WorldWideScience

Sample records for health care programmes

  1. Enhancing health care non-technical skills: the TINSELS programme.

    Science.gov (United States)

    Gordon, Morris; Box, Helen; Halliwell, Jo-Anne; Farrell, Michael; Parker, Linda; Stewart, Alison

    2015-12-01

    Training in 'non-technical skills', i.e. social (communication and teamwork) and cognitive (analytical and personal behaviour) skills, in health care have been of great interest over the last decade. Whereas the majority of publications focus on 'whether' such education can be successful, they overlook 'how' they enhance skills. We designed and piloted a theoretically robust teaching package that addresses non-technical skills in the context of medicine safety through simulation-based interprofessional learning: the Training In Non-technical Skills to Enhance Levels of Medicines Safety (TINSELS) programme. A modified Delphi process was completed to identify learning outcomes, and multi-professional teams were recruited through local publicity. The faculty staff developed a three-session simulation-based intervention: firstly, a simulated ward encounter with multiple medicine-related activities; secondly, an extended debriefing and facilitated discussion; and finally, a 'chamber of horrors', where interprofessional teams identified potential sources of error. Each session was completed in the simulation suite with between six and nine participants, lasted approximately 90 minutes and took place over 2 weeks. Full details of the course will be presented to facilitate dissemination. Training in 'non-technical skills' in health care have been of great interest over the last decade Feedback was collected on a Likert scale after the course (1, strongly disagree; 5, strongly agree). Mean scores were all greater than 4, with qualitative feedback noting the fidelity of the authentic interprofessional groups. A previously validated safety attitudes questionnaire found changes in attitudes towards handover of care and perceptions of safety in the workplace. An original, simulation-based, multi-professional training programme has been developed with learning and assessment materials available for widespread replication. © 2015 John Wiley & Sons Ltd.

  2. Economic evaluation of occupational health and safety programmes in health care.

    Science.gov (United States)

    Guzman, J; Tompa, E; Koehoorn, M; de Boer, H; Macdonald, S; Alamgir, H

    2015-10-01

    Evidence-based resource allocation in the public health care sector requires reliable economic evaluations that are different from those needed in the commercial sector. To describe a framework for conducting economic evaluations of occupational health and safety (OHS) programmes in health care developed with sector stakeholders. To define key resources and outcomes to be considered in economic evaluations of OHS programmes and to integrate these into a comprehensive framework. Participatory action research supported by mixed qualitative and quantitative methods, including a multi-stakeholder working group, 25 key informant interviews, a 41-member Delphi panel and structured nominal group discussions. We found three resources had top priority: OHS staff time, training the workers and programme planning, promotion and evaluation. Similarly, five outcomes had top priority: number of injuries, safety climate, job satisfaction, quality of care and work days lost. The resulting framework was built around seven principles of good practice that stakeholders can use to assist them in conducting economic evaluations of OHS programmes. Use of a framework resulting from this participatory action research approach may increase the quality of economic evaluations of OHS programmes and facilitate programme comparisons for evidence-based resource allocation decisions. The principles may be applicable to other service sectors funded from general taxes and more broadly to economic evaluations of OHS programmes in general. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Financial incentives for disease management programmes and integrated care in German social health insurance.

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    Greb, Stefan; Focke, Axel; Hessel, Franz; Wasem, Jürgen

    2006-10-01

    As a result of recent health care reforms sickness funds and health care providers in German social health insurance face increased financial incentives for implementing disease management and integrated care. Sickness funds receive higher payments form the risk adjustment system if they set up certified disease management programmes and induce patients to enrol. If health care providers establish integrated care projects they are able to receive extra-budgetary funding. As a consequence, the number of certified disease management programmes and the number of integrated care contracts is increasing rapidly. However, contracts about disease management programmes between sickness funds and health care providers are highly standardized. The overall share of health care expenses spent on integrated care still is very low. Existing integrated care is mostly initiated by hospitals, is based on only one indication and is not fully integrated. However, opportunity to invest in integrated care may open up innovative processes, which generate considerable productivity gains. What is more, integrated care may serve as gateway for the introduction of more widespread selective contracting.

  4. Implementing primary health care: some problems of creating national programmes.

    Science.gov (United States)

    Vaughan, J P; Walt, G

    1984-07-01

    While there is a great deal of agreement about the principles underlying Primary Health Care (PHC), there exist many problems, political, planning and management, involved in putting the approach into effect. Some of these difficulties are discussed. It is clear that the PHC approach is essentially political; the way it is implemented in each country will reflect the political priorities and systems of that country. Moreover, ministries of health are not known for their strong position in the ministerial pecking order. Finance and planning ministeries would have to be won over to the importance of the concept of PHC to try to eexpand the health budget and to change the emphasis of existing resource allocation patterns. Costs incurred by a PHC approach ( e.g., expensive transport and communication systems), and resources needed to finance it may be available; however, they may not be channelled to the politically less articulate groups in rural areas. Political implications are not limited to national levels; considerable conflict may exist between different status groups and classes at the village level, thus sabotaging PHC plans. Professional politics will also be played at all levels. It is equally essential to recognize the historical context in which PHC is being introduced. Many countries have inherited colonial infrastructures. Changing the values, perceptions, expectations, administration and organization that accompany such systems is extremely hard, and to put PHC into effect demands radical changes. The planning difficulties which beset PHC are related to the still large private provision of social services like health, and to a flourishing traditional private sector in many developing countries. These may limit the implementation of a national health policy and PHC may thus result in a very patchy service throughout the country. The level of centralized planning will also affect resource allocation and therefore the policy, planning and implementation

  5. Developing a diabetes prevention education programme for community health-care workers in Thailand: formative findings.

    Science.gov (United States)

    Sranacharoenpong, Kitti; Hanning, Rhona M

    2011-10-01

    The aim of this study was to investigate barriers to and supports for implementing a diabetes prevention education programme for community health-care workers (CHCWs) in Chiang Mai province, Thailand. The study also aimed to get preliminary input into the design of a tailored diabetes prevention education programme for CHCWs. Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. As access to diabetes prevention programme is limited in Thailand, especially in rural and semi-urban areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective, and sustainable. Health-care professionals (n = 12) selected from health centres within one district participated in in-depth interviews. In addition, screened people at risk for diabetes participated in interviews (n = 8) and focus groups (n = 4 groups, 23 participants). Coded transcripts from audio-taped interviews or focus groups were analysed by hand and using NVivo software. Concept mapping illustrated the findings. Health-care professionals identified potential barriers to programme success as a motivation for regular participation, and lack of health policy support for programme sustainability. Health-care professionals identified opportunities to integrate health promotion and disease prevention into CHCWs' duties. Health-care professionals recommended small-group workshops, hands-on learning activities, case studies, and video presentations that bring knowledge to practice within their cultural context. CHCWs should receive a credit for continuing study. People at risk for diabetes lacked knowledge of nutrition, diabetes risk factors, and resources to access health information. They desired two-way communication with CHCWs. Formative research supports the need for an effective, sustainable programme to support knowledge translation to CHCWs and at-risk populations in the

  6. Ranking of healthcare programmes based on health outcome, health costs and safe delivery of care in hospital pharmacy practice.

    Science.gov (United States)

    Brisseau, Lionel; Bussières, Jean-François; Bois, Denis; Vallée, Marc; Racine, Marie-Claude; Bonnici, André

    2013-02-01

    To establish a consensual and coherent ranking of healthcare programmes that involve the presence of ward-based and clinic-based clinical pharmacists, based on health outcome, health costs and safe delivery of care. This descriptive study was derived from a structured dialogue (Delphi technique) among directors of pharmacy department. We established a quantitative profile of healthcare programmes at five sites that involved the provision of ward-based and clinic-based pharmaceutical care. A summary table of evidence established a unique quality rating per inpatient (clinic-based) or outpatient (ward-based) healthcare programme. Each director rated the perceived impact of pharmaceutical care per inpatient or outpatient healthcare programme on three fields: health outcome, health costs and safe delivery of care. They agreed by consensus on the final ranking of healthcare programmes. A ranking was assigned for each of the 18 healthcare programmes for outpatient care and the 17 healthcare programmes for inpatient care involving the presence of pharmacists, based on health outcome, health costs and safe delivery of care. There was a good correlation between ranking based on data from a 2007-2008 Canadian report on hospital pharmacy practice and the ranking proposed by directors of pharmacy department. Given the often limited human and financial resources, managers should consider the best evidence available on a profession's impact to plan healthcare services within an organization. Data are few on ranking healthcare programmes in order to prioritize which healthcare programme would mostly benefit from the delivery of pharmaceutical care by ward-based and clinic-based pharmacists. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

  7. Expanded programme on immunization and primary health care.

    Science.gov (United States)

    Basu, R N

    1982-09-01

    The ultimate objective of the Expanded Program on Immunication, better known as EPI, is to reduce the morbidity of the diseases for which vaccine is available. The EPI is a key component of the country effort to provide Health for All by the year 2000. It is planned that by 1990 immunization services will be available for all infants against diphtheria, whooping cough, tetanus, tuberculosis, and poliomyelitis and for all school children for diptheria, tetanus, and typhoid, and for all pregnant women against tetanus. The immunization services will be a part of the comprehensive health care and will be integrated with all hospitals and dispensaries in urban areas and primary health centers/subcenters in the rural areas. Outreach operations are encouraged to bring these services as close to the mother and children as possible. Steps have already been taken to make the country self-sufficient in the production of different quality vaccines to meet the program requirements. New vaccines will be added where found to be epidemiologically necessary and administratively feasible. The vaccination program is effective only if given at the right age. A national immunization schedule has been prepared which emphasizes vaccination of all infants with 1 dose of BCG, 3 doses of DPT and polio at a minimum interval of 1 month, by the 1st birthday. School entrants are given a booster dose of DT and 2 doses of typhoid vaccine at an interval of 1 month. The children leaving primary school and leaving high school are given 1 booster dose of tetanus toxoid. In case of history of tetanus toxoid immunization in the earlier preganancy, 1 booster dose is adequate. Important components of management of EPI are cold chain maintenance, record keeping and evaluation, uniform vaccination coverage standards, and communication with the public through various media. A table gives the number of children/women proposed to be covered with full course of vaccine during each year of the 6th Plan. Disease

  8. Parent education programmes for special health care needs children: a systematic review.

    Science.gov (United States)

    Jackson, Alun C; Liang, Rachel P-T; Frydenberg, Erica; Higgins, Rosemary O; Murphy, Barbara M

    2016-06-01

    The aim of this review was to examine parent education programmes for families with children with special health care needs, to better design interventions focusing on the psychosocial aspects of living with a child's chronic condition. Studies of familial coping with children with special health care needs indicate high levels of parenting stress, with families with children with special health care needs at risk of major psychological and social disturbances and financial strain. Despite increased knowledge of the factors affecting children with special health care needs themselves, evidence for the effectiveness of preventative and treatment interventions in the form of parent education programmes remains limited. Systematic review using PRISMA guidelines. Multi database Boolean searches in EBSCO Discovery Services using the search terms 'complex/special health care needs children', 'child/pediatric/congenital heart disease', 'chronic illness (including diabetes, cancer and cystic fibrosis)', 'family coping', 'siblings' AND 'parenting/family support programs' were conducted. Analysis of 13 included studies showed evidence for the effectiveness of both mixed-health condition and condition-specific parenting programmes delivered in a variety of modes. Three common core intervention approaches were: use of narrative therapy enabling families to tell their own stories, thus facilitating emotional processing and (co-) construction of meaning; a focus on strengthening protective factors such as enhancing parents' skills in communication, and behavioural management and provision of psycho-education to deepen parents' understanding of their child's condition and associated developmental challenges. Irrespective of the type of outcome measures used in the studies, the review showed that there were positive gains and improvements across a range of areas of family functioning such as mental health, parenting, communication and problem-solving skills postprogramme

  9. Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty.

    Science.gov (United States)

    Al, Maiwenn J; Feenstra, Talitha L; Hout, Ben A van

    2005-07-01

    This paper addresses the problem of how to value health care programmes with different ratios of costs to effects, specifically when taking into account that these costs and effects are uncertain. First, the traditional framework of maximising health effects with a given health care budget is extended to a flexible budget using a value function over money and health effects. Second, uncertainty surrounding costs and effects is included in the model using expected utility. Other approaches to uncertainty that do not specify a utility function are discussed and it is argued that these also include implicit notions about risk attitude.

  10. Quality of care in reproductive health programmes: monitoring and evaluation of quality improvement.

    Science.gov (United States)

    Kwast, B E

    1998-12-01

    As 200 million women become pregnant every year, at least 30 million will develop life-threatening complications requiring emergency treatment at any level of society where they live. But it is a basic human right that pregnancy be made safe for all women as complications are mostly unpredictable. This requires reproductive health programmes which are responsive to women's and their families' needs and expectations on the one hand and enhancement of community participation, high quality obstetric services, and both provider collaboration and satisfaction on the other. Monitoring and evaluation of these facets need to be an integral part of any safe motherhood programme, not only to assess progress, but also to use this information for subsequent planning and implementation cycles of national programmes. Lessons learned from ten years' implementation of Safe Motherhood programmes indicate that process and outcome indicators are more feasible for short-term evaluation purposes than impact indicators, such as maternal mortality reduction. The former are described in this paper with relevant country examples. This is the third, and last, article in a series on quality of care in reproductive health programmes. The first (Kwast 1998a) contains an overview of concepts, assessments, barriers and improvements of quality of care. The second (Kwast 1998b) addresses education issues for quality improvement.

  11. Child oral health concerns amongst parents and primary care givers in a Sure Start local programme.

    Science.gov (United States)

    Daly, B; Clarke, W; McEvoy, W; Periam, K; Zoitopoulos, L

    2010-09-01

    To conduct an oral health promotion needs assessment amongst parents and primary care givers of pre-school children in a South East London Sure Start Local Programme (SSLP). To explore the oral health concerns and oral health literacy with regard to children's oral health amongst parents and primary care givers in a South East London SSLP. A qualitative study using four in-depth focus groups with a purposive sample of 20 participants. Data were analysed using the framework method. The SSLP was identified as an important source of information, support and social interaction for participants. Participants rated the informal networks of the programme as equally authoritative as other formal sources of information. Oral health concerns included: introducing healthy eating, establishing tooth brushing, teething and access to dental care. While participants had adequate knowledge of how to prevent oral disease they cited many barriers to acting on their knowledge which included: parents' tiredness, lack of confidence in parenting skills, confusing information, widespread availability of sugary foods and drinks, and lack of local child friendly dentists. Parenting skills and the social support provided by the SSLP appeared to be integral to the introduction of positive oral health behaviours. SSLPs were seen as a trusted source of support and information for carers of pre-school children. Integration of oral health promotion into SSLPs has the potential to tap into early interventions which tackle the wider support needs of carers of pre-school children while also supporting the development of positive oral health behaviours.

  12. TB Notification from Private Health Sector in Delhi, India: Challenges Encountered by Programme Personnel and Private Health Care Providers

    Directory of Open Access Journals (Sweden)

    Mahasweta Satpati

    2017-01-01

    Full Text Available Objective. To identify the challenges encountered by private health care providers (PHCP to notify tuberculosis cases through a programme developed web-based portal mechanism called “NIKSHAY.” Study Design. It is a descriptive qualitative study conducted at two revised national tuberculosis control programme (RNTCP districts of New Delhi. The study included in-depth interviews of PHCP registered with “NIKSHAY” and RNTCP programme personnel. Grounded theory was used to conceptualise the latent social patterns in implementation of tuberculosis case notification process and promptly identifying their challenges. Results. The analysis resulted in identification of three broad themes: (a system implementation by RNTCP: it emphasizes the TB notification process by the RNTCP programme personnel; (b challenges faced by PHCP for TB notification with five different subthemes; and (c perceived gaps and suggestions: to improvise the TB notification process for the private health sector. The challenges encountered by PHCP were mainly related to unsystematic planning and suboptimal implementation by programme personnel at the state and district level. The PHCP lacked clarity on the need for TB notification. Conclusion. Implementation of TB notification among private health care providers requires systematic planning by the programme personnel. The process should be user-friendly with additional benefits to the patients.

  13. Stakeholder analysis of the Programme for Improving Mental health carE (PRIME): baseline findings.

    Science.gov (United States)

    Makan, Amit; Fekadu, Abebaw; Murhar, Vaibhav; Luitel, Nagendra; Kathree, Tasneem; Ssebunya, Joshua; Lund, Crick

    2015-01-01

    The knowledge generated from evidence-based interventions in mental health systems research is seldom translated into policy and practice in low and middle-income countries (LMIC). Stakeholder analysis is a potentially useful tool in health policy and systems research to improve understanding of policy stakeholders and increase the likelihood of knowledge translation into policy and practice. The aim of this study was to conduct stakeholder analyses in the five countries participating in the Programme for Improving Mental health carE (PRIME); evaluate a template used for cross-country comparison of stakeholder analyses; and assess the utility of stakeholder analysis for future use in mental health policy and systems research in LMIC. Using an adapted stakeholder analysis instrument, PRIME country teams in Ethiopia, India, Nepal, South Africa and Uganda identified and characterised stakeholders in relation to the proposed action: scaling-up mental health services. Qualitative content analysis was conducted for stakeholder groups across countries, and a force field analysis was applied to the data. Stakeholder analysis of PRIME has identified policy makers (WHO, Ministries of Health, non-health sector Ministries and Parliament), donors (DFID UK, DFID country offices and other donor agencies), mental health specialists, the media (national and district) and universities as the most powerful, and most supportive actors for scaling up mental health care in the respective PRIME countries. Force field analysis provided a means of evaluating cross-country stakeholder power and positions, particularly for prioritising potential stakeholder engagement in the programme. Stakeholder analysis has been helpful as a research uptake management tool to identify targeted and acceptable strategies for stimulating the demand for research amongst knowledge users, including policymakers and practitioners. Implementing these strategies amongst stakeholders at a country level will

  14. Note On Research Design For The Study Of Community Participation In Health Care Programmes

    Directory of Open Access Journals (Sweden)

    Rifkin Susan B

    1986-01-01

    Full Text Available After describing types of research designs for the study of community participation in health care programmes, this paper examines one methodology, the quantitative methodology, the quantitative methodology, in detail. It presents some of the major attractions and limitations of this approach. The attractions include the need for evaluation of success and failure and of cost effectiveness of programmes. The limitations include the inability of the approach to deal with definitions and interventions that cannot be quantitified and the difficulty of identifying casual relationship between interventions and outcomes. These characteristics are illustrated by a case by a medical school in Asia. Research design, research developments and research outcomes are described and analysed. The paper concludes that an alternative analysis which examines the linkages between participation and health improvements would be more useful as it would allow the political, social and economic dimensions of community participation to be examined.

  15. Community participation in primary health care projects of the Muldersdrift Health and Development Programme

    Directory of Open Access Journals (Sweden)

    M. Barker

    2007-09-01

    Full Text Available After numerous teething problems (1974-1994, the Department of Nursing Education of WITS University took responsibility for the Muldersdrift Health and Development Programme (MHDP. The nursing science students explored and implemented an empowerment approach to community participation. The students worked with MHDP health workers to improve health through community participation, in combination with primary health care (PHC activities and the involvement of a variety of community groups. As the PHC projects evolved overtime, the need arose to evaluate the level of community participation and how much community ownership was present over decision-making and resources. This led to the question “What was the level of community participation in PHC projects of the MHDP?” Based on the question the following objectives were set, i.e. i to evaluate the community participation in PHC initiatives; ii to provide the project partners with motivational affirmation on the level of community participation criteria thus far achieved; iii to indicate to participants the mechanisms that should still be implemented if they wanted to advance to higher levels of community participation; iv to evaluate the MHDP’s implementation of a people-centred approach to community participation in PHC; and v the evaluation of the level of community participation in PHC projects in the MHDP. An evaluative, descriptive, contextual and quantitative research design was used. Ethical standards were adhered to throughout the study. The MHDP had a study population of twentythree (N=23 PHC projects. A purposive sample of seven PHC initiatives was chosen according to specific selection criteria and evaluated according to the “Criteria to evaluate community participation in PHC projects” instrument (a quantitative tool. Structured group interviews were done with PHC projects’ executive committee members. The Joint Management Committee’s data was collected through mailed

  16. Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme.

    Science.gov (United States)

    Ankrah Odame, Emmanuel; Akweongo, Patricia; Yankah, Ben; Asenso-Boadi, Francis; Agyepong, Irene

    2014-05-01

    Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.

  17. Women's participation in rural credit programmes in Bangladesh and their demand for formal health care: is there a positive impact?

    Science.gov (United States)

    Nanda, P

    1999-08-01

    Within the overall aim of poverty alleviation, development efforts have included credit and self-employment programmes. In Bangladesh, the major beneficiaries of such group-based credit programmes are rural women who use the loans to initiate small informal income-generating activities. This paper explores the benefits of women's participation in credit programmes on their own health seeking. Using data from a sample of 1798 households from rural Bangladesh, conducted in 1991-1992 through repeated random sampling of 87 districts covered by Grameen Bank, Bangladesh Rural Advancement Committee (BRAC) and Bangladesh Rural Development Board (BRDB), this paper addresses the question: does women's participation in credit programmes significantly affect their use of formal health care? A non-unitary household preference model is suggested to test the hypothesis that women's empowerment through participation in these programmes results in greater control of resources for their own demand for formal health care. The analysis controls for endogeneity due to self-selection and other unobserved village level factors through the use of a weighted two stage instrumental variable approach with village level fixed effects. The findings indicate a positive impact of women's participation in credit programmes on their demand for formal health care. The policy simulations on the results of this study highlight the importance of credit programmes as a health intervention in addition to being a mechanism for women's economic empowerment.

  18. Inclusion of the equity focus and social determinants of health in health care education programmes in Colombia: a qualitative approach.

    Science.gov (United States)

    Hernández-Rincón, Erwin H; Pimentel-González, Juan P; Orozco-Beltrán, Domingo; Carratalá-Munuera, Concepción

    2016-06-01

    The Pan American Health Organization (PAHO) and the Colombian Ministry of Health and Social Protection have determined a need for an approach to include Equity Focus (EF) and Social Determinants of Health (SDH) in health training programmes in Colombia. We studied the incorporation of EF and SDH in the curricula of several universities in Colombia to identify opportunities to strengthen their inclusion. Qualitative methodology was performed in two stages: (i) initial exploration (self-administered questionnaires and review of curricula) and (ii) validation of the information (semi-structured interviews). The inclusion of the EF and SDH in university curricula is regarded as an opportunity to address social problems. This approach addresses a broad cross-section of the curriculum, especially in the subjects of public health and Primary Health Care (PHC), where community outreach generates greater internalization by students. The dominance of the biomedical model of study plans and practice scenarios focusing on disease and little emphasis on community outreach are factors that limit the inclusion of the approach. The inclusion of EF and SDH in university curricula in Colombia has primarily focused on increasing the knowledge of various subjects oriented towards understanding the social dynamics or comprehensiveness of health and disease and, in some programmes, through practical courses in community health and PHC. Increased integration of EF and SDH in subjects or modules with clinical orientation is recommended. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Implementation of a web-based national child health-care programme in a local context: A complex facilitator role.

    Science.gov (United States)

    Tell, Johanna; Olander, Ewy; Anderberg, Peter; Berglund, Johan Sanmartin

    2018-02-01

    The aim of this study was to investigate child health-care coordinators' experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme 'Being a facilitator: a complex role' was formed to express the child health-care coordinators' experiences. Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.

  20. The personal value of being part of a Tropical Health Education Trust (THET) links programme to develop a palliative care degree programme in Sub Saharan Africa: a descriptive study of the views of volunteer UK health care professionals.

    Science.gov (United States)

    Jack, B A; Kirton, J A; Downing, J; Frame, K

    2015-12-14

    There is a global need to expand palliative care services to reach the increasing number requiring end of life care. In developing countries where the incidences of cancer are rising there is an urgent need to develop the palliative care workforce. This paper reports on a UK Department for international development (DFID) initiative funded through the Tropical Health Education Trust (THET) where palliative care staff, both clinical and academic, volunteered to help to develop, support and deliver a degree in palliative care in sub-Saharan Africa. The objective of the study was to explore the personal impact on the health care professionals of being part of this initiative. An evaluation approach using a confidential electronic survey containing quantitative and qualitative questions was distributed to all 17 volunteers on the programme, three months after completion of the first cohort. Data were analysed using descriptive statistics and content thematic analysis. Ethical review deemed the study to be service evaluation. 82 % (14) responded and several themes emerged from the data including the positive impact on teaching and educational skills; clinical practice and finally personal development. Using a score of 1-10 (1-no impact, 10 maximum impact) 'Lifestyle choices - life work balance' (rating 7.83) had the most impact. This approach to supporting the development of palliative care in Sub-Saharan Africa through skill sharing in supporting the delivery of a degree programme in palliative care was successful in terms of delivery of the degree programme, material development and mentorship of local staff. Additionally, this study shows it provided a range of positive impacts on the volunteer health care professionals from the UK. Professional impacts including increased management skills, and being better prepared to undertake a senior role. However it is the personal impact including lifestyle choices which the volunteers reported as the highest impact

  1. Linking research to practice: the organisation and implementation of The Netherlands health and social care improvement programmes

    NARCIS (Netherlands)

    Ovretveit, John; Klazinga, Niek

    2013-01-01

    Both public and private health and social care services are facing increased and changing demands to improve quality and reduce costs. To enable local services to respond to these demands, governments and other organisations have established large scale improvement programmes. These usually seek to

  2. Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Programme for providing innovative mental health care in rural communities in India

    OpenAIRE

    Maulik, P. K.; Devarapalli, S.; Kallakuri, S.; Praveen, D.; Jha, V.; Patel, A.

    2015-01-01

    Background. India has few mental health professionals to treat the large number of people suffering from mental disorders. Rural areas are particularly disadvantaged due to lack of trained health workers. Ways to improve care could be by training village health workers in basic mental health care, and by using innovative methods of service delivery. The ongoing Systematic Medical Appraisal, Referral and Treatment Mental Health Programme will assess the acceptability, feasibility and prelimina...

  3. From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care.

    Science.gov (United States)

    Harnagea, Hermina; Lamothe, Lise; Couturier, Yves; Esfandiari, Shahrokh; Voyer, René; Charbonneau, Anne; Emami, Elham

    2018-02-15

    Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training non-dental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector.

  4. A pilot training programme for health and social care professionals providing oncological and palliative care to lesbian, gay and bisexual patients in Ireland.

    LENUS (Irish Health Repository)

    Reygan, Finn C G

    2012-05-09

    OBJECTIVE: The international literature points to the specific cancer risks and palliative care needs of lesbian, gay and bisexual (LGB) populations. However, with the exception of a programme in the USA, there is a lack of training internationally for health and social care professionals providing oncological and palliative care to LGB patients. In Ireland, a training project funded by the Irish Cancer Society, the Irish Hospice Foundation and the Health Service Executive developed a training pilot programme for health and social care professionals providing oncological and palliative care to LGB patients. METHODS: Over 200 (N = 201) oncology and palliative care staff participated in 17 brief, 50-min trainings in pilot sites. Evaluation of the training included self-report questionnaires at the end of each training and an evaluation interview with one participant from each of the four sites. RESULTS: The majority of participants reported that they would recommend the training to their colleagues, were interested in further training in the area and found the training useful for their practice. They also reported becoming more familiar with LGB-related language and terminology, became more knowledgeable of LGB health issues and reported becoming more confident in providing care to LGB patients. CONCLUSIONS: Recommendations are that the training be made available across the health services in Ireland and included in postgraduate courses for trainee health and social care professionals. Copyright © 2012 John Wiley & Sons, Ltd.

  5. Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions.

    Science.gov (United States)

    Solberg, Hilde Strøm; Steinsbekk, Aslak; Solbjør, Marit; Granbo, Randi; Garåsen, Helge

    2014-11-08

    Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users' and health professionals' perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients' every-day life situations. The user informants' perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring

  6. Integration of antenatal care services with health programmes in low– and middle– income countries: systematic review

    Directory of Open Access Journals (Sweden)

    Thyra E de Jongh

    2016-06-01

    Full Text Available Antenatal care (ANC presents a potentially valuable platform for integrated delivery of additional health services for pregnant women–services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low– and middle–income countries (LMICs. However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs.

  7. A leadership programme for critical care.

    Science.gov (United States)

    Crofts, Linda

    2006-08-01

    This paper describes the genesis, design and implementation of a leadership programme for critical care. This was an initiative funded by the National Health Service (NHS) Nursing Leadership Project and had at the core of its design flexibility to meet the needs of the individual hospitals, which took part in it. Participation was from the multi-disciplinary critical care team. Six NHS hospitals took part in the programme which was of 20 days duration and took place on hospital sites. The programme used the leadership model of as its template and had a number of distinct components; a baseline assessment, personal development, principles of leadership and critical case reviews. The programme was underpinned by three themes; working effectively in multi-professional teams to provide patient focussed care, managing change through effective leadership and developing the virtual critical care service. Each group set objectives pertinent to their own organisation's needs. The programme was evaluated by a self-reporting questionnaire; group feedback and feedback from stakeholders. Programme evaluation was positive from all the hospitals but it was clear that the impact of the programme varied considerably between the groups who took part. It was noted that there was some correlation between the success of the programme and organisational 'buy in' as well as the organisational culture within which the participants operated. A key feature of the programme success was the critical case reviews, which were considered to be a powerful learning tool and medium for group learning and change management.

  8. Health effects of the Chernobyl accident and special health care programmes. Report of the UN Chernobyl Forum Expert Group 'Health'

    International Nuclear Information System (INIS)

    Bennett, B.; Repacholi, M.; Carr, Z.

    2006-01-01

    Twenty years have passed since the worst nuclear reactor accident in the world occurred at the Chernobyl nuclear power plant in Ukraine. The radioactive contamination which resulted from the explosion and fire in the first few days spread over large areas of neighbouring Belarus and the Russian Federation, with most of the fallout in Belarus. While national and local authorities did not immediately disclose the scale of the accident, the mitigation measures, such as distribution of potassium iodine pills, food restriction, and mass evacuation from areas where the radioactive contamination was greatest, undoubtedly reduced the health impact of the radiation exposure and saved many lives. The accident caused severe social and economic disruption and had significant environmental and health impact. This was aggravated by the political and economical changes in the three affected states related to the break-down of the Soviet Union. In the aftermath of the accident the international scientific and medical community collaborated closely with national experts dealing with health effects of the accident in the affected countries. There is a substantial body of international collaborative projects on the situation, which should lead to advancement in radiation sciences. However, considerable speculation and disinformation remains about the possible health impact of the accident for the millions of affected people. To address the health, environmental and socioeconomic consequences of the Chernobyl accident, the United Nations in 2003 launched an Inter-Agency initiative, the Chernobyl Forum. The Forum's Secretariat, led by the International Atomic Energy Agency (IAEA), the World Health Organization (WHO), the United Nations Development Programme (UNDP), and several other international organizations collaborated with the governments of the affected countries. The purpose of the Chernobyl Forum was to review the consequences of the accident, issue technical reports and, based

  9. Effectiveness of an NGO primary health care programme in rural Bangladesh: evidence from the management information system.

    Science.gov (United States)

    Mercer, Alec; Khan, Mobarak Hossain; Daulatuzzaman, Muhammad; Reid, Joanna

    2004-07-01

    This paper considers evidence of the effectiveness of a non-governmental organization (NGO) primary health care programme in rural Bangladesh. It is based on data from the programme's management information system reported by 27 partner NGOs from 1996-2002. The data indicate relatively high coverage has been achieved for reproductive and child health services, as well as lower infant and child mortality. On the basis of a crude indicator of socio-economic status, the programme is poverty-focused. There is good service coverage among the poorest one-third and others, and the infant and child mortality differential has been eliminated over recent years. A rapid decline in infant mortality among the poorest from 1999-2002 reflects a reduction in neonatal mortality of about 50%. Allowing for some under-reporting and possible misclassification of deaths to the stillbirths category, neonatal mortality is relatively low in the NGO areas. The lower child and maternal mortality for the NGO areas combined, compared with estimates for Bangladesh in recent years, may at least in part be due to high coverage of reproductive and child health services. Other development programmes implemented by many of the NGOs could also have contributed. Despite the limited resources available, and the lower infant and child mortality already achieved, there appears to be scope for further prevention of deaths, particularly those due to birth asphyxia, acute respiratory infection, diarrhoeal disease and accidents. Maternal mortality in the NGO areas was lower in 2000-02 than the most recent estimate for Bangladesh. Further reduction is likely to depend on improved access to qualified community midwives and essential obstetric care at government referral facilities.

  10. Prison mental health in-reach teams in England: the care programme approach and sexual abuse/violence.

    Science.gov (United States)

    Brooker, Charles G D; Forrester, Andrew

    2017-12-01

    Prison mental health in-reach teams have doubled in size over the past decade and case-loads have reduced. Since 2010 it has been mandatory for keyworkers to ask whether prisoners with serious mental illness being treated under the care programme approach have experienced sexual or physical abuse. This is known as routine enquiry and should take place for these prisoners but NHS England, the commissioners, do not audit this activity. It is time to review current interventions and their associated outcomes. © The Royal College of Psychiatrists 2017.

  11. Knowledge and implementation of the National Malaria Control Programme among health-care workers in primary health-care centers in Ogun State, Nigeria

    Directory of Open Access Journals (Sweden)

    Temitope Wunmi Ladi-Akinyemi

    2018-01-01

    Full Text Available Background: Lack of capacity to implement programs effectively and low public education about malaria is some of the factors that Nigeria governments must address to effectively combat malaria. Methods: This descriptive cross-sectional study assessed the knowledge and implementation of the National Malaria Control Programme (NMCP among health-care workers in the primary health-care centers in Ogun state. Three hundred and twenty-five respondents were recruited into the study using cluster sampling method. A pretested self-administered questionnaire was used to collect necessary information. Analysis and statistical calculation was done using SPSS version 20.0. Relationships between categorical variables were tested using Chi-square test with P value at 0.05. Results: One hundred and twenty-five (38.5% of the respondents were from Ado-odo/Ota local government areas (LGAs, 120 (36.9% of the respondents were from Ijebu-ode LGA and 80 (24.6% were from Ewekoro LGA. About 37.8% of the respondents were within age range of 45–54 years, with mean of 41.7 ± 8.5. Over 90% of the respondents knew the mode of transmission of malaria, <50% of them could identified case definition of simple and complicated malaria. Large percentage of the respondents knew the signs and symptoms of simple malaria. The respondents who were older (P = 0.004 with more than 15-year work experience (P = 0.006 had good knowledge score of the NMCP. Conclusion: Knowledge and implementation of NMCP by health-care workers in some of the LGAs in this study was inadequate. Regular visit to the health facilities, especially those in the remote areas by the staff of malaria control unit were recommended.

  12. The National Accreditation Board for Hospital and Health Care Providers accreditation programme in India.

    Science.gov (United States)

    Gyani, Girdhar J; Krishnamurthy, B

    2014-01-01

    Quality in health care is important as it is directly linked with patient safety. Quality as we know is driven either by regulation or by market demand. Regulation in most developing countries has not been effective, as there is shortage of health care providers and governments have to be flexible. In such circumstances, quality has taken a back seat. Accreditation symbolizes the framework for quality governance of a hospital and is based on optimum standards. Not only is India establishing numerous state of the art hospitals, but they are also experiencing an increase in demand for quality as well as medical tourism. India launched its own accreditation system in 2006, conforming to standards accredited by ISQua. This article shows the journey to accreditation in India and describes the problems encountered by hospitals as well as the benefits it has generated for the industry and patients.

  13. Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Programme for providing innovative mental health care in rural communities in India.

    Science.gov (United States)

    Maulik, P K; Devarapalli, S; Kallakuri, S; Praveen, D; Jha, V; Patel, A

    2015-01-01

    India has few mental health professionals to treat the large number of people suffering from mental disorders. Rural areas are particularly disadvantaged due to lack of trained health workers. Ways to improve care could be by training village health workers in basic mental health care, and by using innovative methods of service delivery. The ongoing Systematic Medical Appraisal, Referral and Treatment Mental Health Programme will assess the acceptability, feasibility and preliminary effectiveness of a task-shifting mobile-based intervention using mixed methods, in rural Andhra Pradesh, India. The key components of the study are an anti-stigma campaign followed by a mobile-based mental health services intervention. The study will be done across two sites in rural areas, with intervention periods of 1 year and 3 months, respectively. The programme uses a mobile-based clinical decision support tool to be used by non-physician health workers and primary care physicians to screen, diagnose and manage individuals suffering from depression, suicidal risk and emotional stress. The key aim of the study will be to assess any changes in mental health services use among those screened positive following the intervention. A number of other outcomes will also be assessed using mixed methods, specifically focussed on reduction of stigma, increase in mental health awareness and other process indicators. This project addresses a number of objectives as outlined in the Mental Health Action Plan of World Health Organization and India's National Mental Health Programme and Policy. If successful, the next phase will involve design and conduct of a cluster randomised controlled trial.

  14. Contribution of the education of the prospective fathers to the success of maternal health care programme.

    OpenAIRE

    Bhalerao V; Galwankar M; Kowli S; Kumar R; Chaturvedi R

    1984-01-01

    The role of involving prospective fathers in the care of pregnant women attending the Mother Craft Clinic of the Malavani Health Center in Bombay, India was evaluated. Beginning in October 1982, pregnant women attending the Clinic were requested to ask their husands to meet the resident medical officer of the center who was available on the premises of the Center on all days and evenings including the holidays. 1 of the medico-social workers explained to the women the reason and the need fo...

  15. The benefits and costs of a master's programme in primary health care: a cross-sectional postal survey.

    Science.gov (United States)

    Tsimtsiou, Zoi; Sidhu, Kalwant; Jones, Roger

    2010-11-01

    Master's programmes can provide continuing professional development, equipping GPs to teach, research, and lead general practice. A previous evaluation of the MSc in primary health care found that graduates were contributing significantly to the discipline of general practice. Given the changes in general practice over the last 10 years, it was considered useful to investigate longer-term outcomes. To assess the benefits GPs have derived from the MSc in terms of the intended learning outcomes and their own plans for involvement in research and teaching. A cross-sectional survey using a postal questionnaire. Department of Primary Care and Public Health Sciences, King's College London. A postal questionnaire was sent to the graduates of MSc in primary health care from 1997 until 2008. A total of 50 completed questionnaires were returned (response rate 76%). After graduation, 22 GPs had completed another degree or diploma and 21 had work accepted for publication, resulting in 74 papers. Nine held academic posts at lecturer or senior lecturer level, 21 were GP trainers, and 21 undergraduate teachers. Twenty-five GPs held more than one teaching-related post. The majority of the graduates confirmed the attainment of the MSc's intended outcomes. Positive influences of the MSc were identified, including career development, personal development, and job satisfaction. Graduates reported a number of benefits to themselves, their practices, and their patients. As the requirements for continuing professional development of GPs become more stringent, and with the advent of revalidation, the current ad hoc approach to career development in general practice is becoming unsustainable. To enhance its credibility as an academic discipline, general practice must continue to develop its capacity for research and scholarship. Master's programmes are likely to have an important role in supporting professional development in general practice in the future.

  16. Primary care in the village. An approach to village self-help health programmes.

    Science.gov (United States)

    Suyadi, A; Sadjimin, T; Rohde, J E

    1977-07-01

    The health clinic run in Kalirandu, Indonesia, by Foster Parents Plan, a private philanthropic welfare organization is described. In 1974 the Plan was serving 3000 families through 4 clinics, providing general curative services, pre- and postnatal services, family planning, dental care, and referral to the local urban hospital where needed. Each clinic treated about 100 patients per day at a cost of $1 per client family per month. However, few inocculations were given and few preventive health checks were requested. When the number of Plan families grew to 9500 while the population of the served communities grew to 400,000 with no increase in clinic budget, a different approach was tried. Instead of serving only the families helped direactly by the Plan, a total community service was developed. Plan personnel began to encourage use of the government health clinics. A rural health insurance system was developed which entitles the families to preventive health services. Plan medical staff and the local health center trained volunteers from Kalirandu in the use of a few simple medicines. The volunteers were selected by the village headmen and generally have elementary school education and a position of responsibility. This health "kader" works without payment and has 10-15 families living near him for whom he is responsible. At the time of writing there were over 500 kaders trained. Inservice courses are conducted to keep them up-to-date. An acceptors club was formed to motivate use of family planning. Seeking a more active role in village life, the acceptors club then took on child nutrition as a project, weighing children and reminding mothers of inoculations. The self-help momentum is spreading to housing and better farming practices, which is providing more vegetable gardens and better sources of Vitamin A. It is emphasized that this type of group responsibility cannot be imposed from outside. It is community leaders within that provide the motivation for self

  17. [Oral health hygiene education programme for nursing personnel to improve oral health of residents in long-term care facilities 2010 in Frankfurt/Main, Germany].

    Science.gov (United States)

    Czarkowski, G; Allroggen, S; Köster-Schmidt, A; Bausback-Schomakers, S; Frank, M; Heudorf, U

    2013-06-01

    Many studies have shown the urgent need for improving oral health hygiene in nursing home residents. Deficits in the knowledge of the personnel about dental and oral hygiene are often cited as one of the causes. Therefore, an oral health education programme was provided to the personnel of 20 nursing homes in Frankfurt/Main. Here the results of the assessment of the impact of the education programme on knowledge and attitudes of the personnel as well as on oral health of the residents are presented. In May/June 2010, 471 nurses in 20 nursing homes in the Frankfurt/Main, Germany, received a two-hour education programme on oral health. The lessons were held by dentists with special education in geriatric dentistry. The personnel were asked to complete a questionnaire regarding knowledge and attitudes on oral health care before the education programme and 4-6 months afterwards. The oral health status of 313 residents (i. e., about 10% of the total residents) was examined by two dentists. Before and 4-6 months after education of the caregivers, the following data were recorded in the residents: number of teeth, caries, plaque index (PI), sulcus bleeding index (SBI), community periodontal index of treatment needs (CPITN) and denture hygiene index (DHI). By attending the lessons, good improvements in knowledge of the caregivers could be obtained. The education programme was rated as very good/good by 85% of the nurses, having reduced their fear of oral care in the seniors and having gained more competence in practical oral hygiene procedures. Mean age of the residents was 80±13 years. About 32% of the residents were edentulous. Teeth were carious in 53% of the residents. Initially, one half of the residents exhibited plaque index>2, in 29% of the residents a severe and in 59% of them a very severe parodontitis was found (CPITN 3 or, respectively, 4). At 4-6 months after the education programme, an improvement in oral and dental hygiene of the residents could be

  18. Prison mental health in-reach teams, serious mental illness and the Care Programme Approach in England.

    Science.gov (United States)

    Brooker, Charlie; Webster, Russell

    2017-08-01

    The delivery of prison mental health services in England is examined over the last 12 years. Resources for services have grown significantly during this period and improved organisational models for the delivery of services are now in place. During this period however the challenges of working in the prison environment have increased. The paper argues that a history of sexual abuse or violence are common amongst prisoners and the Care Programme Approach (CPA) provides the vehicle to assess these histories through the use of routine enquiry. Commissioners of prison mental health services now need to ensure that teams are delivering cogent trauma-based interventions where relevant and the outcomes are measured. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  19. Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: a systematic review.

    Science.gov (United States)

    Ahmad Sharoni, Siti Khuzaimah; Minhat, Halimatus Sakdiah; Mohd Zulkefli, Nor Afiah; Baharom, Anisah

    2016-09-01

    To assess the effectiveness of health education programmes to improve foot self-care practices and foot problems among older people with diabetes. The complications of diabetes among older people are a major health concern. Foot problems such as neuropathy, ulcer and ultimately amputation are a great burden on older people with diabetes. Diabetes foot education programmes can influence the behaviour of older people in practising foot self-care and controlling the foot problems. However, the educational approaches used by the educators are different. Therefore, it is important to assess the education programmes from various evidence-based practices. Six databases, EBSCOhost medical collections (MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection), SAGE, Wiley Online Library, ScienceDirect, SpringerLink and Web of Science, were used to search for articles published from January 2000 to March 2015. The search was based on the inclusion criteria and keywords including 'foot', 'care' and 'diabetes'. Fourteen studies were assessed and reviewed in the final stage. Health education programmes varied according to their design, setting, approach, outcome measured and results. Foot assessment, verbal and written instructions and discussion were proved to improve the foot self-care and foot problems. Subsequent follow-ups and evaluations had a significant effect. An improvement was observed in foot self-care scores and foot problems (such as neuropathy, foot disability, lesion, ulcer, tinea pedis and callus grade) after implementation of the health education programme. The findings of this study support the claim that a health education programme increases the foot self-care scores and reduces the foot problems. However, there were certain methodological concerns in the reviewed articles, indicating the need for further evaluation. In future, researchers and practitioners must implement a vigorous education programme focusing on diabetes foot self-care among the

  20. Contribution of the education of the prospective fathers to the success of maternal health care programme.

    Science.gov (United States)

    Bhalerao, V R; Galwankar, M; Kowli, S S; Kumar, R; Chaturvedi, R M

    1984-01-01

    The role of involving prospective fathers in the care of pregnant women attending the Mother Craft Clinic of the Malavani Health Center in Bombay, India was evaluated. Beginning in October 1982, pregnant women attending the Clinic were requested to ask their husands to meet the resident medical officer of the center who was available on the premises of the Center on all days and evenings including the holidays. 1 of the medico-social workers explained to the women the reason and the need for their husbands coming and meeting the doctor at the Center. The outcome of the maternal health care program for the 270 women whose husbands were invited and came (Group 1) was compared with the outcome of the same program, under the same roof, for 405 women whose husbands could not be invited (Group 2). The husbands who attended the center were educated individually and in groups about their role in nutrition and health of their wives during pregnancy and their responsibility in subsequent child rearing. The physiology of pregnancy, complications of pregnancy, and the possible ways and means of preventing the complications were explained in detail. The husbands were also told to encourage their wives to attend the antenatal clinic of the center as often as possible. There was no difference in the socioeconomic, educational, cultural, and religious background of the 2 groups of women who were similar in parity distribution. The main difference between the 2 groups was a significantly lower perinatal mortality in Group 1. Only 60 of the 405 Group 2 women were considered eligible for postpartum sterilization (para 3 and higher). In contrast, 41 of the 270 Group 1 women were considered eligible for postpartum sterilization and 110 women accepted. The excess of those who accepted over those who were eligible came form the lower paras. This effort confirms that the involvement of prospective fathers is possible and pays good dividends even in an uneducated and low socioeconomic

  1. [Dynamics of interdisciplinary around a health care network: simultaneous programme design and evaluation planning].

    Science.gov (United States)

    Bocquet, H; Mantovani, J; Raffy, C; Cayla, F; Clément, S

    2005-12-01

    This article reports on the evaluation experience of a multiple sclerosis care network in the Midi-Pyrénées region (MIPSEP). It shows how an evaluation team composed of public health doctors and sociologists progressively and naturally evolved from having a purely external observation role towards having a collaborative role actively working with the network's members and partners. A qualitative method was chosen for the data collection through interviews with the network's actors, and the frameworks for reference were constituted from official texts which defined the networks and their missions. Coming from a curative and healing culture, the network's actors were concerned primarily about how to organise themselves in order to better respond to the needs expressed by the patients. The various professional backgrounds and cultures, faced with different perspectives from innovation and confronted with the related difficulties, participated in a collective expertise exercise and collaborated in the construction process. This example supports an open, qualitative, evolutionary evaluation approach which is done in close proximity to the field and work on the ground. The study is timely given the current explosion of debate on evaluation methods. With a great deal of exchange and reflection on suitable tools and indicators as well as the respective roles of researchers, care givers and decision-makers, the results of this study advocate to favour multidisciplinary approaches, including opening up this process to funders and planning authorities rather than over-theorising about it, which only serves to enclose and paralyse a process that, on the contrary, should aim to be more inclusive. This could be a useful way to decompartmentalise and break down existing barriers within the health system.

  2. Development of a training programme for home health care workers to promote preventive activities focused on a healthy lifestyle : an intervention mapping approach

    NARCIS (Netherlands)

    Walters, Maaike E.; Dijkstra, Arie; de Winter, Andrea F.; Reijneveld, Sijmen A.

    2015-01-01

    Background: Lifestyle is an important aspect in maintaining good health in older adults, and home health care (HHC) workers can play an important role in promoting a healthy lifestyle. However, there is limited evidence in the literature regarding how to develop an effective training programme to

  3. Programme Biology - Health protection

    International Nuclear Information System (INIS)

    1975-01-01

    The scientific results for 1975, of the five-year Biology-Health Protection programme adopted in 1971, are presented in two volumes. In volume one, Research in Radiation Protection are developed exclusively, including the following topics: measurement and interpretation of radiation (dosimetry); transfer of radioactive nuclides in the constituents of the environment; hereditary effects of radiation; short-term effects (acute irradiation syndrome and its treatment); long-term effects and toxicology of radioactive elements. In volume, two Research on applications in Agriculture and Medicine are developed. It includes: mutagenesis; soil-plant relations; radiation analysis; food conservation; cell culture; radioentomology. Research on applications in Medicine include: Nuclear Medicine and Neutron Dosimetry

  4. Contribution of the education of the prospective fathers to the success of maternal health care programme.

    Directory of Open Access Journals (Sweden)

    Bhalerao V

    1984-01-01

    Full Text Available The role of involving prospective fathers in the care of pregnant women attending the Mother Craft Clinic of the Malavani Health Center in Bombay, India was evaluated. Beginning in October 1982, pregnant women attending the Clinic were requested to ask their husands to meet the resident medical officer of the center who was available on the premises of the Center on all days and evenings including the holidays. 1 of the medico-social workers explained to the women the reason and the need for their husbands coming and meeting the doctor at the Center. The outcome of the maternal health care program for the 270 women whose husbands were invited and came (Group 1 was compared with the outcome of the same program, under the same roof, for 405 women whose husbands could not be invited (Group 2. The husbands who attended the center were educated individually and in groups about their role in nutrition and health of their wives during pregnancy and their responsibility in subsequent child rearing. The physiology of pregnancy, complications of pregnancy, and the possible ways and means of preventing the complications were explained in detail. The husbands were also told to encourage their wives to attend the antenatal clinic of the center as often as possible. There was no difference in the socioeconomic, educational, cultural, and religious background of the 2 groups of women who were similar in parity distribution. The main difference between the 2 groups was a significantly lower perinatal mortality in Group 1. Only 60 of the 405 Group 2 women were considered eligible for postpartum sterilization (para 3 and higher. In contrast, 41 of the 270 Group 1 women were considered eligible for postpartum sterilization and 110 women accepted. The excess of those who accepted over those who were eligible came form the lower paras. This effort confirms that the involvement of prospective fathers is possible and pays good dividends even in an uneducated and low

  5. Impact of an alcohol misuse intervention for health care workers --2: Employee assistance programme utilization, on-the-job injuries, job loss and health services utilization.

    Science.gov (United States)

    Lapham, Sandra C; McMillan, Garnett; Gregory, Cindy

    2003-01-01

    We evaluated the effects of an enhanced substance misuse (SM) prevention/early intervention programme on referrals to an employee assistance programme, health care utilization rates, on-the-job injury rates and job termination rates among health care professionals employed in a managed care organization. The intervention was implemented at one site, with the remaining sites serving as the comparison group. Existing data from hospital databases were used to compare events occurring in the periods before and after initiation of the intervention. To account for baseline differences in age, gender and job class, logistic regression models produced adjusted means for events per employee month-at-risk. We found that employee assistance referrals and non-SM-related in-patient hospitalizations increased significantly post-intervention, while rates of total out-patient SM-related visits decreased at both the intervention and comparison sites post-intervention. There was a small, statistically significant decrease in the monthly rate (OR = 0.92) of non-SM out-patient utilization at the intervention site, once the intervention was in place. No differences potentially attributable to the intervention were detected in job turnover or injury rates. We conclude that, while the intervention did not appear to affect health care utilization for SM-related problems, it was associated with increased referrals for employee assistance.

  6. A needs analysis for a non-abusive intervention programme in the School of Health Care Sciences at the University of Pretoria

    OpenAIRE

    LO Fouché; R du Toit

    2006-01-01

    Due to feedback from students, student abuse during fieldwork, was brought to the attention of the researchers. The study aimed to determine whether a need for a nonabusive intervention programme (NIP) existed amongst the School of Health Care Science students at the University of Pretoria. All students enrolled at the School of Health Care Sciences completed a questionnaire. An overwhelming response indicated that the majority of students (95.85%) have a need for a non-abusive intervention p...

  7. Perceived self-efficacy, personality and bioethics before a heart rehabilitation programme in primary health care.

    Science.gov (United States)

    Madueño Caro, Antonio J; Mellado Fernández, Manuel Luis; Delgado Pacheco, Juana; Muñoz Ayllon, Marta; Pardos Lafarga, Manuel; Saez García, Laura

    There is a clear evidence of the benefit of cardiac rehabilitation after a cardiovascular event on patients' mood and perceived self-efficacy in terms of their own health care. Our aim is to define the correlation between mood-related variables, biotype and self-efficacy in this population. Descriptive study. The entire population of patients discharged from thecardiac rehabilitation unit over 12 months. Universal anthropometric and psychometric (general self-efficacy scale, Salamanca personality traits questionnaire, Hamilton anxiety scale and Beck depression inventory) variables are determined. Descriptive statistics and association between variables (correlation) is determined. This study involved 88 patients, response rate 92%. The average age was 53 years old, 80.23% were males. Descriptive statistics and Pearson correlations for the main dependent variable and associated variables is performed. Significant evidence is shown, self-efficacy is negatively correlated with anxiety (r=-0.4009) and depression (r=-0.4152), as well as dependent(r=-03 175) and impulsive (r=-0.4243) personality traits. Higher levels of anxiety positively correlate with endomorph biotype (r=0.3304), and depression-associated symptoms (r=0.2563). Age and gender do not correlate with self-perceived efficacy. Self-efficacy in the study population is correlated with personality traits, mood and body biotype. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  8. Requirements for laboratory animals in health programmes*

    OpenAIRE

    Held, J. R.

    1981-01-01

    Laboratory animals are essential for the successful execution of many health programmes. A wide variety of animal models is used in the worldwide efforts to improve the control of various diseases, and in the basic research needed to improve health care. Biomedical programmes require specially-bred animals reared under controlled conditions, with close attention given to such factors as physical environment, nutrition, microbiological status, and genetic background. The need for a regular sup...

  9. The National Institute of Health Research (NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC for Leicestershire, Northamptonshire and Rutland (LNR: a programme protocol

    Directory of Open Access Journals (Sweden)

    Brunskill Nigel

    2009-11-01

    Full Text Available Abstract Background In October 2008, the National Institute for Health Research launched nine new research projects to develop and investigate methods of translating research evidence into practice. Given the title Collaborations for Leadership in Applied Health Research and Care (CLAHRC, all involve collaboration between one or more universities and the local health service, but they are adopting different approaches to achieve translation. Methods The translation and implementation programme of this CLAHRC has been built around a pragmatic framework for undertaking research to address live concerns in the delivery of care, in partnership with the managers, practitioners, and patients of the provider organisations of the CLAHRC. Focused on long-term conditions, the constituent research themes are prevention, early detection, self-management, rehabilitation, and implementation. Individual studies have various designs, and include both randomised trials of new ways to deliver care and qualitative studies of, for example, means of identifying barriers to research translation. A mix of methods will be used to evaluate the CLAHRC as a whole, including use of public health indicators, social research methods, and health economics. Discussion This paper describes one of the nine collaborations, that of Leicestershire, Northamptonshire, and Rutland. Drawing a distinction between translation as an organising principle for healthcare providers and implementation as a discrete activity, this collaboration is built on a substantial programme of applied research intended to create both research generation and research use capacity in provider organisations. The collaboration in Leicestershire, Northamptonshire, and Rutland has potential to provide evidence on how partnerships between practitioners, patients, and researchers can improve the transfer of evidence into practice.

  10. Integration of comprehensive women's health programmes into health systems: cervical cancer prevention, care and control in Rwanda.

    Science.gov (United States)

    Binagwaho, Agnes; Ngabo, Fidele; Wagner, Claire M; Mugeni, Cathy; Gatera, Maurice; Nutt, Cameron T; Nsanzimana, Sabin

    2013-09-01

    Although it is highly preventable and treatable, cervical cancer is the most common and most deadly cancer among women in Rwanda. By mobilizing a diverse coalition of partnerships, Rwanda became the first country in Africa to develop and implement a national strategic plan for cervical cancer prevention, screening and treatment. Rwanda - a small, landlocked nation in East Africa with a population of 10.4 million - is well positioned to tackle a number of "high-burden" noncommunicable diseases. The country's integrated response to infectious diseases has resulted in steep declines in premature mortality over the past decade. In 2011-2012, Rwanda vaccinated 227,246 girls with all three doses of the human papillomavirus (HPV) vaccine. Among eligible girls, three-dose coverage rates of 93.2% and 96.6% were achieved in 2011 and 2012, respectively. The country has also initiated nationwide screening and treatment programmes that are based on visual inspection of the cervix with acetic acid, testing for HPV DNA, cryotherapy, the loop electrosurgical excision procedure and various advanced treatment options. Low-income countries should begin to address cervical cancer by integrating prevention, screening and treatment into routine women's health services. This requires political will, cross-sectoral collaboration and planning, innovative partnerships and robust monitoring and evaluation. With external support and adequate planning, high nationwide coverage rates for HPV vaccination and screening for cervical cancer can be achieved within a few years.

  11. Art, music, story: The evaluation of a person-centred arts in health programme in an acute care older persons' unit.

    Science.gov (United States)

    Ford, Karen; Tesch, Leigh; Dawborn, Jacqueline; Courtney-Pratt, Helen

    2018-06-01

    To evaluate the impact of an arts in health programme delivered by a specialised artist within an acute older person's unit. Acute hospitals must meet the increasingly complex needs of older people who experience multiple comorbidities, often including cognitive impairment, either directly related to their admission or longer term conditions, including dementia. A focus on physical illness, efficiency and tasks within an acute care environment can all divert attention from the psychosocial well-being of patients. This focus also decreases capacity for person-centred approaches that acknowledge and value the older person, their life story, relationships and the care context. The importance of arts for health and wellness, including responsiveness to individual need, is well established: however, there is little evidence about its effectiveness for older people in acute hospital settings. We report on a collaborative arts in health programme on an acute medical ward for older people. The qualitative study used collaborative enquiry underpinned by a constructivist approach to evaluate an arts programme that involved participatory art-making activities, customised music, song and illustration work, and enlivening the unit environment. Data sources included observation of art activities, semi-structured interviews with patients and family members, and focus groups with staff. Data were transcribed and thematically analysed using a line by line approach. The programme had positive impacts for the environment, patients, families and staff. The environment exhibited changes as a result of programme outputs; patients and families were engaged and enjoyed activities that aided recovery from illness; and staff also enjoyed activities and importantly learnt new ways of working with patients. An acute care arts in health programme is a carefully nuanced programme where the skills of the arts health worker are critical to success. Utilising such skill, continued focus on person

  12. 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…

  13. National infection prevention and control programmes: Endorsing quality of care.

    Science.gov (United States)

    Stempliuk, Valeska; Ramon-Pardo, Pilar; Holder, Reynaldo

    2014-01-01

    Core components Health care-associated infections (HAIs) are a major cause of morbidity and mortality. In addition to pain and suffering, HAIs increase the cost of health care and generates indirect costs from loss of productivity for patients and society as a whole. Since 2005, the Pan American Health Organization has provided support to countries for the assessment of their capacities in infection prevention and control (IPC). More than 130 hospitals in 18 countries were found to have poor IPC programmes. However, in the midst of many competing health priorities, IPC programmes are not high on the agenda of ministries of health, and the sustainability of national programmes is not viewed as a key point in making health care systems more consistent and trustworthy. Comprehensive IPC programmes will enable countries to reduce the mobility, mortality and cost of HAIs and improve quality of care. This paper addresses the relevance of national infection prevention and control (NIPC) programmes in promoting, supporting and reinforcing IPC interventions at the level of hospitals. A strong commitment from national health authorities in support of national IPC programmes is crucial to obtaining a steady decrease of HAIs, lowering health costs due to HAIs and ensuring safer care.

  14. A needs analysis for a non-abusive intervention programme in the School of Health Care Sciences at the University of Pretoria

    Directory of Open Access Journals (Sweden)

    LO Fouché

    2006-09-01

    Full Text Available Due to feedback from students, student abuse during fieldwork, was brought to the attention of the researchers. The study aimed to determine whether a need for a nonabusive intervention programme (NIP existed amongst the School of Health Care Science students at the University of Pretoria. All students enrolled at the School of Health Care Sciences completed a questionnaire. An overwhelming response indicated that the majority of students (95.85% have a need for a non-abusive intervention programme (NIP. A significant need was identified especially among Nursing-, Physiotherapy- and Radiography students, 2nd and 4,h year students, and within a psychiatric fieldwork setting. Two surprise findings were firstly, that students who have no history of abuse have a greater need for an intervention programme than students with a history of abuse. Secondly superiors in the field are responsible for the majority of abusive incidences reported by students. The implementation of a non-abusive intervention programme (NIP to help students handle abusive incidences effectively and humanely is strongly recommended.

  15. Construction of elderly identity within an education programme for care workers

    DEFF Research Database (Denmark)

    Jensen, Anne Winther

    , the paper focuses on how elderly identity is constructed within an adult basic education programme in the social and health care sector in Denmark. The programme being involved is for adults who would like to work in the social and health care sector at a basic level; the programme consists of theoretical...... an educational research project; however as the programme being studied is withinThe Basic Social and Health Education Programmes in Denmark, Elderly Identity is an important subtheme....

  16. Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study.

    Science.gov (United States)

    Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel; Vives-Cases, Carmen; Marchal, Bruno

    2015-06-09

    Despite the progress made on policies and programmes to strengthen primary health care teams' response to Intimate Partner Violence, the literature shows that encounters between women exposed to IPV and health-care providers are not always satisfactory, and a number of barriers that prevent individual health-care providers from responding to IPV have been identified. We carried out a realist case study, for which we developed and tested a programme theory that seeks to explain how, why and under which circumstances a primary health care team in Spain learned to respond to IPV. A realist case study design was chosen to allow for an in-depth exploration of the linkages between context, intervention, mechanisms and outcomes as they happen in their natural setting. The first author collected data at the primary health care center La Virgen (pseudonym) through the review of documents, observation and interviews with health systems' managers, team members, women patients, and members of external services. The quality of the IPV case management was assessed with the PREMIS tool. This study found that the health care team at La Virgen has managed 1) to engage a number of staff members in actively responding to IPV, 2) to establish good coordination, mutual support and continuous learning processes related to IPV, 3) to establish adequate internal referrals within La Virgen, and 4) to establish good coordination and referral systems with other services. Team and individual level factors have triggered the capacity and interest in creating spaces for team leaning, team work and therapeutic responses to IPV in La Virgen, although individual motivation strongly affected this mechanism. Regional interventions did not trigger individual and/ or team responses but legitimated the workings of motivated professionals. The primary health care team of La Virgen is involved in a continuous learning process, even as participation in the process varies between professionals. This

  17. Initial evaluation of the training programme for health care professionals on the use of Malaysian clinical practice guidelines for management of dementia.

    Science.gov (United States)

    Yusoff, S; Koh, C T; Mohd Aminuddin, M Y; Krishnasamy, M; Suhaila, M Z

    2013-09-01

    The Malaysian Clinical Practice Guidelines (CPG) for Management of Dementia (second edition) was launched in April 2010 by the Ministry of Health Malaysia. A training programme for the management of dementia, involving all categories of staff working at primary and secondary centres, was implemented to ensure that care delivery for people with dementia was in accordance with the guidelines. The study aimed to look into improving knowledge and understanding of dementia following training, and to evaluate the effectiveness of the training programme using a clinical audit indicator recommended in the guidelines. The study entailed 2 phases (at national and state levels). The first phase involved the CPG training programme run as a 1.5-day workshop, in which participants filled up pre- and post-workshop questionnaires. A second phase involved analysing all the referral letters to the memory clinic at the Hospital Sultan Ismail, Johor Bahru 1 year before and after the training programme. There was a significant improvement in knowledge about dementia and its management among the health care professionals following training. The mean percentage score for the pre-workshop test was 63% while for the post-workshop test it was 78%, giving a difference of 15%. Although there was an overall improvement in knowledge gain following training in both specialist and non-specialist groups, these differences were not statistically significant (t = 1.32; 95% confidence interval, -2.61 to 9.61; p = 0.25). The proportion of referrals with a possible diagnosis of dementia from primary clinic referrals to the memory clinic also increased from 18% to 44% after training. There was an overall improvement in the knowledge about dementia among the health care professionals following the training, which was reflected in the increase in referrals to the memory clinic. Although the initial results appeared to be promising, a multicentre study is warranted to conclude that the training had been

  18. Radon programmes and health marketing

    International Nuclear Information System (INIS)

    Fojtikova, I.; Rovenska, K.

    2011-01-01

    Being aware of negative health effects of radon exposure, many countries aim for the reduction of the radon exposure of their population. The Czech radon programme was commenced >20 y ago. Since then experts have gathered a lot of knowledge, necessary legislation has been enacted, tens of thousands of inhabitants have been offered free measurement and subsidy for the mitigation. Despite the effort, the effectiveness of the radon programme seems to be poor. Newly built houses still exhibit elevated radon concentrations and the number of houses mitigated is very low. Is it possible to enhance the effectivity of radon programme while keeping it on a voluntary basis? One possible way is to employ health marketing that draws together traditional marketing theories and science-based strategies to prevention. The potential of using marketing principles in communication and delivery of radon information will be discussed. (authors)

  19. Radon programmes and health marketing.

    Science.gov (United States)

    Fojtikova, Ivana; Rovenska, Katerina

    2011-05-01

    Being aware of negative health effects of radon exposure, many countries aim for the reduction of the radon exposure of their population. The Czech radon programme was commenced >20 y ago. Since then experts have gathered a lot of knowledge, necessary legislation has been enacted, tens of thousands of inhabitants have been offered free measurement and subsidy for the mitigation. Despite the effort, the effectiveness of the radon programme seems to be poor. Newly built houses still exhibit elevated radon concentrations and the number of houses mitigated is very low. Is it possible to enhance the effectivity of radon programme while keeping it on a voluntary basis? One possible way is to employ health marketing that draws together traditional marketing theories and science-based strategies to prevention. The potential of using marketing principles in communication and delivery of radon information will be discussed.

  20. Transparency in Health Programmes

    OpenAIRE

    Vian, Taryn

    2008-01-01

    Transparency is an important tool for good governance, helping to expose abusive practices including fraud, patronage, corruption, and other abuses of power. Increasing transparency can also enhance accountability by providing performance management information and exposing policies and procedures to oversight. This U4 Brief discusses the role of transparency in preventing corruption in the health sector.

  1. Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review.

    Science.gov (United States)

    de Jongh, Thyra E; Gurol-Urganci, Ipek; Allen, Elizabeth; Zhu, Nina Jiayue; Atun, Rifat

    2016-06-01

    Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women-services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs. Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non-integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle-Ottawa Scale, depending on the study design. Due to high heterogeneity no meta-analysis could be conducted. Results are presented narratively. 12 studies were included in the review. Limited evidence, with moderate- to high-risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services. The reported evidence is largely based on non-randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC.

  2. Refuah Shlema: a cross-cultural programme for promoting communication and health among Ethiopian immigrants in the primary health care setting in Israel: evidence and lessons learned from over a decade of implementation.

    Science.gov (United States)

    Levin-Zamir, Diane; Keret, Sandra; Yaakovson, Orit; Lev, Boaz; Kay, Calanit; Verber, Giora; Lieberman, Niki

    2011-03-01

    The Refuah Shlema programme was established to reduce health disparities, promote health literacy and health indicators of the Ethiopian immigrant community in Israel, and included: (i) integrating Ethiopian immigrant liaisons in primary care as inter-cultural mediators; (ii) in-service training of clinical staff to increase cultural awareness and sensitivity; and (iii) health education community activities. Qualitative and quantitative evidence showed improvements in: (i) clinic staff–patient relations; (ii) availability and accessibility of health services, and health system navigation without increasing service expenditure; (iii) perception of general well-being; and (iv) self-care practice with regards to chronic conditions. Evidence significantly contributed to sustaining the programme for over 13 years.

  3. Prevalence of transfusion-transmitted viral pathogens among health-care workers and risk mitigation programme in a paediatric tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Charu Nayyar

    2017-01-01

    Full Text Available The health-care workers (HCWs are at an occupational risk of exposure to blood-borne pathogens, mainly, HIV, hepatitis B virus (HBV and hepatitis C virus. HBV is currently the only blood-borne virus for which a vaccine is available. All health-care institutions must encourage the HCWs to undergo screening for blood-borne pathogens.

  4. Using workshops to develop theories of change in five low and middle income countries: lessons from the programme for improving mental health care (PRIME)

    Science.gov (United States)

    2014-01-01

    Background The Theory of Change (ToC) approach has been used to develop and evaluate complex health initiatives in a participatory way in high income countries. Little is known about its use to develop mental health care plans in low and middle income countries where mental health services remain inadequate. Aims ToC workshops were held as part of formative phase of the Programme for Improving Mental Health Care (PRIME) in order 1) to develop a structured logical and evidence-based ToC map as a basis for a mental health care plan in each district; (2) to contextualise the plans; and (3) to obtain stakeholder buy-in in Ethiopia, India, Nepal, South Africa and Uganda. This study describes the structure and facilitator’s experiences of ToC workshops. Methods The facilitators of the ToC workshops were interviewed and the interviews were recorded, transcribed and analysed together with process documentation from the workshops using a framework analysis approach. Results Thirteen workshops were held in the five PRIME countries at different levels of the health system. The ToC workshops achieved their stated goals with the contributions of different stakeholders. District health planners, mental health specialists, and researchers contributed the most to the development of the ToC while service providers provided detailed contextual information. Buy-in was achieved from all stakeholders but valued more from those in control of resources. Conclusions ToC workshops are a useful approach for developing ToCs as a basis for mental health care plans because they facilitate logical, evidence based and contextualised plans, while promoting stakeholder buy in. Because of the existing hierarchies within some health systems, strategies such as limiting the types of participants and stratifying the workshops can be used to ensure productive workshops. PMID:24808923

  5. Development of a training programme for home health care workers to promote preventive activities focused on a healthy lifestyle: an intervention mapping approach.

    Science.gov (United States)

    Walters, Maaike E; Dijkstra, Arie; de Winter, Andrea F; Reijneveld, Sijmen A

    2015-07-09

    Lifestyle is an important aspect in maintaining good health in older adults, and home health care (HHC) workers can play an important role in promoting a healthy lifestyle. However, there is limited evidence in the literature regarding how to develop an effective training programme to improve the physical activity level and fruit and vegetable consumption of older adults within a HHC setting. The aim of this paper is to describe how Intervention Mapping (IM) was used to develop a training programme to promote preventive activities of HHC workers relating to the physical activity and fruit and vegetable intake of older adults living at home. IM, a systematic theory and evidence-based approach was used to develop, implement and evaluate the training programme. This entailed a literature search, a survey, semi-structured interviews and consultation with HHC workers and various field experts, and a pilot training session. The determinants associated with the provision of preventive activities were identified, and an overview was created of those objectives, matching methods and practical applications that could influence these determinants. The performance objectives for the HHC workers were early detection and monitoring, promoting a healthy lifestyle, informing colleagues, continuing allocated preventive activities and referring to other experts and facilities. Findings were translated into a comprehensive training programme for HHC workers focused on motivating older adults to adopt and maintain a healthier lifestyle. IM was a useful tool in the development of a theory-based training programme to promote preventive activities by HHC workers relating to fruit and vegetable intake and physical activity of older adults.

  6. Childhood obesity management shifting from health care system to school system: intervention study of school-based weight management programme.

    Science.gov (United States)

    Lee, Albert; Ho, Mandy; Keung, Vera M W; Kwong, Amy C M

    2014-11-03

    Home and school environments conducive for unhealthy eating and physical inactivity are precursors of obesity. The aim of this study is evaluation of the effectiveness of a multi-component school-based weight management programme for overweight and obese primary school children via a home-school joint venture. This study made use of variety of behavioural modification strategies integrating into the Health Promoting School approach to promote healthy lifestyles. The participants were overweight and obese students aged between 8 and 12 from six participating schools. The interventions involved students attending ten 75 minutes after-school sessions and one 3-hour week-end session of practical interactive and fun activities on healthy eating and exercise, and meal plan together with parents and printed tailor-made management advices. Parents received an introductory seminar with 2 sets of specially designed exercise for their overweight children. The tools to measure bodyweight and fat percentage and standing height were bio-impedance body fat scale and a portable stadiometer. Self-administered questionnaire was used to measure knowledge, attitudes and behaviours. McNemar test was utilized to compare the proportions of behaviour changes within the same group to assess for the trends of changes. BMI z-score and body fat percentage of intervention participants at baseline, 4 month and 8 month were compared pair-wisely using tests of within subject contrasts in repeated measures ANOVA to assess for programme sustainability. Those students in the intervention group reduced their BMI z-score (-0.21, 95% CI -0.34 to -0.07, P = 0.003) and body fat (-2.67%, 95% CI -5.12 to -0.22, P = 0.033) compared to wait list control group with statistical significant, and the intervention group also had a significant reduction in BMI z-score (-0.06, 95% CI -0.11, -0.007, P = 0.028) and body fat (-1.71%, 95% CI, -3.44 to 0.02, P = 0.052) after a 4 month maintenance period. Improvement of

  7. Assessing the relationship between healthcare market competition and medical care quality under Taiwan's National Health Insurance programme.

    Science.gov (United States)

    Liao, Chih-Hsien; Lu, Ning; Tang, Chao-Hsiun; Chang, Hui-Chih; Huang, Kuo-Cherh

    2018-06-04

    There is still significant uncertainty as to whether market competition raises or lowers clinical quality in publicly funded healthcare systems. We attempted to assess the effects of market competition on inpatient care quality of stroke patients in a retrospective study of the universal single-payer health insurance system in Taiwan. In this 11-year population-based study, we conducted a pooled time-series cross-sectional analysis with a fixed-effects model and the Hausman test approach by utilizing two nationwide datasets: the National Health Insurance Research Database and the National Hospital and Services Survey in Taiwan. Patients who were admitted to a hospital for ischemic or hemorrhagic stroke were enrolled. After excluding patients with a previous history of stroke and those with different types of stroke, 247 379 ischemic and 79 741 hemorrhagic stroke patients were included in our analysis. Four outcome indicators were applied: the in-hospital mortality rate, 30-day post-operative complication rate, 14-day re-admission rate and 30-day re-admission rate. Market competition exerted a negative or negligible effect on the medical care quality of stroke patients. Compared to hospitals located in a highly competitive market, in-hospital mortality rates for hemorrhagic stroke patients were significantly lower in moderately (β = -0.05, P markets (β = -0.05, P market competition on the quality of care of ischemic stroke patients was insignificant. Simply fostering market competition might not achieve the objective of improving the quality of health care. Other health policy actions need to be contemplated.

  8. EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user-involved care planning.

    Science.gov (United States)

    Fraser, C; Grundy, A; Meade, O; Callaghan, P; Lovell, K

    2017-08-01

    alongside ongoing support and supervision. Mental health nurses (and other health professionals) will be better able to involve service users and carers in care planning. Service users and carers may feel more involved in care planning in future. Introduction Limited evidence exists on service user and carer perceptions of undertaking a training course for delivering care planning training to qualified mental health professionals. We know little about trainee motivations for engaging with such train the trainers courses, experiences of attending courses and trainees' subsequent experiences of codelivering training to health professionals, hence the current study. Aim To obtain participants' views on the suitability and acceptability of a training programme that aimed to prepare service users and carers to codeliver training to health professionals. Method Semi-structured interviews with nine service users and carers attending the training programme. Transcripts were analysed using inductive thematic analysis. Results Participants' reasons for attending training included skill development and making a difference to mental health practice. Course content was generally rated highly but may benefit from review and/or extension to allow the range of topics and resulting professional training programme to be covered in more depth. Trainees who delivered the care planning training reported a mix of expectations, support experiences, preparedness and personal impacts. Implications for Practice Mental health nurses are increasingly coproducing and delivering training with service users and carers. This study identifies possibilities and pitfalls in this endeavour, highlighting areas where user and carer involvement and support structures might be improved in order to fully realize the potential for involvement in training. © 2017 The Authors. Journal of Psychiatric and Mental Health Nursing Published by John Wiley & Sons Ltd.

  9. Integrating an infectious disease programme into the primary health care service: a retrospective analysis of Chagas disease community-based surveillance in Honduras.

    Science.gov (United States)

    Hashimoto, Ken; Zúniga, Concepción; Nakamura, Jiro; Hanada, Kyo

    2015-03-24

    Integration of disease-specific programmes into the primary health care (PHC) service has been attempted mostly in clinically oriented disease control such as HIV/AIDS and tuberculosis but rarely in vector control. Chagas disease is controlled principally by interventions against the triatomine vector. In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection. This paper retrospectively analyses the effects and process of integrating a Chagas disease vector surveillance system into health centres. We evaluated the effects of integration at six pilot sites in western Honduras during 2008-2011 on; surveillance performance; knowledge, attitude and practice in schoolchildren; reports of triatomine bug infestation and institutional response; and seroprevalence among children under 15 years of age. The process of integration of the surveillance system was analysed using the PRECEDE-PROCEED model for health programme planning. The model was employed to systematically determine influential and interactive factors which facilitated the integration process at different levels of the Ministry of Health and the community. Overall surveillance performance improved from 46 to 84 on a 100 point-scale. Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points. Seroprevalence declined from 3.4% to 0.4%. Health centres responded to the community bug reports by insecticide spraying. As key factors, the health centres had potential management capacity and influence over the inhabitants' behaviours and living environment directly and through community health volunteers. The National Chagas Programme played an essential role in facilitating changes with adequate distribution of responsibilities, participatory modelling, training and, evaluation and advocacy. We found that Chagas

  10. How Does Counselling in a Stationary Health Care Setting Affect the Attendance in a Standardised Sports Club Programme? Process Evaluation of a Quasi-Experimental Study

    Directory of Open Access Journals (Sweden)

    Sylvia Titze

    2018-01-01

    Full Text Available Actions in partnership across sectors is one principle for the promotion of health behaviours. The objective of this study was to describe the participation in a sports club-based exercise programme—named JACKPOT—following an intervention in a health care setting. Focus was given to the recruitment into JACKPOT, the attendance level, and whether the different programme elements were implemented as intented. The practicability of the project was also retrospectively rated. Participants were 238 inactive people (50% women between 30 and 65 years of age who attended a health resort. Of these, 77% were assigned to the intervention group (IG. The recruitment into the 12 JACKPOT sessions and the attendance levels were recorded via attendance lists. The implementation of the intervention standards was assessed with structured interviews and participatory observation. The Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2 tool served to rate the practicability of the project. Almost 50% of the IG subjects attended JACKPOT sessions at least once and 54% of the attenders visited ≥75% of the 12 sessions. Some of the programme elements were not delivered fully. The process evaluation results showed that the project worked in a real-world setting, and also uncovered potential reasons such as incomplete information delivery for the moderate recruitment and attendance level.

  11. Clinical Impact of a Pharmaceutical Care Programme Developed in a Family Health Unit: Results of a Pharmacist-Physician Collaboration in the Treatment of Hypertensive Patients

    Directory of Open Access Journals (Sweden)

    Mónica Condinho

    2016-07-01

    Full Text Available Introduction: The positive impact of pharmacist-physician collaborative care has been reported in the international literature, although examples of this impact are limited in Portugal. We aim to underline the clinical added value for hypertensive patients that results from pharmacist-physician collaborations. Methods: A community trial was conducted at a Portuguese family health unit for 19 months. The intervention group was randomly selected from the global records and members of the group received pharmaceutical care in addition to physician care. The comparison group received only physician care. Both groups were comparable at the beginning of the study. In the intervention group, we analysed the hypertensive patients to evaluate the impact of pharmacist-physician collaboration on the patients’ blood pressure levels. This evaluation was performed by comparing the obtained blood pressure levels with the levels at baseline and between the groups. Results: A total of 17 patients with hypertension were enrolled in the pharmaceutical care programme, 12 of whom were female. The mean age was 68.50±3.26 years and, on average, each patient consumed 6.06±0.93 medicinal products. Thirteen patients were uncontrolled. Compared with the baseline, the intervention group achieved mean reductions of 28.85±5.90 mmHg (p < 0.0005 and 11.23±2.75 mmHg (p < 0.005 in their systolic and diastolic blood pressure, respectively. Considering the comparison group, improvements of 18.63±6.44 mmHg (p = 0.011 in systolic blood pressure and 9.03±2.63 mmHg ( p < 0.005 in diastolic blood pressure were observed. Conclusion: Pharmacist-physician collaborative care adds clinical value to the typical physician care provided to hypertensive patients within the context of a Portuguese family health unit.

  12. Proceedings of the national seminar and awareness programme on applications of radioisotopes and radiation technology in industry and health care

    International Nuclear Information System (INIS)

    Durairaj, S.; Madan, V. K.

    2012-01-01

    The National Seminar and Awareness Program on Applications of Radioisotopes and Radiation Technology in Industry and Health care is an important national event to learn about the challenges in the development and proliferation of application of radioisotopes and radiation technologies, and in appreciation of the role of these technologies to the benefit of public at large. This program endeavors to disseminate knowledge about lesser known and widely applied technologies and send the right message to the people for their greater acceptance. Applications of radioisotopes and radiation technology in industry such as oil, gas, chemical, petrochemical, steel, mining, paper, mineral and automobile and health care such as non-invasive diagnosis and treatment of a range of important and common conditions like cancer and cardiovascular diseases and radiation processed polymer containing hydrogel for use for bum dressing, and medical and agricultural products sterilization, have seen a significant growth in our country in the last fifty years. The indigenous capacity for the development and utilization of these technologies must be further strengthened. Papers relevant to INIS are indexed separately

  13. Cost-effectiveness of a cardiovascular disease primary prevention programme in a primary health care setting. Results of the Polish part of the EUROACTION project.

    Science.gov (United States)

    Sović, Nevena; Pająk, Andrzej; Jankowski, Piotr; Duenas, Alejandra; Kawecka-Jaszcz, Kalina; Wolfshaut-Wolak, Renata; Stepaniak, Urszula; Kawalec, Paweł

    2013-01-01

    Well designed cardiovascular disease (CVD) prevention programmes appear to be generally applicable and effective in reducing exposure to risk factors and the incidence of disease. However, introducing them broadly into clinical practice would have a significant impact on the healthcare budget, and requires careful consideration. The purpose of this health economic analysis was to assess the potential cost-effectiveness of the model nurse-led, comprehensive CVD primary prevention programme which was prepared and introduced in the EUROACTION project, in high-risk patients in Poland. A Markov model was developed to assess the long-term costs of preventive intervention. The health states modelled were: event-free (all patients at the beginning of observation), stable angina first year, acute myocardial infarction, stable angina subsequent year, myocardial infarction subsequent year, CVD death, and other causes of death. Health benefits from the reduction in risk factors were estimated based on Framingham risk function assuming the probability of defined health states according to British registers. The time horizon of the analysis was ten years, and one Markov cycle length was one year. The analysis was prepared from the healthcare payer's perspective. A willingness to pay threshold of three gross domestic product (GDP) per capita / quality-adjusted life years (QALY) was used. Univariate sensitivity analysis was conducted. Results were presented as an incremental cost-effectiveness ratio (ICER) expressed as an incremental cost per QALY. In Poland, EUROACTION intervention resulted mainly in reductions in the prevalence of smoking (by 14%) and high blood pressure (by 7%). Intervention on other risk factors, including blood lipids, was found to be less effective. Estimated ICERs were 19,524 PLN for men and 82,262 PLN for women. The programme was even more cost-effective in smokers i.e. estimated ICERs were 12,377 PLN in men and 53,471 PLN in women. The results were most

  14. The effect of an e-learning supported Train-the-Trainer programme on implementation of suicide guidelines in mental health care.

    Science.gov (United States)

    de Beurs, Derek P; de Groot, Marieke H; de Keijser, Jos; Mokkenstorm, Jan; van Duijn, Erik; de Winter, Remco F P; Kerkhof, Ad J F M

    2015-04-01

    Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline. 45 psychiatric departments from all over the Netherlands were clustered in pairs and randomized. In the experimental condition, all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme. Guideline adherence of individual professionals was measured by means of the response to on-line video fragments. Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments. Multilevel analysis showed that the intervention resulted in an improvement of individual professionals. At the 3 month follow-up, professionals who received the intervention showed greater guideline adherence, improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination. Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists. No significant effect of the intervention on team performance was found. The ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey. This may have caused considerable drop-out and possibly introduced selection bias, as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study. Our results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients. Netherlands Trial Register (NTR3092 www.trialregister.nl). Copyright © 2015 The

  15. Developing an assessment in dental public health for clinical undergraduates attending a primary dental care outreach programme.

    Science.gov (United States)

    Holmes, R D; Waterhouse, P J; Maguire, A; Hind, V; Lloyd, J; Tabari, D; Lowry, R J

    2011-02-01

    This paper describes the development and implementation of a Dental Public Health (DPH) assessment within the Primary Dental Care Outreach (PDCO) course at Newcastle University. The assessment was piloted alongside the delivery of the Bachelor of Dental Surgery (BDS) curriculum in accordance with established learning outcomes. To design and implement a pilot summative assessment, incorporating patients' social histories obtained by undergraduate students attending primary dental care outreach clinics. Undergraduates were tasked with obtaining a detailed social history from a patient seen during their two-year outreach attachment. Each student submitted a written account of their patient's social history and placed this in context by researching a number of demographic and social variables centred upon their patient's home residence. The final component involved writing a concise case feature for a nominated newspaper based upon the case history, where students were encouraged to identify one or more public health messages using language appropriate to a lay readership. Seventy one clinical undergraduates (98.6% of the year-group) subsequently submitted all components of the assessment. Eighty six per cent of the year-group was deemed to have passed the assessment with 9.9% achieving a 'Merit' grade and 76% a 'Satisfactory' grade. Following the assessment, students and clinical teachers were asked for their feedback through a focus group for staff, and a brief feedback form for students. Undergraduates subsequently reported greater awareness of the significance and importance of obtaining a detailed social history and its relevance when devising appropriate and realistic treatment plans. © 2011 John Wiley & Sons A/S.

  16. Helping doctors in training to STEP-UP: A leadership and quality improvement programme in the Belfast Health and Social Care Trust.

    Science.gov (United States)

    Donaghy, Grainne; McKeever, Kris; Flanagan, Catherine; O'Kane, Donal; McQuillan, Bernie; Cash, Johnny; Jack, Cathy; Lundy, Claire

    2018-05-01

    Medical engagement in healthcare organisations can improve service development and patient experience. Doctors in training have limited opportunities to engage in service improvement work and develop leadership skills. We describe the Specialist Trainees Engaged in Leadership Programme (STEP) , a programme developed to introduce concepts of medical leadership and quality improvement skills in the Belfast Trust. STEP started in 2013 and over 140 trainees have now participated in the programme. Over 42 quality improvement projects have been completed with the support of the programme. Evaluation of STEP has demonstrated an improvement across all domains explored throughout the duration of the programme, with benefits for the individual trainee and the wider organisation. We describe the programme in detail. The STEP curriculum can easily be adapted to meet the needs of NHS trainees, allowing them to understand the objectives and strategy of their employers and improve their ability to plan and deliver safe, effective, patient-centred care.

  17. Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE) clinical guidelines programme: qualitative study.

    Science.gov (United States)

    Graham, Tanya; Alderson, Phil; Stokes, Tim

    2015-01-01

    There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs) are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence). Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE's guideline development centres and 6 chairs of guideline development groups (GDGs). We conducted a thematic analysis. Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take "on trust" the information they receive, certain types of COI (non-financial) are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills. We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice.

  18. Collaborative action around implementation in Collaborations for Leadership in Applied Health Research and Care: towards a programme theory.

    Science.gov (United States)

    Rycroft-Malone, Jo; Wilkinson, Joyce; Burton, Christopher R; Harvey, Gill; McCormack, Brendan; Graham, Ian; Staniszewska, Sophie

    2013-10-01

    In theory, greater interaction between researchers and practitioners should result in increased potential for implementation. However, we know little about whether this is the case, or what mechanisms might operate to make it happen. This paper reports findings from a study that is identifying and tracking implementation mechanisms, processes, influences and impacts in real time, over time in the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). This is a longitudinal, realist evaluation case study. The development of the conceptual framework and initial hypotheses involved literature reviewing and stakeholder consultation. Primary data were collected through interviews, observations and documents within three CLAHRCs, and analysed thematically against the framework and hypotheses. The first round of data collection shows that the mechanisms of collaborative action, relationship building, engagement, motivation, knowledge exchange and learning are important to the processes and outcomes of CLAHRCs' activity, including their capacity for implementation. These mechanisms operated in different contexts such as competing agendas, availability of resources and the CLAHRCs' brand. Contexts and mechanisms result in different impact, including the CLAHRCs' approach to implementation, quality of collaboration, commitment and ownership, and degree of sharing and managing knowledge. Emerging features of a middle range theory of implementation within collaboration include alignment in organizational structures and cognitive processes, history of partnerships, responsiveness and resilience in rapidly changing contexts. CLARHCs' potential to mobilize knowledge may be further realized by how they develop insights into their function as collaborative entities.

  19. Diffusion of a quality improvement programme among allied health professionals.

    NARCIS (Netherlands)

    Sluijs, E.M.; Dekker, J.

    1999-01-01

    Objective: To assess the diffusion of a quality improvement (QI) programme among allied health professions in The Netherlands. Design: Descriptive study, based on a questionnaire distributed to allied health professionals; response rate, 63%. Settings and participants: All subsectors in health care

  20. Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE clinical guidelines programme: qualitative study.

    Directory of Open Access Journals (Sweden)

    Tanya Graham

    Full Text Available There is international concern that conflicts of interest (COI may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence.Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE's guideline development centres and 6 chairs of guideline development groups (GDGs. We conducted a thematic analysis.Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take "on trust" the information they receive, certain types of COI (non-financial are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills.We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice.

  1. Perception of quality of care in HIV/AIDS programmes among patients in a tertiary health care facility in Anambra State.

    Science.gov (United States)

    Nwabueze, S A; Adogu, P O U; Ilika, A L; Asuzu, M C; Adinma, E D

    2011-01-01

    Continuous quality improvement is linked to the use of timely and useful feedback from clients in Human Immuno-deficiency Virus (HIV) care. HIV experts and care professionals agree that consumer involvement, such as patient satisfaction survey, is an essential part of HIV care and policy making today. The introduction ofAnti-Retroviral Treatment (ART) services in Nigeria has significantly impacted positively on the overall well being of People Living with HIV and Acquired Immune Deficiency Syndrome (PLWHA). However, there is little understanding of their satisfaction and perception of quality of care provided. Consequently, this study was carried out to assess patients' satisfaction with ambulatory HIV/AIDS care in a tertiary health facility in Anambra State. The study design is cross-sectional. A total of 150 patients from Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi were selected using systematic sampling technique from the daily AntiRetroviral (ARV) clinic register obtained from the medical records department of the centre. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 13. The mean age of the respondents was 38.3 +/- 9.1. Majority (50.7%) of the patients was married, and most of them (74.7%) were semi-skilled workers. There was a statistically significant difference in the numbers of those who spent >240 naira for transportation to the clinic, compared to those who spent 30 minutes are significantly larger than the number that spent 750 naira than those who spend <750 naira on non-HIV related laboratory (20 versus 9) tests. PLWHAs in this facility were least satisfied with access to care, while they expressed greatest satisfaction with good patient care and quality of service by staff. The overall satisfaction score of the subjects was 4.04 +/- 0.33. HIV patients' overall satisfaction with the services provided to them was quite high. Therefore, there is need to sustain the current

  2. Programme level implementation of malaria rapid diagnostic tests (RDTs) use: outcomes and cost of training health workers at lower level health care facilities in Uganda.

    Science.gov (United States)

    Kyabayinze, Daniel J; Asiimwe, Caroline; Nakanjako, Damalie; Nabakooza, Jane; Bajabaite, Moses; Strachan, Clare; Tibenderana, James K; Van Geetruyden, Jean Pierre

    2012-04-20

    The training of health workers in the use of malaria rapid diagnostic tests (RDTs) is an important component of a wider strategy to improve parasite-based malaria diagnosis at lower level health care facilities (LLHFs) where microscopy is not readily available for all patients with suspected malaria. This study describes the process and cost of training to attain competence of lower level health workers to perform malaria RDTs in a public health system setting in eastern Uganda. Health workers from 21 health facilities in Uganda were given a one-day central training on the use of RDTs in malaria case management, including practical skills on how to perform read and interpret the test results. Successful trainees subsequently integrated the use of RDTs into their routine care for febrile patients at their LLHFs and transferred their acquired skills to colleagues (cascade training model). A cross-sectional evaluation of the health workers' competence in performing RDTs was conducted six weeks following the training, incorporating observation, in-depth interviews with health workers and the review of health facility records relating to tests offered and antimalarial drug (AMD) prescriptions pre and post training. The direct costs relating to the training processes were also documented. Overall, 135 health workers were trained including 63 (47%) nursing assistants, a group of care providers without formal medical training. All trainees passed the post-training concordance test with ≥ 80% except 12 that required re-training. Six weeks after the one-day training, 51/64 (80%) of the health workers accurately performed the critical steps in performing the RDT. The performance was similar among the 10 (16%) participants who were peer-trained by their trained colleagues. Only 9 (14%) did not draw the appropriate amount of blood using pipette. The average cost of the one-day training was US$ 101 (range $92-$112), with the main cost drivers being trainee travel and per

  3. Programme level implementation of malaria rapid diagnostic tests (RDTs use: outcomes and cost of training health workers at lower level health care facilities in Uganda

    Directory of Open Access Journals (Sweden)

    Kyabayinze Daniel J

    2012-04-01

    Full Text Available Abstract Background The training of health workers in the use of malaria rapid diagnostic tests (RDTs is an important component of a wider strategy to improve parasite-based malaria diagnosis at lower level health care facilities (LLHFs where microscopy is not readily available for all patients with suspected malaria. This study describes the process and cost of training to attain competence of lower level health workers to perform malaria RDTs in a public health system setting in eastern Uganda. Methods Health workers from 21 health facilities in Uganda were given a one-day central training on the use of RDTs in malaria case management, including practical skills on how to perform read and interpret the test results. Successful trainees subsequently integrated the use of RDTs into their routine care for febrile patients at their LLHFs and transferred their acquired skills to colleagues (cascade training model. A cross-sectional evaluation of the health workers’ competence in performing RDTs was conducted six weeks following the training, incorporating observation, in-depth interviews with health workers and the review of health facility records relating to tests offered and antimalarial drug (AMD prescriptions pre and post training. The direct costs relating to the training processes were also documented. Results Overall, 135 health workers were trained including 63 (47% nursing assistants, a group of care providers without formal medical training. All trainees passed the post-training concordance test with ≥ 80% except 12 that required re-training. Six weeks after the one-day training, 51/64 (80% of the health workers accurately performed the critical steps in performing the RDT. The performance was similar among the 10 (16% participants who were peer-trained by their trained colleagues. Only 9 (14% did not draw the appropriate amount of blood using pipette. The average cost of the one-day training was US$ 101 (range $92-$112, with the

  4. Effect of a combined education and eHealth programme on the control of oral anticoagulation patients (PORTALS study): a parallel cohort design in Dutch primary care.

    Science.gov (United States)

    Talboom-Kamp, Esther P W A; Verdijk, Noortje A; Kasteleyn, Marise J; Harmans, Lara M; Talboom, Irvin J S H; Numans, Mattijs E; Chavannes, Niels H

    2017-09-27

    To analyse the effect on therapeutic control and self-management skills of the implementation of self-management programmes, including eHealth by e-learning versus group training. Primary Care Thrombosis Service Center. Of the 247 oral anticoagulation therapy (OAT) patients, 63 started self-management by e-learning, 74 self-management by group training and 110 received usual care. Parallel cohort design with two randomised self-management groups (e-learning and group training) and a group receiving usual care. The effect of implementation of self-management on time in therapeutic range (TTR) was analysed with multilevel linear regression modelling. Usage of a supporting eHealth platform and the impact on self-efficacy (Generalised Self-Efficacy Scale (GSES)) and education level were analysed with linear regression analysis. After intervention, TTR was measured in three time periods of 6 months. (1) TTR, severe complications,(2) usage of an eHealth platform,(3) GSES, education level. Analysis showed no significant differences in TTR between the three time periods (p=0.520), the three groups (p=0.460) or the groups over time (p=0.263). Comparison of e-learning and group training showed no significant differences in TTR between the time periods (p=0.614), the groups (p=0.460) or the groups over time (p=0.263). No association was found between GSES and TTR (p=0.717) or education level and TTR (p=0.107). No significant difference was found between the self-management groups in usage of the platform (0-6 months p=0.571; 6-12 months p=0.866; 12-18 months p=0.260). The percentage of complications was low in all groups (3.2%; 1.4%; 0%). No differences were found between OAT patients trained by e-learning or by a group course regarding therapeutic control (TTR) and usage of a supporting eHealth platform. The TTR was similar in self-management and regular care patients. With adequate e-learning or group training, self-management seems safe and reliable for a selected

  5. Radiation and nuclear safety included in the environmental health programme

    International Nuclear Information System (INIS)

    Salomaa, S.

    1996-01-01

    Finland is currently preparing a national environmental health programme, the objective of which is to chart the main environmental health problems in Finland, to identify means for securing a healthy environment, and to draw up a practical action programme for preventing and rectifying problems pertaining to environmental health. Radiation and nuclear safety form an essential part of preventive health care. The action programme is based on decisions and programmes approved at the WHO Conference on the Environment and Health, held in Helsinki in June 1994. In addition to the state of the Finnish environment and the health of the Finnish population, the programme addresses the relevant international issues, in particular in areas adjacent to Finland. The Committee on Environmental Health is expected to complete its work by the end of the year. A wide range of representatives from various branches of administration have contributed to the preparation of the programme. Besides physical, biological and chemical factors, the environmental factors affecting health also include the physical environment and the psychological, social and aesthetic features of the environment. Similarly, environmental factors that have an impact on the health of present or future generations, on the essential preconditions of life and on the quality of life are investigated. The serious risk to nature caused by human actions is also considered as a potential risk to human health. (orig.)

  6. Heart failure programmes in countries with a primary care-based health care system. Are additional trials necessary? Design of the DEAL-HF study

    NARCIS (Netherlands)

    de la Porte, PWFBA; Lok, DJA; van Wijngaarden, J; Cornel, JH; Pruijsers-Lamers, D; van Veldhuisen, DJ; Hoes, AW

    Background: Several randomised studies of heart failure (HF) management programmes in the United States, Australia and Europe have shown a considerable reduction in hospitalisation rates for HE In this article, a comprehensive review of these studies will be provided and their applicability to

  7. Health effects of the Chernobyl accident and special health care programmes. Report of the UN Chernobyl Forum Expert Group 'Health' (EGH). Working draft

    International Nuclear Information System (INIS)

    2005-01-01

    This report has been prepared by three WHO expert committees convened under auspices of the Chernobyl Forum's Expert Group 'Health' (EGH), and by WHO staff. It provides an updated assessment of the health consequences of the Chernobyl accident, and follows a detailed report on this topic published by the United Nations Scientific Committee on the Effects of Atomic Radiation in 2000 (UNSCEAR, 2000). The accident occurred at the Chernobyl nuclear power plant in northern Ukraine on April 26, 1986 and released large amounts of radioactivity, primarily radioactive isotopes of caesium and iodine. These releases contaminated large areas of Belarus, the Russian Federation and Ukraine and other countries to a lesser extent, These releases exposed sizable populations to internal and external radiation doses. The Chernobyl accident caused the deaths of 30 power plant employees and firemen within a few days or weeks (including 28 deaths that were due to radiation exposure). In addition, about 240,000 recovery operation workers (also called 'liquidators' or 'clean-up workers') were called upon in 1986 and 1987 to take part in major mitigation activities at the reactor and within the 30-km zone surrounding the reactor. Residual mitigation activities continued on a relatively large scale until 1990. All together, about 600,000 persons (civilian and military) have received special certificates confirming their status as liquidators, according to laws promulgated in Belarus, the Russian Federation, and Ukraine (UNSCEAR, 2000). In addition, massive releases of radioactive materials into the atmosphere brought about the evacuation of about 116,000 people from areas surrounding the reactor during 1986, and the relocation, after 1986, of about 220,000 people from what are at this time three independent republics of the former Soviet Union: Belarus, the Russian Federation, and Ukraine. Vast territories of those three republics were contaminated to a substantial level. The population of

  8. The effect of an e-learning supported Train-the-Trainer programme on implementation of suicide guidelines in mental health care.

    NARCIS (Netherlands)

    Beurs, D.P. de; Groot, M.H. de; Keijser, J. de; Mokkenstorm, J.; Duijn, E. van; Winter, R.F.P. de; Kerkhof, A.J.F.M.

    2015-01-01

    Background: Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary

  9. Studying policy implementation using a macro, meso and micro frame analysis: the case of the Collaboration for Leadership in Applied Health Research & Care (CLAHRC) programme nationally and in North West London.

    Science.gov (United States)

    Caldwell, Sarah E M; Mays, Nicholas

    2012-10-15

    The publication of Best research for best health in 2006 and the "ring-fencing" of health research funding in England marked the start of a period of change for health research governance and the structure of research funding in England. One response to bridging the 'second translational gap' between research knowledge and clinical practice was the establishment of nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). The goal of this paper is to assess how national-level understanding of the aims and objectives of the CLAHRCs translated into local implementation and practice in North West London. This study uses a variation of Goffman's frame analysis to trace the development of the initial national CLAHRC policy to its implementation at three levels. Data collection and analysis were qualitative through interviews, document analysis and embedded research. Analysis at the macro (national policy), meso (national programme) and micro (North West London) levels shows a significant common understanding of the aims and objectives of the policy and programme. Local level implementation in North West London was also consistent with these. The macro-meso-micro frame analysis is a useful way of studying the transition of a policy from high-level idea to programme in action. It could be used to identify differences at a local (micro) level in the implementation of multi-site programmes that would help understand differences in programme effectiveness.

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Immunization is a proven cost-effective ... immunization programme and control of Vaccine was conducted to assess the ..... HFs where emphasis is on profit maximization revealed that the widespread ... World Health Organization (WHO).

  11. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    care policy which was intended to make health care which of the two alternative methods of health care available to individuals and families in the financing options of free health or DRF was community at very little or no cost at all. However, preferred by the community members within most health facilities would appear to ...

  12. The effectiveness of a structured education pulmonary rehabilitation programme for improving the health status of people with moderate and severe chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial.

    Science.gov (United States)

    Casey, Dympna; Murphy, Kathy; Devane, Declan; Cooney, Adeline; McCarthy, Bernard; Mee, Lorraine; Newell, John; O'Shea, Eamon; Scarrott, Carl; Gillespie, Paddy; Kirwan, Collette; Murphy, Andrew W

    2013-10-01

    To evaluate the effectiveness of a structured education pulmonary rehabilitation programme on the health status of people with chronic obstructive pulmonary disease (COPD). Two-arm, cluster randomised controlled trial. 32 general practices in the Republic of Ireland. 350 participants with a diagnosis of moderate or severe COPD. Experimental group received a structured education pulmonary rehabilitation programme, delivered by the practice nurse and physiotherapist. Control group received usual care. Health status as measured by the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12-14 weeks postcompletion of the programme. Participants allocated to the intervention group had statistically significant higher mean change total CRQ scores (adjusted mean difference (MD) 1.11, 95% CI 0.35 to 1.87). However, the CI does not exclude a smaller difference than the one that was prespecified as clinically important. Participants allocated to the intervention group also had statistically significant higher mean CRQ Dyspnoea scores after intervention (adjusted MD 0.49, 95% CI 0.20 to 0.78) and CRQ Physical scores (adjusted MD 0.37, 95% CI 0.14 to 0.60). However, CIs for both the CRQ Dyspnoea and CRQ Physical subscales do not exclude smaller differences as prespecified as clinically important. No other statistically significant differences between groups were seen. A primary care based structured education pulmonary rehabilitation programme is feasible and may increase local accessibility to people with moderate and severe COPD. ISRCTN52403063.

  13. Physician education programme improves quality of diabetes care

    African Journals Online (AJOL)

    diabetes have been compiled and circulated to health care workers, but ... studied and attempted to improve the quality of diabetes care in primary care ..... project indicators in the Indian Health Service primary care setting. Diabetes Care ...

  14. African Primary Care Research: Performing a programme evaluation

    OpenAIRE

    Dudley, Lilian

    2014-01-01

    Abstract This article is part of a series on Primary Care Research in the African context and focuses on programme evaluation. Different types of programme evaluation are outlined: developmental, process, outcome and impact. Eight steps to follow in designing your programme evaluation are then described in some detail: engage stakeholders; establish what is known; describe the programme; define the evaluation and select a study design; define the indicators; plan and manage data collection an...

  15. Respiratory Home Health Care

    Science.gov (United States)

    ... Us Home > Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources ... Teenagers Living With Lung Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at ...

  16. ARUSHA SCHOOL DENTAL HEALTH PROGRAMME

    African Journals Online (AJOL)

    DENTAL HEALTH PROBLEMS. 1. Pain due to ... increased intake of sweets and sweet snacks, ... to restrain production, import and marketing of modern sweets ... STRATEGY .... water we drink and bathe In. They are always ready to heip us or ...

  17. 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

  18. Health for all children: a programme for health promotion.

    Science.gov (United States)

    Elliman, D A

    'The health of its children is the wealth of a nation.' For this reason a lot of time and energy is expended on preventive child health services, but with little evidence of effectiveness and great variation in programmes. Recently much has been done to rectify this. At the forefront of this work has been the multidisciplinary committee chaired by Professor Hall. Its third report, with its concentration on health promotion rather than 'defect detection', will form the basis for all future programmes.

  19. Developing consumer involvement in rural HIV primary care programmes.

    Science.gov (United States)

    Mamary, Edward M; Toevs, Kim; Burnworth, Karla B; Becker, Lin

    2004-06-01

    As part of a broader medical and psychosocial needs assessment in a rural region of northern California, USA, five focus groups were conducted to explore innovative approaches to creating a system of consumer involvement in the delivery of HIV primary care services in the region. A total of five focus groups (n = 30) were conducted with clients from three of five counties in the region with the highest number of HIV patients receiving primary care. Participants were recruited by their HIV case managers. They were adults living with HIV, who were receiving health care, and who resided in a rural mountain region of northern California. Group discussions explored ideas for new strategies and examined traditional methods of consumer involvement, considering ways they could be adapted for a rural environment. Recommendations for consumer involvement included a multi-method approach consisting of traditional written surveys, a formal advisory group, and monthly consumer led social support/informal input groups. Specific challenges discussed included winter weather conditions, transportation barriers, physical limitations, confidentiality concerns, and needs for social support and education. A multiple-method approach would ensure more comprehensive consumer involvement in the programme planning process. It is also evident that methods for incorporating consumer involvement must be adapted to the specific context and circumstances of a given programme.

  20. Effectiveness of the population-based Check your health preventive programme conducted in primary care with 4 years follow-up [the CORE trial]: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Maindal, Helle Terkildsen; Støvring, Henrik; Sandbaek, Annelli

    2014-08-29

    The periodic health check-up has been a fundamental part of routine medical practice for decades, despite a lack of consensus regarding its value in health promotion and disease prevention. A large-scale Danish population-based preventive programme 'Check your health' was developed based on available evidence of screening and successive accepted treatment, prevention for diseases and health promotion, and is closely aligned with the current health care system.The objective of the 'Check your health' [CORE] trial is to investigate effectiveness on health outcomes of a preventive health check offered at a population-level to all individuals aged 30-49 years, and to establish the cost-effectiveness. The trial will be conducted as a pragmatic household-cluster randomised controlled trial involving 10,505 individuals. All individuals within a well-defined geographical area in the Central Denmark Region, Denmark (DK) were randomised to be offered a preventive health check (Intervention group, n = 5250) or to maintain routine access to healthcare until a delayed intervention (Comparison group, n = 5255). The programme consists of a health examination which yields an individual risk profile, and according to this participants are assigned to one of the following interventions: (a) referral to a health promoting consultation in general practice, (b) behavioural programmes at the local Health Centre, or (c) no need for follow-up.The primary outcomes at 4 years follow-up are: ten-year-risk of fatal cardiovascular event (Heart-SCORE model), physical activity level (self-report and cardiorespiratory fitness), quality of life (SF12), sick leave and labour market attachment. Cost-effectiveness will be evaluated according to life years gained, direct costs and total health costs. Intention to treat analysis will be performed. Results from the largest Danish health check programme conducted within the current healthcare system, spanning the sectors which share responsibility for

  1. Operational Programme Health 2007-2013

    International Nuclear Information System (INIS)

    Anon

    2007-08-01

    development. The OPH ties up with the objectives and priorities of the National Strategic Reference Framework 2007 - 2013 (NSRF) as the basic programming document of the SR for cohesion and regional policies, whereas the OPH implements and details the specific priority of the NSRF 'Modernisation of Healthcare Infrastructure'. The introduction part of the document shortly describes the process of document preparation, partnership principle implementation, the results of ex-ante evaluation and of the strategic environmental assessment. The analytical part of the document provides information about the population health condition in the SR, health care system (hereinafter HCS), health infrastructure, material-technical base and equipment of inpatient and outpatient healthcare providers in the SR. Results of analyses together with the experiences of the programming period 2004 - 2006, the SWOT analyses, definition of the main disparities and development factors are the backgrounds for identification, specification of needs and strategic directing of the investments from the ERDF. Strategic plan follows the results of the complex analysis, defines regional focus in the context of and outpatient health infrastructure. The OPH strategy focuses mainly on the development of the conditions necessary for the improvement of quality of the provided healthcare through the modernisation of healthcare infrastructure with the aim to improve the economic effectiveness, strengthen the economic and social cohesion and achieve harmonised, balanced and sustainable development. Fulfilment of this programme context shall bring benefits in the form of diminishing economic, social and regional differences, which arose in the past and are connected with the ongoing economic and social restructuring and with aging of population. At the same time, the convergence of the least developed regions shall accelerate due to improved conditions within the innovation and cohesion growth poles and thanks to

  2. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India.

    OpenAIRE

    Mohanan, M.; Giardili, S.; Das, V.; Rabin, T. L.; Raj, S. S.; Schwartz, J. I.; Seth, A.; Goldhaber-Fiebert, J. D.; Miller, G.; Vera-Hernández, M.

    2017-01-01

    OBJECTIVE: To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme - the World Health Partners' Sky Program. METHODS: We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were ...

  3. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

    OpenAIRE

    Mohanan, Manoj; Giardili, Soledad; Das, Veena; Rabin, Tracy L; Raj, Sunil S; Schwartz, Jeremy I; Seth, Aparna; Goldhaber-Fiebert, Jeremy D; Miller, Grant; Vera-Hern?ndez, Marcos

    2017-01-01

    Abstract Objective To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme ? the World Health Partners? Sky Program. Methods We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Provider...

  4. Primary health care in the Southern Mediterranean region.

    NARCIS (Netherlands)

    Weide, M.G.; Fakiri, F. el; Kulu Glasgow, I.; Grielen, S.J.; Zee, J. van der

    1998-01-01

    This book gives an overview of primary health care in the Southern Mediterranean region. For twelve countries detailed information is provided on the structure and financing of health care, the organisation of primary care (including mother and child health care and immunisation programmes), health

  5. Health programmes for school employees: improving quality of life, health and productivity.

    Science.gov (United States)

    Kolbe, Lloyd J; Tirozzi, Gerald N; Marx, Eva; Bobbitt-Cooke, Mary; Riedel, Sara; Jones, Jack; Schmoyer, Michael

    2005-01-01

    School health programmes in the 21st century could include eight components: 1) health services; 2) health education; 3) healthy physical and psychosocial environments; 4) psychological, counselling, and social services; 5) physical education and other physical activities; 6) healthy food services; and 7) integrated efforts of schools, families, and communities to improve the health of school students and employees. The eighth component of modern school health programmes, health programmes for school employees, is the focus of this article. Health programmes for school employees could be designed to increase the recruitment, retention, and productivity of school employees by partially focusing each of the preceding seven components of the school health programme on improving the health and quality of life of school employees as well as students. Thus, efforts to improve the quality of life, health, and productivity of school employees may be distinct from, but integrated with, efforts to improve the quality of life, health, and education of students. School employee health programmes can improve employee: 1) recruitment; 2) morale; 3) retention; and 4) productivity. They can reduce employee: 5) risk behaviours (e.g., physical inactivity); 6) risk factors (e.g., stress, obesity, high blood pressure); (7) illnesses; 8) work-related injuries; 9) absentee days; 10) worker compensation and disability claims; and 11) health care and health insurance costs. Further, if we hope to improve our schools' performance and raise student achievement levels, developing effective school employee health programmes can increase the likelihood that employees will: 12) serve as healthy role models for students; 13) implement effective school health programmes for students; and 14) present a positive image of the school to the community. If we are to improve the quality of life, health, and productivity of school employees in the 21st century: school administrators, employees, and

  6. The mediatization of peer-to-peer health care

    DEFF Research Database (Denmark)

    Dindler, Camilla; Ahlmark, Nanna

    2018-01-01

    observations and qualitative interviews from a peer-to-peer programme for men in Copenhagen. The article analyses the tensions that occurred in the media coverage of the programme as well as in the municipal facilitation and management of the peer-to-peer health care programme defined partly...... by a democratization of health expertise and by a broader culture characterized by individualized, risk aware health promotion. We will argue that tensions between media logics and logics of care and of risk created a mediatized conception of health and of the peer programme that highlighted health care...

  7. An Eye Care Outreach Programme in the Federal Capital Territory ...

    African Journals Online (AJOL)

    Objectives: To describe an eye care outreach programme in the Federal Capital Territory (FCT) and the findings therefrom. Main Outcome Measures: Causes of blindness and ocular morbidity, prevalence of blindness. Methods: The programme was sponsored largely by the Bartimaeus Trust. Eighteen communities with a ...

  8. Consumer Directed Health Care

    OpenAIRE

    John Goodman

    2006-01-01

    Consumer driven health care (CDHC) is a potential solution to two perplexing problems: (1) How to choose between health care and other uses of money, and (2) how to allocate resources in an industry where normal market forces have been systemically suppressed. In the consumer-driven model, consumers occupy the primary decision-making role regarding the health care that they receive. From an employee benefits perspective, consumer driven health care in the broadest sense may refer to limited e...

  9. Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: A cluster randomized controlled trial.

    Science.gov (United States)

    Wang, Yao; Xiao, Lily Dongxia; Ullah, Shahid; He, Guo-Ping; De Bellis, Anita

    2017-02-01

    The lack of dementia education programmes for health professionals in primary care is one of the major factors contributing to the unmet demand for dementia care services. To determine the effectiveness of a nurse-led dementia education and knowledge translation programme for health professionals in primary care; participants' satisfaction with the programme; and to understand participants' perceptions of and experiences in the programme. A cluster randomized controlled trial was used as the main methodology to evaluate health professionals' knowledge, attitudes and care approach. Focus groups were used at the end of the project to understand health professionals' perceptions of and experiences in the programme. Fourteen community health service centres in a province in China participated in the study. Seven centres were randomly assigned to the intervention or control group respectively and 85 health professionals in each group completed the programme. A train-the-trainer model was used to implement a dementia education and knowledge translation programme. Outcome variables were measured at baseline, on the completion of the programme and at 3-month follow-up. A mixed effect linear regression model was applied to compare the significant differences of outcome measures over time between the two groups. Focus groups were guided by four semi-structured questions and analysed using content analysis. Findings revealed significant effects of the education and knowledge translation programme on participants' knowledge, attitudes and a person-centred care approach. Focus groups confirmed that the programme had a positive impact on dementia care practice. A dementia education and knowledge translation programme for health professionals in primary care has positive effects on their knowledge, attitudes, care approach and care practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    Journal of Community Medicine and Primary Health Care. 26 (1) 12-20 .... large proportions of the population work in the poor people use health care services far less than. 19 ... hypertension, cancers and road traffic accidents) below 1 dollar ...

  11. Parent involvement when developing health education programmes

    Directory of Open Access Journals (Sweden)

    Holger Hassel

    2008-03-01

    Full Text Available

    Background: The problem of obesity in children and adults has been widely recognised and described in the literature [1]. There are several challenges leading to an augmentation of the problem. Firstly, the aetiology of overweight and obesity is not clear. Secondly, the long term effectiveness of prevention programmes is low. Only in some groups and for a short period of time an effect may be visible [2]. Thirdly, little is known about what children should learn when [3]. A proper concept of educating children in regard to healthy eating or physical activity does not exist. As far as we know an essential pre-requisite for health education programmes is that they are lifestyleoriented and easily transferable into daily family life [4]. For this, working together with the parents would be essential. The main goal of this article will be 1 to get a better understanding of what parents and nurses/ teachers want 2 to strengthen the point that this method is one way to involve the target groups and thus it is likely to increase the acceptance of health education programmes 3 to describe that focus group discussions are a useful tool to identify the opinions of the target group.

    Methods: In the frame of three projects, focus groups with nurses/ teachers and parents have been carried out.

    Results and Conclusions: Results from different focus group discussions with pedagogues and parents will be discussed and conclusions for health education programmes relevant to all key players involved will be identified.

  12. Health Care Delivery.

    Science.gov (United States)

    Starfield, Barbara

    1987-01-01

    The article reviews emerging health care delivery options for handicapped children. Cost structures, quality of care, and future prospects are considered for Health Maintenance Organizations, Preferred Provider Organizations, Tax Supported Direct Service Programs, Hospital-Based Services, and Ambulatory Care Organizations. (Author/DB)

  13. Physician education programme improves quality of diabetes care ...

    African Journals Online (AJOL)

    Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.

  14. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

  15. Community-level impact of the reproductive health vouchers programme on service utilization in Kenya.

    Science.gov (United States)

    Obare, Francis; Warren, Charlotte; Njuki, Rebecca; Abuya, Timothy; Sunday, Joseph; Askew, Ian; Bellows, Ben

    2013-03-01

    This paper examines community-level association between exposure to the reproductive health vouchers programme in Kenya and utilization of services. The data are from a household survey conducted among 2527 women (15-49 years) from voucher and comparable non-voucher sites. Analysis entails cross-tabulations with Chi-square tests and significant tests of proportions as well as estimation of multi-level logit models to predict service utilization by exposure to the programme. The results show that for births occurring after the voucher programme began, women from communities that had been exposed to the programme since 2006 were significantly more likely to have delivered at a health facility and to have received skilled care during delivery compared with those from communities that had not been exposed to the programme at all. There were, however, no significant differences in the timing of first trimester utilization of antenatal care (ANC) and making four or more ANC visits by exposure to the programme. In addition, poor women were significantly less likely to have used safe motherhood services (health facility delivery, skilled delivery care and postnatal care) compared with their non-poor counterparts regardless of exposure to the programme. Nonetheless, a significantly higher proportion of poor women from communities that had been exposed to the programme since 2006 used the services compared with their poor counterparts from communities that had not been exposed to the programme at all. The findings suggest that the programme is associated with increased health facility deliveries and skilled delivery care especially among poor women. However, it has had limited community-level impact on the first trimester timing of antenatal care use and making four or more visits, which remain a challenge despite the high proportion of women in the country that make at least one antenatal care visit during pregnancy.

  16. Health literacy among Danish university students enrolled in health-related study programmes.

    Science.gov (United States)

    Elsborg, Lea; Krossdal, Fie; Kayser, Lars

    2017-12-01

    It is important to address people's health literacy when providing health care. Health professionals should be aware of, and have insight into, people's health literacy when they provide health services. Health professionals need to be health literate themselves. We examined the level of health literacy in students in Denmark attending one of four full university programmes related to health and investigated how their health literacy was associated with their sociodemographic background. The health literacy level of the students was measured using the multi-dimensional Health Literacy Questionnaire (HLQ) supplemented with sociodemographic questions. The questionnaire was administrated through the students' Facebook groups. The students were enrolled in courses on health informatics, medicine, molecular biomedicine or public health. Out of a total of 7663 students, 630 responded to the questionnaire. No sex difference was found although female students scored higher than male students in domain 4 (social support for health). Students attending the public health programme tended to score higher and those attending molecular biomedicine tended to score lower in the HLQ. There was a positive correlation between HLQ scores and the educational level of the students' parents. If one of their parents was employed in the health care sector, the HLQ score tended to be higher in domains 1 and 4. Students who had been hospitalized also tended to score higher in domains 1, 5 and 6. Students' health literacy relates to their personal background and educational path. This may be of importance when planning curricula and educational activities, including cross-disciplinary courses.

  17. The School Health Programme : A Situational Revisit. | Akani ...

    African Journals Online (AJOL)

    School Health Programme (SHP) refers to all the aspects of the total school programme which contribute to the understanding, maintenance and improvement of the health of the population, i.e. school children and staff. It consists of three main areas namely: school health services, school health instruction and healthful ...

  18. US health care crisis.

    Science.gov (United States)

    Cirić, Ivan

    2013-01-01

    The United States health care is presently challenged by a significant economic crisis. The purpose of this report is to introduce the readers of Medicinski Pregled to the root causes of this crisis and to explain the steps undertaken to reform health care in order to solve the crisis. It is hoped that the information contained in this report will be of value, if only in small measure, to the shaping of health care in Serbia.

  19. Cross-sectional survey on awareness of colorectal cancer and a screening programme for primary health care professionals in Catalonia, Spain.

    Science.gov (United States)

    Benito, L; García, M; Binefa, G; Mila, N; Vidal, C; Lluch, M T; Puig, M

    2016-11-01

    This study aimed to assess whether primary health care professionals have accurate information regarding colorectal cancer (CRC) screening procedures, surveillance recommendations and referral strategies. This cross-sectional descriptive study was based on a survey conducted among primary health care professionals in Barcelona, Spain. The questionnaire was used to gather information regarding CRC screening procedures as well as demographic and professional characteristics of the study subjects. A CRC and screening awareness score (ranging from 0 to 12) was created based on the survey questions. The response rate was 58.9% (206/305). The estimated mean score (standard deviation) was 8.43 (SD: 1.30). For four questions, more than 60% of the answers were incorrect: one related to risk factors, two concerning follow-up colonoscopy, and one related to surveillance. Only 30.8% of the participants believed that they were responsible for determining the appropriate surveillance intervals and for scheduling colonoscopies. Although the professionals had sufficient knowledge of CRC screening, professional knowledge of some aspects related to the major non-modifiable risk factors for the disease and surveillance colonoscopy procedures could be improved. Frequent communication with professionals is necessary to maintain updated screening-related information. Possible methods for facilitating communication could include continuous briefings, regular message reminders or educational websites. © 2016 John Wiley & Sons Ltd.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Quarry industry has become a major means of livelihood in Ebonyi state, but insufficient data exists on their operations ... of Dust Mask among Crushers of Selected Quarry (Crushed ... Journal of Community Medicine and Primary Health Care.

  1. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, ... selected from each of the ten wards in the LGA using multistage sampling technique. ..... Knowledge of HIV/AIDS Insurance Companies in Lagos State.

  2. Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study

    Directory of Open Access Journals (Sweden)

    Alexander Bischoff

    2016-05-01

    Full Text Available Background: In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO nursing school and make recommendations for other similar initiatives. Design: This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Results: Six themes emerged from the experiences that shaped the course of the project: 1 Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public–private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2 Communication was an important and often underrated factor for all types of development projects. 3 Managing the unknown and 4 managing expectations characterised the project inception. Almost all themes had to do with 5 handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6 the need to adjust to ever-changing targets. Conclusions: This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1 Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2 Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve

  3. Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study.

    Science.gov (United States)

    Bischoff, Alexander

    2016-01-01

    In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO) nursing school and make recommendations for other similar initiatives. This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Six themes emerged from the experiences that shaped the course of the project: 1) Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public-private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2) Communication was an important and often underrated factor for all types of development projects. 3) Managing the unknown and 4) managing expectations characterised the project inception. Almost all themes had to do with 5) handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6) the need to adjust to ever-changing targets. This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1) Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2) Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve themselves; 3) Think flexibly and do not stubbornly

  4. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Background: The well-being of women and children is one of the major determinants ... The Sample for the study were women recruited from 11 primary health care ... respondents educational level and knowledge of preconception care (X =24.76, ... single adult or married couple) are in an optimal state .... The major site for.

  5. Development and evaluation of a newborn care education programme in primiparous mothers in Nepal.

    Science.gov (United States)

    Shrestha, Sharmila; Adachi, Kumiko; Petrini, Marcia A; Shrestha, Sarita; Rana Khagi, Bina

    2016-11-01

    the health and survival of newborns depend on high levels of attention and care from caregivers. The growth and development of some infants are unhealthy because of their mother's or caregiver's lack of knowledge or the use of inappropriate or traditional child-rearing practices that may be harmful. to develop a newborn care educational programme and evaluate its impact on infant and maternal health in Nepal. a randomised controlled trial. one hundred and forty-three mothers were randomly assigned to the intervention (n=69) and control (n=74) groups. Eligible participants were primiparous mothers who had given birth to a single, full-term, healthy infant, and were without a history of obstetric, medical, or psychological problems. prior to being discharged from the postnatal unit, the intervention group received our structured newborn care education programme, which consisted of one-on-one educational sessions lasting 10-15minutes each and one postpartum follow-up telephone support within two weeks after discharge, in addition to the hospital's routine general newborn care education. The control group received only the regular general newborn care education. Outcomes were measured by using Newborn care Knowledge Questionnaires, Karitane Parenting Confidence Scale, State-Trait Anxiety Inventory for Adults and infant health and care status. the number of mothers attending the health centre due to the sickness of their babies was significantly decreased in the intervention group compared to the control group. Moreover, the intervention group had significant increases in newborn care knowledge and confidence, and decreases in anxiety, compared with the control group. the structured newborn care education programme enhanced the infant and mother health. Moreover, it increased maternal knowledge of newborn care and maternal confidence; and reduced anxiety in primiparous mothers. Thus, this educational programme could be integrated into routine educational programs to

  6. Development of a 22q11DS psycho-educational programme: exploration of the views, concerns and educational needs of parents caring for children or adolescents with 22q11DS in relation to mental health issues.

    Science.gov (United States)

    Alugo, T; Malone, H; Sheehan, A; Coyne, I; Lawlor, A; McNicholas, F

    2017-07-01

    22q11.2 deletion syndrome (22q11DS) is a multisystem genetic condition with a broad phenotype. It is associated with a high prevalence of depression and anxiety during childhood and increased risk of schizophrenia in adulthood. Despite this, studies report that families may receive inadequate information of mental health (MH) risks at diagnosis. Therefore, this study investigated parents' experiences of caring for a child with 22q11DS, investigated their knowledge regarding the risk of MH problems and assessed the need for a psycho-educational programme. A qualitative design and purposeful sampling was utilized. Parents registered with the '22q11 Ireland' support group, and parents listed on the cleft palate database in a children's hospital in Ireland were invited to participate. Focus groups were held with 22 parents. Data were thematically analysed using Burnard's method of analysis. Most parents had some knowledge of the relationship between 22q11DS and an increased risk of MH issues. Parents reported that MH information relating to 22q11DS was mainly obtained from 22q11DS conferences, the '22q11 Ireland' support group and the Internet. Parents expressed a need for information to prevent or cope with their child's MH issues. Parents suggested that the following topics would be quite useful in a psycho-educational programme. These included information on the early warning signs of MH issues and guidance on when and how to tell the child about the condition and how to manage the child or young person's anxiety, obsessive behaviour or hearing voices. The findings indicated parental support for a psycho-educational programme that would provide relevant, accurate and timely information on how to effectively care for a child with 22q11DS MH needs. © 2017 John Wiley & Sons Ltd.

  7. Peer Sexual Health Education: Interventions for Effective Programme Evaluation

    Science.gov (United States)

    Sriranganathan, Gobika; Jaworsky, Denise; Larkin, June; Flicker, Sarah; Campbell, Lisa; Flynn, Susan; Janssen, Jesse; Erlich, Leah

    2012-01-01

    Peer education is used as a health promotion strategy in a number of areas, including sexual health. Although peer education programmes have been around for some time, published systematic evaluations of youth sexual health peer education programmes are rare. This article discusses the advantages and disadvantages of youth sexual health peer…

  8. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    enrol in an insurance scheme feeling that they need more information on health insurance and the willingness to enrol in a ... and utilize the benefits of different types of health insurance services. Conclusion: The findings ..... improvements in access and quality of care, and the ... the 'rising tide' of and information technology.

  9. 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 we...... document pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for assessment and benchmarking the clinical management of HIV-patients in any setting worldwide....

  10. 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.

  11. [Health care networks].

    Science.gov (United States)

    Mendes, Eugênio Vilaça

    2010-08-01

    The demographic and epidemiologic transition resulting from aging and the increase of life expectation means an increment related to chronic conditions. The healthcare systems contemporary crisis is characterized by the organization of the focus on fragmented systems turned to the acute conditions care, in spite of the chronic conditions prevalence, and by the hierarchical structure without communication flow among the different health care levels. Brazil health care situation profile is now presenting a triple burden of diseases, due to the concomitant presence of infectious diseases, external causes and chronic diseases. The solution is to restore the consistence between the triple burden of diseases on the health situation and the current system of healthcare practice, with the implantation of health care networks. The conclusion is that there are evidences in the international literature on health care networks that these networks may improve the clinical quality, the sanitation results and the user's satisfaction and the reduction of healthcare systems costs.

  12. Newborn care practices and home-based postnatal newborn care programme – Mewat, Haryana, India, 2013

    Directory of Open Access Journals (Sweden)

    Latika Nath Sinha

    2014-09-01

    Full Text Available Background: In India, the Home Based Postnatal Newborn Care programme by Accredited Social Health Activists (ASHAs under the National Rural Health Mission was initiated in 2011 to reduce neonatal mortality rates (NMRs. ASHAs get cash incentives for six postnatal home visits for newborn care. We studied newborn care practices among mothers in Mewat, Haryana, having a high NMR and determined risk factors for unsafe practices and described the knowledge and skills of ASHAs during home visits. Methods: A cross-sectional survey was conducted among mothers who had delivered a child during the previous seven months using cluster sampling. We interviewed mothers and ASHAs in the selected subcentres using semi–structured questionnaires on the six safe newborn care practices, namely safe breastfeeding, keeping cord and eyes clean, wrapping baby, kangaroo care, delayed bathing and hand washing. Results: We interviewed 320 mothers, 61 ASHAs and observed 19 home visits. Overall, 60% of mothers adopted less than three safe practices. Wrapping newborns (96% and delayed bathing (64% were better adopted than cord care (49%, safe breastfeeding (48%, hand washing (30%, kangaroo care (20% and eye care (9%. Cultural beliefs and traditional birth attendants influenced the mother’s practices. The lack of supervision by auxiliary nurse midwives (ANM, delayed referral and transportation were the other challenges. Conclusion: Knowledge–practice gaps existed among mothers counselled by ASHAs. Poor utilization of reproductive and child health services decreased opportunities for ASHA–mother dialogue on safe practices. Recommendations included training ANMs, training TBAs as ASHAs, innovative communication strategies for ASHAs and improved referral system.

  13. Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

    Science.gov (United States)

    Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

    2018-04-23

    This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  14. The Care Accelerator R&D Programme in Europe

    NARCIS (Netherlands)

    Napoly, O.; Aleksan, A.; Devred, A.; den Ouden, A.

    CARE, an ambitious and coordinated programme of accelerator research and developments oriented towards high energy physics projects, has been launched in January 2004 by the main European laboratories and the European Commission. This project aims at improving existing infrastructures dedicated to

  15. Global health diplomacy in Iraq: international relations outcomes of multilateral tuberculosis programmes.

    Science.gov (United States)

    Kevany, Sebastian; Jaf, Payman; Workneh, Nibretie Gobezie; Abu Dalod, Mohammad; Tabena, Mohammed; Rashid, Sara; Al Hilfi, Thamer Kadum Yousif

    2014-01-01

    International development programmes, including global health interventions, have the capacity to make important implicit and explicit benefits to diplomatic and international relations outcomes. Conversely, in the absence of awareness of these implications, such programmes may generate associated threats. Due to heightened international tensions in conflict and post-conflict settings, greater attention to diplomatic outcomes may therefore be necessary. We examine related 'collateral' effects of Global Fund-supported tuberculosis programmes in Iraq. During site visits to Iraq conducted during 2012 and 2013 on behalf of the Global Fund to Fight AIDS, Tuberculosis and Malaria, on-site service delivery evaluations, unstructured interviews with clinical and operational staff, and programme documentary review of Global Fund-supported tuberculosis treatment and care programmes were conducted. During this process, a range of possible external or collateral international relations and diplomatic effects of global health programmes were assessed according to predetermined criteria. A range of positive diplomatic and international relations effects of Global Fund-supported programmes were observed in the Iraq setting. These included (1) geo-strategic accessibility and coverage; (2) provisions for programme sustainability and alignment; (3) contributions to nation-building and peace-keeping initiatives; (4) consistent observation of social, cultural and religious norms in intervention selection; and (5) selection of the most effective and cost-effective tuberculosis treatment and care interventions. Investments in global health programmes have valuable diplomatic, as well as health-related, outcomes, associated with their potential to prevent, mitigate or reverse international tension and hostility in conflict and post-conflict settings, provided that they adhere to appropriate criteria. The associated international presence in such regions may also contribute to peace

  16. Organizing Rural Health Care

    DEFF Research Database (Denmark)

    Bunkenborg, Mikkel

    2012-01-01

    to organize rural health care is more regulatory and distanced in its emphasis on nudging patients and doctors towards the right decisions through economic incentives. This bureaucratic approach to organizing health individually offers a sharp contrast to the religious collectivities that form around health...

  17. An activity-based cost analysis of the Honduras community-based, integrated child care (AIN-C) programme.

    Science.gov (United States)

    Fiedler, John L; Villalobos, Carlos A; De Mattos, Annette C

    2008-11-01

    The Honduras AIN-C programme is a preventive health and nutrition programme of the Honduras Ministry of Health (MOH) that relies on volunteers to help mothers monitor and maintain the adequate growth of young children. A quasi-experimental, design-based evaluation found that the programme achieved near-universal coverage and was effective in improving mothers' child-rearing knowledge, attitudes and practices, including feeding and appropriate care-giving and care-seeking practices for children with diarrhoea and acute respiratory illness. The programme is widely regarded as a model. This study was undertaken to provide the first comprehensive estimates of the cost of the AIN-C programme, with the goal of providing a programme and financial planning tool for Honduras. An additional comparison of study findings was also undertaken to determine the cost of the AIN-C programme's community-based services relative to a similar facility-based service. Expressed in mid-2005 US dollars, the study found that after the programme is phased-in: (1) the annual, recurrent cost per child under 2 years participating in the programme is $6.43; (2) the annual, incremental budget requirements per child under 2 years participating in the programme are $3.90; (3) the cost of an AIN-C monthly growth monitoring and counselling session per child is 11% of the cost of a traditional MOH, facility-based growth and development consultation per child; and (4) the effect of mothers substituting AIN-C monitor care for MOH facility-based care 'saves' 203 000 outpatient visits a year, with a potential cost saving of $1.66 million, the equivalent of 60% of the recurrent cost of the programme and roughly equal to the annual incremental budget requirements of the programme. Sensitivity analysis of the cost estimates is performed to provide insight, for countries considering introducing a similar programme, into how modifications of key characteristics of the programme affect its costs.

  18. Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study.

    Science.gov (United States)

    Woringer, Maria; Cecil, Elizabeth; Watt, Hillary; Chang, Kiara; Hamid, Fozia; Khunti, Kamlesh; Dubois, Elizabeth; Evason, Julie; Majeed, Azeem; Soljak, Michael

    2017-06-14

    Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England's National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein.

  19. Strategic planning of the master programme in health informatics at Aalborg University: targeting and updating the programme, to meet explicit customer needs.

    Science.gov (United States)

    Nøhr, C; Bygholm, A; Hejlesen, O

    1998-06-01

    Education is essentially giving people new skills and qualifications to fulfil certain tasks. In planning and managing educational programmes it is crucial to know what skills and what qualifications are needed to carry out the tasks in question, not to mention the importance of knowing what tasks are relevant to carry out. The programme in health informatics at Aalborg University produces health informatics professionals. The students are developing skills in solving informatics problems in health care organisations. The programme has been running for 3 years now and to maintain the perception of the aim for the programme a number of activities have been launched. In the following, the programme will be presented, the activities to obtain information on how to keep the programme targeted and updated will be described and the changes that are going to be introduced will be outlined.

  20. American Health Care Association

    Science.gov (United States)

    ... MO - St. Louis, Qualifications Required: Bachelor’s degree in business, marketing, health care administration or a related field Current ... Work for AHCA/NCAL News Provider Daily Publications Social Media News Releases LTC Leader Blog Research and Data ...

  1. 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...

  2. HealthCare.gov

    Science.gov (United States)

    ... CAN CHANGE Looking for coverage for a small business? Learn more Need to submit documents? SEE HOW ... Find Local Help Visit the HealthCare.gov blog Facebook Twitter YouTube Google+ All Topics | Glossary | Contact Us | ...

  3. Your Health Care Team

    Science.gov (United States)

    ... Rights Employment Discrimination Health Care Professionals Law Enforcement Driver's License For Lawyers Food & Fitness Home Food MyFoodAdvisor ... Fit Types of Activity Weight Loss Assess Your Lifestyle Getting Started Food Choices In My Community Home ...

  4. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    one strategy that could be conducted anywhere, if the health care workers are trained and positively disposed ... places; regulate advertising, manufacturing. 13 .... Gender. Male. 52 (46.0). 61 (54.0). 0.0001. Significant. Female. 82 (73.2).

  5. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    about teething the world over and especially ... children`s out-patients, dental and the ear, nose and throat clinics of a tertiary hospital in south-west Nigeria. ... parents, health care workers and personal experiences were the sources of beliefs ... None (0%) of the respondents had prior knowledge of proven causes of ear.

  6. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    VPDs, this represents 17% of global total. 1 ... Knowledge, Attitude and Practice of Childhood Immunization ... Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi-Araba, P.M.B. 12003, ... include access to services, parental (maternal) ... Calmette Guerin (BCG) vaccine Oral Polio.

  7. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    2012-05-01

    May 1, 2012 ... with the quality of care in a tertiary health facility in Delta State, Nigeria ... includes contributions from families, charges have been .... employees at 23.5%, self employed 19.1% of showed that most of the respondents (41.3%).

  8. Health Care Services

    Science.gov (United States)

    Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice , 2017 Warning - A phone number that was once used for the Denali KidCare program is now being used to ask people for their credit card number in order to win a prize. The phone number related to this

  9. 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.

  10. [Participant structure and economic benefit of prevention bonus programmes in company health insurance funds].

    Science.gov (United States)

    Friedrichs, M; Friedel, H; Bödeker, W

    2009-10-01

    This study investigates differences in sex, age, and educational level between participants and non-participants of prevention bonus programmes. The differences in the utilisation of drugs, hospital care, and sickness absence before the start of the programmes between these groups are also shown. Finally the economic benefit of the health insurance funds attributed to these programmes is estimated. Data from some 5.2 million insured subjects of 74 company health insurance funds in Germany were linked to information on enrollment into a prevention bonus programme anonymously. In a descriptive analysis the differences in the sociodemographic patterns between both groups are shown as well as the differences in costs to the health insurances in the three sectors mentioned above. The benefit to the health insurance funds is estimated by means of an analysis of covariance. Prevention bonus programmes yields an annual benefit of at least 129 euro per participant. Men aged 40 and older and women aged 30 and older are more likely to opt into such a programme. The same is true for persons with a higher educational level. There are only few differences in health-care utilisation between the participants and non-participants of the programmes before enrollment. Only 1.4% of all insured persons participated in the programmes. There is at least a short-term gain to both involved parties: the insured and the health insurance funds. The programmes are not dominated by deadweight effects. Long-term effects and effectiveness of prevention bonus programmes still have to be investigated. Copyright Georg Thieme Verlag KG Stuttgart . New York.

  11. Controlling Health Care Costs

    Science.gov (United States)

    Dessoff, Alan

    2009-01-01

    This article examines issues on health care costs and describes measures taken by public districts to reduce spending. As in most companies in America, health plan designs in public districts are being changed to reflect higher out-of-pocket costs, such as higher deductibles on visits to providers, hospital stays, and prescription drugs. District…

  12. A systematic review of outcome and impact of master's in health and health care

    NARCIS (Netherlands)

    Zwanikken, Prisca A C; Dieleman, Marjolein; Samaranayake, Dulani; Akwataghibe, Ngozi; Scherpbier, Albert J. J. A.

    2013-01-01

    BACKGROUND: The 'human resources for health' crisis has highlighted the need for more health (care) professionals and led to an increased interest in health professional education, including master's degree programmes. The number of these programmes in low- and middle-income countries (LMIC) is

  13. Integrated Care Programme—Department of Health, UK

    OpenAIRE

    Dewji, Mo; Passmore, Julie; Wardell, John

    2010-01-01

    Introduction Integration is seen as a key building block within the strategic plan for improving the health and well-being of the population of England. The Integrated Care Pilot programme is a three-year academically assessed research programme sponsored by the Department of Health, England, which aims to explore and gather evidence to support different approaches to integration. Aims With 16 pilot sites across England the objectives of the programme are based upon a Government commitment to...

  14. Occupational health programme for lead workers in battery plants

    Science.gov (United States)

    Lee, Byung-Kook

    The realization of problems resulting from the exposure to undue high lead levels of workers in lead-using industries, particularly in storage battery plants, has given rise to a new occupational health service, the so-called type specific (harmful agent specific) group occupational health. In 1988, the Korean Ministry of Labor designated the Institute of Industrial Medicine, Soonchunhyang University, as an authorized organization to take care of lead workers in lead industries. The following occupational health services are provided by the Institute: (i) physical health examination; (ii) biological monitoring with zinc protoporphyrin, urine δ-aminolevulinic acid and blood lead; (iii) respiratory protection with maintenance-free respirators; (iv) measurement of the environmental condition of workplaces; (v) health education. A three-year occupational health programme for lead workers has contributed to improvements in the working conditions of lead industries, particularly in large-scale battery plants, and has decreased the unnecessary high lead burden of workers through on-going medical surveillance with biological monitoring and health education schemes. The strong commitment of both employers and the government to improve the working conditions of lead industries, together with the full cooperation of lead workers, has served to reduce the high lead burdens of lead workers. This decreases the number of lead-poisoning cases and provides more comfortable workplaces, particularly in battery plants.

  15. Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

    Science.gov (United States)

    Parr, Jenny M; Bell, Jeanette; Koziol-McLain, Jane

    2018-06-01

    The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care. Five phases were used to explore the evidence, and design and test a measurement and improvement framework. Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements. © 2018 John Wiley & Sons Ltd.

  16. Introducing innovation in a management development programme for a UK primary care organisation.

    Science.gov (United States)

    Smith, Paul; Hampson, Libby; Scott, Jonathan; Bower, Karen

    2011-01-01

    The aim of this paper is to examine the introduction of innovation as part of a management development programme at a primary care organisation, a legal form known as a Primary Care Trust (PCT), in the UK. The paper draws on experience of managing a successful management development programme for a PCT. The report of the case study analyses the key events that took place between 2008 and 2010, from direct observation, surveys, discussion and documentary evidence. The Northern PCT has partnerships with a number of educational providers to deliver their leadership and management development programmes. A close working relationship had developed and the programme is bespoke - hence it is current and of practical use to the UK's National Health Service (NHS). In addition, there are regular meetings, with module leaders gaining a firsthand understanding of the organisation's needs and aspirations. This has resulted in a very focused and personalised offering and a genuine involvement in the programme and individuals concerned. The research was conducted among a relatively small sample, and there is a lack of previous literature evidence to make significant comparisons. The paper identifies key implications for practitioners and educators in this area. This paper is one of few to investigate innovation and improvement in the NHS, and is unique in that it uses the lenses of a management development programme to explore this important, and under-researched, topic.

  17. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India.

    Science.gov (United States)

    Mohanan, Manoj; Giardili, Soledad; Das, Veena; Rabin, Tracy L; Raj, Sunil S; Schwartz, Jeremy I; Seth, Aparna; Goldhaber-Fiebert, Jeremy D; Miller, Grant; Vera-Hernández, Marcos

    2017-05-01

    To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme - the World Health Partners' Sky Program. We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers' performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models. The programme did not significantly improve health-care providers' knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.

  18. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

    Science.gov (United States)

    Giardili, Soledad; Das, Veena; Rabin, Tracy L; Raj, Sunil S; Schwartz, Jeremy I; Seth, Aparna; Goldhaber-Fiebert, Jeremy D; Miller, Grant; Vera-Hernández, Marcos

    2017-01-01

    Abstract Objective To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme – the World Health Partners’ Sky Program. Methods We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers’ performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models. Findings The programme did not significantly improve health-care providers’ knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. Conclusion Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up. PMID:28479635

  19. 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...

  20. 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

  1. The CARE accelerator R&D programme in Europe

    CERN Document Server

    Napoly, Olivier; den Ouden, Andres; Devred, Arnaud; Garoby, Roland; Garvey, Terence; Ghigo, Andrea; Gschwendtner, Edda; Losito, Roberto; Mais, Helmut; Palladino, V; Proch, Dieter; Richard, F; Rinolfi, Louis; Ruggiero, Francesco; Scandale, Walter; Schulte, Daniel; Vretenar, Maurizio

    2005-01-01

    CARE, an ambitious and coordinated programme of accelerator research and developments oriented towards high energy physics projects, has been launched in January 2004 by the main European laboratories and the European Commission. This project aims at improving existing infrastructures dedicated to future projects such as linear colliders, upgrades of hadron colliders and high intensity proton drivers. We describe the CARE R&D plans, mostly devoted to advancing the performance of the superconducting technology, both in the fields of RF cavities for electron or proton acceleration and of high field magnets, as well as to developing high intensity electron and proton injectors. We highlight some results and progress obtained so far.

  2. Managing high-risk patients: the Mass General care management programme

    Directory of Open Access Journals (Sweden)

    Dennis L Kodner

    2015-09-01

    Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program

  3. 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.

  4. 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.

  5. 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 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 precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need...

  6. Participatory action research in the training of primary health care ...

    African Journals Online (AJOL)

    Participatory action research in the training of primary health care nurses in Venda. ... who had been part of the nurse training programme with clinic attenders. ... enough access to financial decision making and were therefore powerless to ...

  7. [Health locus of control of patients in disease management programmes].

    Science.gov (United States)

    Schnee, M; Grikscheit, F

    2013-06-01

    Health locus of control beliefs plays a major role in improving self-management skills of the chronically ill - a main goal in disease management programmes (DMP). This study aims at characterising participants in disease management regarding their health locus of control. Data are based on 4 cross-sectional postal surveys between spring and autumn of 2006 and 2007 within the Health Care Monitor of the Bertelsmann Foundation. Among the 6 285 respondents, 1 266 are chronically ill and not enrolled in a DMP and 327 are participating in a DMP. A high internal locus of control (HLC) occurs significantly less often in DMP patients than in normal chronically ill patients (and healthy people) controlling for age, gender and social class. With increasing age, a high internal locus of control is also significantly less likely. When comparing healthy people, the chronically ill and the DMP participants a social gradient of a high internal locus of control belief can be observed. The weaker internal and higher doctor-related external locus of control of DMP participants should be carefully observed by the physician when trying to strengthen the patients' self-management skills. Evaluators of DMP should take into account the different baselines of DMP patients and relevant control groups and incorporate these differences into the evaluation. © Georg Thieme Verlag KG Stuttgart · New York.

  8. The National Institute for Health Research Leadership Programme

    Science.gov (United States)

    Jones, Molly Morgan; Wamae, Watu; Fry, Caroline Viola; Kennie, Tom; Chataway, Joanna

    2012-01-01

    Abstract RAND Europe evaluated the National Institute for Health Research (NIHR) Leadership Programme in an effort to help the English Department of Health consider the extent to which the programme has helped to foster NIHR's aims, extract lessons for the future, and develop plans for the next phase of the leadership programme. Successful delivery of high-quality health research requires not only an effective research base, but also a system of leadership supporting it. However, research leaders are not often given the opportunity, nor do they have the time, to attend formal leadership or management training programmes. This is unfortunate because research has shown that leadership training can have a hugely beneficial effect on an organisation. Therefore, the evaluation has a particular interest in understanding the role of the programme as a science policy intervention and will use its expertise in science policy analysis to consider this element alongside other, more traditional, measures of evaluation. PMID:28083231

  9. Equity, social determinants and public health programmes--the case of oral health.

    Science.gov (United States)

    Petersen, Poul Erik; Kwan, Stella

    2011-12-01

    The WHO Commission on Social Determinants of Health issued the 2008 report 'Closing the gap within a generation - health equity through action on the social determinants of health' in response to the widening gaps, within and between countries, in income levels, opportunities, life expectancy, health status, and access to health care. Most individuals and societies, irrespective of their philosophical and ideological stance, have limits as to how much unfairness is acceptable. In 2010, WHO published another important report on 'Equity, Social Determinants and Public Health Programmes', with the aim of translating knowledge into concrete, workable actions. Poor oral health was flagged as a severe public health problem. Oral disease and illness remain global problems and widening inequities in oral health status exist among different social groupings between and within countries. The good news is that means are available for breaking poverty and reduce if not eliminate social inequalities in oral health. Whether public health actions are initiated simply depends on the political will. The Ottawa Charter for Health Promotion (1986) and subsequent charters have emphasized the importance of policy for health, healthy environments, healthy lifestyles, and the need for orientation of health services towards health promotion and disease prevention. This report advocates that oral health for all can be promoted effectively by applying this philosophy and some major public health actions are outlined. © 2011 John Wiley & Sons A/S.

  10. Improving homeless persons’ utilization of primary care : Lessons to be learned from an outreach programme in The Netherlands

    NARCIS (Netherlands)

    Elissen, A.M.J.; van Raak, A.J.A.; Derck, E.W.C.C.; Vrijhoef, H.J.M.

    2013-01-01

    Faced with rising homelessness, countries around the world are in need of innovative approaches to caring for those without shelter, who, more often than not, suffer from severe health problems. We conducted a case study of an innovative Dutch Primary Care for the Homeless (PCH) programme to gain

  11. A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation.

    Science.gov (United States)

    Dai, Ruoxi; Lam, Otto L T; Lo, Edward C M; Li, Leonard S W; McGrath, Colman

    2017-06-01

    The objectives of this study were to evaluate and compare the effectiveness of an advanced oral hygiene care programme (AOHCP) and a conventional oral hygiene care programme (COHCP) in improving oral hygiene, and reducing gingival bleeding among patients with stroke during outpatient rehabilitation. Subjects were randomized to receive (i) the COHCP comprising a manual toothbrush, toothpaste, and oral hygiene instruction, or (ii) the AOHCP comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, toothpaste, and oral hygiene instruction. Dental plaque, gingival bleeding, and other clinical oral health outcomes were assessed at baseline, the end of the clinical trial, and the end of observation period. Development of infectious complications was also monitored. Participants of both programmes had a significant reduction in the percentages of sites with moderate to abundant dental plaque (p<0.001) and with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque and gingival bleeding than those in the COHCP controlling for other factors at the end of the clinical trial period (both p<0.001) and the observational period (plaque: p<0.05, gingival bleeding: p<0.01). Although both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding. This study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Horizontal schools-based health programme in rural Kenya.

    Science.gov (United States)

    Bogie, James; Eder, Ben; Magnus, Dan; Amonje, Onguko David; Gant, Martina

    2017-09-01

    Primary school children in low-income countries are at risk of many diseases and poor health affects attendance, cognition and ability to learn. Developing school health and nutrition strategies has been extensively highlighted as a global priority, with a particular focus on complex programme design. However, such programmes are relatively untested in low-income settings. We implemented a complex school health and nutrition programme in two schools in Western Kenya over 3 years. There were numerous elements covering health policy, skills-based health education, infrastructure and disease prevention. A local non-governmental organisation, with involvement from local government and the community, performed programme implementation. Height-for-age, weight-for-age,height-for-weight, anaemia prevalence, academic performance and school attendance were the primary outcome measures. The programme improved nutrition, academic performance and anaemia prevalence. The number of underweight children fell from 20% to 11% (OR 0.51 95% CI 0.39 to 0.68 p=effect on school attendance, the reasons for which are unclear. These results are encouraging and demonstrate that complex schools health programmes can lead to positive gains in health, nutrition and importantly academic performance. There is a need for further evaluation of comprehensive school health interventions in poor communities. © 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.

  13. Medical care of type 2 diabetes in German disease management programmes: a population-based evaluation.

    Science.gov (United States)

    Stark, Reneé G; Schunk, Michaela V; Meisinger, Christine; Rathmann, Wolfgang; Leidl, Reiner; Holle, Rolf

    2011-05-01

    Type 2 diabetes disease management programmes (DDMPs) are offered by German social health insurance to promote healthcare consistent with evidence-based medical guidelines. The aim of this study was to compare healthcare quality and medical endpoints between diabetes management programme participants and patients receiving usual care designated as controls. All patients with type 2 diabetes (age range: 36-81) in a cross-sectional survey of a cohort study, performed by the Cooperative Health Research in the Region of Augsburg, received a self-administered questionnaire regarding their diabetes care. Physical examination and laboratory tests were also performed. The analysis only included patients with social health insurance and whose participation status in a diabetes disease management program was validated by the primary physician (n = 166). Regression analyses, adjusting for age, sex, education, diabetes duration, baseline waist circumference and clustering regarding primary physician were conducted. Evaluation of healthcare processes showed that those in diabetes disease management programmes (n = 89) reported medical examination of eyes and feet and medical advice regarding diet [odds ratio (OR): 2.39] and physical activity (OR: 2.87) more frequently, received anti-diabetic medications (OR: 3.77) and diabetes education more often (OR: 2.66) than controls. Both groups had satisfactory HbA(1c) control but poor low-density lipoprotein cholesterol control. Blood pressure goals (management programmes (OR: 2.21). German diabetes disease management programmes are associated with improved healthcare processes and blood pressure control. Low-density lipoprotein cholesterol control must be improved for all patients with diabetes. Further research will be required to assess the long-term effects of this diabetes disease management programme. Copyright © 2011 John Wiley & Sons, Ltd.

  14. Losing connections and receiving support to reconnect: experiences of frail older people within care programmes implemented in primary care settings

    NARCIS (Netherlands)

    Bindels, J.; Cox, K.; De La Haye, J.; Mevissen, G.; Heijing, S.; van Schayck, O.C.P.; Widdershoven, G.; Abma, T.A.

    2015-01-01

    Aims and objectives: The objective of this study was to evaluate whether care provided in the care programmes matched the needs of older people. Background: Care programmes were implemented in primary-care settings in the Netherlands to identify frail older people and to prevent further

  15. Sustainable practice change: Professionals' experiences with a multisectoral child health promotion programme in Sweden

    Directory of Open Access Journals (Sweden)

    Mogren Ingrid

    2011-03-01

    Full Text Available Abstract Background New methods for prevention and health promotion and are constantly evolving; however, positive outcomes will only emerge if these methods are fully adopted and sustainable in practice. To date, limited attention has been given to sustainability of health promotion efforts. This study aimed to explore facilitators, barriers, and requirements for sustainability as experienced by professionals two years after finalizing the development and implementation of a multisectoral child health promotion programme in Sweden (the Salut programme. Initiated in 2005, the programme uses a 'Salutogenesis' approach to support health-promoting activities in health care, social services, and schools. Methods All professionals involved in the Salut Programme's pilot areas were interviewed between May and September 2009, approximately two years after the intervention package was established and implemented. Participants (n = 23 were midwives, child health nurses, dental hygienists/dental nurses, and pre-school teachers. Transcribed data underwent qualitative content analysis to illuminate perceived facilitators, barriers, and requirements for programme sustainability. Results The programme was described as sustainable at most sites, except in child health care. The perception of facilitators, barriers, and requirements were largely shared across sectors. Facilitators included being actively involved in intervention development and small-scale testing, personal values corresponding to programme intentions, regular meetings, working close with collaborators, using manuals and a clear programme branding. Existing or potential barriers included insufficient managerial involvement and support and perceived constraints regarding time and resources. In dental health care, barriers also included conflicting incentives for performance. Many facilitators and barriers identified by participants also reflected their perceptions of more general and forthcoming

  16. An interdisciplinary approach to palliative care - context and challenges in basic education programmes

    DEFF Research Database (Denmark)

    Sangild Stølen, Karen Marie; Breum, Wanda Elisabeth; Andersen, Tanja Thinggaard

    Background: In Denmark, persons diagnosed with life-threatening diseases are an essential key task in Danish Health system. Work carried out by health care professionals with these patients and their families requires specific professional expertise. A holistic approach focused on the physical, p...... in the palliative area, the physiotherapy and psychomotor education programmes have made valuable contributions to developing the understanding of palliative care to the benefit of patients with life-threatening illnesses and their families......., psychological, social and existential perspectives is necessary in order to be able to meet the needs of these people. The health education programmes should therefore offer instruction in palliative care. On this background, University College Capital has developed an interdisciplinary elective course....... Results: The three courses that have been carried out with the participation of 60 nursing students, 12 physiotherapy students and two psychomotor- therapist students two students have shown that the students and staff from the three programmes have benefitted greatly from the different professional...

  17. International programme on the health effects of the Chernobyl accident

    International Nuclear Information System (INIS)

    1991-01-01

    A memorandum of understanding between the WHO and the Ministry of Health of the USSR was signed in April 1990, calling for the development of a long-term international programme to monitor and mitigate the health effects of the Chernobyl accident. This report examines the scientific, organizational and financial aspects of the programme and describes the action taken by the WHO for its development

  18. International programme on the health effects of the Chernobyl accident

    International Nuclear Information System (INIS)

    1992-01-01

    A memorandum of understanding between the WHO and the Ministry of Health of the USSR was signed in April 1990, calling for the development of a long-term international programme to monitor and mitigate the health effects of the Chernobyl accident. This document reports on progress made to date in terms of technical management and coordination and financial aspects of the programme. It also provides information on future activities and discusses related issues

  19. Keeping health facilities safe: one way of strengthening the interaction between disease-specific programmes and health systems.

    Science.gov (United States)

    Harries, Anthony D; Zachariah, Rony; Tayler-Smith, Katie; Schouten, Erik J; Chimbwandira, Frank; Van Damme, Wim; El-Sadr, Wafaa M

    2010-12-01

    The debate on the interaction between disease-specific programmes and health system strengthening in the last few years has intensified as experts seek to tease out common ground and find solutions and synergies to bridge the divide. Unfortunately, the debate continues to be largely academic and devoid of specificity, resulting in the issues being irrelevant to health care workers on the ground. Taking the theme 'What would entice HIV- and tuberculosis (TB)-programme managers to sit around the table on a Monday morning with health system experts', this viewpoint focuses on infection control and health facility safety as an important and highly relevant practical topic for both disease-specific programmes and health system strengthening. Our attentions, and the examples and lessons we draw on, are largely aimed at sub-Saharan Africa where the great burden of TB and HIV ⁄ AIDS resides, although the principles we outline would apply to other parts of the world as well. Health care infections, caused for example by poor hand hygiene, inadequate testing of donated blood, unsafe disposal of needles and syringes, poorly sterilized medical and surgical equipment and lack of adequate airborne infection control procedures, are responsible for a considerable burden of illness amongst patients and health care personnel, especially in resource-poor countries. Effective infection control in a district hospital requires that all the components of a health system function well: governance and stewardship, financing,infrastructure, procurement and supply chain management, human resources, health information systems, service delivery and finally supervision. We argue in this article that proper attention to infection control and an emphasis on safe health facilities is a concrete first step towards strengthening the interaction between disease-specific programmes and health systems where it really matters – for patients who are sick and for the health care workforce who provide

  20. Measuring and improving the societal impact of health care research

    NARCIS (Netherlands)

    Hansen, J.; Muscat, N.A.; Keskimäki, I.; Lindahl, A.K.; Pfaff, H.; Wismar, M.; Groenewegen, P.P.; et al, [No Value

    2013-01-01

    Health care research is increasingly being evaluated in terms of its contribution to new market products and services, among other factors, in the European Union’s new Framework Programme for Research and Innovation, Horizon 2020. However, discoveries in health care research often are not marketable

  1. Establishing an independent mobile health programme for chronic disease self-management support in Bolivia

    Directory of Open Access Journals (Sweden)

    John D Piette

    2014-08-01

    Full Text Available Background: Mobile health (m-health work in low and middle-income countries (LMICs mainly consists of pilot programmes with an unclear path to scaling and dissemination. We describe the deployment and testing of an m-health platform for non-communicable disease (NCD self-management support in Bolivia. Methods: 364 primary care patients in La Paz with diabetes or hypertension completed surveys about their use of mobile phones, health and access to care. 165 of those patients then participated in a 12-week demonstration of automated telephone monitoring and self-management support. Weekly Interactive Voice Response (IVR calls were made from a platform established at a university in La Paz, under the direction of the regional health ministry. Results: 37% of survey respondents spoke indigenous languages at home, and 38% had six or fewer years of education. 82% had a mobile phone; half (45% used text messaging with a standard phone, and 9% had a smartphone. Smartphones were least common among patients who were older, spoke indigenous languages, or had less education. IVR programme participants completed 1007 self-management support calls, with an overall response rate of 51%. IVR call completion was lower among older adults, but was not related to patients’ ethnicity, health status or healthcare access. IVR health and self-care reports were consistent with information reported during baseline interviews. Patients’ likelihood of reporting excellent, very good, or good health (versus fair or poor health via IVR increased during programme participation, and was associated with better medication adherence. Patients completing follow-up interviews were satisfied with the programme, with 19/20 (95% reporting that they would recommend it to a friend. Conclusions: By collaborating with LMICs, m-health programmes can be transferred from higher-resource centres to LMICs and implemented in ways that improve access to self-management support among people

  2. Community health workers programme in Luanda, Angola: an evaluation of the implementation process.

    Science.gov (United States)

    Giugliani, Camila; Duncan, Bruce Bartholow; Harzheim, Erno; Lavor, Antônio Carlile Holanda; Lavor, Míria Campos; Machado, Márcia Maria Tavares; Barbosa, Maria Idalice; Bornstein, Vera Joana; Pontes, Ana Lúcia; Knauth, Daniela Riva

    2014-12-09

    The Community Health Workers (CHWs) Programme was launched in Luanda, Angola, in 2007 as an initiative of the provincial government. The aim of this study was to assess its implementation process. This is a case study with documental analysis, CHWs reports data, individual interviews and focus groups. Until June 2009, the programme had placed in the community 2,548 trained CHWs, providing potential coverage for 261,357 families. Analysis of qualitative data suggested an association of CHWs with improvements in maternal and child access to health care, as well as an increase in the demand for health services, generating further need to improve service capacity. Nevertheless, critical points for programme sustainability were identified. For continuity and scaling up, the programme needs medium- and long-term technical, political and financial support. The results of this study may be useful in strengthening and reformulating the planning of the CHWs programme in Luanda and in Angola. Moreover, the lessons learned with this experience can also provide insight for the development of CHWs programmes in other parts of the world. By means of cooperation, Brazil has supported the implementation of this CHWs programme and can potentially contribute to its improvement.

  3. Health Care Industry Study

    Science.gov (United States)

    2002-01-01

    press conference with President Toledo of Peru on March 23, 2002, President Bush proclaimed, “education, jobs, and health care are the greatest...allow patients with chronic illnesses such as diabetes and high blood pressure to “visit” their doctors “on-line” while in the comfort and privacy of...to maintain a healthy lifestyle. As a result, non-communicable disease such as 10 heart disease, stroke, diabetes , and cancer are prevalent throughout

  4. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Client Satisfaction with Antenatal Care Services in Primary Health Care. Centres in Sabon ... important information about how well clinicians and the population of women within child bearing. 8 ..... model. Health and Quality of Life outcomes.

  5. International programme on the health effects of the Chernobyl accident

    International Nuclear Information System (INIS)

    1993-01-01

    Two years ago the World Health Assembly approved the establishment of the International Programme on the Health Effects of the Chernobyl Accident (IPHECA). The Programme, set up under the auspices of WHO, provides support to the health authorities in Belarus, the Russian Federation and the Ukraine in dealing with the aftermath of the accident, and is intended to serve as a unifying framework for all international health-related activities arising from the accident carried out in the three countries. This document outlines the Programme's objectives, structure, accomplishments and future plans. As a background, it also provides a brief overview of the accident and of its current and potential impact on health in the three countries. 5 figs, 1 tab

  6. Integrating eHealth in HIV/AIDS intervention programmes in South Africa

    Directory of Open Access Journals (Sweden)

    Babasile D. Osunyomi

    2015-03-01

    Objective: The key aim of this article is to explore the status quo of the implementation of information and communication technologies (ICTs in selected intervention programmes in the South African HIV/AIDS care delivery value chain. The contribution of this article is the mapping of key intervention activities along an HIV care value chain and to suggest a roadmap towards the integration of ICTs in service delivery programmes. Method: 20 managers of HIV/AIDS intervention programmes were surveyed, followed by semi-structured in-depth interviews with these respondents. A further five in-depth interviews were conducted with experts in the ICT area for exploring the uses of and barriers to integrating ICTs in the HIV/AIDS care delivery value chain. Results: The researchers mapped the barriers to implementation and ICT tools utilised within the HIV/AIDS care delivery value chain, which proves to be a useful tool to explore the status quo of technology in such service delivery programmes. The researchers then considered the wider policy environment and provided a roadmap based on the analysis and the South Africa eHealth strategy for driving development in this sector. Conclusion: The authors found that South Africa’s eHealth environment is still nascent and that the South African eHealth strategy does not place enough emphasis on systems integration and stakeholder engagement or the planning and process of uptake of ICTs by target audiences.

  7. Applying the Ottawa Charter to inform health promotion programme design.

    Science.gov (United States)

    Fry, Denise; Zask, Avigdor

    2017-10-01

    There is evidence of a correlation between adoption of the Ottawa Charter's framework of five action areas and health promotion programme effectiveness, but the Charter's framework has not been as fully implemented as hoped, nor is generally used by formal programme design models. In response, we aimed to translate the Charter's framework into a method to inform programme design. Our resulting design process uses detailed definitions of the Charter's action areas and evidence of predicted effectiveness to prompt greater consideration and use of the Charter's framework. We piloted the process by applying it to the design of four programmes of the Healthy Children's Initiative in New South Wales, Australia; refined the criteria via consensus; and made consensus decisions on the extent to which programme designs reflected the Charter's framework. The design process has broad potential applicability to health promotion programmes; facilitating greater use of the Ottawa Charter framework, which evidence indicates can increase programme effectiveness. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme.

    Science.gov (United States)

    Hetzel, Manuel W; Iteba, Nelly; Makemba, Ahmed; Mshana, Christopher; Lengeler, Christian; Obrist, Brigit; Schulze, Alexander; Nathan, Rose; Dillip, Angel; Alba, Sandra; Mayumana, Iddy; Khatib, Rashid A; Njau, Joseph D; Mshinda, Hassan

    2007-06-29

    Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.

  9. Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme

    Directory of Open Access Journals (Sweden)

    Alba Sandra

    2007-06-01

    Full Text Available Abstract Background Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. Project The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. Conclusion The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.

  10. Content, participants and outcomes of three diabetes care programmes in three low and middle income countries.

    NARCIS (Netherlands)

    Olmen, J. van; Ku, G.M.; Darras, C.; Kalobu, J.C.; Bewa, E.; Pelt, M. van; Hen, H.; Acker, K. van; Eggermont, N.; Schellevis, F.; Kegels, G.

    2015-01-01

    Aims: To improve access and quality of diabetes care for people in low-income countries, it is important to understand which elements of diabetes care are effective. This paper analyses three diabetes care programmes in the DR Congo, Cambodia and the Philippines. Methods: Three programmes offering

  11. Content, participants and outcomes of three diabetes care programmes in three low and middle income countries

    NARCIS (Netherlands)

    van Olmen, J.; Marie, K.G.; Christian, D.; Clovis, K.J.; Emery, B.; Maurits, V.P.; Heang, H.; Kristien, V.A.; Natalie, E.; Francois, S.; Guy, K.

    2015-01-01

    Aims To improve access and quality of diabetes care for people in low-income countries, it is important to understand which elements of diabetes care are effective. This paper analyses three diabetes care programmes in the DR Congo, Cambodia and the Philippines. Methods Three programmes offering

  12. Sexual Health Promotion Programme: Participants' Perspectives on Capacity Building

    Science.gov (United States)

    Keogh, Brian; Daly, Louise; Sharek, Danika; De Vries, Jan; McCann, Edward; Higgins, Agnes

    2016-01-01

    Objectives: The aim of this study was to evaluate a Health Service Executive (HSE) Foundation Programme in Sexual Health Promotion (FPSHP) with a specific emphasis on capacity building. Design: A mixed-method design using both quantitative and qualitative methods was used to collect the data. Setting: The FPSHP was delivered to staff working in…

  13. tanzania danida dental health programme progress in prevention

    African Journals Online (AJOL)

    gramme have been reactivated. Three of these projects deal with prevention only and more specifically with dental health education of the population. These projects are the. Tanzania School Health Programme, our work. 8 with the MCH system and, the continuing educa- tion of dental personnel to reorient them towards.

  14. Knowledge of School Health Programme among Public Primary ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Keywords: School-age children, Effective implementation, Adequate knowledge, Positive health ... healthy habits of the future adult population of any nation2 ... understanding of skills that a person has acquired ..... 7. Ofovwe GE, Ofili AN. Knowledge, attitude and practice of school health programme among head teachers of.

  15. Financial aspects of veterinary herd health management programmes

    NARCIS (Netherlands)

    Ifende, V.I.; Derks, M.; Hooijer, G.A.; Hogeveen, H.

    2014-01-01

    Veterinary herd health management (VHHM) programmes are meant to support herd health and farmers’ income (Brand and Guard 1996). They were introduced in the Netherlands in the 1970s (Sol and Renkema 1984) and at present many veterinarians provide them to farmers. VHHM comprises a basic structure of

  16. The retailing of health care.

    Science.gov (United States)

    Paul, T; Wong, J

    1984-01-01

    A number of striking parallels between recent developments in health care marketing and changes in the retailing industry exist. The authors have compared retailing paradigms to the area on health care marketing so strategists in hospitals and other health care institutions can gain insight from these parallels. Many of the same economic, demographic, technological and lifestyle forces may be at work in both the health care and retail markets. While the services or products offered in health care are radically different from those of conventional retail markets, the manner in which the products and services are positioned, priced or distributed is surprisingly similar.

  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. Operations management in health care.

    Science.gov (United States)

    Henderson, M D

    1995-01-01

    Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.

  19. Financial aspects of veterinary herd health management programmes.

    Science.gov (United States)

    Ifende, V I; Derks, M; Hooijer, G A; Hogeveen, H

    2014-09-06

    Veterinary herd health management (VHHM) programmes have been shown to be economically effective in the past. However, no current information is available on costs and benefits of these programmes. This study compared economics and farm performance between participants and non-participants in VHHM programmes in 1013 dairy farms with over 40 cows. Milk Production Registration (MPR) data and a questionnaire concerning VHHM were used. Based on the level of participation in VHHM (as indicated in the questionnaire), costs of the programmes were calculated using a normative model. The economic value of the production effects was similarly calculated using normative modelling based on MPR data. Participants in VHHM had a better performance with regard to production, but not with regard to reproduction. Over 90 per cent of the VHHM participants were visited at least once every six weeks and most participants discussed at least three topics. In most farms, the veterinarian did the pregnancy checks as part of the VHHM programmes. There was a benefit to cost ratio of about five per cow per year for VHHM participants, and a mean difference in net returns of €30 per cow per year after adjusting for the cost of the programme. This portrays that participation in a VHHM programme is cost-efficient. There is, however, much unexplained variation in the net returns, possibly due to diverse approaches by veterinarians towards VHHM or by other factors not included in this analysis, like nutritional quality or management abilities of the farmer. British Veterinary Association.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Colorectal cancer (CRC) is a public health challenge in developed countries and an emerging public health problem in developing ... and public health challenges in their immigrant countries. More so ..... The nutrition transition in Brazil. 46.

  1. Mentoring health researchers globally: Diverse experiences, programmes, challenges and responses.

    Science.gov (United States)

    Cole, Donald C; Johnson, Nancy; Mejia, Raul; McCullough, Hazel; Turcotte-Tremblay, Anne-Marie; Barnoya, Joaquin; Falabella Luco, María Soledad

    2016-10-01

    Mentoring experiences and programmes are becoming increasingly recognised as important by those engaged in capacity strengthening in global health research. Using a primarily qualitative study design, we studied three experiences of mentorship and eight mentorship programmes for early career global health researchers based in high-income and low- and middle-income countries. For the latter, we drew upon programme materials, existing unpublished data and more formal mixed-method evaluations, supplemented by individual email questionnaire responses. Research team members wrote stories, and the team assembled and analysed them for key themes. Across the diverse experiences and programmes, key emergent themes included: great mentors inspire others in an inter-generational cascade, mentorship is transformative in personal and professional development and involves reciprocity, and finding the right balance in mentoring relationships and programmes includes responding creatively to failure. Among the challenges encountered were: struggling for more level playing fields for new health researchers globally, changing mindsets in institutions that do not have a culture of mentorship and building collaboration not competition. Mentoring networks spanning institutions and countries using multiple virtual and face-to-face methods are a potential avenue for fostering organisational cultures supporting quality mentorship in global health research.

  2. Resource needs of an occupational health service to accommodate a hepatitis B vaccination programme.

    Science.gov (United States)

    Jachuck, S J; Jones, C; Nicholls, A; Bartlett, M

    1990-01-01

    The administrative, organizational and clinical commitment of an occupational health department to implement the DHSS recommendation for a hepatitis B vaccination programme for the health care workers in a District General Hospital was reviewed to evaluate the resource implications needed to accommodate the additional workload. The deficiencies observed in the existing DHSS guidance in implementing the plan are described. It is suggested that the Department of Health, while making future recommendations for vaccination, should be more precise in identifying those at risk, in describing the desired titre to be achieved after vaccination, and in describing the follow-up plan for those who accept the vaccination, those who refuse and those who do not seroconvert. The recommendation should describe the commitment of the Health Authorities and must include recommendations for appropriate and adequate resources to support such a programme. Vaccination for 1000 employees at risk required 4000 additional consultations necessitating 16 additional hours of occupational health commitment per week. Eighteen months after initiating the vaccination programme, 677 employees had accepted the vaccine. After receiving 3 vaccines 508 (75 per cent) recipients had protective seroconversion (anti-Hbs greater than 100 I.U.) and a further 61 (9 per cent) converted after the 4th injection, thereby offering protective immunity to 84 per cent of the recipients. During the period 84 (12.4 per cent) were lost to follow-up. Recommendations have been made to accommodate the additional commitment through the vaccination programme to standardize our care and prevent disruption of the existing service.

  3. Losing connections and receiving support to reconnect: experiences of frail older people within care programmes implemented in primary care settings.

    Science.gov (United States)

    Bindels, Jill; Cox, Karen; De La Haye, Jean; Mevissen, Ger; Heijing, Servé; van Schayck, Onno C P; Widdershoven, Guy; Abma, Tineke A

    2015-09-01

    The objective of this study was to evaluate whether care provided in the care programmes matched the needs of older people. Care programmes were implemented in primary-care settings in the Netherlands to identify frail older people and to prevent further deterioration of health. In total, 23 older people participated in in-depth interviews. Within this study, three older people participated as co-researchers; they gathered and analysed the data together with the academic researchers. Content analysis was used to analyse the data. Two categories emerged from the data: 'Losing connections' and 'Receiving support to reconnect.' 'Losing connections' reflects the needs of older people and 'Receiving support to reconnect' reflects their experience and the appreciated aspects of the provided care. A relationship of trust with the practice nurse (PN) appeared to be an important aspect of care, as it fostered the sharing of feelings and issues other than physical or medical problems that could not be shared with the general practitioner. The PNs are experienced as connectors, who help to restore feelings of connectedness and older peoples' access to resources in the community. The relationship with the PN was experienced as valuable because of the feelings of 'connectedness' it created. Through this connectedness, older people could discuss feelings of loneliness, depression and frustration in receiving and acquiring the appropriate resources and services with the PNs. Furthermore, the relationship with the PN helped the older people to gain access to other health professionals and services. The results imply that care for frail older people should include an awareness of the importance of the trusting relationship. Nurses can play a vital role in creating a trusting relationship and are able to bridge the gap between older people and other professionals and services. © 2014 John Wiley & Sons Ltd.

  4. 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.

  5. [Sexual and reproductive health in Roma women: the family planning programme of Polígono Sur in Seville (Spain)].

    Science.gov (United States)

    Escobar-Ballesta, Marta; García-Ramírez, Manuel; Albar-Marín, M ª Jesús; Paloma, Virginia

    2018-04-05

    To describe the challenges, resources and strategies of the staff of the family planning programme of the Polígono Sur Healthcare Centre in Seville (Spain) in their care of Roma women. This is a descriptive study in which in-depth interviews and discussion groups were held with all programme professionals, including a documentary review of the programme. The information was analyzed based on the Roma Health Integration Policy Index, a tool that evaluates the entitlement, accessibility, sensitivity and capacity for change of health programmes for the Roma population. The professionals encountered multiple challenges to implement the family planning programme with Roma women due to the characteristics of the users and the low sensitivity of the programme towards them. The absence of specific actions for Roma women within the family planning programme, agreed to by the healthcare district, obliges professionals to develop adaptations and strategies to ensure quality sexual and reproductive health services for their users. It is necessary to adapt sexual and reproductive health programmes targeted at Roma women by (a) detecting, evaluating, systematizing and disseminating good practices, (b) developing actions that address the multiple vulnerabilities of Roma women, (c) acknowledging professionals who advocate for the health of these women within their organizations, and (d) promoting reproductive justice as the goal of these programmes. Copyright © 2018 SESPAS. All rights reserved.

  6. A European Master's Programme in Public Health Nutrition.

    Science.gov (United States)

    Yngve, A; Warm, D; Landman, J; Sjöström, M

    2001-12-01

    Effective population-based strategies require people trained and competent in the discipline of Public Health Nutrition. Since 1997, a European Master's Programme in Public Health Nutrition has been undergoing planning and implementation, by establishing initial quality assurance systems with the aid of funding from the European Commission (DG SANCO/F3). Partners from 17 European countries have been involved in the process. A European Network of Public Health Nutrition has been developed and accredited by the European Commission.

  7. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    dearth of information on patient satisfaction with HIV/AIDS care. This study sought ... with the doctor. Satisfaction rates were: 94.9% technical quality, ... of the delivery of care into several dimensions of contributed by studies carried out in Western. 14 ... efficiency of services as an index of patient needs of its clients. Secondly ...

  8. Engaging men in health care.

    Science.gov (United States)

    Malcher, Greg

    2009-03-01

    Engaging men in health care involves a multifaceted approach that has as its main principle the recognition that men consume health care differently to women. This article identifies barriers to engaging men in health care and offers potential and existing solutions to overcome these barriers in a range of health care settings. The concept of multiple masculinities recognises that not all men can be engaged via a particular technique or strategy. The perception that men are disinterested in their health is challenged and a range of approaches discussed, both in the community and in health care facilities. In the general practice setting opportunities exist for the engagement of men at the reception desk and waiting room, as well as during the consultation. Use of the workplace in engaging men is discussed. Future activities to build the capacity of health care providers to better engage men are identified and the role of policy and program development is addressed.

  9. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bjärnung Åsa

    2010-10-01

    Full Text Available Abstract Background Osteoarthritis (OA is a degenerative disease, considered to be one of the major public health problems. Research suggests that patient education is feasible and valuable for achieving improvements in quality of life, in function, well-being and improved coping. Since 1994, Primary Health Care in Malmö has used a patient education programme directed towards OA. The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy, function and self-perceived health. Method The study was a single-blind, randomized controlled trial (RCT in which the EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity. Results We found differences between the intervention group and the control group, comparing the results at baseline and after 6 months in EuroQol-5D (p Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree, but not self-efficacy. Further research to investigate the effect of exercise performance on function, as well as self-efficacy is warranted. Trial registration The trial is registered with ClinicalTrials.gov. Registration number: NCT00979914

  10. Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries.

    Science.gov (United States)

    Dal Poz, Mario Roberto; Sepulveda, Hernan Rodrigo; Costa Couto, Maria Helena; Godue, Charles; Padilla, Monica; Cameron, Rick; Vidaurre Franco, Thais de Andrade

    2015-04-28

    The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007-2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.

  11. Accountability in Health Care

    DEFF Research Database (Denmark)

    Vrangbæk, Karsten; Byrkjeflot, Haldor

    2016-01-01

    The debate on accountability within the public sector has been lively in the past decade. Significant progress has been made in developing conceptual frameworks and typologies for characterizing different features and functions of accountability. However, there is a lack of sector specific...... 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...... that reforms can introduce new forms of accountability, change existing accountability relations or change the relative importance of different accountability forms. They may also change the dominant direction and shift the balance between different functions of accountability. We further suggest...

  12. 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.

  13. 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, ...

  14. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    2Department of Community Health, University of Benin, Benin City, Nigeria. ... Mental morbidity is a public health problem that can lead to a great burden of disability in the community. ..... community study in Sao Paulo, Brazil where.

  15. Primary care as a means of decreasing health care costs | van ...

    African Journals Online (AJOL)

    The study was focussedat furthering the health objectives of the Government\\'s Reconstruction and Development Programme in the area ofprimary care. The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary care, so that medical scheme ...

  16. [Methods in health services research. The example of the evaluation of the German disease management programmes].

    Science.gov (United States)

    Morfeld, M; Wirtz, M

    2006-02-01

    According to the established definition of Pfaff, health services research analyses patients' path through the institutions of the health care system. The focus is on development, evaluation and implementation of innovative measures of health care. By increasing its quality health services research strives for an improvement of efficacy and efficiency of the health care system. In order to allow for an appropriate evaluation it is essential to differentiate between structure, process and outcome quality referring to (1) the health care system in its entirety, (2) specific health care units as well as (3) processes of communication in different settings. Health services research comprises a large array of scientific disciplines like public health, medicine, social sciences and social care. For the purpose of managing its tasks adequately a special combination of instruments and methodological procedures is needed. Thus, diverse techniques of evaluation research as well as special requirements for study designs and assessment procedures are of vital importance. The example of the German disease management programmes illustrates the methodical requirements for a scientific evaluation.

  17. Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya.

    Science.gov (United States)

    Djomand, Gaston; Gao, Hongjiang; Singa, Benson; Hornston, Sureyya; Bennett, Eddas; Odek, James; McClelland, R Scott; John-Stewart, Grace; Bock, Naomi

    2016-01-01

    Control of genital infections remains challenging in most regions. Despite advocacy by the World Health Organization for syndromic case management, there are limited data on the syndromic approach, especially in HIV care settings. This study compared the syndromic approach with laboratory diagnosis among women in HIV care in Kenya. A mobile team visited 39 large HIV care programmes in Kenya and enrolled participants using population-proportionate sampling. Participants provided behavioural and clinical data with genital and blood specimens for lab testing. Among 1063 women, 68.4% had been on antiretroviral therapy >1 year; 58.9% were using cotrimoxazole prophylaxis; 51 % had CD4+T-lymphocytes Kenya have high rates of vaginal infections. Syndromic diagnosis was a poor predictor of those infections. © The Author(s) 2015.

  18. Health Care Provider Value Chain

    OpenAIRE

    Kawczynski , Lukasz; Taisch , Marco

    2009-01-01

    International audience; In every society there is a need for an efficient health care system. This paper aims to propose a value definition and a value chain model within the health care. In order to define value patients and experts were surveyed. The proposed definition offers a complex way of looking at the value within the health care sector. The proposal of the value chain model is anticipated with a value stream mapping activities and experts interviews. Proposed model offers consistent...

  19. Health care for people with disability

    Directory of Open Access Journals (Sweden)

    Francisco Javier Leturia Arrazola

    2014-06-01

    Full Text Available Although the majority of disabled people aren’t or don’t feel ill, and despite that they should be taken care of by the general medical services as many other citizens, most of them need a more intense and frequent health care. This is explained by a higher prevalence of some medical conditions as well as a higher risk of comorbidity among the people with disabilities (in comparison to the general population. At the moment there are many problems concerning accessibility, underdiagnose and overtreatment. National health systems should be able to offer all their services adapted to disabled people in order to obtain results for this group that are similar to those of the rest of the population. To achieve this objective it is necessary to improve professional competencies and skills and develop some specific health programmes.

  20. Wellness programme and health policy development at a large faith ...

    African Journals Online (AJOL)

    The study's primary recommendations include: taking its employees' cultural and social norms into consideration; addressing issues related to capacity and ... list of recommendations for other resource-constrained NGOs that also wish to develop and implement wellness programmes and health policies in their workplace.

  1. Health-related doctoral distance education programmes: A review of ...

    African Journals Online (AJOL)

    Health-related doctoral distance education programmes: A review of ethical scholarship considerations. ... Universities should encourage and support supervisors and students to publish research findings in academic journals and to present these at conferences. However, communities that participated in a research project ...

  2. Evaluation of a Health Education Programme about Traumatic Brain Injury

    Science.gov (United States)

    Garcia, Jane Mertz; Sellers, Debra M.; Hilgendorf, Amy E.; Burnett, Debra L.

    2014-01-01

    Objective: Our aim was to evaluate a health education programme (TBIoptions: Promoting Knowledge) designed to increase public awareness and understanding about traumatic brain injury (TBI) through in-person (classroom) and computer-based (electronic) learning environments. Design: We used a pre-post survey design with randomization of participants…

  3. 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.…

  4. National Health-Care Reform

    Science.gov (United States)

    2009-03-24

    and pre/ post partum care during delivery. America should select measures that reflect the health-care goals of the nation. As an example, the Healthy...accidents (8) More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression ...reflect the cumulative efforts of different types of individual care. For example, infant mortality is a reflection of pre-natal care, post - natal care

  5. Optimizing Health Care Environmental Hygiene.

    Science.gov (United States)

    Carling, Philip C

    2016-09-01

    This article presents a review and perspectives on aspects of optimizing health care environmental hygiene. The topics covered include the epidemiology of environmental surface contamination, a discussion of cleaning health care patient area surfaces, an overview of disinfecting health care surfaces, an overview of challenges in monitoring cleaning versus cleanliness, a description of an integrated approach to environmental hygiene and hand hygiene as interrelated disciplines, and an overview of the research opportunities and challenges related to health care environmental hygiene. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Increasing health worker capacity through distance learning: a comprehensive review of programmes in Tanzania

    Directory of Open Access Journals (Sweden)

    Kisimbo Daniel

    2010-12-01

    Full Text Available Abstract Background Tanzania, like many developing countries, faces a crisis in human resources for health. The government has looked for ways to increase the number and skills of health workers, including using distance learning in their training. In 2008, the authors reviewed and assessed the country's current distance learning programmes for health care workers, as well as those in countries with similar human resource challenges, to determine the feasibility of distance learning to meet the need of an increased and more skilled health workforce. Methods Data were collected from 25 distance learning programmes at health training institutions, universities, and non-governmental organizations throughout the country from May to August 2008. Methods included internet research; desk review; telephone, email and mail-in surveys; on-site observations; interviews with programme managers, instructors, students, information technology specialists, preceptors, health care workers and Ministry of Health and Social Welfare representatives; and a focus group with national HIV/AIDS care and treatment organizations. Results Challenges include lack of guidelines for administrators, instructors and preceptors of distance learning programmes regarding roles and responsibilities; absence of competencies for clinical components of curricula; and technological constraints such as lack of access to computers and to the internet. Insufficient funding resulted in personnel shortages, lack of appropriate training for personnel, and lack of materials for students. Nonetheless, current and prospective students expressed overwhelming enthusiasm for scale-up of distance learning because of the unique financial and social benefits offered by these programs. Participants were retained as employees in their health care facilities, and remained in their communities and supported their families while advancing their careers. Space in health training institutions was freed up

  7. Programme

    OpenAIRE

    Hobday, E, fl. 1905, artist

    2003-01-01

    A photograph of an illustrated programme listing dances. The illustration shows a snake charmer playing to a snake while another man watches. Buildings and trees can be seen behind a wall in the distance. In the lower right-hand corner of the programme is the signature 'E. Hobday'. The programme is almost certainly related to the Punjab Ball, Lahore. It is placed next to the Punjab Ball Menu in the album and the Menu is also illustrated by 'E. Hobday'.

  8. Strengthening mental health systems in low- and middle-income countries: the Emerald programme.

    Science.gov (United States)

    Semrau, Maya; Evans-Lacko, Sara; Alem, Atalay; Ayuso-Mateos, Jose Luis; Chisholm, Dan; Gureje, Oye; Hanlon, Charlotte; Jordans, Mark; Kigozi, Fred; Lempp, Heidi; Lund, Crick; Petersen, Inge; Shidhaye, Rahul; Thornicroft, Graham

    2015-04-10

    There is a large treatment gap for mental health care in low- and middle-income countries (LMICs), with the majority of people with mental, neurological, and substance use (MNS) disorders receiving no or inadequate care. Health system factors are known to play a crucial role in determining the coverage and effectiveness of health service interventions, but the study of mental health systems in LMICs has been neglected. The 'Emerging mental health systems in LMICs' (Emerald) programme aims to improve outcomes of people with MNS disorders in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda) by generating evidence and capacity to enhance health system performance in delivering mental health care. A mixed-methods approach is being applied to generate evidence on: adequate, fair, and sustainable resourcing for mental health (health system inputs); integrated provision of mental health services (health system processes); and improved coverage and goal attainment in mental health (health system outputs). Emerald has a strong focus on capacity-building of researchers, policymakers, and planners, and on increasing service user and caregiver involvement to support mental health systems strengthening. Emerald also addresses stigma and discrimination as one of the key barriers for access to and successful delivery of mental health services.

  9. Coffee, Cake & Culture: Evaluation of an art for health programme for older people in the community.

    Science.gov (United States)

    Roe, Brenda; McCormick, Sheila; Lucas, Terri; Gallagher, Wendy; Winn, Andrea; Elkin, Sophie

    2016-07-01

    Arts for health initiatives and networks are being developed in a number of countries and an international literature is emerging on the evidence of their benefits to people's health, wellbeing and quality of life. Engagement in cultural and creative arts by older people can increase their morale and self-confidence and provides opportunities for social connection. Museums and galleries are increasingly required to justify their expenditure, reach and impact and some are working in partnership with local councils, hospitals, schools and communities to improve access to their collections. There is a body of literature emerging that describes such initiatives but empirical evidence of their benefits is less developed. This article reports an evaluation of an art for health initiative - Coffee, Cake & Culture organised and delivered by Whitworth Art Gallery and Manchester Museum in 2012 for older people living in a care home and a supported living facility. The study has identified the benefits and impacts of the arts for health programme and its feasibility for older people, with or without diagnosed memory loss - dementia, living in a care home or supported living facility and their care staff. The findings demonstrate there were benefits to the older people and their care staff in terms of wellbeing, social engagement, learning, social inclusion and creativity. These benefits were immediate and continued in the short term on their return home. The majority of older people and care staff had not previously been to the art gallery or museum and the programme encouraged creative arts and cultural appreciation which promoted social inclusion, wellbeing and quality of life. The programme is feasible and important lessons were identified for future planning. Further research involving partnerships of researchers, arts for health curators, artists, care staff, older people and their families is warranted. © The Author(s) 2014.

  10. Multipurpose Health Care Telemedicine System

    National Research Council Canada - National Science Library

    Kyriacou, E

    2001-01-01

    .... Ambulances, Rural Health Centers (RHC) or other remote health location, Ships navigating in wide seas and Airplanes in flight are common examples of possible emergency sites, while critical care telemetry, and telemedicine home follow-ups...

  11. A taxonomy and results from a comprehensive review of 28 maternal health voucher programmes.

    Science.gov (United States)

    Bellows, Ben W; Conlon, Claudia M; Higgs, Elizabeth S; Townsend, John W; Nahed, Matta G; Cavanaugh, Karen; Grainger, Corinne G; Okal, Jerry; Gorter, Anna C

    2013-12-01

    It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community

  12. A Taxonomy and Results from a Comprehensive Review of 28 Maternal Health Voucher Programmes

    Science.gov (United States)

    Conlon, Claudia M.; Higgs, Elizabeth S.; Townsend, John W.; Nahed, Matta G.; Cavanaugh, Karen; Grainger, Corinne G.; Okal, Jerry; Gorter, Anna C.

    2013-01-01

    It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community

  13. Health care economy II

    International Nuclear Information System (INIS)

    Beer, G.; Slovak, K.

    2008-01-01

    In Slovakia a strange approach to the purchase of health care equipment has not been limited to ophthalmology. Suspicious procurements are symptomatic. This applies also to specialisation where the correct spending of money can make the difference between life and death and can greatly effect the quality of life. More than a year ago, the Ministry of Health started the procurement of linear accelerators for oncology units in three hospitals. This plan placed on the market a potential order worth more than 11 million EUR without VAT. Three companies produce this complex equipment. The US company, Varian, the German company, Siemens, and the Swedish company, Elekta. Three suppliers, three hospitals. What a coincidence that each hospital - in Presov, Banska Bystrica and Bratislava - received only one envelope with an offer. Each from a different supplier. If anyone wanted to prove that the suppliers did not agree on a common approach, he would soon get into trouble. Each tender was organized by Pro-Tender, Kosice. The tender for the purchase of linear accelerators observed all the legal regulations. For each hospital there was only one offer and so it won. No-one complained, because each company got an order. Amedis Piestany will deliver a Varian product to Bystrica. In Narodny onkologicky ustav in Bratislava the winner was Transkontakt with Elekta products. And in Presov it was Ad Rem from Dunajska Streda that succeeded. The small company owned by a local vet joined up with Siemens and is now opening the doors of state-owned and regional hospitals to the company. (authors)

  14. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Department of Epidemiology and Community Health, University of Ilorin, Ilorin, Nigeria .... exercise. All pupils in the selected school later done under the light ..... increased the likelihood of intestinal parasitic of Ilechukwu et al in which a ...

  15. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Subject and Methods: ... To the best of the authors' knowledge, ... increase in percentage of women visiting health categories were decided on because ..... leadership resulted in an empowering work Significant differences in the proportions of.

  16. 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.

  17. Student-Led Health Education Programmes in the Waiting Room of a Free Clinic for Uninsured Patients

    Science.gov (United States)

    Kamimura, Akiko; Tabler, Jennifer; Myers, Kyl; Ahmed, Fattima; Aguilera, Guadalupe; Ashby, Jeanie

    2017-01-01

    Objective: Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged in the USA. Free clinic patients may have health education needs, but experience barriers to attending health education programmes. In an attempt to reach out to free clinic patients who might not…

  18. An international partnership interdisciplinary training programme on public health

    DEFF Research Database (Denmark)

    Andrioti, Despena; Charalambous, George; Skitsou, Alexandra

    2015-01-01

    Background: Targeted training programmes are more efficient towards skills development. Literature on assessing training needs in order to formulate programmes through international partnerships is very limited. This study intended to identify perceived training needs in public health with an aim...... at providing the respective training in cooperation with the World Health Organization, European Office. Method and Material: We distributed a questionnaire to Greek professionals such as doctors, nurses, administrative personnel and social scientists, employed in the public sector all over the country. We...... analysed 197 structured self-administered questionnaires using one way ANOVA to identify associations between individual characteristics of health professionals and perceived training needs. Results: The majority of participants were women (n=143, 73%) and men (n=53, 27%). In terms of motivation...

  19. Diaspora, disease, and health care.

    Science.gov (United States)

    Wick, Jeannette Y; Zanni, Guido R

    2007-03-01

    When groups of people relocate from their homelands to other nations, especially if the movement is involuntary, minority populations are created in the countries that receive them. The issues related to these diaspora and diasporic communities--any groups that have been dispersed outside their traditional homelands--are financial, social, historical, political, or religious. In health care, issues include heritable diseases, cultural barriers, patients' health care beliefs, and unique disease presentations. In long-term care, many residents and health care providers have relocated to the United States from other countries.

  20. The Quiet Health Care Revolution.

    Science.gov (United States)

    Herzlinger, Regina

    1994-01-01

    Discusses how entrepreneurs have helped reduce costs in health care and examines the major changes in the health care system that are simultaneously lowering costs and increasing quality. The author then explains how current reform proposals might affect these entrepreneurial innovations. (GLR)

  1. Organizing emotions in health care.

    Science.gov (United States)

    Mark, Annabelle

    2005-01-01

    To introduce the articles in this special issue, discussing emotion in the in health-care organisations. Discusses such topics as what makes health care different, editorial perspectives, how health care has explored emotion so far, and the impact of emotion on patients and the consequences for staff. Health care provides a setting that juxtaposes emotion and rationality, the individual and the body corporate, the formal and the deeply personal, the public and the private, all of which must be understood better if changes in expectations and delivery are to remain coherent. The papers indicate a shared international desire to understand meaning in emotion that is now spreading across organizational process and into all professional roles within health care.

  2. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    compared the perceived availability of essential drugs and patronage of health facilities in a BI and non-BI Local government areas (LGA) of ... 2Medical Directorate, Hospitals Management Board, Uyo, Akwa Ibom State ... majority of the population in Malaysia had access to .... Ethical clearance for this study was obtained.

  3. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    The level of knowledge of HIV/AIDS among senior secondary school students in Ikpoba Okha LGA was poor. Parents were mainly the first source of information on HCT for the respondents. There is need for more research to update knowledge and information on adolescent health issues and services related to HIV/AIDS.

  4. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    A nation's disease control effort is often as good as the surveillance and notification system put in place, .... Department. Community Health. 11. 4.9. Dentistry. 28. 12.5. Family Medicine. 14 .... formal training and a posting in the Infection control.

  5. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Latin America and Southeast Asia. Cervical ... screening method based on visual Inspection with. 10-13 .... 56(49.6%) had poor knowledge while relating to practice of ... articulated road map and policy frame work to address ... European formal of Public ... Knowledge attitude and Practice ... Tertiary Health Institution. Int J.

  6. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the mobile phones of health workers and their role as a source of hospital acquired infection. The study utilised ..... grew organisms which is much lower than may not be as effective as regular hand. 7 .... Akinyemi KO, Atapu AD, Adetona. 2011 ...

  7. Integrated care programmes for adults with chronic conditions: a meta-review.

    Science.gov (United States)

    Martínez-González, Nahara Anani; Berchtold, Peter; Ullman, Klara; Busato, André; Egger, Matthias

    2014-10-01

    To review systematic reviews and meta-analyses of integrated care programmes in chronically ill patients, with a focus on methodological quality, elements of integration assessed and effects reported. Meta-review of systematic reviews and meta-analyses identified in Medline (1946-March 2012), Embase (1980-March 2012), CINHAL (1981-March 2012) and the Cochrane Library of Systematic Reviews (issue 1, 2012). Methodological quality assessed by the 11-item Assessment of Multiple Systematic Reviews (AMSTAR) checklist; elements of integration assessed using a published list of 10 key principles of integration; effects on patient-centred outcomes, process quality, use of healthcare and costs. Twenty-seven systematic reviews were identified; conditions included chronic heart failure (CHF; 12 reviews), diabetes mellitus (DM; seven reviews), chronic obstructive pulmonary disease (COPD; seven reviews) and asthma (five reviews). The median number of AMSTAR checklist items met was five: few reviewers searched for unpublished literature or described the primary studies and interventions in detail. Most reviews covered comprehensive services across the care continuum or standardization of care through inter-professional teams, but organizational culture, governance structure or financial management were rarely assessed. A majority of reviews found beneficial effects of integration, including reduced hospital admissions and re-admissions (in CHF and DM), improved adherence to treatment guidelines (DM, COPD and asthma) or quality of life (DM). Few reviews showed reductions in costs. Systematic reviews of integrated care programmes were of mixed quality, assessed only some components of integration of care, and showed consistent benefits for some outcomes but not others. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care.

  8. Health care of hunting dogs

    OpenAIRE

    Spasojević-Kosić, Ljubica; Savić, Sara

    2013-01-01

    There are two basic aspects of hunting dog’s health care: infectious diseases of hunting dogs and dog’s hunting performance. Concerning infectious diseases of hunting dogs, special attention is paid to public health, preventing possible dangers that could possibly arise. On the other hand, hunting performance of dogs depends on their nutrition. A complete analysis of hunting dogs’ health care in our country requires an assessment of awareness level in hunte...

  9. Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: a comprehensive approach.

    Science.gov (United States)

    Birkhead, Guthrie S; Klein, Susan J; Candelas, Alma R; O'Connell, Daniel A; Rothman, Jeffrey R; Feldman, Ira S; Tsui, Dennis S; Cotroneo, Richard A; Flanigan, Colleen A

    2007-10-01

    New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration. HCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development. IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain. A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.

  10. Implementation and evaluation of a clinical data management programme in a primary care centre.

    LENUS (Irish Health Repository)

    Sweeney, J

    2014-11-01

    Electronic health records (EHR) support clinical management, administration, quality assurance, research, and service planning. The aim of this study was to evaluate a clinical data management programme to improve consistency, completeness and accuracy of EHR information in a large primary care centre with 10 General Practitioners (GPs). A Clinical Data Manager was appointed to implement a Data Management Strategy which involved coding consultations using ICPC-2 coding, tailored support and ongoing individualised feedback to clinicians. Over an eighteen month period there were improvements in engagement with and level of coding. Prior to implementation (August 2011) 4 of the 10 GPs engaged in regular coding and 69% of their consultation notes were coded. After 12 months, all 10 GPs and 6 nurses were ICPC-2 coding their consultations and monthly coding levels had increased to 98%. This structured Data Management Strategy provides a feasible sustainable way to improve information management in primary care.

  11. Gender disparities in health care.

    Science.gov (United States)

    Kent, Jennifer A; Patel, Vinisha; Varela, Natalie A

    2012-01-01

    The existence of disparities in delivery of health care has been the subject of increased empirical study in recent years. Some studies have suggested that disparities between men and women exist in the diagnoses and treatment of health conditions, and as a result measures have been taken to identify these differences. This article uses several examples to illustrate health care gender bias in medicine. These examples include surgery, peripheral artery disease, cardiovascular disease, critical care, and cardiovascular risk factors. Additionally, we discuss reasons why these issues still occur, trends in health care that may address these issues, and the need for acknowledgement of the current system's inequities in order to provide unbiased care for women in the future. © 2012 Mount Sinai School of Medicine.

  12. Active ingredients in anti-stigma programmes in mental health.

    Science.gov (United States)

    Pinfold, Vanessa; Thornicroft, Graham; Huxley, Peter; Farmer, Paul

    2005-04-01

    This paper draws upon a review of the relevant literature and the results of the recent Mental Health Awareness in Action (MHAA) programme in England to discuss the current evidence base on the active ingredients in effective anti-stigma interventions in mental health. The MHAA Programme delivered educational interventions to 109 police officers, 78 adults from different community groups whose working lives involved supporting people with mental health problems but who had received no mental health training and 472 schools students aged 14-15. Each adult target group received two intervention sessions lasting two hours. The two school lessons were 50 minutes each. Knowledge, attitudes and behavioural intent were assessed at baseline and follow-up. In addition focus groups were held with mental health service users to explore the impact of stigma on their lives and facilitators of educational workshops were interviewed to provide expert opinion on 'what works' to reduce psychiatric stigma. Personal contact was predictive of positive changes in knowledge and attitudes for the school students but not the police officers or community adult group. The key active ingredient identified by all intervention groups and workshop facilitators were the testimonies of service users. The statements of service users (consumers) about their experience of mental health problems and of their contact with a range of services had the greatest and most lasting impact on the target audiences in terms of reducing mental health stigma.

  13. Hope for health and health care.

    Science.gov (United States)

    Stempsey, William E

    2015-02-01

    Virtually all activities of health care are motivated at some level by hope. Patients hope for a cure; for relief from pain; for a return home. Physicians hope to prevent illness in their patients; to make the correct diagnosis when illness presents itself; that their prescribed treatments will be effective. Researchers hope to learn more about the causes of illness; to discover new and more effective treatments; to understand how treatments work. Ultimately, all who work in health care hope to offer their patients hope. In this paper, I offer a brief analysis of hope, considering the definitions of Hobbes, Locke, Hume and Thomas Aquinas. I then differentiate shallow and deep hope and show how hope in health care can remain shallow. Next, I explore what a philosophy of deep hope in health care might look like, drawing important points from Ernst Bloch and Gabriel Marcel. Finally, I suggest some implications of this philosophy of hope for patients, physicians, and researchers.

  14. Global health training in US obstetrics and gynaecology residency programmes: perspectives of students, residents and programme directors.

    Science.gov (United States)

    Nathan, Lisa M; Banks, Erika H; Conroy, Erin M; McGinn, Aileen P; Ghartey, Jeny P; Wagner, Sarah A; Merkatz, Irwin R

    2015-12-01

    Benefits of exposure to global health training during medical education are well documented and residents' demand for this training is increasing. Despite this, it is offered by few US obstetrics and gynaecology (OBGYN) residency training programmes. To evaluate interest, perceived importance, predictors of global health interest and barriers to offering global health training among prospective OBGYN residents, current OBGYN residents and US OGBYN residency directors. We designed two questionnaires using Likert scale questions to assess perceived importance of global health training. The first was distributed to current and prospective OBGYN residents interviewing at a US residency programme during 2012-2013. The second questionnaire distributed to US OBGYN programme directors assessed for existing global health programmes and global health training barriers. A composite Global Health Interest/Importance score was tabulated from the Likert scores. Multivariable linear regression was performed to assess for predictors of Global Health Interest/Importance. A total of 159 trainees (77%; 129 prospective OBGYN residents and 30 residents) and 69 (28%) programme directors completed the questionnaires. Median Global Health Interest/Importance score was 7 (IQR 4-9). Prior volunteer experience was predictive of a 5-point increase in Global Health Interest/Importance score (95% CI -0.19 to 9.85; p=0.02). The most commonly cited barriers were cost and time. Interest and perceived importance of global health training in US OBGYN residency programmes is evident among trainees and programme directors; however, significant financial and time barriers prevent many programmes from offering opportunities to their trainees. Prior volunteer experience predicts global health interest. 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/

  15. [A Maternal Health Care System Based on Mobile Health Care].

    Science.gov (United States)

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

  16. 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.

  17. 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.

  18. Health system challenges to integration of mental health delivery in primary care in Kenya--perspectives of primary care health workers.

    Science.gov (United States)

    Jenkins, Rachel; Othieno, Caleb; Okeyo, Stephen; Aruwa, Julyan; Kingora, James; Jenkins, Ben

    2013-09-30

    Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness. Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training). These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other

  19. Call to action for Scottish health care.

    Science.gov (United States)

    2001-03-07

    SCOTLAND'S NEWLY published strategy for nursing and midwifery, Caring for Scotland, is a reminder of how different professional life can be for nurses across the UK. For example, while developments in telehealth and telemedicine facilities are certainly not unique to the remote rural areas of Scotland, there can be few nurses who can claim to be the sole health professional on a non-doctor island. One such district nurse looks forward with optimism to seeing the effect of the World Health Organization pilot family health nursing programme on her professional credibility. Perhaps not surprisingly, there is a fair bit of emphasis on helping nurses who work in remote and rural areas to develop their practice.

  20. Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes.

    Science.gov (United States)

    Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia

    2017-05-01

    Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

  1. Radiological safety programme for the health departments in Parana, Brazil

    International Nuclear Information System (INIS)

    Schmidt, M.F.S.; Tilly, J.G. Jr.

    1998-01-01

    As a result of Brazil's centralized administration in the past, various parts of the public service were somewhat inefficient. Another reason was the size of the country. To improve the situation in the health sector, it was decided to transfer administrative responsibility to the municipal authorities. Accordingly, the public health system is now defined under the appropriate legislation as the 'Unified Health System' (SUS), comprising federal, state and municipal levels. This system promotes decentralization of therapeutic or preventive services (including the Radiation Facility Health Inspectorate) and proposes any additional legislation required. In Parana the Radiation Facility Health Inspectorate has 3600 organizations listed, employing ionizing radiation in medicine, industry and research, which need to be regularly inspected for licensing and control. In 1994, 50% of the annual inspection target in the state was attained. The Radiation Safety Programme for the Health Departments in Parana directs these activities in this State. Its strategies are: (1) to establish implementation phases for activities planned for each area; (2) to take advantage of the SUS structure to introduce or expand operational services at the primary, secondary and tertiary levels with appropriate equipment. The tertiary level involves co-ordination of the Programme and complementary executive functions, as well as maintaining an information system with other related organizations. The other levels include licensing, control and emergency response. As the Programme develops, indicators will be established to help identify progress achieved and correct operating strategy where necessary. Thus, the services provided to the public will be enhanced in quality and the radiation doses reduced. In addition, in emergency situations, the time elapsing between the event and its notification to the authorities will be reduced, minimizing the consequences of any accidents. (author)

  2. 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

  3. The role of care in nutrition programmes: current research and a research agenda.

    Science.gov (United States)

    Engle, P L; Bentley, M; Pelto, G

    2000-02-01

    The importance of cultural and behavioural factors in children's nutrition, particularly with regard to feeding, has been recognized only recently. The combination of evidence regarding the importance of caregiving behaviour for good nutrition, and improved strategies for measuring behaviour have led to a renewed interest in care. The UNICEF conceptual framework suggests that care, in addition to food security and health care services, are critical for children's survival, growth and development. The present paper focuses on the care practice of complementary feeding, specifically behavioural factors such as parental interaction patterns, feeding style and adaptation of feeding to the child's motor abilities (self-feeding or feeding by others). Three kinds of feeding styles (Birch & Fisher, 1995) are identified: controlling; laissez-faire; responsive. Probable effects of each feeding style on nutrient intake are described. A number of studies of feeding behaviour have suggested that the laissez-faire style is most frequently observed among families and communities with a higher prevalence of malnourished children. Nutrition interventions that have been able to show significant effects on outcomes, such as the Hearth Model in Vietnam (Sternin et al. 1997), have usually incorporated behavioural components in their intervention. At this time, there have been no tests of the efficacy of behavioural interventions to improve feeding practices. Research is needed to understand behavioural factors in complementary feeding, and to identify and test intervention strategies designed to improve nutrient intake of young children. Finally, the paper concludes with a discussion of how nutrition programmes might change if care were incorporated.

  4. 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.

  5. Strengthening of Oral Health Systems: Oral Health through Primary Health Care

    Science.gov (United States)

    Petersen, Poul Erik

    2014-01-01

    Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

  6. Exploring weight loss services in primary care and staff views on using a web-based programme.

    Science.gov (United States)

    Ware, Lisa J; Williams, Sarah; Bradbury, Katherine; Brant, Catherine; Little, Paul; Hobbs, F D Richard; Yardley, Lucy

    2012-01-01

    Demand is increasing for primary care to deliver effective weight management services to patients, but research suggests that staff feel inadequately resourced for such a role. Supporting service delivery with a free and effective web-based weight management programme could maximise primary care resource and provide cost-effective support for patients. However, integration of e-health into primary care may face challenges. To explore primary care staff experiences of delivering weight management services and their perceptions of a web-based weight management programme to aid service delivery. Focus groups were conducted with primary care physicians, nurses and healthcare assistants (n = 36) involved in delivering weight loss services. Data were analysed using inductive thematic analysis. Participants thought that primary care should be involved in delivering weight management, especially when weight was aggravating health problems. However, they felt under-resourced to deliver these services and unsure as to the effectiveness of their input, as routine services were not evaluated. Beliefs that current services were ineffective resulted in staff reluctance to allocate more resources. Participants were hopeful that supplementing practice with a web-based weight management programme would enhance patient services and promote service evaluation. Although primary care staff felt they should deliver weight loss services, low levels of faith in the efficacy of current treatments resulted in provision of under-resourced and 'ad hoc' services. Integration of a web-based weight loss programme that promotes service evaluation and provides a cost-effective option for supporting patients may encourage practices to invest more in weight management services.

  7. Understanding your health care costs

    Science.gov (United States)

    ... ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this page, ... on out-of-pocket costs. Out-of-Pocket Costs The good news is there is a limit ...

  8. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care. ... Ladoke Akintola University of Technology, PMB 4400, Osogbo, Osun State. ... weak management and poor adherence to the basic infrastructure e.g. primary, secondary and tertiary.

  9. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    3Department of Community and Primary Health Care, College of Medicine, University of Lagos, Idiaraba, ... Some of the participants (45.3%) carry out physical exercises such as walking ..... hypertension, continuous effective management of.

  10. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    %) was the least common. On bivariate analysis ... the power to determine what their wives do or fail to ... pregnancy care while joint decision-making ... Other maternal health services rendered This data collection was done by a team of trained.

  11. Czechoslovakia's changing health care system.

    Science.gov (United States)

    Raffel, M W; Raffel, N K

    1992-01-01

    Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.

  12. [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.

  13. 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.

  14. What is Clinical Safety in Electronic Health Care Record Systems?

    Science.gov (United States)

    Davies, George

    There is mounting public awareness of an increasing number of adverse clinical incidents within the National Health Service (NHS), but at the same time, large health care projects like the National Programme for IT (NPFIT) are claiming that safer care is one of the benefits of the project and that health software systems in particular have the potential to reduce the likelihood of accidental or unintentional harm to patients. This paper outlines the approach to clinical safety management taken by CSC, a major supplier to NPFIT; discusses acceptable levels of risk and clinical safety as an end-to-end concept; and touches on the future for clinical safety in health systems software.

  15. Oral health care systems in developing and developed countries

    DEFF Research Database (Denmark)

    Kandelman, Daniel; Arpin, Sophie; Baez, Ramon J

    2012-01-01

    and to provide universal access, especially in disadvantaged communities, in both developing and developed countries. Moreover, even though the most widespread illnesses are avoidable, not all population groups are well informed about or able to take advantage of the proper measures for oral health promotion....... In addition, in many countries, oral health care needs to be fully integrated into national or community health programmes. Improving oral health is a very challenging objective in developing countries, but also in developed countries, especially with the accelerated aging of the population now underway...... intervention procedures aim, at treating existing problems and restore teeth and related structure to normal function. It is unfortunate that the low priority given to oral health hinders acquisition of data and establishment of effective periodontal care programmes in developing countries but also in some...

  16. Health Care Wide Hazards

    Science.gov (United States)

    ... Glossary | References | Site Map | Credits Freedom of Information Act | Privacy & Security Statement | Disclaimers | Important Web Site Notices | International | Contact Us U.S. Department of Labor | Occupational Safety & Health Administration | 200 Constitution Ave., NW, Washington, DC 20210 ...

  17. Primary health care in India.

    Science.gov (United States)

    Deodhar, N S

    1982-03-01

    Concurrently with the development of the general health services infrastructure in India, serveral special health programs were instituted at the national level to provide a massive and concentrated assault on the major public health problems of malaria, smallpox, cholera, trachoma, tuberculosis, leprosy, filariasis, and the rapid population growth. These vertical programs were expected to reduce the heavy morbidity and mortality within the shortest possible time to where they were no longer major public health problems. The impact was variable. Major steps toward providing integrated health care were taken during the first 5-year plan. Emphasis was on the provision of a packet of inttegrated health, family planning, and nutrition services to the vulnerable groups, i.e., children, pregnant women, and nursing mothers. To rectify past shortcomings ssuch as the failures of the national health programs, ineffective coordination in the nutrition programs, and slow rate of development as a result of interdependence of different sectors, it was necessary to improve the health infrastructure and to launch a frontal attack on poverty. The Multipurpose Health Workers Scheme was planned to rationalize the organization and use of available manpower to reduce the area and population covered by each of the field staff in order to reduce travel time and to make services more effective and more satisfactory. Each multipurpose health worker was entrusted with the task of providing comprehensive health care to about 5000 people. Communicable diseases were the main public health problems, and many specific control/eradication programs were launched. the immunization programs against common childhood diseases have not taken deep roots and coverage continues to be poor. The adoption of the Western model of medical services has resulted in emphasis on "cure" rather than on "care". Another problem is maldistribution of the facilities. Overemphasis on medical education has resulted in the

  18. Private sector in public health care systems

    OpenAIRE

    Matějusová, Lenka

    2008-01-01

    This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

  19. Help Yourself to Health Care.

    Science.gov (United States)

    Snyder, Sarah

    A booklet on health care for limited English speakers provides information on choosing the right doctor, buying medicine, paying the bill, and the individual's role in maintaining his or her health. Cartoons, questions and puzzles concerning the message in cartoons and narrative passages, checklists about an individual's personal habits related to…

  20. Health care marketing: Basic features

    OpenAIRE

    Gajić-Stevanović Milena

    2006-01-01

    Paper discuss an introduction to importance's as well as challenges facing health care sector in many countries. Particular attention is devoted to the preconditions and/or basic requirements have to be developed in order to make health sector to functioned. Focusing to end users as well as employing marketing tools ought to be right orientation.

  1. 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.

  2. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    ... Experience in a primary health care facility in Rivers State, South-South Nigeria. ... health center increased by 3.09% (p-value > 0.05); the patients that had their babies in the facility were ... 100, 000 live births, based on historical studies and.

  3. Health care in rural areas.

    Science.gov (United States)

    Nath, L M

    1994-02-01

    In India, although the health care system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary health care centers. This problem has been compounded by the separation of health care and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own health care system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary health care because they fulfill a need not met by the primary health care staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit.

  4. A Review of NICE Methods and Processes Across Health Technology Assessment Programmes: Why the Differences and What is the Impact?

    Science.gov (United States)

    Cowles, Emma; Marsden, Grace; Cole, Amanda; Devlin, Nancy

    2017-08-01

    Decisions made by the National Institute for Health and Care Excellence (NICE) exert an influence on the allocation of resources within 'fixed' National Health Service budgets. Yet guidance for different types of health interventions is handled via different 'programmes' within NICE, which follow different methods and processes. The objective of this research was to identify differences in the processes and methods of NICE health technology assessment programmes and to explore how these could impact on allocative efficiency within the National Health Service. Data were extracted from the NICE technology appraisal programme, medical technologies guidance, diagnostic assessment programme, highly specialised technologies programme, and clinical guidelines process and methods manuals to undertake a systematic comparison. Five qualitative interviews were carried out with NICE members of staff and committee members to explore the reasons for the differences found. The main differences identified were in the required evidence review period, or lack thereof, mandatory funding status, the provision of a reference case for economic evaluation, the requirement for and the type of economic analysis undertaken, and the decision making criteria used for appraisal. Many of the differences found can be justified on grounds of practicality and relevance to the health technologies under assessment. Nevertheless, from a strict utilitarian view, there are several potential areas of inefficiency that could lead to the misallocation of resources within the National Health Service, although some of these might be eliminated or reduced if an egalitarian view is taken. The challenge is determining where society is willing to trade health gains between different people.

  5. EVALUATION OF HEALTH CARE QUALITY

    Directory of Open Access Journals (Sweden)

    Zlatko Fras

    2002-12-01

    Full Text Available Background. It is possible to evaluate quality characteristics of different aspects of health care by many different measures. For these purposes, in various countries all over the world authorised institutions and/or agencies developed number of methodological accessories, criteria and tools for selection of more or less appropriately and optimally defined criteria and indicators of quality clinical performance.Conclusions. Recently we have started with activities for gradual introduction of systematic monitoring, assessment and improvement of quality of health care in Slovenia as well. One of the key prerequisites for selection of valid, practicable, efficient and reliable quality indicators is the establishment of continuous and methodologically appropriate system of development and implementation of evidence-based clinical practice guidelines. We started this process within the framework of national Health Sector Management Project, where all potential key stakeholders from health care sector participated. Also the project on Quality in Health Care in Slovenia, started, leaded and performed by the Medical Chamber of Slovenia, represents one of the important parallel starting steps towards assurance of reliable data on development/establishment of appropriate set of quality indicators and standards of health care in our country.

  6. 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...... up with a more deepgoing review of the relatively small number of studies, which explicitly deal with settlement preferences related to access to health care....

  7. Exploring weight loss services in primary care and staff views on using a web-based programme

    Directory of Open Access Journals (Sweden)

    Lisa J Ware

    2013-09-01

    Full Text Available Background Demand is increasing for primary care to deliver effective weight management services to patients, but research suggests that staff feel inadequately resourced for such a role. Supporting service delivery with a free and effective web-based weight management programme could maximise primary care resource and provide cost-effective support for patients. However, integration of ehealth into primary care may face challenges.Objectives To explore primary care staff experiences of delivering weight management services and their perceptions of a web-based weight management programme to aid service delivery.Methods Focus groups were conducted with primary care physicians, nurses and healthcare assistants (n = 36 involved in delivering weight loss services. Data were analysed using inductive thematic analysis.Results Participants thought that primary care should be involved in delivering weight management, especially when weight was aggravating health problems. However, they felt under-resourced to deliver these services and unsure as to the effectiveness of their input, as routine services were not evaluated. Beliefs that current services were ineffective resulted in staff reluctance to allocate more resources. Participants were hopeful that supplementing practice with a web-based weight management programme would enhance patient services and promote service evaluation.Conclusions Although primary care staff felt they should deliver weight loss services, low levels of faith in the efficacy of current treatments resulted in provision of under-resourced and ‘ad hoc’ services. Integration of a web-based weight loss programme that promotes service evaluation and provides a cost-effective option for supporting patients may encourage practices to invest more in weight management services.

  8. Hypertension and obesity among HIV patients in a care programme ...

    African Journals Online (AJOL)

    Objective: To determine the prevalence of hypertension and obesity among HIV patients enrolled in the Sex Worker Outreach Programme (SWOP), Nairobi, Kenya. Design: A retrospective a study. Setting: SWOP managed by the University of Manitoba, Nairobi team. Subjects: We selected clinic visit records from HIV ...

  9. Marketing occupational health care.

    Science.gov (United States)

    Norris, M J; Harris, J C

    1981-01-01

    A very basic part of marketing success is determining areas of your business in which you have a competitive advantage. In drafting a marketing plan for the Denver Clinic, the competitive advantages group practices have in the area of occupational health were quickly realized. This competitive edge is presented along with the Denver Clinic's marketing strategies and plans to capitalize on occupational healthcare advantages.

  10. Effects of an employee exercise programme on mental health.

    Science.gov (United States)

    Emerson, N D; Merrill, D A; Shedd, K; Bilder, R M; Siddarth, P

    2017-03-01

    Prior research indicates that workplace wellness programmes (WWPs) are generally associated with lowered healthcare costs and improved employee health. Despite the importance of mental well-being in workplace productivity and attendance, few WWP studies have focused on improvements in psychological well-being. To examine the effects of the Bruin Health Improvement Program (BHIP), a 3-month exercise and nutrition WWP, on seven domains of health: physical and mental health, stress, energy level, social satisfaction, self-efficacy and quality of life. Using data from BHIP completers, we conducted multiple one-way multivariate analyses of variance and follow-up univariate t-tests to examine changes in physical and mental health, stress, energy level, social satisfaction, self-efficacy and quality of life. Effect sizes were also calculated post hoc to determine the magnitude of each effect. Results for the 281 participants reveal significant improvements across all seven domains (P < 0.001). Effect sizes ranged from 0.19 to 0.67. This study is unique in revealing the effects of a WWP on multiple domains of psychological well-being. Given rising healthcare costs associated with mental health, targeting mental health through WWP may be an effective strategy for reducing indirect healthcare costs associated with absenteeism and presenteeism. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  11. Access to Health Care

    Centers for Disease Control (CDC) Podcasts

    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.

  12. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2010-03-01

    Full Text Available Introduction: This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA. The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers.Policy description: The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service.Conclusion: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans.Implications: Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a  care professional  to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational

  13. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2010-03-01

    Full Text Available Introduction: This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA. The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers. Policy description: The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service. Conclusion: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans. Implications: Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a  care professional  to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational

  14. Health research 2000. Programme of the Federal German Government. Overview of projects '94

    International Nuclear Information System (INIS)

    Binkelmann, P.

    1995-01-01

    The health research programme of the Federal German Government has existed since 1978. Its implementation has been reported on at regular intervals by project status reports. The last report appeared in 1991. This research promotion pursues the following aims: to enhance preventive health care, to elucidate the causes of diseases and find effective treatments, to develop further an efficient, financially acceptable health care system. The book has three main parts, in accordance with the three main research areas: Intersectorial reseach, health care and preventive health care, fighting of diseases. Within these three sectors, the main research activities carried out in 1994 are described. Each research activity is introduced with a brief text on its aims and state of progress; this is followed by a description of the projects carried out. The projects that were on-going in 1994 are outlined in concise form; finalized projects within each main research activity are shown in tabulated form with their most important characteristics. The annex contains some bibliographic items and addresses. (orig./VHE) [de

  15. Health literacy among Danish university students enrolled in health-related study programmes

    DEFF Research Database (Denmark)

    Elsborg, Lea; Krossdal, Fie; Kayser, Lars

    2017-01-01

    Aims: It is important to address people’s health literacy when providing health care. Health professionals should be aware of, and have insight into, people’s health literacy when they provide health services. Health professionals need to be health literate themselves. We examined the level...

  16. 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

  17. 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.

  18. The emergence of community health worker programmes in the late apartheid era in South Africa: An historical analysis.

    Science.gov (United States)

    van Ginneken, Nadja; Lewin, Simon; Berridge, Virginia

    2010-09-01

    There is re-emerging interest in community health workers (CHWs) as part of wider policies regarding task-shifting within human resources for health. This paper examines the history of CHW programmes established in South Africa in the later apartheid years (1970s-1994) - a time of innovative initiatives. After 1994, the new democratic government embraced primary healthcare (PHC), however CHW initiatives were not included in their health plan and most of these programmes subsequently collapsed. Since then a wide array of disease-focused CHW projects have emerged, particularly within HIV care. Thirteen oral history interviews and eight witness seminars were conducted in South Africa in April 2008 with founders and CHWs from these earlier programmes. These data were triangulated with written primary sources and analysed using thematic content analysis. The study suggests that 1970s-1990s CHW programmes were seen as innovative, responsive, comprehensive and empowering for staff and communities, a focus which respondents felt was lost within current programmes. The growth of these earlier projects was underpinned by the struggle against apartheid. Respondents felt that the more technical focus of current CHW programmes under-utilise a valuable human resource which previously had a much wider social and health impact. These prior experiences and lessons learned could usefully inform policy-making frameworks for CHWs in South Africa today. Copyright 2010 Elsevier Ltd. All rights reserved.

  19. Impact of a mental health teaching programme on adolescents.

    Science.gov (United States)

    Naylor, Paul B; Cowie, Helen A; Walters, Stephen J; Talamelli, Lorenzo; Dawkins, Judith

    2009-04-01

    Child and adolescent mental health disorders are present in around 10% of the population. Research indicates that many young people possess negative attitudes towards mental health difficulties among peers. To assess the impact of a mental health teaching programme on adolescent pupils' understanding. Two-group pre-test-post-test control group study in two English secondary schools. Experimental classes (School E) received a six-lesson teaching intervention on mental health; control classes (School C) did not. Participants were 14- and 15-year-old pupils. The intervention consisted of six lessons on mental health issues common to young people: stress; depression; suicide/self-harm; eating disorders; being bullied; and intellectual disability. School C was given access to these lesson plans and materials on completion of the study. Understanding was measured at two time points, Time 1 (T(1)) and Time 2 (T(2)), 8 months apart, by a Mental Health Questionnaire. Behavioural, emotional and relationship strengths and difficulties were measured by the self-rated Strengths and Difficulties Questionnaire (SDQ) with five subscales: hyperactivity, emotional symptoms, conduct problems, peer problems and prosocial behaviour. At T(2), pupils in School E compared with those in School C showed significantly more sensitivity and empathy towards people with mental health difficulties. They also used significantly fewer pejorative expressions to describe mental health difficulties. There was a significant reduction in SDQ scores on conduct problems and a significant increase on prosocial behaviour among School E pupils compared with controls. Pupils valued the intervention highly, in particular the lessons on suicide/self-harm. Teaching 14- and 15-year-olds about mental health difficulties helps to reduce stigma by increasing knowledge and promoting positive attitudes. The intervention also reduced self-reported conduct problems and increased prosocial behaviour. Generally

  20. 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

  1. Innovation in Health Care Delivery.

    Science.gov (United States)

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

    2016-02-01

    As reimbursement transitions from a volume-based to a value-based system, innovation in health care delivery will be needed. The process of innovation begins with framing the problem that needs to be solved along with the strategic vision that has to be achieved. Similar to scientific testing, a hypothesis is generated for a new solution to a problem. Innovation requires conducting a disciplined form of experimentation and then learning from the process. This manuscript will discuss the different types of innovation, and the key steps necessary for successful innovation in the health care field.

  2. Health Care Regulation Spending Trap

    Directory of Open Access Journals (Sweden)

    Timothy McTighe

    2017-07-01

    Full Text Available Our health care system has faced many challenges over the past 40 plus years. Now these challenges have forced us into a complicated situation that makes it confusing on how best to proceed. Today third party insurance payers make most health care payments. Our premiums are paid into a risk pool-on medical services for other people. Consumers are disconnected from knowing the cost of goods or services that they are receiving. This commentary reviews the current situation and provides a few common sense approaches for pursuing the best potential policies.

  3. The effects of preventive mental health programmes in secondary schools.

    Science.gov (United States)

    Andersen, Bror Just

    2013-01-01

    The author wanted to test the effects of preventive mental health programmes in schools and established a longitudinal study with a test group and a control group, using Solomon's method. Data was collected through questionnaires prior to intervention and at 1, 6, 12, and 24 months after the intervention. The size of the effect on the various indices were estimated in terms of (a) differences in improvement of total percentage scores and (b) Cohen's d. From to to t1, t2 and t3 the intervention group showed significantly greater progress in six out of seven knowledge indexes, and 12 months later we found significant effects on the level of mental health problems.

  4. Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections

    Science.gov (United States)

    Reed, John L; Lyne, Maggi

    2000-01-01

    Objective To investigate the facilities for inpatient care of mentally disordered people in prison. Design Semistructured inspections conducted by doctor and nurse. Expected standards were based on healthcare quality standards published by the Prison Service or the NHS. Setting 13 prisons with inpatient beds in England and Wales subject to the prison inspectorate's routine inspection programme during 1997-8. Main outcomes measures Appraisals of quality of care against published standards. Results The 13 prisons had 348 beds, 20% of all beds in prisons. Inpatient units had between 3 and 75 beds. No doctor in charge of inpatients had completed specialist psychiatric training. 24% of nursing staff had mental health training; 32% were non-nursing trained healthcare officers. Only one prison had occupational therapy input; two had input from a clinical psychologist. Most patients were unlocked for about 3.5 hours a day and none for more than nine hours a day. Four prisons provided statistics on the use of seclusion. The average length of an episode of seclusion was 50 hours. Conclusion The quality of services for mentally ill prisoners fell far below the standards in the NHS. Patients' lives were unacceptably restricted and therapy limited. The present policy dividing inpatient care of mentally disordered prisoners between the prison service and the NHS needs reconsideration. PMID:10764360

  5. Health disparities among health care workers.

    Science.gov (United States)

    Mawn, Barbara; Siqueira, Eduardo; Koren, Ainat; Slatin, Craig; Devereaux Melillo, Karen; Pearce, Carole; Hoff, Lee Ann

    2010-01-01

    In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

  6. FastStats: Home Health Care

    Science.gov (United States)

    ... this? Submit What's this? Submit Button NCHS Home Home Health Care Recommend on Facebook Tweet Share Compartir Data are ... National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  7. 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

  8. A disease management programme for patients with diabetes mellitus is associated with improved quality of care within existing budgets.

    Science.gov (United States)

    Steuten, L M G; Vrijhoef, H J M; Landewé-Cleuren, S; Schaper, N; Van Merode, G G; Spreeuwenberg, C

    2007-10-01

    To assess the impact of a disease management programme for patients with diabetes mellitus (Type 1 and Type 2) on cost-effectiveness, quality of life and patient self-management. By organizing care in accordance with the principles of disease management, it is aimed to increase quality of care within existing budgets. Single-group, pre-post design with 2-year follow-up in 473 patients. Substantial significant improvements in glycaemic control, health-related quality of life (HRQL) and patient self-management were found. No significant changes were detected in total costs of care. The probability that the disease management programme is cost-effective compared with usual care amounts to 74%, expressed in an average saving of 117 per additional life year at 5% improved HRQL. Introduction of a disease management programme for patients with diabetes is associated with improved intermediate outcomes within existing budgets. Further research should focus on long-term cost-effectiveness, including diabetic complications and mortality, in a controlled setting or by using decision-analytic modelling techniques.

  9. Developing mental health services in Nigeria : the impact of a community-based mental health awareness programme.

    Science.gov (United States)

    Eaton, Julian; Agomoh, Ahamefula O

    2008-07-01

    This grass-roots level mental health awareness programme considerably increased use of community-based mental health services in a part of Nigeria where knowledge about treatability of mental illness was limited. The benefits of the programme were sustained for a significant period after the initial awareness programme. In order for attitude changes to be reinforced, similar awareness programmes must be repeated at regular intervals.

  10. Parent-training programmes for improving maternal psychosocial health.

    Science.gov (United States)

    Barlow, J; Coren, E

    2004-01-01

    Mental health problems are common and there is evidence to suggest that the origins of such problems lie in infancy and childhood. In particular, there is evidence from a range of studies to suggest that maternal psychosocial health can have a significant effect on the mother-infant relationship, and that this in turn can have consequences for both the short and long-term psychological health of the child. The use of parenting programmes is increasing in the UK and elsewhere and evidence of their effectiveness in improving outcomes for children has been provided. Evidence is now required of their effectiveness in improving outcomes for mothers. The objective of this review is to address whether group-based parenting programmes are effective in improving maternal psychosocial health including anxiety, depression, and self-esteem. A range of biomedical, social science, educational and general reference electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index. Other sources of information included the Cochrane Library (SPECTR, CENTRAL), and the National Research Register (NRR). Only randomised controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme, and one standardised instrument measuring maternal psychosocial health. A systematic critical appraisal of all included studies was undertaken using a modified version of the Journal of the American Medical Association (JAMA) published criteria. The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to produce an effect size. Where appropriate the results were then combined in a meta

  11. Islamic Cultures: Health Care Beliefs and Practices.

    Science.gov (United States)

    Kemp, Charles

    1996-01-01

    Presents an overview of Islamic health care beliefs and practices, noting health-related social and spiritual issues, fundamental beliefs and themes in Islam, health care beliefs and practices common among Muslims, and health-affecting social roles among Muslims. Cultural, religious, and social barriers to health care and ways to reduce them are…

  12. Health care reform and federalism.

    Science.gov (United States)

    Greer, Scott L; Jacobson, Peter D

    2010-04-01

    Health policy debates are replete with discussions of federalism, most often when advocates of reform put their hopes in states. But health policy literature is remarkably silent on the question of allocation of authority, rarely asking which levels of government ought to lead. We draw on the larger literatures about federalism, found mostly in political science and law, to develop a set of criteria for allocating health policy authority between states and the federal government. They are social justice, procedural democracy, compatibility with value pluralism, institutional capability, and economic sustainability. Of them, only procedural democracy and compatibility with value pluralism point to state leadership. In examining these criteria, we conclude that American policy debates often get federalism backward, putting the burden of health care coverage policy on states that cannot enact or sustain it, while increasing the federal role in issues where the arguments for state leadership are compelling. We suggest that the federal government should lead present and future financing of health care coverage, since it would require major changes in American intergovernmental relations to make innovative state health care financing sustainable outside a strong federal framework.

  13. An assessment of implementation of Community Oriented Primary Care in Kenyan family medicine postgraduate medical education programmes

    Directory of Open Access Journals (Sweden)

    Ian J. Nelligan

    2016-12-01

    Full Text Available Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results: Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1 making a community diagnosis, (2 understanding social determinants of health and (3 training in participatory research. Three community-based enablers for sustainability of COPC were (1 partnerships with community health workers, (2 community empowerment and engagement and (3 institutional financial support. Conclusions: Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.

  14. The Chinese Health Care System

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi

    In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...

  15. Relationship marketing in health care.

    Science.gov (United States)

    Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W

    1994-01-01

    Building relationships with patients is critical to the success of many health care organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results.

  16. Reengineering health care materials management.

    Science.gov (United States)

    Connor, L R

    1998-01-01

    Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management.

  17. Intercultural Health Care and Welfare

    DEFF Research Database (Denmark)

    Nielsen, Ben

    2014-01-01

    Artiklen har fokus på undervisning, planlægning, udvikling og evaluering af et internationalt tværfagligt valgfag Intercultural Health Care and Welfare, der udbydes på Det Sundhedsfaglige og Teknologiske Fakultet på Professionshøjskolen Metropol. Ifølge den tysk-amerikanske professor Iris Varner og...

  18. Health care insolvency and bankruptcy.

    Science.gov (United States)

    Handelsman, L; Speiser, M; Maltz, A; Kirpalani, S

    1998-08-01

    Bankruptcy is an event that is often considered a business' worst nightmare. Debt, lawyers, and the U.S. government can lead to the eventual destruction of a business. This article shows how declaring bankruptcy can be a helpful instrument in continuing a successful venture in the health care marketplace.

  19. International institutions, global health initiatives and the challenge of sustainability: lessons from the Brazilian AIDS programme.

    Science.gov (United States)

    Le Loup, G; Fleury, S; Camargo, K; Larouzé, B

    2010-01-01

    The sustainability of successful public health programmes remains a challenge in low and middle income settings. These programmes are often subjected to mobilization-demobilization cycle. Indeed, political and organizational factors are of major importance to ensure this sustainability. The cooperation between the World Bank and the Brazilian AIDS programme highlights the role of international institutions and global health initiatives (GHI), not only to scale up programmes but also to guarantee their stability and sustainability, at a time when advocacy is diminishing and vertical programmes are integrated within health systems. This role is critical at the local level, particularly when economic crisis may hamper the future of public health programmes. Political and organizational evolution should be monitored and warnings should trigger interventions of GHI before the decline of these programmes.

  20. Lower Costs, Better Care- Reforming Our Health Care Delivery

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

  1. Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years.

    Science.gov (United States)

    Riordan, F; McHugh, S M; Harkins, V; Marsden, P; Kearney, P M

    2018-04-29

    To examine the quality of care delivered by a structured primary care-led programme for people with Type 2 diabetes mellitus in 1999-2016. The Midland Diabetes Structured Care Programme provides structured primary care-led management. Trends over time in care processes were examined (using a chi-squared trend test and age- and gender-adjusted logistic regression). Screening and annual review attendance were reviewed. A composite of eight National Institute for Health and Care Excellence-recommended processes was used as a quality indicator. Participants who were referred to diabetes nurse specialists were compared with those not referred (Student's t-test, Pearson's chi-squared test, Wilcoxon-Mann-Whitney test). Proportions achieving outcome targets [HbA 1c ≤58 mmol/mol (7.5%), blood pressure ≤140/80 mmHg, cholesterol diabetes aged ≥18 years: 1998/1999 (n=336); 2003 (n=843); 2008 (n=988); and 2016 (n=1029). Recording of some processes improved significantly over time (HbA 1c , cholesterol, blood pressure, creatinine), and in 2016 exceeded 97%. Foot assessment and annual review attendance declined. In 2016, only 29% of participants had all eight National Institute for Health and Care Excellence processes recorded. A higher proportion of people with diabetes who were referred to a diabetes nurse specialist had poor glycaemic control compared with those not referred. The proportions meeting blood pressure and lipid targets increased over time. Structured primary care led to improvements in the quality of care over time. Poorer recording of some processes, a decline in annual review attendance, and participants remaining at high risk suggest limits to what structured care alone can achieve. Engagement in continuous quality improvement to target other factors, including attendance and self-management, may deliver further improvements. © 2018 Diabetes UK.

  2. Managed consumerism in health care.

    Science.gov (United States)

    Robinson, James C

    2005-01-01

    The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.

  3. The Sexuality Education Initiative: a programme involving teenagers, schools, parents and sexual health services in Los Angeles, CA, USA.

    Science.gov (United States)

    Marques, Magaly; Ressa, Nicole

    2013-05-01

    In response to abstinence-only programmes in the United States that promote myths and misconceptions about sexuality and sexual behaviour, the comprehensive sexuality education community has been sidetracked from improving the sexuality education available in US schools for almost two decades now. Much work is still needed to move beyond fear-based approaches and the one-way communication of information that many programmes still use. Starting in 2008 Planned Parenthood Los Angeles developed and launched a teen-centred sexuality education programme based on critical thinking, human rights, gender equality, and access to health care that is founded on a theory of change that recognises the complex relationship between the individual and broader environment of cultural norms, socio-economic inequalities, health disparities, legal and institutional factors. The Sexuality Education Initiative is comprised of a 12-session classroom sexuality education curriculum for ninth grade students; workshops for parents; a peer advocacy training programme; and access to sexual health services. This paper describes that experience and presents the rights-based framework that was used, which seeks to improve the learning experience of students, strengthen the capacity of schools, teachers and parents to help teenagers manage their sexuality effectively and understand that they have the right to health care, education, protection, dignity and privacy. Copyright © 2013 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  4. Equity in Health Care Expenditure in Nigeria

    Directory of Open Access Journals (Sweden)

    Olanrewaju Olaniyan

    2013-07-01

    Full Text Available Equity isone of the basic principles of health systems and features explicitly in theNigerian health financing policy. Despite acclaimed commitment to theimplementation of this policy through various pro-poor health programmes andinterventions, the level of inequity in health status and access to basichealth care interventions remain high. This paper examines the equity of healthcare expenditure by individuals in Nigeria. The paper evaluated equity in out-of-pocketspending( OOP for the country and separately for the six geopolitical zones ofthe country.The methodological framework rests onKakwani Progressivity Indices (KPIs, ReynoldSmolensky indices andconcentration indices (CIs using data from the 2004 Nigerian National LivingStandard Survey( NLSS collected by the National Bureau of Statistics. .The results reveal that health financing isregressive with the incidence disproportionately rest on poor households withabout 70% of the total expenditure on health is through out-of-pocket paymentsby households. Poor households are prone to bear most of the expenses in theevent of any health shock. The catastrophic consequences thus push some intopoverty, and aggravate the poverty of others.The paper therefore suggests that thecountry’s health financingsystems must be designed not only to allow people to access services when theyare needed, but must also protect household, from financial catastrophe, byreducing OOP spending through risk pooling and prepayment schemes within thehealth system.Keywords:                            Equity, Health careexpenditure, Kakwani progressivity index, Nigeria.

  5. Preserving community in health care.

    Science.gov (United States)

    Emanuel, E J; Emanuel, L L

    1997-02-01

    There are two prominent trends in health care today: first, increasing demands for accountabilty, and second, increasing provision of care through managed care organizations. These trends promote the question: What form of account-ability is appropriate to managed care plans? Accountability is the process by which a party justifies its actions and policies. Components of accountability include parties that can be held or hold others accountable, domains and content areas being assessed, and procedures of assessment. Traditionally, the professional model of accountability has operated in medical care. In this model, physicians establish the standards of accountability and hold each other accountable through professional organizations. This form of accountability seems outdated and inapplicable to managed care plans. The alternatives are the economic and the political models of accountability. In the economic model, medicine becomes more like a commodity, and "exit" (consumers changing providers for reasons of cost and quality) is the dominant procedure of accountability. In the political model, medicine becomes more like a community good, and "voice" (citizens communicating their views in public forums or on policy committees, or in elections for representatives) is the dominant procedure of accountability. The economic model's advantages affirm American individualism, make minimal demands on consumers, and use a powerful incentive, money. Its disadvantages undermine health care as a nonmarket good, undermine individual autonomy, undermine good medical practice, impose significant demands on consumers to be informed, sustain differentials of power, and use indirect procedures of accountability. The political model's advantages affirm health care as a matter of justice, permit selecting domains other than price and quality for accountability, reinforce good medical practice, and equalize power between patients and physicians. Its disadvantages include inefficiency in

  6. Health care technology as a policy issue

    NARCIS (Netherlands)

    Banta, H.D.

    1994-01-01

    Health care technology has become an increasingly visible issue in many countries, primarily because of the rising costs of health care. In addition, many questions concerning quality of care are being raised. Health care technology assessment has been seen as an aid in addressing questions

  7. (ARV) treatment training programme

    African Journals Online (AJOL)

    Winnie

    Keywords:ARV, training, evaluation, HIV, health care provider. RÉSUMÉ .... workers, adequate laboratory facilities for measuring viral load and .... questionnaire guide, the head of unit of the ART ...... begins its scale-up programme. Some of ...

  8. Improving eye care in the primary health care setting

    Directory of Open Access Journals (Sweden)

    M de Wet

    2000-09-01

    Full Text Available One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO’s providing eye care, decentralisation of services and the establishment of an eye care committee in the region.

  9. Oral Health Care Delivery Within the Accountable Care Organization.

    Science.gov (United States)

    Blue, Christine; Riggs, Sheila

    2016-06-01

    The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

  10. Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery programme.

    Science.gov (United States)

    Kim, BoYeoul; Park, SungHee; Park, KyuJoo; Ryoo, SeungBum

    2017-11-01

    To investigate the effects of a standardised care protocol as part of an enhanced recovery after surgery programme on the management of patients who underwent open colon surgery at the University Hospital, South Korea. Patients who undergo open colon surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after surgery programme with a care protocol. Records of 219 patients who underwent open colon surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. The findings can be used to facilitate the implementation of an enhanced recovery after surgery programme with a care protocol following open colon surgery. We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open colon surgery. This care protocol empowers long

  11. Financing the health care Internet.

    Science.gov (United States)

    Robinson, J C

    2000-01-01

    Internet-related health care firms have accelerated through the life cycle of capital finance and organizational destiny, including venture capital funding, public stock offerings, and consolidation, in the wake of heightened competition and earnings disappointments. Venture capital flooded into the e-health sector, rising from $3 million in the first quarter of 1998 to $335 million two years later. Twenty-six e-health firms went public in eighteen months, raising $1.53 billion at initial public offering (IPO) and with post-IPO share price appreciation greater than 100 percent for eighteen firms. The technology-sector crash hit the e-health sector especially hard, driving share prices down by more than 80 percent for twenty-one firms. The industry now faces an extended period of consolidation between e-health and conventional firms.

  12. Focus on CSIR research in pollution waste: The South African river health programme

    CSIR Research Space (South Africa)

    Hill, Liesl

    2007-08-01

    Full Text Available the design of the River Health Programme (RHP) to monitor the health of rivers in South Africa. The RHP forms part of a bigger initiative, the National Aquatic Ecosystem Health Monitoring Programme which will eventually cover all surface water resources...

  13. The Impact of Health Insurance on Health Care Provision in ...

    African Journals Online (AJOL)

    This study assesses the impact of the NHIS scheme in promoting access to health care. It identifies a need for all stakeholders to engage in the active promotion of awareness on health insurance as option of health care provisioning. It argues that health insurance can make health care more accessible to a wider segment ...

  14. Telemedicine and rural health care applications

    Directory of Open Access Journals (Sweden)

    Smith Anthony

    2005-01-01

    Full Text Available Telemedicine has the potential to help facilitate the delivery of health services to rural areas. In the right circumstances, telemedicine may also be useful for the delivery of education and teaching programmes and the facilitation of administrative meetings. In this paper reference is made to a variety of telemedicine applications in Australia and other countries including telepaediatrics, home telehealth, critical care telemedicine for new born babies, telemedicine in developing countries, health screening via e-mail, and teleradiology. These applications represent some of the broad range of telemedicine applications possible. An overriding imperative is to focus on the clinical problem first with careful consideration given to the significant organisational changes which are associated with the introduction of a new service or alternative method of service delivery. For telemedicine to be effective it is also important that all sites involved are adequately resourced in terms of staff, equipment, telecommunications, technical support and training. In addition, there are a number of logistical factors which are important when considering the development of a telemedicine service including site selection, clinician empowerment, telemedicine management, technological requirements, user training, telemedicine evaluation, and information sharing through publication.

  15. Scaling up proven public health interventions through a locally owned and sustained leadership development programme in rural Upper Egypt.

    Science.gov (United States)

    Mansour, Morsi; Mansour, Joan Bragar; El Swesy, Abdo Hasan

    2010-01-19

    In 2002, the Egypt Ministry of Health and Population faced the challenge of improving access to and quality of services in rural Upper Egypt in the face of low morale among health workers and managers.From 1992 to 2000, the Ministry, with donor support, had succeeded in reducing the nationwide maternal mortality rate by 52%. Nevertheless, a gap remained between urban and rural areas. In 2002, the Ministry, with funding from the United States Agency for International Development and assistance from Management Sciences for Health, introduced a Leadership Development Programme (LDP) in Aswan Governorate. The programme aimed to improve health services in three districts by increasing managers' ability to create high performing teams and lead them to achieve results.The programme introduced leadership and management practices and a methodology for identifying and addressing service delivery challenges. Ten teams of health workers participated. In 2003, after participation in the LDP, the districts of Aswan, Daraw and Kom Ombo increased the number of new family planning visits by 36%, 68% and 20%, respectively. The number of prenatal and postpartum visits also rose.After the United States funding ended, local doctors and nurses scaled up the programme to 184 health care facilities (training more than 1000 health workers). From 2005 to 2007, the Leadership Development Programme participants in Aswan Governorate focused on reducing the maternal mortality rate as their annual goal. They reduced it from 85.0 per 100,000 live births to 35.5 per 100,000. The reduction in maternal mortality rate was much greater than in similar governorates in Egypt. Managers and teams across Aswan demonstrated their ability to scale up effective public health interventions though their increased commitment and ownership of service challenges. When teams learn and apply empowering leadership and management practices, they can transform the way they work together and develop their own solutions

  16. Attending Unintended Transformations of Health Care Infrastructure

    DEFF Research Database (Denmark)

    Wentzer, Helle; Bygholm, Ann

    2007-01-01

    Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background of theor......Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background...

  17. What is the health care product?

    Science.gov (United States)

    France, K R; Grover, R

    1992-06-01

    Because of the current competitive environment, health care providers (hospitals, HMOs, physicians, and others) are constantly searching for better products and better means for delivering them. The health care product is often loosely defined as a service. The authors develop a more precise definition of the health care product, product line, and product mix. A bundle-of-elements concept is presented for the health care product. These conceptualizations help to address how health care providers can segment their market and position, promote, and price their products. Though the authors focus on hospitals, the concepts and procedures developed are applicable to other health care organizations.

  18. Solidarity as a national health care strategy.

    Science.gov (United States)

    West-Oram, Peter

    2018-05-02

    The Trump Administration's recent attempts to repeal the Affordable Care Act have reignited long-running debates surrounding the nature of justice in health care provision, the extent of our obligations to others, and the most effective ways of funding and delivering quality health care. In this article, I respond to arguments that individualist systems of health care provision deliver higher-quality health care and promote liberty more effectively than the cooperative, solidaristic approaches that characterize health care provision in most wealthy countries apart from the United States. I argue that these claims are mistaken and suggest one way of rejecting the implied criticisms of solidaristic practices in health care provision they represent. This defence of solidarity is phrased in terms of the advantages solidaristic approaches to health care provision have over individualist alternatives in promoting certain important personal liberties, and delivering high-quality, affordable health care. © 2018 John Wiley & Sons Ltd.

  19. Improving CKD Diagnosis and Blood Pressure Control in Primary Care: A Tailored Multifaceted Quality Improvement Programme

    Directory of Open Access Journals (Sweden)

    John Humphreys

    2017-04-01

    Full Text Available Background: Chronic kidney disease (CKD is a worldwide public health issue. From 2009 to 2014, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM in England ran 4 phased, 12-month quality improvement (QI projects with 49 primary care practices in GM. Two measureable aims were set – halve undiagnosed CKD in participating practices using modelled estimates of prevalence; and optimise blood pressure (BP control (<140/90 mm Hg in CKD patients without proteinuria; <130/80 mm Hg in CKD patients with proteinuria for 75% of recorded cases of CKD. The 4 projects ran as follows: P1 = Project 1 with 19 practices (September 2009 to September 2010, P2 = Project 2 with 11 practices (March 2011 to March 2012, P3 = Project 3 with 12 practices (September 2012 to October 2013, and P4 = Project 4 with 7 practices (April 2013 to March 2014. Methods: Multifaceted intervention approaches were tailored based on a contextual analysis of practice support needs. Data were collected from practices by facilitators at baseline and again at project close, with self-reported data regularly requested from practices throughout the projects. Results: Halving undiagnosed CKD as per aim was exceeded in 3 of the 4 projects. The optimising BP aim was met in 2 projects. Total CKD cases after the programme increased by 2,347 (27% from baseline to 10,968 in a total adult population (aged ≥18 years of 231,568. The percentage of patients who managed to appropriate BP targets increased from 34 to 74% (P1, from 60 to 83% (P2, from 68 to 71% (P3, and from 63 to 76% (P4. In nonproteinuric CKD patients, 88, 90, 89, and 91%, respectively, achieved a target BP of <140/90 mm Hg. In proteinuric CKD patients, 69, 46, 48, and 45%, respectively, achieved a tighter target of <130/80 mm Hg. Analysis of national data over similar timeframes indicated that practices participating in the programme achieved

  20. [Implementation of a health promotion programme for women in social exclusion in the city of Seville (Spain)].

    Science.gov (United States)

    Rodríguez Fernández-Viagas, Cristina; García Gil, Carmen; Bayo Barroso, Nora; Villalba Quesada, Cristina; Álvarez Girón, Manuela

    2018-01-09

    Health promotion can contribute towards reducing inequality and ensuring equal opportunities, providing the means to enable the entire population to develop its maximum health possibilities. Women living in areas with social transformation needs (ASTN) are an especially vulnerable group due to the situation of material deprivation and social exclusion in which they live. Health promotion programmes for this group can bring about an improvement in their health. This paper describes the health promotion programme Socio-educational Groups of Primary Care for Women (SEGPC-W), and evaluates its implementation in ASTN in the city of Seville (Spain), as well as the benefits and difficulties of its development through a documentary analysis and interviews with participating professionals. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. From Community to Meta-Community Mental Health Care

    Directory of Open Access Journals (Sweden)

    Nick Bouras

    2018-04-01

    Full Text Available Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care.

  2. The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study.

    Science.gov (United States)

    Mytton, Oliver T; Jackson, Christopher; Steinacher, Arno; Goodman, Anna; Langenberg, Claudia; Griffin, Simon; Wareham, Nick; Woodcock, James

    2018-03-01

    The National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation. We developed a microsimulation model to estimate the health benefits (incident ischaemic heart disease, stroke, dementia, and lung cancer) of the NHS Health Check programme in England. We simulated a population of adults in England aged 40-45 years and followed until age 100 years, using data from the Health Survey of England (2009-2012) and the English Longitudinal Study of Aging (1998-2012), to simulate changes in risk factors for simulated individuals over time. We used recent programme data to describe uptake of NHS Health Checks and of 4 associated interventions (statin medication, antihypertensive medication, smoking cessation, and weight management). Estimates of treatment efficacy and adherence were based on trial data. We estimated the benefits of the current NHS Health Check programme compared to a healthcare system without systematic health checks. This counterfactual scenario models the detection and treatment of risk factors that occur within 'routine' primary care. We also explored the impact of making feasible changes to implementation of the programme concerning eligibility, uptake of NHS Health Checks, and uptake of treatments offered through the programme. We estimate that the NHS Health Check programme prevents 390 (95% credible interval 290 to 500) premature deaths before 80 years of age and results in an additional 1,370 (95% credible interval 1,100 to 1,690) people

  3. Re-Imagining School Health in Education and Health Programmes: A Study across Selected Municipal Schools in Delhi

    Science.gov (United States)

    Deshpande, Mita; Baru, Rama V.; Nundy, Madhurima

    2014-01-01

    The idea of school health is re-imagined with an emphasis on the need for children's health programmes to be rooted in an understanding of the social context. Such programmes must address health, nutrition and education in a comprehensive manner. The article details findings and insights emerging from a qualitative study conducted in municipal…

  4. Internet in Continuous Health Care

    Czech Academy of Sciences Publication Activity Database

    Zvárová, Jana; Hanzlíček, Petr

    2005-01-01

    Roč. 13, č. 5 (2005), s. 451-452 ISSN 0928-7329. [MedNet 2005. World Congress on the Internet in Medicine /10./. 04.12.2005-07.12.2005, Prague] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : Internet * health care * technology Subject RIV: BD - Theory of Information

  5. A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability

    DEFF Research Database (Denmark)

    Eshoj, Henrik; Rasmussen, Sten; Frich, Lars Henrik

    2017-01-01

    BACKGROUND: Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence......-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme...... dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status...

  6. Efficiency of the health extension programme in Tigray, Ethiopia: a data envelopment analysis

    Directory of Open Access Journals (Sweden)

    Lemma Hailemariam

    2010-06-01

    Full Text Available Abstract Background Since 2004, the government of Ethiopia has made a bold decision to strengthen and expand its primary health care system by launching the Health Extension Program (HEP. While the scaling up of the HEP is necessary to achieve the aim of universal access to primary health care, close attention should be paid to the performance of the program. Using a data envelopment analysis this study aimed at (i to estimate the technical efficiency of a sample of health posts in rural Tigray, ii to identify those factors which might be explaining the efficiency results. Methods Efficiency was measured using a data envelopment analysis model. A Tobit model was performed to identify factors associated with efficiency. Seven rural districts (out of 35 were purposely chosen. Input/output information was collected from the database of the Tigray Health Bureau during July 2007-June 2008. Information was also collected on environmental factors that might influence the efficiency outcomes through a structured questionnaire from the correspondent district health officers. Results Analysis was based on data from 60 health posts. The mean scores for technical and scale efficiency were 0.57 (SD = 0.32 and 0.95 (SD = 0.11 respectively. Out of the 60 health posts, 15 (25.0% were found to be technically efficient constituting the best practice frontier. Thirty eight (63.3% were operating at their most productive scale size. In the regression analysis, none of the variables was significantly associated with the efficiency outcome. Conclusion There is a need to review the management of the health information system in the region. The findings have also revealed that only a quarter of the health posts are working efficiently and pointed the need for improvement. A closer monitoring of the health extension programme is required in order to achieve the best possible performance.

  7. Oncology in primary health care

    International Nuclear Information System (INIS)

    Mendoza del Pino, Mario Valentín

    2009-01-01

    The book O ncology in the primary health care , constitutes an important contribution to the prevention and treatment of cancer, from a very comprehensive assessment. It's a disease that is the second leading cause of death in our country, to much pain and suffering is for the patient and their family. The book has a very useful for basic health equipment approach, since it emphasizes that cancer can be prevented if achieved in the population changes in lifestyle. The book is valued not correct food as responsible for one third of all cancers. Currently important research being developed in relation to psiconeuroinmuno-Endocrinology, who is studying the association between psychological factors and the development of cancer valuing that kept stress and depression reduces the antitumor activity of the immune system; that made programs with encouraging results where the treatment of cancer has joined elements of psychotherapy, immunotherapy and the use of the biotherapy. The focus of the book fills an important place in the primary health care and is an indispensable guide for professionals at this level of care (author)

  8. Leadership as a Health Research Policy Intervention: An Evaluation of the NIHR Leadership Programme (Phase 2).

    Science.gov (United States)

    Marjanovic, Sonja; Cochrane, Gavin; Manville, Catriona; Harte, Emma; Chataway, Joanna; Jones, Molly Morgan

    2016-01-29

    In early 2012, the National Institute for Health Research (NIHR) leadership programme was re-commissioned for a further three years following an evaluation by RAND Europe. During this new phase of the programme, we conducted a real-time evaluation, the aim of which was to allow for reflection on and adjustment of the programme on an on-going basis as events unfold. This approach also allowed for participants on the programme to contribute to and positively engage in the evaluation. The study aimed to understand the outputs and impacts from the programme, and to test the underlying assumptions behind the NIHR Leadership Programme as a science policy intervention. Evidence on outputs and impacts of the programme were collected around the motivations and expectations of participants, programme design and individual-, institutional- and system-level impacts.

  9. A Systematic Review of Reporting Tools Applicable to Sexual and Reproductive Health Programmes: Step 1 in Developing Programme Reporting Standards.

    Directory of Open Access Journals (Sweden)

    Anna Kågesten

    Full Text Available Complete and accurate reporting of programme preparation, implementation and evaluation processes in the field of sexual and reproductive health (SRH is essential to understand the impact of SRH programmes, as well as to guide their replication and scale-up.To provide an overview of existing reporting tools and identify core items used in programme reporting with a focus on programme preparation, implementation and evaluation processes.A systematic review was completed for the period 2000-2014. Reporting guidelines, checklists and tools, irrespective of study design, applicable for reporting on programmes targeting SRH outcomes, were included. Two independent reviewers screened the title and abstract of all records. Full texts were assessed in duplicate, followed by data extraction on the focus, content area, year of publication, validation and description of reporting items. Data was synthesized using an iterative thematic approach, where items related to programme preparation, implementation and evaluation in each tool were extracted and aggregated into a consolidated list.Out of the 3,656 records screened for title and abstracts, full texts were retrieved for 182 articles, out of which 108 were excluded. Seventy-four full text articles corresponding to 45 reporting tools were retained for synthesis. The majority of tools were developed for reporting on intervention research (n = 15, randomized controlled trials (n = 8 and systematic reviews (n = 7. We identified a total of 50 reporting items, across three main domains and corresponding sub-domains: programme preparation (objective/focus, design, piloting; programme implementation (content, timing/duration/location, providers/staff, participants, delivery, implementation outcomes, and programme evaluation (process evaluation, implementation barriers/facilitators, outcome/impact evaluation.Over the past decade a wide range of tools have been developed to improve the reporting of health research

  10. [Evaluation of disease management programmes--assessing methods and initial outcomes from a health economic perspective].

    Science.gov (United States)

    Birnbaum, Dana Sophie; Braun, Sebastian

    2010-01-01

    Evaluation represents a substantial component of the concept of Disease Management Programmes. This and the fact that the implementation of Disease Management Programmes constitutes a major change in the German healthcare system require that the criteria established by the German Federal Social Insurance Authority (Bundesversicherungsamt) be carefully reviewed. The present paper focuses on the evaluation method and the economic data. The pre-/-post study design used in the evaluation is known to be vulnerable to threats to internal validity. The objective of this paper is to analyze whether these threats to internal validity which have been known theoretically are confirmed by the results of the final reports. A review of the final reports of health insurance companies like the AOK, Barmer and a group of the BKK in Westfalen-Lippe shows that this question can be answered in the affirmative. The pre-/-post design without control groups is unable to recognize the failure or success of the Disease Management concept. The reasons include a high drop-out rate as well as the lack of consideration of the characteristics of chronic disease. Hence the evaluation method has failed to prove the quality of Disease Management Programmes in Germany. This is why consistent further development is needed.

  11. Empowering women and health care.

    Science.gov (United States)

    Shiva, M

    1993-02-01

    Women health workers have made great contributions to the health of their community for many years. In India, women physicians have established some hospitals, e.g., Christian Medical Colleges in Ludhiana and Vellore. Some such hospitals operate in remote areas to serve the poor and the suffering. Women health workers of Jamkhed, Deen Bandhu of Pachod, have proved that village women can improve the health status of their community, particularly that of women and children, if they receive encouragement to learn health care skills In India, community health care lies mainly with women (e.g., nursing personnel and in rural areas). Yet, despite their competence and experience, few become physicians, health project directors, and administrators because the society continues to be patriarchal and discriminates against females. Women need to become empowered to ensure equal opportunities for training and promotion and equal wages for equal work. In Bangladesh, use of bicycles to visit houses allows women paramedical workers from Gonasasthya Kendra, Sawar, freedom and imparts confidence. People must identify customs, practices, laws, attitudes, religious misrepresentations, and policies that discriminate against women and then oppose them. They should set these changes in motion at home, in villages, and from district to national, and even global levels. In India, society blames the mother for having a girl, but the man donates the chromosome determining sex. In Gandhigram, a woman physician and her peers have effected an apparent change in attitude toward the birth of a girl. Now the people confer equal happiness to her birth as they do to a boy's birth. Yet, female infanticides still occur in some villages of Salem District of Tamil Nadu. Sex determination tests often lead to abortion of female fetuses. Once a woman marries she has no right to her maternal home and often suffers from domestic violence. Many people resist legislation to grant women more rights, e

  12. An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

    Science.gov (United States)

    Dwinnells, Ronald; Misik, Lauren

    2017-10-01

    Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

  13. Consumer Attitudes toward Health and Health Care: A Differential Perspective.

    Science.gov (United States)

    Gould, Stephen J.

    1988-01-01

    Questionnaires returned by 343 out of 350 subjects measured health attitudes and health status. Results suggest that some consumers take a more scientific approach to health care and prevention. Demographic factors, health status, and health consciousness are partial predictors of consumer attitudes and approach to health care. (SK)

  14. Improving Quality of the Child Care Environment through a Consultancy Programme for Centre Directors

    Science.gov (United States)

    Helmerhorst, Katrien O. W.; Fukkink, Ruben G.; Riksen-Walraven, J. Marianne A.; Gevers Deynoot-Schaub, Mirjam J. J. M.; Tavecchio, Louis W. C.

    2017-01-01

    This study examined the effects of a newly developed on-site consultancy programme to improve global quality of the child care environment in non-parental child care centres for 0- to 4-year-old children as measured with the ITERS-R/ECERS-R. Using a randomised controlled trial with a pretest, posttest, and follow-up test, we compared 35…

  15. Managed care: employers' influence on the health care system.

    Science.gov (United States)

    Corder, K T; Phoon, J; Barter, M

    1996-01-01

    Health care reform is a complex issue involving many key sectors including providers, consumers, insurers, employers, and the government. System changes must involve all sectors for reform to be effective. Each sector has a responsibility to understand not only its own role in the health care system, but the roles of others as well. The role of business employers is often not apparent to health care providers, especially nurses. Understanding the influence employers have on the health care system is vital if providers want to be proactive change agents ensuring quality care.

  16. How to achieve care coordination inside health care organizations

    DEFF Research Database (Denmark)

    Prætorius, Thim; C. Becker, Markus

    2015-01-01

    Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from...

  17. [An ethical reflection on outreaching mental health care].

    Science.gov (United States)

    Liégeois, A; Eneman, M

    Care providers have a conflicting societal role: on the one hand they must respect the autonomy of individuals with psychiatric problems, but on the other hand they often feel the need to offer these individuals outreaching care. To compile an ethical reflection on some of the ways in which outreaching mental health care interventions can be provided in a responsible manner. This ethical reflection is based on an ethical advice by the Ethics committee for Mental Health Care of the Brothers of Charity in Flanders. The method combines ethical discussion and a study of the relevant literature. A good starting point is a relational view of the human being that emphasises connectedness and involvement. Consequently, the care provider begins to intervene in the care programme by building a trusting relationship with the person with psychiatric problems. This is how these persons, their close family and friends and care providers exercise their responsibility. There is a gradation of responsibility that extends in a continuous line: personal responsibility develops into shared responsibility which can then become vicarious responsibility. On that basis there is also a gradation in the nature of outreaching care; the care providers first make themselves available and give information, then provide advice, negotiate, persuade, increase pressure, and finally take over and force the person with psychiatric problems. The care providers choose in dialogue and in a considered and consistent way for the appropriate form of outreaching care, in line with the degree of responsibility that the person with psychiatric problems can assume.

  18. Technology in health care logistics

    DEFF Research Database (Denmark)

    Jørgensen, Pelle; Wallin, Michael

    In most of the developed countries hospitals are facing a major challenge – they have to provide more health care using the same resources. Due to the demographic trend and the increasing share of the population being in a more health-demanding age, the hospitals will have to deal with more...... patients in the future. It is therefore essential that the hospitals are more efficient in order to meet the requirement of providing more health for the same or less resources. Studies have shown that more than 30% of hospital expenditures are related to various logistics cost, making the logistics...... papers presented at scientific conferences, and three articles submitted to scientific journals. In addition to the results, the thesis presents a detailed description of the scientific approach taken, as well as considerations in relation to the scientific approach and the achieved results....

  19. Development of Health Promoting Leadership--Experiences of a Training Programme

    Science.gov (United States)

    Eriksson, Andrea; Axelsson, Runo; Axelsson, Susanna Bihari

    2010-01-01

    Purpose: The purpose of this paper is to describe and analyse the experiences of an intervention programme for development of health promoting leadership in Gothenburg in Sweden. The more specific purpose is to identify critical aspects of such a programme as part of the development of a health promoting workplace. Design/methodology/approach: A…

  20. Review of a community oral health programme in Nigeria after ten ...

    African Journals Online (AJOL)

    It comprises school health programmes, health education programmes for specific target groups, examination for early detection of diseases and provision of dental services at the clinic located on site. Within the first ten years under review (1988-1997), a total of 780 patients were seen at the dental clinic. Three hundred ...

  1. Programme Costing of a Physical Activity Programme in Primary Prevention: Should the Costs of Health Asset Assessment and Participatory Programme Development Count?

    Directory of Open Access Journals (Sweden)

    Silke B. Wolfenstetter

    2012-01-01

    Full Text Available This analysis aims to discuss the implications of the “health asset concept”, introduced by the WHO, and the “investment for health model” requiring a “participatory approach” of cooperative programme development applied on a physical activity programme for socially disadvantaged women and to demonstrate the related costing issues as well as the relevant decision context. The costs of programme implementation amounted to €48,700. Adding the costs for developing the programme design of €48,800 results in total costs of €97,500; adding on top of that the costs of asset assessment running to €35,600 would total €133,100. These four different cost figures match four different types of potentially relevant decisions contexts. Depending on the decision context the total costs, and hence the incremental cost-effectiveness ratio of a health promotion intervention, could differ considerably. Therefore, a detailed cost assessment and the identification of the decision context are of crucial importance.

  2. Teaching Health Care in Introductory Economics

    Science.gov (United States)

    Cutler, David M.

    2017-01-01

    Health care is one of the economy's biggest industries, so it is natural that the health care industry should play some role in the teaching of introductory economics. There are many ways that health care can appear in such a context: in the teaching of microeconomics, as a macroeconomic issue, to learn about social welfare, and even to learn how…

  3. Women's health care: from whom and why?

    NARCIS (Netherlands)

    Brink-Muinen, A. van den

    1997-01-01

    Differences are investigated between female practice populations of female general practitioners providing women's health care and of women and men general practitioners providing regular health care. Women's health care in the Netherlands is provided in the general practice "Aletta" and is based

  4. Use of programme budgeting and marginal analysis as a framework for resource reallocation in respiratory care in North Wales, UK.

    Science.gov (United States)

    Charles, J M; Brown, G; Thomas, K; Johnstone, F; Vandenblink, V; Pethers, B; Jones, A; Edwards, R T

    2016-09-01

    Since the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of 'prudent healthcare' championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted. A PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest. A sum of £86.9 million was spent on respiratory care in 2012-13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment. This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health.

  5. Mental health in primary health care in a rural district of Cambodia: a situational analysis.

    Science.gov (United States)

    Olofsson, Sofia; Sebastian, Miguel San; Jegannathan, Bhoomikumar

    2018-01-01

    While mental and substance use disorders are common worldwide, the treatment gap is enormous in low and middle income countries. Primary health care is considered to be the most important way for people to get mental health care. Cambodia is a country with a long history of war and has poor mental health and limited resources for care. The aim of this study was to conduct a situational analysis of the mental health services in the rural district of Lvea Em, Kandal Province, Cambodia. A cross-sectional situational analysis was done to understand the mental health situation in Lvea Em District comparing it with the national one. The Programme for improving mental health care (PRIME) tool was used to collect systematic information about mental health care from 14 key informants in Cambodia. In addition, a separate questionnaire based on the PRIME tool was developed for the district health care centres (12 respondents). Ethical approval was obtained from the National Ethics Committee for Health Research in Cambodia. Mental health care is limited both in Lvea Em District and the country. Though national documents containing guidelines for mental health care exist, the resources available and health care infrastructure are below what is recommended. There is no budget allocated for mental health in the district; there are no mental health specialists and the mental health training of health care workers is insufficient. Based on the limited knowledge from the respondents in the district, mental health disorders do exist but no documentation of these patients is available. Respondents discussed how community aspects such as culture, history and religion were related to mental health. Though there have been improvements in understanding mental health, discrimination and abuse against people with mental health disorders seems still to be present. There are very limited mental health care services with hardly any budget allocated to them in Lvea Em District and Cambodia

  6. Rationalising health care in india : Challenges & strategies

    Directory of Open Access Journals (Sweden)

    K I Mathai

    2014-01-01

    Full Text Available An overview of health care delivery in India is essential, if we are to plan and to improve health care delivery and the indices of health in the coming decades. The health sector in India is a mix of private and government services. While some health care indices appear dismal, several others, including life expectancy are heartening. A balance between regulation and free enterprise is possibly the best option. In this paper we provide a glimpse of health and health related statistics & a n overview of the public health care delivery systems. In the end, we offer suggestion on rationalisation of health care delivery to provide maximum services for the majority of our population within the budget of an optimal health care system outlay

  7. [Indicators of governance in mental health policies and programmes in Mexico: a perspective of key actors].

    Science.gov (United States)

    Díaz-Castro, Lina; Arredondo, Armando; Pelcastre-Villafuerte, Blanca Estela; Hufty, Marc

    To analyse the role of Mexico's mental health system governance in the development of mental health policies and programmes, from the perspective of its own actors. A map was developed for identifying the actors in Mexico's mental health system. A guide was designed for in-depth interviews, which were recorded and arranged in categories for their analysis. The Atlas-ti v.7 software was used for the organisation of qualitative data and Policy Maker v.4 was used to determine the position and influence of actors within the health system. The actors were identified according to their level of influence in mental health policies: high, medium and low. Actors with a high level of influence participate in national policies, actors with medium influence are involved in regional or local policies and the participation of actors with a low level of influence is considered marginal. This study facilitated understanding of governance in mental health. The level of influence of the actors directly affects the scope of governance indicators. Relevant data were obtained to improve policies in mental health care. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Remote Health Care Provision in Care Homes.

    Science.gov (United States)

    Newbould, Louise; Mountain, Gail; Hawley, Mark; Ariss, Steve

    2017-01-01

    A survey was developed to map provision, knowledge, attitudes and views towards videoconferencing in care homes in Yorkshire and The Humber. The survey was sent to 859 care homes, with a 14% response rate. Twelve homes reported using videoconferencing. Non-users appeared skeptical, managers using the system reported improvements in outcomes.

  9. Let's put "care" back into health care.

    Science.gov (United States)

    Wesolowski, C E

    1990-01-01

    Organizations that clearly demonstrate they care about their people reap the benefits of a positive self-image, higher productivity and financial gains. Consider the effects that a demoralized, unappreciated staff have on productivity, recruitment and retention, public relations, marketing, customer satisfaction and the resulting financial repercussions. Can we afford not to care?

  10. Master of Primary Health Care degree: who wants it and why?

    Science.gov (United States)

    Andrews, Abby; Wallis, Katharine A; Goodyear-Smith, Felicity

    2016-06-01

    INTRODUCTION The Department of General Practice and Primary Health Care at the University of Auckland is considering developing a Master of Primary Health Care (MPHC) programme. Masters level study entails considerable investment of both university and student time and money. AIM To explore the views of potential students and possible employers of future graduates to discover whether there is a market for such a programme and to inform the development of the programme. METHODS Semi-structured interviews were conducted with 30 primary health care stakeholders. Interviews were digitally recorded, transcribed and analysed using a general inductive approach to identify themes. FINDINGS Primary care practitioners might embark on MPHC studies to develop health management and leadership skills, to develop and/or enhance clinical skills, to enhance teaching and research skills, or for reasons of personal interest. Barriers to MPHC study were identified as cost and a lack of funding, time constraints and clinical workload. Study participants favoured inter-professional learning and a flexible delivery format. Pre-existing courses may already satisfy the post-graduate educational needs of primary care practitioners. Masters level study may be superfluous to the needs of the primary care workforce. CONCLUSIONS Any successful MPHC programme would need to provide value for PHC practitioner students and be unique. The postgraduate educational needs of New Zealand primary care practitioners may be already catered for. The international market for a MPHC programme is yet to be explored.

  11. Impact of a national QI programme on reducing electronic health record notifications to clinicians.

    Science.gov (United States)

    Shah, Tina; Patel-Teague, Shilpa; Kroupa, Laura; Meyer, Ashley N D; Singh, Hardeep

    2018-03-05

    Emerging evidence suggests electronic health record (EHR)-related information overload is a risk to patient safety. In the US Department of Veterans Affairs (VA), EHR-based 'inbox' notifications originally intended for communicating important clinical information are now cited by 70% of primary care practitioners (PCPs) to be of unmanageable volume. We evaluated the impact of a national, multicomponent, quality improvement (QI) programme to reduce low-value EHR notifications. The programme involved three steps: (1) accessing daily PCP notification load data at all 148 facilities operated nationally by the VA; (2) standardising and restricting mandatory notification types at all facilities to a recommended list; and (3) hands-on training for all PCPs on customising and processing notifications more effectively. Designated leaders at each of VA's 18 regional networks led programme implementation using a nationally developed toolkit. Each network supervised technical requirements and data collection, ensuring consistency. Coaching calls and emails allowed the national team to address implementation challenges and monitor effects. We analysed notification load and mandatory notifications preintervention (March 2017) and immediately postintervention (June-July 2017) to assess programme impact. Median number of mandatory notification types at each facility decreased significantly from 15 (IQR: 13-19) to 10 (IQR: 10-11) preintervention to postintervention, respectively (Pmanage them. Nevertheless, our project suggests feasibility of using large-scale 'de-implementation' interventions to reduce unintended safety or efficiency consequences of well-intended electronic communication systems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Pre- and post-intervention assessment of a PMTCT-programme ...

    African Journals Online (AJOL)

    PMTCT) services following implementation of programme-strengthening activities in a ... Keywords: antenatal care, health service delivery, HIV/AIDS, maternal health services, postnatal care, programme evaluation, quantitative research, women

  13. Evaluating the systematic implementation of the 'Let Me Decide' advance care planning programme in long term care through focus groups: staff perspectives.

    LENUS (Irish Health Repository)

    Cornally, Nicola

    2015-11-01

    The \\'Let Me Decide\\' Advance Care Planning (LMD-ACP) programme offers a structured approach to End-of-Life (EoL) care planning in long-term care for residents with and without capacity to complete an advance care directive\\/plan. The programme was implemented in three homes in the South of Ireland, with a view to improving quality of care at end of life. This paper will present an evaluation of the systematic implementation of the LMD-ACP programme in the homes.

  14. Rethinking programme evaluation in health professions education: beyond 'did it work?'.

    Science.gov (United States)

    Haji, Faizal; Morin, Marie-Paule; Parker, Kathryn

    2013-04-01

    For nearly 40 years, outcome-based models have dominated programme evaluation in health professions education. However, there is increasing recognition that these models cannot address the complexities of the health professions context and studies employing alternative evaluation approaches that are appearing in the literature. A similar paradigm shift occurred over 50 years ago in the broader discipline of programme evaluation. Understanding the development of contemporary paradigms within this field provides important insights to support the evolution of programme evaluation in the health professions. In this discussion paper, we review the historical roots of programme evaluation as a discipline, demonstrating parallels with the dominant approach to evaluation in the health professions. In tracing the evolution of contemporary paradigms within this field, we demonstrate how their aim is not only to judge a programme's merit or worth, but also to generate information for curriculum designers seeking to adapt programmes to evolving contexts, and researchers seeking to generate knowledge to inform the work of others. From this evolution, we distil seven essential elements of educational programmes that should be evaluated to achieve the stated goals. Our formulation is not a prescriptive method for conducting programme evaluation; rather, we use these elements as a guide for the development of a holistic 'programme of evaluation' that involves multiple stakeholders, uses a combination of available models and methods, and occurs throughout the life of a programme. Thus, these elements provide a roadmap for the programme evaluation process, which allows evaluators to move beyond asking whether a programme worked, to establishing how it worked, why it worked and what else happened. By engaging in this process, evaluators will generate a sound understanding of the relationships among programmes, the contexts in which they operate, and the outcomes that result from them

  15. Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence.

    Science.gov (United States)

    Bosch-Capblanch, Xavier; Marceau, Claudine

    2014-12-01

    To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi-component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming-up of CHW, micro-franchising or social franchising. On-site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers' basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Large, multi-faceted, iCCM programmes, with strong components of training, supervision, which

  16. Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence

    Science.gov (United States)

    Bosch–Capblanch, Xavier; Marceau, Claudine

    2014-01-01

    Aim To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Methods Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. Results The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi–component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming–up of CHW, micro–franchising or social franchising. On–site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers’ basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Conclusion Large, multi–faceted, iCCM programmes, with strong

  17. Hospitals and health care establishments

    International Nuclear Information System (INIS)

    1999-01-01

    These guidelines have been drown up to assist all those involved in the management and maintenance of hospitals and health care establishments. Compliance with this guidance should minimise the risk of pollution occurring. The guidelines are jointly produced by the Environment Agency for England and Wales, the Scottish Environment Protection Agency and the Environment and Heritage Service for Northern Ireland, referred to as the Agency or Agencies. It includes guidelines on site drainage, sewage and waste water disposal, treatment of surface water drainage and waste management

  18. Why do managers allocate resources to workplace health promotion programmes in countries with national health coverage?

    Science.gov (United States)

    Downey, Angela M; Sharp, David J

    2007-06-01

    There is extensive evidence that worksite health promotion (WHP) programmes reduce healthcare costs and improve employee productivity. In many countries, a large proportion of healthcare costs are borne by the state. While the full benefits of WHP are still created, they are shared between employers and the state, even though the employer bears the full (after-tax) cost. Employers therefore have a lower incentive to implement WHP activity. We know little about the beliefs of managers with decision responsibility for the approval and implementation of WHP programmes in this context. This article reports the results of a study of the attitudes of Canadian senior general managers (GMs) and human resource managers (HRMs) in the auto parts industry in Ontario, Canada towards the consequences of increasing discretionary spending on WHP, using Structural Equation Modelling and the Theory of Planned Behaviour. We identified factors that explain managers' intentions to increase discretionary spending on wellness programmes. While both senior GMs and HRMs are motivated primarily by their beliefs that WHP reduces indirect costs of health failure, GMs were also motivated by their moral responsibility towards employees (but surprisingly HRMs were not). Importantly, HRMs, who usually have responsibility for WHP, felt constrained by a lack of power to commit resources. Most importantly, we found no social expectation that organizations should provide WHP programmes. This has important implications in an environment where the adoption of WHP is very limited and cost containment within the healthcare system is paramount.

  19. Experiences of homosexual patients' access to primary health care services in Umlazi, KwaZulu-Natal.

    Science.gov (United States)

    Cele, Nokulunga H; Sibiya, Maureen N; Sokhela, Dudu G

    2015-09-28

    Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate healthcare. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk. The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC) services in Umlazi in the province ofKwaZulu-Natal (KZN). A qualitative, exploratory, descriptive study was conducted which was contextual innature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis. Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel. Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.

  20. Evaluation of Maternal Health Component of Reproductive and Child Health (RCH II Programme in Beed District, Maharashtra, India 2013

    Directory of Open Access Journals (Sweden)

    Dnyaneshwar Nipte,

    2015-04-01

    Full Text Available Introduction: Situation analysis of Reproductive and Child Health programme of Government of India in Beed district of Maharashtra state in India indicated lack of achievement of targeted maternal health indicators. Evaluation of the utilization of maternal health services component of Reproductive and Child Health (RCH II programme in Beed district of Maharashtra state in India was undertaken. Material and Methods: A cross sectional survey in the rural area of Beed district using cluster sampling method was conducted. The information about the utilization of maternal health services was collected from mothers who delivered between 1st April and 30th June 2013. A facility survey using pre tested check list was undertaken. Analysis of the data using Epi Info Version 3.5.3 and proportion for selected maternal health care indicators were calculated. Results: Out of the 374 mothers included in the study, 122 (33.0% had registered within first trimester of pregnancy; nearly 50% had received more than three antenatal care (ANC visits and 90% had institutional delivery. Of the 70 mothers, who made phone call for ambulance service, 56 (80% utilized ambulance from their residence to the hospitals. Of the 183 mothers who delivered in Government hospitals, 103 (56.3% utilized it to reach home from hospitals after delivery. Of the eligible women, 96 (76.2% were registered for Janani Suraksha Yojana (JSY scheme of the Government and 67 (69.8% received the benefit. In all 46 (16.4% Auxiliary Nurse Midwives (ANMs were trained as Skilled Birth Attendant (SBA. Of the 22 facilities, 14 (63.6% had delivery kits and in 6 (27.3% facilities maternal health services were monitored by medical officers. Conclusion: The utilization of maternal health care services and knowledge and implementation regarding JSY Scheme and ambulance service utilization among mothers was less than desirable. The coverage of training of ANMs as SBA was low. Provision of antenatal services in

  1. Managing Cancer Care - Finding Health Care Services

    Science.gov (United States)

    ... my condition? Has it been rated by state, consumer, or other groups for its quality of care? ... be both rewarding and demanding. It can change relationships and require families to cope with all aspects ...

  2. [Geriatric health promotion and prevention for independently living senior citizens: programmes and target groups].

    Science.gov (United States)

    Dapp, U; Anders, J; Meier-Baumgartner, H P; v Renteln-Kruse, W

    2007-08-01

    Nearly all diseases in old age that are epidemiologically important can be reduced or prevented successfully through consequent changes in individual lifestyle, a systematic provision of measures in primary prevention (i.e. vaccination programmes) and the creation of health promoting settings. However, at the moment the amount of potential for preventative interventions is neither systematically nor sufficiently utilised in Germany. Two different preventative approaches: a) multidimensional advice session in small groups through an interdisciplinary team at a geriatric centre (seniors come to seek advice offered at a centre) or b) multidimensional advice at the seniors home through one member of the interdisciplinary team from the geriatric centre (expert takes advice to seniors home) were tested simultaneously with a well-described study sample of 804 independent community-dwelling senior citizens aged 60 years or over, without need of care and cognitive impairments recruited from general practices. Information about target group specific approaches in health promotion and prevention for senior citizens were retrieved from analyses of sociodemographic, medical, psychological and spacial characteristics of this study sample. The majority of the study sample (580 out of 804 or 72.1%) decided to participate: a) 86.7% (503 out of 580) attended at the geriatric centre and sought advice in group sessions and b) 13.3% (77 out of 580) decided to receive advice in a preventive home visit. A total of 224 seniors (224 out of 804 or 27.9%) refused to participate at all. These three target groups were characterised on the basis of their age, gender, education, social background, health status, health behaviour, use of preventive care, self perceived health, functional disabilities, social net and social participation and distance or accessibility of preventative approaches. The 503 senior citizens who participated in small group sessions at the geriatric centre were

  3. Investigating the validity and usability of an interactive computer programme for assessing competence in telephone-based mental health triage.

    Science.gov (United States)

    Sands, Natisha; Elsom, Stephen; Keppich-Arnold, Sandra; Henderson, Kathryn; King, Peter; Bourke-Finn, Karen; Brunning, Debra

    2016-02-01

    Telephone-based mental health triage services are frontline health-care providers that operate 24/7 to facilitate access to psychiatric assessment and intervention for people requiring assistance with a mental health problem. The mental health triage clinical role is complex, and the populations triage serves are typically high risk; yet to date, no evidence-based methods have been available to assess clinician competence to practice telephone-based mental health triage. The present study reports the findings of a study that investigated the validity and usability of the Mental Health Triage Competency Assessment Tool, an evidence-based, interactive computer programme designed to assist clinicians in developing and assessing competence to practice telephone-based mental health triage. © 2015 Australian College of Mental Health Nurses Inc.

  4. Integrated occupational health care at sea

    DEFF Research Database (Denmark)

    Jensen, Olaf Chresten

    2011-01-01

    exposures during life at sea and work place health promotion. SEAHEALTH and some of the shipping companies have already added workplace health promotion to occupational health care programs. The purpose of this article is to reinforce this trend by adding some international perspectives and by providing......Workplace Health Promotion is the combined efforts of employers, employees and society to improve the health and well-being of people at work. Integrated maritime health care can be defined as the total maritime health care function that includes the prevention of health risks from harmful...

  5. Mothers' health services utilization and health care seeking ...

    African Journals Online (AJOL)

    Background: data from different studies showed health care behaviour and estimated per capita health care expenditure for the general population, but the specific data for infants at different levels of care are lacking. The objectives of this study were to describe mothers' health service utilization during pregnancy and ...

  6. Exploring competing experiences and expectations of the revitalized community health worker programme in Mozambique: an equity analysis.

    Science.gov (United States)

    Give, Celso Soares; Sidat, Mohsin; Ormel, Hermen; Ndima, Sozinho; McCollum, Rosalind; Taegtmeyer, Miriam

    2015-09-01

    Mozambique launched its revitalized community health programme in 2010 in response to inequitable coverage and quality of health services. The programme is focused on health promotion and disease prevention, with 20 % of community health workers' (known in Mozambique as Agentes Polivalentes Elementares (APEs)) time spent on curative services and 80 % on activities promoting health and preventing illness. We set out to conduct a health system and equity analysis, exploring experiences and expectations of APEs, community members and healthcare workers supervising APEs. This exploratory qualitative study captured the perspectives of a range of participants including women caring for children under 5 years (service clients), community leaders, service providers (APEs) and their supervisors. Participants in the Moamba and Manhiça districts, located in Maputo Province (Mozambique), were selected purposively. In total, 29 in-depth interviews and 9 focus group discussions were conducted in the local language and/or Portuguese. A framework approach was used for analysis, assisted by NVivo10 software. Our analysis revealed that health equity is viewed as linked to the quality and coverage of the APE programme. Demand and supply factors interplay to shape health equity. The availability of responsive and appropriate services led to tensions between community expectations for curative services (and APEs' willingness to perform them) and official policy focusing APE efforts mainly on preventive services and health promotion. The demand for more curative services by community members is a result of having limited access to healthcare services other than those offered by APEs. This study highlights the need to pay attention to the determinants of demand and supply of community interventions in health, to understand the opportunities and challenges of the difficult interface role played by APEs and to create communication among stakeholders in order to build a stronger, more

  7. The Obama health care plan: what it means for mental health care of older adults.

    Science.gov (United States)

    Sorrell, Jeanne M

    2009-01-01

    Health care was an important issue for both the Obama and McCain election campaigns. Now that Barack Obama is poised to serve as the 44th President of the United States, many health care providers are focused on what Obama's administration will mean for new health care initiatives. This article focuses specifically on aspects of the Obama and Biden health care plan that affects mental health care for older adults.

  8. Delegation within municipal health care.

    Science.gov (United States)

    Bystedt, Maria; Eriksson, Maria; Wilde-Larsson, Bodil

    2011-05-01

    To describe how registered nurses (RNs) perceive delegation to unlicensed personnel (UP) in a municipal healthcare context in Sweden. Within municipal health care RNs often delegate tasks to UP. The latter have practical training, but lack formal competence. Twelve RNs were interviewed and the material was analysed using a phenomenographic approach. Owing to a shortage of RNs, delegation is seen as a prerequisite for a functioning organization. This necessity also involves a number of perceived contradictions in three areas: (1) the work situation of RNs - facilitation and relief vs. lack of control, powerlessness, vagueness regarding responsibility, and resignation; (2) the relationship with unlicensed personnel - stimulation, possibility for mentoring, use of UP competence and the creation of fairness vs. questioning UP competence; and (3) The patients - increase in continuity, quicker treatment, and increased security vs. insecurity (with respect to, for example, the handling of medicine). Registered nurses perceptions of delegation within municipal healthcare involve their own work situation, the UP and the patients. Registered nurses who delegate to UP must be given time for mentoring such that the nursing care is safe care of high quality. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  9. Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines.

    Science.gov (United States)

    Stark, Renee; Kirchberger, Inge; Hunger, Matthias; Heier, Margit; Leidl, Reiner; von Scheidt, Wolfgang; Meisinger, Christa; Holle, Rolf

    2014-03-01

    Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years. The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes. Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95% CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95% CI 0.64-1.27). Guideline-care significantly improved survival (HR 0.41, 95% CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care. This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.

  10. Health Care Information System (HCIS) Data File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...

  11. Reforming health care in Hungary.

    Science.gov (United States)

    Császi, L; Kullberg, P

    1985-01-01

    Over the past two decades Hungary has initiated a series of social and economic reforms which have emphasized decentralization of control and the reintroduction of market mechanisms into the socialized economy. These reforms both reflect and reinforce a changing social structure, in particular the growing influence of upper class special interest groups. Market reforms are an expression of concurrent ideological shifts in Hungarian society. We examined the political significance of three recent proposals to reform health services against the backdrop of broader social and economic changes taking place. The first proposes a bureaucratic reorganization, the second, patient co-payments, and the third, a voucher system. The problems each proposal identifies, as well as the constituency each represents, reveal a trend toward consolidation of class structure in Hungary. Only one of these proposals has any potential to democratize the control and management of the heath care system. Moreover, despite a governmental push toward decentralization, two of these proposals would actually increase centralized bureaucratic control. Two of the reforms incorporate market logic into their arguments, an indication that the philosophical premises of capitalism are re-emerging as an important component of the Hungarian world-view. In Hungary, as well as in other countries, social analysis of proposed health care reforms can effectively illuminate the social and political dynamics of the larger society.

  12. [Teletransmission, health care and deontology].

    Science.gov (United States)

    Lousson, J P

    1995-01-01

    EDI is the technique the most frequently used by Chemists to relay their daily orders to their suppliers. Three out of four Chemists in France are computerised using various forms of computer hardware and software. The Health Care organisations propose that Chemists use the EDI to relay to the CETELIC all the items of information concerning their invoicing. This means handing over administrative information identifying the patient, the doctor ... as well as financial and confidential data such as the CIP code of the prescribed and delivered medicine. The law of the 4th January 1993 was instigated to control the rising expenses of the Health Care organisations and it mandates the Caisse Primaire d'Assurance Maladie (the French social security organisations) to retrieve and analyse the information thus gathered from all of the medical professionals involved. However, the accumulation of all these items of computerised information constitutes in effect a confidential medical file on each patient. This raises the following issues: Who does this confidential data belong to? Who should the Chemists give it to? What is to be done with it? Who will be responsible for its analysis in respect of the confidentiality problem? (Another medical professional bound by oath?) And how can we insure against subsequent abuse of this material?

  13. 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.

  14. From end of life to chronic care: the provision of community home-based care for HIV and the adaptation to new health care demands in Zambia.

    Science.gov (United States)

    Aantjes, Carolien J; Simbaya, Joseph; Quinlan, Tim K C; Bunders, Joske F G

    2016-11-01

    Aim We present the evolution of primary-level HIV and AIDS services, shifting from end of life to chronic care, and draw attention to the opportunities and threats for the future of Zambia's nascent chronic care system. Although African governments struggled to provide primary health care services in the context of a global economic crisis, civil society organisations (CSO) started mobilising settlement residents to respond to another crisis: the HIV and AIDS pandemic. These initiatives actively engaged patients, families and settlement residents to provide home-based care to HIV-infected patients. After 30 years, CHBC programmes continue to be appropriate in the context of changing health care needs in the population. The study took place in 2011 and 2012 and was part of a multi-country study. It used a mixed method approach involving semi-structured interviews, focus group discussions, structured interviews, service observations and a questionnaire survey. Findings Our research revealed long-standing presence of extensive mutual support amongst residents in many settlements, the invocation of cultural values that emphasise social relationships and organisation of people by CSO in care and support programmes. This laid the foundation for a locally conceived model of chronic care capable of addressing the new care demands arising from the country's changing burden of disease. However, this capacity has come under threat as the reduction in donor funding to community home-based care programmes and donor and government interventions, which have changed the nature of these programmes in the country. Zambia's health system risks losing valuable capacity for fulfilling its vision 'to bring health care as close to the family as possible' if government strategies do not acknowledge the need for transformational approaches to community participation and continuation of the brokering role by CSO in primary health care.

  15. Lessons learned from England's Health Checks Programme: using qualitative research to identify and share best practice.

    Science.gov (United States)

    Ismail, Hanif; Kelly, Shona

    2015-10-20

    This study aimed to explore the challenges and barriers faced by staff involved in the delivery of the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program in primary care. Data have been derived from three qualitative evaluations that were conducted in 25 General Practices and involved in depth interviews with 58 staff involved all levels of the delivery of the Health Checks. Analysis of the data was undertaken using the framework approach and findings are reported within the context of research and practice considerations. Findings indicated that there is no 'one size fits all' blueprint for maximising uptake although success factors were identified: evolution of the programme over time in response to local needs to suit the particular characteristics of the patient population; individual staff characteristics such as being proactive, enthusiastic and having specific responsibility; a supportive team. Training was clearly identified as an area that needed addressing and practitioners would benefit from CVD specific baseline training and refresher courses to keep them up to date with recent developments in the area. However there were other external factors that impinged on an individual's ability to provide an effective service, some of these were outside the control of individuals and included cutbacks in referral services, insufficient space to run clinics or general awareness of the Health Checks amongst patients. The everyday experiences of practitioners who participated in this study suggest that overall, Health Check is perceived as a worthwhile exercise. But, organisational and structural barriers need to be addressed. We also recommend that clear referral pathways be in place so staff can refer patients to appropriate services (healthy eating sessions, smoking cessation, and exercise referrals). Local authorities need to support initiatives that enable data sharing and linkage so that

  16. An evaluation of staff engagement programmes in four National Health Service Acute Trusts.

    Science.gov (United States)

    Hewison, Alistair; Gale, Nicola; Yeats, Rowena; Shapiro, Jonathan

    2013-01-01

    The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision-making, and the related literature. A mixed-methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used. The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were "championed" by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation. The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations. Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done.

  17. Children in family foster care have greater health risks and less involvement in Child Health Services.

    Science.gov (United States)

    Köhler, M; Emmelin, M; Hjern, A; Rosvall, M

    2015-05-01

    This study investigated the impact of being in family foster care on selected health determinants and participation in Child Health Services (CHS). Two groups of 100 children, born between 1992 and 2008, were studied using data from Swedish Child Health Services for the preschool period up to the age of six. The first group had been in family foster care, and the controls, matched for age, sex and geographic location, had not. Descriptive statistics were used to describe differences in health determinants and participation in Child Health Services between the two groups. The foster care group had higher health risks, with lower rates of breastfeeding and higher levels of parental smoking. They were less likely to have received immunisations and attended key nurse or physician visits and speech and vision screening. Missing data for the phenylketonuria test were more common in children in family foster care. Children in family foster care were exposed to more health risks than the control children and had lower participation in the universal child health programme during the preschool period. These results call for secure access to high-quality preventive health care for this particularly vulnerable group of children. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  18. Collaborative HIV care in primary health care: nurses' views.

    Science.gov (United States)

    Ngunyulu, R N; Peu, M D; Mulaudzi, F M; Mataboge, M L S; Phiri, S S

    2017-12-01

    Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care. © 2017 International Council of Nurses.

  19. Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh

    Directory of Open Access Journals (Sweden)

    Sarika Chaturvedi

    2015-07-01

    Full Text Available Background: Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. Design: 1 Non-participant observations (n=18 of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2 Interviews (n=10 with providers to explore reasons for this care. Thematic framework analysis was used. Results: Three themes emerged from the data: 1 delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2 Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3 Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as ‘go-betweens’ patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Conclusions: Our observational study did not suggest an adequate level of skilled birth attendance (SBA. The findings reveal insufficiencies in the health system and organisational structures to provide an

  20. Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh.

    Science.gov (United States)

    Chaturvedi, Sarika; De Costa, Ayesha; Raven, Joanna

    2015-01-01

    Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as 'go-betweens' patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an 'enabling environment' for SBA. We highlight the need to ensure

  1. Ineffective programme management on the delivery of health ...

    African Journals Online (AJOL)

    outsourced to the Department of Public Works and the Independent. Development .... achieve a common strategic or business goal. ... Since programme management ... civil and structural engineering together with quantity surveying. The.

  2. Evaluation of an occupational health intervention programme on whole‐body vibration in forklift truck drivers: a controlled trial

    Science.gov (United States)

    Hulshof, C T J; Verbeek, J H A M; Braam, I T J; Bovenzi, M; van Dijk, F J H

    2006-01-01

    Objectives To evaluate process and outcome of a multifaceted occupational health intervention programme on whole‐body vibration (WBV) in forklift truck drivers. Methods An experimental pretest/post‐test control group study design. The authors trained occupational health services (OHS) in the experimental group in the use of the programme. OHS in the control group were asked to deliver care as usual. In total, 15 OHS, 32 OHS professionals, 26 companies, and 260 forklift drivers were involved. Post‐test measurements were carried out one year after the start of the programme. Results Baseline data before the start of the programme showed no difference between experimental and control group. Results of the outcome evaluation indicate a slight, although not statistically significant, reduction of WBV exposure in the experimental group (p = 0.06). Process evaluation revealed a positive influence on company policy toward WBV, attitude and intended behaviour of forklift drivers, and a trend towards an increase in knowledge of OHS professionals and company managers. The number of observed control measures with a major impact (levelling of surface and reduction of speed) was rather low. In those cases where control measures had been taken, there was a significant reduction in WBV exposure. This limited effect of the programme might be caused by the short period of follow up and the dropout of participants. The feasibility and the usefulness of the programme within the OHS setting were rated good by the participants. Conclusions This programme to decrease WBV exposure was partially effective. Significant effects on intermediate objectives were observed. More research on the effectiveness of intervention in the field of WBV is needed. PMID:16551762

  3. Trialling a shaken baby syndrome prevention programme in the Auckland District Health Board.

    Science.gov (United States)

    Kelly, Patrick; Wilson, Kati; Mowjood, Aqeela; Friedman, Joshua; Reed, Peter

    2016-02-19

    To describe and evaluate a shaken baby prevention programme trialled in the Auckland District Health Board from January 2010, to December 2011. Development and implementation of the programme, telephone survey of a sample of caregivers and written survey of a sample of providers. At least 2,592 caregivers received the trial programme. 150 (6%) were surveyed by telephone a median of 6 weeks later. 128 (85%) remembered at least one key message, unprompted; most commonly "It's OK to walk away" (94/150, 63%). When asked, 92% had made a plan for what to do when frustrated and 63% had shared the information with others. Only 98/150 (65%) watched the programme DVD. Many said they already knew about the risks of shaking a baby, but still found the programme highly relevant. Thirty-one nurses were surveyed. There was a high degree of agreement that the programme was relevant. Barriers to programme delivery included time, workload and the documentation required. A shaken baby prevention programme adapted to New Zealand can be introduced in a District Health Board and is acceptable to caregivers and health professionals. Further research is needed to evaluate the content, mode of delivery and effectiveness of this programme.

  4. Home Health Care: Services and Cost

    Science.gov (United States)

    Widmer, Geraldine; And Others

    1978-01-01

    Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

  5. 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

  6. Using appreciative inquiry to transform health care.

    Science.gov (United States)

    Trajkovski, Suza; Schmied, Virginia; Vickers, Margaret; Jackson, Debra

    2013-08-01

    Amid tremendous changes in contemporary health care stimulated by shifts in social, economic and political environments, health care managers are challenged to provide new structures and processes to continually improve health service delivery. The general public and the media are becoming less tolerant of poor levels of health care, and health care professionals need to be involved and supported to bring about positive change in health care. Appreciative inquiry (AI) is a philosophy and method for promoting transformational change, shifting from a traditional problem-based orientation to a more strength-based approach to change, that focuses on affirmation, appreciation and positive dialog. This paper discusses how an innovative participatory approach such as AI may be used to promote workforce engagement and organizational learning, and facilitate positive organizational change in a health care context.

  7. Awareness among tertiary care doctors about Pharmacovigilance Programme of India: Do endocrinologists differ from others?

    Directory of Open Access Journals (Sweden)

    Pramod Kumar Sharma

    2016-01-01

    Full Text Available Background and Objectives: Reporting adverse drug reactions (ADRs associated with drug use is an important factor in patient safety. Majority of ADRs are preventable through improved prescribing and monitoring. Endocrinologists prescribe drugs with actions on almost all organs and for relatively longer durations. ADR are expected following the use of these drugs. Pharmacovigilance is the study of drug-related adverse effects aimed at protecting patients and public from drug-related harms. The concept of pharmacovigilance is relatively new in India, and this survey is an attempt to explore awareness among doctors of an establishing institution of national importance. Materials and Methods: The survey was conducted on faculty and resident doctors by administering a written structured questionnaire in a voluntary manner. The questionnaire contained questions meant to evaluate their awareness, understanding, and misconception about ADR reporting. Identity of the responder was kept confidential. Results: A total of 106 (faculty = 56; residents = 50 participated in survey. The most common cause cited for not reporting an ADR was “do not know how to report” by 64.15%. Majority of them (64% had no information about the Pharmacovigilance Programme of India (PvPI, and only few (8.5% had actually reported or published an ADR. Interpretation and Conclusions: ADRs are major public health problem that needs to be addressed at all levels of health care. High index of clinical suspicion are crucial for their timely detection and management. Various educational interventions have shown to improve medical professionals' awareness, understanding about ADRs and in their reporting behavior. PvPI is an important initiative toward ensuring patient safety.

  8. Loss to follow-up among children in pre-ART care under the National AIDS Programme, Tamil Nadu, South India

    Science.gov (United States)

    Kumar, A. M. V.; Chinnakali, P.; Rajendran, M.; Valan, A. S.; Rewari, B. B.; Swaminathan, S.

    2017-01-01

    Setting: Children aged Tamil Nadu, India, during the year 2012. Design: This was a retrospective cohort study involving a review of programme records. Results: Of 656 children registered for HIV care, 20 (3%) were not assessed for ART eligibility. Of those remaining, 226 (36%) were not ART eligible and entered pre-ART care. Among these, at 1 year of registration, 50 (22%) were LTFU, 40 (18%) were transferred out and 136 (60%) were retained in care at the same centre. The child's age, sex, World Health Organization stage or occurrence of opportunistic infection were not associated with LTFU. Conclusion: One in five children registered under pre-ART care were lost to follow-up. Stronger measures to prevent LTFU and reinforce retrieval actions are necessary in the existing National HIV Programme. PMID:28695080

  9. Health promotion and sustainability programmes in Australia: barriers and enablers to evaluation.

    Science.gov (United States)

    Patrick, Rebecca; Kingsley, Jonathan

    2017-08-01

    In an era characterised by the adverse impacts of climate change and environmental degradation, health promotion programmes are beginning to actively link human health with environmental sustainability imperatives. This paper draws on a study of health promotion and sustainability programmes in Australia, providing insights to evaluation approaches being used and barriers and enablers to these evaluations. The study was based on a multi-strategy research involving both quantitative and qualitative methods. Health promotion practitioners explained through surveys and semi-structured interviews that they focused on five overarching health and sustainability programme types (healthy and sustainable food, active transport, energy efficiency, contact with nature, and capacity building). Various evaluation methods and indicators (health, social, environmental, economic and demographic) were identified as being valuable for monitoring and evaluating health and sustainability programmes. Findings identified several evaluation enablers such as successful community engagement, knowledge of health and sustainability issues and programme champions, whereas barriers included resource constraints and competing interests. This paper highlights the need for ecological models and evaluation tools to support the design and monitoring of health promotion and sustainability programmes.

  10. Dual Loyalty in Prison Health Care

    Science.gov (United States)

    Stöver, Heino; Wolff, Hans

    2012-01-01

    Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners. PMID:22390510

  11. Contribution by primary health nurses and general practitioners to the Diabetes Annual Review (Get Checked) programme in Auckland, New Zealand.

    Science.gov (United States)

    Daly, Barbara; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert

    2013-08-16

    To describe primary health care (practice and specialist) nurses involvement in the government-funded annual diabetes review 'Get Checked' programme and the division of care between nurses and general practitioners in Auckland, New Zealand. Of the total 911 practice and specialist nurses identified and working in the greater Auckland region, 276 (30%) were randomly selected and invited to undertake a self-administered questionnaire and telephone interview in 2006-8. An 86% response rate was achieved. Over 60% of practice nurses and over half of specialist nurses participate in 'Get Checked' reviews. Of those nurses, 40% of practice and 70% specialist nurses, reported completing over half of the total number of 'Get Checked' reviews at their practice. Of the nurses sampled who work in general practice (n=198), 38% reported that 'nurses mostly complete' the reviews, 45% stated that 'nurses and doctors equally complete' them and 17% reported that only 'doctors' did so. For the nurses who reported that 'nurses and doctors equally complete' the reviews (n=89), most nurses undertake blood pressure measurements (90%), weigh patients (88%), give lifestyle advice (87%), examine patient's feet (73%), and 44% carried out the complete review of the patients they consult. These findings show the 'Get Checked' programme was successful in engaging practice and community-based specialist nurses in the community management of diabetes and has revealed positive relationships between nurses and doctors, extended roles for nurses and the importance of engaging nurses in the design of health care programmes.

  12. Integrated primary health care in Australia

    Directory of Open Access Journals (Sweden)

    Gawaine Powell Davies

    2009-10-01

    Full Text Available Introduction: To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy: Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Discussion: Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

  13. Integrated primary health care in Australia.

    Science.gov (United States)

    Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna

    2009-10-14

    To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

  14. Health care of youth aging out of foster care.

    Science.gov (United States)

    2012-12-01

    Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.

  15. Experiences of instructors delivering the Mental Health First Aid training programme: a descriptive qualitative study.

    Science.gov (United States)

    Terry, J

    2010-09-01

    Mental health literacy among the public is often poor, and although people frequently encounter others experiencing mental distress in their workplace, families and communities, they may be ill-equipped to provide appropriate support. 'Mental Health First Aid' (MHFA), a 12-h mental health promotion programme seeks to address this, training people in the knowledge and skills needed to engage with someone experiencing mental health problems. Research relating to the MHFA programme has centred on course attendees, with a paucity of research surrounding the delivery of basic mental health training programmes. Understanding experiences of instructors delivering such programmes is key to the success of future delivery. This study sought to identify the views and experiences of instructors delivering the MHFA programme in Wales. Fourteen MHFA instructors participated in semi-structured audio-recorded interviews, with the transcripts analysed to identify key themes. This paper explores two of the identified themes namely prerequisite skills and support required by instructors. The study highlighted that because of the ensuing emotional labour experienced by instructors, universal mental health training programmes must put in place a clear infrastructure to train, support and monitor those delivering them, for programme roll-out to be effective.

  16. Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

    Science.gov (United States)

    Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

    2015-01-01

    Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry

  17. Distributed leadership in health care

    DEFF Research Database (Denmark)

    Günzel-Jensen, Franziska; Jain, Ajay K.; Kjeldsen, Anne Mette

    2018-01-01

    Management and health care literature is increasingly preoccupied with leadership as a collective social process, and related leadership concepts such as distributed leadership have therefore recently gained momentum. This paper investigates how formal, i.e. transformational, transactional...... and empowering, leadership styles affect employees’ perceived agency in distributed leadership, and whether these associations are mediated by employees’ perceived organizational efficacy. Based on large-scale survey data from a study at one of Scandinavia’s largest public hospitals (N = 1,147), our results show...... that all leadership styles had a significant positive impact on employees’ perceived agency in distributed leadership. Further, organizational efficacy related negatively to employees’ perceived agency in distributed leadership; however a mediatory impact of this on the formal leadership styles...

  18. Medical and health care sector

    International Nuclear Information System (INIS)

    Ainul Hayati Daud; Hazmimi Kasim

    2010-01-01

    The medical and health care sector in general supplies products and provides services that can be categorized as diagnostic radiology, therapeutic application and nuclear medicine (both, diagnostic and/ or therapeutic). The institutions offer different categories of services. Some provide only one category of service, for example, diagnostic radiology. Others may provide more than one categories, for example, diagnostic nuclear medicine and therapeutic nuclear medicine services. A total of 90 entities comprising 65 public agencies and 34 private companies were selected in this study for this sector. The majority of the entities, 75.6 %, operate in Peninsular Malaysia. The remainders operate in Sabah and Sarawak. The findings of the study on both public agencies and private companies are presented in subsequent sections of this chapter. (author)

  19. Managing Home Health Care (For Parents)

    Science.gov (United States)

    ... this topic for: Parents Kids Teens Palliative Care Electronic Health Records When Your Child's in the Pediatric Intensive Care ... Us Contact Us Partners Editorial Policy Permissions Guidelines Privacy Policy & Terms of Use Notice of Nondiscrimination Visit ...

  20. 8 ways to cut health care costs

    Science.gov (United States)

    ... care include strep throat, bladder infection, or a dog bite. You will save both time and money ... health services. www.healthcare.gov/coverage/preventive-care-benefits . Accessed October 18, 2016. U.S. Preventive Services Taskforce ...

  1. The Phelophepa Health Care Train: a pharmacoepidemiological ...

    African Journals Online (AJOL)

    2009-11-19

    Nov 19, 2009 ... Background: The Phelophepa Health Care Train is the only primary healthcare train in the world. Phelophepa is an ... history of caring.3. The Phelophepa .... Skin conditions were, according to the pharmacists, common in the ...

  2. 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 ...

  3. Health Care Access among Deaf People

    Science.gov (United States)

    Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes

    2016-01-01

    Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in…

  4. Predictors of Adolescent Health Care Utilization

    Science.gov (United States)

    Vingilis, Evelyn; Wade, Terrance; Seeley, Jane

    2007-01-01

    This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…

  5. Competition in the Dutch Health Care Sector

    NARCIS (Netherlands)

    F.T. Schut (Erik)

    1995-01-01

    textabstractFor more than two decades, Dutch health policy has been marked by a search for a suitable market order in health care. Suitable in the sense of maintaining universal access, containing the growth of health care expenditure and improving the technical and allocative efficiency of

  6. Health care law versus constitutional law.

    Science.gov (United States)

    Hall, Mark A

    2013-04-01

    National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding health care delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status.

  7. Profiling health-care accreditation organizations: an international survey.

    Science.gov (United States)

    Shaw, Charles D; Braithwaite, Jeffrey; Moldovan, Max; Nicklin, Wendy; Grgic, Ileana; Fortune, Triona; Whittaker, Stuart

    2013-07-01

    To describe global patterns among health-care accreditation organizations (AOs) and to identify determinants of sustainability and opportunities for improvement. Web-based questionnaire survey. Organizations offering accreditation services nationally or internationally to health-care provider institutions or networks at primary, secondary or tertiary level in 2010. s) External relationships, scope and activity public information. Forty-four AOs submitted data, compared with 33 in a survey 10 years earlier. Of the 30 AOs that reported survey activity in 2000 and 2010, 16 are still active and stable or growing. New and old programmes are increasingly linked to public funding and regulation. While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to complement mechanisms of regulation, health-care funding or governmental commitment to quality and health-care improvement that offer a supportive environment. Principal challenges include unstable business (e.g. limited market, low uptake) and unstable politics. Many organizations make only limited information available to patients and the public about standards, procedures or results.

  8. [Population impact of a podiatric school health programme].

    Science.gov (United States)

    Ramos-Galván, José; Álvarez-Ruiz, Verónica; Tovaruela-Carrión, Natalia; Mahillo-Durán, Ramón; Gago-Reyes, Fernando

    2016-01-01

    This article presents an overview of the work done over the past 12 years in a collaboration between the school communities at various primary and secondary schools and the practical experience managers working in the Preventive and Community Podiatry area of the Podiatry degree at the University of Seville (Spain). The article presents several strategies, which were carried out in the fields of Foot Health for All and Preventive and Community Podiatry as part of the Hermes Research Group (CTS-601) aimed at promoting general foot health. Foot examinations were conducted in a total of 4,630 school pupils, with foot problems being confirmed in 677 of them. Some 7,145 members of the school community were also helped, with these people being reached through educational activities around foot care. The aim of the initiative was to prevent foot damage among children, which could have a harmful impact on their quality of life as adults. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  9. Health care: economic impact of caring for geriatric patients.

    Science.gov (United States)

    Rich, Preston B; Adams, Sasha D

    2015-02-01

    National health care expenditures constitute a continuously expanding component of the US economy. Health care resources are distributed unequally among the population, and geriatric patients are disproportionately represented. Characterizing this group of individuals that accounts for the largest percentage of US health spending may facilitate the introduction of targeted interventions in key high-impact areas. Changing demographics, an increasing incidence of chronic disease and progressive disability, rapid technological advances, and systemic market failures in the health care sector combine to drive cost. A multidisciplinary approach will become increasingly necessary to balance the delicate relationship between our constrained supply and increasing demand. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Costs of health care across primary care models in Ontario

    OpenAIRE

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-01-01

    Background 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. Methods Utilization data for a one year period was measured using administrative databases for a 1...

  11. Discrimination against older women in health care.

    Science.gov (United States)

    Belgrave, L L

    1993-01-01

    Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly women's poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older women's health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.

  12. Understanding a Value Chain in Health Care.

    Science.gov (United States)

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

    2015-10-01

    As the US health care system transitions toward a value-based system, providers and health care organizations will have to closely scrutinize their current processes of care. To do this, a value chain analysis can be performed to ensure that only the most efficient steps are followed in patient care. Ultimately this will produce a higher quality or equal quality product for less cost by eliminating wasteful steps along the way.

  13. Depressive Disorders in Primary Health Care

    OpenAIRE

    Vuorilehto, Maria

    2008-01-01

    The Vantaa Primary Care Depression Study (PC-VDS) is a naturalistic and prospective cohort study concerning primary care patients with depressive disorders. It forms a collaborative research project between the Department of Mental and Alcohol Research of the National Public Health Institute, and the Primary Health Care Organization of the City of Vantaa. The aim is to obtain a comprehensive view on clinically significant depression in primary care, and to compare depressive patients in prima...

  14. The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial.

    Science.gov (United States)

    Lloyd-Evans, Brynmor; Fullarton, Kate; Lamb, Danielle; Johnston, Elaine; Onyett, Steve; Osborn, David; Ambler, Gareth; Marston, Louise; Hunter, Rachael; Mason, Oliver; Henderson, Claire; Goater, Nicky; Sullivan, Sarah A; Kelly, Kathleen; Gray, Richard; Nolan, Fiona; Pilling, Stephen; Bond, Gary; Johnson, Sonia

    2016-03-22

    As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity. Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services' electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study's primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline

  15. Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs.

    Science.gov (United States)

    Ssonko, Charles; Gonzalez, Lucia; Mesic, Anita; da Fonseca, Marcio Silveira; Achar, Jay; Safar, Nadia; Martin, Beatriz; Wong, Sidney; Casas, Esther C

    2017-07-21

    Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076-16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12-255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and

  16. Health care and equity in India.

    Science.gov (United States)

    Balarajan, Y; Selvaraj, S; Subramanian, S V

    2011-02-05

    In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. [Care for immigrant patients: facts and professionals' perception in 6 primary health care zones in Navarre].

    Science.gov (United States)

    Fuertes Goñi, Maria Carmen; Elizalde, L; De Andrés, M R; García Castellano, P; Urmeneta, S; Uribe, J M; Bustince, P

    2010-01-01

    To describe utilisation of health care services and motives for consultation in Primary Care in the native and the immigrant population, and compare this with the perception of primary care professionals. Data was collected on health care activity during the year 2006 for all people registered (N=86,966) in the 6 basic health care zones with the highest proportion of immigrants (14.4%) and on the following variables: country of origin, age, sex, year of inscription in the public health service. The health card and OMI-AP programme databases were used. A qualitative methodology of focus groups and in-depth interviews was employed. Seventy-two point four percent of immigrants requested care from the primary care professionals in 2006, of whom 50% proceeded from Ecuador and 70% were between 25 and 44 years old. Eighty-two percent of the natives made consultations and required more referrals to specialised care than the immigrants of the same age group. The most frequent consultation with natives and with immigrants was "acute respiratory infections" (7 to 23% according to age group). The second most frequent with immigrants was "administrative problems". The consultations with immigrants were not related to preventive aspects such as smoking and there were more consultations (p>0.001) for gynaeco-obstetric episodes (10.7%) and those related to work (19%) or psychosomatic problems (8.5%). The perception of the primary care professionals was that the immigrants carry out more consultations than the natives and generate a certain "disorder" in the clinic. Immigrants use healthcare services less than the native population. Nonetheless, this fact is not perceived in this way by the primary care professionals. Fewer preventive activities are carried out with immigrants, who suffer from more labour and psychosomatic problems.

  18. Impact of media health campaign for primary health care among mothers in karachi

    International Nuclear Information System (INIS)

    Habibullah, S.

    2008-01-01

    To evaluate the knowledge, attitude and practice of media-based primary health care (i.e. Expanded Programme of Immunization, National Polio Day, oral rehydration therapy, breast feeding, contraceptive practices, modes of spread of hepatitis B, C, and HIV) among mothers with children under five years of age in an urban and a rural area of Karachi and changes in the same after community-based health education The study was conducted in two phases. In the first phase 600 mothers with children under five years of age were selected at random (300 urban and 300 rural) for the evaluation of knowledge, attitude and practice of media-based primary health care i.e. Expanded Programme of Immunization, National Polio Day, oral rehydration therapy, breast feeding, contraceptive practices and modes of spread of Hepatitis B, C and HIV. In the second phase, health education on the same components of primary health care was given by lady health workers of the area to the same community for one month. Data of 200 mothers (100 urban and 100 rural) was re-evaluated after three months, to find out if there was any change, in the same. All the three areas were given scores and grade. In this study, 58% were Sindhi speaking. The mean age of mothers was 29 years. Majority (91% urban and 45% rural mothers) had access to one or more media channels. The knowledge of media-based primary health care was poor (score=10.09) among all mothers but attitude (score=8.07) and practice (score=11.09) was good for the same in more than 70% mothers in both communities. In the second phase of the study, it was found that the knowledge of primary health care had not improved but attitude and practice was good as observed earlier in both communities. Despite the national media based health education of Primary Health Care for decades, knowledge of primary health care was poor among mothers (urban and rural) but attitude and practice was good. Age and exposure to one or more media channels was found

  19. The healthy device and the definition of health: The example of the National Programme for a Healthy Life

    Directory of Open Access Journals (Sweden)

    Federico Andrés De Francisco

    2010-11-01

    Full Text Available The National Programme for a Healthy Life emerges from the creation of three other programmes that encourage the so-called healthy habits among individuals. Due to be implemented by the National Ministry of Health between 2007 and 2010, it is not a unique case in its group, as the National Programme for a Healthy Life presents the opportunity to think about the importance of health in modern society. In the modern context of a transition that migrates from medicine as curative medicine to a conception of medicine as a preventive science, and from the perspective of the concept of biopolitics, developed by the French philosopher Michel Foucault, it is inferred the existence of a healthy mechanism which organizes the discourses on health and builds truthful discourses about it. The presence of this mechanism could be a possible explanation of the omnipresence of health in modern society, the constant concern to prolong life and the instigation of self-control, care and improvement of an individual's health

  20. Applying principles of health system strengthening to eye care

    Directory of Open Access Journals (Sweden)

    Karl Blanchet

    2012-01-01

    Full Text Available Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.

  1. Professional commitment to changing chronic illness care: results from disease management programmes.

    Science.gov (United States)

    Lemmens, Karin; Strating, Mathilde; Huijsman, Robbert; Nieboer, Anna

    2009-08-01

    The aim of this exploratory study was to investigate to what extent primary care professionals are able to change their systems for delivering care to chronic obstructive pulmonary disease (COPD) patients and what professional and organizational factors are associated with the degree of process implementation. Quasi-experimental design with 1 year follow-up after intervention. Three regional COPD management programmes in the Netherlands, in which general practices cooperated with regional hospitals. All participating primary care professionals (n = 52). COPD management programme. Professional commitment, organizational context and degree of process implementation. Professionals significantly changed their systems for delivering care to COPD patients, namely self-management support, decision support, delivery system design and clinical information systems. Associations were found between organizational factors, professional commitment and changes in processes of care. Group culture and professional commitment appeared to be, to a moderate degree, predictors of process implementation. COPD management was effective; all processes improved significantly. Moreover, theoretically expected associations between organizational context and professional factors with the implementation of COPD management were indeed confirmed to some extent. Group culture and professional commitment are important facilitators.

  2. [Work place health promotion programmes of the statutory German Pension Insurance].

    Science.gov (United States)

    Meffert, C; Mittag, O; Jäckel, W H

    2013-12-01

    In 2009, the amendment of § 31 Abs. 1 Nr. 2 SGB VI gave the German Pension Insurance the opportunity to provide outpatient medical treatments for insured people who have an occupation with particularly high risk of health. Ever since, the German Pension Insurance has developed various work place prevention programmes, which have been implemented as pilot projects. This article aims at systematically recording and comparatively analyzing these programmes in a synopsis which meets the current state of knowledge. We developed an 8 page questionnaire focusing on work place prevention programmes by the German Pension Insurance. This questionnaire was sent to people in charge of all programmes known to us. All programmes have been drafted -across indications. They are aiming at insured people who already suffer from first health disorders but who are not in imminent need of rehabilitation. However, the concrete target groups at which the specific programmes are aimed differ (shift workers, nurses, elderly employees). Another difference between the various programmes is the setting (in- or outpatients) as well as the duration. All programmes are using existing structures offered by the German Pension Insurance. They provide measures in pension insurance owned rehabilitation centers. It would be desirable to link these performances with internal work place health promotion and offers of other social insurances. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Learning essentials: what graduates of mental health nursing programmes need to know from an industry perspective.

    Science.gov (United States)

    McAllister, Margaret; Happell, Brenda; Flynn, Trudi

    2014-12-01

    To explore the perspectives of nursing directors in mental health in Queensland, Australia, regarding the skills and attributes of graduates of comprehensive nursing programme to provide an industry perspective and thus augment knowledge from theoretical and professional dimensions. There is a worldwide shortage of appropriately qualified nurses with the knowledge, skills and attitudes to work effectively in mental health services. Within Australia, this has been well documented since the introduction of comprehensive nursing education. The underrepresentation of mental health content in undergraduate curricula has been identified as the primary reason for nursing graduates not being adequately prepared for practice in this field. To date, this issue has primarily been addressed from the perspective of university academics, with the voice of industry relatively silent in the published literature. Qualitative exploratory. In-depth telephone interviews with Director of Nursing (Mental Health) in Queensland, Australia. The concerns of participants were expressed in six main themes: (1) foundational knowledge of mental health and disorders, (2) recovery-oriented skills, (3) physical as well as mental health skills, (4) therapeutic strategies, (5) resilience and self-development and (6) advanced knowledge and skills. The education of comprehensive nursing education needs to be reviewed as a matter of priority to ensure graduates with the attributes required to provide high-quality care for consumers of mental health services. A skilled and knowledgeable workforce is an essential component of high-quality mental health services. Research highlighting the current deficits and issues is therefore of the highest priority. © 2014 John Wiley & Sons Ltd.

  4. Attending unintended transformations of health care infrastructure

    Directory of Open Access Journals (Sweden)

    Helle Wentzer

    2007-11-01

    Full Text Available Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results: This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion: The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes.

  5. 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 ...

  6. Cross-cultural barriers to health care.

    Science.gov (United States)

    Vidaeff, Alex C; Kerrigan, Anthony J; Monga, Manju

    2015-01-01

    Culturally sensitive health care represents a real ethical and practical need in a Western healthcare system increasingly serving a multiethnic society. This review focuses on cross-cultural barriers to health care and incongruent aspects from a cultural perspective in the provision of health care. To overcome difficulties in culturally dissimilar interactions and eventually remove cross-cultural barriers to health care, a culturally sensitive physician considers his or her own identity, values, and beliefs; recognizes the similarities and differences among cultures; understands what those similarities and differences mean; and is able to bridge the differences to accomplish clear and effective communication.

  7. Public health lessons from a pilot programme to reduce mother-to ...

    African Journals Online (AJOL)

    Public health lessons from a pilot programme to reduce mother-to-child transmission of HIV-1 in Khayelitsha. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... took blood for HIV enzyme-linked imrnunosorbent assay (EUSA) testing.

  8. Care of children with disabilities in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Thaís Giudice Schultz

    2016-07-01

    Full Text Available Objective: This article describes an experience report that aimed to present perceptions on the care of children with disabilities in the Family Health Strategy (FHS, showing its limits and potentials based on the experience of participation in the program ‘PET-Saúde’. Method: Data were collected from field notes which recorded the monitoring of the care process offered to children with disabilities by the FHS teams. The study was conducted in a health facility in the city of Rio de Janeiro for one year. Results: Content analysis results listed the two main themes that composed the issues of concern for child care in this experience: the coordination of health care and the family and community orientation as the core for child care in the FHS. Conclusion: Despite the weakness in compliance with these categories, which are principles and fundamentals of the FHS, this is a privileged space with regard to care practices for children with disabilities.

  9. Programme Reporting Standards (PRS for improving the reporting of sexual, reproductive, maternal, newborn, child and adolescent health programmes

    Directory of Open Access Journals (Sweden)

    Anna E. Kågesten

    2017-08-01

    Full Text Available Abstract Background Information about design, implementation, monitoring and evaluation is central to understand the impact of programmes within the field of sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH. Existing reporting guidelines do not orient on reporting of contextual and implementation issues in sufficient detail. We therefore developed Programme Reporting Standards (PRS to be used by SRMNCAH programme implementers and researchers. Methods Building on the first step of the PRS development (a systematic review to identify reporting items, we conducted a three-round online Delphi consensus survey with experts. Consensus was defined a-priori as 80% agreement of items as essential. This was followed by a technical consultation with a group of experts to refine the items, definitions and their structuring. The revised PRS was piloted to assess its relevance to current SRMNCAH programme reports and identify key issues regarding the use of the PRS. Results Of the 81 participants invited to the Delphi survey, 20 responded to all three rounds. In the final round, 27 items received consensus as essential; three items were ranked as “borderline” essential; 20 items as supplementary. The items were subsequently revised, followed by a technical consultation with 29 experts to further review and refine the PRS. The feedback resulted in substantial changes to the structure and content of the PRS into 24 items across five domains: Programme overview; Programme components and implementation; Monitoring of Implementation; Evaluation and Results; and Synthesis. This version was used in a piloting exercise, where questions regarding how much information to report and how to comment on the quality of the information reported were addressed. All items were kept in the PRS following the pilot although minor changes were made to the flow and description of items. Conclusions The PRS 1.0 is the result of a structured

  10. Ministry of health care and the medical industry of the Russian Federation

    International Nuclear Information System (INIS)

    Shamov, O.I.

    1995-01-01

    Organizational structure of Ministry of Health Care and the Medical Industry of the Russian Federation (FDMEP), functions of an industrial public health laboratory, responsibilities of FDMEP for radwaste management and its activities in this area, as well as current programmes of FDMEP related to radwaste management are described. 6 tabs

  11. Collaborating for oral health in support of vulnerable older people: co-production of oral health training in care homes.

    Science.gov (United States)

    Patel, Rakhee; Robertson, Claire; Gallagher, Jennifer E

    2017-11-23

    In recent years, the value of co-production has become embedded in the social care agenda. Care home residents are at significantly higher risk of dental diseases and often rely on the care team for support. It is therefore vital that staff are trained and confident in delivering evidence based oral care to their clients. Three London care homes co-produced a pilot oral health training programme, informed by in-depth interviews and group discussions. The initiative was evaluated using pre/post-questionnaires of carers and semi-structured interviews of managers and the dental teams. Two care homes were available for delivery of the programme, which resulted in training of 64% (n = 87) of care staff. The training programme involved videos and resources and was delivered flexibly with the support of an oral health educator and a dental therapist. There was an improvement in knowledge and self-reported confidence post-training; however, only 54% (n = 45) completed the post-training questionnaire. This study suggests that co-production of an oral care training package for care home staff, is possible and welcome, but challenging in this complex and changing environment. Further work is needed to explore the feasibility, sustainability and impact of doing so. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  12. Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.

    Science.gov (United States)

    Schneider, Helen; Nxumalo, Nonhlanhla

    2017-09-15

    National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa's community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. This analysis, from real-life systems, adds to understanding of the processes

  13. The Child Health Care System in Italy.

    Science.gov (United States)

    Corsello, Giovanni; Ferrara, Pietro; Chiamenti, Gianpietro; Nigri, Luigi; Campanozzi, Angelo; Pettoello-Mantovani, Massimo

    2016-10-01

    Pediatric care in Italy has been based during the last 40 years on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. The pediatric health care system in Italy is part of the national health system. It is made up of 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care. This overview will also include a brief report on neonatal care, pediatric preventive health care, health service accreditation programs, and postgraduate training in pediatrics. The quality of the Italian child health care system is now considered to be in serious danger because of the restriction of investments in public health caused both by the 2008 global and national economic crisis and by a reduction of the pediatric workforce as a result of progressively insufficient replacement of specialists in pediatrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. 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 .... compliance, exercise and diets recommended for diabetes patients.

  15. Policy challenges in modern health care

    National Research Council Canada - National Science Library

    Mechanic, David

    2005-01-01

    ... for the Obesity Epidemic KENNETH E. WARNER 99 8 Patterns and Causes of Disparities in Health DAVID R. WILLIAMS 115 9 Addressing Racial Inequality in Health Care SARA ROSENBAUM AND JOEL TEITELBAU...

  16. Acute mental health care according to recent mental health ...

    African Journals Online (AJOL)

    acute care, treatment and rehabilitation as a 72-hour assessment unit in a .... resemble prisons, such as unnecessary bars on windows and one-way glass. ..... model to consider design solutions for other acute mental health care settings.

  17. global health strategies versus local primary health care priorities

    African Journals Online (AJOL)

    CARE PRIORITIES - A CASE STUDY. OF NATIONAL ... development of comprehensive primary health care (pHC). The routine ..... on injection safety will be sustainable. On the negative side, ... This is mainly at management level, where time ...

  18. eHealth and quality in health care: implementation time

    NARCIS (Netherlands)

    Ossebaard, Hans Cornelis; van Gemert-Pijnen, Julia E.W.C.

    2016-01-01

    The use of information and communication technologies in health and health care could improve healthcare quality in many ways. Today's evidence base demonstrates the (cost-)effectiveness of online education, self-management support and tele-monitoring in several domains of health and care. While new

  19. Changes in physical health among participants in a multidisciplinary health programme for long-term unemployed persons.

    Science.gov (United States)

    Schutgens, Christine A E; Schuring, Merel; Voorham, Toon A J; Burdorf, Alex

    2009-06-19

    The relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health. A longitudinal, non-controlled design was used. The programme consisted of two weekly exercise sessions and one weekly cognitive session during 12 weeks. The main outcome measures were body mass index, blood pressure, cardiorespiratory fitness, abdominal muscle strength, and low back and hamstring flexibility. Potential determinants of change in physical health were demographic variables, psychological variables (self-esteem, mastery, and kinesiophobia), and self-perceived health. The initial response was 73% and 252 persons had complete data collection at baseline. In total, 36 subjects were lost during follow-up. Participants were predominantly low educated, long-term unemployed, and in poor health. Participation in the programme was not influenced by demographic and psychological factors or by self-reported health. Drop-outs were younger and had a lower body mass index at baseline than subjects who completed the programme. At post-test, participants' cardiorespiratory fitness, abdominal muscle strength, and flexibility had increased by 6.8%-51.0%, whereas diastolic and systolic blood pressures had decreased by 2.2%-2.5%. The effect sizes ranges from 0.17-0.68. Participants with the poorest physical health benefited most from the programme and gender differences in improvement were observed. Physical health of unemployed persons with health complaints improved after participation in this health promotion programme, but not sufficiently, considering their poor physical health at baseline.

  20. Changes in physical health among participants in a multidisciplinary health programme for long-term unemployed persons

    Directory of Open Access Journals (Sweden)

    Schuring Merel

    2009-06-01

    Full Text Available Abstract Background The relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health. Methods A longitudinal, non-controlled design was used. The programme consisted of two weekly exercise sessions and one weekly cognitive session during 12 weeks. The main outcome measures were body mass index, blood pressure, cardiorespiratory fitness, abdominal muscle strength, and low back and hamstring flexibility. Potential determinants of change in physical health were demographic variables, psychological variables (self-esteem, mastery, and kinesiophobia, and self-perceived health. Results The initial response was 73% and 252 persons had complete data collection at baseline. In total, 36 subjects were lost during follow-up. Participants were predominantly low educated, long-term unemployed, and in poor health. Participation in the programme was not influenced by demographic and psychological factors or by self-reported health. Drop-outs were younger and had a lower body mass index at baseline than subjects who completed the programme. At post-test, participants' cardiorespiratory fitness, abdominal muscle strength, and flexibility had increased by 6.8%–51.0%, whereas diastolic and systolic blood pressures had decreased by 2.2%–2.5%. The effect sizes ranges from 0.17–0.68. Conclusion Participants with the poorest physical health benefited most from the programme and gender differences in improvement were observed. Physical health of unemployed persons with health complaints improved after participation in this health promotion programme, but not

  1. Vantage point - Prudent health care.

    Science.gov (United States)

    Ellis, Gemma

    2014-09-25

    DESPITE PRODUCTIVITY improvement programmes in the NHS, the Nuffield Trust warns us that the NHS in Wales is likely to face a funding gap of £2.5 billion by 2025. Obviously then, we need to keep searching for ways to ensure long-term sustainability that does not compromise quality.

  2. HIV care continuum in Rwanda: a cross-sectional analysis of the national programme.

    Science.gov (United States)

    Nsanzimana, Sabin; Kanters, Steve; Remera, Eric; Forrest, Jamie I; Binagwaho, Agnes; Condo, Jeanine; Mills, Edward J

    2015-05-01

    Rwanda has made remarkable progress towards HIV care programme with strong national monitoring and surveillance. Knowledge about the HIV care continuum model can help to improve outcomes in patients. We aimed to quantify engagement, mortality, and loss to follow-up of patients along the HIV care continuum in Rwanda in 2013. We collated data for individuals with HIV who participated in the national HIV care programme in Rwanda and calculated the numbers of individuals or proportions of the population at each stage and the transition probabilities between stages of the continuum. We calculated factors associated with mortality and loss to follow-up by fitting Cox proportional hazards regression models, one for the stage of care before antiretroviral therapy (ART) initiation and another for stage of care during ART. An estimated 204,899 individuals were HIV-positive in Rwanda in 2013. Among these individuals, 176,174 (86%) were in pre-ART or in ART stages and 129,405 (63%) had initiated ART by the end of 2013. 82·1% (95% CI 80·7-83·4) of patients with viral load measurements (n=3066) were virally suppressed (translating to 106,371 individuals or 52% of HIV-positive individuals). Mortality was 0·6% (304 patients) in the pre-ART stage and 1·0% (1255 patients) in the ART stage; 2247 (3·9%) patients were lost to follow-up in pre-ART stage and 2847 (2·2%) lost in ART stage. Risk factors for mortality among patients in both pre-ART and ART stages included older age, CD4 cell count at initiation, and male sex. Risk factors for loss to follow-up among patients at both pre-ART and ART stages included younger age (age 10-29 year) and male sex. The HIV care continuum is a multitrajectory pathway in which patients have many opportunities to leave and re-engage in care. Knowledge about the points at which individuals are most likely to leave care could improve large-scale delivery of HIV programmes. The Bill & Melinda Gates Foundation. Copyright © 2015 Elsevier Ltd. All

  3. The Future of Home Health Care

    Science.gov (United States)

    Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

    2016-01-01

    The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

  4. The authoritarian reign in American health care.

    Science.gov (United States)

    Ballou, Kathryn A; Landreneau, Kandace J

    2010-02-01

    The aim of this article is to increase understanding of the mechanisms of the continuation of elite hegemonic control of a highly valued social system--American health care. White, male physicians and administrators achieved control of the health care industry and its workers, including nurses, at the start of the 20th century. Using critical theorists' work on authoritarianism and incorporating gender analysis, the authors describe the health care system from a critical social- psychological perspective. The authors discuss the meaning and presence of authoritarian hierarchy and gender effects in today's health system through a critical analysis of the profession of medicine, the profession of nursing, corporate and bureaucratic health care, and patients or consumers. It is concluded that the social-psychological behavior of the American health care system has profound implications that must be taken into account in any recommendations for change.

  5. [The role of management in health care].

    Science.gov (United States)

    Güntert, Bernhard J

    2007-01-01

    The situation in the health care sector is affected by a shortage of public funds on the one hand and, on the other hand, by rapid developments in medicine and nursing with an enormous expansion of both diagnostic and therapeutic possibilities. This and the aging population are generating a steadily increasing demand for health care services. The result is an increased cost consciousness in society calling for more professional management in health care organizations. However, the traditional administration of health care organizations, which is closely aligned with health professionals and production processes, was not able to cope with these dynamics or did so only unsatisfactorily. An improved management would surely lead to an optimization of health care delivery processes and a more effective use of resources. The question, however, is whether the effectiveness of the total system can be improved and whether patients' and society's needs can actually be met by classical management approaches.

  6. [The ethics of health care organization].

    Science.gov (United States)

    Goic, Alejandro

    2004-03-01

    Health care organization is not only a technical issue. Ethics gives meaning to the medical profession's declared intent of preserving the health and life of the people while honoring their intelligence, dignity and intimacy. It also induces physicians to apply their knowledge, intellect and skills for the benefit of the patient. In a health care system, it is important that people have insurance coverage for health contingencies and that the quality of the services provided be satisfactory. People tend to judge the medical profession according to the experience they have in their personal encounter with physicians, health care workers, hospitals and clinics. Society and its political leaders must decide upon the particular model that will ensure the right of citizens to a satisfactory health care. Any health care organization not founded on humanitarian and ethical values is doomed tofailure. The strict adherence of physicians to Hippocratic values and to the norms of good clinical practice as well as to an altruistic cooperative attitude will improve the efficiency of the health care sector and reduce its costs. It is incumbent upon society to generate the conditions where by the ethical roots of medical care can be brought to bear upon the workings of the health care system. Every country must strive to provide not only technically efficient medical services, but also the social mechanisms that make possible a humanitarian interaction between professionals and patients where kindness and respect prevail.

  7. Developing a structured education reminiscence-based programme for staff in long-stay care facilities in Ireland.

    Science.gov (United States)

    Cooney, Adeline; O'Shea, Eamon; Casey, Dympna; Murphy, Kathy; Dempsey, Laura; Smyth, Siobhan; Hunter, Andrew; Murphy, Edel; Devane, Declan; Jordan, Fionnuala

    2013-07-01

    This paper describes the steps used in developing and piloting a structured education programme - the Structured Education Reminiscence-based Programme for Staff (SERPS). The programme aimed to prepare nurses and care assistants to use reminiscence when caring for people with dementia living in long-term care. Reminiscence involves facilitating people to talk or think about their past. Structured education programmes are used widely as interventions in randomised controlled trials. However, the process of developing a structured education programme has received little attention relative to that given to evaluating the effectiveness of such programmes. This paper makes explicit the steps followed to develop the SERPS, thereby making a contribution to the methodology of designing and implementing effective structured education programmes. The approach to designing the SERPS was informed by the Van Meijel et al. (2004) model (Journal of Advanced Nursing 48, 84): (1) problem definition, (2) accumulation of building blocks for intervention design, (3) intervention design and (4) intervention validation. Grounded theory was used (1) to generate data to shape the 'building blocks' for the SERPS and (2) to explore residents, family and staff's experience of using/receiving reminiscence. Analysis of the pilot data indicated that the programme met its objective of preparing staff to use reminiscence with residents with dementia. Staff were positive both about the SERPS and the use of reminiscence with residents with dementia. This paper outlines a systematic approach to developing and validating a structured education programme. Participation in a structured education programme is more positive for staff if they are expected to actively implement what they have learnt. Ongoing support during the delivery of the programme is important for successful implementation. The incorporation of client and professional experience in the design phase is a key strength of this approach

  8. Scaling up proven public health interventions through a locally owned and sustained leadership development programme in rural Upper Egypt

    Directory of Open Access Journals (Sweden)

    Mansour Joan

    2010-01-01

    Full Text Available Abstract Introduction In 2002, the Egypt Ministry of Health and Population faced the challenge of improving access to and quality of services in rural Upper Egypt in the face of low morale among health workers and managers. From 1992 to 2000, the Ministry, with donor support, had succeeded in reducing the nationwide maternal mortality rate by 52%. Nevertheless, a gap remained between urban and rural areas. Case description In 2002, the Ministry, with funding from the United States Agency for International Development and assistance from Management Sciences for Health, introduced a Leadership Development Programme (LDP in Aswan Governorate. The programme aimed to improve health services in three districts by increasing managers' ability to create high performing teams and lead them to achieve results. The programme introduced leadership and management practices and a methodology for identifying and addressing service delivery challenges. Ten teams of health workers participated. Discussion and evaluation In 2003, after participation in the LDP, the districts of Aswan, Daraw and Kom Ombo increased the number of new family planning visits by 36%, 68% and 20%, respectively. The number of prenatal and postpartum visits also rose. After the United States funding ended, local doctors and nurses scaled up the programme to 184 health care facilities (training more than 1000 health workers. From 2005 to 2007, the Leadership Development Programme participants in Aswan Governorate focused on reducing the maternal mortality rate as their annual goal. They reduced it from 85.0 per 100,000 live births to 35.5 per 100,000. The reduction in maternal mortality rate was much greater than in similar governorates in Egypt. Managers and teams across Aswan demonstrated their ability to scale up effective public health interventions though their increased commitment and ownership of service challenges. Conclusions When teams learn and apply empowering leadership and

  9. Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme.

    Directory of Open Access Journals (Sweden)

    Tom H Boyles

    2011-05-01

    Full Text Available The prognosis of patients with HIV in Africa has improved with the widespread use of antiretroviral therapy (ART but these successes are threatened by low rates of long-term retention in care. There are limited data on predictors of retention in care, particularly from rural sites.Prospective cohort analysis of outcome measures in adults from a rural HIV care programme in Madwaleni, Eastern Cape, South Africa. The ART programme operates from Madwaleni hospital and seven primary care feeder clinics with full integration between inpatient and outpatient services. Outreach workers conducted home visits for defaulters.1803 adults initiated ART from June 2005 to May 2009. At the end of the study period 82.4% were in active care or had transferred elsewhere, 11.1% had died and 6.5% were lost to follow-up (LTFU. Independent predictors associated with an increased risk of LTFU were CD4 nadir >200, initiating ART as an inpatient or while pregnant, and younger age, while being in care for >6 months before initiating ART was associated with a reduced risk. Independent factors associated with an increased risk of mortality were baseline CD4 count 6 months before initiating ART and initiating ART while pregnant were associated with a reduced risk.Serving a socioeconomically deprived rural population is not a barrier to successful ART delivery. Patients initiating ART while pregnant and inpatients may require additional counselling and support to reduce LTFU. Providing HIV care for patients not yet eligible for ART may be protective against being LTFU and dying after ART initiation.

  10. Targeting health visitor care: lessons from Starting Well.

    Science.gov (United States)

    Wright, C M; Jeffrey, S K; Ross, M K; Wallis, L; Wood, R

    2009-01-01

    UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage. A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data. Starting Well project, Glasgow, UK. Health visitor rating of family needs. Families receiving high visiting rates or referred to social work services. Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work. Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.

  11. Where there is no psychiatrist: A mental health programme in Sierra ...

    African Journals Online (AJOL)

    Background. For most low- and middle-income countries, mental health remains a neglected area, despite the recognised burden associated with neuropsychiatric conditions and the inextricable link to other public health priorities. Objectives. To describe the results of a free outpatient mental health programme delivered by ...

  12. An Evaluation of Participation in a Schools-Based Youth Mental Health Peer Education Training Programme

    Science.gov (United States)

    O'Reilly, Aileen; Barry, James; Neary, Marie-Louise; Lane, Sabrina; O'Keeffe, Lynsey

    2016-01-01

    The use of peer education has been well documented within the discipline of health promotion, but not within the youth mental health domain. This paper describes an evaluation of an innovative schools-based peer education training programme that involved preparing young people to deliver a mental health workshop to their peers. Participants…

  13. Can Low-Cost Support Programmes with Coaching Accelerate Doctoral Completion in Health Science Faculty Academics?

    Science.gov (United States)

    Geber, Hilary; Bentley, Alison

    2012-01-01

    Career development for full-time Health Sciences academics through to doctoral studies is a monumental task. Many academics have difficulty completing their studies in the minimum time as well as publishing after obtaining their degree. As this problem is particularly acute in the Health Sciences, the PhD Acceleration Programme in Health Sciences…

  14. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

  15. Health federalism: the role of health care professionals in Nepal.

    Science.gov (United States)

    Dulal, R K

    2009-01-01

    Nepal has entered from its unitary system into a new "Federal Democratic Republic State". The current constitution presents basic health care services as a fundamental right. The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes, e.g., life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously.

  16. An assessment of the Zimbabwe ministry of health and child welfare provider initiated HIV testing and counselling programme

    Directory of Open Access Journals (Sweden)

    Sibanda Euphemia L

    2012-05-01

    Full Text Available Abstract Background Provider-initiated HIV testing and counselling (PITC is widely recommended to ensure timely treatment of HIV. The Zimbabwe Ministry of Health introduced PITC in 2007. We aimed to evaluate institutional capacity to implement PITC and investigate patient and health care worker (HCW perceptions of the PITC programme. Methods Purposive selection of health care institutions was conducted among those providing PITC. Study procedures included 1 assessment of implementation procedures and institutional capacity using a semi-structured questionnaire; 2 in-depth interviews with patients who had been offered HIV testing to explore perceptions of PITC, 3 Focus group discussions with HCW to explore views on PITC. Qualitative data was analysed according to Framework Analysis. Results Sixteen health care institutions were selected (two central, two provincial, six district hospitals; and six primary care clinics. All institutions at least offered PITC in part. The main challenges which prevented optimum implementation were shortages of staff trained in PITC, HIV rapid testing and counselling; shortages of appropriate counselling space, and, at the time of assessment, shortages of HIV test kits. Both health care workers and patients embraced PITC because they had noticed that it had saved lives through early detection and treatment of HIV. Although health care workers reported an increase in workload as a result of PITC, they felt this was offset by the reduced number of HIV-related admissions and satisfaction of working with healthier clients. Conclusion PITC has been embraced by patients and health care workers as a life-saving intervention. There is need to address shortages in material, human and structural resources to ensure optimum implementation.

  17. Legislating health care coverage for the unemployed.

    Science.gov (United States)

    Palley, H A; Feldman, G; Gallner, I; Tysor, M

    1985-01-01

    Because the unemployed and their families are often likely to develop stress-related health problems, ensuring them access to health care is a public health issue. Congressional efforts thus far to legislate health coverage for the unemployed have proposed a system that recognizes people's basic need for coverage but has several limitations.

  18. High and rising health care costs.

    Science.gov (United States)

    Ginsburg, Paul B

    2008-10-01

    The U.S. is spending a growing share of the GDP on health care, outpacing other industrialized countries. This synthesis examines why costs are higher in the U.S. and what is driving their growth. Key findings include: health care inefficiency, medical technology and health status (particularly obesity) are the primary drivers of rising U.S. health care costs. Health payer systems that reward inefficiencies and preempt competition have impeded productivity gains in the health care sector. The best evidence indicates medical technology accounts for one-half to two-thirds of spending growth. While medical malpractice insurance and defensive medicine contribute to health costs, they are not large enough factors to significantly contribute to a rise in spending. Research is consistent that demographics will not be a significant factor in driving spending despite the aging baby boomers.

  19. An oral health programme for schoolchildren in Kuwait 1986-97

    DEFF Research Database (Denmark)

    Vigild, M.; Skougaard, M.; Hadi, R.

    1999-01-01

    caries prevalence, caries prevention, community dental services, dental caries, DMFS, health education, Kuwait, primary dental care, schoolchildren......caries prevalence, caries prevention, community dental services, dental caries, DMFS, health education, Kuwait, primary dental care, schoolchildren...

  20. Implementing the learning health care system.

    NARCIS (Netherlands)

    Verheij, R.; Barten, D.J.; Hek, K.; Nielen, M.; Prins, M.; Zwaanswijk, M.; Bakker, D. de

    2014-01-01

    Background: As computerisation of primary care facilities is rapidly increasing, a wealth of data is created in routinely recorded electronic health records (EHRs). This data can be used to create a true learning health care system, in which routinely available data are processed and analysed in

  1. 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...

  2. Quality systems in Dutch health care institutions.

    NARCIS (Netherlands)

    Casparie, A.F.; Sluijs, E.M.; Wagner, C.; Bakker, D.H. de

    1997-01-01

    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived

  3. Future health care technology and the hospital

    NARCIS (Netherlands)

    Banta, H.D.

    1990-01-01

    The past decades have been a time of rapid technological change in health care, but technological change will probably accelerate during the next decade or so. This will bring problems, but it will also present certain opportunities. In particular, the health care system is faced with the need to

  4. Gender and communication style in general practice: differences between women's health care and regular health care.

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Bensing, J.M.; Kerssens, J.J.

    1998-01-01

    Objectives: differences were investigated between general practitioners providing women's health care (4 women) and general practitioners providing regular health care (8 women and 8 men). Expectations were formulated on the basis of the principles of women's health care and literature about gender

  5. Changing trends in health care tourism.

    Science.gov (United States)

    Karuppan, Corinne M; Karuppan, Muthu

    2010-01-01

    Despite much coverage in the popular press, only anecdotal evidence is available on medical tourists. At first sight, they seemed confined to small and narrowly defined consumer segments: individuals seeking bargains in cosmetic surgery or uninsured and financially distressed individuals in desperate need of medical care. The study reported in this article is the first empirical investigation of the medical tourism consumer market. It provides the demographic profile, motivations, and value perceptions of health care consumers who traveled abroad specifically to receive medical care. The findings suggest a much broader market of educated and savvy health care consumers than previously thought. In the backdrop of the health care reform, the article concludes with implications for health care providers.

  6. Integrating Community Health Workers (CHWs) into Health Care Organizations.

    Science.gov (United States)

    Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam

    2017-10-01

    Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.

  7. Evaluating impact of a multi-dimensional education programme on perceived performance of primary care professionals in diabetes care.

    Science.gov (United States)

    Parekh, Sanjoti; Bush, Robert; Cook, Susan; Grant, Phillipa

    2015-11-01

    The purpose of this study is to evaluate an educational programme, 'Diabetes Connect: Connecting Professions', which was developed to enhance communication across primary care networks, to support best practice in clinical interventions and progress multidisciplinary team work to benefit patients in diabetes care. A total of 26 workshops were successfully delivered for 309 primary care professionals across the state of Queensland in Australia from November 2011. It consists of two separate, but complementary training elements: a series of online clinical education training modules and state-wide interprofessional learning workshops developed to enhance professional competencies. The evaluation design included completion of online surveys by the participants at two time points: first upon registering for the online modules or workshops; second, one week after attending a workshop. The survey included questions to evaluate the change in role performance measures. Overall, significant increases in participants' current knowledge, perceived ability to adopt this knowledge at work and willingness to change professional behaviour in the short term were observed. The study suggests that for maximum benefit both, workshop and online training, should be combined and made available widely. Future programmes should use a randomised trial design to test the delivery model.

  8. The effects of a household conditional cash transfer programme on coverage and quality of antenatal care: a secondary analysis of Indonesia's pilot programme.

    Science.gov (United States)

    Triyana, Margaret; Shankar, Anuraj H

    2017-10-22

    To analyse the effectiveness of a household conditional cash transfer programme (CCT) on antenatal care (ANC) coverage reported by women and ANC quality reported by midwives. The CCT was piloted as a cluster randomised control trial in 2007. Intent-to-treat parameters were estimated using linear regression and logistic regression. Secondary analysis of the longitudinal CCT impact evaluation survey, conducted in 2007 and 2009. This included 6869 pregnancies and 1407 midwives in 180 control subdistricts and 180 treated subdistricts in Indonesia. ANC component coverage index, a composite measure of each ANC service component as self-reported by women, and ANC provider quality index, a composite measure of ANC service provided as self-reported by midwives. Each index was created by principal component analysis (PCA). Specific ANC component items were also assessed. The CCT was associated with improved ANC component coverage index by 0.07 SD (95% CI 0.002 to 0.141). Women were more likely to receive the following assessments: weight (OR 1.56 (95% CI 1.25 to 1.95)), height (OR 1.41 (95% CI 1.247 to 1.947)), blood pressure (OR 1.36 (95% CI 1.045 to 1.761)), fundal height measurements (OR 1.65 (95% CI 1.372 to 1.992)), fetal heart beat monitoring (OR 1.29 (95% CI 1.006 to 1.653)), external pelvic examination (OR 1.28 (95% CI 1.086 to 1.505)), iron-folic acid pills (OR 1.42 (95% CI 1.081 to 1.859)) and information on pregnancy complications (OR 2.09 (95% CI 1.724 to 2.551)). On the supply side, the CCT had no significant effect on the ANC provider quality index based on reports from midwives. The CCT programme improved ANC coverage for women, but midwives did not improve ANC quality. The results suggest that enhanced ANC utilisation may not be sufficient to improve health outcomes, and steps to improve ANC quality are essential for programme impact. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

  9. Orchestrating care through the fast-track perspective: A qualitative content analysis of the provision of individualised nursing care in orthopaedic fast-track programmes.

    Science.gov (United States)

    Berthelsen, Connie Bøttcher; Frederiksen, Kirsten

    2017-02-01

    The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim and Lundman. The main theme of the overall interpretation was Orchestrating care through the fast-track perspective, accompanied by three sub-themes: Identifying and legitimising relevant individual care in the fast-track programme, Struggling to fit all patients in the fast-track programme and Justifying individualised care-related actions in the fast-track programme. The study concluded that, even though the nurses struggled to comply with the programme, they still found themselves compromising their nursing care and ethics to follow the standardised regime. There is a need to establish more specific inclusion criteria to maintain the effective elements in the programme and to facilitate nurses' opportunities to offer individual care, thereby ensuring that fragile patients have access to other possibilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. An evaluation of a morphine public health programme for cancer and AIDS pain relief in Sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Harding Richard

    2005-08-01

    Full Text Available Abstract Background Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication. Methods A multi-methods protocol appraised morphine regulation, storage, prescribing, and consumption in three phases: key informant interviews throughout the opioid supply chain, and direct observation and audit of clinical practice. Results Regulation had achieved its goal of preventing misuse and leakage from the supply chain. However, the Government felt that relaxation of regulation was now appropriate. Confusion and complexity in storage and authorisation rules led to discontinuation of opioid pain management at the patient level and also wasted service time in trying to obtain supplies to which they were entitled. Continued neglect to prescribe among clinicians and public fear of opioids led to under prescribing, and clinical skills showed some evidence of need for improvement with respect to physical assessment and follow-up. Conclusion The Ugandan programme offers a successful model for both advocacy and Governmental support in achieving opioid roll-out across health districts. Despite initial concerns, abuse of opioids has not been evident. Further work is required to ensure that available supplies of opioids are prescribed to those in need, and that clinical standards are met. However, the programme for roll-out has proved a useful model to expand opioid availability as the first step in improving patient care, and may prove a useful template for other Sub-Saharan African countries.

  11. Integration of HIV Care into Community Management of Acute Childhood Malnutrition Permits Good Outcomes: Retrospective Analysis of Three Years of a Programme in Lusaka.

    Science.gov (United States)

    Amadi, Beatrice; Imikendu, Mercy; Sakala, Milika; Banda, Rosemary; Kelly, Paul

    2016-01-01

    While HIV has had a major impact on health care in southern Africa, there are few data on its impact on acute malnutrition in children in the community. We report an analysis of outcomes in a large programme of community management of acute malnutrition in the south of Lusaka. Over 3 years, 68,707 assessments for undernutrition were conducted house-to-house, and children with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) were enrolled into either Outpatient Therapeutic Programme (OTP) or Supplementary Feeding Programme (SFP) respectively. Case records were analysed using tabulation and unconditional logistic regression. 1,859 children (889 boys, 970 girls; median age 16 months) with MAM (n = 664) or SAM (n = 1,195) were identified. Of 1,796 children whose parents consented to testing, 185 (10.3%) were HIV positive. Altogether 1,163 (62.6%) were discharged as recovered from acute malnutrition. Case fatality while in the programme was 4.2% in children with SAM and 0.5% in those with MAM (RR of SAM 10.9; 95%CI 3.4,34.8; Pmalnutrition programme, incorporating HIV care, can achieve low mortality even in a population heavily affected by HIV.

  12. Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial.

    Science.gov (United States)

    Pyszora, Anna; Budzyński, Jacek; Wójcik, Agnieszka; Prokop, Anna; Krajnik, Małgorzata

    2017-09-01

    Cancer-related fatigue (CRF) is a common and relevant symptom in patients with advanced cancer that significantly decreases their quality of life. The aim of this study was to evaluate the effect of a physiotherapy programme on CRF and other symptoms in patients diagnosed with advanced cancer. The study was designed as a randomized controlled trial. Sixty patients diagnosed with advanced cancer receiving palliative care were randomized into two groups: the treatment group (n = 30) and the control group (n = 30). The therapy took place three times a week for 2 weeks. The 30-min physiotherapy session included active exercises, myofascial release and proprioceptive neuromuscular facilitation (PNF) techniques. The control group did not exercise. The outcomes included Brief Fatigue Inventory (BFI), Edmonton Symptom Assessment Scale (ESAS) and satisfaction scores. The exercise programme caused a significant reduction in fatigue scores (BFI) in terms of severity of fatigue and its impact on daily functioning. In the control group, no significant changes in the BFI were observed. Moreover, the physiotherapy programme improved patients' general well-being and reduced the intensity of coexisting symptoms such as pain, drowsiness, lack of appetite and depression. The analysis of satisfaction scores showed that it was also positively evaluated by patients. The physiotherapy programme, which included active exercises, myofascial release and PNF techniques, had beneficial effects on CRF and other symptoms in patients with advanced cancer who received palliative care. The results of the study suggest that physiotherapy is a safe and effective method of CRF management.

  13. Cognitive systems engineering in health care

    CERN Document Server

    Bisantz, Ann M; Fairbanks, Rollin J

    2014-01-01

    Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...

  14. Feasibility and effectiveness of the implementation of a primary prevention programme for type 2 diabetes in routine primary care practice: a phase IV cluster randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Sanchez Alvaro

    2012-11-01

    Full Text Available Abstract Background The objective of this study is to perform an independent evaluation of the feasibility and effectiveness of an educational programme for the primary prevention of type 2 diabetes (DM2 in high risk populations in primary care settings, implanted within the Basque Health Service - Osakidetza. Methods/design This is a prospective phase IV cluster clinical trial conducted under routine conditions in 14 primary health care centres of Osakidetza, randomly assigned to an intervention or control group. We will recruit a total sample of 1089 individuals, aged between 45 and 70 years old, without diabetes but at high risk of developing the condition (Finnish Diabetes Risk Score, FINDRISC ≥ 14 and follow them up for 2 years. Primary health care nursing teams of the intervention centres will implement DE-PLAN, a structured educational intervention program focused on changing healthy lifestyles (diet and physical activity; while the patients in the control centres will receive the usual care for the prevention and treatment of DM2 currently provided in Osakidetza. The effectiveness attributable to the programme will be assessed by comparing the changes observed in patients exposed to the intervention and those in the control group, with respect to the risk of developing DM2 and lifestyle habits. In terms of feasibility, we will assess indicators of population coverage and programme implementation. Discussion The aim of this study is to provide the scientific basis for disseminate the programme to the remaining primary health centres in Osakidetza, as a novel way of addressing prevention of DM2. The study design will enable us to gather information on the effectiveness of the intervention as well as the feasibility of implementing it in routine practice. Trial registration ClinicalTrials.gov NCT01365013

  15. The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit.

    Science.gov (United States)

    Picheansathian, Wilawan; Pearson, Alan; Suchaxaya, Prakin

    2008-08-01

    This quasi-experimental study aimed to identify the impact of a promotion programme on hand hygiene practices and its effect on nosocomial infection rates in a neonatal intensive care unit of a university hospital in Thailand. The study populations were 26 nursing personnel. After implementing a hand hygiene promotion programme, compliance with hand hygiene among nursing personnel improved significantly from 6.3% before the programme to 81.2% 7 months after the programme. Compliance rate did not correlate with the intensity of patient care. Nosocomial infection rate did not decrease after the intervention, probably because of the multifactorial nature of infections. All participants agreed that promotion programme implemented in this project motivated them to practise better hand hygiene. This study indicated that multiple approaches and persistent encouragement are key factors leading to a sustained high level of appropriate hand hygiene practices among nursing personnel.

  16. Working on wellness (WOW): A worksite health promotion intervention programme

    Science.gov (United States)

    2012-01-01

    CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention. Trial registration United States Clinical Trails Register NCT 01494207 PMID:22625844

  17. Working on wellness (WOW: A worksite health promotion intervention programme

    Directory of Open Access Journals (Sweden)

    Kolbe-Alexander Tracy L

    2012-05-01

    employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention. Trial registration United States Clinical Trails Register NCT 01494207

  18. Working on wellness (WOW): a worksite health promotion intervention programme.

    Science.gov (United States)

    Kolbe-Alexander, Tracy L; Proper, Karin I; Lambert, Estelle V; van Wier, Marieke F; Pillay, Julian D; Nossel, Craig; Adonis, Leegale; Van Mechelen, Willem

    2012-05-24

    , this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention. United States Clinical Trails Register NCT 01494207.

  19. Health care employee perceptions of patient-centered care.

    Science.gov (United States)

    Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L

    2015-03-01

    Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.

  20. Developing primary health care and public health competencies in ...

    African Journals Online (AJOL)

    Stephen E Knight

    community-based programme within the undergraduate medical curriculum, which aims to develop primary ... educational imperatives, namely improving medical students' ... Selectives is an innovative longitudinal, ... assessments of students in the Selectives module is the collective .... health and well-being of individuals,.