. If the elements of voluntariness, appropriate information and capacity have not been satisfied, a signed informed consent form will not make the consent valid. Nowadays it is widely accepted that prior to the application of any medical procedure, its benefits, risks and alternatives must have been explained to the patient, and the competent patient should have voluntarily and understandingly consented. Hence, the informed consent refers

  18. Effect of a Comprehensive Health Care Program by Korean Medicine Doctors on Medical Care Utilization for Common Infectious Diseases in Child-Care Centers

    Directory of Open Access Journals (Sweden)

    Minjung Park

    2014-01-01

    Full Text Available As the role of traditional medicine in community health improvement increases, a comprehensive health care program for infectious diseases management in child-care centers by Korean medicine doctors was developed. The purpose of this study is to evaluate the effects of the program intervention on infection-related medical care utilization among children. The study used a quasi-experimental design with nonequivalent control group, comparing pre- and post-intervention data of the same children. The program implemented interventions in terms of management, education, and medical examination for the teachers, parents, and children in 12-week period. The frequency of utilization, cost, and prescription days of drugs and antibiotics due to infectious diseases prior to the intervention were compared with those during the 3-month intervention, using health insurance claim data. A panel analysis was also conducted to support the findings. A significant reduction (12% in infection-related visit days of hospitals was observed with the intervention (incident rate ratio = 0.88, P=0.01. And medical cost, drug prescription days, and antibiotics prescription days were decreased, although not statistically significant. A further cost-effectiveness analysis in terms of social perspectives, considering the opportunity costs for guardians to take children to medical institutions, would be needed.

  19. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol.

    Science.gov (United States)

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-05-18

    The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Formal ethical approval is not required. The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. CRD42014009685. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Kangaroo mother care in resource-limited settings: implementation, health benefits, and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-06-01

    Full Text Available Samuel N Uwaezuoke Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku–Ozalla, Enugu, Nigeria Abstract: Kangaroo mother care (KMC represents an intervention in low birth weight infants for resource-limited settings which aims to reduce mortality rates by thermoregulation, supporting breastfeeding, and promoting early hospital discharge. In terms of cost and impact on neonatal survival, it has comparative advantages over the conventional method of care (CMC. This paper aimed to review the evidence concerning the progress of KMC implementation, its health benefits, and its cost-effectiveness, especially in developing countries. From the synthesized evidence, KMC was shown to be a useful adjunct to CMC particularly with respect to improving neonatal survival, supporting breastfeeding, and promoting early discharge from the hospital. Substantial progress has been made in its implementation in many developing countries where facility-based KMC has been institutionalized. Despite the cost-effectiveness of KMC in neonatal care, its global implementation is bedeviled with country-specific, multifaceted challenges. In developed countries, there is an implementation gap due to easy accessibility to technology-based CMC. Nevertheless, many developing countries have initiated national policies to scale up KMC services in their domain. Given the major constraints to program implementation peculiar to these resource-limited countries, it has become imperative to boost caregiver confidence and experience using dedicated spaces in the hospital, as well as dedicated staff meant for adequate ambulatory follow-up and continuous health education. Capacity training for health professionals and provision of space infrastructure thus constitute the basic needs which could be funded by International Aid Agencies in order to scale up the program in these settings. Keywords: neonatal care, low birth weight infants, thermoregulation, breastfeeding

  1. Back schools in occupational health care: Design of a randomized controlled trial and cost-effectiveness study

    NARCIS (Netherlands)

    Heymans, M.W.; Vet, H.C. de; Bongers, P.M.; Koes, B.W.; Mechelen, W. van

    2004-01-01

    To describe the design of a randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing high-intensity and low-intensity back schools with usual care in occupational health care. RCT and cost-effectiveness analysis. Employees sick-listed for a period of 3 to 6 weeks because

  2. Telemedicine, the effect of nurse-initiated telephone follow up, on health status and health-care utilization in COPD patients : A randomized trial

    NARCIS (Netherlands)

    Berkhof, Farida F.; van den Berg, Jan W. K.; Uil, Steven M.; Kerstjens, Huib A. M.

    Background and objectiveTelemedicine, care provided by electronic communication, may serve as an alternative or extension to traditional outpatient visits. This pilot study determined the effects of telemedicine on health-care utilization and health status of chronic obstructive pulmonary disease

  3. Spillover Effects of Drug Safety Warnings on Preventive Health Care Use

    DEFF Research Database (Denmark)

    Daysal, N. Meltem; Orsini, Chiara

    2015-01-01

    We examine how new medical information on drug safety impacts preventive health care use. We exploit the release of the findings of the Women’s Health Initiative Study (WHIS) – the largest randomized controlled trial of women’s health – which demonstrated in 2002 the health risks associated...

  4. Health care workers' compliance with hand hygiene regulations: Positive effects of a poster

    NARCIS (Netherlands)

    Karreman, Joyce; Berendsen, Femke; Pol, Bert; Dorman, Hilde

    2015-01-01

    Health care workers in nursing homes do not always comply with hand hygiene regulations, such as not wearing jewelry. Non-compliance with these regulations is a threat to patients' safety. We did two studies to investigate if compliance could be improved by a poster that reminds health care workers

  5. Effects of health-care services and commodities cost on the patients ...

    African Journals Online (AJOL)

    Introduction: The payment for health-care services is a major problem for many poor patients in developing nations. The aim of the study was to examine the cost of services and commodities and how these affect the patients who utilizes the primary health-care centers in Zaria, North western Nigeria. Methodology: A ...

  6. Psychotherapy: Attendance and effects on utilisation of health care services and occupational functioning. PhD

    DEFF Research Database (Denmark)

    Fenger, Morten Munthe

    2012-01-01

    This thesis investigates to what degree mental health care actually reaches the patients seeking help and to what degree psychotherapy achieves reducing health care consumption and improving occupational functioning. The thesis includes three studies of patients referred to and offered treatment...

  7. Production gains from health care: what should be included in cost-effectiveness analyses?

    Science.gov (United States)

    Olsen, J A; Richardson, J

    1999-07-01

    Recent literature has been concerned with the correct measurement of the 'indirect costs and benefits' of health care as well as the issue of including these items in economic evaluations. This article considers the question of which 'indirect benefits' to include in cost effectiveness analysis and cost utility analysis. Within the context of a collectively financed health scheme the relevant issues include not only the size of the net resource costs of providing health care but also which costs and benefits the society is prepared to consider in its assessment of health services. The strong preference for 'equal access for equal need' implies that some production gains may have to be disregarded in the social welfare function. We introduce the notion of socially relevant and socially irrelevant production gains. The analysis suggests that the magnitude of the socially relevant part of the production gains may vary between countries as it depends, first, upon differences in patients' potential contributions to the rest of society (tax rates), and second, the strength of preferences for equity.

  8. Effects of knowledge and internal locus of control in groups of health care workers judging likelihood of pathogen transfer.

    Science.gov (United States)

    McLaughlin, Anne Collins; Walsh, Fran; Bryant, Michelle

    2013-08-01

    A study was conducted to measure the effects of attitudes and beliefs on the risk judgments of health care workers. Lack of hand hygiene compliance is a worldwide issue in health care, contributing to infections, fatalities, and increased health care costs. Human factors methods are a promising solution to the problem of compliance, although thus far, the concentration has been on process and engineering methods, such as the design of no-touch sinks. Factors internal to the health care worker, such as their attitudes and beliefs about hand hygiene, have received less attention. For this study, three groups of health care workers completed measures of attitudes, control beliefs, and hand hygiene knowledge. They then provided risk judgments of touching various surfaces via a factorial survey. Attitudes, knowledge, control beliefs, and surface type all predicted the risk judgments of the sample of health care workers, with differences between professional groups. Health care workers perceive less risk when touching surfaces,which may explain historically low rates of hand hygiene compliance after surface contact. Although more research is needed to directly connect risk judgments to failures of hand hygiene, the current results can inform interventions targeting the internal attitudes and beliefs of health care workers.

  9. New York's Health Care Workforce Recruitment and Retention Act: an investigation of the effects of nonrecurring increases in health worker wage on health worker supply.

    Science.gov (United States)

    Patel, Kavin

    2014-01-01

    This article analyzes New York's Health Care Workforce Recruitment and Retention Act of 2002. The analysis comes in 4 parts: part 1 provides a brief overview of New York's economy as it relates to health care, a feel for the political climate at the time, and a detailed presentation of the chain of events that connect this climate to the birth of the Health Care Workforce Recruitment and Retention Act of 2002; part 2 consists of a breakdown of the provisions contained within bill, including major and minor goals, intended effects, and the mechanics behind raising supporting funds; part 3 explores what actually happened by evaluating available data to determine whether the bill's 2 major goals of workforce recruitment and retention were fulfilled; and finally, part 4 will take all the aforementioned information to determine the overall success of the bill, the implications, and specific suggestions for future policy changes that time has revealed since its inception.

  10. Effects on quality of care and health care worker satisfaction of ...

    African Journals Online (AJOL)

    To determine whether teaching Xhosa language skills and cultural understanding to HCWs affects patient satisfaction, HCWs' ability to communicate effectively ... HCWs completed a ten week basic language course comprising ten 120 minute interactive contact sessions developing basic Xhosa speaking and listening skills ...

  11. The Effect of Medicaid on Dental Care of Poor Adults: Evidence from the Oregon Health Insurance Experiment.

    Science.gov (United States)

    Baicker, Katherine; Allen, Heidi L; Wright, Bill J; Taubman, Sarah L; Finkelstein, Amy N

    2017-09-08

    To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations. Primary and secondary data on health care use and outcomes for participants in Oregon's 2008 Medicaid lottery. We used the lottery's random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care. Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229). Emergency department (ED) records were matched to lottery participants in Portland (N = 24,646). Medicaid coverage significantly reduced the share of respondents who reported needing dental care (-9.8 percentage points, p < .001) or having unmet dental care needs (-13.5 percentage points, p < 0.001). Medicaid doubled the share visiting the ED for dental care (+2.6 percentage points, p = .003) and the use of anti-infective medications often prescribed for dental care, but it had no detectable effect on uncovered dental care or out-of-pocket spending. Expansion of Medicaid covering emergency dental care substantially reduced unmet need for dental care, increasing ED dental visits and medication use, while not changing patient use of uncovered dental services. © Health Research and Educational Trust.

  12. Primary health care.

    Science.gov (United States)

    Romualdez, A

    1980-01-01

    This paper presents a short discussion of essential concepts in primary health care based on the Alma Ata Declaration of 1978 and a brief description of the Philippine Ministry of Health primary health program. The phrase primary health care implies that PHC is a package of goods to be delivered to people, whereas in fact it is an approach to health care which emphasizes community involvement and participation in health development. Community participation is too often taken to mean that communities should participate in programs designed, implemented, and run by health professionals. PHC however requires that health programs be designed, implemented, run by, and belong to the people of the community. External agencies and health professionals must find ways of becoming involved and participating in the community's programs. A thorough reorientation of health professionals, particularly doctors and nurses, away from technology and toward the ideals and wisdom of the people is needed if PHC is to succeed. PHC should provide the bridge between technological knowledge and indigenous wisdom. The national government is embarking on a nationwide PHC program, with structures being organized at national, regional, provincial, municipal, and barangay levels for PHC. The higher organizational levels are intended to ensure access to their available resources to complement resources at the lower levels, especially at the critical barangay level. Because over 70% of the national population lives in rural areas, the national government's effort through the Ministry of Health will stress rural needs and approaches. Different approaches will be needed for poor urban communities, and the Manila Health Department may be able to provide leadership for developing the new ideas needed to tailor health development programs to Filipino urban communities.

  13. Health care in the Netherlands.

    NARCIS (Netherlands)

    Weel, C. van; Schers, H.J.; Timmermans, A.

    2012-01-01

    This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and

  14. Identifying attributes of care that may improve cost-effectiveness in the youth mental health service system.

    Science.gov (United States)

    Hamilton, Matthew P; Hetrick, Sarah E; Mihalopoulos, Cathrine; Baker, David; Browne, Vivienne; Chanen, Andrew M; Pennell, Kerryn; Purcell, Rosemary; Stavely, Heather; McGorry, Patrick D

    2017-11-20

    To identify attributes of youth mental health care for which there is evidence of potential cost-effectiveness. We performed a literature review of economic evaluations that examined both costs and outcomes for attributes of youth mental health care other than pharmacological or individual psychological therapies for full-threshold disorders. We searched the United Kingdom National Health Service Economic Evaluations Database for evaluations published to the end of 2014; and MEDLINE, Google Scholar and the citation lists of relevant publications for peer-reviewed studies published in English since 1997. Forty economic evaluations met inclusion criteria. Psychosis was the mental disorder with the most developed economic evidence base, with good evidence of cost-effectiveness for first-episode psychosis services. There was a developing cost-effectiveness evidence base for other disorders. The most common attributes of the interventions examined in the included studies were the location of services, engagement and support of families, assessment, prevention, early intervention, group delivery format and information provision. We used our findings to formulate a list of attributes of youth mental health care that may be acceptable to young people and potentially cost-effective. There is at least suggestive cost-effectiveness evidence for a range of attributes of youth mental health care. Further economic research is needed to substantiate most cost-effectiveness findings and to improve targeting of care among young people. Future economic evaluations should examine costs from both societal and health care perspectives and incorporate evidence regarding young people's preferences.

  15. Do income effects mask social and behavioural factors when looking at universal health care provision?

    Science.gov (United States)

    Sabates, Ricardo; Feinstein, Leon

    2008-01-01

    To investigate whether permanent and transitory income effects mask the impact of unobservable factors on the uptake of health check-ups in Britain. We used a secondary data representative of the British population, the British Household Panel Survey. Outcome variables included uptake of dental health check-ups, eyesight tests, blood pressure checks, cholesterol tests, mammograms and cervical smear tests. Transitory income was measured as monthly household income and permanent income as average income over 13 years. Estimation method applied dynamic random effect probit model. Results showed the absence of permanent and transitory effects on the uptake of eyesight tests, cholesterol tests, mammograms and cervical smear tests. Permanent income was associated with dental check-ups and transitory income with uptake of blood pressure tests. The presence of income effects on the uptake of blood pressure checks may be due to factors associated with income, such as stress or lifestyles, rather than income per se. A permanent income effect on dental health care in Britain, which is not free of charge, could indicate the possibility of economic constraints to service uptake, but it does not guarantee that income is the only factor that matters as there may important cultural and behavioural barriers.

  16. Effects of health and social care spending constraints on mortality in England: a time trend analysis.

    Science.gov (United States)

    Watkins, Johnathan; Wulaningsih, Wahyu; Da Zhou, Charlie; Marshall, Dominic C; Sylianteng, Guia D C; Dela Rosa, Phyllis G; Miguel, Viveka A; Raine, Rosalind; King, Lawrence P; Maruthappu, Mahiben

    2017-11-15

    Since 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates. We collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011-2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends. Spending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65-6.54) (pconstraints, especially PES, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Health Care Industry

    Science.gov (United States)

    2007-01-01

    and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicaid is a federal and...living care. “Medicine has been slow to confront the very changes that it has been responsible for – or to apply the knowledge we already have about how...challenge to the nation. Challenges of the Industry As already outlined, a number of challenges confront the U.S. health care industry. Below are six

  18. Health care reforms.

    Science.gov (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

    In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  19. Health care reforms

    Directory of Open Access Journals (Sweden)

    Marušič Dorjan

    2016-09-01

    Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Background: Quarry industry has become a major means of livelihood in Ebonyi state, but insufficient data exists on their operations and use of control measures like dust mask, with no serious attempt at comprehensive health education. The study sought to assess the effect of health education on the perception and ...

  1. Quality of health care and its effects in the utilisation of maternal and ...

    African Journals Online (AJOL)

    Objective: To assess the quality of care provided by the Kisumu Municipal health facilities, with special reference to Maternal and Child health services (MCH). Design: A descriptive cross-sectional survey. Setting: Kisumu Municipal Health facilities. Subjects: Four hundred and eighty two mothers were interviewed in a ...

  2. Effect of Health Insurance on Demand for Outpatient Medical Care in ...

    African Journals Online (AJOL)

    ahavugimana

    the average transport cost decreased the likelihood to seek curative care by 25 percent. Evidence from empirical ... the health related goods that yield utility to the sick person and improve health status; H is the health production ..... utilization for women were related to specific diseases such as cardiovascular and chronic ...

  3. Low income parents' reports of communication problems with health care providers: effects of language and insurance.

    Science.gov (United States)

    Clemans-Cope, Lisa; Kenney, Genevieve

    2007-01-01

    This study examines how parental reports of communication problems with health providers vary over a wider range of characteristics of low income children than considered in previous studies. Data were drawn from the 1999 and 2002 National Survey of America's Families. Communication problems, insurance type, socioeconomic characteristics, health factors, and provider type were examined. Data were analyzed using bivariate and multivariate techniques. Bivariate analysis identified that the parents of 24.4% of low income children and 36.4% of publicly covered low income children with a Spanish interview reported poor communication with health providers. Coefficients from regression analysis suggest that, controlling for covariates, foreign-born parents with a Spanish interview were 11.8 percentage points (pcommunication problems than U.S.-born parents with an English interview. Among low income publicly covered children with a Spanish interview, regression analysis suggests that parents of children who used clinics or hospital outpatient departments as their usual source of care were 9.5 percentage points (pcommunication problems compared with those whose usual source of care was a doctor's or HMO office. Implementing policies to improve communication barriers for low income children, particularly those with foreign-born parents whose native language is not English, may be necessary to reduce health disparities relative to higher income children across a variety of health domains including utilization, satisfaction, and outcomes. Focusing attention on the availability of professional translation services in clinics or hospital outpatient departments may be a cost-effective strategy for reducing communication problems for publicly insured children.

  4. Growth and Welfare Effects of Health Care in Knowledge Based Economies

    OpenAIRE

    Kuhn, Michael; Prettner, Klaus

    2013-01-01

    We consider an endogenous growth model with Blanchard-Yaari-type overlapping generations that is built around four sectors: final and intermediate goods production, an R&D sector and a health care sector. Health care serves to lower mortality and morbidity, the latter being related to participation/productivity in the labor market. We show that, regardless of its finance, the impact of health care on economic growth crucially depends on whether or not it increases employment in the R&D sector...

  5. The effect of information technology investment on firm-level performance in the health care industry.

    Science.gov (United States)

    Thouin, Mark F; Hoffman, James J; Ford, Eric W

    2008-01-01

    The return on investment for information technology (IT) has been the subject of much debate throughout the history of management information systems research. Often referred to as the productivity paradox, increased IT investments have not been consistently associated with increased productivity. Understanding individual IT factors that directly contribute to business value should provide insight into the productivity paradox. The effects of 3 different firm-level IT characteristics on financial performance in the health care industry are studied. Specifically, the effects of IT budget, IT outsourcing, and the relative number of IT personnel on firm-level financial performance are analyzed. Regression analysis of archival survey data for 914 Integrated Healthcare Delivery Systems is performed. IT budgetary expenditures and the number of IT services outsourced are associated with increases in the profitability of Integrated Healthcare Delivery Systems, whereas increases in IT personnel are not significantly associated with increased profitability. Each one tenth of a percentage increase in IT expenditures is associated with approximately $100,000 in increased profit, and each additional IT service outsourced is associated with approximately $950,000 in increased profit for an average-sized Integrated Healthcare Delivery System. To increase profitability, IT administrators should increase IT budgetary expenditures along with IT outsourcing levels. IT administrators in the health care industry can use such findings during budgeting cycles to justify increased investments in IT personnel as being budget neutral while increasing organizational capacity.

  6. Effect of continuity of care on hospital utilization for seniors with multiple medical conditions in an integrated health care system.

    Science.gov (United States)

    Bayliss, Elizabeth A; Ellis, Jennifer L; Shoup, Jo Ann; Zeng, Chan; McQuillan, Deanna B; Steiner, John F

    2015-03-01

    Lower continuity of care has been associated with higher rates of adverse outcomes for persons with multiple chronic medical conditions. It is unclear, however, whether this relationship also exists within integrated systems that offer high levels of informational continuity through shared electronic health records. We conducted a retrospective cohort study of 12,200 seniors with 3 or more chronic conditions within an integrated delivery system. Continuity of care was calculated using the Continuity of Care Index, which reflects visit concentration with individual clinicians. Using Cox proportional hazards regression permitting continuity to vary monthly until the outcome or censoring event, we separately assessed inpatient admissions and emergency department visits as a function of primary care continuity and specialty care continuity. After adjusting for covariates (demographics; baseline, primary, and specialty care visits; baseline outcomes; and morbidity burden), greater primary care continuity and greater specialty care continuity were each associated with a lower risk of inpatient admission (respective hazard ratios (95% CIs) = 0.97 (0.96, 0.99) and 0.95 (0.93, 0.98)) and a lower risk of emergency department visits (respective hazard ratios = 0.97 (0.96, 0.98) and 0.98 (0.96, 1.00)). For the subgroup with 3 or more primary care and 3 or more specialty care visits, specialty care continuity (but not primary care continuity) was independently associated with a decreased risk of inpatient admissions (hazard ratio = 0.94 (0.92, 0.97)), and primary care continuity (but not specialty care continuity) was associated with a decreased risk of emergency department visits (hazard ratio = 0.98 (0.96, 1.00)). In an integrated delivery system with high informational continuity, greater continuity of care is independently associated with lower hospital utilization for seniors with multiple chronic medical conditions. Different subgroups of patients will benefit from

  7. Effectiveness of wound, ostomy and continence-certified nurses on individual patient outcomes in home health care.

    Science.gov (United States)

    Bliss, Donna Z; Westra, Bonnie L; Savik, Kay; Hou, Yuefeng

    2014-01-01

    To assess whether there was a significant improvement and stabilization (not worse at discharge) in pressure ulcers, lower extremity venous ulcers, surgical wounds, urinary incontinence, bowel incontinence, and urinary tract infections in home health care (HHC) patients cared for by a certified WOC nurse. There were 449,170 episodes of care from a national convenience sample of 785 HHC agencies with 447,309 nonmaternity, adult patients between October 1, 2008, and December 31, 2009. Descriptive and comparative. Data from the Outcome and Assessment Information Set documented by HHC clinicians were analyzed using mixed-effects logistic regression, propensity score analysis, and appropriate parametric and nonparametric tests. An Internet survey identified whether WOC nurses provided care to patients in an HHC agency. Home health care agencies identified records of patients receiving WOC nurse visits/consults. An HHC patient assigned to a WOC nurse had surgical wounds, pressure ulcers, and incontinence problems that were significantly worse than HHC patients not assigned to a WOC nurse. Patients cared for by a WOC nurse showed significant improvement and stabilization of the number of pressure ulcers and surgical wounds and the frequency of urinary and bowel incontinence, despite having problems that were more severe than other patients. Home health care patients not cared for by WOC nurses, with less-severe wound and incontinence problems, also got better. WOC nurses are effective in achieving positive health outcomes for pressure ulcers, surgical wounds, and incontinence in HHC patients with severe health problems.

  8. The Effect of Health Information Technology on Health Care Provider Communication: A Mixed-Method Protocol

    National Research Council Canada - National Science Library

    Manojlovich, Milisa; Adler-Milstein, Julia; Harrod, Molly; Sales, Anne; Hofer, Timothy P; Saint, Sanjay; Krein, Sarah L

    2015-01-01

    ...), which is a component of health information technology (HIT), may help reduce some communication failures but increase others because of an inadequate understanding of how communication technology is used...

  9. Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care.

    Science.gov (United States)

    Deutsch, Stephanie Anne; Fortin, Kristine

    2015-10-01

    Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed. Copyright © 2015 Mosby, Inc. All rights reserved.

  10. Measuring the catastrophic and impoverishing effect of household health care spending in Serbia.

    Science.gov (United States)

    Arsenijevic, Jelena; Pavlova, Milena; Groot, Wim

    2013-02-01

    Out-of-pocket patient payments can impose a catastrophic burden on households. This problem may not only affect poor but also wealthy households who need to use health care frequently. The available literature offers no consensus on how to measure poverty and how to measure the effects of out-of-pocket payments on household budgets. The objective of this paper is to contribute to current research in this area by comparing results across different approaches. In particular, the paper examines the catastrophic and impoverishing effects of health care spending in Serbia applying different types of thresholds used in previous research. The application of various approaches allows us to analyze the robustness and convergent validity of the results. We also include the subjective poverty approach in our examination. We use household data from the Serbian Living Standard Measurement Study (LSMS). The Serbian LSMS data were collected in 2007 and consists of 17,375 participants living in 5557 households (sample representative for Serbia). Our results indicate that irrespective of the approach applied, out-of-pocket patient payments have a catastrophic effect on poor households in Serbia. Moreover, households that are above the absolute, relative and subjective poverty lines respectively, after the subtraction of out-of-pocket payments fall below these poverty lines. The probability of catastrophic out-of-pocket patient payments is higher in rural areas, in larger households, and among chronically sick household members (namely, people with diabetes and mental diseases, as well as cardiology diseases in some instances). Perceived health status also appears to be a significant indicator. Policy in Serbia should aim to protect vulnerable groups, especially chronically sick patients and people from rural areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. The effect on the patient flow in local health care services after closing a suburban primary care emergency department: a controlled longitudinal follow-up study.

    Science.gov (United States)

    Mustonen, Katri; Kantonen, Jarmo; Kauppila, Timo

    2017-11-28

    It has not been studied what happens to patient flow to EDs and other parts of local health care system if distances to ED services are manipulated as a part of health policy in urban areas. The present work was an observational and quasi-experimental study with a control and it was based on before-after comparisons. The impact of terminating a geographically distant suburban primary care ED on patient flow to doctors in local public primary care EDs, office-hour primary care, secondary care EDs and in private primary care was studied. The effect of this intervention was compared with a primary care system where no similar intervention was performed. The number of monthly visits to doctors in different departments of health care was scored as the main measure of the study in each department studied (e.g. in primary care EDs, secondary care ED, office-hour public primary care and private primary care). Monthly mortality rates were also recorded. Increasing the distance to ED services by terminating a peripheral ED did not cause an increase in the use of local office-hour services in those areas whose local ED was terminated, although use of ED services decreased by 25% in these areas (P primary care doctor services rather decreased - if anything - after this intervention while use of doctor services in secondary care ED remained unaffected. Doctor visits to the complementary private primary care increased but this was probably not associated with the intervention because a simultaneous increase in this parameter was observed in the control. There was no increased mortality in any age groups. Manipulating distances to ED services can be used to direct patient flows to different parts of the health care system. The correlation between distance to ED and the tendency to use ED by inhabitants is negative. If secondary care ED was available there were no life-threatening side-effects at the level of general public health when a minor ED was closed in a primary care ED

  12. Long term effects of preventive activities of youth health care in The Netherlands: results of a four-part study

    Directory of Open Access Journals (Sweden)

    Pieter A. Wiegersma

    2004-12-01

    Full Text Available

    Background. In this article the results are presented of a four part study on the effect of screening for scoliosis and (repeated well-care visits and freely accessible consultation hours at secondary schools, on the incidence and prevalence of (parasuicide, mental health, adolescent health compromising behaviour and lastly obesity.

    Methods. An ecologic case-referent study design was used with data from the Netherlands Bureau of Statistics, the Ministry of Defence, the 1992 High-School Student Study, all of the youth health care departments in The Netherlands and relevant censuses.

    Results. Attention to mental and physical health and health compromising behaviour, either during screening, open consultation hours or during well-care visits seems to be ineffective and in some instances even detrimental to youth health.

    Of the 18 different outcome measurements, 5 were significantly negative and none were significantly positive.

    Conclusions. This four part study does not support the hypothesis that on a population level, the preventive activities of youth health care departments such as screening for scoliosis, (more frequent well-care visits or offering open consultation hours at secondary schools, have a beneficial effect on prevention of (parasuicide, poor mental health, health compromising behaviour or obesity.

  13. Quality competition among hospitals: the effects of perceived quality and perceived expense on health care consumers.

    Science.gov (United States)

    Cheng, Shou-Hsia; Wei, Yu-Jung; Chang, Hong-Jen

    2006-01-01

    Quality of care rather than price is the main concern in health care. However, does price not matter at all? To investigate what quality and cost factors influence whether patients perceive health care services as expensive and will recommend a hospital to other patients, the authors analyzed data from a national survey of patients in Taiwan in 2002. A total of 6725 subjects returned questionnaires. Results from logistic regression models showed that (1) a patient's perception of expense was determined simultaneously with the perceived quality and the out-of-pocket price of care, (2) a patient's perception of hospital quality appeared to be the most important determinant for recommending a hospital, and(3) while the out-of-pocket price did not affect a patient's recommendation, the perceived expense of the services did. The perceived value rather than the price itself-is the essence of quality competition in Taiwan's health care market.

  14. Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol.

    Science.gov (United States)

    Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta

    2015-10-01

    To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. © 2015 John Wiley & Sons Ltd.

  15. Nursing care community health

    Directory of Open Access Journals (Sweden)

    Diana Acosta-Salazar

    2016-07-01

    Full Text Available Process Nursing Care (PAE is a systematic tool that facilitates the scientificity of care in community practice nurse, the application of scientific method in community practice, allows nursing to provide care in logical, systematic and comprehensive reassessing interventions to achieve the proposed results. It began with the valuation of Marjory Gordon Functional Patterns and then at the stage of diagnosis and planning North American Nursing Diagnosis Association (NANDA, Nursing Interventions Classification (NIC and Nursing Outcomes Classification (NOC is interrelate. It is a descriptive and prospective study. Diagnosis was made by applying the instruments measuring scale of the socio-demographic characteristics, symptom questionnaire for early detection of mental disorders in the community and appreciation for functional patterns. The PAE includes more frequent diagnoses, criteria outcomes, indicators, interventions and activities to manage community issues. alteration was evidenced in patterns: Adaptation and Stress Tolerance, Self-perception-Self-concept-, Role-Relationships, sleep and rest and Perception and Health Management. A standardized NANDA-NIC-NOC can provide inter care holistic care from the perspective of community mental health with a degree of scientific nature that frames the professional work projecting the individual, family and community care.

  16. The effectiveness of the health system in Serbia in 2014 and 2015 and mental health care indicators

    Directory of Open Access Journals (Sweden)

    Simonović Periša

    2016-01-01

    Full Text Available The World Health Organization emphasized the importance of mental health by including it in their definition of health as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.' Mental health has direct influence to the quality of life of citizens as well as to productivity of economy. Therefore, both government and enterprises are interested for further improvement in this field. The European Health Consumer Index (EHCI was founded as a project in 2006, and it has been working ever since on comparison and ranking of the health systems of the European countries. Its main aim is the setting of standards for well-functioning and organization of health care from the perspective of patients (consumers - users of the health system. Assessment of the health system is based on pre-determined forty eight indicators, divided into six groups. The aim of this study was to assess the state of Serbian mental health care in 2014 and 2015 from the perspective of European health consumer index and propose recommendations for its improvement and functioning in accordance with the norms of European standards. The Republic of Serbia, according to the European Health Consumer Index, was ranked 33rd. in 2014 among European countries, with 473 points, while in 2015 was ranked 30 with 554 points. Mental health care indicators shows improvement in 2015 comparing with 2014. year.

  17. American Health Care Association

    Science.gov (United States)

    ... Program SNF Requirements of Participation SNF Value-Based Purchasing (SNF VBP) Survey and Regulatory Therapy Services Workforce ... out, stay informed and spread. Looking for more information reguarding Prefered Provider Program Quality Care Book Store ... ​ ​​​ ​ Nursing Home Administrator | Benedictine Health System US - MO - St. Louis, Qualifications Required: Bachelor’s degree ...

  18. Home health care

    Science.gov (United States)

    ... Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health Topics Home Care Services Browse the Encyclopedia A.D.A.M., ...

  19. Accountability in Health Care

    DEFF Research Database (Denmark)

    Vrangbæk, Karsten; Byrkjeflot, Haldor

    2016-01-01

    adjustment of such frameworks. In this article we present a framework for analyzing accountability within health care. The paper makes use of the concept of "accountability regime" to signify the combination of different accountability forms, directions and functions at any given point in time. We show...

  20. Effects of Health-Care Services and Commodities Cost on the ...

    African Journals Online (AJOL)

    2017-09-14

    .[7] Most developed nations today attained their present status by the enormous contributions. Introduction. Despite enormous developmental partners and government interventions, the payment for health- care services is a ...

  1. Sex Trafficking and Health Care in Metro Manila: Identifying Social Determinants to Inform an Effective Health System Response

    National Research Council Canada - National Science Library

    Williams, Timothy P; Alpert, Elaine J; Ahn, Roy; Cafferty, Elizabeth; Konstantopoulos, Wendy Macias; Wolferstan, Nadya; Castor, Judith Palmer; McGahan, Anita M; Burke, Thomas F

    2010-01-01

    .... Through key informant interviews with 51 health care and anti-trafficking stakeholders in Metro Manila, this study reports on observations about sex trafficking in Metro Manila that provide insight...

  2. The effect of leadership style on the employees’ job motivation in health care centers in Shiraz

    OpenAIRE

    EHSAN GOORAKI; HESAMEDDIN NOROOZI; SAADAT MARHAMATI; FARANAK BEHZADI

    2013-01-01

    Introduction: Leadership style is one of the most debated topics in management (urban health-care centers), which has influenced a great number of managers and employees. The present study aimed to determine the impact of the managers’ leadership styles on the employees’ job motivation based on the Vroom-Yetton model. Methods: This study was a descriptive–analytical one and the research environment included the managers of health-care centers in Shiraz, Iran. The study da...

  3. Health Care Procedure Considerations and Individualized Health Care Plans

    Science.gov (United States)

    Heller, Kathryn Wolff; Avant, Mary Jane Thompson

    2011-01-01

    Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…

  4. The effect of rehabilitation on health-care utilisation in COPD patients in Copenhagen

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Rusch, Ea; Andersen, Per Kragh

    2014-01-01

    INTRODUCTION: The Integrated Rehabilitation Programme for Chronic Conditions project (SIKS) implemented rehabilitation programmes for people with four chronic conditions in the local area within the Municipality of Copenhagen. OBJECTIVES: The objective of this study was to evaluate the impact......-in-difference analysis. RESULTS: Compared with their matched controls, the patients participating in the rehabilitation programme showed a statistically significantly smaller increase in hospital admissions, bed days and outpatient visits. CONCLUSIONS: The study provides the policy decision makers in the Municipality...... of Copenhagen with an assessment of the effect of a real-life intervention. It shows that the pulmonary rehabilitation programme introduced had the anticipated effects on health-care utilisation. The study also suggests that the methods used for evaluation were appropriate....

  5. No evidence of the effect of the interventions to combat health care fraud and abuse: a systematic review of literature.

    Directory of Open Access Journals (Sweden)

    Arash Rashidian

    Full Text Available BACKGROUND: Despite the importance of health care fraud and the political, legislative and administrative attentions paid to it, combating fraud remains a challenge to the health systems. We aimed to identify, categorize and assess the effectiveness of the interventions to combat health care fraud and abuse. METHODS: The interventions to combat health care fraud can be categorized as the interventions for 'prevention' and 'detection' of fraud, and 'response' to fraud. We conducted sensitive search strategies on Embase, CINAHL, and PsycINFO from 1975 to 2008, and Medline from 1975-2010, and on relevant professional and organizational websites. Articles assessing the effectiveness of any intervention to combat health care fraud were eligible for inclusion in our review. We considered including the interventional studies with or without a concurrent control group. Two authors assessed the studies for inclusion, and appraised the quality of the included studies. As a limited number of studies were found, we analyzed the data using narrative synthesis. FINDINGS: The searches retrieved 2229 titles, of which 221 full-text studies were assessed. We found no studies using an RCT design. Only four original articles (from the US and Taiwan were included: two studies within the detection category, one in the response category, one under the detection and response categories, and no studies under the prevention category. The findings suggest that data-mining may improve fraud detection, and legal interventions as well as investment in anti-fraud activities may reduce fraud. DISCUSSION: Our analysis shows a lack of evidence of effect of the interventions to combat health care fraud. Further studies using robust research methodologies are required in all aspects of dealing with health care fraud and abuse, assessing the effectiveness and cost-effectiveness of methods to prevent, detect, and respond to fraud in health care.

  6. No evidence of the effect of the interventions to combat health care fraud and abuse: a systematic review of literature.

    Science.gov (United States)

    Rashidian, Arash; Joudaki, Hossein; Vian, Taryn

    2012-01-01

    Despite the importance of health care fraud and the political, legislative and administrative attentions paid to it, combating fraud remains a challenge to the health systems. We aimed to identify, categorize and assess the effectiveness of the interventions to combat health care fraud and abuse. The interventions to combat health care fraud can be categorized as the interventions for 'prevention' and 'detection' of fraud, and 'response' to fraud. We conducted sensitive search strategies on Embase, CINAHL, and PsycINFO from 1975 to 2008, and Medline from 1975-2010, and on relevant professional and organizational websites. Articles assessing the effectiveness of any intervention to combat health care fraud were eligible for inclusion in our review. We considered including the interventional studies with or without a concurrent control group. Two authors assessed the studies for inclusion, and appraised the quality of the included studies. As a limited number of studies were found, we analyzed the data using narrative synthesis. The searches retrieved 2229 titles, of which 221 full-text studies were assessed. We found no studies using an RCT design. Only four original articles (from the US and Taiwan) were included: two studies within the detection category, one in the response category, one under the detection and response categories, and no studies under the prevention category. The findings suggest that data-mining may improve fraud detection, and legal interventions as well as investment in anti-fraud activities may reduce fraud. Our analysis shows a lack of evidence of effect of the interventions to combat health care fraud. Further studies using robust research methodologies are required in all aspects of dealing with health care fraud and abuse, assessing the effectiveness and cost-effectiveness of methods to prevent, detect, and respond to fraud in health care.

  7. Healthy happiness: Effects of happiness on physical health and the consequences for preventive health care

    NARCIS (Netherlands)

    R. Veenhoven (Ruut)

    2009-01-01

    textabstractIs happiness good for your health? This common notion is tested in a synthetic analysis of 30 follow-up studies on happiness and longevity. It appears that happiness does not predict longevity in sick populations, but that it does predict longevity among healthy populations. So,

  8. The Effectiveness of Integrated Care Pathways for Adults and Children in Health Care Settings: A Systematic Review.

    Science.gov (United States)

    Allen, Davina; Gillen, Elizabeth; Rixson, Laura

    2009-01-01

    Integrated Care Pathways (ICPs) are management technologies which formalise multi-disciplinary team-working and enable professionals to examine and address how they articulate their respective roles, responsibilities and activities. They map out a patient's journey and aim to have: 'the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome'. Initially introduced into the health care context in the 1980s in the US, enthusiasm for ICPs now extends across the world. They have been promoted as a means to realise: evidence based practice, clinical governance, continuity of care, patient empowerment, efficiency gains, service re-engineering, role realignment and staff education.While ICPs are now being developed and implemented across international health care arena, evidence to support their use is equivocal and understanding of their 'active ingredients' is poor. Reviews of evidence of ICP effectiveness have focused on their use in specific patient populations. However, ICPs are 'complex interventions' and are increasingly being implemented for a variety of purposes in a range of organisational contexts. Identification of the circumstances in which ICPs are effective is the first step towards developing hypotheses about their active ingredients and the generative mechanisms by which they have their effects.This review was designed to address a slightly different set of questions to those that typify systematic reviews of ICP effectiveness. Rather than simply asking: 'Are ICPs effective?', our concern was to identify the circumstances in which ICPs are effective, for whom and in what contexts. In addition to identifying evidence of ICP effectiveness, the review therefore required attention to the contexts in which ICPs are utilised, the purposes to which they are put and the factors critical to their success. In framing the review in this way we are drawing on the insights afforded by Pawson and Tilley

  9. Evaluation of a recovery-oriented care training program for mental healthcare professionals : Effects on mental health consumer outcomes

    NARCIS (Netherlands)

    Wilrycx, G.K.M.L.; Croon, M.A.; van den Broek, A.; van Nieuwenhuizen, Ch.

    2015-01-01

    Objectives: To examine the effects of a recovery-oriented care training program for mental healthcare professionals on mental health consumer outcomes. Methods: The Mental Health Recovery Measure (MHRM) and the Recovery-Promoting Relationship Scale (RPRS) were administered to a sample of 142

  10. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review.

    Science.gov (United States)

    Free, Caroline; Phillips, Gemma; Galli, Leandro; Watson, Louise; Felix, Lambert; Edwards, Phil; Patel, Vikram; Haines, Andy

    2013-01-01

    Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers. We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72-0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47-1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77-2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature. Text messaging interventions increased adherence to ART and

  11. The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review

    Science.gov (United States)

    Free, Caroline; Phillips, Gemma; Galli, Leandro; Watson, Louise; Felix, Lambert; Edwards, Phil; Patel, Vikram; Haines, Andy

    2013-01-01

    Background Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers. Methods and Findings We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990–Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72–0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47–1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77–2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature. Conclusions Text

  12. Did contracting effect the use of primary health care units in Pakistan?

    Science.gov (United States)

    Malik, Muhammad Ashar; Van de Poel, Ellen; Van Doorslaer, Eddy

    2017-09-01

    For many years, Pakistan has had a wide network of Basic Health Units spread across the country, but their utilization by the population in rural and peri-urban areas has remained low. As of 2004, in an attempt to improve the utilization and performance of these public primary healthcare facilities, the government has gradually started contracting-in intergovernmental organizations to manage these BHUs. Using five nationally representative household surveys conducted between 2001 and 2012, and exploiting the gradual roll-out of this reform to apply a difference-in-difference approach, we evaluate its impact on BHU utilization. We find that contracting of the BHU management did not have any effect on health care use generally in the population, but it did significantly increase the use of BHU for childhood diarrhoea for the poor (by 4% points) and rural (3% points) households. These increases were accompanied by lower rates of self-treatment and private facilities usage. We do not find any significant effects on the self-reported satisfaction with BHU utilization. Our findings contrast with earlier small-scale studies that reported larger effects of the contracting of primary care in Pakistan. We speculate that the modest additional budget, the limited management authority of the contracting agency and the lack of clear performance indicators are reasons for the small impact of the contracting reform. Apparently critical aspects of services delivery such as location of BHUs, ineffective referral system and medical practice variation in public and private sectors have contributed to the overall low utilization of BHUs, yet these were beyond the scope of the contracting reform. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Expanding health insurance to increase health care utilization: will it have different effects in rural vs. urban areas?

    Science.gov (United States)

    Erlyana, Erlyana; Damrongplasit, Kannika Kampanya; Melnick, Glenn

    2011-05-01

    This study investigates the importance of medical fee and distance to health care provider on individual's decision to seek care in developing countries. The estimation method used a mixed logit model applied to data from the third wave of the Indonesian family life survey (2000). The key variables of interest include medical fee and distance to different types of health care provider and individual characteristic variables. Urban dweller's decision to choose health care providers are sensitive to the monetary cost of medical care as measured by medical fee but they are not sensitive to distance. For those who reside in rural area, they are sensitive to the non-medical component cost of care as measured by travel distance but they are not sensitive to medical fee. As a result of those findings, policy makers should consider different sets of policy instruments when attempting to expand health service's usage in urban and rural areas of Indonesia. To increase access in urban areas, we recommend expansion of health insurance coverage in order to lower out-of-pocket medical expenditures. As for rural areas, expansion of medical infrastructures to reduce commuting distance and costs will be needed to increase utilization. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Anal Health Care Basics.

    Science.gov (United States)

    Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar

    2016-01-01

    Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.

  15. Debate over NAFTA's effect on health care a sign medicare will be dominant election issue

    Science.gov (United States)

    Gray, Charlotte

    1996-01-01

    Does the North American Free Trade Agreement (NAFTA) pose a threat to Canada's medicare system? There was a flurry of political activity in March over concerns that US health care companies were eagerly eyeing the Canadian market because NAFTA had opened it to them. The issue disappeared almost as quickly as it arrived, but it caught the attention of federal politicians, who hastened to negotiate to protect all existing health and social services. The rapidity with which the question grabbed the headlines was another reminder that health care remains one of the key political issues in Canada, and politicians will ignore it at their peril.

  16. Celiac Disease Testing (for Health Care Professionals)

    Science.gov (United States)

    ... Series Urinary Tract Imaging Urodynamic Testing Virtual Colonoscopy Celiac Disease Testing (for Health Care Professionals) Serologic tests for celiac disease provide an effective first step in identifying candidates ...

  17. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    child deaths among under-fives were due to. Childhood immunization is an effective public. VPDs, this represents 17% of global total. 1 health initiative aimed at reducing the burden mortality in children under five years of age. of vaccine preventable diseases (VPDs) and. To achieve the Millennium Developmental.

  18. Women's health and behavioral health issues in health care reform.

    Science.gov (United States)

    Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E

    2014-01-01

    As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.

  19. Estimating The Effects Of Health Insurance And Other Social Programs On Poverty Under The Affordable Care Act.

    Science.gov (United States)

    Remler, Dahlia K; Korenman, Sanders D; Hyson, Rosemary T

    2017-10-01

    The effects of health insurance on poverty have been difficult to ascertain because US poverty measures have not taken into account the need for health care and the value of health benefits. We developed the first US poverty measure to include the need for health insurance and to count health insurance benefits as resources available to meet that need-in other words, a health-inclusive poverty measure. We estimated the direct effects of health insurance benefits on health-inclusive poverty for people younger than age sixty-five, comparing the impacts of different health insurance programs and of nonhealth means-tested cash and in-kind benefits, refundable tax credits, and nonhealth social insurance programs. Private health insurance benefits reduced poverty by 3.7 percentage points. Public health insurance benefits (from Medicare, Medicaid, and Affordable Care Act premium subsidies) accounted for nearly one-third of the overall poverty reduction from public benefits. Poor adults with neither children nor a disability experienced little poverty relief from public programs, and what relief they did receive came mostly from premium subsidies and other public health insurance benefits. Medicaid had a larger effect on child poverty than all nonhealth means-tested benefits combined. Project HOPE—The People-to-People Health Foundation, Inc.

  20. The effects of the financial crisis and austerity measures on the Spanish health care system: a qualitative analysis of health professionals' perceptions in the region of Valencia.

    Science.gov (United States)

    Cervero-Liceras, Francisco; McKee, Martin; Legido-Quigley, Helena

    2015-01-01

    The recent financial crisis has seen severe austerity measures imposed on the Spanish health care system. However, the impacts are not yet well documented. We describe the findings from a qualitative study that explored health care professionals' perception of the effects of austerity measures in the Spanish Autonomous Community of Valencia. A total of 21 semi-structured interviews were conducted with health professionals, recorded and fully transcribed. We coded all interviews using an inductive approach, drawing on techniques used in the constant comparative method. Health professionals reported increases in mental health conditions and malnutrition linked to a loss of income from employment and cuts to social support services. Health care professionals perceived that the quality of health care had become worse and health outcomes had deteriorated as a result of austerity measures. Interviewees also suggested that increased copayments meant that a growing number of patients could not afford necessary medication. While a few supported reforms and policies, such as the increase in copayments for pharmaceuticals, most opposed the privatization of health care facilities, and the newly introduced Royal Decree-law 16/2012, particularly the exclusion of non-residents from the health care system. The prevailing perception is that austerity measures are having negative effects on the quality of the health care system and population health. In light of this evidence there is an urgent need to evaluate the austerity measures recently introduced and to consider alternatives such as the derogation of the Royal Decree-law 16/2012. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Privatizing health care: caveat emptor.

    Science.gov (United States)

    Young, D W

    1990-01-01

    Many Western European countries are moving toward privatization of their health care systems. The United States' health care system, since it is almost entirely privatized, is therefore worthy of study. Doing so raises several questions. How is privatization being managed in the US? How could its management be improved? What management lessons must be kept in mind if it is to be used effectively? What potential pitfalls should European countries consider as they move toward greater privatization? With operating costs, European countries must avoid the mistakes that have led to dramatic increases in annual health care costs in the US, simultaneous with reductions in access and quality. Doing so requires designing systems that promote hospital behavior consistent with a country's health objectives. With capital costs, an approach must be designed that allows policy-makers to work closely with both managers and physicians in order to make strategically sound choices about access and quality. Such an approach will require physicians to incorporate their clinical judgments into community standards of care, and to adopt a regional (rather than an institutional or personal) perspective in the determination of any incremental capital expenditures. By making regulation proactive and strategic, rather than punitive, health policymakers in Western Europe can achieve the best privatization has to offer without feeling the sting of its unintended consequences. In so doing they can help to move their health systems toward achieving the multiple and illusive goals of access, quality and reasonable cost.

  2. The effect of electronic health records on the use of clinical care guidelines for patients with medically complex conditions.

    Science.gov (United States)

    Fricton, James; Rindal, D Brad; Rush, William; Flottemesch, Thomas; Vazquez, Gabriela; Thoele, Merry Jo; Durand, Emily; Enstad, Chris; Rhodus, Nelson

    2011-10-01

    The emergence of health information technology provides an opportunity for health care providers to improve the quality and safety of dental care, particularly for patients with medically complex conditions. The authors randomized each of 15 dental clinics (HealthPartners, Bloomington, Minn.) to one of three groups to evaluate the impact of two clinical decision support (CDS) approaches during an 18-month study period. In the first approach--provider activation through electronic dental records (EDRs)--a flashing alert was generated at the dental visit to identify patients with medically complex conditions and to direct the dental care provider to Web-based personalized care guidelines. In the second approach--patient activation through personal health records--a secure e-mail was generated or a letter was mailed to patients before dental visits encouraging them to ask their dental care provider to review the care guidelines specific to their medical conditions. The authors evaluated the rate of reviewing care guidelines among 102 providers. Participants in the provider and patient activation groups increased their use of the system during the first six months, which had a generalized effect of increasing use of the guidelines for all patients, even if they were not part of the study (P electronic alerts. The study results demonstrated that review of clinical care guidelines for patients with medically complex conditions can be improved with CDS systems that involve the use of electronic health records. As the U.S. population ages, dentists must be vigilant in adapting care for patients with medically complex conditions to ensure therapeutic safety and effectiveness. Expanded use of CDS via EDRs can help dental care providers achieve this objective.

  3. Effect of a primary health-care-based controlled trial for cardiorespiratory fitness in refugee women

    Directory of Open Access Journals (Sweden)

    Johansson Sven-Erik

    2010-08-01

    Full Text Available Abstract Background Refugee women have a high risk of coronary heart disease with low physical activity as one possible mediator. Furthermore, cultural and environmental barriers to increasing physical activity have been demonstrated. The aim of the study was to evaluate the combined effect of an approximate 6-month primary health care- and community-based exercise intervention versus an individual written prescription for exercise on objectively assessed cardiorespiratory fitness in low-active refugee women. Methods A controlled clinical trial, named "Support for Increased Physical Activity", was executed among 243 refugee women recruited between November 2006 and April 2008 from two deprived geographic areas in southern Stockholm, Sweden. One geographic area provided the intervention group and the other area the control group. The control group was on a higher activity level at both baseline and follow-up, which was taken into consideration in the analysis by applying statistical models that accounted for this. Relative aerobic capacity and fitness level were assessed as the two main outcome measures. Results The intervention group increased their relative aerobic capacity and the percentage with an acceptable fitness level (relative aerobic capacity > 23 O2ml·kg·min-1 to a greater extent than the control group between baseline and the 6-month follow-up, after adjusting for possible confounders (P = 0.020. Conclusions A combined primary health-care and community-based exercise programme (involving non-profit organizations can be an effective strategy to increase cardiorespiratory fitness among low-active refugee women. Trial Registration ClinicalTrials.gov ID: NCT00747942

  4. A study and comparative analysis of effective and ineffective leadership skills of physician and non-physician health care administrators.

    Science.gov (United States)

    Shipper, F; Pearson, D A; Singer, D

    1998-05-01

    This paper explores and compares, at both micro and macro levels, the leadership skills of effective and ineffective managers in a health care setting. In addition, it compares the leadership skills of physician and non-physician health care administrators at both levels. The results indicate that effective managers have significantly different leadership skill profiles than ineffective managers. Furthermore, effective managers have a more complete set of skills and are not as likely to rely on one type of skills as the ineffective managers. In addition, no substantial evidence was found to support prior assertions that physician administrators would be deficient in leadership skills.

  5. Chiropractic care and public health

    DEFF Research Database (Denmark)

    Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre

    2012-01-01

    The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues...... through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries...... of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?...

  6. [Primary health care contributes to global health].

    Science.gov (United States)

    Aabenhus, Mette Morre; Schriver, Michael; Kallestrup, Per

    2012-05-28

    Global health interventions often focus on specific diseases, thus forming vertical programmes. Studies show that vertical programmes perform poorly, which underlines the need for a horizontal basis: universal community-based primary health care, which improves health equity and outcomes. The diagonal approach supports an integrated patient-centered health-care system. The ''15% by 2015''-initiative suggests that vertical programmes invest 15% of their budgets in strengthening integrated primary health care. Strategies depend on local context.

  7. Controversies in faith and health care.

    Science.gov (United States)

    Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon

    2015-10-31

    Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Comparative effectiveness research as choice architecture: the behavioral law and economics solution to the health care cost crisis.

    Science.gov (United States)

    Korobkin, Russell

    2014-02-01

    With the Patient Protection and Affordable Care Act ("ACA") set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. "Consumer directed health care" proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated but market-based approach to improving efficiency in the private market for medical care that I call "relative value health insurance." This approach focuses on the "choice architecture" necessary to enable even boundedly rational patients to contract for an efficient level of health care services through their health insurance purchase decisions. It uses comparative effectiveness research, which the ACA funds at a significant level for the first time, to rate medical treatments on a scale of one to ten based on their relative value, taking into account expected costs and benefits. These relative value ratings would enable consumers to contract with insurers for different levels of medical care at different prices, reflecting different cost-quality trade-offs. The Article describes both the benefits of relative value health insurance and the impediments to its implementation. It concludes with a brief discussion of how relative value ratings could also help to rationalize expenditures on public health insurance programs.

  9. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    @hotmail.com, A.Ehigiegba@shell.com. KEYWORDS. Volunteer,. Obio Cottage. Hospital,. Participants,. Nigeria journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care.

  10. Types of health care providers

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Types of health care providers URL of this page: //medlineplus.gov/ency/article/001933.htm Types of health care providers To ...

  11. Understanding your health care costs

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this ... This is the payment you make for certain health care provider visits and prescriptions. It is a set ...

  12. A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia

    Directory of Open Access Journals (Sweden)

    Snow Jill

    2008-10-01

    Full Text Available Abstract Background Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general practitioners (GPs with diabetes management. This approach uses a centralized database of clinical data of an Australian Division of General Practice (a network of GPs to co-ordinate care according to national guidelines. Methods Long term outcomes for patients in the program were derived using clinical parameters after 5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years post-diagnosis. Cost information was obtained from a range of sources. While program costs are directly available, and costs of complications can be estimated from the UKPDS model, other costs are estimated by comparing costs in the Division with average costs across the state or the nation. The outcome and cost measures are used derive incremental cost-effectiveness ratios. Results The clinical data show that the program is effective in the short term, with improvement or no statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than expected over the 5 year period. While the program is estimated to generate treatment cost savings, overall net costs are positive. However, the program led to projected improvements in expected life years and Quality Adjusted Life Expectancy (QALE, with incremental cost effectiveness ratios of $A8,106 per life-year saved and $A9,730 per year of QALE gained. Conclusions The combination of an established model of diabetes progression and generally available data has provided an opportunity to establish robust methods of testing the cost effectiveness of a program for which a formal control group was not available. Based on this methodology, integrated health care

  13. Health care failure mode and effect analysis to reduce NICU line-associated bloodstream infections.

    Science.gov (United States)

    Chandonnet, Celeste J; Kahlon, Prerna S; Rachh, Pratik; Degrazia, Michele; Dewitt, Eileen C; Flaherty, Kathleen A; Spigel, Nadine; Packard, Stephanie; Casey, Denise; Rachwal, Christine; Agrawal, Pankaj B

    2013-06-01

    Central line-associated bloodstream infections (CLABSIs) in NICU result in increased mortality, morbidity, and length of stay. Our NICU experienced an increase in the number of CLABSIs over a 2-year period. We sought to reduce risks for CLABSIs using health care failure mode and effect analysis (HFMEA) by analyzing central line insertion, maintenance, and removal practices. A multidisciplinary team was assembled that included clinicians from nursing, neonatology, surgery, infection prevention, pharmacy, and quality management. Between March and October 2011, the team completed the HFMEA process and implemented action plans that included reeducation, practice changes, auditing, and outcome measures. The HFMEA identified 5 common failure modes that contribute to the development of CLABSIs. These included contamination, suboptimal environment of care, improper documentation and evaluation of central venous catheter dressing integrity, issues with equipment and suppliers, and lack of knowledge. Since implementing the appropriate action plans, the NICU has experienced a significant decrease in CLABSIs from 2.6 to 0.8 CLABSIs per 1000 line days. The process of HFMEA helped reduce the CLABSI rate and reinforce the culture of continuous quality improvement and safety in the NICU.

  14. The effect of training in primary health care centers on medical students' clinical skills.

    Science.gov (United States)

    Abdullatif Alnasir, Faisal; Jaradat, Ahmed Abdel-Karim

    2013-01-01

    Medical students' effective clinical skills training are an important goal of any medical school. When adequate, graduate doctors will have sufficient skills to consult a patient by taking proper history and conducting appropriate physical examination. The question under scrutiny is the optimal place for providing such training. Since the aim is to graduate general physicians, many literatures highlighted the importance of implementing such training in the primary health care centers. A special clinical skills training program was developed for the Year 4 pre-clerkship medical students of the Arabian Gulf University during the academic year 2011-2012. It was important for these students to acquire certain skills before transferring to the clerkship phase where they deal directly with patients. For the 130 students involved in this study, a self-assessment and clinical exam were conducted at the beginning and end of the program. The study showed that students benefited greatly from this training program with significant differences between their preexisting known skills and clinical skills acquired by the end of the program. Primary care centers are ideal places for optimal training because of small group training setting that is one tutor to two students and of the advantage that students face real patient environment.

  15. A consistent decomposition of the redistributive, vertical, and horizontal effects of health care finance by factor components.

    Science.gov (United States)

    Hierro, Luis A; Gómez-Álvarez, Rosario; Atienza, Pedro

    2014-01-01

    In studies on the redistributive, vertical, and horizontal effects of health care financing, the sum of the contributions calculated for each financial instrument does not equal the total effects. As a consequence, the final calculations tend to be overestimated or underestimated. The solution proposed here involves the adaptation of the Shapley value to achieve additive results for all the effects and reveals the relative contributions of different instruments to the change of whole-system equity. An understanding of this change would help policy makers attain equitable health care financing. We test the method with the public finance and private payments of health care systems in Denmark and the Netherlands. Copyright © 2013 John Wiley & Sons, Ltd.

  16. Assessment of the effectiveness of ventilation types for reducing the occupational exposure to bioaerosols in health care staffs

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Jafari

    2015-11-01

    Full Text Available Background & Objectives : Hospital indoor air contains a wide range of airborne pathogenic bioaerosols which have a significant impact on health care staff’ health and welfare. The aim of this study was to assess the effects of ventilation system types on occupational exposure of the health care staffs to airborne bioaerosols in the isolation room based on the patient bed arrangements and the standing locations of the health care staff. Methods: Personal exposures were measured based on five given types of ventilation system, 2 patient bed arrangements (at a corner and in the middle of the room, and two different standing locations for the health care staff (standing close to the patient’s bed, and down a side section of the bed. For personal sampling, filtration method recommended by th e American conference of governmental industrial hygienists(ACGIH was used. Result: The highest exposure to airborne bioaerosols was observed when the ventilation system was switched off. There were significant decreases in the bioaerosols concentration after using all types of ventilation system (P value 0.05. Conclusions : The most effective ventilation system for decreasing health care staff’ exposures in the isolation room was associated with supplying of air from a circular grill located on the northern wall and exhausting it through a linear slot located on the southern wall (type 1 with the ventilation rate of 12 air changes per hour.

  17. Economic perspectives on pediatric obesity: impact on health care expenditures and cost-effectiveness of preventive interventions.

    Science.gov (United States)

    John, Jürgen

    2010-01-01

    This chapter surveys two segments of the economic literature on pediatric obesity: first, research regarding the impact of childhood obesity on health care expenditure, and second, research evaluating the cost-effectiveness of programs to prevent pediatric obesity. Evidence in support of the hypothesis that obese children and adolescents have higher health care costs than their otherwise similar healthy-weight peers has been found for female adolescents. Studies trying to calculate the complete lifetime health care costs attributable to childhood obesity are missing. Only a small number of studies assessing the cost-effectiveness of preventive obesity interventions among children have been published until now. The results call for the inclusion of nutrition behavior as an intervention target. There is some evidence that childhood obesity prevention might be successful in combining health gains with cost savings. However, it is not possible to rank the interventions according to their cost-effectiveness or to assess the generalizability of their results. Cost-effectiveness increasingly will be a major consideration in public reimbursement decisions. Therefore, evaluation research has to pay more attention to the economic aspects of new health technologies. Without providing good value for money, those technologies probably will not turn from inventions to innovations in health care. Moreover, future research should address various methodological and conceptual challenges and limitations which economic evaluations of preventive interventions into childhood obesity are faced with. Copyright © 2010 S. Karger AG, Basel.

  18. Environmental Health: Health Care Reform's Missing Pieces.

    Science.gov (United States)

    Fadope, Cece Modupe; And Others

    1994-01-01

    A series of articles that examine environmental health and discuss health care reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for health care professionals who want to address…

  19. Driving a more effective health care market by putting consumers behind the wheel.

    Science.gov (United States)

    Beauregard, T R

    2001-01-01

    In any other rational market, the consumer drives demand, and the provider responds with products and services aimed at meeting individual needs. This rational market does not exist in today's group health care system. The ramifications are significant: declining consumer and provider satisfaction, out-of-control costs, a rising uninsured population, and growing employer burdens. Turning this chaotic world around requires a more active and informed consumer. Transformation is under way with solutions like Sageo, a new e-business from Hewitt Associates that is revolutionizing the way health care benefits are offered, selected, and administered. For companies that offer Sageo's services, their employees and retirees gain direct access to health care coverage and content, enabling them to research, select, and enroll in the appropriate package based on their individual needs.

  20. Consumers' interpretation and use of comparative information on the quality of health care: the effect of presentation approaches

    NARCIS (Netherlands)

    Damman, O.C.; Hendriks, M.; Rademakers, J.; Spreeuwenberg, P.; Delnoij, D.M.J.; Groenewegen, P.P.

    2012-01-01

    Background Public reports about health-care quality have not been effectively used by consumers thus far. A possible explanation is inadequate presentation of the information. Objective To assess which presentation features contribute to consumers' correct interpretation and effective use of

  1. Consumers’ interpretation and use of comparative information on the quality of health care: the effect of presentation approaches.

    NARCIS (Netherlands)

    Damman, O.C.; Hendriks, M.; Rademakers, J.; Spreeuwenberg, P.; Delnoij, D.M.J.; Groenewegen, P.P.

    2012-01-01

    Background: Public reports about health-care quality have not been effectively used by consumers thus far. A possible explanation is inadequate presentation of the information. Objective To assess which presentation features contribute to consumers’ correct interpretation and effective use of

  2. 78 FR 68364 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date

    Science.gov (United States)

    2013-11-14

    ...The Department of Veterans Affairs (VA) published in the Federal Register on May 6, 2013 (78 FR 26250) a final rule to change the billing methodology for non-VA providers of home health services and hospice care. The preamble of that final rule stated the effective date was November 15, 2013. This document delays that effective date to April 1, 2014.

  3. Evaluation of the awareness and effectiveness of IT security programs in a large publicly funded health care system.

    Science.gov (United States)

    Hepp, Shelanne L; Tarraf, Rima C; Birney, Arden; Arain, Mubashir Aslam

    2017-01-01

    Electronic health records are becoming increasingly common in the health care industry. Although information technology (IT) poses many benefits to improving health care and ease of access to information, there are also security and privacy risks. Educating health care providers is necessary to ensure proper use of health information systems and IT and reduce undesirable outcomes. This study evaluated employees' awareness and perceptions of the effectiveness of two IT educational training modules within a large publicly funded health care system in Canada. Semi-structured interviews and focus groups included a variety of professional roles within the organisation. Participants also completed a brief demographic data sheet. With the consent of participants, all interviews and focus groups were audio recorded. Thematic analysis and descriptive statistics were used to evaluate the effectiveness of the IT security training modules. Five main themes emerged: (i) awareness of the IT training modules, (ii) the content of modules, (iii) staff perceptions about differences between IT security and privacy issues, (iv) common breaches of IT security and privacy, and (v) challenges and barriers to completing the training program. Overall, nonclinical staff were more likely to be aware of the training modules than were clinical staff. We found e-learning was a feasible way to educate a large number of employees. However, health care providers required a module on IT security and privacy that was relatable and applicable to their specific roles. Strategies to improve staff education and mitigate against IT security and privacy risks are discussed. Future research should focus on integrating health IT competencies into the educational programs for health care professionals.

  4. Long-term effectiveness of the New Zealand Green Prescription primary health care exercise initiative.

    Science.gov (United States)

    Hamlin, M J; Yule, E; Elliot, C A; Stoner, L; Kathiravel, Y

    2016-11-01

    The rising incidence of non-communicable diseases in western countries is being driven by poor lifestyle choices, including increasingly inadequate physical activity. The aim of this study was to quantify the effectiveness of a physical activity primary care intervention named the 'Green Prescription' on changes in physical activity levels 2-3 year's following original prescription. A retrospective study design using a telephone interview. Physical activity and health information was gathered from participants in June-September 2015, who were originally prescribed a primary care physical activity intervention 2-3 years ago. Respondents were classified as either having completed the programme (adherence group, n = 91) or having not completed the programme (non-adherence group, n = 56). Participants who had completed the programme within the past 2-3 years reported an additional 64 min (95% CI = 16-110) of total physical activity per week compared to those who had dropped out. Forty-two percent of participants in the adherence group reported increased physical activity levels after receiving the Green Prescription compared to 29% in the non-adherence group. The adherence group were less likely to be sedentary (odds ratio 0.7, 95% CI = 0.5-0.9) and more likely to meet the current physical activity guidelines of at least 150 min of physical activity per week (OR = 1.1, 95% CI = 1.0-1.3). The findings indicate a long-term benefit is likely to participants who completed Green Prescription. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  5. Global health and primary care research.

    NARCIS (Netherlands)

    Beasley, J.W.; Starfield, B.; Weel, C. van; Rosser, W.W.; Haq, C.L.

    2007-01-01

    A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in

  6. Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects

    OpenAIRE

    Kenter Robin; Warmerdam Lisanne; Brouwer-Dudokdewit Christine; Cuijpers Pim; van Straten Annemieke

    2013-01-01

    Abstract Background Due to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session. Offering guided online treatment might be an effective solution to reduce waiting time and to increase patient outcomes at relatively low cost. In this study we report on uptake, drop-out and effects of online problem solving treatment that was implemented in a mental health center. Methods We...

  7. Interpreting the quality of health care database studies on the comparative effectiveness of oral anticoagulants in routine care

    Directory of Open Access Journals (Sweden)

    Schneeweiss S

    2013-09-01

    Full Text Available Sebastian Schneeweiss, Krista F Huybrechts, Joshua J Gagne Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA Background: Dabigatran, an oral direct thrombin inhibitor, has now been available for 2 years in the US for the prevention of stroke in patients with nonvalvular atrial fibrillation, and direct Xa inhibitors are also starting to enter the market. Studies examining the effects of new oral anticoagulants in health care databases are beginning to emerge. The purpose of this study was to describe the validity of early published observational studies on the comparative safety and effectiveness of new oral anticoagulants in patients with atrial fibrillation. Methods: We identified published nonrandomized post-marketing studies (articles or conference abstracts or posters and critically appraised their internal validity, with a particular focus on their ability to control confounding and other biases. Results: Two full-length journal articles, three conference posters, two conference presentation abstracts, and a US Food and Drug Administration analysis form the basis of the early comparative effectiveness and safety experience with new oral anticoagulants. Some published studies exhibit substantial biases and have insufficient precision for several important endpoints. Several studies suffer from biases arising from comparing ongoing users of the older drug, warfarin, who seem to tolerate it, to initiators of the new treatment who may have switched from warfarin or have had no prior experience with anticoagulants. Analyses tended to not adjust or not adjust adequately for confounding, and unsound propensity score application was also observed. Several studies introduced selection bias by excluding patients who died during follow-up and by restricting the study population to those with continuous database enrollment following cohort entry. We

  8. Family dental health care service

    OpenAIRE

    Riana Wardani

    2008-01-01

    The Family Dental Health Care Service is a new approach that includes efforts to serve oral and dental patients that focuses on maintenance, improvement and protection. This oral and dental health approach uses basic dentistry science and technology. The vision of the Family Dental Health Care Service is the family independences in the effort of dental health maintenance and to achieve the highest oral and dental health degree as possible through family dentist care that is efficient, effecti...

  9. Sexual Trauma: Women Veterans Health Care

    Science.gov (United States)

    ... Enter ZIP code here Health Awareness Campaigns: Sexual Trauma Sexual Trauma Women Veterans Health Care has created materials to ... 10-320LG Dimensions: 11" x 17" Effects of Sexual Trauma One in five women in the United States ...

  10. Using Statewide Data on Health Care Quality to Assess the Effect of a Patient-Centered Medical Home Initiative on Quality of Care.

    Science.gov (United States)

    Shippee, Nathan D; Finch, Michael; Wholey, Douglas

    2017-06-13

    Patient-centered medical homes comprise a large portion of modern health care redesign. However, most efforts have reflected rigid, limited models of transformation. In addition, evaluations of their impact on quality of care have relied on data designed for other purposes. Minnesota's Health Care Home (HCH) initiative is a statewide medical home model relying on state-run, adaptive certification and supportive data infrastructure. This longitudinal study leverages a unique statewide system of clinic-reported, patient-level quality data (2010-2013) to assess the effect of being in a HCH clinic on health care quality. Measures included optimal quality (meeting all targets) and average quality (number of targets met) for asthma, vascular, and diabetes care; colorectal cancer screening; depression follow-up; and depression remission. Depending on measure and year, the analytic sample included 246,023 - 3,335,994 child and adult patients in 404-651 clinics. Using endogenous treatment effects models to address endogeneity, and including patient- and clinic-level covariates and clinic-level selection bias corrections, the authors produced potential outcomes means and average treatment effects (ATEs). HCH patients received better quality versus non-HCH patients for most outcomes. For example, the adjusted rate receiving optimal diabetes care was 453.7/1000 adult HCH patients versus 327.2/1000 non-HCH adult patients (ATE = 126.5; P quality generally echoed optimal care findings. These findings indicate the usefulness of statewide quality data and support the effectiveness of adaptive, state-run medical home programs. Additional integration of services may be needed for mental health conditions.

  11. The effect of health care reform on academic medicine in Canada. Editorial Committee of the Canadian Institute for Academic Medicine.

    OpenAIRE

    Hollenberg, C H

    1996-01-01

    Although Canadian health care reform has constrained costs and improved efficiency, it has had a profound and mixed effect on Canadian academic medicine. Teaching hospitals have been reduced in number and size, and in patient programs have shifted to ambulatory and community settings. Specialized care programs are now multi-institutional and multidisciplinary. Furthermore, the influence of regional planning bodies has grown markedly. Although these changes have likely improved clinical servic...

  12. International health care spending.

    Science.gov (United States)

    Schieber, G J; Puollier, J P

    1986-01-01

    Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, health care prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10

  13. Effect of Mindfulness-Based Stress Reduction Training on Health Care Worker Safety: A Randomized Waitlist Controlled Trial.

    Science.gov (United States)

    Valley, Morgan Anne; Stallones, Lorann

    2017-10-01

    The study assessed the impact of mindfulness training on occupational safety of hospital health care workers. The study used a randomized waitlist-controlled trial design to test the effect of an 8-week mindfulness-based stress reduction (MBSR) course on self-reported health care worker safety outcomes, measured at baseline, postintervention, and 6 months later. Twenty-three hospital health care workers participated in the study (11 in immediate intervention group; 12 in waitlist control group). The MBSR training decreased workplace cognitive failures (F [1, 20] = 7.44, P = 0.013, (Equation is included in full-text article.)) and increased safety compliance behaviors (F [1, 20] = 7.79, P = 0.011, (Equation is included in full-text article.)) among hospital health care workers. Effects were stable 6 months following the training. The MBSR intervention did not significantly affect participants' promotion of safety in the workplace (F [1, 20] = 0.40, P = 0.54, (Equation is included in full-text article.)). Mindfulness training may potentially decrease occupational injuries of health care workers.

  14. Effects of Mobility and Multimorbidity on Inpatient and Post-Acute Health Care Utilization.

    Science.gov (United States)

    Ensrud, Kristine E; Lui, Li-Yung; Langsetmo, Lisa; Vo, Tien N; Taylor, Brent C; Cawthon, Peggy M; Kilgore, Meredith L; McCulloch, Charles E; Cauley, Jane A; Stefanick, Marcia L; Yaffe, Kristine; Orwoll, Eric S; Schousboe, John T

    2017-06-22

    This study examines effects of mobility and multimorbidity on hospitalization and inpatient and post-acute care (PAC) facility days among older men. Prospective study of 1701 men (mean age 79.3 years) participating in MrOS Study Year 7 (Y7) examination (2007-2008) linked with their Medicare claims. At Y7, mobility ascertained by usual gait speed and categorized as poor, intermediate, or good. Multimorbidity quantified by applying Elixhauser algorithm to inpatient and outpatient claims and categorized as none, mild-moderate, or high. Hospitalizations and PAC facility stays ascertained during 12 months following Y7. Reduced mobility and greater multimorbidity burden were independently associated with a higher risk of inpatient and PAC facility utilization, after accounting for each other and traditional indicators. Adjusted mean total facility days/year were 1.13 (95% confidence interval [CI] 0.74-1.40) among men with good mobility increasing to 2.43 (95% CI 1.17-3.84) among men with poor mobility, and 0.67 (95% CI 0.38-0.91) among men without multimorbidity increasing to 2.70 (95% CI 1.58-3.77) among men with high multimorbidity. Men with poor mobility and high multimorbidity had a 9-fold increase in mean total facility days/year (5.50, 95% CI 2.78-10.87) compared with men with good mobility without multimorbidity (0.59, 95% CI 0.37-0.95). Among older men, mobility limitations and multimorbidity were independent predictors of higher inpatient and PAC utilization after considering each other and conventional predictors. Marked combined effects of reduced mobility and multimorbidity burden may be important to consider in clinical decision-making and planning health care delivery strategies for the growing aged population.

  15. 'It's unbelievably humiliating'-Patients' expressions of negative effects of coercion in mental health care.

    Science.gov (United States)

    Nyttingnes, Olav; Ruud, Torleif; Rugkåsa, Jorun

    Some patients criticize coercive mental health treatment using extremely strong words. This may be connected to poor therapeutic relationships and unfavourable treatment outcomes, so a better understanding of this criticism is warranted. Data consisted of detailed notes from 15 all-day dialogue seminars on coercion and voluntariness in Oslo, Norway from 2006 to 2009. Very dissatisfied patients and ex-patients were a central voice through the seminars. To gain a better understanding of their negative experiences of coercion, we conducted a stepwise qualitative thematic analysis of the seminar notes, with a mix of inductive and deductive coding followed by focused coding and analytic induction. Coercive care was described in strong terms, such as humiliation and Nazism. To explain this, we suggest a model of two pathways towards such strong language: (i) Participants understood their symptoms as mental crises following trauma or spiritual problems, and perceived involuntary medication to harm rather than help. Some found that their complaints were dismissed as lack of insight. (ii) Minor incidents were experienced as coercive, such as being 'defined' by the medical model, receiving repeated negative remarks and feeling one needed to succumb to get care. The accumulated effect could be experienced as eroding self-confidence and trust in their own feelings and thoughts. Involuntary medication and dismissal of patient perspective, combined with the accumulated effects of minor negative incidents, can explain the feelings of humiliation, oppression and the use of metaphors such as imprisonment by totalitarian systems. Our model can help explain such patient reactions seen in clinical practice and the literature. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders

    National Research Council Canada - National Science Library

    Seekles, Wike; van Straten, Annemieke; Beekman, Aartjan; van Marwijk, Harm; Cuijpers, Pim

    2009-01-01

    .... Therefore, optimal treatment of these disorders is highly important. In this study we will examine the effectiveness of a stepped care program for primary care patients with mood and anxiety disorders...

  17. Health care engineering

    CERN Document Server

    Frize, Monique

    2013-01-01

    Part II of Health Care Engineering begins with statistics on the occurrence of medical errors and adverse events, and includes some technological solutions. A chapter on electronic medical records follows. The knowledge management process divided into four steps is described; this includes a discussion on data acquisition, storage, and retrieval. The next two chapters discuss the other three steps of the knowledge management process (knowledge discovery, knowledge translation, knowledge integration and sharing). The last chapter briefly discusses usability studies and clinical trials.This two-

  18. Health care need

    DEFF Research Database (Denmark)

    Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter

    2006-01-01

    The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precis......, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation...

  19. The effectiveness of allied health care in patients with ataxia: a systematic review

    NARCIS (Netherlands)

    Fonteyn, E.M.R.; Keus, S.H.J.; Verstappen, C.C.P.; Schols, L.; Groot, I.J.M. de; Warrenburg, B.P.C. van de

    2014-01-01

    Many patients with cerebellar ataxia have serious disabilities in daily life, while pharmacological treatment options are absent. Therefore, allied health care is considered to be important in the management of these patients. The goal of this review is to evaluate scientific evidence for allied

  20. The Effect of Chronological Age on the Acceptance of Internet-Based Hearing Health Care.

    Science.gov (United States)

    Moore, Ashley N; Rothpletz, Ann M; Preminger, Jill E

    2015-09-01

    The purpose of this article is to offer design considerations in developing Internet-based hearing health care for older adults by analyzing and discussing the relationship between chronological age, computer skills, and the acceptance of Internet-based hearing health care. This article reports baseline data from a training study measuring the acceptance of Internet-based hearing health care. Participants (n = 26; 20 men, 6 women) were aged 55–95 years. All passed a cognitive screen and failed a hearing screen. Participants completed the Patient- Technology Acceptance questionnaire (Or, 2008). Computer literacy was measured using the Northstar Digital Literacy Assessment (Cytron-Hysom, Hadley, Vanek, Graif, & Asp, 2012). Computer literacy was negatively correlated with increasing age. Additional negative relationships were seen between computer literacy and computer anxiety and between computer literacy and computer self-efficacy. Finally, there was a negative relationship between computer self-efficacy and computer anxiety. These results suggest computer literacy is lower in adults of advanced age than in those who are a few years younger. Indirect relationships were observed between age and computer self-efficacy and between age and computer anxiety. Consideration should be given to addressing discrepancies in self-efficacy and computer literacy in older adults to increase the likelihood of acceptance of Internet-based hearing health care.

  1. Effect of financial relationships on the behaviors of health care professionals: a review of the evidence.

    Science.gov (United States)

    Robertson, Christopher; Rose, Susannah; Kesselheim, Aaron S

    2012-01-01

    This paper explores the empirical evidence regarding the impact financial relationships on the behavior of health care providers, specifically, physicians. We identify and synthesize peer-reviewed data addressing whether financial incentives are causally related to patient outcomes and health care costs. We cover three main areas where financial conflicts of interest arise and may have an observable relationship to health care practices: (1) physicians' roles as self-referrers, (2) insurance reimbursement schemes that create incentives for certain clinical choices over others, and (3) financial relationships between physicians and the drug and device industries. We found a well-developed scientific literature consisting of dozens of empirical studies, some that allow stronger causal inferences than others, but which altogether show that such financial conflicts of interests can, and sometimes do, impact physicians' clinical decisions. Further research is warranted to document the causal relationship of such changes on health outcomes and the cost of care, but the current base of evidence is sufficiently robust to motivate policy reform. © 2012 American Society of Law, Medicine & Ethics, Inc.

  2. The Effect on Academic Health Centers of Tertiary Care in Community Hospitals.

    Science.gov (United States)

    Gee, David A.; Rosenfeld, Lisa A.

    1984-01-01

    The growing cost of medical education and the provision of care to the indigent can be endangered by the dilution of revenue sources traditionally available to the academic health centers but which are being taken over by suburban hospitals. (Author/MLW)

  3. The 7 Habits of Highly Effective Implementation of eHealth Enabled Integrated Care

    NARCIS (Netherlands)

    Keijser, Wouter Alexander; Penterman, L; van Montfort, Augustinus P.W.P.; Smits, Jacco Gerardus Wilhelmus Leonardus; Wilderom, Celeste P.M.

    2017-01-01

    Introduction: ‘E-health enabled integrated care’ (eHEIC) has high potential to improve quality of care, widen access and increase efficiency. Experts and scholars increasingly report about difficulties of sustainable eHEIC implementation. These reports indicate in particular ‘human factors’ often

  4. Workshop: Out-of-pocket costs in Europe and their effects on health-care use.

    NARCIS (Netherlands)

    Jong, J. de

    2017-01-01

    Over the past decades, health care expenditures increased in most OECD countries and are expected to increase even more. A wide ranges of policies are implemented to try to limit this development. Several governments (e.g. of Denmark, Estonia, France, Greece, Ireland, Romania, Russian Federation,

  5. FastStats: Home Health Care

    Science.gov (United States)

    ... Adult Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap ... Centers Hospice Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare ...

  6. Cost-effectiveness analysis for a tele-based health coaching program for chronic disease in primary care.

    Science.gov (United States)

    Oksman, Erja; Linna, Miika; Hörhammer, Iiris; Lammintakanen, Johanna; Talja, Martti

    2017-02-15

    The burden of chronic disease and multimorbidity is rapidly increasing. Self-management support interventions are effective in reduce cost, especially when targeted at a single disease group; however, economical evidence of such complex interventions remains scarce. The objective of this study was to evaluate a cost-effectiveness analysis of a tele-based health-coaching intervention among patients with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF). A total of 1570 patients were blindly randomized to intervention (n = 970) and control (n = 470) groups. The intervention group received monthly individual health coaching by telephone from a specially trained nurse for 12-months in addition to routine social and healthcare. Patients in the control group received routine social and health care. Quality of life was assessed at the beginning of the intervention and follow-up measurements were made after 12 months health coaching. The cost included all direct health-care costs supplemented with home care and nursing home-care costs in social care. Utility was based on a Health Related Quality of Life (HRQoL) measurement (15D instrument), and cost effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). The cost-effectiveness of health coaching was highest in the T2D group (ICER €20,000 per Quality-Adjusted Life Years [QALY]). The ICER for the CAD group was more modest (€40,278 per QALY), and in the CHF group, costs increased with no marked effect on QoL. Probabilistic sensitivity analysis indicated that at the societal willingness to pay threshold of €50,000 per QALY, the probability of health coaching being cost effective was 55% in the whole study group. The cost effectiveness of health coaching may vary substantially across patient groups, and thus interventions should be targeted at selected subgroups of chronically ill. Based on the results of this study, health coaching improved the QoL of

  7. Intensive care delirium - effect on memories and health-related quality of life - a follow-up study

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Tønnesen, Else K; Videbech, Poul

    2013-01-01

    after intensive care unit. Interviews were repeated after two and six months and supplemented with Short Form-36 and the Barthel Index. RESULTS: Delirium was detected in 60% of the patients in our study, and delirious patients had significantly fewer factual memories and more memories of delusion than...... than half of the patients in intensive care unit experience delirium, which is associated with fewer factual memories and more memories of delusions. Short Form-36 might not be sensitive to delirium-related outcomes. Future research should include the development of better assessment tools to determine......AIMS AND OBJECTIVES: To investigate the effects of delirium in the intensive care unit on health-related quality of life, healthcare dependency and memory after discharge and to explore the association between health-related quality of life and memories, patient diaries and intensive care unit...

  8. The new architects of health care reform.

    Science.gov (United States)

    Schaeffer, Leonard D

    2007-01-01

    Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.

  9. Effectiveness of psychological interventions for chronic pain on health care use and work absence: systematic review and meta-analysis.

    Science.gov (United States)

    Pike, Andrew; Hearn, Leslie; Williams, Amanda C de C

    2016-04-01

    Psychological interventions for chronic pain and its consequences have been shown to improve mood, disability, pain, and catastrophic thinking, but there has been no systematic review specifically of their effects on health care use or time lost from work as treatment outcomes in mixed chronic pain. We conducted a systematic review and meta-analysis to evaluate the effectiveness of psychological therapies for chronic pain (excluding headache) in adults for these outcomes. We used searches from 2 previous systematic reviews and updated them. Eighteen randomized controlled trials were found that reported health care use (15 studies) and work loss (9 studies) as outcomes. Fourteen studies provided data for meta-analysis. There were moderate effects for psychological interventions compared with active controls, treatment as usual and waiting list controls in reducing health care use, with confidence in the findings. No benefits were found for medication reduction, but with less confidence in this result. Analysis of work loss showed no significant effects of psychological interventions over comparisons, but the use of many different metrics necessitated fragmenting the planned analyses, making summary difficult. The results are encouraging for the potential of routine psychological intervention to reduce posttreatment health care use, with associated cost savings, but it is likely that the range and complexity of problems affecting work necessitate additional intervention over standard group psychological intervention.

  10. The effectiveness of a perinatal education programme on smoking, infant care, and psychosocial health for ethnic Turkish women

    NARCIS (Netherlands)

    Hesselink, A.E.; van Poppel, M.N.M.; van Eijsden, M.; Twisk, J.W.; van der Wal, M.F.

    2012-01-01

    Objective: antenatal programmes might be effective in preventing unhealthy lifestyles, poor maternal infant care practices, and poor psychosocial health in ethnic minority women, but there are few evidence-based interventions. For this reason an antenatal education programme, called 'Happy Mothers,

  11. The Interface of School, Community, and Health Care Reform: Organizational Directions toward Effective Services for Children and Youth.

    Science.gov (United States)

    Knoff, Howard M.

    1996-01-01

    Three areas of reform have been under national scrutiny: school reform, community services reform, and health-care reform. Few have discussed how these three areas interface and can be organized toward more effective services for children and youth. Describes organizational and planning methodology that coordinates these three reform areas into a…

  12. Factors affecting effective community participation in maternal and newborn health programme planning, implementation and quality of care interventions.

    Science.gov (United States)

    Howard-Grabman, Lisa; Miltenburg, Andrea Solnes; Marston, Cicely; Portela, Anayda

    2017-08-31

    Community participation in in health programme planning, implementation and quality improvement was recently recommended in guidelines to improve use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns. How to implement community participation effectively remains unclear. In this article we explore different factors. We conducted a secondary analysis, using the Supporting the Use of Research Evidence framework, of effectiveness studies identified through systematic literature reviews of two community participation interventions; quality improvement of maternity care services; and maternal and newborn health programme planning and implementation. Community participation ranged from outreach educational activities to communities being full partners in decision-making. In general, implementation considerations were underreported. Key facilitators of community participation included supportive policy and funding environments where communities see women's health as a collective responsibility; linkages with a functioning health system e.g. via stakeholder committees; intercultural sensitivity; and a focus on interventions to strengthen community capacity to support health. Levels of participation and participatory approaches often changed over the life of programmes as community and health services capacity to interact developed. Implementation requires careful consideration of the context: previous experience with participation, who will be involved, gender norms, and the timeframe for implementation. Relevant stakeholders must be actively involved, particularly those often excluded from decision making. Current limited evidence suggests that the vision of community participation as a process and the presence of a focus to strengthen community capacity to participate and to improve health may be a key factor for long term success.

  13. Exploring the Effects of User Fees, Quality of Care and Utilization of Health Services on Enrolment in Community Health Fund, Bagamoyo District, Tanzania.

    OpenAIRE

    Lekashingo, Lawrence Davidson

    2012-01-01

    The co-existence of Community Health Fund (CHF) and user fees in Tanzania as health financial mechanisms have affected to CHF enrolment. However, little is known about the effect of user fees on CHF enrolment, non-enrollment and drop-out. The study aimed at exploring the effects of coexistence of user fees and Community Health Fund scheme, quality of care and utilization of health services on CHF enrolment, non-enrollment and drop out in Bagamoyo District, Coast Region, Tanzania. An explorato...

  14. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Client Satisfaction with Antenatal Care Services in Primary Health Care. Centres in Sabon Gari Local Government Area, Kaduna State Nigeria. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. 1. 1. 1. M.B Sufiyan , A.A Umar , A. Shugaba . 1Department of Community Medicine, Ahmadu Bello University, ...

  15. Reforming the health care system: implications for health care marketers.

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  16. The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities.

    Science.gov (United States)

    Kimura, Akiko C; Nguyen, Christine N; Higa, Jeffrey I; Hurwitz, Eric L; Vugia, Duc J

    2007-04-01

    We examined barriers to influenza vaccination among long-term care facility (LTCF) health care workers in Southern California and developed simple, effective interventions to improve influenza vaccine coverage of these workers. In 2002, health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine. Results were used to develop 2 interventions, an educational campaign and Vaccine Day (a well-publicized day for free influenza vaccination of all employees at the worksite). Seventy facilities were recruited to participate in an intervention trial and randomly assigned to 4 study groups. The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage (53% coverage; prevalence ratio [PR]=1.45; 95% confidence interval [CI]=1.24, 1.71, compared with 27% coverage in the control group). Vaccine Day alone was also effective (46% coverage; PR= 1.41; 95% CI=1.17, 1.71). The educational campaign alone was not effective in improving coverage levels (34% coverage; PR=1.18; 95% CI=0.93, 1.50). Influenza vaccine coverage of LTCF health care workers can be improved by providing free vaccinations at the worksite with a well-publicized Vaccine Day.

  17. Acute mental health care and South African mental health legislation

    African Journals Online (AJOL)

    Introduction. Reliable data is necessary to facilitate the effective planning, management and restructuring of mental health care facilities. Access to accurate information on clinical conditions, treatment outcomes and expenditure is essential to ensure accountability, quality and cost-effective mental health care. This article is ...

  18. Effect of shared decision-making on therapeutic alliance in addiction health care

    Directory of Open Access Journals (Sweden)

    EAG Joosten

    2008-10-01

    Full Text Available EAG Joosten1,2, GH de Weert3, T Sensky4, CPF van der Staak5, CAJ de Jong1,21Novadic-Kentron, Network for Addiction Treatment Services, Vught, the Netherlands; 2Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA, Nijmegen, the Netherlands; 3Julius Center for Health Sciences and Primary Health Care, UMC Utrecht, Utrecht, the Netherlands; 4Department of Psychological Medicine, Imperial College London, London, United Kingdom; 5Academic Centre for Social Sciences, Radboud University Nijmegen, Nijmegen, the NetherlandsBackground: In recent decades, shared decision-making (SDM models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to examine the effect of a shared decision-making intervention (SDMI for substance-dependent patients on patients’ and clinicians’ perceptions of therapeutic alliance.Methods: Clinicians were randomly assigned to SDMI or usual procedures to reach a treatment agreement. SDMI is a structured, manualized, 5-session procedure to facilitate treatment agreement and consists of five standardized sessions.Results: Patients’ perceptions of the therapeutic alliance were very favorable at start of treatment, and no differences were found between intervention groups. Clinicians’ scores on perceived helpfulness and on the overall therapeutic alliance were higher in the SDMI group than in the controls, after 8 weeks of treatment and at the end of treatment.Conclusion: The present study has shown that a specific intervention to enhance shared decision-making results in favorable changes in clinicians’ perceptions of the therapeutic alliance.Keywords: therapeutic alliance, helping alliance, shared decision-making, addiction, substance-dependence

  19. Health care process modelling: which method when?

    Science.gov (United States)

    Jun, Gyuchan Thomas; Ward, James; Morris, Zoe; Clarkson, John

    2009-06-01

    The role of process modelling has been widely recognized for effective quality improvement. However, application in health care is somewhat limited since the health care community lacks knowledge about a broad range of methods and their applicability to health care. Therefore, the objectives of this paper are to present a summary description of a limited number of distinct modelling methods and evaluate how health care workers perceive them. Various process modelling methods from several different disciplines were reviewed and characterized. Case studies in three different health care scenarios were carried out to model those processes and evaluate how health care workers perceive the usability and utility of the process models. Eight distinct modelling methods were identified and characterized by what the modelling elements in each explicitly represents. Flowcharts, which had been most extensively used by the participants, were most favoured in terms of their usability and utility. However, some alternative methods, although having been used by a much smaller number of participants, were considered to be helpful, specifically in understanding certain aspects of complex processes, e.g. communication diagrams for understanding interactions, swim lane activity diagrams for roles and responsibilities and state transition diagrams for a patient-centred perspective. We believe that it is important to make the various process modelling methods more easily accessible to health care by providing clear guidelines or computer-based tool support for health care-specific process modelling. These supports can assist health care workers to apply initially unfamiliar, but eventually more effective modelling methods.

  20. The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women.

    Science.gov (United States)

    Valentine, Sarah E; Elsesser, Steven; Grasso, Chris; Safren, Steven A; Bradford, Judith B; Mereish, Ethan; O'Cleirigh, Conall

    2015-12-01

    Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.

  1. Urban–Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures

    Science.gov (United States)

    Meng, Hongdao; Wamsley, Brenda; Liebel, Diane; Dixon, Denise; Eggert, Gerald; Van Nostrand, Joan

    2009-01-01

    Purpose: To evaluate the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. To determine if these outcomes vary by urban or rural residence. Design and Methods: We analyzed data from a 22-month randomized controlled trial of a health promotion/disease self-management program that included 766 elderly Medicare beneficiaries from western New York, West Virginia, and Ohio. Physical function was measured by changes in self-reported dependencies in activities of daily living over the study period. Total health care expenditures were measured by aggregating expenditures from major sources (acute, postacute, and long-term care). We used ordinary least squares models to examine the effects of the intervention on both physical function and cost outcomes during the 22-month period. Results: The results indicated that the intervention reduced physical functional decline by 54% (p = .03) in the study sample. Stratified analyses showed that the intervention effect was much stronger in the rural sample. Mean total health care expenditures were 11% ($3,100, p = .30) lower in the intervention group. The effects of the intervention on average health care expenditures were similar among urban and rural participants. Implications: The intervention offered a promising strategy for reducing decline in physical function and potentially lowering total health care expenditures for high-risk Medicare beneficiaries, especially for those in rural areas. Future studies need to investigate whether the findings can be replicated in other types of rural areas through a refined intervention and better targeting of the study population. PMID:19401357

  2. Occupational Health for Health Care Providers

    Science.gov (United States)

    Health care workers are exposed to many job hazards. These can include Infections Needle injuries Back injuries ... prevention practices. They can reduce your risk of health problems. Use protective equipment, follow infection control guidelines, ...

  3. Improving the effectiveness of short-term courses for multidisciplinary health care professionals

    DEFF Research Database (Denmark)

    Kapur, Kavita; McAleer, Sean; Persson, Frederik

    2015-01-01

    in knowledge and change in attitudes; and self-assessment of action plan implementation at six months to determine level of behaviour change. In total, 327 multidisciplinary HCPs participated in the seven PD courses. End of course evaluation indicated that the PD course was valued by course participants......The Practical Diabetology (PD) course for multidisciplinary health care professionals (HCPs) is directed at building a team-based approach to diabetes care delivery. Participants were asked to apply course learning to identify deficiencies in care delivery in their own settings and develop action...... in terms of relevance of the topics and learning experience. A significant gain in knowledge and positive changes in attitudes were seen immediately post course in both groups. Of the 160 action plans prepared by participating teams (consisting of at least two members each - one medical and one non...

  4. Ageing world: Health care challenges

    Directory of Open Access Journals (Sweden)

    Vinay Mahishale

    2015-01-01

    Full Text Available The world population reached 7 billion in 2012, which is 6 billion more than in 1800. This remarkable population growth is the result of several factors like advances in the medical, technological and public health systems resulting in the control and treatment of communicable diseases, the control of pandemics, the end of large-scale wars, improvements in living conditions and the revolutions in the field of agriculture. Because of all these factors, there has been a considerable improvement in the life expectancy of human beings. There is also an alarming reduction in fertility rates. The combination of declining fertility rate and augmented life expectancies has led to a change in the demographics of the population with the strata of older individuals growing faster than the younger individuals. The aging of populations is poised to become the next global public health challenge. Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanization, modernization, globalization, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic non-infective conditions. Health systems need to find effective strategies to extend health care and to respond to the needs of older adults. This review highlights the pathophysiology of aging, biological and physiological changes, impact of aging on health, epidemiological transitions, multi-morbidity in elderly and challenges for health care system.

  5. Federalism and Health Care

    Directory of Open Access Journals (Sweden)

    G. Alan Tarr

    2011-10-01

    Full Text Available President Barack Obama proposed a major overhaul of the American healthsystem, and in 2010 the U.S. Congress enacted his proposal, the PatientProtection and Affordable Care Act. Opponents of the Act challenged itsconstitutionality in federal court, claiming that it exceeds the powers grantedto the federal government under the Commerce Clause and the NecessaryProper Clause of the federal Constitution. Some courts have upheldthe law, but others have agreed with the critics, in particular ruling thatthe provision requiring citizens to buy health insurance is unconstitutional.Eventually the U.S. Supreme Court will rule on the issue. This article tracesthe controversy, surveys the interpretation of pertinent constitutional provisionsin past cases, analyzes the constitutional arguments presented byproponents and opponents of the Act, and concludes that the Act is constitutional.

  6. Implementing Comprehensive Health Care Management for Sickle ...

    African Journals Online (AJOL)

    This reduction was not achieved through the use of sophisticated care such as bone marrow transplant, but through the adoption of a Comprehensive Health Care Management protocol for sickle cell disease. This protocol of care emphasizes prevention of crises through effective management of the disease. In Africa, where ...

  7. Sex trafficking and health care in Metro Manila: identifying social determinants to inform an effective health system response.

    Science.gov (United States)

    Williams, Timothy P; Alpert, Elaine J; Ahn, Roy; Cafferty, Elizabeth; Konstantopoulos, Wendy Macias; Wolferstan, Nadya; Castor, Judith Palmer; McGahan, Anita M; Burke, Thomas F

    2010-12-15

    This social science case study examines the sex trafficking of women and girls in Metro Manila through a public health lens. Through key informant interviews with 51 health care and anti-trafficking stakeholders in Metro Manila, this study reports on observations about sex trafficking in Metro Manila that provide insight into understanding of risk factors for sex trafficking at multiple levels of the social environment: individual (for example, childhood abuse), socio-cultural (for example, gender inequality and a "culture of migration"), and macro (for example, profound poverty caused, inter alia, by environmental degradation disrupting traditional forms of labor). It describes how local health systems currently assist sex-trafficking victims, and provides a series of recommendations, ranging from prevention to policy, for how health care might play a larger role in promoting the health and human rights of this vulnerable population. Copyright © 2010 Williams, Alpert, Ahn, Cafferty, Konstantopoulos, Wolferstan, Castor, McGahan, and Burke. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

  8. Effect of ethiopia's health extension program on maternal and newborn health care practices in 101 rural districts: a dose-response study.

    Science.gov (United States)

    Karim, Ali Mehryar; Admassu, Kesetebirhane; Schellenberg, Joanna; Alemu, Hibret; Getachew, Nebiyu; Ameha, Agazi; Tadesse, Luche; Betemariam, Wuleta

    2013-01-01

    Improving newborn survival is essential if Ethiopia is to achieve Millennium Development Goal 4. The national Health Extension Program (HEP) includes community-based newborn survival interventions. We report the effect of these interventions on changes in maternal and newborn health care practices between 2008 and 2010 in 101 districts, comprising 11.6 million people, or 16% of Ethiopia's population. Using data from cross-sectional surveys in December 2008 and December 2010 from a representative sample of 117 communities (kebeles), we estimated the prevalence of maternal and newborn care practices, and a program intensity score in each community. Women with children aged 0 to 11 months reported care practices for their most recent pregnancy and childbirth. The program intensity score ranged between zero and ten and was derived from four outreach activities of the HEP front-line health workers. Dose-response relationships between changes in program intensity and the changes in maternal and newborn health were investigated using regression methods, controlling for secular trend, respondents' background characteristics, and community-level factors. Between 2008 and 2010, median program intensity score increased 2.4-fold. For every unit increase in the score, the odds of receiving antenatal care increased by 1.13 times (95% CI 1.03-1.23); the odds of birth preparedness increased by 1.31 times (1.19-1.44); the odds of receiving postnatal care increased by 1.60 times (1.34-1.91); and the odds of initiating breastfeeding immediately after birth increased by 1.10 times (1.02-1.20). Program intensity score was not associated with skilled deliveries, nor with some of the other newborn health care indicators. The results of our analysis suggest that Ethiopia's HEP platform has improved maternal and newborn health care practices at scale. However, implementation research will be required to address the maternal and newborn care practices that were not influenced by the HEP

  9. Effect of slow rhythmic voluntary breathing pattern on isometric handgrip among health care students

    OpenAIRE

    Rajajeyakumar M, Janitha A, Madanmohan, Balachander J

    2014-01-01

    Introduction: Hand grip strength is a widely used test in experimental and epidemiologicalstudies. The measure of hand grip strength is influenced by several factors, including age; gender; different angle of the shoulder, elbow, forearm, and wrist; and posture.So we planned to study theeffect of slow voluntary breathing exercise (Savitri Pranayam) onthe various strengths of isometric hand grip (IHG) amongyoung health care students.Methods: The present study was conducted on 60 volunteers 17-...

  10. Primary health care models

    Science.gov (United States)

    Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric

    2012-01-01

    Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904

  11. Online Health Care Communication in Denmark

    DEFF Research Database (Denmark)

    Andersen, Kim Normann; Agger Nielsen, Jeppe; Kim, Soonhee

    2013-01-01

    This paper brings forward five propositions on the use of online communication in health care, its potential impacts on efficiency and effectiveness in health care, and which role government should play in moving forward the use of online communication. In the paper, each of the five propositions...

  12. [Towards a sustainable, cost-effective mental health care; a policy perspective].

    Science.gov (United States)

    Jeurissen, P P T; Ravesteijn, B A; Janssen, R T J M; Tanke, M A C

    After a decade of robust growth in spending, Dutch mental healthcare is on a more stricter budgetary path since 2012. High prevalence of illness and limited spending, imply the need for efficient mental healthcare delivery. AIM: To advise how mental health care can be managed more efficiently. There will also have to be more differentiation between mild and serious psychiatric illnesses. METHOD: Review of academic articles and policy studies. RESULTS: With regard to the treatment of fairly common disorders, more attention needs to be given to integrated basic care and e-health. Employers and stakeholders can perhaps play a role in financing some of these services. Severe mental disorders can be handled more often on an integrated ambulatory basis setting than only in a hospital setting, while scaling down inpatient capacity. These steps would represent a major transition and would require spending cuts and a change in the provider 'landscape'. CONCLUSION: Sustainable mental healthcare is inseparably linked to an agenda that provides value for money and it implies a major transition. However, in principle, it should be possible to fit these changes into the current system of governance. More attention needs to be given to coordination between the various domains, and to a reduction in administrative costs. Reimbursement methods should align e-health, collaborative care, case-management and best-practice pathways.

  13. An Evaluation of the Effects of Human Factors and Ergonomics on Health Care and Patient Safety Practices: A Systematic Review.

    Science.gov (United States)

    Mao, Xuanyue; Jia, Pengli; Zhang, Longhao; Zhao, Pujing; Chen, Ying; Zhang, Mingming

    2015-01-01

    From the viewpoint of human factors and ergonomics (HFE), errors often occur because of the mismatch between the system, technique and characteristics of the human body. HFE is a scientific discipline concerned with understanding interactions between human behavior, system design and safety. To evaluate the effectiveness of HFE interventions in improving health care workers' outcomes and patient safety and to assess the quality of the available evidence. We searched databases, including MEDLINE, EMBASE, BIOSIS Previews and the CBM (Chinese BioMedical Literature Database), for articles published from 1996 to Mar.2015. The quality assessment tool was based on the risk of bias criteria developed by the Cochrane Effective Practice and Organization of Care (EPOC) Group. The interventions of the included studies were categorized into four relevant domains, as defined by the International Ergonomics Association. For this descriptive study, we identified 8, 949 studies based on our initial search. Finally, 28 studies with 3,227 participants were included. Among the 28 included studies, 20 studies were controlled studies, two of which were randomized controlled trials. The other eight studies were before/after surveys, without controls. Most of the studies were of moderate or low quality. Five broad categories of outcomes were identified in this study: 1) medical errors or patient safety, 2) health care workers' quality of working life (e.g. reduced fatigue, discomfort, workload, pain and injury), 3) user performance (e.g., efficiency or accuracy), 4) health care workers' attitudes towards the interventions(e.g., satisfaction and preference), and 5) economic evaluations. The results showed that the interventions positively affected the outcomes of health care workers. Few studies considered the financial merits of these interventions. Most of the included studies were of moderate quality. This review highlights the need for scientific and standardized guidelines regarding

  14. Workforce diversity: implications for the effectiveness of health care delivery teams.

    Science.gov (United States)

    Dreachslin, J L; Hunt, P L; Sprainer, E

    2000-05-01

    This paper examines the implications of racial diversity for the self-perceived communication effectiveness of nursing care teams. An RN leads the nursing care team (NCT) and delivers care in collaboration with two or more nonlicensed caregivers. Overlap is intentionally designed into the roles of NCT members and the range of duties the team performs is generally expanded to include functions previously performed by personnel from centralized departments. NCTs are highly reliant on mutual respect and effective communication among team members. Team conflict and miscommunication can be exacerbated by the strong correlation between role on the nursing care team (NCT) and race. Verbatim transcripts of fourteen focus groups from two study hospitals were used to develop a grounded theory of the role that race plays in the self-perceived communication effectiveness of nursing care teams. Two themes that emerged from the focus group discussions constitute the overarching framework within which racially diverse team members evaluate team communication effectiveness: different perspectives and alternative realities. Three additional themes, social isolation, selective perception and stereotypes, that serve as reinforcing factors were also identified, i.e., these factors deepen the conflict and dissatisfaction with team communication that occurs as a natural consequence of the overarching framework of different perspectives and alternative realities. Leadership emerged as a powerful mitigating factor in the model of how race influences the self-perceived communication effectiveness of nursing care teams. Leaders who can transcend racial identity as evidenced by the ability to validate alternative realities and appreciate different perspectives appear to moderate the potential negative effects of racial diversity on team communication processes and strengthen the positive aspects of diversity.

  15. Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis

    Science.gov (United States)

    2014-01-01

    This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form of a checklist, is especially targeted at decision makers who set priorities at national and sub-national levels, and those who interpret findings from cost-effectiveness analysis. It is also targeted at researchers conducting cost-effectiveness analysis to improve reporting of their results in the light of these other criteria. The guidance was develop through a series of expert consultation meetings and involved three steps: i) methods and normative concepts were identified through a systematic review; ii) the review findings were critically assessed in the expert consultation meetings which resulted in a draft checklist of normative criteria; iii) the checklist was validated though an extensive hearing process with input from a range of relevant stakeholders. The GPS-Health incorporates criteria related to the disease an intervention targets (severity of disease, capacity to benefit, and past health loss); characteristics of social groups an intervention targets (socioeconomic status, area of living, gender; race, ethnicity, religion and sexual orientation); and non-health consequences of an intervention (financial protection, economic productivity, and care for others). PMID:25246855

  16. Health and Disability: Partnerships in Health Care

    Science.gov (United States)

    Tracy, Jane; McDonald, Rachael

    2015-01-01

    Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…

  17. The effect of universal influenza immunization on mortality and health care use.

    Directory of Open Access Journals (Sweden)

    Jeffrey C Kwong

    2008-10-01

    = 0.45, p < 0.001, and doctors' office visits (RR = 0.21 versus 0.52, ratio of RRs = 0.41, p < 0.001. Sensitivity analyses were carried out to assess consistency, specificity, and the presence of a dose-response relationship. Limitations of this study include the ecological study design, the nonspecific outcomes, difficulty in modeling baseline events, data quality and availability, and the inability to control for potentially important confounders. CONCLUSIONS: Compared to targeted programs in other provinces, introduction of universal vaccination in Ontario in 2000 was associated with relative reductions in influenza-associated mortality and health care use. The results of this large-scale natural experiment suggest that universal vaccination may be an effective public health measure for reducing the annual burden of influenza.

  18. Health care consumerism movement takes a step forward.

    Science.gov (United States)

    Thompson, Michael; Cutler, Charles M

    2010-01-01

    One of the contributing factors to both the increase in health care costs and the backlash to managed care was the lack of consumer awareness of the cost of health care service, the effect of health care costs on profits and wages, and the need to engage consumers more actively as consumers in health care decisions. This article reviews the birth of the health care consumerism movement and identifies gaps in health care consumerism today. The authors reveal some of the keys to building a sustainable health care consumerism framework, which involves enlisting consumers as well as other stakeholders.

  19. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    2013-09-02

    Port Harcourt. ... Journal of Community Medicine and Primary Health Care. 25 (2) 53-58. KEYWORDS. Healer shopping,. Discharge Against. Medical Advice,. Non- communicable diseases, epidemiological transition, Port.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    1Department of Paediatrics and Child Health, Faculty of Clinical Sciences, College of Health Sciences,. Obafemi Awolowo ... Younger parents less than 35years, parents with lower educational attainments and low .... staffing, availability of immunization consumables was estimated using the Computer Programme for.

  1. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    financing are critical issues that continue to bother health policy makers. .... Ethical approval. Ethical approval was obtained from the. Health Research Ethics Committee of the Delta. State University Teaching Hospital, Oghara and informed written (and or verbal) ... Teachers/Religious Leaders. Indifferent. 85. 24.3%. 117.

  2. Training competent and effective Primary Health Care Workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia

    Directory of Open Access Journals (Sweden)

    Keni Bhalachandra H

    2006-12-01

    Full Text Available Abstract Background Human resources for health are non-existent in many parts of the world and the outer islands of Marshall Islands in Micronesia are prime examples. While the more populated islands with hospital facilities are often successful in recruiting qualified health professionals from overseas, the outer islands generally have very limited health resources, and are thus less successful. In an attempt to provide reasonable health services to these islands, indigenous people were trained as Health Assistants (HA to service their local communities. In an effort to remedy the effectiveness of health care delivery to these islands, a program to train mid-level health care workers (Hospital Assistants was developed and implemented by the Ministry of Health in conjunction with the hospital in Majuro, the capital city of the Marshall Islands. Methods A physician instructor with experience and expertise in primary health care in these regions conducted the program. The curriculum included training in basic health science, essentials of endemic disorders and their clinical management appropriate to the outer islands. Emphasis was given to prevention and health promotion as well as to the curative aspects. For clinical observation, the candidates were assigned to clinical departments of the Majuro hospital for 1 year during their training, as assistants to the nursing staff. This paper discusses the details of the training, the modalities used to groom the candidates, and an assessment of the ultimate effectiveness of the program. Results Out of 16 boys who began training, 14 candidates were successful in completing the program. In 1998 a similar program was conducted exclusively for women under the auspices of Asian Development Bank funding, hence women were not part of this program. Conclusion For developing countries of the Pacific, appropriately trained human resources are an essential component of economic progress, and the health workforce

  3. Effect of heartfulness meditation on burnout, emotional wellness, and telomere length in health care professionals.

    Science.gov (United States)

    Thimmapuram, Jayaram; Pargament, Robert; Sibliss, Kedesha; Grim, Rodney; Risques, Rosana; Toorens, Erik

    2017-01-01

    Background: Burnout poses significant challenges during training years in residency and later in the career. Meditation is a tool to treat stress-related conditions and promote wellness. Telomere length may be affected by burnout and stress. However, the benefits of meditation have not been fully demonstrated in health care professionals. Objective: We assessed the effects of a 12-week 'Heartfulness Meditation' program on burnout, emotional wellness, and telomere length in residents, faculty members, and nurses at a large community teaching hospital during the 2015-16 academic year. Methods: All subjects completed a baseline Maslach Burnout Inventory (MBI) and Emotional Wellness Assessment (EWA) at the beginning of the study. Meditators received instructions in Heartfulness Meditation. At week 12, subjects completed a follow up MBI and EWA scores. Salivary telomere length was measured at baseline and week 12. Results: Twenty-seven out of a total 155 residents (17.4%) along with eight faculty physicians and 12 nurses participated in the study. Thirty-five enrolled as meditators and 12 as controls. At 12 weeks, the meditators had statistically significant improvement in all measures of burnout and in nearly all attributes of EWA. Controls showed no statistically significant changes in either burnout or emotional wellness scores. Relative telomere length increased with statistical significance in a younger subset of meditators. Conclusion: Our results indicate that meditation offers an accessible and efficient method by which physician and nurse burnout can be ameliorated and wellness can be enhanced. The increased telomere length is an interesting finding but needs to be confirmed with further research. Abbreviations: EWA: Emotional wellness assessment; MBI: Maslach burnout inventory; EE: Emotional exhaustion; DP: Depersonalization; PA: Personal accomplishment; PI: Prinicipal investigator; JT: Jayaram Thimmapuram.

  4. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    mania) and anxiety disorders (General anxiety, agoraphobia, social phobia, obsessive-compulsive disorder and post traumatic stress disorder). Conclusion: Findings suggest that there is need to consider mental and psychological care of clients with HIV/AIDS to minimise the prevalence of psychiatric disorder among HIV ...

  5. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Methodology. A cross-sectional survey of patients at the antiretroviral clinic of the Federal Medical Centre,. Makurdi, Nigeria, was conducted between June and August 2008. An adapted version of the RAND. Patient Satisfaction Questionnaire Long Form was used to assess seven dimensions of care: general satisfaction ...

  6. Effect of Self–Care Educational Program to Improving Quality of Life among Elderly Referred to Health Centers in Zanjan

    Directory of Open Access Journals (Sweden)

    Fatemeh Salimi

    2015-09-01

    Full Text Available Background and Objectives: Since elderlies are susceptible to various impairments due to different physical and mental problems, they need more attention and abiding and efficient self-care program for their health promotion. The present study investigated the effect of self-care training program on quality of life of elderlies. Materials and Methods: This pre- and post-quasi-experimental study was carried out on 160 elderly clients selected from eight health care centers in Zanjan, Iran. The elderlies were selected by randomized sampling and assigned to two groups of experimental (n = 80 and control (n = 80 groups. The experimental group participated in the self-care training program for six sessions of one hour. The study instruments were questionnaires regarding demographic information and short-form health survey (SF-36. Data analysis was performed using SPSS-22 software by independent t-test, Mann-Whitney and chi-squared. Results: The finding showed a significant difference in mean scores of quality of life between the experimental and control groups after the intervention (P < 0.001. Conclusions: Self-care education to elderlies about the practices of proper nutrition, exercise, rest and medication can prevent several problems and help them to improve their quality of lives.

  7. Space age health care delivery

    Science.gov (United States)

    Jones, W. L.

    1977-01-01

    Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.

  8. Effects of Self-care Health Behaviors on Quality of Life Mediated by Cardiovascular Risk Factors Among Individuals with Coronary Artery Disease: A Structural Equation Modeling Approach

    Directory of Open Access Journals (Sweden)

    Sukhee Ahn, RN, PhD

    2016-06-01

    Conclusions: The findings indicate that self-efficacy, self-care health behaviors, and modifiable risk factors play an important role in QOL in adults with coronary artery disease. Patients could be more confident in performing self-care health behaviors, leading to a better QOL, by more effectively managing their cardiovascular risk factors. Nursing strategies to improve QOL in this population should include motivating them to perform self-care health behaviors.

  9. Effect of public health nurses' educational intervention on self-care of the patients with type 2 diabetes.

    Science.gov (United States)

    Zandiyeh, Zahra; Hedayati, Batool; Zare, Elahe

    2015-01-01

    Diabetes is the most common metabolic disease and the sixth cause of mortality in the world. Most of the conducted studies show that the only way to control this disease and prevent its disabling complications is constant administration of self-care. This study was conducted with the goal of determining the effect of public health nurses' educational intervention on the self-care of the patients with type 2 diabetes who referred to Hazrat Ali clinic in Isfahan. This is a two-group two-step clinical trial with a before-after intervention design in which 50 patients with type 2 diabetes and with a mean age of 40-70 years were selected and assigned to study (n = 25) and control (n = 25) groups by allotting them even and add numbers. Educational intervention was conducted in the study group through seven educational sessions. Mean scores of self-care before and after interventions were compared by Toobert and Glasgow brief self-care activities questionnaire. Results showed no significant difference in the self-care scores before intervention in the two groups (P = 0.67, z = 0.43), but the mean score of self-care showed a significant increase after intervention in the study group, compared to the control group (P = 0.002, z = 3.14). Based on the obtained results, it is suggested to provide constant education of self-care for diabetic patients in health care centers, with more emphasis on a change in self-care skills and behavior.

  10. Evaluation of effectiveness and satisfaction outcomes of a mental health screening and referral clinical pathway for community nursing care.

    Science.gov (United States)

    Allen, J; Annells, M; Nunn, R; Petrie, E; Clark, E; Lang, L; Robins, A

    2011-06-01

    The study aimed to explore the effectiveness of a mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia on outcomes of client self-reported mental health, quality of life, and client and carer satisfaction. The pathway was developed by literature review and consultation, then trialled and evaluated. Validated screening tools were embedded within the pathway to support generalist nurses' mental health decision making. Pre- and post-measures were applied. Clients on whom the pathway was trialled were invited to complete an evaluation survey questionnaire, as were their informal carers. Most clients and carers who responded to these questionnaires were highly satisfied or satisfied with care provided through application of the pathway. This study adds understanding about one way that community nurses might identify people with mental health difficulties. The trialled pathway, which was modified and refined following the study, is now available on the Internet as an evidence-based resource for community nurses in Australia to guide practice and maximize holistic care for war veterans and war widow(er)s where that care is funded by Department of Veterans' Affairs. © 2011 Commonwealth of Australia.

  11. Child Care Health Consultation Improves Infant and Toddler Care.

    Science.gov (United States)

    Johnston, Rosemary; DelConte, Beth A; Ungvary, Libby; Fiene, Richard; Aronson, Susan S

    2017-08-08

    Many families enroll their infants and toddlers in early education and child care programs. The Pennsylvania Chapter of the American Academy of Pediatrics recruited 32 child care centers that care for infants and toddlers to be linked with a child care health consultant (CCHC). Project staff assigned the centers alternately to an immediate intervention or a 1-year delayed intervention (contrast) group. At entry into the project, and then 1 and 2 years later, an evaluator assessed center compliance with 13 standards for infants and toddler care selected from Caring for Our Children: National Health and Safety Performance Standards (3rd ed.). Project staff linked the Immediate Intervention centers with a CCHC in Year 1. In Year 2, in a crossover comparison, project staff linked Contrast centers with a CCHC. Working with a CCHC effectively improved compliance with some selected health and safety standards. Copyright © 2017 National Association of Pediatric Nurse Practitioners. All rights reserved.

  12. Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities.

    Science.gov (United States)

    Lawless, Angela; Freeman, Toby; Bentley, Michael; Baum, Fran; Jolley, Gwyn

    2014-05-15

    This paper describes the development of a model of Comprehensive Primary Health Care (CPHC) applicable to the Australian context. CPHC holds promise as an effective model of health system organization able to improve population health and increase health equity. However, there is little literature that describes and evaluates CPHC as a whole, with most evaluation focusing on specific programs. The lack of a consensus on what constitutes CPHC, and the complex and context-sensitive nature of CPHC are all barriers to evaluation. The research was undertaken in partnership with six Australian primary health care services: four state government funded and managed services, one sexual health non-government organization, and one Aboriginal community controlled health service. A draft model was crafted combining program logic and theory-based approaches, drawing on relevant literature, 68 interviews with primary health care service staff, and researcher experience. The model was then refined through an iterative process involving two to three workshops at each of the six participating primary health care services, engaging health service staff, regional health executives and central health department staff. The resultant Southgate Model of CPHC in Australia model articulates the theory of change of how and why CPHC service components and activities, based on the theory, evidence and values which underpin a CPHC approach, are likely to lead to individual and population health outcomes and increased health equity. The model captures the importance of context, the mechanisms of CPHC, and the space for action services have to work within. The process of development engendered and supported collaborative relationships between researchers and stakeholders and the product provided a description of CPHC as a whole and a framework for evaluation. The model was endorsed at a research symposium involving investigators, service staff, and key stakeholders. The development of a theory

  13. Comparison of cost accounting methods from different DRG systems and their effect on health care quality.

    Science.gov (United States)

    Leister, Jan Eric; Stausberg, Jürgen

    2005-09-28

    Diagnosis related groups (DRGs) are a well-established provider payment system. Because of their imminent potential of cost reduction, they have been widely introduced. In addition to cost cutting, several social objectives - e.g., improving overall health care quality - feed into the DRG system. The WHO compared different provider payment systems with regard to the following objectives: prevention of further health problems, providing services and solving health problems, and responsiveness to people's legitimate expectations. However, no study has been published which takes the impact of different cost accounting systems across the DRG systems into account. We compared the impact of different cost accounting methods within DRG-like systems by developing six criteria: integration of patients' health risk into pricing practice, incentives for quality improvement and innovation, availability of high class evidence based therapy, prohibition of economically founded exclusions, reduction of fragmentation incentives, and improvement of patient oriented treatment. We set up a first overview of potential and actual impacts of the pricing practices within Yale-DRGs, AR-DRGs, G-DRGs, Swiss AP-DRGs adoption and Swiss MIPP. It could be demonstrated that DRGs are not only a 'homogenous' group of similar provider payment systems but quite different by fulfilling major health care objectives connected with the used cost accounting methods. If not only the possible cost reduction is used to put in a good word for DRG-based provider payment systems, maximum accurateness concerning the method of cost accounting should prevail when implementing a new DRG-based provider payment system.

  14. Female college student awareness of exposures to environmental toxins in personal care products and their effect on preconception health.

    Science.gov (United States)

    Chan, Lisa M; Chalupka, Stephanie M; Barrett, Roseann

    2015-02-01

    This research study investigated college women's usage of personal care products and their views on health effects from exposures during the preconception period. Many personal care products and cosmetics contain chemical ingredients that have been known to disrupt human endocrine and neurological systems, and contribute to infertility and adverse birth outcomes. Seventy-two female college students from a single, medium-sized university campus completed a researcher-developed questionnaire. Findings provide insight into the daily exposures young women experience during their reproductive years. Results can inform occupational and environmental health nurses about the personal daily exposures of young women when conducting risk assessments in the workplace or at a school, and can aid in developing interventions that support the environmental health of employees or future employees. © 2015 The Author(s).

  15. Consumers’ interpretation and use of comparative information on the quality of health care: the effect of presentation approaches

    Science.gov (United States)

    Damman, Olga C.; Hendriks, Michelle; Rademakers, Jany; Spreeuwenberg, Peter; Delnoij, Diana M. J.; Groenewegen, Peter P.

    2011-01-01

    Abstract Background  Public reports about health‐care quality have not been effectively used by consumers thus far. A possible explanation is inadequate presentation of the information. Objective  To assess which presentation features contribute to consumers’ correct interpretation and effective use of comparative health‐care quality information and to examine the influence of consumer characteristics. Design  Fictitious Consumer Quality Index (CQI) data on home care quality were used to construct experimental presentation formats of comparative information. These formats were selected using conjoint analysis methodology. We used multilevel regression analysis to investigate the effects of presenting bar charts and star ratings, ordering of the data, type of stars, number of stars and inclusion of a global rating. Setting and participants  Data were collected during 2 weeks of online questioning of 438 members of an online access panel. Results  Both presentation features and consumer characteristics (age and education) significantly affected consumers’ responses. Formats using combinations of bar charts and stars, three stars, an alphabetical ordering of providers and no inclusion of a global rating supported consumers. The effects of the presentation features differed across the outcome variables. Conclusions  Comparative information on the quality of home care is complex for consumers. Although our findings derive from an experimental situation, they provide several suggestions for optimizing the information on the Internet. More research is needed to further unravel the effects of presentation formats on consumer decision making in health care. PMID:21615637

  16. The effects of integrated home care and discharge practice on functional ability and health-related quality of life: a cluster-randomised trial among home care patients

    Directory of Open Access Journals (Sweden)

    Teija Hammar

    2007-08-01

    Full Text Available Objectives: The aim was to evaluate the effects of integrated home care and discharge practice on the functional ability (FA and health-related quality of life (HRQoL of home care patients. Methods: A cluster randomised trial (CRT with Finnish municipalities (n=22 as the units of randomisation. At baseline the sample included 669 patients aged 65 years or over. Data consisted of interviews (at discharge, and at 3-week and 6-month follow-up, medical records and care registers. The intervention was a generic prototype of care/case management-practice (IHCaD-practice that was tailored to municipalities needs. The aim of the intervention was to standardize practices and make written agreements between hospitals and home care administrations, and also within home care and to name a care/case manager pair for each home care patient. The main outcomes were HRQoL—as measured by a combination of the Nottingham Health Profile (NHP and the EQ-5D instrument for measuring health status—and also Activities of Daily Living (ADL. All analyses were based on intention-to-treat. Results: At baseline over half of the patient population perceived their FA and HRQoL as poor. At the 6-month follow-up there were no improvements in FA or in EQ-5D scores, and no differences between groups. In energy, sleep, and pain the NHP improved significantly in both groups at the 3-week and at 6-month follow-up with no differences between groups. In the 3-week follow-up, physical mobility was higher in the trial group. Conclusions: Although the effects of the new practice did not improve the patients' FA and HRQoL, except for physical mobility at the 3-week follow-up, the workers thought that the intervention worked in practice. The intervention standardised practices and helped to integrate services. The intervention was focused on staff activities and through the changed activities also had an effect on patients. It takes many years to achieve permanent changes in every worker

  17. The effect of leadership style on the employees’ job motivation in health care centers in Shiraz

    Directory of Open Access Journals (Sweden)

    EHSAN GOORAKI

    2013-04-01

    Full Text Available Introduction: Leadership style is one of the most debated topics in management (urban health-care centers, which has influenced a great number of managers and employees. The present study aimed to determine the impact of the managers’ leadership styles on the employees’ job motivation based on the Vroom-Yetton model. Methods: This study was a descriptive–analytical one and the research environment included the managers of health-care centers in Shiraz, Iran. The study data were collected through two questionnaires which were developed by the researchers, and the statistical analyses were performed using the SPSS statistical software. Results: The findings of the study indicated that 37%, 32%, and 7% of the managers’ leadership styles were cooperative type 1, cooperative type 2, and centric, respectively. In addition, 48% and 42% of the study subjects had average and high levels of maintenance motivational needs, respectively. Besides, 54% and 41% of the employees had average and high levels of motivational needs, respectively. The results showed a significant relationship between the employees’ motivational needs and the type of service as well as age (a <0.05. A significant relationship was also found between the employees’ provocative motivational needs and the type of service; however, no significant relationship was observed between the employees’ motivational needs and the demographic variables. No significant relationship was found between the managers’ leadership style and demographic variables, either. Conclusion: Given that the majority of the mangers of the research society have the leadership style of consultative and cooperative, this matter can improve the employees’ provocative and maintenance motivational needs in health-care centers.

  18. Patients struggle to access effective health care due to ongoing violence, distance, costs and health service performance in Afghanistan.

    Science.gov (United States)

    Nic Carthaigh, Niamh; De Gryse, Benoit; Esmati, Abdul Sattar; Nizar, Barak; Van Overloop, Catherine; Fricke, Renzo; Bseiso, Jehan; Baker, Corinne; Decroo, Tom; Philips, Mit

    2015-05-01

    The Afghan population suffers from a long standing armed conflict. We investigated patients' experiences of their access to and use of the health services. Data were collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member. To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year. Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  19. Health care's service fanatics.

    Science.gov (United States)

    Merlino, James I; Raman, Ananth

    2013-05-01

    The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life.

  20. Health care for nautical tourist.

    Science.gov (United States)

    Nikolić, N

    1992-01-01

    Nautical tourism is one of the developing branches of tourism in Europe. It differs from other forms of tourism. Conditions under which nautical tourists live are similar to those of seamen employed on vessels in costal shipping. The health care for nautical tourists should be organized according to the principles of health care for crews of merchant ships engaged in constal shipping.

  1. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    communicable diseases such as hypertension and transitions currently experienced in Sub-Saharan. 96. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. KEYWORDS journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine ...

  2. Prospects for Health Care Reform.

    Science.gov (United States)

    Kastner, Theodore

    1992-01-01

    This editorial reviews areas of health care reform including managed health care, diagnosis-related groups, and the Resource-Based Relative Value Scale for physician services. Relevance of such reforms to people with developmental disabilities is considered. Much needed insurance reform is not thought to be likely, however. (DB)

  3. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26 (1) 21-29. KEYWORDS. Household, expenditure,. Treatment, presumptive malaria,. Gimba ... A cross-sectional descriptive study conducted during community diagnosis posting of final year medical students of. Ahmadu Bello University ...

  4. Dealing with Health and Health Care System Challenges in China: assessing health determinants and health care reforms

    NARCIS (Netherlands)

    H. Zhang (Hao)

    2017-01-01

    markdownabstractThis dissertation investigates the challenges faced by China around 2010 in two domains – population health and the health care system. Specifically, chapters 2 and 3 are devoted to health challenges, explaining the female health disadvantage in later life and assessing the effect

  5. Effects of language concordance and interpreter use on therapeutic alliance in Spanish-speaking integrated behavioral health care patients.

    Science.gov (United States)

    Villalobos, Bianca T; Bridges, Ana J; Anastasia, Elizabeth A; Ojeda, Carlos A; Rodriguez, Juventino Hernandez; Gomez, Debbie

    2016-02-01

    The discrepancy between the growing number of Spanish speakers in the U.S. and the availability of bilingual providers creates a barrier to accessing quality mental health care. Use of interpreters provides one strategy for overcoming this linguistic barrier; however, concerns about whether sessions with interpreters, versus bilingual providers, impede therapeutic alliance remain. The current study explored associations between the use of interpreters and therapeutic alliance in a sample of 458 Spanish-speaking patients seen for integrated behavioral health visits at primary care clinics. Patients completed a brief (4 item) therapeutic alliance scale at their behavioral health appointment. In addition, to supplement the quantitative study data, a pilot study of 30 qualitative interviews was conducted with a new sample of 10 Spanish-speaking patients, 10 behavioral health consultants (BHCs), and 10 trained interpreters. Quantitative results showed that interpreter use did not relate to therapeutic alliance, even when controlling for relevant demographic variables. However, qualitative interviews suggested major themes regarding the relative benefits and challenges of using interpreters for patients, interpreters, and BHCs. In interviews, patients expressed a strong preference for bilingual providers. Benefits included greater privacy, sense of trust, and accuracy of communication. However, in their absence, interpreters were seen as increasing access to services and facilitating communication with providers, thereby addressing the behavioral health needs of patients with limited English proficiency. BHCs and interpreters emphasized the importance of interpreter training and a good collaborative relationship with interpreters to minimize negative effects on the quality of care. (c) 2016 APA, all rights reserved).

  6. Sickness Presenteeism Among Health Care Workers and the Effect of BMI, Cardiorespiratory Fitness, and Muscle Strength

    DEFF Research Database (Denmark)

    Christensen, Jeanette Reffstrup; Kongstad, Malte Bue; Sjøgaard, Gisela

    2015-01-01

    OBJECTIVES: The primary objective of this study was to assess the relationship between sickness presenteeism and body mass index (BMI), cardiorespiratory fitness (CRF), and maximal voluntary contraction (MVC). METHODS: Female health care workers (n = 139) were analyzed cross-sectional as well...... as longitudinal after 3 and 12-month follow-up. Sickness presenteeism was assessed as a summed score using validated questions from three questionnaires: Health and Work Performance Questionnaire, Work Ability Index, and Quantity and Quality Method. CRF was assessed by a maximal cycling test and MVC from four...... muscle groups. RESULTS: Significant relationships were found between sickness presenteeism and BMI as well as MVC both cross-sectional and as changes over 3 months. Participants with BMI more than 30 kg/m had significantly higher sickness presenteeism than those with BMI less than 25 kg/m. CONCLUSIONS...

  7. Sickness Presenteeism Among Health Care Workers and the Effect of BMI, Cardiorespiratory Fitness, and Muscle Strength.

    Science.gov (United States)

    Christensen, Jeanette Reffstrup; Kongstad, Malte Bue; Sjøgaard, Gisela; Søgaard, Karen

    2015-12-01

    The primary objective of this study was to assess the relationship between sickness presenteeism and body mass index (BMI), cardiorespiratory fitness (CRF), and maximal voluntary contraction (MVC). Female health care workers (n = 139) were analyzed cross-sectional as well as longitudinal after 3 and 12-month follow-up. Sickness presenteeism was assessed as a summed score using validated questions from three questionnaires: Health and Work Performance Questionnaire, Work Ability Index, and Quantity and Quality Method. CRF was assessed by a maximal cycling test and MVC from four muscle groups. Significant relationships were found between sickness presenteeism and BMI as well as MVC both cross-sectional and as changes over 3 months. Participants with BMI more than 30  kg/m had significantly higher sickness presenteeism than those with BMI less than 25  kg/m. This study suggests that actions that decrease BMI and increase MVC decrease the amount of sickness presenteeism.

  8. The significance of age and duration of effect in social evaluation of health care.

    Science.gov (United States)

    Nord, E; Street, A; Richardson, J; Kuhse, H; Singer, P

    1996-05-01

    To give priority to the young over the elderly has been labelled 'ageism'. People who express 'ageist' preferences may feel that, all else equal, an individual has greater right to enjoy additional life years the fewer life years he or she has already had. We shall refer to this as egalitarian ageism. They may also emphasise the greater expected duration of health benefits in young people that derives from their greater life expectancy. We may call this utilitarian ageism. Both these forms of ageism were observed in an empirical study of social preferences in Australia. The study lends some support to the assumptions in the QALY approach that duration of benefits and hence old age, should count in prioritising at the budget level in health care.

  9. Health Professionals' Knowledge of Women's Health Care.

    Science.gov (United States)

    Beatty, Rebecca M.

    2000-01-01

    Survey responses from 71 health professionals, benchmarking data from 8 hospitals, continuing education program evaluations, and focus groups with nursing, allied health, and primary care providers indicated a need for professional continuing education on women's health issues. Primary topic needs were identified. The data formed the basis for…

  10. Academic Health Centers and Health Care Reform.

    Science.gov (United States)

    Miles, Stephen H.; And Others

    1993-01-01

    A discussion of the role of academic health centers in health care reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…

  11. Immediate effects of reiki on heart rate variability, cortisol levels, and body temperature in health care professionals with burnout.

    Science.gov (United States)

    Díaz-Rodríguez, Lourdes; Arroyo-Morales, Manuel; Fernández-de-las-Peñas, Cesar; García-Lafuente, Francisca; García-Royo, Carmen; Tomás-Rojas, Inmaculada

    2011-10-01

    Burnout is a work-related mental health impairment comprising three dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. Reiki aims to help replenish and rebalance the body's energetic system, thus stimulating the healing process. The objective of this placebo-controlled, repeated measures, crossover, single-blind, randomized trial was to analyze the immediate effects of Reiki on heart rate variability (HRV), body temperature, and salivary flow rate and cortisol level in health care professionals with burnout syndrome (BS). Participants included 21 health care professionals with BS, who were asked to complete two visits to the laboratory with a 1-week interval between sessions. They were randomly assigned the order in which they would receive a Reiki session applied by an experienced therapist and a placebo treatment applied by a therapist with no knowledge of Reiki, who mimicked the Reiki treatment. Temperature, Holter ECG recordings (standard deviation of the normal-to-normal interval [SDNN], square root of mean squared differences of successive NN intervals [RMSSD], HRV index, low frequency component [LF], and high frequency component [HF]), salivary flow rate and cortisol levels were measured at baseline and postintervention by an assessor blinded to allocation group. SDNN and body temperature were significantly higher after the Reiki treatment than after the placebo. LF was significantly lower after the Reiki treatment. The decrease in the LF domain was associated with the increase in body temperature. These results suggest that Reiki has an effect on the parasympathetic nervous system when applied to health care professionals with BS.

  12. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    2012-05-01

    May 1, 2012 ... Results: The findings reveal different modes money was made available for payment for health services. On the whole, about 98% of payment was through out-of pocket spending (user-charges) with most respondents using their own money. Although this financing method shown to be associated with ...

  13. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    2Department of Community Health, University of Benin Teaching Hospital, Benin City, Edo State. 1. 2. 2. Awunor N.S , Omuemu V.O , Adam V.Y. ABSTRACT. Introduction. A nation's disease control effort is often as good as the surveillance and notification system put in place, which would help to generate the much needed ...

  14. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    living on each square inch of the phone. This study determined the prevalence of micro-organisms on the mobile phones of health workers and their role as a source of hospital acquired infection. The study utilised a cross-sectional design. A total of one hundred and eighty swabs were collected from the mobile phones of ...

  15. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    2011-10-07

    Oct 7, 2011 ... These factors include poor environmental and personal hygiene, poverty, malnutrition, unsafe water supply and ... The environment farmers live in, their standard of living and nutrition are very important to their health. ..... Globalization of food system: JOURNAL OF COMMUNITY MEDICINE AND PRIMARY ...

  16. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    instruments were pretested self-administered questionnaire and observational checklist. The data generated were analyzed using .... The observational checklist (OBL) was used to. Kwara State was carried from April to ..... supervision of health workers by middle cadre Central Zonal Office). Report on Routine immunization ...

  17. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Further studies on this subject are recommended. Employees' Assessment of Leadership in a Tertiary. Hospital in South-South Nigeria. Adeleye O. A, Aduh U. Department of Community Health, .... National Institute of Standards and Technology, (where it is trying to go in the future)”; “my senior were originally designed for ...

  18. Teens, technology, and health care.

    Science.gov (United States)

    Leanza, Francesco; Hauser, Diane

    2014-09-01

    Teens are avid users of new technologies and social media. Nearly 95% of US adolescents are online at least occasionally. Health care professionals and organizations that work with teens should identify online health information that is both accurate and teen friendly. Early studies indicate that some of the new health technology tools are acceptable to teens, particularly texting, computer-based psychosocial screening, and online interventions. Technology is being used to provide sexual health education, medication reminders for contraception, and information on locally available health care services. This article reviews early and emerging studies of technology use to promote teen health. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Effects of the State Children's Health Insurance Program on access to dental care and use of dental services.

    Science.gov (United States)

    Wang, Hua; Norton, Edward C; Rozier, R Gary

    2007-08-01

    To provide national estimates of implementation effects of the State Children's Health Insurance Program (SCHIP) on dental care access and use for low-income children. The 1997-2002 National Health Interview Survey. The study design is based on variation in the timing of SCHIP implementation across states and among children observed before and after implementation. Two analyses were conducted. The first estimated the total effect of SCHIP implementation on unmet need for dental care due to cost in the past year and dental services use for low-income children (family income below state SCHIP eligibility thresholds) using county and time fixed effects models. The second analysis estimated differences in dental care access and use among low-income children with SCHIP or Medicaid coverage and their uninsured counterparts, using instrumental variables methods to control for selection bias. Both analyses controlled for child and family characteristics. When SCHIP had been implemented for more than 1 year, the probability of unmet dental care needs for low-income children was lowered by 4 percentage points. Compared with their uninsured counterparts, those who had SCHIP or Medicaid coverage were less likely to report unmet dental need by 8 percentage points (standard error: 2.3), and more likely to have visited a dentist within 6 or 12 months by 17 (standard error: 3.7) and 23 (standard error: 3.6) percentage points, respectively. SCHIP program type had no differential effects. Consistent results from two analytical approaches provide evidence that SCHIP implementation significantly reduced financial barriers for dental care for low-income children in the U.S. Low-income children enrolled in SCHIP or Medicaid had substantially increased use of dental care than the uninsured.

  20. The effectiveness of interventions in workplace health promotion as to maintain the working capacity of health care personal.

    Science.gov (United States)

    Buchberger, Barbara; Heymann, Romy; Huppertz, Hendrik; Friepörtner, Katharina; Pomorin, Natalie; Wasem, Jürgen

    2011-01-01

    The increasing proportion of elderly people with respective care requirements and within the total population stands against aging personnel and staff reduction in the field of health care where employees are exposed to high load factors. Health promotion interventions may be a possibility to improve work situations and behavior. A systematic literature search is conducted in 32 databases limited to English and German publications since 1990. Moreover, internet-searches are performed and the reference lists of identified articles are scanned. The selection of literature was done by two reviewers independently according to inclusion and exclusion criteria. Data extraction and tables of evidence are verified by a second expert just like the assessment of risk of bias by means of the Cochrane Collaboration's tool. We identified eleven intervention studies and two systematic reviews. There were three randomized controlled trials (RCT) and one controlled trial without randomization (CCT) on the improvement of physical health, four RCT and two CCT on the improvement of psychological health and one RCT on both. Study duration ranged from four weeks to two years and the number of participants included from 20 to 345, with a median of 56. Interventions and populations were predominantly heterogeneous. In three studies intervention for the improvement of physical health resulted in less complaints and increased strength and flexibility with statistically significant differences between groups. Regarding psychological health interventions lead to significantly decreased intake of analgesics, better stress management, coping with workload, communication skills and advanced training. Taking into consideration the small to very small sample sizes, other methodological flaws like a high potential of bias and poor quality of reporting the validity of the results has to be considered as limited. Due to the heterogeneity of health interventions, study populations with differing job

  1. The effectiveness of interventions in workplace health promotion as to maintain the working capacity of health care personal

    Directory of Open Access Journals (Sweden)

    Buchberger, Barbara

    2011-01-01

    Full Text Available Background: The increasing proportion of elderly people with respective care requirements and within the total population stands against aging personnel and staff reduction in the field of health care where employees are exposed to high load factors. Health promotion interventions may be a possibility to improve work situations and behavior. Methods: A systematic literature search is conducted in 32 databases limited to English and German publications since 1990. Moreover, internet-searches are performed and the reference lists of identified articles are scanned. The selection of literature was done by two reviewers independently according to inclusion and exclusion criteria. Data extraction and tables of evidence are verified by a second expert just like the assessment of risk of bias by means of the Cochrane Collaboration’s tool. Results: We identified eleven intervention studies and two systematic reviews. There were three randomized controlled trials (RCT and one controlled trial without randomization (CCT on the improvement of physical health, four RCT and two CCT on the improvement of psychological health and one RCT on both. Study duration ranged from four weeks to two years and the number of participants included from 20 to 345, with a median of 56. Interventions and populations were predominantly heterogeneous. In three studies intervention for the improvement of physical health resulted in less complaints and increased strength and flexibility with statistically significant differences between groups. Regarding psychological health interventions lead to significantly decreased intake of analgesics, better stress management, coping with workload, communication skills and advanced training. Discussion: Taking into consideration the small to very small sample sizes, other methodological flaws like a high potential of bias and poor quality of reporting the validity of the results has to be considered as limited. Due to the heterogeneity

  2. Problems with health information technology and their effects on care delivery and patient outcomes: a systematic review.

    Science.gov (United States)

    Kim, Mi Ok; Coiera, Enrico; Magrabi, Farah

    2017-03-01

    To systematically review studies reporting problems with information technology (IT) in health care and their effects on care delivery and patient outcomes. We searched bibliographic databases including Scopus, PubMed, and Science Citation Index Expanded from January 2004 to December 2015 for studies reporting problems with IT and their effects. A framework called the information value chain, which connects technology use to final outcome, was used to assess how IT problems affect user interaction, information receipt, decision-making, care processes, and patient outcomes. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of the 34 studies identified, the majority ( n  = 14, 41%) were analyses of incidents reported from 6 countries. There were 7 descriptive studies, 9 ethnographic studies, and 4 case reports. The types of IT problems were similar to those described in earlier classifications of safety problems associated with health IT. The frequency, scale, and severity of IT problems were not adequately captured within these studies. Use errors and poor user interfaces interfered with the receipt of information and led to errors of commission when making decisions. Clinical errors involving medications were well characterized. Issues with system functionality, including poor user interfaces and fragmented displays, delayed care delivery. Issues with system access, system configuration, and software updates also delayed care. In 18 studies (53%), IT problems were linked to patient harm and death. Near-miss events were reported in 10 studies (29%). The research evidence describing problems with health IT remains largely qualitative, and many opportunities remain to systematically study and quantify risks and benefits with regard to patient safety. The information value chain, when used in conjunction with existing classifications for health IT safety problems, can enhance

  3. Digital signature technology for health care applications.

    Science.gov (United States)

    Wang, H A; Wang, Y Z; Wang, S

    2001-03-01

    The personal computer and the Internet have provided many useful services to both health care professionals and the general public. However, security remains a key factor that could limit their further growth potential. We reviewed and assessed the potential use of the cryptographic technique to resolve security issues. We also analyzed services available in the current market environment and determined their viability in supporting health care applications. While the cryptographic application has a great potential in protecting security of health care information transmitted over the Internet, a nationwide security infrastructure is needed to support deployment of the technology. Although desirable, it could be cost prohibitive to build a national system to be dedicated for the health care purpose. A hybrid approach that involves the government's development of a dedicated security infrastructure for health care providers and the use of commercial off-the-shelf products and services by the general public offers the most cost-effective and viable approach.

  4. Effect of fast and slow pranayama on perceived stress and cardiovascular parameters in young health-care students

    OpenAIRE

    Vivek Kumar Sharma; Madanmohan Trakroo; Velkumary Subramaniam; Rajajeyakumar, M.; Bhavanani, Anand B; Ajit Sahai

    2013-01-01

    Context: Perceived stress is higher for students in various healthcare courses. Previous studies have shown that pranayama practice is beneficial for combating stress and improve cardiovascular functions but both fast and slow pranayama practice produce different physiological responses. Aim: Present study was conducted to compare the effects of commonly practiced slow and fast pranayama on perceived stress and cardiovascular functions in young health-care students. Materials and Methods: Pre...

  5. Traveling technologies and transformations in health care

    DEFF Research Database (Denmark)

    Juul, Annegrete

    2010-01-01

    light, its chances of influencing those it would like bear down on is bound to be minimal. For a health care program to have an effect it must be able to travel or move between practices. Some health care programs successfully accomplish this task. They come to be widely adopted, apparently having...... global relevance, as for example the Chronic Disease Self-Management Program, which has been adopted by countries as diverse as Japan, Australia and Denmark. But how does this happen and which effects does traveling have on a health care program and its place of arrival? This question is the starting...

  6. Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.

    Science.gov (United States)

    Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J

    2011-04-23

    Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had

  7. Academic health centers and health care reform.

    Science.gov (United States)

    Miles, S H; Lurie, N; Fisher, E S; Haugen, D

    1993-09-01

    There is increasing support for the proposition that academic health centers have a duty to accept broad responsibility for the health of their communities. The Health of the Public program has proposed that centers become directly involved in the social-political process as advocates for reform of the health care system. Such engagement raises important issues about the roles and responsibilities of centers and their faculties. To address these issues, the authors draw upon the available literature and their experiences in recent health care reform efforts in Minnesota and Vermont in which academic health center faculty participated. The authors discuss (1) the problematic balance between academic objectivity and social advocacy that faculty must attempt when they engage in the health care reform process; (2) the management of the sometimes divergent interests of academic health centers, some of their faculty, and society (including giving faculty permission to engage in reform efforts and developing a tacit understanding that distinguishes faculty positions on reform issues from the center's position on such issues); and (3) the challenge for centers to develop infrastructure support for health reform activities. The authors maintain that academic health centers' participation in the process of health care reform helps them fulfill the trust of the public that they are obligated to and ultimately depend on.

  8. Transdisciplinarity in Health Care: A Concept Analysis.

    Science.gov (United States)

    Van Bewer, Vanessa

    2017-10-01

    To analyze the concept of transdisciplinarity and provide an enhanced definition of transdisciplinarity in health care. The term transdisciplinarity is increasingly prevalent in health care research and has been identified as important to improving the effectiveness and efficiency in health care. However, the term continues to be misappropriated and poorly understood by researchers and clinicians alike which hinders its potential use and impact. Walker and Avant's (2005) method of concept analysis was used as a framework for the study of the concept. The databases PubMed, CINAHL, Academic Search Premier, PsycInfo and ERIC were used searching the terms transdisciplinarity, transdisciplinary, interdisciplinary and interdisciplinarity. Transdisciplinarity in health care involves transcending of disciplinary boundaries, a sharing of knowledge, skills and decision-making, a focus on real-world problems and the inclusion of multiple stakeholders including patients, their families and their communities. An enhanced definition of transdisciplinarity in health care emerged from this concept analysis that may provide clarity and direction for health care providers. Nurses, and other health care providers, can look to this definition to understand transdisciplinary health care teams as opposed to multidisciplinary, and interdisciplinary ones. © 2017 Wiley Periodicals, Inc.

  9. Costs and expected gain in lifetime health from intensive care versus general ward care of 30,712 individual patients: a distribution-weighted cost-effectiveness analysis.

    Science.gov (United States)

    Lindemark, Frode; Haaland, Øystein A; Kvåle, Reidar; Flaatten, Hans; Norheim, Ole F; Johansson, Kjell A

    2017-08-21

    Clinicians, hospital managers, policy makers, and researchers are concerned about high costs, increased demand, and variation in priorities in the intensive care unit (ICU). The objectives of this modelling study are to describe the extra costs and expected health gains associated with admission to the ICU versus the general ward for 30,712 patients and the variation in cost-effectiveness estimates among subgroups and individuals, and to perform a distribution-weighted economic evaluation incorporating extra weighting to patients with high severity of disease. We used a decision-analytic model that estimates the incremental cost per quality-adjusted life year (QALY) gained (ICER) from ICU admission compared with general ward care using Norwegian registry data from 2008 to 2010. We assigned increasing weights to health gains for those with higher severity of disease, defined as less expected lifetime health if not admitted. The study has inherent uncertainty of findings because a randomized clinical trial comparing patients admitted or rejected to the ICU has never been performed. Uncertainty is explored in probabilistic sensitivity analysis. The mean cost-effectiveness of ICU admission versus ward care was €11,600/QALY, with 1.6 QALYs gained and an incremental cost of €18,700 per patient. The probability (p) of cost-effectiveness was 95% at a threshold of €22,000/QALY. The mean ICER for medical admissions was €10,700/QALY (p = 97%), €12,300/QALY (p = 93%) for admissions after acute surgery, and €14,700/QALY (p = 84%) after planned surgery. For individualized ICERs, there was a 50% probability that ICU admission was cost-effective for 85% of the patients at a threshold of €64,000/QALY, leaving 15% of the admissions not cost-effective. In the distributional evaluation, 8% of all patients had distribution-weighted ICERs (higher weights to gains for more severe conditions) above €64,000/QALY. High-severity admissions gained the most, and were more

  10. Health Protective Effects of Attachment Among African American Girls in Psychiatric Care

    OpenAIRE

    Emerson, Erin; Donenberg, Geri R.; Wilson, Helen W.

    2011-01-01

    African American (AA) girls in psychiatric care are at increased risk for HIV and STI infection through sexual risk taking. Adolescent sexual behavior often reflects peer norms and behavior. Secure attachment patterns with mothers and peers might lessen the effects of negative peer influences and reduce sexual risk taking among AA girls. This study examined the relationships among mother-daughter and peer attachment, peer norms, and sexual risk behaviors in African American girls seeking outp...

  11. A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD.

    Science.gov (United States)

    McDowell, Janet E; McClean, Sally; FitzGibbon, Francis; Tate, Stephen

    2015-03-01

    We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease (COPD). A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Ireland. Patients had at least two of: emergency department admissions, hospital admissions or emergency general practitioner (GP) contacts in the 12 months before the study. Exclusion criteria were patients who had any respiratory disorder other than COPD, or were cognitively unable to learn the process of monitoring. Patients were randomised to receive six months of home telemonitoring with usual care, or six months of usual care. The primary outcome measure was disease-specific quality of life, as measured by the St George's Respiratory Questionnaire for COPD patients (SGRQ-C). Of 100 patients completing the study, 48 patients were randomised to telemonitoring and 52 patients were randomised to the control group. The SGRQ-C scores improved significantly in the intervention group compared to usual care (P = 0.001). The HADS anxiety score was significantly higher in the telehealth group compared to the usual care group (P = 0.01). There were significantly more contacts with the Community Respiratory Team in the telemonitoring group compared to the control group (P = 0.029). There were no significant between group differences in EQ-5D scores, HADS depression scores, GP activity, emergency department visits, hospital admissions or exacerbations. The total cost to the health service of the intervention over the 6-month study period was £2039, giving an estimated ICER of £203,900. In selected patients with COPD, telemonitoring was effective in improving health-related quality of life and anxiety, but was not a cost-effective intervention. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. Traveling technologies and transformations in health care

    DEFF Research Database (Denmark)

    Juul, Annegrete

    2010-01-01

    global relevance, as for example the Chronic Disease Self-Management Program, which has been adopted by countries as diverse as Japan, Australia and Denmark. But how does this happen and which effects does traveling have on a health care program and its place of arrival? This question is the starting......Plenty of policies, politics and programs preoccupied with the health of the worker, the patient, the children, the old or society at large are being launched. The success of these programs is related to their geographical spread. If a health care program does not leave the desk where it first saw...... light, its chances of influencing those it would like bear down on is bound to be minimal. For a health care program to have an effect it must be able to travel or move between practices. Some health care programs successfully accomplish this task. They come to be widely adopted, apparently having...

  13. The health care information directive

    Directory of Open Access Journals (Sweden)

    Goel Vivek

    2001-04-01

    Full Text Available Abstract Background Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on technical solutions to protect the privacy of personal health information, there is very little research on ways to improve individuals power over their health information. This paper proposes a health care information directive, analogous to an advance directive, to facilitate choices regarding health information disclosure. Results and Discussion A health care information directive is described which creates a decision matrix that combines the ethical appropriateness of the use of personal health information with the sensitivity of the data. It creates a range of possibilities with in which individuals can choose to contribute health information with or without consent, or not to contribute information at all. Conclusion The health care information directive may increase individuals understanding of the uses of health information and increase their willingness to contribute certain kinds of health information. Further refinement and evaluation of the directive is required.

  14. The Effects of Organization Design and Patient Perceptions of Care on Switching Behavior and Reliance on a Health Care System Across Time.

    Science.gov (United States)

    Labonte, Alan J; Benzer, Justin K; Burgess, James F; Cramer, Irene E; Meterko, Mark; Pogoda, Terri K; Charns, Martin P

    2016-04-01

    Sustaining ongoing relationships with patients is a strategic, clinically relevant goal of health care systems. This study develops and tests a conceptual model that aims to account for the influence of organization design, perceptions of quality of patient care, and other patient-level factors on the extent to which patients sustain reliance on a health care system. We use a longitudinal survey design and structural equation modeling to predict increases or decreases in patient reliance on the Department of Veterans Affairs health care system across a 4-year period for Veterans with Parkinson's Disease. Our findings show that specialized and integrated clinical practices have a positive association with the quality of patient care. Health care systems may be able to foster long-term relations with patients and improve service quality by allocating resources to form integrated, specialized, disease-specific centers of care designed for patients with chronic illnesses. © The Author(s) 2016.

  15. Interactive effect of negative affectivity and anxiety sensitivity in terms of mental health among Latinos in primary care.

    Science.gov (United States)

    Zvolensky, Michael J; Paulus, Daniel J; Bakhshaie, Jafar; Garza, Monica; Ochoa-Perez, Melissa; Medvedeva, Angela; Bogiaizian, Daniel; Robles, Zuzuky; Manning, Kara; Schmidt, Norman B

    2016-09-30

    From a public health perspective, primary care medical settings represent a strategic location to address mental health disapirty among Latinos. Yet, there is little empirical work that addresses affective vulnerability processes for mental health problems in such settings. To help address this gap in knowledge, the present investigation examined an interactive model of negative affectivity (tendency to experience negative mood states) and anxiety sensitivity (fear of the negative consequences of aversive sensations) among a Latino sample in primary care in terms of a relatively wide range of anxiety/depression indices. Participants included 390 Latino adults (Mage=38.7, SD=11.3; 86.9% female; 95.6% reported Spanish as first language) from a primary care health clinic. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability. Consistent with prediction, the interaction between negative affectivity and anxiety sensitivity was significantly related to suicidal, social anxiety, and anxious arousal symptoms, as well as number of mood/anxiety diagnoses and disability among the primary care Latino sample. The form of the interactions indicated a synergistic effect, such that the greatest levels of each outcome were found among those with high negative affectivity and high anxiety sensitivity. There was a trending interaction for depressive symptoms. Overall, these data provide novel empirical evidence suggesting that there is a clinically-relevant interplay between anxiety sensitivity and negative affectivity in regard to the expression of anxiety and depressive symptoms among a Latino primary care sample. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Financing of Pediatric Home Health Care.

    Science.gov (United States)

    Simpser, Edwin; Hudak, Mark L

    2017-03-01

    Pediatric home health care is an effective and holistic venue of treatment of children with medical complexity or developmental disabilities who otherwise may experience frequent and/or prolonged hospitalizations or who may enter chronic institutional care. Demand for pediatric home health care is increasing while the provider base is eroding, primarily because of inadequate payment or restrictions on benefits. As a result, home care responsibilities assumed by family caregivers have increased and imposed financial, physical, and psychological burdens on the family. The Patient Protection and Affordable Care Act set forth 10 mandated essential health benefits. Home care should be considered as an integral component of the habilitative and rehabilitative services and devices benefit, even though it is not explicitly recognized as a specific category of service. Pediatric-specific home health care services should be defined clearly as components of pediatric services, the 10th essential benefit, and recognized by all payers. Payments for home health care services should be sufficient to maintain an adequate provider work force with the pediatric-specific expertise and skills to care for children with medical complexity or developmental disability. Furthermore, coordination of care among various providers and the necessary direct patient care from which these care coordination plans are developed should be required and enabled by adequate payment. The American Academy of Pediatrics advocates for high-quality care by calling for development of pediatric-specific home health regulations and the licensure and certification of pediatric home health providers. Copyright © 2017 by the American Academy of Pediatrics.

  17. Econometric analysis to evaluate the effect of community-based health insurance on reducing informal self-care in Burkina Faso.

    Science.gov (United States)

    Robyn, Paul Jacob; Hill, Allan; Liu, Yuanli; Souares, Aurélia; Savadogo, Germain; Sié, Ali; Sauerborn, Rainer

    2012-03-01

    This study examines the role of community-based health insurance (CBHI) in influencing health-seeking behaviour in Burkina Faso, West Africa. Community-based health insurance was introduced in Nouna district, Burkina Faso, in 2004 with the goal to improve access to contracted providers based at primary- and secondary-level facilities. The paper specifically examines the effect of CBHI enrolment on reducing the prevalence of seeking modern and traditional methods of self-treatment as the first choice in care among the insured population. Three stages of analysis were adopted to measure this effect. First, propensity score matching was used to minimize the observed baseline differences between the insured and uninsured populations. Second, through matching the average treatment effect on the treated, the effect of insurance enrolment on health-seeking behaviour was estimated. Finally, multinomial logistic regression was applied to model demand for available health care options, including no treatment, traditional self-treatment, modern self-treatment, traditional healers and facility-based care. For the first choice in care sought, there was no significant difference in the prevalence of self-treatment among the insured and uninsured populations, reaching over 55% for each group. When comparing the alternative option of no treatment, CBHI played no significant role in reducing the demand for self-care (either traditional or modern) or utilization of traditional healers, while it did significantly increase consumption of facility-based care. The average treatment effect on the treated was insignificant for traditional self-care, modern self-care and traditional healer, but was significant with a positive effect for use of facility care. While CBHI does have a positive impact on facility care utilization, its effect on reducing the prevalence of self-care is limited. The policy recommendations for improving the CBHI scheme's responsiveness to population health care

  18. Mothers Caring for an Adult Child with Schizophrenia: The Effects of Subjective Burden on Maternal Health.

    Science.gov (United States)

    Greenberg, Jan Steven; And Others

    1993-01-01

    Examined long-term effects that burdens associated with coping with mental illness have on parental health. Data from 81 mothers of adult children with schizophrenia revealed that subjective burdens associated with stigma and worries were related to lower levels of physical well-being among the mothers. (Author/NB)

  19. Independent effect of physical workload and childhood socioeconomic status on low back pain among health care workers in Denmark

    DEFF Research Database (Denmark)

    Jørgensen, Marie Birk; Nabe-Nielsen, Kirsten; Clausen, Thomas

    2013-01-01

    STUDY DESIGN: Prospective cohort study. OBJECTIVE: To investigate the independent effect of physical workload and childhood socioeconomic status (CSES) on low back pain (LBP) and LBP-related sickness absence among female health care workers. SUMMARY OF BACKGROUND DATA: The role of physical workload...... on LBP independently from CSES is still subject to controversy. METHODS: We used questionnaire data from 1661 female social and health care workers responding to a questionnaire in 2004, 2005, and 2006. We collected information on CSES (parental occupation), physical workload, and LBP-prevalence (no LBP......, subchronic LBP, and frequent LBP), and LBP-related sickness absence. The participants were categorized into 5 groups according to CSES (I = highest, V = lowest). Data were analyzed using logistic regression analysis. RESULTS: Irrespective of CSES, high physical workload increased the odds ratio (OR...

  20. Evaluating public relations effectiveness in a health care setting. The identification of communication assets and liabilities via a communication audit.

    Science.gov (United States)

    Henderson, Julie K

    2005-01-01

    The practice of public relations has experienced tremendous growth and evolution over the past 25 years, especially in the area of medical public relations. The constant changes in health care delivery have often led to increased need for communication with important publics. At the same time, practitioners in all fields of public relations have explored methods of accurately measuring the effectiveness of public relations programs. One such method of evaluation is the communication audit. This paper includes a brief overview of the communication audit concept followed by a case study based on an audit conducted for a small, multicultural non-profit health-care agency. Steps taken to conduct the audit and the methodology used are discussed. An analysis of the data is used to address two research questions regarding the efficacy of the Center's mission and vision. Suggestions for future audits are provided.

  1. & PRIMARY HEALTH CARE COMMUNITY MEDICINE

    African Journals Online (AJOL)

    health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity. Access to family planning also has the and mortality. It confers important health and potential to control population growth and in the development benefits to individuals, families, long run reduce green house gas emission ...

  2. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    activities in the health centres ( Table 2) The study showed that community health extension workers were responsible for ... development goals for mothers and children as distant as it was 40 years ago when primary health care strategy was adopted for ... Most of them were very experienced, 50% of. The study (Table II) ...

  3. Trastuzumab treatment of early stage breast cancer is cost-effective from the perspective of the Belgian health care authorities.

    Science.gov (United States)

    Van Vlaenderen, I; Canon, J L; Cocquyt, V; Jerusalem, G; Machiels, J P; Neven, P; Nechelput, M; Delabaye, I; Gyldmark, M; Annemans, L

    2009-01-01

    Trastuzumab (Herceptin, Roche) is a recombinant, humanized monoclonal antibody directed against the neu-HER2 protein, since May 2002 reimbursed in Belgium for the treatment of metastatic HER2+ breast cancer and since June 2007 also in adjuvant therapy of HER2+ early stage breast cancer. The purpose of this study was to estimate the cost-effectiveness from the Belgian health care payer perspective of reimbursing trastuzumab in the Latter indication. A Markov state transition model was designed to adequately capture the natural history and course of disease for early stage breast cancer patients, and to simulate cost and disease progression over a life time perspective. The model estimates differences in outcomes for patients treated with adjuvant trastuzumab during 1 year compared to current therapy, and captures cost consequences and health benefits of trastuzumab treatment. Health benefits were expressed in terms of quality-adjusted life years gained, and future benefits were discounted at 1.5%. Costs were calculated from the perspective of the Belgian authorities' health care budget, and future costs were discounted at 3%. Where relevant, the costs per Markov state were obtained from the IMS Hospital Disease database. Additionally, an expert opinion analysis on resource use during the follow-up of treated early breast cancer patients provided the cost estimates for states with minor or without hospital costs. The incremental cost-effectiveness ratio based on a life time simulation was estimated at Euro 10,315 per quality-adjusted life year gained. It can be concluded that trastuzumab treatment of HER2+ early stage breast cancer patients is cost-effective from the perspective of the Belgian health care authorities.

  4. Conscientious objection in health care

    Directory of Open Access Journals (Sweden)

    Kuře Josef

    2016-12-01

    Full Text Available The paper deals with conscientious objection in health care, addressing the problems of scope, verification and limitation of such refusal, paying attention to ideological agendas hidden behind the right of conscience where the claimed refusal can cause harm or where such a claim is an attempt to impose certain moral values on society or an excuse for not providing health care. The nature of conscientious objection will be investigated and an ethical analysis of conscientious objection will be conducted. Finally some suggestions for health care policy will be proposed.

  5. Home Health Care Agencies

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of all Home Health Agencies that have been registered with Medicare. The list includes addresses, phone numbers, and quality measure ratings for each agency.

  6. Calling For Diversity In Health Care Executive Suites And Evaluation Of Effects On Efficiency Using Data Envelopment Analysis

    OpenAIRE

    Jocelyn L. Steward; Philip F. Musa; Geoff Willis; Shahid Ali

    2011-01-01

    Adequate diversity in the leadership of health care organizations is a problem that potentially affects overall performance.  In this paper, we propose the application of data envelopment analysis (DEA) and strategic human information systems to determine how diversity affects the efficiency, stability, and long-term viability of health care organizations at the organization level.  Data envelopment analysis could also be applied within a given health care organization to examine how the orga...

  7. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    Significant distress, deterioration into major illness, loss of productivity at work, personal disability and premature death resulting from suicide are recognized consequences of mental morbidity especially when it is not. 12 detected and treated early The damaging effect of stigma relating to mental illness in the community ...

  8. Health care agents

    Science.gov (United States)

    ... Sloane PD, Warshaw GA, et al, eds. Ham's Primary Care Geriatrics: A Case-Based Approach . 6th ed. ... Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, ...

  9. Adherence and health care costs

    Directory of Open Access Journals (Sweden)

    Iuga AO

    2014-02-01

    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  10. Health-protective effects of attachment among African American girls in psychiatric care.

    Science.gov (United States)

    Emerson, Erin; Donenberg, Geri R; Wilson, Helen W

    2012-02-01

    African American girls in psychiatric care are at increased risk for HIV and sexually transmitted infection (STI) through sexual risk taking. Adolescent sexual behavior often reflects peer norms and behavior. Secure attachment patterns with mothers and peers might lessen the effects of negative peer influences and reduce sexual risk taking among African American girls. This study examined the relationships among mother-daughter and peer attachment, peer norms, and sexual-risk behaviors in African American girls seeking outpatient psychiatric care. A group of 12-16-year-old African American girls (N = 262; M age = 14.45 years) reported on their attachment to their mothers and peers, peer risk-taking and dating behaviors, peer pressure, and sexual-risk behaviors (e.g., number of partners, high-risk partners, and condom use). Structural equation modeling examined whether peer attachment and peer norms mediated the relationship between mother attachment and sexual risk. Findings supported peer norms, but not peer attachment, as a mediator of mother attachment and girls' sexual-risk behaviors. Findings revealed important family and peer factors for African American girls in psychiatric care. HIV prevention programs may be strengthened by improving mother-daughter relationships, addressing the importance of peer relationships, and emphasizing how secure mother-daughter relationships can temper the impact of peer norms.

  11. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold.

    Science.gov (United States)

    Claxton, Karl; Martin, Steve; Soares, Marta; Rice, Nigel; Spackman, Eldon; Hinde, Sebastian; Devlin, Nancy; Smith, Peter C; Sculpher, Mark

    2015-02-01

    Cost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement. There are no empirical estimates of the cost-effectiveness threshold used by the National Institute for Health and Care Excellence. (1) To provide a conceptual framework to define the cost-effectiveness threshold and to provide the basis for its empirical estimation. (2) Using programme budgeting data for the English NHS, to estimate the relationship between changes in overall NHS expenditure and changes in mortality. (3) To extend this mortality measure of the health effects of a change in expenditure to life-years and to QALYs by estimating the quality-of-life (QoL) associated with effects on years of life and the additional direct impact on QoL itself. (4) To present the best estimate of the cost-effectiveness threshold for policy purposes. Earlier econometric analysis estimated the relationship between differences in primary care trust (PCT) spending, across programme budget categories (PBCs), and associated disease-specific mortality. This research is extended in several ways including estimating the impact of marginal increases or decreases in overall NHS expenditure on spending in each of the 23 PBCs. Further stages of work link the econometrics to broader health effects in terms of QALYs. The most relevant 'central' threshold is estimated to be £12,936 per QALY (2008 expenditure, 2008-10 mortality). Uncertainty analysis indicates that the probability that the threshold is estimate is, if anything, likely to be an

  12. Vertical Integration Spurs American Health Care Revolution.

    Science.gov (United States)

    Phillips, Richard C.

    1986-01-01

    Under new "managed health care systems," the classical functional separation of risk taker, claims payor, and provider are vertically integrated into a common entity. This evolution should produce a competitive environment with medical care rendered to all Americans on a more cost-effective basis. (CJH)

  13. [Renewing primary health care in the Americas].

    Science.gov (United States)

    Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa

    2007-01-01

    At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.

  14. Challenges towards Realization of Health Care Sector Goals of ...

    African Journals Online (AJOL)

    Background: Human resource for health (HRH) is an essential building block for effective and efficient health care system. In Tanzania this component is faced by many challenges which in synergy with others make the health care system inefficient. In vision 2025 the country recognizes the importance of the health care ...

  15. Ideology drives health care reforms in Chile.

    Science.gov (United States)

    Reichard, S

    1996-01-01

    The health care system of Chile evolved from rather unique historical circumstances to become one of the most progressive in Latin America, offering universal access to all citizens. Since the advent of the Pinochet regime in 1973, Chile has implemented Thatcherite/Reaganite reforms resulting in the privatization of much of the health care system. In the process, state support for health care has been sharply curtailed with deleterious effects on health services. As Chile emerges from the shadow of the Pinochet dictatorship, it faces numerous challenges as it struggles to rebuild its health care system. Other developing nations considering free-market reforms may wish to consider the high costs of the Chilean experiment.

  16. Poverty and health care demand in Kenya.

    Science.gov (United States)

    Awiti, Japheth Osotsi

    2014-11-22

    There is a wide range of actions an individual could take when sick or injured such as self-care, consulting a traditional healer, or seeking treatment from a private or public health care facility. The specific action taken is influenced by individual characteristics, provider characteristics, societal factors, and geographical factors. A key individual characteristic is the ability to afford the required health care. The study examines the effect of poverty on an individual's choice of a health care provider in the event of sickness or injury in Kenya. Using data from the Kenya Integrated Household and Budget Survey carried out between 2005 and 2006, we estimate a multinomial probit model that links an individual's poverty status to the individual's health care provider choice. The choices are classified as none, non-modern, and modern. The model is estimated for four age groups: infants, children aged 1 to 5 years, children aged 6 to 14 years, and adults. We control for the potential endogeneity of poverty status. Our results indicate that for all age groups, the predictors of poverty include large household sizes and longer distances to the nearest health facility. We further find that poverty reduces the probability of visiting a modern health care provider amongst all age groups. Poverty has a negative effect on the individual's demand for modern health care services, holding other factors constant. To encourage the use of modern health care facilities, therefore, requires the pursuit of poverty-reduction strategies. Some of the ways this could be done include lowering the household sizes and reducing the average distance to modern health care facilities.

  17. Change management in health care.

    Science.gov (United States)

    Campbell, Robert James

    2008-01-01

    This article introduces health care managers to the theories and philosophies of John Kotter and William Bridges, 2 leaders in the evolving field of change management. For Kotter, change has both an emotional and situational component, and methods for managing each are expressed in his 8-step model (developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short-term wins, don't let up, and making it stick). Bridges deals with change at a more granular, individual level, suggesting that change within a health care organization means that individuals must transition from one identity to a new identity when they are involved in a process of change. According to Bridges, transitions occur in 3 steps: endings, the neutral zone, and beginnings. The major steps and important concepts within the models of each are addressed, and examples are provided to demonstrate how health care managers can actualize the models within their health care organizations.

  18. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. INTRODUCTION disability from complications of pregnancy and. 1 child birth. MI in birth preparedness is. Birth preparedness by a couple ensures that indispensible in rural communities where patriarchy appropriate care ...

  19. Health care technology in Sweden

    NARCIS (Netherlands)

    Jonsson, E.; Banta, H.D.

    1994-01-01

    Health care in Sweden is a public sector responsibility and equity in access to care is quite important. The Swedish system is organized into several levels, with the Federation of County Councils at the top, and with regional, county, and local levels. In theory, the four hospital tiers developed

  20. "Cloud" health-care workers.

    OpenAIRE

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

    2001-01-01

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

  1. [Corruption and health care system].

    Science.gov (United States)

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.

  2. Effectiveness of home health care service for elders after spinal surgery.

    Science.gov (United States)

    Jun, Myunghee; Jung, Ji Young

    2012-12-01

    This study was done to evaluate effectiveness of home healthcare services (HHCS) specialized for elders who received spinal surgeries. A non-equivalent control group pre-post test quasi-experimental study was performed. HHCS was developed based on the Rice model of dynamic self-determination for self-care. For data collection, a control group (n=23) and an experimental group (n=23) were selected by matching age, BMI, pain, general characteristics and type of spine surgery. Measurement tools to evaluate uncertainty and knowledge were developed by the authors. The Numeric Rating Scale (NRS) and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were used to evaluate pain levels. Muscular strength in the legs was measured using a digital muscle tester and tape ruler. Questionnaires were used to evaluate disability in performing ADL and psychological distress levels. The experimental group showed significant decrease in uncertainty (p=.028), increased knowledge (p=.038), and partially decreased pain (p=.003-.331). Partial muscle strength increased significantly (p=.021-.644). Disability in performing ADL and psychological distress in the experimental group decreased significantly compared to control group (p=.002, p=.004). Results indicate HHCS is an efficient home care nursing program for these elders. Further experimental studies with larger samples are required to confirm effects of HHCS.

  3. The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Free, Caroline; Phillips, Gemma; Watson, Louise; Galli, Leandro; Felix, Lambert; Edwards, Phil; Patel, Vikram; Haines, Andy

    2013-01-01

    Background Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. Methods and Findings We searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990–Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05–1.07, I 2 = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89–1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94–1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature. Conclusions The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold

  4. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis.

    Science.gov (United States)

    Free, Caroline; Phillips, Gemma; Watson, Louise; Galli, Leandro; Felix, Lambert; Edwards, Phil; Patel, Vikram; Haines, Andy

    2013-01-01

    Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. We searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05-1.07, I(2) = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89-1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94-1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature. The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. SMS appointment reminders have modest

  5. Improving educational preparation for transcultural health care.

    Science.gov (United States)

    Le Var, R M

    1998-10-01

    There is increasing evidence that the health care needs of people from black and ethnic minority groups in England are not being met. A growing number of initiatives are being undertaken to remedy the situation. Many of them are focused on health care delivery at local and national levels. However, unless the preparation of health care professionals in the area of multi-cultural health care is appropriate and effective, a great deal of corrective action will continue to have to be taken. Despite 1997 having been the European Year Against Racism, it is still necessary to consider what educational preparation should be like. The article draws on identified inadequacies in health care provision as well as examples of initiatives taken to improve care provision. The author identifies deficiencies in educational preparation and proposes a range of actions to be taken. The article is focused on nursing, midwifery and health visiting education in England, but is deemed to be relevant to all health care professionals not only in Europe but other continents, as they become increasingly international and multi-ethnic.

  6. Latex allergy in health care

    Directory of Open Access Journals (Sweden)

    Tina Virtič

    2012-11-01

    Full Text Available The increasing use of natural rubber latex medical gloves in the last three decades has caused an increase in latex allergy. The majority of risk groups for allergy development include health care workers, workers in the rubber industry, atopic individuals and children with congenital malformations. Three types of pathological reactions can occur in people using latex medical gloves: irritant contact dermatitis, allergic contact dermatitis and immediate hypersensitivity. The latex allergy is caused by constituent components of latex gloves and added powders; there are also numerous latex allergens involved in cross-reactivity between latex and fruits and vegetables, the so-called latex-fruit syndrome. The diagnosis is based on an accurate history of exposure, clinical presentation and confirmatory in vivo and in vitro tests. Prevention is the easiest, most effective and least expensive way to avoid latex allergy. Powder-free latex gloves with reduced levels of proteins and chemicals, and synthetic gloves for allergic workers must be provided in the work environment. There are already many health care institutions around the world where all latex products have been replaced by synthetic material products.

  7. Clinical Effectiveness of Integrating Depression Care Management into Medicare Home Health: The Depression CAREPATH Cluster-Randomized Trial

    Science.gov (United States)

    Bruce, Martha L.; Raue, Patrick J.; Reilly, Catherine F.; Greenberg, Rebecca L.; Meyers, Barnett S.; Banerjee, Samprit; Pickett, Yolonda R.; Sheeran, Thomas F.; Ghesquiere, Angela; Zukowski, Diane; Rosas, Vianca H.; McLaughlin, Jeanne; Pledger, Lori; Doyle, Joan; Joachim, Pamela; Leon, Andrew C.

    2015-01-01

    Importance Depression is highly prevalent, inadequately treated, and contributes to hospitalization and other poor outcomes in older home healthcare patients. Feasible and effective interventions are needed to reduce this burden of depression. Objective To determine whether among older Medicare home health recipients who screen positive for depression, patients of nurses randomized to intervention have greater improvement in depressive symptoms over one year compared to patients receiving enhanced usual care. Design The cluster-randomized effectiveness trial randomized nurse-teams to Intervention (12 teams) or enhanced usual care (9 teams). Patients were recruited 2009–2012, assessed, and followed at 3, 6, and 12-months by research staff blind to intervention status. Setting Conducted at six home healthcare agencies nationwide. Patients interviewed at home and by telephone. Participants Medicare home health patients age ≥65 who screened positive for depression on routine nurse assessments. Of 502 eligible patients, 306 enrolled. Intervention Depression CAREPATH (CARE for PATients at Home) requires nurses to manage depression during routine home visits by weekly symptom assessment, medication management, care coordination, education, goal setting. Training totaled 7 hours (4 on-site, 3 web). Researchers telephoned supervisors every other week. Main Outcome and Measure Depression severity, assessed by 24-item Hamilton Depression Rating Scale (HDRS). Results 306 participants were predominately female (69.6%), diverse (18.0% Black, 16.0% Hispanic), average age 76.5 (SD=8.0) years. In full sample, the intervention had no effect (treatment × time interaction: P=0.13). Adjusted HDRS scores (CAREPATH vs control) did not differ at three (10.5 vs 11.4; P=0.26) or six months (9.3 vs 10.5; P=0.12), barely reaching significance at twelve months (8.7 vs 10.6; P=0.05). In subsample with mild depression (HDRS<10), the intervention had no effect (P=.90) and HDRS did not differ

  8. Delivering Health Care and Mental Health Care Services to Children in Family Foster Care after Welfare and Health Care Reform.

    Science.gov (United States)

    Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.

    1999-01-01

    Describes the essential features of a health care system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and health care reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)

  9. Respiratory Home Health Care

    Science.gov (United States)

    ... Control Preventing infections can help the respiratory home care patient stay as healthy as possible. Hand-washing is the single most important thing for patients and caregivers to perform on a routine basis. Use a liquid soap and lots of warm running water. Work up a good lather and scrub for at ...

  10. Health care entrepreneurship: financing innovation.

    Science.gov (United States)

    Grazier, Kyle L; Metzler, Bridget

    2006-01-01

    Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.

  11. Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes.

    Science.gov (United States)

    Arditi, Chantal; Rège-Walther, Myriam; Wyatt, Jeremy C; Durieux, Pierre; Burnand, Bernard

    2012-12-12

    Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting the doctor to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. To evaluate the effects of reminders automatically generated through a computerized system and delivered on paper to healthcare professionals on processes of care (related to healthcare professionals' practice) and outcomes of care (related to patients' health condition). For this update the EPOC Trials Search Co-ordinator searched the following databases between June 11-19, 2012: The Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Library (Economics, Methods, and Health Technology Assessment sections), Issue 6, 2012; MEDLINE, OVID (1946- ), Daily Update, and In-process; EMBASE, Ovid (1947- ); CINAHL, EbscoHost (1980- ); EPOC Specialised Register, Reference Manager, and INSPEC, Engineering Village. The authors reviewed reference lists of related reviews and studies.  We included individual or cluster-randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals on processes and/or outcomes of care. Review authors working in pairs independently screened studies for eligibility and abstracted data. We contacted authors to obtain important missing information for studies that were published within the last 10 years. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median absolute improvement and interquartile range (IQR) in process adherence across included studies using the primary

  12. EFFECT OF INDIVIDUAL AND COMMUNITY FACTORS ON MATERNAL HEALTH CARE SERVICE USE IN INDIA: A MULTILEVEL APPROACH.

    Science.gov (United States)

    Yadav, Awdhesh; Kesarwani, Ranjana

    2016-01-01

    This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005-06). The study sample constituted ever-married women aged 15-49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.

  13. Efficiency and competition in the Dutch non-life insurance industry: Effects of the 2006 health care reform

    NARCIS (Netherlands)

    Bikker, Jaap; Popescu, Adelina

    This paper investigates the cost efficiency and competitive behaviour of the non-life – or property and casualty – insurance market in the Netherlands over the period 1995-2012. We focus on the 2006 health care reform, where public health care insurance has been included in the non-life insurance

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

    Science.gov (United States)

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

    2008-01-01

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

  15. Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994-2013.

    Directory of Open Access Journals (Sweden)

    Kayvan Bozorgmehr

    Full Text Available Access to health care for asylum-seekers and refugees (AS&R in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a restricted access; and (b two major policy reforms (1997, 2007 on incident health expenditures for AS&R in 1994-2013.We used annual, nation-wide, aggregate data of the German Federal Statistics Office (1994-2013 to compare incident health expenditures among AS&R with restricted access (exposed to AS&R with regular access (unexposed. We calculated incidence rate differences (∆IRt and rate ratios (IRRt, as well as attributable fractions among the exposed (AFe and the total population (AFp. The effects of between-group differences in need, and of policy reforms, on differences in per capita expenditures were assessed in (segmented linear regression models. The exposed and unexposed groups comprised 4.16 and 1.53 million person-years. Per capita expenditures (1994-2013 were higher in the group with restricted access in absolute (∆IRt = 375.80 Euros [375.77; 375.89] and relative terms (IRR = 1.39. The AFe was 28.07% and the AFp 22.21%. Between-group differences in mean age and in the type of accommodation were the main independent predictors of between-group expenditure differences. Need variables explained 50-75% of the variation in between-group differences over time. The 1997 policy reform significantly increased ∆IRt adjusted for secular trends and between-group differences in age (by 600.0 Euros [212.6; 986.2] and sex (by 867.0 Euros [390.9; 1342.5]. The 2007 policy reform had no such effect.The cost of excluding AS&R from health care appears ultimately higher than granting regular access to care. Excess expenditures attributable to the restriction were substantial and could not be completely explained by differences in need. An evidence-informed discourse on access to health care for AS&R in Germany is needed; it

  16. Health Care Team

    Science.gov (United States)

    ... in medical offices or in the dialysis unit. Nephrology Nurse Nephrology nurses are licensed, registered nurses who ... nutritional intake to ensure the patient's optimal health. Nephrology Social Worker Most nephrology social workers have a ...

  17. Agents of Change for Health Care Reform

    Science.gov (United States)

    Buchanan, Larry M.

    2007-01-01

    It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…

  18. Mental Health Care: Who's Who

    Science.gov (United States)

    ... Living Listen Español Text Size Email Print Share Mental Health Care: Who's Who Page Content Article Body Psychiatrist: ... degree in psychology, counseling or a related field. Mental Health Counselor: Master’s degree and several years of supervised ...

  19. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    the children didnot receive BCG vaccine while spiritual homes was the pattern in 6.9 households. 22.9% did not receive measles vaccine. A total of 63 under-five deaths were reported in 53. Table VI shows the health-seeking behaviour of. 6. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL.

  20. Babesiosis for Health Care Providers

    Centers for Disease Control (CDC) Podcasts

    2012-04-25

    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.

  1. Cautious Citizenship: The Deterring Effect of Immigration Issue Salience on Health Care Use and Bureaucratic Interactions among Latino US Citizens.

    Science.gov (United States)

    Pedraza, Franciso I; Nichols, Vanessa Cruz; LeBrón, Alana M W

    2017-10-01

    Research shows that health care use among Latino immigrants is adversely affected by restrictive immigration policy. A core concern is that immigrants shy away from sharing personal information in response to policies that expand bureaucratic monitoring of citizenship status across service-providing organizations. This investigation addresses the concern that immigration politics also negatively influences health care utilization among Latino US citizens. One implication is that health insurance expansions may not reduce health care inequities among Latinos due to concern about exposure to immigration law enforcement authorities. Using data from the 2015 Latino National Health and Immigration Survey, we examine the extent to which the politics of immigration deters individuals from going to health care providers and service-providing institutions. Results indicate that Latino US citizens are less likely to make an appointment to see a health care provider when the issue of immigration is mentioned. Additionally, Latino US citizens who know someone who has been deported are more inclined to perceive that information shared with health care providers is not secure. We discuss how cautious citizenship, or risk-avoidance behaviors toward public institutions in order to avoid scrutiny of citizenship status, informs debates about reducing health care inequities. Copyright © 2017 by Duke University Press.

  2. delivering equitable health care in Malawi

    African Journals Online (AJOL)

    poor logistical support of services. Individuals may be discour- aged from seekinc medical care due to misdiagnosis, delays in receiving treatment and interaction with health providers“. This is clearly an inequitable situation with the majority of the popu- lation being unable to access effective health services. Inadequate ...

  3. Independent effects of socioeconomic and psychological social determinants of health on self-care and outcomes in Type 2 diabetes.

    Science.gov (United States)

    Walker, Rebekah J; Gebregziabher, Mulugeta; Martin-Harris, Bonnie; Egede, Leonard E

    2014-01-01

    The purpose of this study was to investigate the independent effects of socioeconomic and psychological social determinants of health on diabetes knowledge, self-care, diabetes outcomes and quality of life. Cross-sectional sample of 615 adults from two adult primary care clinics in the southeastern United States. Primary outcome variables were diabetes knowledge, self-care behaviors (diet, exercise, medication adherence, blood sugar testing, foot care) and diabetes outcomes (HbA1c, low-density lipoprotein, blood pressure, physical component summary score of SF12 quality of life, mental component summary score of SF12 quality of life). Covariates included age, sex, race/ethnicity, marital status, health literacy and comorbidity. Linear regression models were used to assess independent associations controlling for covariates. In final adjusted models, significant associations for HbA1c included education [β = -0.72, 95% confidence interval (CI): -1.36 to -0.08], income (β = -0.66, CI: -1.30 to -0.16), self-efficacy (β = -0.12, CI: -0.15 to -0.08) and diabetes distress (β = 0.43, CI: 0.14 to 0.72). Significant associations for self-care included medication adherence with diabetes distress (β = -0.58, CI: -0.91 to -0.25) and perceived stress (β = -0.12, CI: -0.18 to -0.05) and exercise with depression (β = -0.06, CI: -0.10 to -0.01) and self-efficacy (β = 0.06, CI: 0.01 to 0.10). Significant associations for quality of life included depression (β = -0.08, CI: -0.12 to -0.03), serious psychological distress (β = -0.09, CI: -0.12 to -0.05), social support (β = 0.01, CI: 0.001 to 0.02) and perceived stress (β = -0.12, CI: -0.19 to -0.06). Social determinants of health were significantly associated with diabetes self-care and outcomes with socioeconomic factors being most often associated with diabetes outcomes and psychological factors, specifically self-efficacy and perceived stress being most often associated with self-care and quality of life. Copyright

  4. Health promotion innovation in primary health care

    Directory of Open Access Journals (Sweden)

    Alexandra McManus

    2013-01-01

    Full Text Available Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.

  5. Health promotion innovation in primary health care.

    Science.gov (United States)

    McManus, Alexandra

    2013-01-01

    Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.

  6. Effect of the health extension program and other accessibility factors on care-seeking behaviors for common childhood illnesses in rural Ethiopia.

    Science.gov (United States)

    Ashenafi, Addis; Karim, Ali Mehryar; Ameha, Agazi; Erbo, Amano; Getachew, Nebiyu; Betemariam, Wuleta

    2014-10-01

    In January 2011, Health Extension Workers (HEWs) of Ethiopia's Health Extension Program (HEP) began providing pneumonia case management for children less than five years of age through the integrated Community Case Management (iCCM) strategy. To report the effect of HEP, following the introduction of iCCM, and other accessibility factors on care-seeking behaviors for common childhood illnesses (acute respiratory infection [ARI], diarrhea, and fever). Three possible care-seeking outcomes for childhood illnesses were considered: not seeking appropriate care, seeking care from HEP sources, or seeking care from other appropriate sources. The baseline care-seeking outcomes from the Ethiopian Demographic and Health Survey, 2011, were compared with the care-seeking outcomes in a follow-up iCCM survey in December 2012. The effects of the HEP intensity and other factors on care-seeking outcomes were estimated using regression analyses. Appropriate care-seeking for children with acute respiratory infection, ARI, diarrhea, or fever increased two-fold, from 19% at baseline to 38% at follow-up, mainly due to an increase in seeking care for common child- hood illnesses from HEWs. Higher intensity of the HEP and other accessibility factors were associated with higher care-seeking for childhood illnesses from HEP sources. Incorporating iCCM within the HEP service package significantly improved the appropriate care-seeking behaviors for childhood illnesses in rural Ethiopia.

  7. Leadership research in business and health care.

    Science.gov (United States)

    Vance, Connie; Larson, Elaine

    2002-01-01

    To summarize research on leadership in the health care and business literature and to identify the outcomes of leadership on individuals, groups, and organizations. A computerized search and review of research studies was conducted in the health care and business literature from 1970-1999. Studies were categorized and analyzed according to participants, design, primary topic area, and effects or outcomes of leadership. Most of the health care and business literature on leadership consisted of anecdotal or theoretical discussion. Only 4.4% (n = 290) of 6,628 articles reviewed were data-based. Further, the largest proportion of the research (120/290, 41.4%) was purely descriptive of the demographic characteristics or personality traits of leaders. Other studies showed the influence of leadership on subordinates (27.9%). Only 15 (5.2%) of 290 research articles include correlations of qualities or styles of leadership with measurable outcomes on the recipients of services or positive changes in organizations. Research on leadership in the health care and business literature to date has been primarily descriptive. Although work in the social sciences indicates that leadership styles can have a major influence on performance and outcomes, minimal transfer of this work to the health care system is evident. Limited research on leadership and health care outcomes exists, such as changes in patient care or improvements in organizational outputs. In this era of evidence-based practice, such research, although difficult to conduct, is urgently needed.

  8. Effect of slow rhythmic voluntary breathing pattern on isometric handgrip among health care students

    Directory of Open Access Journals (Sweden)

    Rajajeyakumar M, Janitha A, Madanmohan, Balachander J

    2014-11-01

    Full Text Available Introduction: Hand grip strength is a widely used test in experimental and epidemiologicalstudies. The measure of hand grip strength is influenced by several factors, including age; gender; different angle of the shoulder, elbow, forearm, and wrist; and posture.So we planned to study theeffect of slow voluntary breathing exercise (Savitri Pranayam onthe various strengths of isometric hand grip (IHG amongyoung health care students.Methods: The present study was conducted on 60 volunteers 17-20 yrs.The subjects were randomly assigned to Pranayam and control groups. They were divided into two groups: control (n=30, Savitri (n=30 Savitri group were practiced slow yogic breathing for three months, Paired’ test was done to compare the values within group and unpaired’ test was done to compare the values between male and female subjects.Results: In Savitri Pranayam group, the blood pressure responses to IHG were higher in males, as compared to females.The rate pressure product (RPP also decreased during IHG 60%. A decrease in SBP and DBP was observed at the end of the study period. Briefly, a gender difference in various parameters such as MAP, QTc existed in the control group at the beginning of the study and the differences persisted at the end of three months.Conclusion: Our study reported that slow Pranayam are known to enhance parasympathetic tone, produce a highly significant decrease in oxygen consumption and psychosomatic relaxation.

  9. Value added telecommunication services for health care.

    Science.gov (United States)

    Danelli-Mylonas, Vassiliki

    2003-01-01

    The successful implementation and operation of health care networks and the efficient and effective provision of health care services is dependent upon a number of different factors: Telecommunications infrastructure and technology, medical applications and services, user acceptance, education and training, product and applications/services development and service provision aspects. The business model and market development regarding policy and legal issues also must be considered in the development and deployment of telemedicine services to become an everyday practice. This chapter presents the initiatives, role and contribution of the Greek Telecommunications Company in the health care services area and also refers to specific case-studies focusing upon the key factors and issues of applications related to the telecommunications, informatics, and health care sectors, which can also be the drivers to create opportunities for Citizens, Society and the Industry.

  10. Starting a health care system green team.

    Science.gov (United States)

    Mejia, Elisa A; Sattler, Barbara

    2009-07-01

    The health care industry is often overlooked as a major source of industrial pollution, but as this becomes more recognized, many health care facilities are beginning to pursue green efforts. The OR is a prime example of an area of health care that is working to lessen its environmental impact. Nurses can play key roles in identifying areas of waste and presenting ideas about recovering secondary materials. For instance, although infection prevention measures encourage one-time use of some products, nurses can investigate how to reprocess these items so they can be reused. This article examines how the efforts of a Green Team can affect a hospital's waste stream. A health care Green Team can facilitate a medical facility's quest for knowledge and awareness of its effect on the waste stream and environment.

  11. Rural migration and health care

    DEFF Research Database (Denmark)

    Svendsen, Gunnar Lind Haase; Jensen, Marit Vatn

    This literature study focuses on possible links between access to health services and migration in rural areas. Why do people move to or from rural areas or why do they stay? What determines where people settle? And, in this context, do local health care services play an important or minor role......, or no role at all? First, the paper reports on key findings from rural migration studies, in order to shed light on two migration trends: urbanization and counter-urbanization. Then we take a closer look on settlement preferences in rural areas, including the impact of health care facilities. Finally, we end...

  12. Linking quality of care and training costs: cost-effectiveness in health professions education.

    Science.gov (United States)

    Tolsgaard, Martin G; Tabor, Ann; Madsen, Mette E; Wulff, Camilla B; Dyre, Liv; Ringsted, Charlotte; Nørgaard, Lone N

    2015-12-01

    To provide a model for conducting cost-effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as compared with obstetricians. The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost-effectiveness ratio (ICER) and (iv) estimating cost-effectiveness probability for different willingness to pay (WTP) values. To provide a model example, we conducted a randomised cost-effectiveness trial. Midwives were randomised to CLM training (midwife-performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention-group participants underwent simulation-based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre-term labour. Outcomes for women managed by intervention and control-group participants were compared. These data were then used for the remaining steps of the cost-effectiveness model. Intervention-group participants needed a mean 268.2 (95% confidence interval [CI], 140.2-392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4-10.3) supervised scans to attain proficiency. Women who were scanned by intervention-group participants had significantly reduced waiting time compared with those managed by the control group (n = 65; mean difference, 36.6 [95% CI 7.3-65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute(-1) . For WTP values less than EUR 0.26 minute(-1) , obstetrician-performed CLM was the most cost-effective strategy, whereas midwife-performed CLM was cost-effective for WTP values above EUR 0.73 minute(-1) . Cost-effectiveness models can be used to link quality of care to

  13. Cost-effectiveness of preventive oral health care in medical offices for young Medicaid enrollees.

    Science.gov (United States)

    Stearns, Sally C; Rozier, R Gary; Kranz, Ashley M; Pahel, Bhavna T; Quiñonez, Rocio B

    2012-10-01

    To estimate the cost-effectiveness of a medical office-based preventive oral health program in North Carolina called Into the Mouths of Babes (IMB). Observational study using Medicaid claims data (2000-2006). Medical staff delivered IMB services in medical offices, and dentists provided dental services in offices or hospitals. A total of 209 285 children enrolled in Medicaid at age 6 months. Into the Mouths of Babes visits included screening, parental counseling, topical fluoride application, and referral to dentists, if needed. The cost-effectiveness analysis used the Medicaid program perspective and a propensity score-matched sample with regression analysis to compare children with 4 or more vs 0 IMB visits. Dental treatments and Medicaid payments for children up to age 6 years enabled assessment of the likelihood of whether IMB was cost-saving and, if not, the additional payments per hospital episode avoided. Into the Mouths of Babes is 32% likely to be cost-saving, with discounting of benefits and payments. On average, IMB visits cost $11 more than reduced dental treatment payments per person. The program almost breaks even if future benefits from prevention are not discounted, and it would be cost-saving with certainty if IMB services could be provided at $34 instead of $55 per visit. The program is cost-effective with 95% certainty if Medicaid is willing to pay $2331 per hospital episode avoided. Into the Mouths of Babes improves dental health for additional payments that can be weighed against unmeasured hospitalization costs.

  14. [Calculation of workers' health care costs].

    Science.gov (United States)

    Rydlewska-Liszkowska, Izabela

    2006-01-01

    In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference

  15. Health care financing and the sustainability of health systems

    OpenAIRE

    Liaropoulos, Lycourgos; Goranitis, Ilias

    2015-01-01

    The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to “traditional” issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a glo...

  16. Effectiveness of hand hygiene depends on the patient's health condition and care environment.

    Science.gov (United States)

    Okada, Junko; Yamamizu, Yukiko; Fukai, Kiyoko

    2016-10-01

    The present authors examined how patient hand contamination was associated with underlying disease and treatment environment in order to determine effective hand hygiene methods. Samples were collected from inpatients (45 with hematological malignancies, 48 postoperative), outpatients (48 undergoing hemodialysis, 55 on chemotherapy), and 44 individuals living in nursing homes. All participants provided informed consent for study participation. All subjects performed hand hygiene. Before and after hand hygiene, samples of bacteria were collected from the palm of the hand onto agar media. Bacteria were counted and bacterial strains were identified. The authors then collected smear samples from the contralateral palm and measured adenosine triphosphate (ATP) levels. Patient hand contamination was the highest in hemodialysis patients, followed by residents of nursing homes, postoperative patients, patients with cancer receiving chemotherapy, and patients of hematological malignancies. Regardless of the underlying disease and treatment environment, patients were able to reduce the number of bacterial colonies and ATP by proper hand hygiene. Compared with wet wipes, hand washing seemed to remove bacteria more effectively. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 30 subjects, none of whom were patients of hematological malignancies. Of these, 19 tested negative for MRSA after performing proper hand hygiene. Patient hand contamination is affected by underlying disease and care environment, but can be reduced by encouraging proper hand washing. Proper patient hand hygiene can reduce MRSA on patients' hands, and thus may serve as an effective tool for prevention of healthcare-associated infections. © 2016 Japan Academy of Nursing Science.

  17. Effects of a training program for home health care workers on the provision of preventive activities and on the health-related behavior of their clients: A quasi-experimental study.

    Science.gov (United States)

    Walters, Maaike E; Reijneveld, Sijmen A; van der Meulen, Anja; Dijkstra, Arie; de Winter, Andrea F

    2017-09-01

    Because home health care workers repeatedly visit the same older adults, they are in an excellent position to improve the health-related behavior of older adults, their clients, by providing preventive activities. The objective of this study was to determine the short- and medium term effects of an intervention to support workers in providing preventive activities for older adults. To do this, the number of activities undertaken by workers and the health-related behavior of their clients were assessed. A quasi-experimental study was performed with a pre-post design and inclusion of one control group. The study took place in a deprived, semi-rural area in The Netherlands (2011-2013). Data in three districts served by one home health care organization were gathered. The participants were home health care workers (registered nurses and nurse aides) and home health care clients aged 55 and over (community-dwelling, dependent older adults receiving home health care). 205 home health care workers participated in the study, 97 of them in the first effect measurement; and 83 of them in the second effect measurement. A total of 304 home health care clients participated, 214 of them in the first effect measurement; and 186 of them in the second effect measurement. Differences in change were determined in health-related behavior between groups of older adults as a result of training home health care workers in preventive activities RESULTS: In the control group of home health care professionals a significant increase was found regarding the provision of preventive activities for the domain 'weight' (partial eta squared: 0.05 and 0.08 at first and second effect measurements, respectively). We found preventive activities performed by home health care professionals to have no significant effects on older adult-reported health-related behavior, but observed in the intervention group a non-significant trend in improvement of physical activity of, respectively, 85 and 207min for

  18. SUPPLY-SIDE EFFECT OF HEALTH CARE FACILITIES ON PRODUCTIVITY AMONG THE FEMALE WORKER IN THE READYMADE GERMENT SECTOR

    Directory of Open Access Journals (Sweden)

    Md Aminul Haque

    2008-01-01

    Full Text Available This study was conducted in 4 selected garment factories within Dhaka city. The objectives of this study were to find out health care access (Supply-side effect in the garments factory for the women workers and their relation to the productivity. A total of 300 women garment workers were included in this study. Most (60.0% of the respondents were adolescents, unmarried and having only primary level education (5 years of school education. Their average take home monthly salary was 1791.7 taka which was spent mostly on food. They passed a tight work schedule from 6 AM to 11.30 PM without any rest. Hundred percent of female workers had no previous idea about garments nor had any formal training, but they produced on an average 1016 garment pieces a day. They did not get any vaccine, health education or health related knowledge from the garments factory. There was no provision of health care centre or doctor, treatment for fire burn (other than gas, medicine and support in chronic, severe illness for themselves or their family members. More than half (63.0% of the respondents mentioned about loss of time due to illness. There was a strong correlation (r=0.858 between sickness and production loss, between hour loss and production loss (r=0.9283, between production loss and percentage loss (r=0.871. Though there was loss due to illness, no health access or facility for women workers in the garments factory was available. To overcome the situation and improve the productivity, owners have to provide health access and women workers have to come forward for their rights. Ibrahim Med. Coll. J. 2008; 2(1: 4-8

  19. The effects of health care-based violence intervention programs on injury recidivism and costs: A systematic review.

    Science.gov (United States)

    Strong, Bethany L; Shipper, Andrea G; Downton, Katherine D; Lane, Wendy G

    2016-11-01

    Youth violence affects thousands annually, with homicide being the third leading cause of death for those aged 10 to 24 years. This systematic review aims to evaluate the published evidence for the effects of health care-based violence intervention programs (VIPs), which focus on reducing recurrent presentations for injury due to youth violence ("recidivism"). Health literature databases were searched. Studies were retained if peer reviewed and if programs were health care based, focused on intentional injury, addressed secondary or tertiary prevention (i.e., preventing recidivism and reducing complications), included participants aged 14 to 25 years, had greater than 1-month follow-up, and evaluated outcomes. Studies of child and sexual abuse and workplace, intimate partner, and self-inflicted violence were excluded. Extracted data subject to qualitative analysis included enrollment and retention, duration of follow-up, services provided, statistical analysis, and primary and intermediate outcomes. Of the 2,144 citations identified, 22 studies were included in the final sample. Twelve studies were randomized controlled trials representing eight VIPs. Injury recidivism was assessed in six (75%) of eight programs with a significant reduction in one (17%) of six programs. Of the randomized controlled trials showing no difference in recidivism, all were either underpowered or did not include a power analysis. Two observational studies also showed significant reduction in recidivism. Significant intermediate outcomes included increased service use, attitude change, and decreases in violence-related behavior. Reductions in injury recidivism led to reductions in health care and criminal justice system costs. Three studies showing reduced injury recidivism and several studies showing positive intermediate outcomes identify VIPs as a promising practice. Many studies were limited by poor methodological quality, including high losses to follow-up. Systematic review, level

  20. Effects of Cognition, Function, and Behavioral and Psychological Symptoms on Medicare Expenditures and Health Care Utilization for Persons With Dementia.

    Science.gov (United States)

    Jutkowitz, Eric; Kane, Robert L; Dowd, Bryan; Gaugler, Joseph E; MacLehose, Richard F; Kuntz, Karen M

    2017-06-01

    Clinical features of dementia (cognition, function, and behavioral/psychological symptoms [BPSD]) may differentially affect Medicare expenditures/health care utilization. We linked cross-sectional data from the Aging, Demographics, and Memory Study to Medicare data to evaluate the association between dementia clinical features among those with dementia and Medicare expenditures/health care utilization (n = 234). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Function was evaluated as the number of functional limitations (0-10). BPSD was evaluated as the number of symptoms (0-12). Expenditures were estimated with a generalized linear model (log-link and gamma distribution). Number of hospitalizations, institutional outpatient visits, and physician visits were estimated with a negative binomial regression. Medicare covered skilled nursing days were estimated with a zero-inflated negative binomial model. Cognition and BPSD were not associated with expenditures. Among individuals with less than seven functional limitations, one additional limitation was associated with $123 (95% confidence interval: $19-$227) additional monthly Medicare spending. Better cognition and poorer function were associated with more hospitalizations among those with an MMSE less than three and less than six functional limitations, respectively. BPSD had no effect on hospitalizations. Poorer function and fewer BPSD were associated with more skilled nursing among individuals with one to seven functional limitations and more than four symptoms, respectively. Cognition had no effect on skilled nursing care. No clinical feature was associated with institutional outpatient care. Of individuals with an MMSE less than 15, poorer cognition was associated with fewer physician visits. Among those with more than six functional limitations, poorer function was associated with fewer physician visits. Poorer function, not cognition or BPSD, was associated with higher Medicare

  1. Prison health care: a review of the literature.

    Science.gov (United States)

    Watson, Roger; Stimpson, Anne; Hostick, Tony

    2004-02-01

    The prison population is increasing and the health problems of prisoners are considerable. Prison is designed with punishment, correction and rehabilitation to the community in mind and these goals may conflict with the aims of health care. A literature review showed that the main issues in prison health care are mental health, substance abuse and communicable diseases. Women prisoners and older prisoners have needs which are distinct from other prisoners. Health promotion and the health of the community outside prisons are desirable aims of prison health care. The delivery of effective health care to prisoners is dependent upon partnership between health and prison services and telemedicine is one possible mode of delivery.

  2. Effectiveness of a Web-Based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial.

    Science.gov (United States)

    Ab Malik, Normaliza; Mohamad Yatim, Sa'ari; Lam, Otto Lok Tao; Jin, Lijian; McGrath, Colman Patrick Joseph

    2017-03-31

    Oral hygiene care is of key importance among stroke patients to prevent complications that may compromise rehabilitation or potentially give rise to life-threatening infections such as aspiration pneumonia. The aim of this study was to evaluate the effectiveness of a Web-based continuing professional development (CPD) program on "general intention" of the health carers to perform daily mouth cleaning for stroke patients using the theory of planned behavior (TPB). A double-blind cluster randomized controlled trial was conducted among 547 stroke care providers across 10 hospitals in Malaysia. The centers were block randomized to receive either (1) test intervention (a Web-based CPD program on providing oral hygiene care to stroke patients using TPB) or (2) control intervention (a Web-based CPD program not specific to oral hygiene). Domains of TPB: "attitude," "subjective norm" (SN), "perceived behavior control" (PBC), "general intention" (GI), and "knowledge" related to providing oral hygiene care were assessed preintervention and at 1 month and 6 months postintervention. The overall response rate was 68.2% (373/547). At 1 month, between the test and control groups, there was a significant difference in changes in scores of attitude (P=.004) and subjective norm (P=.01), but not in other TPB domains (GI, P=.11; PBC, P=.51; or knowledge, P=.08). At 6 months, there were significant differences in changes in scores of GI (P=.003), attitude (P=.009), SN (Psubjective norms, and knowledge to provide oral hygiene care among stroke carers for their patients. Changing subjective norms and perceived behavioral control are key factors associated with changes in general intention to provide oral hygiene care. National Medical Research Register, Malaysia NMRR-13-1540-18833 (IIR); https://www.nmrr.gov.my/ fwbLoginPage.jsp.

  3. Effects of the 1974-75 Recession on Health Care for the Disadvantaged. NCHSR Research Summary Series, June 24, 1975 through September 30, 1977.

    Science.gov (United States)

    Daugherty, James C., Ed.

    The findings from seven studies on the effects of the 1974-75 economic recession on the health care of low socioeconomic status individuals are summarized. The studies include: (1) an evaluation of the impact of adverse economic conditions on the health status of the poor; (2) the effects of unemployment and inflation on the utilization of…

  4. Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.

    Directory of Open Access Journals (Sweden)

    Joilda Silva Nery

    2014-11-01

    Full Text Available Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP and primary health care (Family Health Program-FHP programs on new case detection rate of leprosy.We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  =0.74-0.83 and significantly increased in municipalities with FHP coverage in the medium (72-95% (Risk Ratio 1.05; 95% CI  =1.02-1.09 and higher coverage tertiles (>95% (Risk Ratio 1.12; 95% CI  =1.08-1.17.At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

  5. Health Care Provider Initiative Strategic Plan

    Science.gov (United States)

    National Environmental Education & Training Foundation, 2012

    2012-01-01

    This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…

  6. Effectiveness of mental health screening and coordination of in-theater care prior to deployment to Iraq: a cohort study.

    Science.gov (United States)

    Warner, Christopher H; Appenzeller, George N; Parker, Jessica R; Warner, Carolynn M; Hoge, Charles W

    2011-04-01

    The authors assessed the effectiveness of a systematic method of predeployment mental health screening to determine whether screening decreased negative outcomes during deployment in Iraq's combat setting. Primary care providers performed directed mental health screenings during standard predeployment medical screening. If indicated, on-site mental health providers assessed occupational functioning with unit leaders and coordinated in-theater care for those cleared for deployment. Mental health-related clinical encounters and evacuations during the first 6 months of deployment in 2007 were compared for 10,678 soldiers from three screened combat brigades and 10,353 soldiers from three comparable unscreened combat brigades. Of 10,678 soldiers screened, 819 (7.7%, 95% confidence interval [CI]=7.2-8.2) received further mental health evaluation; of these, 74 (9.0%, 95% CI=7.1-11.0) were not cleared to deploy and 96 (11.7%, 95% CI=9.5-13.9) were deployed with additional requirements. After 6 months, soldiers in screened brigades had significantly lower rates of clinical contacts than did those in unscreened brigades for suicidal ideation (0.4%, 95% CI=0.3-0.5, compared with 0.9%, 95% CI=0.7-1.1), for combat stress (15.7%, 95% CI=15.0-16.4, compared with 22.0%, 95% CI=21.2-22.8), and for psychiatric disorders (2.9%, 95% CI=2.6-3.2, compared with 13.2%, 95% CI=12.5-13.8), as well as lower rates of occupational impairment (0.6%, 95% CI=0.4-0.7, compared with 1.8%, 95% CI=1.5-2.1) and air evacuation for behavioral health reasons (0.1%, 95% CI=0.1-0.2, compared with 0.3%, 95% CI=0.2-0.4). Predeployment mental health screening was associated with significant reductions in occupationally impairing mental health problems, medical evacuations from Iraq for mental health reasons, and suicidal ideation. This predeployment screening process provides a feasible system for screening soldiers and coordinating mental health support during deployment.

  7. Pharmaceutical care in Brazil's primary health care.

    Science.gov (United States)

    Araújo, Patricia Sodré; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

    2017-11-13

    To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285) were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were "pharmaceutical guidance" and "pharmaceutical care." The registration of activities is mainly made in the users' medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. Activities of clinical nature performed by pharmacists in Brazil are still incipient. The difficulties found point out

  8. The rise in health care coverage and affordability since health reform took effect: findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014.

    Science.gov (United States)

    Collins, Sara R; Rasmussen, Petra W; Doty, Michelle M; Beutel, Sophie

    2015-01-01

    New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act's subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014.

  9. Incentives of Health Care Expenditure

    Directory of Open Access Journals (Sweden)

    Eero Siljander

    2012-12-01

    Full Text Available The incentives of health care expenditure (HCE have been a topic of discussion in the USA (Obama reforms and in Europe (adjustment to debt crisis. There are competing views of institutional versus GDP (unit income elasticity and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of

  10. National Health Care Reform, Medicaid, and Children in Foster Care.

    Science.gov (United States)

    Halfon, Neal; And Others

    1994-01-01

    Outlines access to health care for children in out-of-home care under current law, reviews how health care access for these children would be affected by President Clinton's health care reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…

  11. disasters: implications for public health and health care system

    African Journals Online (AJOL)

    user

    GLOBAL JOURNAL OF MEDICAL SCIENCES VOL 9, NO. 1&2 ... disasters on public health and the health care system within the fundamental principles that guide the ..... Preparedness. • Assure capacity to respond effectively to disasters and emergencies. • Assess the populations at risk for special needs during a disaster.

  12. Cost-effectiveness analysis of health care waste treatment facilities in iran hospitals; a provider perspective.

    Science.gov (United States)

    Rashidian, Arash; Alinia, Cyrus; Majdzadeh, Reza

    2015-03-01

    Our aim was to make right and informative decision about choosing the most cost-effectiveness heterogeneous infectious waste treatment methods and devices. In this descriptive study, decision tree analysis, with 10-yr time horizon in bottom-up approach was used to estimate the costs and effectiveness criteria of the employed devices at provider perspective in Iranian hospitals. We used the one-way and scenario sensitivity analysis to measure the effects of variables with uncertainty. The resources of data were national Environmental and Occupational Health Center Survey (EOHCS) in 2012, field observation and completing questionnaire by relevant authorities in mentioned centers. Devices called Saray 2, Autoclave based, and Newster 10, Hydroclave based, with 92032.4 (±12005) and 6786322.9 (±826453) Dollars had the lowest and highest costs respectively in studied time period and given the 5-10% discount rate. Depending on effectiveness factor type, Newster 10 with Ecodas products and Saray products respectively had the highest and lowest effectiveness. In most considered scenarios, Caspian-Alborz device was the most cost-effectiveness alternative, so for the treatment of each adjusted unit of volume and weight of infectious waste in a 10 year period and in different conditions, between 39.4 (±5.1) to 915 (±111.4) dollars must be spent. The findings indicate the inefficiency and waste of resources, so in order to efficient resource allocation and to encourage further cost containment in infectious waste management we introduce policy recommendation that be taken in three levels.

  13. [A free market is unfavourable for health care].

    Science.gov (United States)

    Kant, A

    2006-05-06

    The new health care system in the Netherlands introduces a free market into the health care sector. Because health care lacks some essential conditions, a free market will not provide effective resource allocation in this sector. In addition, a free market leads to more bureaucracy and less solidarity, cooperation and freedom of choice. It also impairs the autonomy of the medical professional.

  14. Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN)

    DEFF Research Database (Denmark)

    Neupane, Dinesh; McLachlan, Craig S; Mishra, Shiva Raj

    2018-01-01

    Introduction Elevated blood pressure greatly contributes to cardiovascular deaths in low-income and middle-income countries. We aimed to investigate the effectiveness of a population-level intervention led by existing community health workers in reducing the burden of hypertension in a low......-income population. Methods We did a community-based, open-label, two-group, cluster-randomised controlled trial in Nepal. Using computer-generated codes, we randomly assigned (1:1) 14 clusters to a lifestyle intervention led by female community health volunteers (FCHVs) or usual care (control group...... or pregnant. The primary outcome was mean systolic blood pressure at 1 year. We included all participants who remained in the trial at 1 year in the primary analysis. This trial is registered with ClinicalTrials.gov, number NCT02428075. Findings Between April 1, 2015, and Dec 31, 2015, we recruited 1638...

  15. Multipurpose Health Care Telemedicine System

    Science.gov (United States)

    2001-10-25

    telemonitoring . In emergency cases where immediate medical treatment is the issue, recent studies conclude that early and specialized pre-hospital patient ...Lama, J Vila: “Intelligent Telemonitoring of Critical Care Patients ”, IEEE EMB Mag, Vol 18, No 4, pp 80-88, Jul/Aug 1999. [7] Strode S, Gustke S...Abstract- In this study we present a multipurpose health care telemedicine system, which can be used for emergency or patient monitoring cases

  16. Health Care Ergonomics: Contributions of Thomas Waters.

    Science.gov (United States)

    Poole Wilson, Tiffany; Davis, Kermit G

    2016-08-01

    The aim of this study was to assess the contributions of Thomas Waters's work in the field of health care ergonomics and beyond. Waters's research of safe patient handling with a focus on reducing musculoskeletal disorders (MSDs) in health care workers contributed to current studies and prevention strategies. He worked with several groups to share his research and assist in developing safe patient handling guidelines and curriculum for nursing students and health care workers. The citations of articles that were published by Waters in health care ergonomics were evaluated for quality and themes of conclusions. Quality was assessed using the Mixed Methods Appraisal Tool and centrality to original research rating. Themes were documented by the type of population the citing articles were investigating. In total, 266 articles that referenced the top seven cited articles were evaluated. More than 95% of them were rated either medium or high quality. The important themes of these citing articles were as follows: (a) Safe patient handling is effective in reducing MSDs in health care workers. (b) Shift work has negative impact on nurses. (c) There is no safe way to manually lift a patient. (d) Nurse curriculums should contain safe patient handling. The research of Waters has contributed significantly to the health care ergonomics and beyond. His work, in combination with other pioneers in the field, has generated multiple initiatives, such as a standard safe patient-handling curriculum and safe patient-handling programs. © 2016, Human Factors and Ergonomics Society.

  17. Multidisciplinary teamwork in US primary health care.

    Science.gov (United States)

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

    2007-08-01

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

  18. Access to Health Care

    Centers for Disease Control (CDC) Podcasts

    2010-11-09

    This podcast is based on the November, 2010 CDC Vital Signs report which indicates that more than one in four adults 18-64 years old (about 50 million) report being uninsured for at least part of the past 12 months, and focuses on the growing number of middle-income adults and those with a chronic illness or disability who have no health insurance.  Created: 11/9/2010 by Centers for Disease Control and Prevention (CDC).   Date Released: 11/9/2010.

  19. Nanotechnology in health care

    CERN Document Server

    Sahoo, Sanjeeb K

    2012-01-01

    Nanomedicine: Emerging Field of Nanotechnology to Human HealthNanomedicines: Impacts in Ocular Delivery and TargetingImmuno-Nanosystems to CNS Pathologies: State of the Art PEGylated Zinc Protoporphyrin: A Micelle-Forming Polymeric Drug for Cancer TherapyORMOSIL Nanoparticles: Nanomedicine Approach for Drug/Gene Delivery to the BrainMagnetic Nanoparticles: A Versatile System for Therapeutic and Imaging SystemNanobiotechnology: A New Generation of Biomedicine Application of Nanotechnology-Based Drug Delivery and Targeting to LungsAptamers and Nanomedicine in C

  20. Health promotion and primary health care: examining the discourse.

    Science.gov (United States)

    Ashcroft, Rachelle

    2015-01-01

    The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.

  1. Good Health Before Pregnancy: Preconception Care

    Science.gov (United States)

    ... Management Education & Events Advocacy For Patients About ACOG Good Health Before Pregnancy: Preconception Care Home For Patients Search ... Pregnancy: Preconception Care FAQ056, April 2017 PDF Format Good Health Before Pregnancy: Preconception Care Pregnancy What is a ...

  2. Helping You Choose Quality Behavioral Health Care

    Science.gov (United States)

    Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special ... for and what to ask will help you choose an organization that provides safe, quality care, treatment ...

  3. [Contribution of Health Care Research to Establishing Social Equality in Health and Health Care Opportunities].

    Science.gov (United States)

    Pfaff, H; Pförtner, T-K

    2016-02-01

    Social inequalities in health and health care services represent issues of major concern. Findings in this area reveal inequalities in health and health care indicating disadvantages for individuals with a low socioeconomic background. Although the health care system plays a marginal role in the explanation of inequalities in health, health services research can be an important part in the development of equal health opportunities. The current article describes the causal associations between social inequalities, health inequalities and the health care service. Health services research can make a contribution to increasing equal opportunities in health and health care service. Against this background, we discuss the existing potential and need of research in the area of health services. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Health care competition in the 1980s: its potential impact.

    Science.gov (United States)

    Peddecord, K M

    1983-03-01

    The health care industry will face continuing pressure from government and the private sector to contain costs. This paper provides an overview of health care costs, financing changes and cost inflation in the health care sector. The potential impact of competition oriented insurance plans, activities of business health care costs containment coalitions, and preferred provider organizations are reviewed. Regulatory trends and the effects of hospital reimbursement reforms on diagnostic radiographic and imaging services are discussed.

  5. The stress-reducing effects of art in pediatric health care: art preferences of healthy children and hospitalized children.

    Science.gov (United States)

    Eisen, Sarajane L; Ulrich, Roger S; Shepley, Mardelle M; Varni, James W; Sherman, Sandra

    2008-09-01

    Art is assumed to possess therapeutic benefits of healing for children, as part of patient-focused design in health care. Since the psychological and physiological well-being of children in health care settings is extremely important in contributing to the healing process, it is vitally important to identify what type of art supports stress reduction. Based on adult studies, nature art was anticipated to be the most preferred and to have stress-reducing effects on pediatric patients. Nature art refers to art images dominated by natural vegetation, flowers or water. The objective of this study was to investigate what type of art image children prefer, and what type of art image has potentially stress-reducing effects on children in hospitals. This study used a three-phase, multi-method approach with children aged 5-17 years: a focus group study (129 participants), a randomized study (48 participants), and a quasi-experimental study design (48 participants). Findings were evaluated from three phases.

  6. Phytotherapy in primary health care

    Science.gov (United States)

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

    2014-01-01

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

  7. The changing economic structure of the maritime industry and its adverse effects on seafarers' health care rights.

    Science.gov (United States)

    Guillot-Wright, Shannon

    2017-01-01

    This review seeks to understand whether and how seafarers can exercise their human right to health care and the factors that facilitate or impede that exercise. The general focus is on a critical policy analysis of labour policies from the mid-twentieth century through today, with a specific focus on how Filipino seafarers access their health care rights. The methodology includes a critical policy analysis of seafaring, focusing on mid-twentieth century political shifts in the recognition and regulation of health care rights. The analysis of international and United States policy provides the backbone for understanding the health care experiences of seafarers by laying the ideological, theoretical, and political foundations of labour rights and precarious employment. Policy analysis shows that there are numerous laws, regulations, and human rights norms that have been established to protect seafarers, but uncertain and limited recourse to lay claim to such laws, regulations, and norms while at sea. Lack of recourse to policies and regulations, taken together with the changed conditions of labour and worker protections through technology and neoliberal policies, create the conditions that may increase the health inequity among seafarers'. Health policy discussions in the United States and internationally must not solely focus on the health of seafarers as an interruption to travel and trade, but policy makers should consider that their decisions may contribute to how seafarers can exercise their rights to health care. In this context, health is more than disease and access to care - economic and governance structures come to not only matter, but play an integral role in the facilitation or impediment of health care and to the health arrangements/conditions of workers.

  8. [The effectiveness of hand hygiene products on MRSA colonization of health care workers by using CHROMagar MRSA].

    Science.gov (United States)

    Koçak Tufan, Zeliha; Irmak, Hasan; Bulut, Cemal; Cesur, Salih; Kınıklı, Sami; Demiröz, Ali Pekcan

    2012-04-01

    The aims of this study were; to investigate the hand hygiene compliance of the health care workers (HCWs) during their routine patient care, to determine the methicillin-resistant Staphylococcus aureus (MRSA) hand colonization of the HCWs, to investigate the effect of different hand hygiene products on MRSA colonization and to evaluate the effectiveness of chromogenic agar for detecting MRSA. HCWs were investigated during their routine patient care and hand cultures were taken before and after hand wash/hygiene. Two different techniques were used to obtain the hand cultures: fingertip method (CHROMagar MRSA containing HygiSlide); and direct swab method and then inoculation to CHROMagar MRSA media. MRSA strains grown on those cultures were confirmed with conventional methods. A total of 100 HCWs (of them 61 were female; mean age: 32.7 ± 5.2 years; age range: 25-51 years) involving physicians (n= 33), nurses (n= 38) and health care assistants (n= 29), were included in the study. MRSA was detected in 39% and 11% before hand hygiene and in 13% and 6% after hand hygiene, with HygiSlide CHROMagar media and with CHROMagar in plate media, respectively. No difference were found regarding clinics, occupations, or the type of patient handling in those HCWs who were positive (n= 13) for MRSA colonization following hand hygiene, and those who were negative (n= 26). However, the type of the hand hygiene product used exhibited a statistical difference. None of the seven HCWs who used alcohol based hand rub revealed growth in the second culture while 10 of 19 (53%) HCWs who used soap and three of 13 (23%) HCWs who used chlorhexidine were still colonized with MRSA. In terms of reduction in the MRSA counts, the most effective one was the alcohol based hand rub while the soap was the least, since seven of 19 (37%) HCWs who used soap showed no reduction at all in the MRSA counts. A high ratio of hand colonization with MRSA was detected in our hospital staff (39%). It was shown that

  9. Health care providers' perspective of the gender influences on immigrant women's mental health care experiences.

    Science.gov (United States)

    O'Mahony, Joyce M; Donnelly, Tamphd T

    2007-10-01

    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.

  10. Costs of health care across primary care models in Ontario.

    Science.gov (United States)

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-08-01

    The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the

  11. The Effectiveness of Inpatient Rehabilitation in the Acute Postoperative Phase of Care After Transtibial or Transfemoral Amputation: Study of an Integrated Health Care Delivery System

    Science.gov (United States)

    Stineman, Margaret G.; Kwong, Pui L.; Kurichi, Jibby E.; Prvu-Bettger, Janet A.; Vogel, W. Bruce; Maislin, Greg; Bates, Barbara E.; Reker, Dean M.

    2010-01-01

    Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system. Arch Phys Med Rehabil 2008;89:1863-72. Objective To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system. Design An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias. Setting Data compiled from 9 administrative databases from Veterans Affairs Medical Centers. Participants A national cohort of veterans (N=2673) who underwent transtibial or transfemoral amputation between October 1, 2002, and September 30, 2004. Interventions Not applicable. Main Outcome Measures One-year cumulative survival, home discharge from the hospital, and prosthetic limb procurement within the first postoperative year. Results After reducing selection bias, patients who received acute postoperative inpatient rehabilitation compared to those with no evidence of inpatient rehabilitation had an increased likelihood of 1-year survival (odds ratio [OR]=1.51; 95% confidence interval [CI], 1.26–1.80) and home discharge (OR=2.58; 95% CI, 2.17–3.06). Prosthetic limb procurement did not differ significantly between groups. Conclusions The receipt of rehabilitation in the acute postoperative inpatient period was associated with a greater likelihood of 1-year survival and home discharge from the hospital. Results support early postoperative inpatient rehabilitation following amputation. PMID:18929014

  12. "Barking up the right tree": challenges for health care reform.

    Science.gov (United States)

    Sturmberg, Joachim P; O'Halloran, Diana E; Jackson, Claire; Mitchell, Christopher D; Martin, Carmel M

    2009-07-20

    Current approaches to health care reform are largely based on the metaphor of imminent flood waves threatening to inundate the health care system. This metaphor reflects the system's preoccupation with disease and disease management in a hospital-centric environment. We suggest that the debate needs to be reframed around health, or more precisely the patient's health experience. Most patients are healthy most of the time, and even those with identifiable morbidities generally regard themselves as being in good health. The majority of people receive most of their care in the community from primary care professionals. An integrated, effective and efficient primary health care system supports continuity of care through a primary care provider and fosters clinical leadership that is supported by other primary health care professionals and medical specialists. Each primary care setting will have its own model that best provides flexible and responsive services to meet its patients' needs and expectations.

  13. The effects of influenza vaccination of health care workers in nursing homes: insights from a mathematical model.

    Directory of Open Access Journals (Sweden)

    Carline van den Dool

    2008-10-01

    Full Text Available BACKGROUND: Annual influenza vaccination of institutional health care workers (HCWs is advised in most Western countries, but adherence to this recommendation is generally low. Although protective effects of this intervention for nursing home patients have been demonstrated in some clinical trials, the exact relationship between increased vaccine uptake among HCWs and protection of patients remains unknown owing to variations between study designs, settings, intensity of influenza seasons, and failure to control all effect modifiers. Therefore, we use a mathematical model to estimate the effects of HCW vaccination in different scenarios and to identify a herd immunity threshold in a nursing home department. METHODS AND FINDINGS: We use a stochastic individual-based model with discrete time intervals to simulate influenza virus transmission in a 30-bed long-term care nursing home department. We simulate different levels of HCW vaccine uptake and study the effect on influenza virus attack rates among patients for different institutional and seasonal scenarios. Our model reveals a robust linear relationship between the number of HCWs vaccinated and the expected number of influenza virus infections among patients. In a realistic scenario, approximately 60% of influenza virus infections among patients can be prevented when the HCW vaccination rate increases from 0 to 1. A threshold for herd immunity is not detected. Due to stochastic variations, the differences in patient attack rates between departments are high and large outbreaks can occur for every level of HCW vaccine uptake. CONCLUSIONS: The absence of herd immunity in nursing homes implies that vaccination of every additional HCW protects an additional fraction of patients. Because of large stochastic variations, results of small-sized clinical trials on the effects of HCW vaccination should be interpreted with great care. Moreover, the large variations in attack rates should be taken into

  14. Effects of mindfulness meditation on occupational functioning and health care utilization in individuals with anxiety.

    Science.gov (United States)

    Hoge, Elizabeth A; Guidos, Brittany M; Mete, Mihriye; Bui, Eric; Pollack, Mark H; Simon, Naomi M; Dutton, Mary Ann

    2017-04-01

    To examine the effect of mindfulness meditation on occupational functioning in individuals with Generalized anxiety disorder (GAD). Fifty-seven individuals with GAD (mean (SD) age=39 (13); 56% women) participated in an 8-week clinical trial in which they were randomized to mindfulness-based stress reduction (MBSR) or an attention control class. In this secondary analysis, absenteeism, entire workdays missed, partial workdays missed, and healthcare utilization patterns were assessed before and after treatment. Compared to the attention control class, participation in MBSR was associated with a significantly greater decrease in partial work days missed for adults with GAD (t=2.734, df=51, p=0.009). Interestingly, a dose effect was observed during the 24-week post-treatment follow-up period: among MBSR participants, greater home mindfulness meditation practice was associated with less work loss and with fewer mental health professional visits. Mindfulness meditation training may improve occupational functioning and decrease healthcare utilization in adults with GAD. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Effecting Successful Community Re-Entry: Systems of Care Community Based Mental Health Services

    Science.gov (United States)

    Estes, Rebecca I.; Fette, Claudette; Scaffa, Marjorie E.

    2005-01-01

    The need for system reform for child and adolescent mental health services, long recognized as a vital issue, continues to challenge mental health professionals. While past legislation has not adequately addressed the issues, the 2003 President's New Freedom Commission may begin to reorient mental health systems toward recovery. Supported by this…

  16. Mindfulness-based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care.

    Science.gov (United States)

    Lilja, Josefine L; Zelleroth, Clara; Axberg, Ulf; Norlander, Torsten

    2016-10-01

    This study examined the effectiveness of mindfulness-based cognitive therapy (MBCT) in primary care for patients with recurrent depression (major depressive disorder: MDD). According to the World Health Organization (WHO), MDD is now the leading cause of disease burden in middle- and high-income countries. Patients (N = 45) with three or more previous depressive episodes were recruited to participate in MBCT as a preventative intervention. Using a benchmarking approach, outcome data was compared with data from a recent efficacy study. The methodology is a rigorous approach to assessing effectiveness when evidence-based UK protocols are transferred into the existing Scandinavian service delivery. Additionally, a person-centred methodological approach was used to assess clinical significance on the Reliable Change Index (RCI). The analysis revealed comparable or larger effects from pre-test to post-test in reduced psychiatric symptoms, increased quality of life and level of mindfulness, and the effects were maintained over 14 months. Analysis of the relapse rate in the current study (16%) compared to the TAU in the efficacy study (68%) yielded an h value of 0.78, a moderate effect size. Only 13% dropped out of the treatment. According to the RCI findings, 65% to 67% of participants in the clinical group improved, no individual worsened, and women showed a significantly greater improvement of depression and anxiety than men. Therapeutic alliance and motivation had no impact on the outcome. The overall result suggests that MBCT can be implemented successfully in Scandinavian primary health care as a preventive intervention for patients with recurrent depression. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

  17. Priorities of health care outcomes for the elderly.

    Science.gov (United States)

    Akishita, Masahiro; Ishii, Shinya; Kojima, Taro; Kozaki, Koichi; Kuzuya, Masafumi; Arai, Hidenori; Arai, Hiroyuki; Eto, Masato; Takahashi, Ryutaro; Endo, Hidetoshi; Horie, Shigeo; Ezawa, Kazuhiko; Kawai, Shuji; Takehisa, Yozo; Mikami, Hiroshi; Takegawa, Shogo; Morita, Akira; Kamata, Minoru; Ouchi, Yasuyoshi; Toba, Kenji

    2013-07-01