Sofia Zyga; Vasilios Kanellopoulos; Helen Bakola
Full Text Available Health was and will always be the supreme good for human kind. From this scope, people should have equal opportunities for health and all healthcare systems must be build around the term of equity. The aim of this review article is to present, through extensive literature and relevant articles review from Internet, the main aspects of todays inequalities in healthcare provision and the strategies that must be followed so as different social-economical groups have the same access in health care. Also special credit is given on how the political systems must design their healthcare policies according to the facts (social-economical layers and status of their citizens (diseases.
Consuelo Helena Aires de Freitas
Full Text Available Objective: To discuss the practice of mental health care performed by healthcare professionals from the Family Health Strategy in Fortaleza-CE, Brazil. Methods: This is a critical and reflective study conducted in six Basic Health Units in Fortaleza-Ce. The study subjects were 12 health workers of the following professions: doctor, nurse, community health agents and technical and/or nursing assistant. Semi-structured interviews, systematic observationand questionnaire were used for data collection. The empirical analysis was based on an understanding of the discourses through critical hermeneutics. Results: It was evident that the mental health services are developed by some health workers in the ESF, such as, matrix support, relational technologies, home visits and community group therapy. However, there is still deficiency in training/coaching by most professionals in primary care, due to anenduring model of pathological or curative health care. Conclusion: Mental health care is still occasionally held by some workers in primary care. However, some progresses are already present as matrix support, relational technologies in health care, home visits andcommunity therapy.
Kingsley, B R
As health care markets mature and expand, strategies available in other industries become useful. This article examines how traditional push-pull strategies apply to health care. Marketers using a push strategy recognize that the sale of their services or goods is dependent upon the endorsement of a middleman and promote their product through the middleman. Those using a pull strategy market directly to the consumer. In this article, the author outlines the advantages and disadvantages of using each strategy.
Wheeler, J R; Smith, D G; Rivenson, H L; Reiter, K L
The capital structures (the relative use of debt and equity to support assets) of leading health care systems are viewed as a strategic component of their financial plans. While not-for-profit hospitals as a group have maintained nearly constant levels of debt over the past decade, investor-owned hospitals and a group of leading health care systems have reduced their relative use of debt. Chief financial officers indicated that in addition to reducing debt because of less favorable reimbursement incentives, there was a focus on maintaining high bond ratings. Debt levels have not been reduced as sharply in these health care systems as they have in investor-owned hospitals, in part due to the use of debt to support investments in financial markets. Because these health care systems do not have easy access to equity, high bond ratings and solid investment earnings are central to their capital structure policies of preserving access to debt markets.
Marcelo Costa Fernandes
Full Text Available Objective: to identify, from nurses’ speeches, the actions that enable care management in the Family Health Strategy.Methods: descriptive study with a qualitative approach conducted with 32 nurses of primary care. It was used a semistructuredinterview as the data collection technique. The methodological process of the collective subject discourse wasused to organize the data Results: from the nurses’ speeches one identified the categories: complementary relationshipbetween care and management; meeting with community health agents, a care management strategy in nurses’ work;health education activities such as a care management action and a health information system as an essential tool forcare Conclusion: it was possible to observe that nurses understood the importance of coordination and complementaritybetween the activities of the working process of care and management.
Iveroth, Einar; Fryk, Pontus; Rapp, Birger
Information technology (IT) plays a key role in public health care management because it could improve quality, efficiency, and patient care. Researchers and practitioners repeatedly contend that a health care organization's information systems strategy should be aligned with its objectives and strategies, a notion commonly known as IT alignment. Actor-related IT alignment issues in health care institutions were explored in this study. More specifically, it explores the possibility of moving beyond the current IT alignment perspective and, in so doing, explores whether IT alignment-as currently conceptualized in the dominant body of research-is sufficient for attaining improved quality, efficiency, and patient care in health care organizations. The findings are based on a qualitative and longitudinal study of six health care organizations in the Stockholm metropolitan area. The empirical data were gathered over the 2005-2011 period from interviews, a focus group, observations, and archival material. The data suggest recurrent misalignments between IT strategy and organizational strategy and operations due to the failure to deconstruct the IT artifact and to the existence of various levels of IT maturity. A more complex picture of IT alignment in health care that goes beyond the current perspective is being offered by this study. It argues that the previously common way of handling IT as a single artifact and applying one IT strategy to the entire organizational system is obsolete. MANAGERIAL IMPLICATIONS: The article suggests that considerable benefits can be gained by assessing IT maturity and its impact on IT alignment. The article also shows that there are different kinds of IT in medical care that requires diverse decisions, investments, prioritizations, and implementation approaches.
Dhar, Michael; Griffin, Margaret; Hollin, Ilene; Kachnowski, Stan
Innovation remains an understudied resource within health care. Furthermore, the goals of US health care reform make innovation vitally important, while the time and resource limitations characteristic of health care make new strategies for innovation both necessary and potentially highly meaningful. The purpose of this study was to examine strategies for innovation in various industries and draw lessons for improving innovation in health care. This qualitative study began with literature research that provided a framework for discussion and identified a recurrent challenge in innovation: balancing the freedom to be creative with the need for structured management of ideas. Researchers then identified leading innovative companies and conducted phone interviews with innovation officers and other experts about their strategies for addressing the major innovation challenge. This article breaks out innovation strategies into 6 categories (dedicated times, formal teams, outside ideas, idea-sharing platforms, company/job goals, and incentives) and evaluates them for levels of control, yield, and pervasiveness. Based on this analysis, recommendations are offered for improving innovation in health care, calling for employee time allocated to innovation, dedicated innovation teams, and the incorporation of outside ideas.
Olawale Ibrahim Olateju
Full Text Available We examine the TQM Strategies and health care delivery in Nigeria, and the various means of measuring service quality. Nigeria continues to suffer outbreaks of various diseases cholera, malaria, cerebrospinal meningitis, measles, yellow fever, Bird flu e.t.c., all these diseases combine to cause high morbidity and mortality in the population. To assess the situation this paper looks at the relevant indicators like Annual Budgets by Government, Individual’s income, the role of Nigerian Medical Association (NMA and various health care agencies vested with the sole responsibility for elaborating standards for products and processes in Health care Delivery.The paper also examines the implication of Government Budget estimates on the Life expectancy of an average Nigerian. The findings necessitated the need for the government to seek support from WHO to assist in strengthening the health care system by advocating and providing technical support to health sector reforms.
This book is intended to assist teachers, practitioners, and administrators to develop programs for training nonphysician, primary health care workers in Third World countries. It contains the instructional context of a comprehensive training program, organized into chapters and presented in outline form. Learning strategies follow each section of…
In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Boland, R G; Young, M E
Since the 1978 Alma-Alta International Conference on Primary Health Care, investments in primary health care projects throughout the world have been increasing. However, with the exception of China, no national projects have demonstrated the ability to provide longterm comprehensive primary health care in conditions of chronic proverty with local resources. Programs in China, Cuba, and Tanzania have achieved primary health care coverage for 100% of their populations. These countries have in common strong governments that have been able to implement radical changes in the health system. Individual freedoms in these societies have been restricted in favor of improved health. Programs in Nigeria, India, and Afghanistan have been less successful, although some progress has been made in projects using external funds, inspite of a strong committment by the governments. Efforts to reorganize the health care system have lacked needed political strength. Currently, these systems have resulted in less than complete coverage, without the prospect of attaining acceptable levels of infant mortality, life expectancy and net population growth. Economic, political, and cultural costs may be high as for example, national security or traditional practices are traded to achieve primary health care with 100% coverage. WHO has devised a global strategy which, when translated into operational policies will need to address several unresolved issues. These include recognizing that the goal of comprehensive primary health care may not be justified given the lack of progress to date and that effective, selective primary health care focused on nutrition, immunization, control of endemic diseases, and health education may be a more realistic goal; and that a system of international social security may be an effective means of assuring that the poorest countries are able to provide care. In addition, questions concerning continued funding of programs that can never be locally funded, the role
Trovo de Araújo, Monica Martins; da Silva, Maria Júlia Paes
The objective of this study is to verify the relevance and utilization of communication strategies in palliative care. This is a multicenter qualitative study using a questionnaire, performed from August of 2008 to July of 2009 with 303 health care professionals who worked with patients receiving palliative care. Data were subjected to descriptive statistical analysis. Most participants (57.7%) were unable to state at least one verbal communication strategy, and only 15.2% were able to describe five signs or non-verbal communication strategies. The verbal strategies most commonly mentioned were those related to answering questions about the disease/treatment. Among the non-verbal strategies used, the most common were affective touch, looking, smiling, physical proximity, and careful listening. Though professionals have assigned a high degree of importance to communication in palliative care, they showed poor knowledge regarding communication strategies. Final considerations include the necessity of training professionals to communicate effectively in palliative care.
Stephanie B. Ewart
Full Text Available People with mental illness have higher rates of physical health problems and consequently live significantly shorter lives. This issue is not yet viewed as a national health priority and research about mental health consumer views on accessing physical health care is lacking. The aim of this study is to explore the experience of mental health consumers in utilizing health services for physical health needs. Qualitative exploratory design was utilized. Semistructured focus groups were held with 31 consumer participants. Thematic analysis revealed that three main themes emerged: scarcity of physical health care, with problems accessing diagnosis, advice or treatment for physical health problems; disempowerment due to scarcity of physical health care; and tenuous empowerment describing survival resistance strategies utilized. Mental health consumers were concerned about physical health and the nonresponsive health system. A specialist physical health nurse consultant within mental health services should potentially redress this gap in health care provision.
Dannapfel, Petra; Poksinska, Bozena; Thomas, Kristin
The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations. The Ostergötland county council, Sweden (CCO) was chosen as a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark. The Lean improvement programme was introduced to tackle challenges such as an ageing society, rising care expectations and budgetary and economic constraints. It was designed as a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCO strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHSI attempted to address nurses needs during dissemination, which questioned whether the CCO managers' dissemination strategy is sustainable. This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations. There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.
Aston, Megan; Meagher-Stewart, Donna; Edwards, Nancy; Young, Linda M
Citizen participation is heralded as a critical element of community health programs that emphasize empowerment and health promotion strategies. Although there is a growing body of research on public health nurses' primary health care practice, few studies have described how public health nurses foster citizen participation. This article presents findings from an interpretive qualitative study of public health nurses' perceptions of their role in fostering citizen participation in an eastern Canadian province at a time of significant health care restructuring. The findings from this study clearly profile public health nurses as integral to the practice of fostering citizen participation.
Antón, F; Richart, M J; Serrano, S; Martínez, A M; Pruteanu, D F
Vaccination coverage reached in adults is insufficient, and there is a real need for new strategies. To compare strategies for improving influenza vaccination coverage in persons older than 64 years. New strategies were introduced in our health care centre during 2013-2014 influenza vaccination campaign, which included vaccinating patients in homes for the aged as well as in the health care centre. A comparison was made on vaccination coverage over the last 4 years in 3 practices of our health care centre: P1, the general physician vaccinated patients older than 64 that came to the practice; P2, the general physician systematically insisted in vaccination in elderly patients, strongly advising to book appointments, and P3, the general physician did not insist. These practices looked after P1: 278; P2: 320; P3: 294 patients older than 64 years. Overall/P1/P2/P3 coverages in 2010: 51.2/51.4/55/46.9% (P=NS), in 2011: 52.4/52.9/53.8/50.3% (P=NS), in 2012: 51.9/52.5/55.3/47.6% (P=NS), and in 2013: 63.5/79.1/59.7/52.7 (P=.000, P1 versus P2 and P3; P=NS between P2 and P3). Comparing the coverages in 2012-2013 within each practice P1 (P=.000); P2 (P=.045); P3 (P=.018). In P2 and P3 all vaccinations were given by the nurses as previously scheduled. In P3, 55% of the vaccinations were given by the nurses, 24.1% by the GP, 9.7% rejected vaccination, and the remainder did not come to the practice during the vaccination period (October 2013-February 2014). The strategy of vaccinating in the homes for the aged improved the vaccination coverage by 5% in each practice. The strategy of "I've got you here, I jab you here" in P1 improved the vaccination coverage by 22%. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
Khabriev, R U; Lindendraten, A L; Komarov, Yu M
The overwhelming majority of underlying documents adopted during last years in area of health care first of all relate to development of public health system i.e. that most important branch targeted to rendering medical care and restoring lost health. At the same time, absence of the Federal strategy of health care of population hinders both achievement of goals stated for country and development of regional health strategies. Overall, this situation significantly decreases effectiveness of public policy in this sphere of activity. The main directions of strategy are presented. The major purpose of strategy as a public intersectoral approach to health care and health promotion of population is discussed.
Maria Salete Bessa Jorge
Full Text Available Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, considering the words as units and providing context in the corpus. Results The representations emerge in two opposing poles: the users require satisfaction with care and the professionals realize the need for improvement of health actions. Although the matricial support in mental health and the home visits are developed, the barriers related to investment in health, continuing education and organization of care persist. Conclusion The different representations enable improvements in customer service, solvability of care and aggregate knowledge and practices in the expanded perspective of health needs in the family, social and therapeutic context.
Maria Salete Bessa Jorge; Mardênia Gomes Ferreira Vasconcelos; Euton Freitas de Castro Junior; Levi Alves Barreto; Lianna Ramalho de Sena Rosa; Leilson Lira Lima
Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, c...
Phillips, Robert L; Bazemore, Andrew W; DeVoe, Jennifer E; Weida, Thomas J; Krist, Alex H; Dulin, Michael F; Biagioli, Frances E
Health information technology (health IT) and health technology, more broadly, offer tremendous promise for connecting, synthesizing, and sharing information critical to improving health care delivery, reducing health system costs, and achieving personal and community health. While efforts to spur adoption of electronic health records (EHRs) among US practices and hospitals have been highly successful, aspirations for effective data exchanges and translation of data into measureable improvements in health outcomes remain largely unrealized. There are shining examples of health enhancement through new technologies, and the discipline of family medicine is well poised to take advantage of these innovations to improve patient and population health. The Future of Family Medicine led to important family medicine health IT initiatives over the past decade. For example, the American Academy of Family Physicians (AAFP) Center for Health Information Technology and the Robert Graham Center provided important leadership for informing health IT policy and standard-setting, such as the Centers for Medicare and Medicaid Services EHR incentives programs (often referred to as "meaningful use."). As we move forward, there is a need for a new and more comprehensive family medicine strategy for technology. To inform the Family Medicine for America's Health (FMAHealth) initiative, this paper explores strategies and tactics that family medicine could pursue to improve the utility of technology for primary care and to help primary care become a leader in rapid development, testing, and implementation of new technologies. These strategies were also designed with a broader stakeholder audience in mind, intending to reach beyond the work being done by FMAHealth. Specific suggestions include: a shared primary care health IT center, meaningful primary care quality measures and capacity to assess/report them, increased primary care technology research, a national family medicine registry
Koster, John; Stewart, Elizabeth; Kolker, Eugene
Today's consumers purchasing any product or service are armed with information and have high expectations. They expect service providers and payers to know about their unique needs. Data-driven decisions can help organizations meet those expectations and fulfill those needs.Health care, however, is not strictly a retail relationship-the sacred trust between patient and doctor, the clinician-patient relationship, must be preserved. The opportunities and challenges created by the digitization of health care are at the crux of the most crucial strategic decisions for academic medicine. A transformational vision grounded in data and analytics must guide health care decisions and actions.In this Commentary, the authors describe three examples of the transformational force of data and analytics to improve health care in order to focus attention on academic medicine's vital role in guiding the needed changes.
Introduction International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically-informed key dimensions and
Browne Annette J
Full Text Available Abstract Introduction International evidence shows that enhancement of primary health care (PHC services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a the key dimensions of equity-oriented services to guide PHC organizations, and (b strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a in-depth interviews with a total of 114 participants (73 patients; 41 staff, (b over 900 hours of participant observation, and (c an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically
Asarnow, Joan Rosenbaum; Hoagwood, Kimberly E.; Stancin, Terry; Lochman, John E.; Hughes, Jennifer L.; Miranda, Jeanne M.; Wysocki, Tim; Portwood, Sharon G.; Piacentini, John; Tynan, Douglas; Atkins, Marc; Kazak, Anne E.
Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health (a broad term referring to mental health, substance use, and health behavior) care in the United States. Advances in knowledge regarding effective treatment and services coupled with incentives for innovation in health and behavioral health care delivery systems make this a unique time for mobilizing our science to enhance the success of health and behavioral health care redesign. To optimize the potential of our current health care environment, a team was formed composed of leaders from the Societies of Clinical Child & Adolescent Psychology, Pediatric Psychology, and Child and Family Policy and Practice (Divisions 53, 54, and 37 of the American Psychological Association). This team was charged with reviewing the scientific and policy literature with a focus on five major issues: (a) improving access to care and reducing health disparities, (b) integrating behavioral health care within primary care, (c) preventive services, (d) enhancing quality and outcomes of care, and (e) training and workforce development. The products of that work are summarized here, including recommendations for future research, clinical, training, and policy directions. We conclude that the current emphasis on accountable care and evaluation of the outcomes of care offer numerous opportunities for psychologists to integrate science and practice for the benefit of our children, families, and nation. The dramatic changes that are occurring in psychological and behavioral health care services and payment systems also require evolution in our practice and training models. PMID:26430948
Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung
Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities.
Lund, Stine; Probst, Helene Bilsted; Bygbjerg, Ib Christian
Thirty years ago the Alma-Ata declaration on primary health care was developed. Implementation has been compounded by inadequate financing, changing disease patterns and immature health systems, and there is an ongoing discussion between selective and comprehensive primary health care supporters. Globally, child mortality for under-five-year-olds has been reduced by 50%, but there are still large regional differences. This year the WHO development report is about revitalisation of the primary health care strategy. Recognition of this strategy may be the best instrument to improve health globally.
Sanchez, Katherine; Chapa, Teresa; Ybarra, Rick; Martinez, Octavio N
This report is the outcome of an expert consensus meeting sponsored by the United States Deparment of Health and Human Services Office of Minority Health, which was convened to formulate consensus statements, provide recommendations and identify key strategies from practice for implementing integrated health and behavioral health care intended to improve health status for underserved populations.
Chandra, Ashish; Frank, Zachary D
Performance appraisal systems that are designed to objectively evaluate an employee's performance and then outline measures to be taken for improvements are essential for an organization to move ahead. These systems are often organization specific and health care organizations are no exception. However, health care managers seem to be more vocal and have often expressed dissatisfaction with the use of their company's performance appraisal system. This article is based on a case study of a health care organization's current performance appraisal techniques. This organization's current use of performance appraisals are discussed in brief, and strategies for health care organizations to improve their performance appraisal system have also been identified.
Pflaum, B B; Rivers, J S
Each year health care fraud drains millions of dollars from employer-sponsored health plans. Historically, employers have taken a rather tolerant view of fraud. As the pressure to manage health plan costs increases, however, many employers are beginning to see the detection and prosecution of fraud as an appropriate part of a cost management program. Fraud in medical insurance covers a wide range of activities in terms of cost and sophistication--from misrepresenting information on a claim, to billing for services never rendered, to falsifying the existence of an entire medical organization. To complicate matters, fraudulent activities can emanate from many, many sources. Perpetrators can include employees, dependents or associates of employees, providers and employees of providers--virtually anyone able to make a claim against a plan. This article addresses actions that employers can take to reduce losses from fraud. The first section suggests policy statements and administrative procedures and guidelines that can be used to discourage employee fraud. Section two addresses the most prevalent form of fraud--provider fraud. To combat provider fraud, employers should set corporate guidelines and should enlist the assistance of employees in identifying fraudulent provider activities. Section three suggests ways to improve fraud detection through the claims payment system--often the first line of defense against fraud. Finally, section four discusses the possibility of civil and criminal remedies and reviews the legal theories under which an increasing number of fraud cases have been prosecuted.
Most poor countries have a large and growing private medical sector. Evidence suggests that a large proportion of tuberculosis patients in many high TB- burden countries first approach a private health care provider. Further, private providers manage a significant proportion of tuberculosis cases. Surprisingly though, there is virtually no published evidence on linking private providers to tuberculosis programmes. As a part of global efforts to control tuberculosis through effective DOTS implementation, the World Health Organization has recently begun addressing the issue of private providers in TB control through an evolving global strategy. As a first step, a global assessment of private providers' participation in tuberculosis programmes was undertaken. The findings of the assessment were discussed and debated in a consultation involving private practitioners, TB programme managers and policy makers. Their recommendations have contributed to the evolving global strategy called Public-Private Mix for DOTS implementation (PPM DOTS). This paper presents the guiding principles of PPM DOTS and major elements of the global strategy. These include: informed advocacy; setting-up "learning projects"; scaling-up successful projects and formulation of regional, national and local strategies; developing practical tools to facilitate PPM DOTS and pursuing an operational research agenda to help better design and shape PPM DOTS strategies. Encouraging results from some ongoing project sites are discussed. The paper concludes that concerted global efforts and local input are required for a sustained period to help achieve productive engagement of private practitioners in DOTS implementation. Such efforts have to be targeted as much towards national tuberculosis programmes as towards private providers and their associations. Continued apathy in this area could not only potentially delay achieving global targets for TB control but also undo, in the long run, the hard
Full Text Available Oral health care for disabled patients is an important health issue in Taiwan. Disabled patients seeking dental care include those with mental retardation, cerebral palsy, epilepsy, Down syndrome, autism, xerostomia, AIDS, loss of function of major organs, and neurologic diseases. Current dental health care policies do not completely address this critical oral health issue. Most of these physically or mentally disabled patients cannot find suitable or qualified dental services in local dental clinics or even hospitals. Our current health care insurance system should provide greater benefits for dental practitioners who are willing to care for such disabled patients. The Department of Health (DOH should legislate policies to provide greater financial support and equipment and encourage hospital dental clinics and dentists to join this special oral care program. Dental schools, hospitals, and the DOH can also provide curricula and special training programs for both dentists and undergraduate dental students so that they can learn about diseases and dental care of these patients. The government and DOH should cover the fees of lawsuits if dentists have medical legal problems while treating patients with disabilities. Questions on special care dentistry can possibly be included in the National Board Dental Examination. The government can establish some national oral health care centers to treat these disabled patients. Through the development of effective preventive and treatment strategies, the incidence of oral diseases in these patients can be reduced in the future.
Park, Jungsun; Park, Jong-Tae; Kim, Soo Geun; Yoo, Cheol-In; Son, Junseok; Yim, Jun; Kim, Dae-Seong; Rhee, Kyung Young; Kim, Yangho
The rapid aging trend in South Korea will cause a growing shortage of labor and decreasing quality of the labor force. The purpose of this commentary is to recommend a health care strategy to maintain and promote the work ability of employees in an aging Korea. Strategies to promote the work ability require the collaboration of governmental agencies at the central and local levels. First, the common goal should be the reinforcement of follow-up measure in general medical examinations and the promotion of healthy lifestyles for workers. Second, collaborating activities should be performed among the Worker's Health Center, the Health Promotion Center, and community health centers. In conclusion, health care strategies for ensuring the work ability in an aging Korea require the collaboration of governmental agencies at the central and local levels.
Schwamm, Lee H
"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.
Noorein Inamdar, S
Use theory and data to examine the scope of corporate strategies for multibusiness health care firms, also known as organized or integrated health care delivery systems. Data are from the 2000 HIMSS Analytics Annual Survey of integrated health care delivery systems (IHDS), which provides complete information on businesses owned by IHDS. Scope defined as the breadth and type of businesses in which a firm chooses to compete is measured across seven separate business areas: (1) health plans, (2) ambulatory, (3) acute, (4) subacute, (5) home health, (6) other related nonpatient care businesses, and (7) external collaborations. Theories on strategy and organizational configurations along with measures of scope and a novel dataset were used to classify 796 firms into five mutually exclusive groups. The bases for classification were two competitive dimensions of scope: (1) breadth of businesses and (2) mix of existing core businesses versus new noncore businesses. Unit of analysis is the multibusiness health care firm. Sample consists of 796 firms, defined as nonprofit organizations that own two or more direct patient care businesses in two or more separate areas across the health care value chain. Firms were clustered into five mutually exclusive organizational configurations with unique scope characteristics revealing a new taxonomy of corporate strategies. Analysis of the scope variables revealed five strategic types (along with the number of firms and distinguishing features of each strategy) defined as follows: (1) Core Service Provider (340 firms with the smallest scope providing core set of patient care services), (2) Mission Based (52 firms with the next smallest scope offering core set of services to underserved populations), (3) Contractor (266 firms with medium scope and contracting with physician groups), (4) Health Plan Focus (83 firms with large scope and providing health plans), and (5) Entrepreneur (55 firms with the largest scope offering both a core set
Arroyo-Cobo, J M
A review was carried out of scientific literature on health care strategies for mental health problems in the prison environment. Data is given about the main activities put into practice by prison administrations as a response to the worrying information that has come to light in recent epidemiological studies on mental disorders in prison, with figures that, when compared to the general population, give results of double the number of cases of Common Mental Illness (CMI) and four times the number of cases of Severe Mental Illness (SMI) amongst prison inmates. A review was made of the most important bibliographical databases containing health care policies for mental health problems in prison published by prison administrations in the last 10 years. This information was completed with other data obtained from an analysis of the indicators available in Health Care Coordination on its health care strategies for mental health in centres run by the Secretary General of Prisons, in Spain. There is little in the way of scientific literature that clearly states health care policies for mental illness in the prison environment. Those that do tend to agree with a number of affirmations that include the obligation to offer a therapeutic response of equal quality to that received by patients in the community, the need for a multi-disciplinary team responsible for caring for this type of patient, along with a coordinated effort between the medical, social, legal and prison administrations that at a given time have to care for them.
Wong, V C; Chiu, S W
Analyses the features, strategies and characteristics of health-care reforms in the People's Republic of China. Since the 14th Central Committee of the Chinese Communist Party held in 1992, an emphasis has been placed on reform strategies such as cost recovery, profit making, diversification of services, and development of alternative financing strategies in respect of health-care services provided in the public sector. Argues that the reform strategies employed have created new problems before solving the old ones. Inflation of medical cost has been elevated very rapidly. The de-linkage of state finance bureau and health service providers has also contributed to the transfer of tension from the state to the enterprises. There is no sign that quasi-public health-care insurance is able to resolve these problems. Finally, cooperative medicine in the rural areas has been largely dismantled, though this direction is going against the will of the state. Argues that a new balance of responsibility has to be developed as a top social priority between the state, enterprises and service users in China in order to meet the health-care needs of the people.
Farmanova, Elina; Bonneville, Luc; Bouchard, Louise
The availability of health services in French is not only weak but also inexistent in some regions in Canada. As a result, estimated 78% of more than a million of Francophones living in a minority situation in Canada experience difficulties accessing health care in French. To promote the delivery of health services in French, publicly funded organizations are encouraged to take measures to ensure that French-language services are clearly visible, available, easily accessible, and equivalent to the quality of services offered in English. This study examines the reorganization and management strategies taken by health care organizations in Ontario that provide health services in French. Review and analysis of designation plans of a sample of health care organizations. Few health care organizations providing services in French have concrete strategies to guarantee availability, visibility, and accessibility of French-language services. Implementation of the active offer of French-language services is likely to be difficult and slow. The Ontario government must strengthen collaboration with health care organizations, Francophone communities, and other key actors participating in the designation process to help health care organizations build capacities for the effective offer of French-language services. Copyright © 2017 John Wiley & Sons, Ltd.
Cinthia Mendonça Cavalcante
Full Text Available Objective: To discuss the practice of mental health care performed by healthcare professionals from the Family Health Strategy in Fortaleza-CE, Brazil. Methods: This is a critical and reflective study conducted in six Basic Health Units in Fortaleza-Ce. The study subjects were 12 health workers of the following professions: doctor, nurse, community health agents and technical and/or nursing assistant. Semi-structured interviews, systematic observation and questionnaire were used for data collection. The empirical analysis was based on an understanding of the discourses through critical hermeneutics. Results: It was evident that the mental health services are developed by some health workers in the ESF, such as, matrix support, relational technologies, home visits and community group therapy. However, there is still deficiency in training/coaching by most professionals in primary care, due to an enduring model of pathological or curative health care. Conclusion: Mental health care is still occasionally held by some workers in primary care. However, some progresses are already present as matrix support, relational technologies in health care, home visits and community therapy
Ahmann, Elizabeth; Dokken, Deborah
The 5th International Conference of the Institute for Patient- and Family-Centered Care (IPFCC), held in Washington, DC, from June 4-6, 2012, offered an opportunity for almost 1,000 conference participants to share and learn about exciting new patient- and family-centered initiatives occurring across the U.S. and in many other countries. One focus addressed by keynote and plenary speakers, as well as numerous conference sessions and poster presentations, was how nurses and other health care professionals can encourage patients and family members to become partners with their health care teams. Various presenters shared strategies ranging from initial approaches to acknowledging family members as part of the team and offering simple, non-threatening roles in care provision, to policies and approaches inviting increased participation in health care encounters, to higher level involvement in the care planning process, and to partnership roles extending beyond care of the individual child and family. A wealth of ideas can be implemented at various levels by individual nurses, units, and health care institutions.
payment for health care services; a widely used strategy to supplement ... and opportunities for sustainable health care financing for low income communities in sub-. Saharan ..... funding and rising costs for health care services, More so, evidence from research studies have ... provider payment method has the potential to.
Jasso-Aguilar, Rebeca; Waitzkin, Howard; Landwehr, Angela
In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institutions and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector
Olayiwola, J Nwando; Rubin, Ashley; Slomoff, Theo; Woldeyesus, Tem; Willard-Grace, Rachel
The use of electronic health records (EHRs) and the vendors that develop them have increased exponentially in recent years. While there continues to emerge literature on the challenges EHRs have created related to primary care provider satisfaction and workflow, there is sparse literature on the perspective of the EHR vendors themselves. We examined the role of EHR vendors in optimizing primary care practice through a qualitative study of vendor leadership and developers representing 8 companies. We found that EHR vendors apply a range of strategies to elicit feedback from their clinical users and to engage selected users in their development and design process, but priorities are heavily influenced by the macroenvironment and government regulations. To improve the "marriage" between primary care and the EHR vendor community, we propose 6 strategies that may be most impactful for primary care stakeholders seeking to influence EHR development processes. © Copyright 2016 by the American Board of Family Medicine.
Silveira, Antonio Dercy; Moysés, Samuel Jorge; Kusma, Solena Ziemer; Moysés, Simone Tetu
To evaluate the potential effectiveness of strategies of Oral Health Promotion (OHP), which are carried out by teams in primary health care (PHC) in Brazilian capitals and regions. A sample of 1,848 dentists were interviewed (1,819 valid responses) working in the PHC of 26 capitals and the Federal District. The Effectiveness of the Assessment Tool for the Promotion of Oral Health Strategies was used. It is composed of 23 indicators grouped into three dimensions: oral health, health public policies, and human and social development. The answers were arranged in a Likert scale (1-5), and the final score obtained for each sample unit can range from 23 to 115. Higher score values indicate greater potential for the strategy to promote oral health. Statistically significant differences were identified among the analyzed geopopulation units considering the study object. The Southeast and South regions had better performance for the OHP strategies in comparison to the other regions of Brazil (p ≤ 0.01). The OHP strategies identified in the study were heterogeneous, with better results favoring the Southeast regions, with disadvantages for people living in capitals from the Central-North-Northeast of Brazil. Efforts should be undertaken aiming to qualify the PHC teams, especially for those in disadvantageous regions. Therefore, an alignment of PSB strategies to the principles and values of health promotion is required, addressed to the social health determinants (SHDs) and in order to fight the inequalities in oral health.
Fernandes, Roberta Zanelli Sartori; Vilela, Maria Filomena de Gouveia
Mother and infant mortality has been the scope of analysis throughout the history of public health in Brazil and various strategies to tackle the issue have been proposed to date. The Ministry of Health has been working on this and the Rede Cegonha strategy is the most recent policy in this context. Given the principle of comprehensive health care and the structure of the Unified Health System in care networks, it is necessary to ensure the integration of health care practices, among which are the sanitary surveillance actions (SSA). Considering that the integration of health care practices and SSA can contribute to reduce mother and infant mortality rates, this article is a result of qualitative research that analyzed the integration of these actions in four cities in the State of São Paulo/Brazil: Campinas, Indaiatuba, Jaguariúna and Santa Bárbara D'Oeste. The research was conducted through interviews with SSA and maternal health managers, and the data were evaluated using thematic analysis. The results converge with other studies, identifying the isolation of health care practices and SSA. The insertion of SSA in collectively-managed areas appears to be a potential strategy for health planning and implementation of actions in the context under scrutiny.
Yarbrough, Amy K; Powers, Thomas L
The distribution of management structures in health care has been shifting from independent ownership to interorganizational relationships with other firms. A shortage of resources has been cited as one cause for such collaboration among health care entities. The resource- based view of the firm suggests that organizations differentiate between strategic alliances and acquisition strategies based on a firm's internal resources and the types of resources a potential partner organization possesses. This paper provides a review of the literature using the resource-based theory of the firm to understand what conditions foster different types of health care partnerships. A model of partnership alliances using the resource-based view is presented, strategic linkages are presented, managerial implications are outlined, and directions for future research are given.
J. W. De Jager
Full Text Available Purpose: The purpose of the paper is to determine the levels of satisfaction in respect of pre identified internal marketing-related variables in a large provincial hospital in South Africa. Problem investigated: Low job satisfaction is often cited as a major cause of high turnover among health care providers worldwide. Likewise the Public Health Care Industry in South Africa is facing complex employee retention issues. In determining the reasons for high turnover an interest in evaluating employee satisfaction among health care providers has increased. Measuring components of job satisfaction will assist not only the health care organisations' management to understand hospital culture, but also to compile an effective internal marketing plan and strategy. Design/Methodology/Approach: A staff satisfaction survey was conducted amongst staff members at a provincial hospital in the Tshwane region, South Africa. Attitudes of staff on pre-identified staff satisfaction variables were assessed. These variables were employed to implement an internal marketing strategy. A list of variables was formulated after an extensive literature study had been conducted. A total of 416 staff members voluntarily completed a self-administered questionnaire. A five-point Likert type scale was used to measure the levels of satisfaction on staff-related issues, with a view to addressing issues in the internal marketing strategy. Findings : It was evident that the management principles currently employed by the management team were a cause for concern among staff members. Based on the analysis that identified the satisfaction variables best it was clear that management should take immediate steps to address the following issues : Clarification of hospital goals \\ objectives; Understanding the goals of the respective departments; The functioning of the Human resource department; Functioning of the overall hospital management; andImplications: This paper aims to present a
Full Text Available Objective. To evaluate the feasibility and acceptability of a comprehensive educational strategy designed to improve care quality in rural areas of Mexico. Materials and methods. A demonstration study was performed in 18 public rural health centers in Mexico, including an educational intervention that consists of the following steps: Development of the strategy; Selection and training of instructors (specialist physicians from the referral hospital and multidisciplinary field teams; Implementation of the strategy among health care teams for six priority causes of visit, through workshops, individual tutorials, and round-table case-review sessions. Feasibility and acceptability were evaluated using checklists, direct observation, questionnaires and in-depth interviews with key players. Results. Despite some organizational barriers, the strategy was perceived as worthy by the participants because of the personalized tutorials and the improved integration of health teams within their usual professional practice. Conclusion. The educational strategy proved to be acceptable; its feasibility for usual care conditions will depend on the improvement of organizational processes at rural facilities.
Blumenthal, Daniel J; Bader, Judith L; Christensen, Doran; Koerner, John; Cuellar, John; Hinds, Sidney; Crapo, John; Glassman, Erik; Potter, A Bradley; Singletary, Lynda
The detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. Members throughout the health care delivery system, including medical first responders, hospital first receivers, and health care institution support personnel such as janitors, hospital administrators, and security personnel, lack radiation-related training. This lack of knowledge can lead to failure of these groups to respond appropriately after a nuclear detonation or other major radiation incident and limit the effectiveness of the medical response and recovery effort. Efficacy of the response can be improved by getting each group the information it needs to do its job. This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.
Juliane Portella Ribeiro
Full Text Available Objective: To identify and analyze the production of knowledge about the strategies that health care institutions have implemented to humanize care of hospitalized children. Method: This is a systematic review conducted in the Virtual Health Library - Nursing and SciELO, using the seven steps proposed by the Cochrane Handbook. Results: 15 studies were selected, and strategies that involved relationship exchanges were used between the health professional, the hospitalized child and their families, which may be mediated by leisure activities, music and by reading fairy tales. We also include the use of the architecture itself as a way of providing welfare to the child and his/her family, as well as facilitating the development of the work process of health professionals. Conclusion: Investments in research and publications about the topic are necessary, so that, the National Humanization Policy does not disappear and that the identified strategies in this study do not configure as isolated and disjointed actions of health policy.
Pitkajarvi, Marianne; Eriksson, Elina; Pitkala, Kaisu
All over the world, current health care students come from a variety of cultural, linguistic and educational backgrounds. Their expectations and learning needs vary, yet little is known about how our current education system meets their needs. The purpose of this study was to explore culturally diverse health care students' experiences of teaching strategies in polytechnic faculties of health care in Finland. Specifically, we aimed to compare how international students and Finnish students experience the same curriculum. A cross sectional survey. Ten polytechnic faculties of health care in Finland offering English-Language-Taught Degree Programmess (ELTDPs). 283 students studying nursing, public health nursing, or physiotherapy in English. Of these, 166 were international students and 112 were Finnish students. The data were collected using a questionnaire designed specifically for this study. The survey included items grouped into seven dimensions: 1. concreteness of theoretical instruction, 2. encouragement of student activity, 3. use of skills labs, 4. variation among teaching strategies, 5. assessment, 6. interaction in the English-Language-Taught Degree Programmes, and 7. approach to diversity in the English-Language-Taught Degree Programmes. The most positive experiences for all students were with the approach to cultural diversity and the concreteness of theoretical instruction, whereas the most negative experiences were with assessment. International students' experiences were more positive than Finnish students' in the following dimensions: encouragement of student activity (p=0.005), variation among teaching strategies (p<0.001), and assessment (p<0.001). Compared to the Finnish students, more than double the number of international students were dissatisfied with their lives (p<0.001). The implications for education include the strengthening teachers' leadership role in small group activities, providing individual and detailed feedback, and ensuring
Costello, Michelle; Taylor, Jane; O'Hara, Lily
A comprehensive primary health care approach is required to address complex health issues and reduce inequities. However, there has been limited uptake of this approach by health services nationally or internationally. Reorienting health services towards becoming more health promoting provides a mechanism to support the delivery of comprehensive primary health care. The aim of this study was to determine the impact of a health promotion-focused organisational development strategy on the capacity of a primary health care service to deliver comprehensive primary health care. A questionnaire and semistructured individual interviews were used to collect quantitative and qualitative impact evaluation data, respectively, from 13 health service staff across three time points with regard to 37 indicators of organisational capacity. There were significant increases in mean scores for 31 indicators, with effect sizes ranging from moderate to nearly perfect. A range of key enablers and barriers to support the delivery of comprehensive primary health care was identified. In conclusion, an organisational development strategy to reorient health services towards becoming more health promoting may increase the capacity to deliver comprehensive primary health care.
Kakuma, Ritsuko; Minas, Harry; van Ginneken, Nadja; Dal Poz, Mario R; Desiraju, Keshav; Morris, Jodi E; Saxena, Shekhar; Scheffler, Richard M
A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.
Farmer Elizabeth A
Full Text Available Abstract Background General practitioners and other primary health care professionals are often the first point of contact for patients requiring health care. Identifying, understanding and linking current evidence to best practice can be challenging and requires at least a basic understanding of research principles and methodologies. However, not all primary health care professionals are trained in research or have research experience. With the aim of enhancing research skills and developing a research culture in primary health care, University Departments of General Practice and Rural Health have been supported since 2000 by the Australian Government funded 'Primary Health Care Research Evaluation and Development (PHCRED Strategy'. A small grant funding scheme to support primary health care practitioners was implemented through the PHCRED program at Flinders University in South Australia between 2002 and 2005. The scheme incorporated academic mentors and three types of funding support: bursaries, writing grants and research fellowships. This article describes outcomes of the funding scheme and contributes to the debate surrounding the effectiveness of funding schemes as a means of building research capacity. Methods Funding recipients who had completed their research were invited to participate in a semi-structured 40-minute telephone interview. Feedback was sought on acquisition of research skills, publication outcomes, development of research capacity, confidence and interest in research, and perception of research. Data were also collected on demographics, research topics, and time needed to complete planned activities. Results The funding scheme supported 24 bursaries, 11 writing grants, and three research fellows. Nearly half (47% of all grant recipients were allied health professionals, followed by general practitioners (21%. The majority (70% were novice and early career researchers. Eighty-nine percent of the grant recipients were
Skillman, Megan; Cross-Barnet, Caitlin; Singer, Rachel Friedman; Ruiz, Sarah; Rotondo, Christina; Ahn, Roy; Snyder, Lynne Page; Colligan, Erin M; Giuriceo, Katherine; Moiduddin, Adil
To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs. Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations. NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews. We used qualitative thematic coding for data from 21 programs actively engaging physicians as part of HCIA interventions. Establishing physician champions and ensuring an innovation-values fit between physicians and programs, including the strategies programs employed, facilitated engagement. Among engagement practices identified in this study, tailoring team working styles to meet physician preferences and conducting physician outreach and education were the most common successful approaches. We describe engagement strategies derived from a diverse range of programs. Successful programs considered physicians' values and engagement as components of process and policy, rather than viewing them as exogenous factors affecting innovation adoption. These types of approaches enabled programs to accelerate acceptance of innovations within organizations. © Health Research and Educational Trust.
Zaza, C; Sellick, S M; Willan, A; Reyno, L; Browman, G P
Many studies have confirmed unnecessary suffering among cancer patients, due to the inadequate use of analgesic medication and other effective interventions. While pharmacological treatments are appropriately the central component of cancer pain management, the under-utilization of effective nonpharmacological strategies (NPS) may contribute to the problem of pain and suffering among cancer patients. The purpose of this study was to determine health care professionals' familiarity with, and perceptions regarding, NPS for managing cancer pain, and to assess their interest in learning more about NPS as adjuncts to pharmacological analgesics. Two-hundred and fourteen health care professionals were surveyed at two cancer treatment centres in Ontario, Canada. The self-report questionnaire included questions regarding 11 psychological strategies (e.g. imagery) and eight other NPS (e.g. acupuncture). The response rate was 67% (141/214). Subjects were found to be the least familiar with autogenic training, operant conditioning, and cognitive therapy. Other than radiation and surgery, subjects most commonly reported recommending support groups (67%), imagery (54%), music or art therapy (49%) and meditation (43%) for managing cancer pain. Participants were most interested in learning more about acupuncture, massage therapy, therapeutic touch, hypnosis, and biofeedback. Participants were somewhat familiar with most of the 19 NPS presented; however, they use or recommend few NPS for managing cancer pain. Health professionals' interest in NPS has important implications for the supportive care of cancer patients.
Kelly Karine Pasqual
Full Text Available OBJECTIVE: To assess the health care process for women over 50 at a Family Health Unit based on the concept of programmatic vulnerability. METHOD: This study is inserted in the field of health care assessments. The framework proposed by Donabedian was used to analyze 90.5% of the 790 records of women registered at the unit. RESULTS: It was observed that none of the women that did not have a diagnosed pathology attended the recommended consultations or underwent the recommended tests. Of the total number of women with hypertension or diabetes, 20.7% were registered in the Hiperdia Programme and less than 1.0% had attended the consultations and undergone the necessary tests. Only 11.9% of the women had had a gynaecological examination, a clinical breast examination and a mammography the year before data collection. CONCLUSION: It is concluded that women over 50 are in a situation of programmatic vulnerability in terms of the indicators established in this study. Knowledge of this reality can help nurses provide care that is best suited for this group.
Ponsford, B J; Barlow, D
This research reviews the factors affecting the pricing or rate schedules of home health care agencies. A large number of factors affect costs and thus rate structures. The major factors include reimbursement structures with accompanying discount structures, administrative burdens, and risks. Channel issues include bargaining power, competition, and size. Staffing issues affect pricing and product through the provider level, productivity, and quality outcomes. Physician and patient issues include quality concerns and choices. These factors are discussed in light of overall marketing strategy and the interaction of pricing with other marketing controllables such as product, place/distribution, and promotion. Economic and accounting principles are also reviewed with consideration to understanding direct and indirect costs in order to enable negotiators to effectively price health care services.
Banner Health consists of 19 hospitals, 6 long-term care centers and a number of family health clinics, home care programs, and home medical equipment providers in 9 Western and Midwestern states. Banner Health has developed an integrated organization-wide effort called Care Management to simultaneously address quality and safety, reduce patient errors, and measure and report performance, outcomes, and patient satisfaction, while controlling costs through utilization management, care coordination, and performance improvement. Eleven functional areas were identified and more than 36 cross-functional and cross-facility work groups have been created. These work groups use a deliberate process in which knowledge is created, reviewed, synthesized, distributed, taught, and implemented within the system. Key lessons after the first 2 years of this effort are as follows: information sharing and collegial support can be established within newly merged organizations; there must be continued enhancement of both the accuracy and timeliness of data; the ability of health care professionals to understand and use sophisticated statistical tools has increased; a variety of methods should be used to distribute the knowledge products; and the strategy to have functional teams and work groups develop systemwide policies and toolkits but leave implementation to facility employees has worked relatively well.
Walker, Rebekah J; Campbell, Jennifer A; Egede, Leonard E
The purpose of this narrative review was to synthesize the evidence on effective strategies for global health research, training and clinical care in order to identify common structures that have been used to guide program development. A Medline search from 2001 to 2011 produced 951 articles, which were reviewed and categorized. Thirty articles met criteria to be included in this review. Eleven articles discussed recommendations for research, 8 discussed training and 11 discussed clinical care. Global health program development should be completed within the framework of a larger institutional commitment or partnership. Support from leadership in the university or NGO, and an engaged local community are both integral to success and sustainability of efforts. It is also important for program development to engage local partners from the onset, jointly exploring issues and developing goals and objectives. Evaluation is a recommended way to determine if goals are being met, and should include considerations of sustainability, partnership building, and capacity. Global health research programs should consider details regarding the research process, context of research, partnerships, and community relationships. Training for global health should involve mentorship, pre-departure preparation of students, and elements developed to increase impact. Clinical care programs should focus on collaboration, sustainability, meeting local needs, and appropriate process considerations.
Female genital mutilation/cutting (FGM/C) is a traditional practice originating in Africa. Its worst forms cause irreparable harm to girls and women and have no medical justification. Based on a literature review of global responses to FGM/C and conversations with Australian women who migrated from FGM/C practicing countries, this paper provides some background on FGM/C and its epidemiology, outlining its prevalence, types, and health risks and complications for women and girls. It discusses risk-prevention strategies, first, for health practitioners in identifying, screening, and supporting women affected by FGM/C and, second, for welfare and social workers and health care professionals to identify, work with, and prevent girls from being cut. Consistent with international trends in addressing the risks of FGM/C, the paper suggests practice responses for coordinated responses between professionals, communities from practicing countries, and governments of different countries.
Drake, Paul R; Davies, Bethan M
decisions that have been made in the local authorities surveyed and critiques the alternative home care outsourcing strategies so derived. To date, the research has focused on Wales in general plus a few local authorities in England. The next stage will be to survey England in more detail along with other countries that are implementing substantial outsourcing of home care, such as Canada. This paper provides timely guidance to public sector and health care managers seeking Best Value in home care through outsourcing. Little has been found in the literature on strategies for outsourcing home care, yet such strategies are needed urgently in the U.K. to achieve Best Value. The World Health Organization stresses that strategies should be drawn up for providing support to patients and carers at community level in order to avoid costly institutional care.
Weening-Verbree, L.; Huisman-de Waal, G.; van Dusseldorp, L.; van Achterberg, T.; Schoonhoven, L.
Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the imp
Weening-Verbree, L.; Huisman-de Waal, G.J.; Dusseldorp, L. van; Achterberg, T. van; Schoonhoven, L.
OBJECTIVES: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the
Weening-Verbree, L.; Huisman-de Waal, G.; van Dusseldorp, L.; van Achterberg, T.; Schoonhoven, L.
Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the
Adanela Musaraj; Arta Musaraj; Aida Dervishi
Due to the significant boost in community expenditure with health topics, mainly regarding drugs, numerous countries, have already put into operation, or are in the process of arguing the adoption of actions to guarantee the excellence of health care provided to the population. One of the less risky strategies-is the adoption of economic procedures applied to health, more specifically, pharmaco-economics analysis. This paper aims to contribute to the dissemination of notions and techniques...
Torgovicky, Refael; Goldberg, Avishay; Shvarts, Shifra; Bar Dayan, Yosefa; Onn, Erez; Levi, Yehezkel; BarDayan, Yaron
A number of typologies have been developed in the strategic management literature to categorize strategies that an organization can pursue at the business level. Extensive research has established Porter's generic strategies of (1) cost leadership, (2) differentiation, (3) differentiation focus, (4) cost focus, and (5) stuck-in-the-middle as the dominant paradigm in the literature. The purpose of the current study was to research competitive strategies in the Israeli ambulatory health care system, by comparing managerial perceptions of present and ideal business strategies in two Israeli sick funds. We developed a unique research tool, which reliably examines the gap between the present and ideal status managerial views. We found a relation between the business strategy and performance measures, thus strengthening Porter's original theory about the nonviability of the stuck-in-the-middle strategy, and suggesting the applicability Porter's generic strategies to not-for-profit institutes in an ambulatory health care system.
Sundar Rao PSS
Full Text Available Pamidipani SS Sundar Rao LEPRA India, Secunderabad, India Abstract: Throughout its history, leprosy has been much feared and misunderstood. Today, we have the best knowledge, expertise, therapies, and surgical and physiotherapeutic skills to virtually cure and eradicate the disease, but the continuing high levels of stigma pose insurmountable obstacles in our efforts to remove the scourges of leprosy. In this review, the medical, social, and political aspects related to the impact of stigma on leprosy are elaborated, and strategies for providing access to equitable and effective care are described. Leprosy is a biosocial disease, and experience has shown that both the medical and social dimensions must be aggressively confronted. Stigma in leprosy is based on religious, sociocultural, psychological, and demographic experience over centuries of human existence. Therefore, any attempt to eradicate or reduce stigma will require strong multifaceted approaches that will permeate psychological, social, and mental layers of the human mind and result in necessary health-seeking behaviors. What then is needed is a social multidrug therapy similar to the medical multidrug therapy, where there would be one arm for curing the medical problems of leprosy, a second arm focusing on empowering the people, especially affected persons, through appropriate education, awareness, especially for early detection and treatment, encouraging positive attitudes and perceptions, and a third arm for advocacy, attacking derogatory and discriminatory laws, enabling opportunities for persons with leprosy disabilities to be profitably employed, and providing necessary rehabilitation facilities. Health can never be adequately protected by health services without the active understanding and involvement of communities whose health is at stake. The review cautions that without a social multidisciplinary approach using community-based participatory techniques, we cannot provide
Reijneveld, SA; Brugman, E; Verhulst, FC; Verloove-Vanhorick, SP
Psychosocial problems in pre-school children: recognition and strategy applied by doctors and nurses in child health care Objective. To assess the degree to which preventive child health professionals (CHPs) identify and manage psychosocial problems among pre-school children in the general populatio
Aires, Marinês; Paz, Adriana Aparecida
This study had the objective of identifying the needs of care reported by a group of elderly people in a region covered by the Family Health Strategy (ESF). The methodology used was based on a descriptive cross-sectional study, with a sample of 176 persons over 60 years of age. Most of the individuals were females, between 60 and 69-years-old, with an average of 69.6 +/- 7.4 years. The elderly reported co-morbidities, most of which were related to diseases of the circulatory and endocrine systems, as well as nutritional and metabolic disturbances, musculoskeletal and conjunctive tissue diseases. Regarding the Basic Activities of Daily Life, 93.2% of the elderly reported to be independent, 81.3% were able to conduct instrumental daily life activities, and 24.4% reported needing a caregiver at home. The need for the family health team to adopt care technologies for the elderly in the scope of their homes is discussed.
Walker, Kelly; Arbour, Megan; Waryold, Justin
Graduate medical, nursing, and midwifery curricula often have limited amounts of time to focus on issues related to cultural competency in clinical practice, and respectful sexual and reproductive health care for all individuals in particular. Respectful health care that addresses sexual and reproductive concerns is a right for everyone, including those who self-identify as lesbian, gay, bisexual, or transgender (LGBT). LGBT persons have unique reproductive health care needs as well as increased risks for poor health outcomes. Both the World Health Organization and Healthy People 2020 identified the poor health of LGBT persons as an area for improvement. A lack of educational resources as well as few student clinical experiences with an LGBT population may be barriers to providing respectful sexual and reproductive health care to LGBT persons. This article offers didactic educational strategies for midwifery and graduate nursing education programs that may result in reducing barriers to the provision of respectful sexual and reproductive health care for LGBT clients. Specific ideas for implementation are discussed in detail. In addition to what is presented here, other educational strategies and clinical experiences may help to support students for caring for LGBT persons prior to entrance into clinical practice. © 2016 by the American College of Nurse-Midwives.
Kudlacek, Stefan; Meran, Johannes G
Management and leadership are an integral part of any organisation, to optimise procedures and increase efficiency. Aims, ideals and structures first need to be defined for tasks to be carried out successfully, particularly in difficult times. A good example for the way communities can effectively and with conviction pass on their values and standpoints from generation to generation, grow in strength and also influence their surroundings is provided by religion. This paper focuses leadership provided by charismatic personalities within the Jewish and Christian religions. Monasteries have run hospitals without governmental support ever since the Middle Ages. Leadership within today's health care system calls for a variety of strategies in the different phases of development. In times of limited resources and multifarious societies, leadership implies both a scientific as well as an ethical challenge.
Dolinsky, A L; Stinerock, R
Culturally based values are known to influence consumer purchase decisions, but little is known about how those values affect health care choices. To rectify that situation and provide health care marketers with a framework for developing culturally based segmentation strategies, the authors undertook an exploratory research project in which Hispanic-, African-, and Anglo-Americans were asked to rate the importance of 16 different health care attributes. Those attributes can be grouped under five categories: quality of physician, quality of nurses and other medical staff, economic issues, access to health care, and nonmedically related experiential aspects. Survey responses identified distinct differences in the importance attached to the various attributes by the three cultural groups. The study also looks at the impact of six demographic and social characteristics on the evaluations made by each cultural group. Those characteristics are educational level, gender, age, health status, marital status, and number of people living in the household.
Full Text Available Susan Costello School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia Abstract: Female genital mutilation/cutting (FGM/C is a traditional practice originating in Africa. Its worst forms cause irreparable harm to girls and women and have no medical justification. Based on a literature review of global responses to FGM/C and conversations with Australian women who migrated from FGM/C practicing countries, this paper provides some background on FGM/C and its epidemiology, outlining its prevalence, types, and health risks and complications for women and girls. It discusses risk-prevention strategies, first, for health practitioners in identifying, screening, and supporting women affected by FGM/C and, second, for welfare and social workers and health care professionals to identify, work with, and prevent girls from being cut. Consistent with international trends in addressing the risks of FGM/C, the paper suggests practice responses for coordinated responses between professionals, communities from practicing countries, and governments of different countries. Keywords: female genital mutilation, female genital cutting, female circumcision, child protection, risk management
Arantes, Luciano José; Shimizu, Helena Eri; Merchán-Hamann, Edgar
The aim of this study was to analyze what contributions the Family Health Strategy has made towards the development of primary healthcare in Brazil, and what challenges it faces. A literature review was conducted and articles were analyzed from three dimensions: political/institutional, organizational, and technical/healthcare. In the first dimension, the Family Health Strategy was found to have helped expand primary healthcare, the institutionalization of evaluations, and the promotion of equity. The main challenges identified were funding, the training, education, and management of personnel, and cross-sectoral action. In terms of organization, the benefits include a broader supply of services, access to health services through organized initiatives for specific diseases or age groups, and more comprehensive healthcare. The challenges involve access, the entry point, integration with the healthcare network, planning, and social participation. As for technical/healthcare considerations, the main benefits identified were the fostering of multidisciplinary working practices, family focus, reception, rapport, humanization, community orientation, production of care, and performance. The challenges for its improvement are associated with complex factors and require greater political/institutional effort.
Abreu, Tatiana Fernandes Kerches de; Amendola, Fernanda; Trovo, Monica Martins
This article aims to identify the relational technologies used by Family Health Strategy nurses in their daily work when treating patients. Descriptive and cross-sectional study with qualitative approach; conducted between May and July 2015, in three Basic Health Units of the Southern Region of the Municipality of São Paulo, with 19 nurses of the Family Health Strategy. Data were collected through a semi-structured interview, and the speeches were fully transcribed and analyzed according to the technique of content analysis. From the speeches of the participants, three categories emerged, showing the unawareness of the concept, but the valorization of its use; which are the relational technologies used by the participating nurses (communication, listening, empathy and welcoming reception), as well as the report of barriers to the use of relational technologies. Although the nurses value the use of relational technologies, the participants denoted unawareness of the nomenclature and its associated concepts, suggesting superficiality in the understanding and use of these instruments in the context of care in the Family Health Strategy. Identificar as tecnologias relacionais utilizadas por enfermeiros de Estratégia Saúde da Família em seu cotidiano de trabalho no atendimento aos usuários. Estudo descritivo, transversal, com abordagem qualitativa; desenvolvido entre maio e julho de 2015, em três Unidades Básicas de Saúde da Região Sul do Município de São Paulo, com 19 enfermeiros da Estratégia Saúde da Família. Os dados foram coletados por meio de entrevista semiestruturada, e os discursos foram transcritos na íntegra, analisados segundo a técnica de análise de conteúdo. Das falas dos participantes, surgiram três categorias, que evidenciam o desconhecimento do conceito, mas valorização do uso; quais são as tecnologias relacionais utilizadas pelos enfermeiros participantes (comunicação, escuta, empatia e acolhimento), além do relato de barreiras
Millery, Mari; Kukafka, Rita
Health information technology (health IT) has potential for facilitating quality improvement and reducing quality disparities found in underresourced settings (URSs). With this systematic literature review, complemented by key informant interviews, the authors sought to identify evidence regarding health IT and quality outcomes in URSs. The review included 105 peer-reviewed studies (2004-2009) in all settings. Only 15 studies included URSs, and 8 focused on URSs. Based on literature across settings, most evidence was available for quality impact of order entry, clinical decision support systems, and computerized reminders. Study designs were predominantly quasi-experimental (37%) or descriptive (35%); 90% of the studies focused on the microsystem level of quality improvement, indicating a need for expanding research into patient experience and organizational and environmental levels. Key informants highlighted organizational partnerships and health IT champions and emphasized that for health IT to have an impact on quality, there must be an organizational culture of quality improvement.
Andrulis, D P
Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs.
Daniel, C; Mora, B
The integrated project using parasite control and nutrition as entry points for family planning practice has shown considerable success in promoting health consciousness among health workers and project beneficiaries. This progress is evident in the Family Planning, Parasite Control and Nutrition (FAPPCAN) areas. The project has also mobilized technical and financial support from the local government as well as from private and civic organizations. The need for integration is underscored by the following considerations: parasite control has proved to be effective for preventive health care; the integrated project uses indigenous community health workers to accomplish its objectives; the primary health care (PHC) movement depends primarily on voluntary community participation and the integrated project has shown that it can elicit this participation. The major health problems in the Philippines are: a prevalence of communicable and other infectious diseases; poor evironmental sanitation; malnutrition; and a rapid population growth rate. The integrated program utilizes the existing village health workers in identifying problems related to family planning, parasite control and nutrition and integrates these activities into the health delivery system; educates family members on how to detect health and health-related problems; works out linkages with government agencies and the local primary health care committee in defining the scope of health-related problems; mobilizes community members to initiate their own projects; gets the commitment of village officials and committe members. The integrated project operates within the PHC. A health van with a built-in video playback system provides educational and logistical support to the village worker. The primary detection and treatment of health problems are part of the village health workers' responsibilities. Research determines the project's capability to reactivate the village primary health care committees and sustain
Holt, Martin; Treloar, Carla
Little is understood about the self-care activities undertaken by drug treatment clients. Using data from a qualitative study of drug treatment and mental health we identify the self-care practices of drug treatment clients diagnosed with anxiety and depression. Seventy-seven participants were interviewed in four sites across Australia.…
Bachman, Sara S; Comeau, Meg; Long, Thomas F
There is increasing interest in maximizing health care purchasing value by emphasizing strategies that promote cost-effectiveness while achieving optimal health outcomes. These value-based purchasing (VBP) strategies have largely focused on adult health, and little is known about the impact of VBP program development and implementation on children, especially children and youth with special health care needs (CYSHCN). With the increasing emphasis on VBP, policymakers must critically analyze the potential impact of VBP for CYSCHN, because this group of children, by definition, uses more health care services than other children and inevitably incurs higher per person costs. We provide a history and definition of VBP and insurance design, noting its origin in employer-sponsored health insurance, and discuss various financing and payment strategies that may be pursued under a VBP framework. The relevance of these approaches for CYSHCN is discussed, and recommendations for next steps are provided. There is considerable work to be done if VBP strategies are to be applied to CYSHCN. Issues include the low prevalence of specific special health care need conditions, how to factor in a life course perspective, in which investments in children's health pay off over a long period of time, the marginal savings that may or may not accrue, the increased risk of family financial hardship, and the potential to exacerbate existing inequities across race, class, ethnicity, functional status, and other social determinants of health. Copyright © 2017 by the American Academy of Pediatrics.
López Fernández, J C; Masjuan Vallejo, J; Arenillas Lara, J; Blanco González, M; Botia Paniagua, E; Casado Naranjo, I; Deyá Arbona, E; Escribano Soriano, B; Freijo Guerrero, M M; Fuentes, B; Gállego Cullere, J; Geffners Sclarskyi, D; Gil Núñez, A; Gómez Escalonilla, C; Lago Martin, A; Legarda Ramírez, I; Maciñeiras Montero, J L; Maestre Moreno, J; Moniche Álvarez, F; Muñoz Arrondo, R; Purroy García, F; Ramírez Moreno, J M; Rebollo Álvarez Amandix, M; Roquer, J; Rubio Borrego, F; Segura, T; Serrano Ponza, M; Tejada García, J; Tejero Juste, C; Vidal Sánchez, J A
The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24h/7d, nurse ratio, protocols), SU bed ratio/100,000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and
Bisbe, Josep; Barrubés, Joan
Both prior literature and reported managerial practices have claimed that the Balanced Scorecard is a management tool that can help organizations to effectively implement strategies. In this article, we examine some of the contributions, dilemmas, and limitations of Balanced Scorecards in health care organizations. First, we describe the evolution of Balanced Scorecards from multidimensional performance measurement systems to causal representations of formulated strategies, and analyze the applicability of Balanced Scorecards in health care settings. Next, we discuss several issues under debate regarding Balanced Scorecard adoption in health care organizations. We distinguish between issues related to the design of Balanced Scorecards and those related to the use of these tools. We conclude that the Balanced Scorecard has the potential to contribute to the implementation of strategies through the strategically-oriented performance measurement systems embedded within it. However, effective adoption requires the adaptation of the generic instrument to the specific realities of health care organizations. Full English text available from:www.revespcardiol.org. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.
Full Text Available This paper undertakes a content analysis of the discourse on the Open Method of Coordination on Health Care (OMC/HC in order to show how equity and solidarity are increasingly linked to optimisation and, as such, how neoliberalism increasingly frames health care. Some of the side-effects of this reframing for politics are highlighted: legitimating and extending European Union governance, reducing the space for oppositional formations and limited citizenship. The analysis begins by interrogating the broader context of the Lisbon Strategy II, after which the techniques of the OMC/HC and its substantive outputs are analysed.
Scarborough, Jane; Eliott, Jaklin; Miller, Emma; Aylward, Paul
To suggest ways of increasing the cohesiveness of national primary healthcare strategies and hepatitis C strategies, with the aim of ensuring that all these strategies include ways to address barriers and facilitators to access to primary healthcare and equity for people with hepatitis C. A critical review was conducted of the first national Primary Healthcare System Strategy and Health Workforce Strategy with the concurrent Hepatitis C Strategy. Content relating to provision of healthcare in private general practice was examined, focussing on issues around access and equity. In all strategies, achieving access to care and equity was framed around providing sufficient medical practitioners for particular locations. Equity statements were present in all policies but only the Hepatitis C Strategy identified discrimination as a barrier to equity. Approaches detailed in the Primary Healthcare System Strategy and Health Workforce Strategy regarding current resource allocation, needs assessment and general practitioner incentives were limited to groups defined within these documents and may not identify or meet the needs of people with hepatitis C. Actions in the primary healthcare system and health workforce strategies should be extended to additional groups beyond those listed as priority groups within the strategies. Future hepatitis C strategies should outline appropriate, detailed needs assessment methodologies and specify how actions in the broad strategies can be applied to benefit the primary healthcare needs of people with hepatitis C.
... health care provider if you can switch to generic medicines. They have the same active ingredient, but ... Trust for America's Health. A Healthy America 2013: Strategies to Move From Sick Care to Health Care ...
Hopper, J A; Busbin, J W
America is undergoing a profound age shift in its demographic make-up with people 55 and over comprising an increasing proportion of the population. Marketers may need to increase their response rate to this shift, especially in refining the application of marketing theory and practice to older age consumers. To this end, a survey of older couple buying behavior for health insurance coverage is reported here. Results clarify evaluative criteria and the viability of multiple market segmentation for health care coverage among older consumers as couples. Commentary on the efficacy of present health coverage marketing programs is provided.
Vhuromu, E N; Davhana-Maselesele, M
Treatment of the under five years is a national priority as an attempt in curbing deaths and deformities affecting children. Primary health care was implemented in the clinics in order to help in the treatment of illnesses affecting the community, including children. As a result of childhood illnesses; the World Health Organization (WHO) and United Nation Children's Fund (UNICEF) came up with Integrated Management of Childhood illnesses (IMCI) strategy to enhance treatment of such illnesses in developing countries. Primary health care nurses (PHCNS) in Limpopo Province were also trained to implement the strategy. This study is intended to explore and describe the experiences of PHCNS in implementing the IMCI strategy at selected clinics in Vhembe District in the Limpopo Province. A qualitative, explorative, descriptive and contextual design was used. In-depth interviews were conducted with PHCNS who are IMCI trained and have implemented the strategy for a period of not less than two years. Data analysis was done through using Tesch 's method of open coding for qualitative analysis. Findings revealed that PHCNS had difficulty in rendering IMCI services due to lack of resources and poor working conditions. Recommendations address the difficulties experienced by PHCNS when implementing the IMCI strategy.
E. N. Vhuromu
Full Text Available Treatment of the under five years is a national priority as an attempt in curbing deaths and deformities affecting children. Primary health care was implemented in the clinics in order to help in the treatment of illnesses affecting the community, including children. As a result of childhood illnesses; the World Health Organization (WHO and United Nation Children's Fund (UNICEF came up with Integrated Management of Childhood illnesses (IMCI strategy to enhance treatment of such illnesses in developing countries. Primary health care nurses (PHCNS in Limpopo province were also trained to implement the strategy. This study is intended to explore and describe the experiences of PHCNS in implementing the IMCI strategy at selected clinics in Vhembe District in the Limpopo Province. A qualitative, explorative, descriptive and contextual design was used. In-depth interviews were conducted with PHCNS who are IMCI trained and have implemented the strategy for a period of not less than two years. Data analysis was done through using Tesch’s method of open coding for qualitative analysis. Findings revealed that PHCNS had difficulty in rendering IMCI services due to lack of resources and poor working conditions. Recommendations address the difficulties experienced by PHCNS when implementing the IMCI strategy.
Nadirlene Pereira Gomes
Full Text Available OBJECTIVE: to construct a theoretical matrix based on the meanings of the interactions and actions experienced by the professionals regarding the nursing care practices and the health of women in situations of conjugal violence in the ambit of the Family Health Strategy. METHODS: research based in Grounded Theory. Following approval by the Research Ethics Committee, 52 professionals were interviewed in Santa Catarina, Brazil. The analysis was based on open, axial and selective codifications. RESULTS: the theoretical model was delimited based on the phenomenon "Recognizing conjugal violence as a public health problem, and the need for management of the care for the woman", which reflects the experience of the professionals in relation to care for the woman, as well as the meanings attributed to this care. CONCLUSIONS: the phenomenon allows one to understand the movement of action and interaction regarding the care for the woman in a situation of conjugal violence.
Crawford, H A; Barton, B; Wilson, M J; Berman, Y; McKelvey-Martin, V J; Morrison, P J; North, K N
Lifelong health monitoring is recommended in neurofibromatosis type 1 (NF1) because of the progressive and unpredictable range of disabling and potentially life-threatening symptoms that arise. In Australia, strategies for NF1 health surveillance are less well developed for adults than they are for children, resulting in inequalities between pediatric and adult care. The aims of this study were to determine the uptake of health monitoring and capacity of adults with NF1 to self-manage their health. Australian adults with NF1 (n = 94, 18-40 years) participated in a semi-structured interview. Almost half reported no regular health monitoring. Thematic analysis of interviews identified four main themes as to why: (i) did not know where to seek care, (ii) unaware of the need for regular monitoring, (iii) futility of health monitoring as nothing can be done for NF1, and (iv) feeling healthy, therefore monitoring unnecessary. Overall, there were low levels of patient activation, indicating that adults with NF1 lacked knowledge and confidence to manage their health and health care. Findings are discussed in the context of service provision for adults with NF1 in New South Wales, Australia.
Kendall-Gallagher, Deborah; Breslin, Eileen
The success of graduates with a doctor of nursing practice (DNP) degree in transforming health care will depend significantly on their leadership ability to think strategically, innovate, and engage stakeholders in meaningful system improvement. Known as adaptive work, these graduates will need a portfolio of adaptive leadership skills that prepare them to move health care from a volume-driven to value-based system. This article describes development of a core DNP leadership course in a postmaster's point of entry DNP program at an academic health science center school of nursing. The course, designed as DNP students' initial step on their professional development journey to becoming adaptive leaders capable of driving transformative change, created an alternative lens for students to undertake strategic adaptive change initiatives within themselves and their organizations.
Petrochuk, M A; Javalgi, R G
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.
Guo, Kristina L
This article addresses survival strategies of academic health centers (AHCs) in responding to market pressures and government reforms. Using six case studies of AHCs, the study links strategic changes in structure and management to managerial role performance. Utilizing Mintzberg's classification of work roles, the roles of liaison, monitor, entrepreneur, and resource allocator were found to be used by top-level managers as they implement strategies to enhance the viability of their AHCs. Based on these new roles, the study recommends improving management practices through education and training as well as changing organizational culture to support management decision making and foster the continued growth of managers and their AHCs.
Sanchez, Alvaro; Grandes, Gonzalo; Cortada, Josep M; Pombo, Haizea; Martinez, Catalina; Corrales, Mary Helen; de la Peña, Enrique; Mugica, Justo; Gorostiza, Esther
Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care. A descriptive study of 2-year implementation indicators for the PVS clinical intervention was conducted in four primary health care centers. A multifaceted collaborative modeling implementation strategy was developed to enhance the integration of a clinical intervention to promote healthy lifestyles into clinical practice. Process indicators were assessed for intervention reach, adoption, implementation, sustainability and their variability at center, practice, and patient levels. Mean rates of adoption by means of active collaboration among the three main professional categories (family physicians, nurses and administrative personnel) were 75% in all centers. Just over half of the patients that attended (n = 11650; 51.9%) were reached in terms of having their lifestyle habits assessed, while more than a third (33.7%; n = 7433) and almost 10% (n = 2175) received advice or a printed prescription for at least one lifestyle change, respectively. Only 3.7% of the target population received a repeat prescription. These process indicators significantly (p < 0.001) varied by center, lifestyle habit and patient characteristics. Sustainability of intervention components changed thorough the implementation period within centers. The implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of
Martinez, Catalina; Bacigalupe, Gonzalo; Cortada, Josep M; Grandes, Gonzalo; Sanchez, Alvaro; Pombo, Haizea; Bully, Paola
leaders. Our findings indicate that the success of the implementation seems to be associated with the following components: the context, the implementation process, and the collaborative modelling. Identifying barriers and enablers is useful for designing implementation strategies for health promotion in primary health care centers that are essential for innovation success. An implementation model is proposed to highlight the relationships between the CFIR constructs in the context of health promotion in primary care.
Lavoie-Tremblay, Mélanie; Bonneville-Roussy, Arielle; Richer, Marie-Claire; Aubry, Monique; Vezina, Michel; Deme, Mariama
This article describes the contribution of a Transition Support Office (TSO) in a health care center in Canada to supporting changes in practice based on evidence and organizational performance in the early phase of a major organizational change. Semistructured individual interviews were conducted with 11 members of the TSO and 13 managers and clinicians from an ambulatory sector in the organization who received support from the TSO. The main themes addressed in the interviews were the description of the TSO, the context of implementation, and the impact. Using the Competing Value Framework by Quinn and Rohrbaugh [Public Product Rev. 1981;5(2):122-140], results revealed that the TSO is a source of expertise that facilitates innovation and implementation of change. It provides material support and human expertise for evidence-based projects. As a single organizational entity responsible for managing change, it gives a sense of cohesiveness. It also facilitates communication among human resources of the entire organization. The TSO is seen as an expertise provider that promotes competency development, training, and evidence-based practices. The impact of a TSO on change in practices and organizational performance in a health care system is discussed.
Shortell, S M; Morrison, E M; Hughes, S L; Friedman, B S; Vitek, J L
The present findings suggest that the trend toward greater diversification of hospital services is likely to be most strongly influenced by state Medicaid policies and certain hospital characteristics. Increasing Medicaid eligibility and payment levels is likely to have a positive effect on services diversification. Growth in the number of inpatient services provided and a more severe case mix are also likely to be involved with greater service diversification. Affiliation with a not-for-profit hospital system is likely to be associated with more diversified hospital services but not affiliation with an investor-owned system. There is also some indication that the overall portfolio of services which a hospital offers in regard to market share and market growth characteristics influences diversification. Specifically, a low market share portfolio is likely to be associated with less diversification. Competition is likely to be associated with more diversification; particularly for hospitals belonging to systems. The effect of competition on hospital strategy and services diversification is a particularly important area for further investigation. Increasing Medicaid payment and eligibility levels are also likely to have a positive effect on the provision of services which are usually unprofitable. Raising such levels is likely to be particularly beneficial to inner-city hospitals who are already providing a greater number of such services. However, the present data suggest that investor-owned hospitals are least likely to provide such services. Increasing Medicaid eligibility levels is also likely to be associated with fewer services for which charity care has to be provided. State regulation in the form of rate review and certificate of need is likely to be associated with more services for which hospitals provide some charity care. But such policies alone do not deal with the larger issue of how to finance care for the medically indigent. Present data suggest the
Kawamoto, Kensaku; Anstrom, Kevin J; Anderson, John B; Bosworth, Hayden B; Lobach, David F; McAdam-Marx, Carrie; Ferranti, Jeffrey M; Shang, Howard; Yarnall, Kimberly S H
The Chronic Care Model (CCM) is a promising framework for improving population health, but little is known regarding the long-term impact of scalable, informatics-enabled interventions based on this model. To address this challenge, this study evaluated the long-term impact of implementing a scalable, electronic health record (EHR)- enabled, and CCM-based population health program to replace a labor-intensive legacy program in 18 primary care practices. Interventions included point-of-care decision support, quality reporting, team-based care, patient engagement, and provider education. Among 6,768 patients with diabetes receiving care over 4 years, hemoglobin A1c levels remained stable during the 2-year pre-intervention and post-intervention periods (0.03% and 0% increases, respectively), compared to a 0.42% increase expected based on A1c progression observed in the United Kingdom Prospective Diabetes Study long-term outcomes cohort. The results indicate that an EHR-enabled, team- based, and scalable population health strategy based on the CCM may be effective and efficient for managing population health.
Villamil, María Del Pilar; Barrera, David; Velasco, Nubia; Bernal, Oscar; Fajardo, Esteban; Urango, Carlos; Buitrago, Sebastian
While, at its inception in 1993, the health care system in Colombia was publicized as a paradigm to be copied across the developing world, numerous problems in its implementation have led to, what is now, an inefficient and crisis-ridden health system. Furthermore, as a result of inappropriate tools to measure the quality of the health service providers, several corruption scandals have arisen in the country. This study attempts to tackle this situation by proposing a strategy for the quality assessment of the health service providers (Entidades Promotoras de Salud, EPS) in the Colombian health system. In particular, as a case study, the quality of the treatment of stomach cancer is analyzed. The study uses two complementary techniques to address the problem. These techniques are applied based on data of the treatment of gastric cancer collected on a nation-wide scale by the Colombian Ministry of Health and Welfare. First, Data Envelopment Analysis (DEA) and the Malmquist Index (MI) are used to establish the most efficient EPS's within the system, according to indicators such as opportunity indicators. Second, sequential clustering algorithm, related to process mining a field of data mining, is used to determine the medical history of all patients and to construct typical care pathways of the patients belonging to efficient and inefficient EPS's. Lastly, efforts are made to identify traits and differences between efficient and inefficient EPS's. Efficient and inefficient EPS were identified for the years 2010 and 2011. Additionally, a Malmquist Index was used to calculate the relative changes in the efficiency of the health providers. Using these efficiency rates, the typical treatment path of patients with gastric cancer was found for two EPSs: one efficient and another inefficient. Finally, the typical traits of the care pathways were established. Combining DEA and process mining proved to be a powerful approach understanding the problem and gaining valuable
Getzlaf, Beverley A; Osborne, Margaret
Healthcare leaders who develop a critical perspective of the relationship between culture and health; value respect for differences, inclusiveness, equity, and social justice; and use their power to enact these values in their spheres of influence, both professionally and personally, are better able to improve care for a diversity of clients. Graduate students can be assisted to develop such a critical perspective through a course designed as a journey of critical consciousness. We describe this journey that takes students through phases of awareness, reflection, and action in which they come to understand the concepts of critical theory and discourse analysis and begin to use these to create changes in their work settings in the direction of equity and social justice. We suggest broader implications for programs and invite readers to begin their own journeys of critical consciousness.
Slipicevic, Osman; Malicbegovic, Adisa
In Bosnia and Herzegovina citizens receive health care from both public and private providers. The current situation calls for a clear government policy and strategy to ensure better position and services from both parts. This article examines how health care services are delivered, particularly with respect to relationship between public and private providers. The paper notes that the public sector is plagued by a number of weaknesses in terms of inefficiency of services provision, poorly motivated staff, prevalent dual practice of public employees, poor working conditions and geographical imbalances. Private sector is not developing in ways that address the weaknesses of the public sector. Poorly regulated, it operates as an isolated entity, strongly profit-driven. The increasing burdens on public health care system calls for government to abandon its passive role and take action to direct growth and use potential of private sector. The paper proposes a number of mechanisms that can be used to influence private as well as public sector, since actions directed toward one part of the system will inevitable influence the other. PMID:23678309
Carlfjord, S; Andersson, A; Nilsen, P; Bendtsen, P; Lindberg, M
The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC. © 2010 Blackwell Publishing Ltd.
Park, Melissa M; Lencucha, Raphael; Mattingly, Cheryl; Zafran, Hiba; Kirmayer, Laurence J
The Mental Health Commission of Canada worked collaboratively with stakeholders to create a new framework for a federal mental health strategy, which is now mandated for implementation by 2017. The proposed strategies have been written into provincial health plans, hospital accreditation standards, and the annual objectives of psychiatric departments and community organizations. This project will explore the decision-making process among those who contributed to Canada's first federal mental health policy and those implementing this policy in the clinical setting. Despite the centrality of ethical reasoning to the successful uptake of the recent national guidelines for recovery-oriented care, to date, there are no studies focused exclusively on the ethical tensions that emerged and continue to emerge during the creation and implementation of the new standards for recovery-oriented practice. This two-year Canadian Institute of Health Research Catalyst Grant in Ethics (2015-2017) consists of three components. C-I, a retrospective, qualitative study consisting of document analysis and interviews with key policy-makers of the ethical tensions that arose during the development of Canada's Mental Health Strategy will be conducted in parallel to C-II, a theory-based, focused ethnography of how mental health practitioners in a psychiatric setting reason about and act upon new standards in everyday practice. Case-based scenarios of ethical tensions will be developed from C-I/II and fed-forward to C-III: participatory forums with policy-makers, mental health practitioners, and other stakeholders in recovery-oriented services to collectively identify and prioritize key ethical concerns and generate action steps to close the gap between the policy-making process and its implementation at the local level. Policy-makers and clinicians make important everyday decisions that effect the creation and implementation of new practice standards. Particularly, there is a need to
Santos, Wagner Jorge dos; Giacomin, Karla Cristina; Firmo, Josélia Oliveira Araújo
In the health field, technologies of care relations are in the scope of the worker-user encounter, implying intersubjectivity with the development of relationships between subjects, resulting in action. Evaluation studies synthesize knowledge produced on the consequences of using these technologies for society. This anthropological study aims to understand the perception of the elderly regarding the resolution capability and effectiveness of the acts produced in health care relationships in the context of the Family Health Strategy (ESF). The group studied consisted of 57 elderly residents in Bambui, State of Minas Gerais, Brazil. The model of signs, meanings and actions was used for collecting and analyzing data and the semi-structured interview was applied as a research technique. Elderly individuals assess resolution capability and effectiveness of the acts of care in the ESF as negative, with relation to the quality of user and professional interaction. The ESF is not effective and the desired change in the health care model has not occurred in practice. It repeats the centrality of the medical-drug-procedure model that treats the disease rather than the patient, perceiving old age as a disease and illness as being related to aging.
Carter, M.W.; Hans, Elias W.; Kolisch, R.
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
Reijneveld, SA; Brugman, E; Verhulst, FC; Verloove-Vanhorick, SP
Psychosocial problems in pre-school children: recognition and strategy applied by doctors and nurses in child health care Objective. To assess the degree to which preventive child health professionals (CHPs) identify and manage psychosocial problems among pre-school children in the general
Bhutta, Zulfiqar A; Ali, Samana; Cousens, Simon; Ali, Talaha M; Haider, Batool Azra; Rizvi, Arjumand; Okong, Pius; Bhutta, Shereen Z; Black, Robert E
Several recent reviews of maternal, newborn, and child health (MNCH) and mortality have emphasised that a large range of interventions are available with the potential to reduce deaths and disability. The emphasis within MNCH varies, with skilled care at facility levels recommended for saving maternal lives and scale-up of community and household care for improving newborn and child survival. Systematic review of new evidence on potentially useful interventions and delivery strategies identifies 37 key promotional, preventive, and treatment interventions and strategies for delivery in primary health care. Some are especially suitable for delivery through community support groups and health workers, whereas others can only be delivered by linking community-based strategies with functional first-level referral facilities. Case studies of MNCH indicators in Pakistan and Uganda show how primary health-care interventions can be used effectively. Inclusion of evidence-based interventions in MNCH programmes in primary health care at pragmatic coverage in these two countries could prevent 20-30% of all maternal deaths (up to 32% with capability for caesarean section at first-level facilities), 20-21% of newborn deaths, and 29-40% of all postneonatal deaths in children aged less than 5 years. Strengthening MNCH at the primary health-care level should be a priority for countries to reach their Millennium Development Goal targets for reducing maternal and child mortality.
This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.
Opiate dependency is a medical disorder that requires treatment intervention. Primary health care not only entails treatment of illness but also involves disease prevention and health promotion. Based on Pender's revised Health Promotion Model, a descriptive study comparing the health promoting behaviors/practices in abusing and recovering opiate-dependent drug users is analyzed. Using the Health Promoting Lifestyle Profile II, a comparative descriptive, exploratory, nonexperimental design study was conducted to identify key health-promoting behaviors in recovering opiate-dependent drug users. Prevention strategy recommendations are discussed, along with future research recommendations.
Balakrishnan, Ramkrishnan; Gopichandran, Vijayaprasad; Chaturvedi, Sharadprakash; Chatterjee, Rahul; Mahapatra, Tanmay; Chaudhuri, Indrajit
was equity of services across castes for all the indicators. Timely capture of data was also ensured compared to paper-based reporting. By virtue of its impact on quality, efficiency and equity of service delivery, health care manpower efficiency and governance, the mHealth inclusion at service provision level can be one of the potential strategy to strengthen the health system.
Andela, Marie; Auzoult, Laurent; Truchot, Didier
The goal of this study was to assess relations between public self-consciousness, private self-consciousness (self-reflectiveness and internal state awareness), and two emotion-regulation strategies: cognitive reappraisal and expressive suppression. 59 employees of a public hospital completed a survey. Public self-consciousness was not associated with either emotion-regulation strategy, while both dimensions of private self-consciousness were related to the strategies. While self-reflectiveness was correlated with expressive suppression, internal states awareness was associated with cognitive reappraisal.
Full Text Available BACKGROUND: Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs. We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. METHODS: The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. RESULTS: Of 258 initially active participants, 225 (225/258=87.2% successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85% attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001. The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001. A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills. CONCLUSION: This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills
Flys, Tamara; González, Rosalba; Sued, Omar; Suarez Conejero, Juana; Kestler, Edgar; Sosa, Nestor; McKenzie-White, Jane; Monzón, Irma Irene; Torres, Carmen-Rosa; Page, Kathleen
Background Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. Methods The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. Results Of 258 initially active participants, 225 (225/258 = 87.2%) successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200 = 85%) attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001). The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001). A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills. Conclusion This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills acquired
Francine Baltazar Assad
Full Text Available Introduction: The psychosocial rehabilitation centered care in experience with the suffering, thus breaking with the hegemonic logic of disease-focused care. Occupational therapy has supported this detachment, with actions targeting the daily life to achieve social inclusion and autonomy of people with a diagnosis of mental disorder. Objective: To identify the care strategies used by occupational therapists in psychosocial care centers and understand how these strategies contribute to psychosocial rehabilitation. Method: Descriptive Study of qualitative approach, with five occupational therapists of three psychosocial care centers that responded to an interview, which was recorded, transcribed and analyzed by thematic content analysis. Results: Were extracted the categories: Integral Care Strategies; Singular Care Strategies and Interdisciplinary Care Strategies. Another category, Understanding and expansion of everyday life, referred to the contribution in psychosocial rehabilitation. The specificity was diluted between the possibilities of actions, because the strategies are common to other professional groups, but are guided by a new conception of health care from the perspective of integrality and network. From the understanding and expansion of everyday life as a contribution of occupational therapy, emerged the specificity of the group and its contribution in psychosocial rehabilitation. Some strategies have been punctual and effectuated in the service itself; however, many have reached the territory. Conclusion: There is a need for reports of occupational therapists practices even if in care projects common to other groups, in order to keep up with the discussions on strengthening the professional institutionalization in country.
Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi-Araba, P.M.B. ... the child's health, culturally based beliefs and ..... immunization safety as this was a rural ... Charles SW, Olalekan AU, Peter MN,.
Landman, Natalie; Aannestad, Liv K; Smoldt, Robert K; Cortese, Denis A
It is becoming increasingly clear that maintaining and improving the health of the population, and doing so in a financially sustainable manner, requires the coordination of acute medical care with long-term care, and social support services, that is, team-based care. Despite a growing body of evidence on the benefits of team-based care, the health care ecosystem remains "resistant" to a broader implementation of such care models. This resistance is a function of both system-wide and organizational barriers, which result primarily from fragmentation in reimbursement for health care services, regulatory restrictions, and the siloed nature of health professional education. To promote the broader adoption of team-based care models, the health care system must transition to pay for value reimbursement, as well as break down the educational silos and move toward team-based and value-based education of health professionals.
马俊凤; 李杰; 庄辉
Health care workers are among the high-risk populations for hepatitis B virus (HBV) infection as they have more opportunities exposing to blood or other body fluids from HBV infected patients.The main routes of HBV infection are needle sticks or sharp injuries for health care workers.Vaccination is the most effective measure to prevent HBV infection in this population.The prevalence of HBsAg varies because of different immunization strategies and vaccination coverage rates of health care workers in different regions.In Europe such as France,all of the health care workers except housekeeping and supporting staff must be vaccinated compulsorily and the vaccination coverage rate reached up to 97.0％,which resulted in a quick decrease in HBV infection.In America such as United States,each medical facility is required to provide hepatitis B vaccine free for its health care workers.In 2006,the vaccination coverage rate in USA was 90.0％,and HBV infection rate (1.0× 10-4) was lower than that in general population (5.0 × 10-4).In East Mediterranean countries such as Pakistan,the vaccination coverage rate in health care workers was 73.4％ but no immunization strategy for them was found.The relatively high vaccination coverage rate decreased the rate of HBsAg carrier to 0.6％-2.2％,lower than that in the regular population (6.0％).In Africa such as Uganda,only 6.2％ of health care workers had history of HBV vaccination,and HBsAg carrier rate was as high as 9.0％.Uganda is currently drafting hepatitis B vaccination strategies for health care workers.In Western Pacific area such as Hong Kong and Taiwan of China,the vaccination coverage rates in health care workers were 85.0％ and 73.7 ％ respectively,but the vaccination strategies were unclear.In 2009,we investigated the HBV infection status in 3 126 health care workers in Jilin province of China,and the positive rates of HBsAg and antiHBc were 1.4％ and 33.4％,respectively,which were lower than that in common
Schabetsberger, Thomas; Gross, Erich; Haux, Reinhold; Lechleitner, Georg; Pellizzari, Thomas; Schindelwig, Klaus; Stark, Christian; Vogl, Raimund; Wilhelmy, Immanuel
Today, information processing in healthcare facilities is usually primarily directed towards the information needs of the respective institution. This stands in apparent contradiction to the fact that patients may not be solely treated in one general practice or hospital. More information processing towards patient-centered, shared care would better support high quality as well as efficient health care. We developed a stepwise approach transforming trans-institutional information system architectures (TISAs) from an inefficient state caused by redundancy and media cracks towards a state which better supports patient centered, shared care. In a total of three steps we want to establish electronic communication between existing information systems of different healthcare facilities for transmission of discharge summaries and diagnostic results. In further stages we plan to expand this communication solution to a regional comprehensive and consistent electronic patient record for multiple hospitals and general practices in Tyrol, Austria. In addition, two related approaches towards supporting shared care have been compared with our approach. The aim of this paper is to report on our approach and first experiences.
Cumming, Jacqueline; Mays, Nicholas
Since 2001, implementation of a New Zealand's Primary Health Care Strategy (the Strategy) has led to an increase in the proportion of primary health care services which are publicly funded, the development of 82 primary health organisations (PHOs) to oversee primary health care services and universal public capitation funding of PHOs. This approach has replaced the previous system of fee-for service targeted public subsidies paid to individual general practitioners (GPs). Patient copayments, although at a reduced level but still set by individual practitioners, have remained a core feature of the system. This paper focuses on the implementation and impact of key policy changes over the first five years of the Strategy. Although patient copayments have fallen and consultation rates have increased, the new funding and payment system has raised a number of unresolved issues - whether to retain the new universal funding system or revert to the former targeted approach; how to achieve the potential gains from capitation when GPs continue to receive their income from a variety of sources and in a variety of different ways; and how to manage the potential for 'cream skimming'. Recent improvements in access may, in time, improve health status and reduce inequalities in health, but there is no guarantee that a universal system will necessarily improve average health or reduce inequalities. Much depends on the services being delivered and the populations that are benefiting most - something New Zealand needs better evidence on before determining future policy directions in primary health care.
Kroth, Michael; Keeler, Carolyn
The purpose of this article is to broaden the discourse about caring as a managerial strategy by describing caring from three perspectives: nursing, education, and management. The authors suggest that current organizational models inadequately address the caring connection between manager and employee. Definitions of managerial caring and care…
McWilliam, C. L.
The current emphasis on health promotion raises questions among experienced health professionals. Many wonder whether such care differs from what we have always done and have doubts about cost effectiveness and government motives. This paper explores the latest meaning of the term health promotion, the evolution of strategies to promote health, and the implications of these strategies for practising family medicine.
Monaghan, Dr Hugh
The National Rehabilitation Hospital was one of a number of sites that contributed to a research study in the area of music therapy service development. This research aimed to examine the experiences of expert music therapists in developing new work and to identify strategies for introducing a new role to an existing healthcare team.\\r\
Sarrami-Foroushani, Pooria; Travaglia, Joanne; Debono, Deborah; Braithwaite, Jeffrey
There is growing recognition of the importance of the active involvement of consumers and community members in health care. Despite the long history of consumer and community engagement (CCE) research and practice, there is no consensus on the best strategies for CCE. In this paper, we identify various dimensions of CCE-related strategies and offer a practical model to assist policy-makers, practitioners and researchers. We undertook a large-scale, scoping meta-review and searched six databases using a list of nine medical subject headings (MeSH) and a comprehensive list of 47 phrases. We identified and examined a total of 90 relevant systematic reviews. Identified reviews show that although there is a significant body of research on CCE, the development of the field is hindered by a lack of evidence relating to specific elements of CCE. They also indicate a diverse and growing enterprise, drawing on a wide range of disciplinary, political and philosophical perspectives and a mix of definitions, targets, approaches, strategies and mechanisms. CCE interventions and strategies aim to involve consumers, community members and the public in general, as well as specific sub-groups, including children and people from culturally and linguistically diverse backgrounds. Strategies for CCE vary in terms of their aim and type of proposed activity, as do the methods and tools which have been developed to support them. Methods and tools include shared decision making, use of decision aids, consumer representation, application of electronic and internet-based facilities, and peer support. The success of CCE is dependent on both the approach taken and contextual factors, including structural facilitators such as governmental support, as well as barriers such as costs, organisational culture and population-specific limitations. The diversity of the field indicates the need to measure each component of CCE. This meta-review provides the basis for development of a new eight stage
The fact that I have used for this article the title proposed by the organizers of this conference does not mean that I agree with the philosophy which inspires it: a philosophy of means instead of a philosophy of finalities. Indeed, the use of computers in health care is not unavoidable simply because computers do exist. This is a mistake that has frequently been made since the beginning, and which is probably the source of most of our illusions and delusions. Computers are tools, and no more, and we must and can resist the 'instrumental reason' criticized in depth by philosophers such as R. Garaudy , M. Henry , E. Morin , and scientists like J. Weizenbaum . I would prefer to reverse the question of how to use computers in health care and answer the following ones: What are the main information problems in medicine and health? and What is the part of computer technology in their solution? Connected to these questions is the consideration of the mental, intellectual, cultural, and even ethical impact of the machinery on its designers and users. With regard to the latter, I will mention the benefits of a better methodological education and the threat of an excessive rationalistic drift. This ethical consideration will lead me back to a brief discussion of 'instrumental reason'. This discussion will thus provide guidelines and caveats rather than true strategic recommendations. It will deal with attitudes more than with specific actions. Indeed, we cannot escape some kind of consideration of our humanity, and the mutual relationship between technology and our existence and actions.
Valerio Nobili; Melania Manco
Non-alcoholic steato-hepatitis (NASH) is related to insulin resistance and, thus, frequently occurs as part of the metabolic changes that accompany obesity, diabetes and hyperlipidemia. In childhood, the overwhelming boost of obesity and its co-morbidities have lead to the extraordinarily increased prevalence of NASH.Establishing effective therapeutic strategies to treat the disease represents the challenge for hepatologists and gastroenterologists in the next decade. Therapeutic approaches have aimed at treating associated conditions (obesity, insulin resistance, hyperlipemia, etc) or reducing liver oxidative damage (vitamin E).
Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier
Background The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. Methods From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Results Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Conclusion Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. PMID:24581011
Kepler, Kalle; Vladimirov, Anatoli
In recent years, starting from 2001, conventional film-screen radiography has been rapidly replaced by digital (mostly by computed radiography, CR) techniques in Estonia. New strategies for optimisation and quality assurance for digital radiography have been introduced by the DIMOND III and SENTINEL partners recently. It includes consideration to diagnostic requirements of a given clinical situation, but also objectivation and standardisation of image quality, e.g. using CDRAD test phantom, and constancy testing. The aim of this work is to evaluate the performance of an automatic exposure control (AEC) at different sensitivities when used with the Fujifilm CR system. Image quality, using threshold contrast-detail detectability (TCDD) and signal-to-noise ratio squared related to dose (SNR2/D), was also investigated for different sensitivities and tube potential values for this combination. Based on the image evaluation data, optimum speed modes for the organ programme settings have been proposed.
Ribeiro Andréia Q
Full Text Available Abstract Background Poor adherence to non-pharmacological treatment of hypertension represents a serious challenge for public health policies in several countries. This study was conducted to compare two intervention strategies regarding the adherence of adult women to dietary changes recommended for the treatment of hypertension in a community covered by Primary Health Care Unit. Methods This study is a randomized controlled trial of a sample composed of 28 women with hypertension enrolled in the Primary Health Care Unit located in the urban area of southeastern Brazil. The participants were already undergoing treatment for hypertension but devoid of nutritional care; and were divided into two groups, each composed of 14 individuals, who received interventions that consisted of two different strategies of nutritional guidance: monthly health education workshops alone (Group 1 and combined with family orientation through home visits (Group 2. Adherence to nutritional guidelines was evaluated by dietary, anthropometric, clinical and serum biochemical parameters, measured before and after the interventions. Knowledge on control and risk of hypertension was also investigated. The study lasted five months. Results Mean age was 55.6 (± 2.8 and 50.7 (± 6.5 in the groups 1 and 2, respectively. The home orientation strategy promoted greater adherence to dietary changes, leading to a statistically significant improvement in the clinical, anthropometric, biochemical and dietary parameters. The group 2 reduced the consumption of risk foods (p = 0.01, oil (p = 0.002 and sugar (p = 0.02, and decreased body mass index (-0.7 kg/m2; p = 0.01; waist circumference (-4.2 cm; p = 0.001, systolic blood pressure (-13 mm HG; p = 0.004 and glycemia (-18.9 mg/dl; p = 0. 01. In group 1 only waist circumference (-2 cm; p = 0.01 changed significantly. Conclusion Nutritional orientations at the household level were more effective with regard to the adherence of
Full Text Available The paper presents a comprehensive study on assessing family physicians’ activity in terms ofoccupational medicine. The research was organized and conducted in 30 primary health careinstitutions. It evaluated the amount of work of 221 family physicians over a week period, out ofwhich about 97.4% are women with an average age of 43 and who have been working in thisprofession for 8.5 years. Its aim was to identify the factors that induce occupational stress to familyphysicians. The applied value of the research consists in providing information about the causes ofstress in the activity of family physicians, making them aware of the consequences of occupationalstress, and providing measures for coping with it. By rating the frequency of occupational riskfactors, we have obtained the occupational diagram of the family physician. We have alsoproposed ways to prevent occupational stress.
catastrophic health expenditures (CHE) and risk of being impoverished as a result of cost of care were assessed. Statistical ... Impact and contributors to cost of managing long term conditions in a ... sectors is ongoing, it has become clear that.
Journal of Community Medicine and Primary Health Care. ... This is one of the factors that determine whether or ..... Expired vaccines found in fridge / cold box .... date vaccine temperature monitoring charts. were stored on refrigerator door ...
This was a cross-sectional, multi clinic study involving 265 mothers whose children had erupted at least a tooth and attending the ... parents, health care workers and personal experiences were the sources of beliefs ..... Ethiopians abroad.
Lukito, Widjaja; Wibowo, Lindawati; Wahlqvist, Mark L
Despite progress with the food-associated health agenda in the public health and clinical domains, much remains to be done in Indonesia. There are reasons to be optimistic which include economic development, increasing literacy, progress towards universal health coverage and community organizational arrangements across the archipelago which focus on health through some 10,000 puskesmas. These community health centres are variably staffed with voluntary cadres from the community, bidans (nurses) and general medical practitioners. For more effective prevention and management of nutritionally-related health problems, innovative community and clinical nutrition research and expertise is required. With rapid urbanisation, the growth of the digital economy, increasing socio-economic inequity and climate change, there are imperatives for ecologically sustainable, nonemployment dependent livelihoods which provide energy, food, water, education and health care security. A relevant health care workforce will include those who research and practice clinical nutrition. Here we gather together an account of an extensive body of published and emerging literature which makes a case collectively for a more ecological approach to nutrition and health and how it might revitalise the Indonesian and other health care systems.
Full Text Available ABSTRACT The Electronic Medical Records EMRs are the primary sources to study the enhancement of health and medical care. The rapid development in science and medical technology has produced various methods to detect verify prevent and treat diseases. This has led to the generation of big health-care data and difficulties in processing and managing data. To capture all the information about a patient and to get a more detailed and complete view for insight into care coordination and management decisions big data technologies can be used. A more detailed and complete picture about patients and populations can be identified along with patients at risk before any health issue arises. Optimal strategies to commercialize treatments and the next generation of health care treatments can be identified and developed by it.
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...... 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...... are important, but that economics cannot alone explain the differences in health care utilization....
La Rosa-Salas, Virginia; Tricas-Sauras, Sandra
It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which this health care equity paper is based are fundamental human rights. The main aim is to ensure the implementation of these essential rights by those carrying out public duties. Viewed from this angle, equity in health care means equality: equality in access to services and treatment, and equality in the quality of care provided. As a result, this paper attempts to address both human dignity and efficiency through the context of equity to reconcile them in the middle ground.
This paper aims to contribute to the dissemination of notions and techniques of economic study with a view to integrate these into strategy decisions of payment rationalization and the search for clinical effectiveness. It includes a literature review covering the category of expenses and reimbursement in health issues, the methodologies of pharmaco-economics revision, cost-minimization, cost-benefits, cost-effectiveness and cost-utility analysis, as well as its main characteristics, advantages, disadvantages and applicability.
Hawthorne, Henry C; Masterson, David J
Principles of Lean management are being adopted more widely in health care as a way of improving quality and safety while controlling costs. The authors, who are chief executive officers of rural North Carolina hospitals, explain how their organizations are using Lean principles to improve quality and safety of health care delivery.
Cooper, P D
Health Care Marketing Management is the process of understanding the needs and the wats of a target market. Its purpose is to provide a viewpoint from which to integrate the analysis, planning, implementation (or organization) and control of the health care delivery system.
Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W
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.
Jul 31, 2014 ... Key Words: Primary Health Care, Strategies for implementation, Constraints, Alma Ata Declaration, Nigeria. 4th June, 2014. Accepted: ... including family planning; immunization against the ... evolved to meet the challenges associated with these diversities. .... and urban areas in Nigeria with the intention of.
... and Human Services Indian Health Service The Federal Health Program for American Indians and Alaska Natives Feedback ... Forgot Password IHS Home Find Health Care Find Health Care IMPORTANT If you are having a health ...
Perlin, Johnathan B; Kolodner, Robert M; Roswell, Robert H
The Veterans Health Administration is the United States' largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators. Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.
Florence F Folami
Full Text Available Background: The use of complementary and alternative medicine (CAM has increased tremendously in the past decades. Herbs in this study involved the use of plant products in their raw or cooked forms which have not been subjected to laboratory investigations for their safety and efficacy. Objective: To explore strategies to reduce barriers in reporting herbal use to the health-care provider among childbearing age women in two communities in Ogun state, Nigeria. Materials and Methods: A descriptive cross-sectional survey was used to explore strategies to reduce barriers in reporting herbal use to the health-care provider. The study population constitutes childbearing age women that attend two private hospitals and one comprehensive health center in two communities of Ogun state, Nigeria. Out of the 270 patients who were randomly sampled for the study, 250 agreed to participate (response rate: 92.6%. Results: The mean age of the participants was 29.3 years ± 5.5 and 77.6% were married. The majority (69% had used herbal medicines in the last 6 months before seeking medical care, and 66% did not disclose the use of herbal medicines to health-care providers. Conclusion: Health-care professionals should routinely include herbal remedy category in the list of drug history when asking about the patient's drug. This will help identify herbal remedy use and assist to take precautions relating to safety. Patients and traditional birth attendants should be educated through community mobilization and educational programs about alternative medicines particularly herbal. The disclosure of CAM use and its adverse outcomes should be encouraged by health-care professionals.
El-Jardali, Fadi; Fadlallah, Racha
Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking
Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda
ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care were...... assessed: Compliance with current guidelines on initiation of 1) combination antiretroviral therapy (cART), 2) chemoprophylaxis, 3) frequency of laboratory monitoring, and 4) virological response to cART (proportion of patients with HIV-RNA 90% of time on cART). RESULTS: 7097 Euro...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p HIV health care utilization...
Full Text Available Abstract Background Most services provided by health and social care organisations for older people living at home rely on interprofessional working (IPW. Although there is research investigating what supports and inhibits how professionals work together, less is known about how different service models deliver care to older people and how effectiveness is measured. The aim of this study was to describe how IPW for older people living at home is delivered, enacted and evaluated in England. Method An online survey of health and social care managers across England directly involved in providing services to older people, and a review of local strategies for older people services produced by primary care organisations and local government adult services organisations in England. Results The online survey achieved a 31% response rate and search strategies identified 50 local strategies that addressed IPW for older people living at home across health and social care organisations. IPW definitions varied, but there was an internal consistency of language informed by budgeting and organisation specific definitions of IPW. Community Services for Older People, Intermediate Care and Re-enablement (rehabilitation Teams were the services most frequently identified as involving IPW. Other IPW services identified were problem or disease specific and reflected issues highlighted in local strategies. There was limited agreement about what interventions or strategies supported the process of IPW. Older people and their carers were not reported to be involved in the evaluation of the services they received and it was unclear how organisations and managers judged the effectiveness of IPW, particularly for services that had an open-ended commitment to the care of older people. Conclusion Health and social care organisations and their managers recognise the value and importance of IPW. There is a theoretical literature on what supports IPW and what it can achieve
Perry, Henry; Morrow, Melanie; Borger, Sarah; Weiss, Jennifer; DeCoster, Mary; Davis, Thomas; Ernst, Pieter
In view of the slow progress being made in reducing maternal and child mortality in many priority countries, new approaches are urgently needed that can be applied in settings with weak health systems and a scarcity of human resources for health. The Care Group approach uses facilitators, who are a lower-level cadre of paid workers, to work with groups of 12 or so volunteers (the Care Group), and each volunteer is responsible for 10-15 households. The volunteers share messages with the mothers of the households to promote important health behaviors and to use key health services. The Care Groups create a multiplying effect, reaching all households in a community at low cost. This article describes the Care Group approach in more detail, its history, and current NGO experience with implementing the approach across more than 28 countries. A companion article also published in this journal summarizes the evidence on the effectiveness of the Care Group approach. An estimated 1.3 million households—almost entirely in rural areas—have been reached using Care Groups, and at least 106,000 volunteers have been trained. The NGOs with experience implementing Care Groups have achieved high population coverage of key health interventions proven to reduce maternal and child deaths. Some of the essential criteria in applying the Care Group approach include: peer-to-peer health promotion (between mothers), selection of volunteers by mothers, limited workload for the volunteers, limited number of volunteers per Care Group, frequent contact between the volunteers and mothers, use of visual teaching tools and participatory behavior change methods, and regular supervision of volunteers. Incorporating Care Groups into ministries of health would help sustain the approach, which would require creating posts for facilitators as well as supervisors. Although not widely known about outside the NGO child survival and food security networks, the Care Group approach deserves broader
Dahlgren, G; Diderichsen, Finn
In recent years the Swedish debate on health policy has been focusing on resource allocation between primary care versus secondary care, private care versus public care, and prevention versus care. The National Commission on the "Swedish Health Services in the 1990s" brought attention to the prev...... to the prevailing inequalities in health. The Health Policy Bill of 1985 defines the reduction of inequalities in health as a major target of national health policy. The health policy measures discussed are mainly outside the health care sector....
Gonzalo, Jed D; Dekhtyar, Michael; Hawkins, Richard E; Wolpaw, Daniel R
As health systems evolve, the education community is seeking to reimagine student roles that combine learning with meaningful contributions to patient care. The authors sought to identify potential stakeholders regarding the value of student work, and roles and tasks students could perform to add value to the health system, including key barriers and associated strategies to promote value-added roles in undergraduate medical education. In 2016, 32 U.S. medical schools in the American Medical Association's (AMA's) Accelerating Change in Education Consortium met for a two-day national meeting to explore value-added medical education; 121 educators, systems leaders, clinical mentors, AMA staff leadership and advisory board members, and medical students were included. A thematic qualitative analysis of workshop discussions and written responses was performed, which extracted key themes. In current clinical roles, students can enhance value by performing detailed patient histories to identify social determinants of health and care barriers, providing evidence-based medicine contributions at the point-of-care, and undertaking health system research projects. Novel value-added roles include students serving as patient navigators/health coaches, care transition facilitators, population health managers, and quality improvement team extenders. Six priority areas for advancing value-added roles are student engagement, skills, and assessments; balance of service versus learning; resources, logistics, and supervision; productivity/billing pressures; current health systems design and culture; and faculty factors. These findings provide a starting point for collaborative work to positively impact clinical care and medical education through the enhanced integration of value-added medical student roles into care delivery systems.
Lifestyle Changes and the Risk of Colorectal Cancer among. Immigrants in the United .... food rich in red meat, animal fat, sugars and refined of CRC in Africa .... region to improve health care delivery and secure the is obtainable in the UK, ...
Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre
through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries...... in children? What ways can doctors of chiropractic stay updated on evidence-based information about vaccines and immunization throughout the lifespan? Can smoking cessation be a prevention strategy for back pain? Does chiropractic have relevance within the VA Health Care System for chronic pain and comorbid...... of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?...
Mekonnen, Robin; Noonan, Kathleen; Rubin, David
This article reviews the challenges health care systems face as they attempt to improve health care outcomes for children in foster care. It discusses several of the promising health care strategies occurring outside the perimeter of child welfare and identifies some of the key impasses in working alongside efforts in child welfare reform. The authors posit that the greatest impasse in establishing a reasonable quality of health care for these children is placement instability, in which children move frequently among multiple homes and in and out of the child welfare system. The authors propose potential strategies in which efforts to improve placement stability can serve as a vehicle for multidisciplinary reform across the health care system.
Hollnagel, E.; Braithwaite, J.; Wears, R. L.
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......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...
... Disease (Nephropathy) Gastroparesis Mental Health Step On Up Treatment & Care Blood Glucose Testing Medication Doctors, Nurses & More ... us get closer to curing diabetes and better treatments for those living with diabetes. Other Ways to ...
Curtiss, F R
The fundamental components of managed-care plans are described; the development of managed-care programs is discussed; and the impact of managed care on pharmacy services and the price, quality, and accessibility of health care are reviewed. Health care can be considered to be managed when at least one of the following fundamental components is present: prospective pricing, "UCR" (usual, customary, and reasonable) pricing of services, peer review, mandatory use review, benefit redesign, capitation payments, channeling, quality criteria, and health promotion. The managed-care industry consists of health maintenance organizations (HMOs), preferred provider organizations (PPOs), and managed fee-for-service plans. Managed-care reimbursement principles involve transferring some or all of the impetus for controlling use of services to the health-care provider. Means by which this is done include prospective pricing, services bundling, price discounts and negotiated fees, and capitation financing and reimbursement. Financial risk-sharing arrangements with providers--including hospitals, physicians, pharmacies, and home-care companies--are necessary for any managed-care plan to attain true control over its service costs. Use-review and use-management services are also fundamental to containing health-care spending. These include retrospective, concurrent, and prospective reviews of the necessity and appropriateness of medical services. Use management, like services bundling and prospective pricing, has been more effective in reducing costs of hospital inpatient services than costs associated with ambulatory care. Per case payments and services bundling have made individual charges for items irrelevant to hospital revenue. This has forced hospital pharmacy managers to become more sensitive to cost management. Drug formularies, improved productivity, and use of prescribing protocols are means by which hospital pharmacies have controlled costs. However, since shorter hospital
Ramsaran-Fowdar, Roshnee R
Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings.
Full Text Available OBJECTIVES: Efforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship. METHODS: We undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence. FINDINGS: Methodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions. CONCLUSION: Existing evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.
Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja
The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.
Full Text Available Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP have issued guidelines for the countries′ health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now.
Rustagi, Neeti; Singh, Ritesh
Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries’ health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now. PMID:21120080
Rustagi, Neeti; Singh, Ritesh
Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries' health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now.
As part of the primary care strategy, the Governments of the Americas have included the agricultural and animal health sectors among the public health activities of the Plan of Action. This means that both sectors--agricultural and veterinary--must be guided in their work by a multidisciplinary and multisectoral approach, with full community participation. Hence, it is certain that both the study of veterinary medicine and the practice of the profession in the Region will have to be reoriented so that they may be more fully integrated with the primary care strategy. The reorientation of animal health activities is the subject of this paper. There can be no doubt that animal health has a vital part to play in improving the quality of human life and that veterinary practice itself offers excellent opportunities for building a sense of personal and community responsibility for the promotion, care, and restoration of health. Through their contact with the rural population while caring for their livestock (an integral part of the rural socioeconomic structures), the veterinarian and animal health assistant establish close bonds of trust not only with farmers, but with their families and the entire community as well; they are thus well placed to enlist community participation in a variety of veterinary public health activities such as zoonoses control, hygiene programs, and so forth. While the goal of the Plan of action is to extend primary care to the entire population, the lack of material and human resources requires that priority attention be given to the needs of the more vulnerable groups, including the extremely poor living in rural and urban areas. These are the groups at greatest risk from the zoonoses still present in the Americas. In the face of these facts, it is clear that primary care in the animal health field should be based on the application in each country of proven, effective, appropriate technology by personnel who, whether new or retrained, are well
The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.
Development of primary care in Japan in still relatively unorganized and unstructured. As mentioned above, the author describes some strengths and weaknesses of the Japanese primary care system. In addressing the weaknesses the following suggestions are offered for the Japanese primary care delivery system: Increase the number of emergency rooms for all day, especially on holidays and at night. Introduce an appointment system. Introduce an open system of hospitals. Coordinate with public hospitals and primary care clinics. Organize the referral system between private practitioners and community hospitals. Increase the number of paramedical staff. Strengthen group practice among primary care physicians. Increase the establishment of departments of primary care practice with government financial incentives to medical schools and teaching hospitals. Develop a more active and direct teaching role for primary care practice or family practice at undergraduate, graduate, and postgraduate levels. Improve and maintain present health insurance payment method, shifting from quantity of care to quality and continuity of care. Introduce formal continuing education. Introduce formal training programs of primary care and strengthen ambulatory care teaching programs.
The liberalization of health care in the course of three decades of ‘reform and opening up’ has given people in rural China access to a diverse range of treatment options, but the health care system has also been marred by accusations of price hikes, fake pharmaceuticals, and medical malpractice....... This chapter offers an ethnographic description of health as an issue in a Hebei township and it focuses on a popular and a statist response to the perceived inadequacy of the rural health care system. The revival of religious practices in rural China is obviously motivated by many factors, but in the township...... in question, various forms of healing play a significant role in religious movements and the rising cost of medical services as well as a general distrust of formal medical institutions seem to be part of the reason why people choose to follow spirit mediums and religious movements that offer alternative...
Chang, Jason; McLemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate. Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area. Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases. In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists. PMID:27723447
Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
The growth of the elderly population, the desire to buy and increased purchasing power, pose a huge el-derly consumer market. Potential market opportunities for the elderly to lead the health care products companies competing to compete, but companies in the pursuit of profit at the same marketing ethics are neglected, elderly health care products market marketing chaos Create a specification of elderly health care products market enterprise effort required to launch the appropriate marketing strategy, marketing, health and care to the elderly.%老年人口数量的增长、购买欲望和购买力的增强，构成巨大的老年消费市场。老年市场潜在的商机引领各保健品企业争相竞逐，但企业在追求利润的同时营销伦理却被忽视，老年保健品市场出现营销乱象。营造一个规范的老年保健品市场需企业付出努力，推出相应的营销策略，向老年人营销健康与关怀。
Full Text Available Abstract Background Internet education is increasingly provided to health professionals, but little is known about the most effective strategies for delivering the content. The purpose of this study is to compare four strategies for delivering an Internet-based (e- curriculum on clinicians' knowledge (K, confidence (CONF, and communication (COMM about herbs and other dietary supplements (HDS. Methods This national randomized 2 × 2 factorial trial included physicians, pharmacists, nurses, nutritionists and trainees in these fields. Participants were randomly assigned to one of four curriculum delivery strategies for 40 brief modules about HDS: a delivering four (4 modules weekly over ten (10 weeks by email (drip-push; b modules accessible on web site with 4 reminders weekly for 10 weeks (drip-pull; c 40 modules delivered within 4 days by email (bolus-push; and d 40 modules available on the Internet with one email informing participants of availability (bolus-pull. Results Of the 1,267 enrollees, 25% were male; the average age was 40 years. The completion rate was 62%, without significant differences between delivery groups. There were statistically significant improvements in K, CONF and COMM scores after the course (P Conclusion All delivery strategies tested similarly improved K, CONF, COMM scores about HDS. Educators can use the strategy that is most convenient without diminishing effectiveness. Additional curricula may be necessary to make substantial changes in clinicians' communication practices.
Hovenga, Evelyn J S
This chapter gives an educational overview of: * many competing characteristics within national health systems * national primary information and knowledge flows between health care entities * the role of information technologies in assisting health organizations become sustainable enterprises * the business of maintaining healthy populations for any nation * desirable e-health strategy objectives.
Sutton, Roberta; Lahuerta, Maria; Abacassamo, Fatima; Ahoua, Laurence; Tomo, Maria; Lamb, Matthew R; Elul, Batya
Challenges to ensuring timely linkage to and retention in HIV care are well documented. Combination intervention strategies can be effective in improving the HIV care continuum. Data on feasibility and acceptability of intervention types within intervention packages are limited. The Engage4Health study assessed the effectiveness of a combination intervention strategy to increase linkage and retention among adults newly diagnosed with HIV in Mozambique. The study included 2 health communication interventions-modified delivery of pre-antiretroviral therapy (pre-ART) counseling sessions and SMS reminders-and 3 structural interventions-point-of-care CD4 testing after diagnosis, accelerated ART initiation, and noncash financial incentives. We used a process evaluation framework to assess dose delivered-extent each intervention was delivered as planned-and dose received-participant acceptability-of health communication versus structural interventions in the effectiveness study to understand associated benefits and challenges. Data sources included study records, participant interviews, and clinical data. For dose delivered of health communication interventions, 98% of eligible clients received pre-ART counseling and 90% of participants received at least one SMS reminder. For structural interventions, 74% of clients received CD4 testing and 53% of eligible participants initiated ART within 1 month. Challenges for structural interventions included facility-level barriers, staffing limitations, and machine malfunctions. For dose received, participants reported pre-ART counseling and CD4 testing as the most useful interventions for linkage and financial incentives as the least useful for linkage and retention. Findings demonstrate that health communication interventions can be feasibly and acceptably integrated with structural interventions to create combination intervention strategies.
Weel, C. van; Schers, H.J.; Timmermans, A.
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
Maria Cristina Barbaro
Full Text Available OBJECTIVE: evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC guidelines. METHOD: quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes. RESULTS: for all the participating units, the attribute Access scored =6.6; the attributes Longitudinality, Coordination (integration of care, Coordination (information systems and Integrality scored =6.6, and the Essential Score =6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored =6.6, the others attributes scored =6.6; however, in the basic units, the Essential Score was =6.6 and, in the family health units, =6.6. CONCLUSION: expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.
Loeliger, Kelsey B; Niccolai, Linda M; Mtungwa, Lillian N; Moll, Anthony; Shenoi, Sheela V
With a 19.2% HIV prevalence, South Africa has the largest HIV/AIDS epidemic worldwide. Despite a recent scale-up of public sector HIV resources, including community-based programs to expand HIV care, suboptimal rates of antiretroviral therapy (ART) initiation and adherence persist. As community stakeholders with basic healthcare training, community health workers (CHWs) are uniquely positioned to provide healthcare and insight into potential strategies to improve HIV treatment outcomes. The study goal was to qualitatively explore the self-perceived role of the CHW, unmet CHW needs, and strategies to improve HIV care in rural KwaZulu-Natal, South Africa. Focus groups were conducted in May-August 2014, with 21 CHWs working in Msinga subdistrict. Interviews were audio-recorded, transcribed, and translated from Zulu into English. A hybrid deductive and inductive analytical method borrowed from grounded theory was applied to identify emergent themes. CHWs felt they substantially contributed to HIV care provision but were inadequately supported by the healthcare system. CHWs' recommendations included: (1) sufficiently equipping CHWs to provide education, counseling, social support, routine antiretroviral medication, and basic emergency care, (2) modifying clinical practice to provide less stigmatizing, more patient-centered care, (3) collaborating with traditional healers and church leaders to reduce competition with ART and provide more holistic care, and (4) offsetting socioeconomic barriers to HIV care. In conclusion, CHWs can serve as resources when designing and implementing interventions to improve HIV care. As HIV/AIDS policy and practice evolves in South Africa, it will be important to recognize and formally expand CHWs' roles supporting the healthcare system.
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.
Marušič, Dorjan; Prevolnik Rupel, Valentina
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.
Hollnagel, E.; Braithwaite, J.; Wears, R. L.
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......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...... concepts and methods that are able to cope with this complexity. Resilience engineering provides that capacity because its focus is on a system's overall ability to sustain required operations under both expected and unexpected conditions rather than on individual features or qualities. Resilience...
Travers, Catherine; Martin-Khan, Melinda; Lie, David
A comprehensive literature review was undertaken to: (i) identify and summarise the research evidence regarding barriers and enablers of health promotion, prevention and early intervention (PPEI) in primary care to reduce the risk of chronic disease in the older population; and (ii) use this evidence to make recommendations to inform the Australian national dementia prevention strategy around the translation of evidence-based care into practice. PPEI activities in primary care have the potential to not only reduce the prevalence and impact of a number of chronic diseases, but may also prevent or slow the onset of dementia given the apparent overlap in risk factors. While sizeable gaps exist regarding the most effective ways to promote the adoption of these activities, limited evidence suggests that, to be effective, PPEI activities should be quick and easy to administer, have a sound rationale and be readily incorporated into existing work processes.
Sonnenwald, Diane H.; Söderholm, Hanna Maurin; Welch, Gregory F.;
reported the technology would require additional training, changes to existing financial models used in emergency health care, and increased access to physicians. Conclusions. Teaching collaboration skills and strategies to physicians and paramedics could benefit their collaboration today, and increase...
Cannavò, M; Fusaro, N; Colaiuda, F; Rescigno, G; Fioravanti, M
The Emergency Department (ED) is vulnerable for workplace violence, but little is known about this and its consequences. Objectives of this study were presence, characteristics and effects of violence from patients and visitors on health care workers in an Emergency Department (ED). This study was about the Accident and Emergency Department, S. Pertini Hospital, (ASL RMB, Rome, Italy). Data were collected from November 2014 to January 2015 on frequency and type of violent behavior in the past five years experienced by staff members and their level of stress by an ad hoc questionnaire for the evaluation of violent events in health activities (QVS) and a questionnaire on perceived work-related stress (QES). Of the 58 eligible workers, 51 completed the interview. Health care workers were regularly exposed to violence with a consequent severe underreporting to work authorities and only a minor reporting to the police. A diffuse belief that workplace violence is a normal part of the work was also identified. Aggressors were usually patients or their relatives and were mainly males. Health care workers may suffer physical and emotional harm. Emergency Department health care workers are at risk of experiencing workplace violence and should have specific training and support in the management of violent situations focused on early identification, communication strategies, and de-escalation techniques.
Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter
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...
Jackson, C N; Manning, M R
This study explores the relationship between burnout and health care utilization of 238 employed adults. Burnout was measured by the Maslach Burnout Inventory and health care utilization by insurance company records regarding these employees' health care costs and number of times they accessed health care services over a one year period. ANOVAs were conducted using Golembiewski and Munzenrider's approach to define the burnout phase. Significant differences in health care costs were found.
Gibson, Diane M
To describe the patterns of local eye care provider availability in the US. Data from 2011 on the number of ophthalmologists and optometrists in each of the 3143 counties in the US were drawn from the Area Health Resources File. Population-weighted quartiles of the county-level number of ophthalmologists per capita and the county-level number of optometrists per capita were defined. Descriptive statistics were calculated and a cross tabulation of quartiles of ophthalmologist availability and quartiles of optometrist availability was conducted for all the counties in the US and for the set of counties in each region of the US. 24.0% of US counties had no ophthalmologists or optometrists. 60.7% of counties in the US were in one of the lower two quartiles of both ophthalmologist availability and optometrist availability, and 24.1% of counties were in one of the lower two quartiles of ophthalmologist availability but in one of the upper two quartiles of optometrist availability. Public health interventions that are effective in a context of limited local eye care provider availability or that are able to leverage optometrist availability effectively in areas with limited ophthalmologist availability could be of widespread use in the US. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Process Nursing Care (PAE is a systematic tool that facilitates the scientificity of care in community practice nurse, the application of scientific method in community practice, allows nursing to provide care in logical, systematic and comprehensive reassessing interventions to achieve the proposed results. It began with the valuation of Marjory Gordon Functional Patterns and then at the stage of diagnosis and planning North American Nursing Diagnosis Association (NANDA, Nursing Interventions Classification (NIC and Nursing Outcomes Classification (NOC is interrelate. It is a descriptive and prospective study. Diagnosis was made by applying the instruments measuring scale of the socio-demographic characteristics, symptom questionnaire for early detection of mental disorders in the community and appreciation for functional patterns. The PAE includes more frequent diagnoses, criteria outcomes, indicators, interventions and activities to manage community issues. alteration was evidenced in patterns: Adaptation and Stress Tolerance, Self-perception-Self-concept-, Role-Relationships, sleep and rest and Perception and Health Management. A standardized NANDA-NIC-NOC can provide inter care holistic care from the perspective of community mental health with a degree of scientific nature that frames the professional work projecting the individual, family and community care.
Mayeda, Tadashi A.
The report stresses the fact that while there is unity in the continuum of medicine, information in health care is markedly different from information in medical education and research. This difference is described as an anomaly in that it appears to deviate in excess of normal variation from needs common to research and education. In substance,…
Nitika Pant Pai
Full Text Available BACKGROUND: In South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facility-based HIV testing. With 50% of adults having ever tested for HIV in their lifetime, private, alternative testing options are urgently needed. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited. METHODS: A pilot cross-sectional study was conducted from January to June 2012 in health care workers based at the University of Cape Town, South Africa. An innovative, unsupervised, self-testing strategy was evaluated for feasibility; defined as completion of self-testing process (i.e., self test conduct, interpretation and linkage. An oral point-of-care HIV test, an Internet and paper-based self-test HIV applications, and mobile phones were synergized to create an unsupervised strategy. Self-tests were additionally confirmed with rapid tests on site and laboratory tests. Of 270 health care workers (18 years and above, of unknown HIV status approached, 251 consented for participation. FINDINGS: Overall, about 91% participants rated a positive experience with the strategy. Of 251 participants, 126 evaluated the Internet and 125 the paper-based application successfully; completion rate of 99.2%. All sero-positives were linked to treatment (completion rate:100% (95% CI, 66.0-100. About half of sero-negatives were offered counselling on mobile phones; completion rate: 44.6% (95% CI, 38.0-51.0. A majority of participants (78.1% were females, aged 18-24 years (61.4%. Nine participants were found sero-positive after confirmatory tests (prevalence 3.6% 95% CI, 1.8-6.9. Six of nine positive self-tests were accurately interpreted; sensitivity: 66.7% (95% CI, 30.9-91.0; specificity:100% (95% CI, 98.1-100. INTERPRETATION: Our unsupervised self-testing strategy was feasible to operationalize in health care workers in South Africa. Linkages were successfully
Norris, M J; Harris, J C
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.
Full Text Available Background. Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines. Methods. Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using four Nepal Demographic and Health Surveys (NDHS, nationally representative cross-sectional surveys conducted by interviewing women who gave birth 3–5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities. Findings. The percentage of mothers that received four antenatal care (ANC consultations increased from 9% to 54%, the institutional delivery rate increased from 6% to 47%, and the cesarean section (C-section rate increased from 1% in 1994 to 6% in 2011. The ratio of the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI: 3.82–6.76, 9.00 (95% CI: 6.55–12.37, and 9.37 (95% CI: 4.22–20.83, respectively. However, inequality is reducing over time; for the use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56–0.64 in 1994–1996 to 0.31 (95% CI: 0.29–0.33 in 2009–2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62–0.70 to 0.40 (95% CI: 0.38–0.40 between 1994–1996 and 2009–2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51–0.77; 0.76 (95% CI: 0.64–0.88; 0.77 (95% CI: 0.71–0.84; and 0.66 (95% CI: 0.60–0.72 in the periods 1994–1996, 1999–2001, 2004–2006, and 2009–2011, respectively. All sociodemographic variables were significant predictors of use of maternal health services, out of which maternal
Edgar, Andrew Robert; Pattison, Stephen
The purpose of this paper is to offer an account of ‘flourishing’ that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as ‘happiness’, ‘well-being’ or ‘quality of life’, ‘flourishing’ uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is argued...
Brock, D W
This paper will explore the application of an account of justice in health and health care to the special case of children. It is tempting to hold that children require no special treatment in an account of just health care; justice requires guaranteeing access to at least basic health care services to all persons, whatever their age group, within the constraints of a society's resources. However, I will argue that for a number of reasons we need to address what justice requires specifically for children from the health care system, even if the answer must be embedded within a general account of justice in health and health care.
Andrade, Raquel Dully; Mello, Débora Falleiros; Silva, Marta Angélica Iossi; Ventura, Carla Aparecida Arena
This narrative literature review aimed to identify the publications about health law, in the ambit of child health care. The databases LILACS and MEDLINE were searched, between 2004 and 2009. Thirteen articles were analyzed, and three themes were identified: Emphasis on knowledge, abilities and attitudes for the development of competencies; Partnerships as an imperative; Health and Law: intersectorial relationship. The studies about the practice of health law are relevant to our reality, especially in primary health care, pointing out for the possibilities of its applicability in the role of the nurses acting in the family health strategy, with families and children.
Bloch, P H
This paper examines the impact of the growing national health consciousness on the delivery of health care services. The health-involved consumer is first profiled and implications for health care marketing strategy are then identified. Suggestions are also made regarding the tailoring of health services to the health-involved segment.
Worldwide the application of information and communication technologies to support national health-care services is rapidly expanding and increasingly important. This is especially so at a time when all health systems face stringent economic challenges and greater demands to provide more and better care especially to those most in need. The National eHealth Strategy Toolkit is an expert practical guide that provides governments their ministries and stakeholders with a solid foundation and method for the development and implementation of a national eHealth vision action plan and monitoring fram
Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa
At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.
Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A
Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO(®) (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.
Governance processes and change within organizational participants of multi-sectoral community health care alliances: the mediating role of vision, mission, strategy agreement and perceived alliance value.
Hearld, Larry R; Alexander, Jeffrey A
Multi-sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long-term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their 'home' organizations and institutionalize the vision, goals, and programs within participating organizations and the broader community. The purpose of this study was to investigate two mechanisms by which alliance leadership and management processes may promote such changes within organizations participating in alliances. The findings of the study suggest that, despite modest levels of change undertaken by participating organizations, more positive perceptions of alliance leadership, decision making, and conflict management were associated with a greater likelihood of participating organizations making changes as a result of their participation in the alliance, in part by promoting greater vision, mission, and strategy agreement and higher levels of perceived value. Leadership processes had a stronger relationship with change within participating organizations than decision-making style and conflict management processes. Open-ended responses by participants indicated that participating organizations most often incorporated new measures or goals into their existing portfolio of strategic plans and activities in response to alliance participation.
This guide for infant day care providers examines the importance of early experience for brain development and strategies for providing optimal infant care. The introduction discusses the current devaluation of day care and idealization of maternal care and identifies benefits of quality day care experience for intellectual development, sleep…
Kuhlthau, Karen A.; Warfield, Marji E.; Hurson, Jill; Delahaye, Jennifer; Crossman, Morgan K.
Few youth with autism spectrum disorder (ASD) nationally report receiving services to help them transition from the pediatric health care system to the adult health care system. For example, only one-fifth (21.1%) of youth with ASD receive any transition planning services. To better understand why the transition from pediatric to adult health care…
Coile, R C
The arrival of the Internet offers the opportunity to fundamentally reinvent medicine and health care delivery. The "e-health" era is nothing less than the digital transformation of the practice of medicine, as well as the business side of the health industry. Health care is only now arriving in the "Information Economy." The Internet is the next frontier of health care. Health care consumers are flooding into cyberspace, and an Internet-based industry of health information providers is springing up to serve them. Internet technology may rank with antibiotics, genetics, and computers as among the most important changes for medical care delivery. Utilizing e-health strategies will expand exponentially in the next five years, as America's health care executives shift to applying IS/IT (information systems/information technology) to the fundamental business and clinical processes of the health care enterprise. Internet-savvy physician executives will provide a bridge between medicine and management in the adoption of e-health technology.
Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam
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.
Health care firms of all types helped fuel the biggest short-selling frenzy in the New York Stock Exchange's history, recently hitting a record 2.2 billion shares. While some analysts say this means nothing, the fact is that many investors are "shorting" the stock; in other words, they're betting against it. What appears as a lack of confidence may be nothing more than a simple quirk of Wall Street. Good, bad or indifferent, selling short is no tall tale.
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-
Kreps, G L
The systemic prejudices and biases that often limit the effectiveness of health care delivery are examined. How the inherent imbalance in control between consumers and providers of health care, based on the micropolitics of sharing relevant health information, perpetuates a system of marginalization and alienation within health care delivery systems is discussed. Communication barriers that often confront many stigmatized groups of health care consumers, such as the poor, people with AIDS, minorities, the ill elderly, and women, are identified. Such prejudicial treatment is framed within a cultural ideologies model, leading to identification of communication strategies for promoting justice in the modern health care system and enhancing the quality of health care delivery.
... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...
Faller, Marcia; Gogek, Jim
The powerful transformation in the health care industry is reshaping not only patient care delivery and the business of health care but also demanding new strategies from vendors who support the health care system. These new strategies may be most evident in workforce solutions and health care staffing services. Consolidation of the health care industry has created increased demand for these types of services. Accommodating a changing workforce and related pressures resulting from health care industry transformation has produced major change within the workforce solutions and staffing services sector. The effect of the growth strategy of mergers, acquisitions, and organic development has revealed organizational opportunities such as expanding capacity for placing physicians, nurses, and allied professionals, among other workforce solutions. This article shares insights into workforce challenges and solutions throughout the health care industry.
Mascarenhas, O A
Providing cost-contained comprehensive quality health care to maintain healthy and productive employees is a challenging problem for all employers. Using a representative panel of metropolitan employees, the author investigates the internal and external structure of employee satisfaction with company-sponsored health care plans. Employee satisfaction is differentiated into four meaningful groups of health care benefits, whereas its external structure is supported by the traditional satisfaction paradigms of expectation-disconfirmation, attribution, and equity. Despite negative disconfirmation, employees register sufficiently high health care satisfaction levels, which suggests some useful strategies that employers may consider implementing.
Miller, Franklin G; Kim, Scott Y H
The idea of a "learning health care system"--one that systematically integrates clinical research with medical care--has received considerable attention recently. Some commentators argue that under certain conditions pragmatic comparative effectiveness randomized trials can be conducted ethically within the context of a learning health care system without the informed consent of patients for research participation. In this article, we challenge this perspective and contend that conducting randomized trials of individual treatment options without consent is neither necessary nor desirable to promote and sustain learning health care systems. Our argument draws on the normative conception of personal care developed by Charles Fried in a landmark 1974 book on the ethics of randomized controlled trials.
MacRae, Nancy; Strout, Kelley
Self-care among health care providers is an important component of their ability to provide quality health care to patients. Health care institutions have programs in place for students that emphasize health and wellness, but few programs are available for faculty and staff. To address this gap and facilitate modeling health and wellness strategies for students, a New England institution that educates health care practitioners began a pilot self-care project for faculty and staff. Both quantitative and qualitative data were collected. The template used for this project could be used as a stepping-stone for future wellness self-care program in higher education for faculty, staff, and students.
Approximately 45.7 million people in the United States are uninsured and unknown numbers of this population are underinsured, severely limiting their access to medical care. To address this problem, people use innovative strategies to increase their access through cross-border care options. The U.S.-Mexico border provides unique challenges and opportunities for health care in this context. The lower cost of medical and dental procedures and medications in Mexico makes that country an attracti...
Beek, K.; Woitha, K.; Ahmed, N.; Menten, J.; Jaspers, B.; Engels, Y.; Ahmedzai, S.H.; Vissers, K.; Hasselaar, J.
BACKGROUND: According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This pa
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, ...
Suelen Brito Azevedo
Full Text Available Objective Evaluating the practice of nurses of the Family Health Strategy (FHS in child hearing health care. Method A normative assessment of structure and process, with 37 nurses in the Family Health Units, in the city of Recife, Pernambuco. The data collection instrument originated from the logical model of child hearing health care provided by nurses of the Family Health Strategy, and the matrix of indicators for evaluation of nursing practice. Results All the nurses identified the hearing developmental milestones. At least two risk factors were identified by 94.5% of the nurses, and 21.6% of them carried out educational activities. Conclusion The normative assessment was considered adequate despite existing limitations in the structure and process.
A primary health care approach is essential to contemporary nursing roles such as practice nursing. This paper examines the evolution of primary health care as a global strategy for responding to the social determinants of health. Primary health care roles require knowledge of, and a focus on social determinants of health, particularly the societal factors that allow and perpetuate inequities and disadvantage. They also require a depth and breadth of leadership skills that are responsive to health needs, appropriate in the social and regulatory context, and visionary in balancing both workforce and client needs. The key to succeeding in working with communities and groups under a primary health care umbrella is to balance the big picture of comprehensive primary health care with operational strategies for selective primary health care. The other essential element involves using leadership skills to promote inclusiveness, empowerment and health literacy, and ultimately, better health.
This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.
Vrangbæk, Karsten; Byrkjeflot, Haldor
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...
G. Alan Tarr
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.
Berger, J; Dauten, M S
As the year 2000 approaches, it is apparent that employer-sponsored health plans will again begin to experience high rate increases. Employers will need to utilize an up-to-date benefits philosophy and health plan purchasing strategy coupled with monitoring tools and vendor performance guarantees to deal with the situation. While many of the cost drivers are beyond an employer's control, taking a preemptive strike at health care inflation through design, cost sharing and other focused initiatives will minimize its impact.
Rudomin, M L; Spirakes, A S
The era of managed care has forced an unprecedented restructuring of the health care environment. As hospitals downsize in response, materiel managers should consider adopting strategies that may help ensure their survival, including innovative approaches to supply management and the development of individual responses that will best position them to succeed in this new reality.
Tracy, Jane; McDonald, Rachael
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.…
Tracy, Jane; McDonald, Rachael
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.…
Durán-Arenas, Luis; Salinas-Escudero, Guillermo; Granados-García, Víctor; Martínez-Valverde, Silvia
Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the health care packages so that members of the SS and SP do not have same type of coverage. The question is: which model of health care system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary health care team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year.
Edgar, Andrew; Pattison, Stephen
The purpose of this paper is to offer an account of 'flourishing' that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as 'happiness', 'well-being' or 'quality of life', 'flourishing' uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one's life as a narrative. To flourish, it is argued, is to tell a story of one's life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one's life.
Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.
Schellekens, O P; Lindner, M E; van Esch, J P L; van Vugt, M; Rinke de Wit, T F
Long-term substantial development aid has not prevented many African countries from being caught in a vicious circle in health care: the demand for care is high, but the overburdened public supply of low quality care is not aligned with this demand. The majority of Africans therefore pay for health care in cash, an expensive and least solidarity-based option. This article describes an innovative approach whereby supply and demand of health care can be better aligned, health care can be seen as a value chain and health insurance serves as the overarching mechanism. Providing premium subsidies for patients who seek health care through private, collective African health insurance schemes stimulates the demand side. The supply of care improves by investing in medical knowledge, administrative systems and health care infrastructure. This initiative comes from the Health Insurance Fund, a unique collaboration of public and private sectors. In 2006 the Fund received Euro 100 million from the Dutch Ministry of Foreign Affairs to implement insurance programmes in Africa. PharmAccess Foundation is the Fund's implementing partner and presents its first experiences in Africa.
Full Text Available As of 2013, the latest statistics available, more than 400,000 individuals are lodged in Indian prisons. Prisoners represent a heterogeneous population, belonging to socially diverse and economically disadvantaged sections of society with limited knowledge about health and healthy lifestyles. There is considerable evidence to show that prisoners in India have an increased risk of mental disorders including self-harm and are highly susceptible to various communicable diseases. Coupled together with abysmal living conditions and poor quality of medical services, health in prisons is a matter of immense human rights concern. However, the concept and the subsequent need to view prison health as an essential part of public health and as a strategic investment to reach persons and communities out of the primary health system ambit is poorly recognized in India. This article discusses the current status of prison healthcare in India and explores various potential opportunities the "prison window" provides. It also briefly deliberates on the various systematic barriers in the Indian prison health system and how these might be overcome to make primary healthcare truly available for all.
Full Text Available The process of collective education in an organization that has the capacity to impact an organization’s operations, performance and outcomes is called organizational learning. In health care organizations, patient care is provided through one or more visible and invisible teams. These teams are composed of experts and novices from diverse backgrounds working together to provide coordinated care. The number of teams involved in providing care and the possibility of breakdowns in communication and coordinated care increases in direct proportion to sophisticated technology and treatment strategies of complex disease processes. Safe patient care is facilitated by individual professional learning; inter-professional team learning and system based organizational learning, which encompass modified context specific learning by multiple teams and team members in a health care organization. Organizational learning in health care systems is central to managing the learning requirements in complex interconnected dynamic systems where all have to know common background knowledge along with shared meta-knowledge of roles and responsibilities to execute their assigned functions, communicate and transfer the flow of pertinent information and collectively provide safe patient care. Organizational learning in health care is not a onetime intervention, but a continuing organizational phenomenon that occurs through formal and informal learning which has reciprocal association with organizational change. As such, organizational changes elicit organizational learning and organizational learning implements new knowledge and practices to create organizational changes.
Tor I. Romøren
Full Text Available Introduction: The Norwegian health care system is well organized within its two main sectors - primary health and long term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures.Policy practice: Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented.Discussion: The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.
Tor I. Romøren
Full Text Available Introduction: The Norwegian health care system is well organized within its two main sectors - primary health and long term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures. Policy practice: Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented. Discussion: The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.
2Department of Health Policy and Management, Faculty of Public Health, College of Medicine and University ... 86 (21%) had primary school education, 210 (51.3%) were married, and 357 (87.3%) were employed. ...... patient satisfaction and behavioral intentions in. 5. .... Psychological Assessment 1995; 7 (3):309-319.
2Department of Community Health, University of Benin, Benin City, Nigeria. ... public health problem that can lead to a great burden of disability in the community. ..... women. Equally worthy of note, is the fact that a higher proportion of females ...
Burgel, Barbara Jean; Gillen, Marion; White, Mary Castle
This study describes health and safety concerns and self-care strategies of San Francisco taxi drivers. Focus groups and a written cross-sectional survey were done in a convenience sample of taxi drivers working in San Francisco. Sessions were audiotaped, transcribed in English, and independently coded to identify major health and safety themes, using thematic content analysis. Strategies to manage health and safety issues are the focus of this analysis. Five focus groups were held in 2009 with 36 participants. Major health and safety themes included stress, body pain, danger, vulnerable employment status, and concerns related to unhealthy working conditions. Self-care strategies included diffusion/decompression to manage stress, maintaining a positive attitude, maintaining power and control, and practicing proactive self-care. Creative self-care strategies were described by taxi drivers to keep healthy and safe at work. These data will inform future self-care interventions to reduce health and safety risks of taxi driving.
Nakanishi, Miharu; Nakashima, Taeko
The Ministry of Health, Labour, and Welfare of the Japanese national government announced a "Five-Year Plan for Promotion of Measures Against Dementia (Orange Plan)" in September 2012. This article described features of the Japanese dementia strategy in comparison with international dementia policies. An international comparative study was implemented on national dementia policies to seek suggestions for Japanese national strategy. The study consisted of a bibliographical survey, a field survey, and an online case vignette survey in several countries. The Japanese health- and social-care system had multiple access points in the dementia care pathway, as did Australia, France, South Korea, and the Netherlands. Contrary to Japan, a simplified access point was observed in Denmark, England, and Sweden. The Orange Plan aimed to establish specific health-care services, social-care services, and the coordination of agencies for persons with dementia. However, fragmentation remains in the dementia care pathway. The national government should examine fundamental revisions in health, social-care services, and advocacy in joint initiatives with Alzheimer's Association Japan to improve the national dementia strategy. Copyright © 2014 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
Warner, Echo L; Ding, Qian; Pappas, Lisa; Bodson, Julia; Fowler, Brynn; Mooney, Ryan; Kirchhoff, Anne C; Kepka, Deanna
Human papillomavirus (HPV) vaccination is below national goals in the United States. Health care providers are at the forefront of improving vaccination in the United States, given their close interactions with patients and parents. The objective of this study was to assess the associations between demographic and practice characteristics of the health care providers with the knowledge of HPV vaccination and HPV vaccine guidelines. Furthermore, our aim was to contextualize the providers' perceptions of barriers to HPV vaccination and strategies for improving vaccination in a state with low HPV vaccine receipt. In this mixed-methods study, participating providers (N=254) were recruited from statewide pediatric, family medicine, and nursing organizations in Utah. Participants completed a Web-based survey of demographics, practice characteristics, HPV vaccine knowledge (≤10 correct vs 11-12 correct answers), and knowledge of HPV vaccine guidelines (correct vs incorrect). Demographic and practice characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes. Four open-ended questions pertaining to the barriers and strategies for improving HPV vaccination were content analyzed. Family practice providers (52.2%, 71/136; P=.001), institutional or university clinics (54.0%, 20/37; P=.001), and busier clinics seeing 20 to 29 patients per day (50.0%, 28/56; P=.04) had the highest proportion of respondents with high HPV vaccination knowledge. Older providers aged 40 to 49 years (85.1%, 57/67; P=.04) and those who were a Vaccines for Children provider (78.7%, 133/169; P=.03) had the highest proportion of respondents with high knowledge of HPV vaccine recommendations. Providers perceived the lack of parental education to be the main barrier to HPV vaccination. They endorsed stronger, consistent, and more direct provider recommendations for HPV vaccination delivered to parents through printed materials available in clinical settings and
Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication...
be used to design policies and programmes to help workers identify environmental health risks, and improve their ... and his/her co-workers, who are subject to (SHE) departments and the Staff Clinic. It ... television and internet sources.
Cervical cancer remains a major public health challenge in developing countries ... relation to knowledge on cervical cancer, primary level of education ... Latin America and Southeast Asia. ... practices such as level of awareness, educational.
PURPOSE: The purpose of this paper is to investigate different types of patient involvement in Denmark, and to discuss the potential implications of pursuing several strategies for patient involvement simultaneously. DESIGN/METHODOLOGY/APPROACH: The paper presents a preliminary framework...... for analysis of patient involvement in health care. This framework is used to analyze key governance features of patient involvement in Denmark based on previous research papers and reports describing patient involvement in Danish health care. FINDINGS: Patient involvement is important in Denmark...... implications for the development of patient involvement in health care. ORIGINALITY/VALUE: This paper fulfills a need to study different types of patient involvement and to develop a theoretical framework for characterizing and analyzing such involvement strategies....
Croxson, L J; Purdell-Lewis, D
Community and individual involvement are essential needs in preventive programmes for periodontal health. Campaigns should be directed towards a better individual understanding of the importance of healthy gum tissues if a functional healthy dentition is to be retained over a lifetime. Effective awareness campaigns require not only participation and education of the general public, but also all levels of health care professionals. Awareness programmes need to be carefully planned and their messages clear, non-conflicting and regularly reinforced. The complete programme should be based on, and include, specific aims, goals, strategies, monitoring and evaluation. Oral health and hygiene promotion campaigns need careful coordination between the relevant agencies or institutions involved in their implementation, such as government agencies, professional associations, industry, aid groups and education organisations.
Ozbolt, Judy G.
Perrow's models of organizational technologies provide a framework for analyzing clinical work processes and identifying the management structures and informatics tools to support each model. From this perspective, health care is a mixed model in which knowledge workers require flexible management and a variety of informatics tools. A Venn diagram representing the content of clinical decisions shows that uncertainties in the components of clinical decisions largely determine which type of clinical work process is in play at a given moment. By reducing uncertainties in clinical decisions, informatics tools can support the appropriate implementation of knowledge and free clinicians to use their creativity where patients require new or unique interventions. Outside health care, information technologies have made possible breakthrough strategies for business success that would otherwise have been impossible. Can health informatics work similar magic and help health care agencies fulfill their social mission while establishing sound business practices? One way to do this would be through personalized health care. Extensive data collected from patients could be aggregated and analyzed to support better decisions for the care of individual patients as well as provide projections of the need for health services for strategic and tactical planning. By making excellent care for each patient possible, reducing the “inventory” of little-needed services, and targeting resources to population needs, informatics can offer a route to the “promised land” of adequate resources and high-quality care. PMID:10495097
Soleimani, Farzad; Zenios, Stefanos
To build enabling innovation frameworks for health care entrepreneurs to better identify, evaluate, and pursue entrepreneurial opportunities. Powerful frameworks have been developed to enable entrepreneurs and investors identify which opportunity areas are worth pursuing and which start-up ideas have the potential to succeed. These frameworks, however, have not been clearly defined and interpreted for innovations in health care. Having a better understanding of the process of innovation in health care allows physician entrepreneurs to innovate more successfully. A review of academic literature was conducted. Concepts and frameworks related to technology innovation were analyzed. A new set of health care specific frameworks was developed. These frameworks were then applied to innovations in various health care subsectors. Health care entrepreneurs would greatly benefit from distinguishing between incremental and disruptive innovations. The US regulatory and reimbursement systems favor incrementalism with a greater chance of success for established players. Small companies and individual groups, however, are more likely to thrive if they adopt a disruptive strategy. Disruption in health care occurs through various mechanisms as detailed in this article. While the main mechanism of disruption might vary across different health care subsectors, it is shown that disruptive innovations consistently require a component of contrarian interpretation to guarantee considerable payoff. If health care entrepreneurs choose to adopt an incrementalist approach, they need to build the risk of disruption into their models and also ascertain that they have a very strong intellectual property (IP) position to weather competition from established players. On the contrary, if they choose to pursue disruption in the market, albeit the competition will be less severe, they need to recognize that the regulatory and reimbursement hurdles are going to be very high. Thus, they would benefit
Wick, Jeannette Y; Zanni, Guido R
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.
McDavid, Lolita M
Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care. Copyright © 2015 Elsevier Inc. All rights reserved.
There is a wealth of evidence that health is inextricably linked to housing. For instance, research has shown that those in substandard housing have poorer health outcomes than other groups, and they often must forgo costly medication in order to pay for housing. Further, the health care and housing concerns faced by the underserved often compound one another--people with poor health often have trouble maintaining housing, and those with substandard homes, in turn, often have trouble maintaining their health. Three groups are especially vulnerable to the health care risks associated with housing issues: children, seniors, and the chronically homeless. As the research suggests, substandard housing is a contributing factor to the U.S. health care crisis. Therefore, as part of its efforts to reform the nation's health care system, the ministry should address housing issues as well. Seven Catholic health systems are doing this through the Strategic Health Care Partnership. The partnership, in collaboration with Mercy Housing, enables the seven organizations to work together to create healthy communities. The partnership's key goal is to increase access to affordable housing and health care. Just providing homes often is not enough, however. A holistic approach, through which supportive services are offered to the underserved, is most effective.
Merlino, James I; Raman, Ananth
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.
Full Text Available This paper addresses the need for quantitative data for planning health care risk waste (HCRW) management from hospitals and clinics in South Africa. Quantitative estimates of HCRW generation and treatment capacity are determined for hospitals...
Leanza, Francesco; Hauser, Diane
Teens are avid users of new technologies and social media. Nearly 95% of US adolescents are online at least occasionally. Health care professionals and organizations that work with teens should identify online health information that is both accurate and teen friendly. Early studies indicate that some of the new health technology tools are acceptable to teens, particularly texting, computer-based psychosocial screening, and online interventions. Technology is being used to provide sexual health education, medication reminders for contraception, and information on locally available health care services. This article reviews early and emerging studies of technology use to promote teen health. Copyright © 2014 Elsevier Inc. All rights reserved.
Tobacco is a risk factor Organization (WHO) at World Health Assembly for six of the ... information. Stata statistical software version 11 was used to describe the data and determine ... Only 5% of respondents ever received training on tobacco control. .... Pharmacist. 54. 23.2 .... and dental students surveyed in Lagos by .15.
May 1, 2012 ... quality service delivery as perceived by the respondents', however it remains ... However, there remain the problems of inequities in tertiary ... unrelenting struggle in financing health households to the financial risk ... other things improve efficiency in utilization of Using a cross-sectional approach, this study.
eligible patients as they emerged from the pharmacy with their ... compare proportions while student's t-test was used to compare .... preference between the free and B.I. health services in an LGA in ... and training manual for the development.
study assessed the knowledge and practice of disease surveillance and notification ... for active surveillance especially if an outbreak Health workers play a key role in .... ethical clearance was obtained from the ethics and Eighty one percent of .... Salami S. Knowledge of disease notification among New York: John Wiley ...
Gisele Nepomuceno de Andrade
Full Text Available Objective: Understanding the experiences of health professionals in primary care with the Child Health Booklet in child health care. Method: A qualitative study with a phenomenological approach, in which participated nurses and doctors from six teams of the Family Health Strategy (FHS in Belo Horizonte, MG. In total, were carried out 12 non-directive interviews, using two guiding questions. Results: A comprehensive analysis of the speeches enabled the construction of three categories that signal the experiences of the professionals with the booklet. The experiments revealed difficulties arising from the limitations of knowledge about the instrument; incomplete filling out of the booklet by many professionals that care for children; the daily confrontations of the process and the organization of work teams; disinterest of families with the instrument. Conclusion: The research points possible and necessary ways to improve the use of booklets as an instrument of full child health surveillance.
Stempsey, William E
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.
Correia, M Isabel T D; Hegazi, Refaat A; Higashiguchi, Takashi; Michel, Jean-Pierre; Reddy, B Ravinder; Tappenden, Kelly A; Uyar, Mehmet; Muscaritoli, Maurizio
The prevalence of malnutrition ranges up to 50% among patients in hospitals worldwide, and disease-related malnutrition is all too common in long-term and other health care settings as well. Regrettably, the numbers have not improved over the past decade. The consequences of malnutrition are serious, including increased complications (pressure ulcers, infections, falls), longer hospital stays, more frequent readmissions, increased costs of care, and higher risk of mortality. Yet disease-related malnutrition still goes unrecognized and undertreated. To help improve nutrition care around the world, the feedM.E. (Medical Education) Global Study Group, including members from Asia, Europe, the Middle East, and North and South America, defines a Nutrition Care Pathway that is simple and can be tailored for use in varied health care settings. The Pathway recommends screen, intervene, and supervene: screen patients' nutrition status on admission or initiation of care, intervene promptly when needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans. This article is a call-to-action for health caregivers worldwide to increase attention to nutrition care.
Estrategias asistenciales de los problemas de salud mental en el medio penitenciario, el caso español en el contexto europeo Health care strategies for mental health problems in the prison environment, the Spanish case in a European context
J. M. Arroyo-Cobo
Full Text Available Introducción: Se ha revisado la literatura científica sobre estrategias de atención a los problemas de salud mental en el medio penitenciario. Se aportan datos de las principales actuaciones puestas en práctica por las administraciones penitenciarias para responder a las preocupantes cifras que señalan los más recientes estudios epidemiológicos de trastornos mentales en prisión, con tasas que comparadas con la población general, duplican los Trastornos Mentales Comunes (TMC y cuadriplican los Trastornos Mentales Graves (TMG entre las personas que se encuentran en prisión. Material y métodos: Se han revisado las bases de datos bibliográficas más importantes sobre las políticas asistenciales a los problemas de salud mental en el medio penitenciario, que han sido publicadas por los responsables de las administraciones penitenciarias en los últimos 10 años. Estos datos se han completado con datos obtenidos con el análisis de los indicadores disponibles en la Coordinación de Sanidad sobre las estrategias propias en materia de asistencia a problemas de salud mental en centros dependientes de la Secretaría General de Instituciones Penitenciarias, en España. Resultados: Hay poca literatura científica donde se enuncien las políticas asistenciales de las diferentes administraciones sobre la asistencia a problemas de salud mental en el medio penitenciario. Las que lo hacen están de acuerdo en una serie de afirmaciones: se debe ofrecer una respuesta terapéutica de igual calidad a la recibida por los enfermos en la comunidad, debe ser un equipo multidisciplinar el encargado de atender a este tipo de pacientes, es preciso un esfuerzo de coordinación entre las administraciones que en un momento determinado deben atender a estos pacientes, la asistencial, la social, la judicial y la penitenciaria.Introduction: A review was carried out of scientific literature on health care strategies for mental health problems in the prison environment
Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S
Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.
Kossaify, A; Hleihel, W; Lahoud, J-C
Highlight the importance of teamwork in health care institutions by performing a review and discussion of the relevant literature. Review paper. A MEDLINE/Pubmed search was performed starting from 1990, and the terms 'team, teamwork, managers, healthcare, and cooperation' were searched in titles, abstracts, keywords, and conclusions; other terms 'patient safety, ethics, audits and quality of care' were specifically searched in abstracts and were used as additional filters criteria to select relevant articles. Thirty-three papers were found relevant; factors affecting the quality of care in health care institutions are multiple and varied, including issues related to individual profile, to administrative structure and to team-based effort. Issues affecting teamwork include mainly self-awareness, work environment, leadership, ethics, cooperation, communication, and competition. Moreover, quality improvement plans aiming to enhance and expand teams are essential in this context. Team monitoring and management are vital to achieve efficient teamwork with all the required qualities for a safer health system. In all cases, health managers' responsibility plays a fundamental role in creating and sustaining a teamwork atmosphere. Teamwork is known to improve outcomes in medicine, whether at the clinical, organizational, or scientific level. Teamwork in health care institutions must increasingly be encouraged, given that individual effort is often insufficient for optimal clinical outcome. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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
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.
If you have been diagnosed with cancer, finding a doctor and treatment facility for your cancer care is an important step to getting the best treatment possible. Learn tips for choosing a doctor and treatment facility to manage your cancer care.
Mohan, Viswanathan; Seedat, Yackoob K.; Pradeepa, Rajendra
Aim. To review the available literature on burden of diabetes mellitus (DM) and hypertension (HTN) and its coexistence in Southeast Asian (SEA) and the African (AFR) regions and to suggest strategies to improve DM and HTN prevention and control in primary health care (PHC) in the two regions. Methods. A systematic review of the papers published on DM, HTN, and prevention/control of chronic diseases in SEA and AFR regions between 1980 and December 2012 was included. Results. In the year 2011, SEA region had the second largest number of people with DM (71.4 million), while the AFR region had the smallest number (14.7 million). Screening studies identified high proportions (>50%) of individuals with previously undiagnosed HTN and DM in both of the SEA and AFR regions. Studies from both regions have shown that DM and HTN coexist in type 2 DM ranging from 20.6% in India to 78.4% in Thailand in the SEA region and ranging from 9.7% in Nigeria to 70.4% in Morocco in the AFR region. There is evidence that by lifestyle modification both DM and HTN can be prevented. Conclusion. To meet the twin challenge of DM and HTN in developing countries, PHCs will have to be strengthened with a concerted and multipronged effort to provide promotive, preventive, curative, and rehabilitative services. PMID:23573413
colleagues, that can help in dealing with risky situations and therefore shouldn´t be overlooked. In comparison with non-risky professions professionals care significantly more about their physical and psychical health. Closer analysis showed some uniqueness with respect to a particular type of risky profession. Police officers and fire fighters are more interested in their physical condition, which is important for example in rescuing a person from an object in fire or in a situation where physical force needs to be used. In comparison with it, paramedics use more psychical self-care strategies, namely they are trying more to control their negative emotional state, to minimize risky situation and to preserve health. Lastly they are caring more about their personal improvement. This study has several limits. Equality of gender in sample should be taken to account in future researches. We also recommend to involve other risky professions to the analysis (for example soldiers. Results can be used as a basis for trainee or education programs, which could help professionals in dealing with traumatic situations.
Full Text Available The article proposes a critical reflection, based on national law, scholarly, scientific, on the current development of Networks of Health Care, as a strategy for strengthening the Single Health System (SUS. Are weighted inefficiency of traditional ways of organizing care and management, the challenge of Network Health Care for comprehensive care and management mechanisms used in this process. The work provides subsidies for the care practices and health management are reflected, pointing strategies that result in disruptions of paradigms through a refocusing of attention in existing models. For networks of health care can be consolidated, is fundamental to political sensitivity of health managers with a commitment to build a new model of care, through the struggle to consolidate the SUS and the realization of the principles of universality, comprehensiveness and equity.
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.
Maestri, Eleine; do Nascimento, Eliane Regina Pereira; Bertoncello, Kátia Cilene Godinho; de Jesus Martins, Josiane
This qualitative study was performed at the adult Intensive Care Unit (ICU) of a public hospital in Southern Brazil with the objective to evaluate the implemented welcoming strategies. Participants included 13 patients and 23 relatives. Data collection was performed from July to October 2008, utilizing semi-structured interviews. All interviews were recorded. Data analysis was performed using the Collective Subject Discourse. The collected information yielded two discourses: the family recognized the welcoming strategies and the patients found the ICU team to be considerate. By including the family as a client of nursing care, relatives felt safe and confident. Results show that by committing to the responsibility of making changes in heath care practices, nurses experience a novel outlook towards ICU care, focused on human beings and associating the welcoming to the health care model that promotes the objectivity of care.
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.
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
... Care Association Responds to Ruling on Injunction Delaying CMS Implementation of Arbitration Rule AHCA/NCAL Elects New ... Information Technology Integrity Medicaid Medicare Patient Privacy and Security Survey and Regulatory Therapy Services Workforce Events Calendar ...
birth attendants, and if there is a proper division of labour amongst the three tiers of the health system. 3 ... Obstetric. Care,. Traditional. Birth. Attendants,. Maternal. Mortality,. Neonatal ..... interview believed that sudden onset of labor and.
Big employers like Boeing and Intel are directly contracting with hospitals in an effort to control health care prices. Some hospital CEOs see direct contracting as the future, while others wonder how they can participate.
Marasović Šušnjara, Ivana
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.
Chiesa, Anna Maria; Fracolli, Lislaine Aparecida; Zoboli, Elma Lourdes Pavone Campos; Maeda, Sayuri Tanaka; Castro, Danielle Freitas Alvim de; Barros, Débora Gomes; Ermel, Regina Célia; Chang, Katherine
By increasing the health promotion actions in the Family Health Strategy it is possible to contribute to implement comprehensive care. Nevertheless, technologies gap still hinder the process of training the professionals to analyze the health potentials of the population. The objective of this study is to synthesize the contributions of the WHOQOL-bref in training professionals regarding the health promotion actions in the Family Health Strategy. A qualitative meta-synthesis was performed based on the research conducted by the group Technological health care models and health promotion using the WHOQOL-bref and its interface with health promotion. The synyhesis of the five studies revealed that there are conceptual relationships between the WHOQOL-bref domains and health promotion, which legitimizes it as a tool for health promotion. Using the WHOQOL-bref can help establish the attachment and continuous care in the Family Health Strategy.
Agness, Chanel; Murrell, Erica; Nkansah, Nancy; Martin, Caren McHenry
Only 12% of adults have proficient health literacy, according to the National Assessment of Adult Literacy. In other words, nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease. The elderly patient is at especially high risk for having low health literacy. To provide optimal care for patients, pharmacists and other health care practitioners must understand the problems of health literacy and incorporate strategies and tools to improve the effectiveness of their communication with patients.
Racine, Andrew D
The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty.
The South East Asian state of Vietnam is currently undergoing a transition from a centralised socialism to a so-called socialist market economy strongly promoting the private sector. For the last 17 years economy experienced an impressive growth. If the assumption is true that economic growth is positively correlated with the health status of the population, the strengthened economy of Vietnam must go along with an improved health situation and health care system of this country. The following paper evaluates this assumption. It is demonstrated that there is indeed a strongly positive correlation between health and development in many aspects. However, it becomes obvious that economic growth is definitely accompanied by increasing regional and social disparity challenging the health care policy of Vietnam and her international partners.
During the past decade, health care delivery has undergone enormous changes. The nationwide growth in managed care organizations and the changing methods of provider reimbursement are restructuring the entire health care system. Diversification and integration strategies have blurred historical separations between the activities of hospitals, nursing homes, physicians, and other providers. Services are being offered in and shifting to less costly settings, such as ambulatory clinics, work sites, and homes. Many factors have contributed to the increasing trend of health care delivery outside hospitals. This presentation will provide insight to the management and surveillance of infection prevention in these health care settings.
Antoni, Conny H
Providing health care requires the integrative co-operation of physicians, nurses and other professionals in the health care sector. The success of such interprofessional teamwork does not only rely on the team members' task knowledge, but also on their teamwork-related knowledge, their skills and attitudes. In this paper a theoretical framework for team effectiveness is developed and used to identify factors improving team success. Within this context interprofessional team composition is perceived as a characteristic of team diversity, which needs to be perceived as a chance for better patient care in order to be used effectively.
Margaret I Fitch
Full Text Available Caring for individuals at the end of life in the hospital environment is a challenging proposition. Understanding the challenges to provide quality end of life care is an important first step in order to develop appropriate approaches to support and educate staff members and facilitate their capacity remaining "caring." Four studies were undertaken at our facility to increase our understanding about the challenges health professionals experience in caring for patients at end of life and how staff members could be supported in providing care to patients and families: (1 In-depth interviews were used with cancer nurses (n = 30 to explore the challenges talking about death and dying with patients and families; (2 Surveys were used with nurses (n = 27 and radiation therapists (n = 30 to measure quality of work life; (3 and interprofessional focus groups were used to explore what it means "to care" (five groups held; and (4 interprofessional focus groups were held to understand what "support strategies for staff" ought to look like (six groups held. In all cases, staff members confirmed that interactions concerning death and dying are challenging. Lack of preparation (knowledge and skill in palliative care and lack of support from managers and colleagues are significant barriers. Key strategies staff members thought would be helpful included: (1 Ensuring all team members were communicating and following the same plan of care, (2 providing skill-based education on palliative care, and (3 facilitating "debriefing" opportunities (either one-on-one or in a group. For staff to be able to continue caring for patients at the end of life with compassion and sensitivity, they need to be adequately prepared and supported appropriately.
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.
In this paper I argue that the metaphysical ethics of Emmanuel Levinas captures some essential moral intuitions that are central to health care. However, there is an ongoing discussion about the relevance of ethical metaphysics for normative ethics and in particular on the question of the relationship between justice and individualized care. In this paper I take part in this debate and I argue that Levinas' idea of an ethics of the Other that guides politics and justice can shed important light on issues that are central to priorities in health care. In fact, the ethics of Levinas in seeking the foundation of normativity itself, captures the ethical core and central values of health care.
Full Text Available Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
Rivers, P A; Glover, S H
Health care represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in strategic decision-making processes research but not the study of health care strategy research. This article reviews strategic decision-making in health care domains. Adopting Rajagopalan, Rusheed, and Datta's (1993) framework, the authors evaluate the theoretical and empirical contributions of this research. The limitations and theoretical implications of these efforts are also explored.
Quinn, Amity E; Reif, Sharon; Evans, Brooke; Creedon, Timothy B; Stewart, Maureen T; Garnick, Deborah W; Horgan, Constance M
Given the large numbers of providers and enrollees with which they interact, health plans can encourage the use of health information technology (IT) to advance behavioral health care. The manner and extent to which commercial health plans promote health IT to improve behavioral health care is unknown. This study aims to address that gap. Cross-sectional study. Data are from a nationally representative survey of commercial health plans regarding administrative and clinical dimensions of behavioral health services in 2010. Data are weighted to be representative of commercial managed care products in the United States (n = 8427; 88% response rate). Approaches within the domains of provider support, access to care, and assessment and treatment were investigated as examples of how health plans can promote health IT to improve behavioral health care delivery. Health plans were using health IT approaches in each domain. About a quarter of products offered financial support for electronic health records, but technical assistance was rare. Primary care providers could bill for e-mail contact with patients for behavioral health in about a quarter of products. Few products offered member-provider e-mail, and none offered online appointment scheduling. However, online referral systems and online provider directories were common, and nearly all offered an online self-assessment tool; most offered online counseling and online personalized responses to questions or problems. In 2010, commercial health plans encouraged the use of health IT strategies for behavioral health care. Health plans have an important role to play for increasing health IT as a tool for behavioral health care.
Many employers have begun moving toward health care consumerism strategies designed to encourage employees to take more responsibility for their health care and the cost of that care. Recent surveys suggest ways employers can ensure their consumerism strategies succeed in engaging employees and, ultimately, encourage employees to change their behavior. This article describes what those surveys reveal about employer and employee perspectives on consumerism and suggests steps employers can take to align their interests with those of their employees in order to manage the demand for and use of health care.
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....
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....
Robert L. Drury
Full Text Available We begin by placing our discussion in the context of the chronic crisis in medical care, noting key features, including economic, safety and conceptual challenges. Then we review the most promising elements of a broadened conceptual approach to health and wellbeing, which include an expanded role for psychological, social, cultural, spiritual and environmental variables. The contributions of positive and evolutionary psychology, complex adaptive systems theory, genomics and neuroscience are described and the rapidly developing synthetic field of resilience as a catalytic unifying development is traced in some detail, including analysis of the rapidly growing empirical literature on resilience and its constituents, particularly heart rate variability. Finally, a review of the use of miniaturized ambulatory data collection, analysis and self-management and health management systems points out an exemplar, the Extensive Care System, which takes advantage of the continuing advances in biosensor technology, computing power, networking dynamics and social media to facilitate not only personalized health and wellbeing, but higher quality evidence-based preventive, treatment and epidemiological outcomes. This development will challenge the acute care episode model typified by the ER or ICU stay and replace it with an extensive care system capable of facilitating not only healthyautonomic functioning, but both ipsative/individual and normative/population health.
Márcio Roney Mota Lima
Full Text Available This is a descriptive and qualitative study that aimed to verify the knowledge of nurses, doctors and dentists of the Family Health Strategy in the municipality of Bela Cruz, Ceará, Brazil, about health regulation. Data collection happened from November to December 2008 by applying a questionnaire. Data were organized according to content analysis of Bardin. The results show that the participants have knowledge about the referral flow of patients referred from the primary care to specialized care, the mechanisms used for this purpose, as well as the reference and counter-reference system; they also reported difficulties in the return of patients with the counter-reference form properly filled, thus jeopardizing the continuity of assistance. For these professionals, the regulation is an important management tool for SUS, guaranteeing the right to health.
and rubella); • medical readiness laboratory tests, such as a human immunodeficiency virus test and results current within the past 24 months...established in order to provide for medical recovery from childbirth and to allow additional time to prepare family care plans and child care. However...164.530(c). The Department of Health and Human Services does not consider restructuring of hospitals and doctors’ offices, such as providing
This bachleor thesis was created to analyse variety of marketing strategies, such as consumer orientation, segmentation, targeting or positioning. As the theoretical part continues, an overview of the Ethicon product portfolio is introduced. For the purposes of this thesis, products were divided into particular groups. Furthermore, for Ethicon CZ, a Johnson and Johnson Medical Company, there was a SWOT analysis prepared as well as the analysis of the Czech market and its competitors. In the p...
Ternullo, Joseph; Jethwani, Kamal; Lane, Susan; Myint-U, Khinlei; Havasy, Robert; Carter, Michael; Kvedar, Joseph
This article reviews the history, current status, and future plans of the Partners HealthCare Center for Connected Health (the Center). Established in 1995 by Harvard Medical School teaching hospitals, the Center develops strategies to move healthcare from the hospital and doctor's office into the day-to-day lives of patients. It leverages information technology to help manage chronic conditions, maintain health and wellness, and improve adherence to prescribed regimen, patient engagement, and clinical outcomes. Since inception, it has served over 30,000 patients. The Center's core functions include videoconference-based real-time virtual visits, home vital sign monitoring, store-and-forward online consultations, social media, mobile technology, and other novel methods of providing care and enabling health and wellness remotely and independently of traditional time and geographic constraints. It offers a wide range of services, programs, and research activities. The Center comprises over 40 professionals with various technical and professional skills. Internally within Partners HealthCare, the role of the Center is to collaborate, guide, advise, and support the experimentation with and the deployment and growth of connected health technologies, programs, and services. Annually, the Center engages in a deliberative planning process to guide its annual research and operational agenda. The Center enjoys a diversified revenue stream. Funding sources include institutional operating budget/research funds from Partners HealthCare, public and private competitive grants and contracts, philanthropic contributions, ad hoc funding arrangements, and longer-term contractual arrangements with third parties.
The costs of providing antiretroviral therapy services to HIV-infected individuals presenting with advanced HIV disease at public health centres in Dar es Salaam, Tanzania: Findings from a randomised trial evaluating different health care strategies
Kimaro, Godfather Dickson; Mfinanga, Sayoki; Simms, Victoria; Kivuyo, Sokoine; Bottomley, Christian; Hawkins, Neil; Harrison, Thomas S.; Jaffar, Shabbar; Guinness, Lorna
Background Understanding the costs associated with health care delivery strategies is essential for planning. There are few data on health service resources used by patients and their associated costs within antiretroviral (ART) programmes in Africa. Material and methods The study was nested within a large trial, which evaluated screening for cryptococcal meningitis and tuberculosis and a short initial period of home-based adherence support for patients initiating ART with advanced HIV disease in Tanzania and Zambia. The economic evaluation was done in Tanzania alone. We estimated costs of providing routine ART services from the health service provider's perspective using a micro-costing approach. Incremental costs for the different novel components of service delivery were also estimated. All costs were converted into US dollars (US$) and based on 2012 prices. Results Of 870 individuals enrolled in Tanzania, 434 were enrolled in the intervention arm and 436 in the standard care/control arm. Overall, the median (IQR) age and CD4 cell count at enrolment were 38 [31, 44] years and 52 [20, 89] cells/mm3, respectively. The mean per patient costs over the first three months and over a one year period of follow up following ART initiation in the standard care arm were US$ 107 (95%CI 101–112) and US$ 265 (95%CI 254–275) respectively. ART drugs, clinic visits and hospital admission constituted 50%, 19%, and 19% of the total cost per patient year, while diagnostic tests and non-ART drugs (co-trimoxazole) accounted for 10% and 2% of total per patient year costs. The incremental costs of the intervention to the health service over the first three months was US$ 59 (p<0.001; 95%CI 52–67) and over a one year period was US$ 67(p<0.001; 95%CI 50–83). This is equivalent to an increase of 55% (95%CI 51%–59%) in the mean cost of care over the first three months, and 25% (95%CI 20%–30%) increase over one year of follow up. PMID:28234969
Relationships between the characteristics of oncohematology services providing palliative care and the sociodemographic characteristics of caregivers using health indicators: social support, perceived stress, coping strategies, and quality of work life.
Pronost, Anne-Marie; Le Gouge, Amélie; Leboul, Daniele; Gardembas-Pain, Martine; Berthou, Christian; Giraudeau, Bruno; Fouquereau, Evelyne; Colombat, Philippe
The aim of this study was to analyze the relationships between the characteristics of the management of oncohematology services and the psychosocial determinants of caregivers' health at work including social support, stress, and coping strategies. Investigation using questionnaires was carried out about nurses and nurse aides in hematology and oncology services. All hematology and oncology services of Western France were requested. Five questionnaires concerning sociodemographic characteristics, measurements of quality of work life, of social support, of perceived stress, and of coping strategies and quality of work life were delivered among health professionals. Five hundred seventy-four questionnaires from 53 different services were analyzed. There were 57.4% nurses and 42.6% nurse aides. Some 94.1% were female and 33.5% were older than 40 years. Several characteristics of oncohematology services were significantly linked to health indicators, as the need for time and recognition, the importance of training (in palliative care, pain management, and help relationship), the care of patients and their families, the interdisciplinary efficiency, and external interventions (psychologists and volunteers). We showed that participative management which includes implementation of service projects and of multidisciplinary staff influence the quality of work life of health professionals. We showed also how much the characteristics of services organized around an effective social support (need for recognition) favor a better quality of work life among caregivers, influencing their perceived stress and their coping strategies. To our knowledge, it is the first study showing a relationship between participative management (including multidisciplinary staffs, approach with a service project, and internal training) and the quality of work life in the domain of health care. The implementation of this model should be promoted in health care services.
... Other Hazards (Lack of) PPE Slips/Trips/Falls Stress Tuberculosis Universal Precautions Workplace Violence Use of Medical Lasers Health Effects Use ... Needlesticks Noise Mercury Inappropriate PPE Slips/Trips/Falls ... of Universal Precautions Workplace Violence For more information, see Other Healthcare Wide ...
Banks, Jane L.; And Others
The first of eight articles discusses the current state of the sensitive but unclassified information controversy. A series of six articles then explores the use of integrated information systems in the area of health services. Current trends in document management are provided in the last article. (CLB)
Myths impede the effective management of health care, for example that the system is failing (indeed, that is a system), and can be fixed by detached social engineering and heroic leadership, or treating it more like a business. This field needs to reframe its management, as distributed beyond the "top"; its strategy as venturing, not planning; its organizing as collaboration beyond control, and especially itself, as a system beyond its parts.
The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.
Guirguis-Younger, Manal; McNeil, Ryan; Runnels, Vivien
Health-care workers serving homeless persons often face difficulties in addressing the needs of this population due to the complexity of the health challenges and gaps in clinical knowledge. How can health-care workers enhance their ability to care for this population? The authors explore the learning and knowledge-integration strategies of nurses and client care workers employed by organizations targeting homeless persons in a Canadian city. Semi-structured qualitative interviews were conducted with 8 health-care workers.The data were examined using narrative analysis and constant comparative analysis. Three strategies were identified: integrating past experiences into clinical practice, interacting with clients to identify care needs and boundaries, and engaging in interprofessional knowledge exchange. A better understanding of these strategies may help nursing programs and health-services organizations to equip health-care workers with the skills they need to serve homeless persons.
What does it mean to say that there is a right to health care? Health care is part of a cooperative project that organizes finite resources. How are these resources to be distributed? This essay discusses three rival theories. The first two, a utilitarian theory and an interst theory, are both instrumental, in that they collapse rights to good states of affairs. A third theory, offered by Thomas Pogge, locates the question within an institutional legal context and distinguishes between a right to health care that results in claimable duties and other dimensions of health policy that do not. Pogge's argument relies on a list of "basic needs," which itself, however, relies on some kind of instrumental reasoning. The essay offers a reconstruction of Pogge's argument to bring it in line with a political conception of a right to health care. Health is a matter of equal liberty and equal citizenship, given our common human vulnerability. If we are to live as equal members in a political community, then our institutions need to create processes by which we are protected from the kinds of suffering that would make it impossible for us to live as equal members.
Gehrt, K C; Pinto, M B
Health care marketing research has examined the relationship between health care utilization and (1) client demographic characteristics and (2) service characteristics. The impact of situational factors on health care utilization has received limited attention. The authors find that the influence of situational factors in the health care market is substantial and suggest some preliminary situational segmentation strategies.
Domaszewicz, Sander; Havlin, Linda; Connolly, Susan
Employers affected by the recession's 2009 peak must press for cost containment in 2010, especially in health care benefits. Encouraging employee consumerism--through consumer-directed health plans and other strategies--can be enhanced by incentives, but federal efforts at health care reform add some element of uncertainty to the consumer-directed solution. This article provides some lessons to guide the course of action for employers considering implementing a consumerist approach to improve employee health and control the cost trend.
Gisele Damian Antonio
Full Text Available 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.
Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio
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
Sahoo, Sanjeeb K
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
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.
Munga, Michael A; Gideon, Gilbert M
Addressing inequities in health care provision and financing has been at the center stage of Health Sector Reform (HSR) discussions since the early 1980s. The poor, women, and informal health sector workers in most developing countries are rarely covered by formal health insurance mechanisms that are meant to ensure access to essential health services. They are also sidelined in formal banking and credit systems due to their being predominantly low income earners, with little resources to meet eligibility criteria for borrowing and also to be considered creditworthy. In light of this fact, the present paper analyzes both quantitative and qualitative data in an attempt to explore and discuss the experiences and coping strategies of women and men employed in the informal sector economy in their daily attempts to access health care services. The paper employs Malaria as a tracer disease and gender as a unit of analysis. Analysis indicated the significance, as perceived by interviewees, of both informal credit networks and formal insurance and banking systems as important shock-absorbers for vulnerable populations in their struggle to access basic health services in times of need. The paper further highlights and discusses diverse coping strategies that households employ in dealing with illness-related costs and a greater willingness to be integrated into both formal and informal financial mechanisms. The paper finally concludes that the government must take the following steps: 1) enhance existing formal and communitybased initiatives to make them sustainable, 2) devise ways to reduce the lack of flexibility in membership requirements for insurance schemes/financial institutions, and 3) reduce perverse incentives inherent in the health system that may prevent people from seeking membership in available insurance mechanisms. In addition, deliberate steps must be taken by the government to employ 'targeted measures' to ensure that health care access is improved and
Heller, Kathryn Wolff; Avant, Mary Jane Thompson
Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…
Full Text Available Research Question (RQ: What is socially responsible behavior in the Slovenian health care system, where we have three main entities which they are actively involved in so called health care system. Purpose: Through the article, I would like for all three entities in the health sector to present, what is socially responsible behavior, which contributes to improving mutual cooperation for each of them and the wider society. Method: The results I achieved by studying domestic and foreign literature, laws and regulations that define social responsibility to the other two entities in the health care and the integration of literature in practice. Results: Each social responsibility within the organization, starting with superiors or managers, whose activities transferred the positive impact of social responsibility on employees and therefore the wider society. Society: By being aware of our role in society or position in the health system, any individual with a positive socially responsible actions have a positive impact on the wider community and to improve the benefits, at least in theoretical terms. Originality: I have not registered any discussions that would include mutual social responsibility - related conduct that contributes to the overall satisfaction of all. Most are present in one entity in health and his social responsibility in the internal and external environment, where they performance. Limitations/Future Research: Accessibility of data nature, from which it was evident social responsibility to other entities in the health system. The lack of literature covering social responsibility in Slovenia.
Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R
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.
Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len
Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experie...
Punjabi, Chitra D; Perloff, Sarah R; Zuckerman, Jerry M
Patients with tuberculosis (TB) pose a risk to other patients and health care workers, and outbreaks in health care settings occur when appropriate infection control measures are not used. In this article, we discuss strategies to prevent transmission of Mycobacterium tuberculosis within health care settings. All health care facilities should have an operational TB infection control plan that emphasizes the use of a hierarchy of controls (administrative, environmental, and personal respiratory protection). We also discuss resources available to clinicians who work in the prevention and investigation of nosocomial transmission of M tuberculosis. Copyright © 2016 Elsevier Inc. All rights reserved.
da Silva, Sílvio Eder Dias; Ramos, Flávia Regina Souza; Martins, Cleusa Rios; Padilha, Maria Itayra; Vasconcelos, Esleane Vilela
This article presents a reflection on the meaning of the terms citizenship and health, addressing the Theory of Social Representations as a strategy for implementing and evaluating health care models in Brazil. First, a brief history about the concept of citizenship is presented; then the article addresses the principles of freedom and equality according to Kant; the third section of the article shows that health is as a right of the citizen and a duty of the state. Finally, the Theory of Social Representations is emphasized as a strategy to evaluate and implement the health services provided to citizens by the current health care models in Brazil.
Pavoni, Daniela Soccoloski; Medeiros, Cássia Regina Gotler
The Family Health Strategy requires a redefinition of the health care model, characterized by interdisciplinary team work. This study is aimed at knowiong the work processes in a Family Health Team. The research was qualitative, and 10 team members were interviewed. Results demonstrated that the nurse performs a variety of functions that could be shared with other people; this overloads him/her and makes inherent job task execution difficult. Task planning and performing are usually done in teams, but some professionals get more involved in these activities. It was concluded that there is a need for the team to reflect upon work process as well as reassess task assignment, so that each individual is able to perform the work and contribute for an integrated work.
Perla, Rocco J; Provost, Lloyd P; Murray, Sandra K
Sampling in improvement work can pose challenges. How is it different from the sampling strategies many use with research, clinical trials, or regulatory programs? What should improvement teams consider when determining a useful approach to sampling and a useful sample size? The aim of this article is to introduce some of the concepts related to sampling for improvement. We give specific guidance related to determining a useful sample size to a wider health care audience so that it can be applied to improvement projects in hospitals and health systems.
Marketing strategies are employed to ensure the success of new products, services or programs. Both profit and non-profit organizations have used social marketing strategies to inform, to motivate interest, and to engage the involvement of the consumer. A client-dependent health care system did not find it necessary to market services, but a health care system that encourages clients to choose the most appropriate health promotion service available must market services. Nurses are in the business of promoting the health of clients. Therefore, it is essential that nurses become familiar with, and involved in, the development of marketing plans and strategies. The connection between the four variables of the marketing mix (product, promotion, place, and price) and promoting the health of clients is described. A case example recapitulating the marketing strategies employed to raise public awareness of a self-help group for family caregivers is related, the marketing response is evaluated, and future recommendations are proposed.
Chow, Clara K; Ariyarathna, Nilshan; Islam, Sheikh Mohammed Shariful; Thiagalingam, Aravinda; Redfern, Julie
Mobile health (mHealth) has been defined as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices and personal digital assistants. Cardiovascular mHealth is, arguably, leading the mHealth space, through innovation, research and implementation, and especially in the areas of prevention, cardiac rehabilitation and education. mHealth includes simple strategies, such as the use of short message service (SMS) or text messages in successful short-term smoking-cessation, weight loss and diabetes management programs. The recent Australian Tobacco, Exercise and Diet Messages (TEXT ME) randomised clinical trial addressed multiple cardiovascular risk factors. mHealth can also involve more complex strategies, such as smart phone applications (apps), global positioning systems (GPS) and Bluetooth technologies. Although many apps could be considered suitable for primary prevention, they are largely unregulated and most are not evidence-based. Some have been well-developed, such as the Food Switch app and an iPhone electrocardiogram (ECG) system. The "explosion" of apps has driven initiatives such as the Mobile Applications Rating Scale (MARS). More recently, the use of sensors to monitor and provide feedback to patients and healthcare providers is being explored. With almost two billion people currently owning a Smartphone, and 50% of adults (globally) predicted to own one by 2018, mHealth provides the prospect of delivering efficient, affordable healthcare services to widespread populations both locally and globally. In particular, it has the potential to reduce socioeconomic disparity and alleviate the burden of cardiovascular disease. There is now a need to rethink traditional health service structures and bioengineering capacity, to ensure mHealth systems are also safe, secure and robust. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Full Text Available This paper examines the current notion of universal health care (UHC in key legal and policy documents and argues that the recommendations for UHC in these entail further abdication of the State′s responsibility in health care with the emphasis shifting from public provisioning of services to merely ensuring universal access to services. Acts of commission (recommendations for public private partnership [PPPs], definition and provision of an essential health package to vulnerable populations to ensure universal access to care and omission (silence maintained on tertiary care will eventually strengthen the private and corporate sector at the cost of the public health care services and access to care for the marginalized. Thus, the current UHC strategy uses equity as a tool for promoting the private sector in medical care rather than health for all.
This paper examines the current notion of universal health care (UHC) in key legal and policy documents and argues that the recommendations for UHC in these entail further abdication of the State's responsibility in health care with the emphasis shifting from public provisioning of services to merely ensuring universal access to services. Acts of commission (recommendations for public private partnership [PPPs], definition and provision of an essential health package to vulnerable populations to ensure universal access to care) and omission (silence maintained on tertiary care) will eventually strengthen the private and corporate sector at the cost of the public health care services and access to care for the marginalized. Thus, the current UHC strategy uses equity as a tool for promoting the private sector in medical care rather than health for all.
Wolf, Michael S; Wilson, Elizabeth A H; Rapp, David N; Waite, Katherine R; Bocchini, Mary V; Davis, Terry C; Rudd, Rima E
The relationship between literacy and health outcomes are well documented in adult medicine, yet specific causal pathways are not entirely clear. Despite an incomplete understanding of the problem, numerous interventions have already been implemented with variable success. Many of those who proposed earlier strategies assumed the problem to originate from reading difficulties only. Given the timely need for more effective interventions, it is of increasing importance to reconsider the meaning of health literacy to advance our conceptual understanding of the problem and how best to respond. One potentially effective approach might involve recognizing the known associations between a larger set of cognitive and psychosocial abilities with functional literacy skills. Here we review the current health literacy definition and literature and draw on relevant research from the fields of education, cognitive science, and psychology. In this framework, a research agenda is proposed that considers an individual's "health-learning capacity," which refers to the broad constellation of cognitive and psychosocial skills from which patients or family members must draw to effectively promote, protect, and manage their own or a child's health. This new, related concept will lead, ideally, to more effective ways of thinking about health literacy interventions, including the design of health-education materials, instructional strategies, and the delivery of health care services to support patients and families across the life span.
Silvia Padilla Loredo
Full Text Available This article reflects on the strategies of Celestin Freinet, which can be adapted to health education in primary care. The purpose of these strategies is to contribute to the effectiveness of social and sanitary actions in Mexico, especially with regards to self-help groups.
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...
availability and affordability of ACTs in Secondary Health Care (SHC) facilities in Lagos State and ... percent (37.5%) of the hospitals did not have the drug in stock at the time of visit and drugs had been out of .... Only one in the community pharmacies as single dose .... funding and international competitive bidding for.
This paper reports in detail on a project of Integrated Health Care in cardiology at Nuremberg, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Handelsman, L; Speiser, M; Maltz, A; Kirpalani, S
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.
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...
Journal of Community Medicine and Primary Health Care. 26 (1) 96-107 ... obesity. Specific criteria for MetS developed by. 19 of hypertension. .... Triglycerides 150 mg/dL or more or on Christians 329 (96.2%); and lower grade income.
4 and optimal use. In Nigeria, despite the The main objective of this study is therefore to .... Islam. Others. 185. 205. 5. 46.8. 51.9. 1.3. Utilization (use) of PHC Services and educational qualifications and of low socio-economic .... other zones except in the south-east region. .... primary health care interventions, the evidence is.
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...
India's health care system, despite several significant achievements, suffers from some weaknesses and deficiencies. There has been a preoccupation with the promotion of curative and clinical services through city based hospitals which have essentially catered to certain sections of the urban population. The concept of health in its totality, with preventive and promotive health care services in addition to the curative, has yet to be made operational. There has been an overdependence on the states for health care measures and voluntary and local effort has not been able to accept responsibility in any significant way. The involvement of the people in solving their health problems has been almost nonexistent. Health needs to be viewed as part of the strategy of human resources development. Horizontal and vertical linkages must be obtained among all the interrelated programs--protected water supply environmental sanitation and hygiene, nutrition, education, family planning, and maternal and child welfare. Only with such linkages can the benefits of the various programs be optimized. An attack on the problems of diseases cannot be completely successful unless it is accompanied by an attack on poverty. For this reason the 6th plan assigns a high priority to programs of promotion, or gainful employment, eradication of poverty, population control, and meeting the basic human needs of the population. The Alma Alta Declaration of 1977 has become the accepted health policy of India, simplified into the slogan "health for all by 2000." To realize this goaL, the Planning Commission recommends in the 6th 5-Year Plan a restructing and reorientation of the country's health services. The proposed alternative scheme is more decentralized and provides for many more people to be trained at the grassroots level. People would be involved in tackling their health problems and community participation would be encouraged. Finally, the alternative strongly urges the screening of patients
Robinson, James C
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.
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
Full Text Available All health systems across the world have faced new challenges, which is primarily referable to increasing the cost of health care services as well as growing demands for new and expensive health technologies. The aim of this study is to analyse the main challenges facing the Iranian health system. A review of available governmental and relevant publications about Iranian health care system was undertaken to assess the direction of future healthcare policy. Electronic news agencies, newspapers, and parliament’s electronic news also reviewed to realise policy-makers points of view about the health system. Healthcare services in Iran have had a great success in primary healthcare services in last 25 years, which is mainly attributable to National Health Networks policy. Between 1979 and 2003, average life expectancy at birth increased from 57 to 70 and infant mortality rate fell from 104 to 26 per thousand live births. Active vaccination system, very good distribution and coverage, free end point services, family planning, maternal teaching, and primary referral system are of strong advantages of health networks in Iran. However, the healthcare system is now subject to a range of new pressures that must be addressed. Many of these pressures are common to all health services (rising consumer demands and expectations for expensive new technologies, changing disease patterns, and resources shortage, but some are largely specific to Iran. Financial fairness contribution of the population to health system, responsiveness of health system, overusing new technologies, inadequate integration of health services, and inequitable distribution of the resources are of the main challenges of health system in Iran. In addition, considering demographic changes of the Iranian population in recent decades, which made Iranian population young, potential pressures due to an aging population will reveal in coming years. Many of these pressures relate to policies and
Kizer, K W
As the US health care system begins to reengineer itself to address the need for quality improvement, it also is being actively reshaped by the expectations of consumers. The confluence of these forces requires a new approach to setting health care performance standards. The National Quality Forum (NQF) has been established as a private, not-for-profit, open membership, public benefit corporation for the purposes of developing consensus about standardized health care performance measures, reporting mechanisms, and a national strategy for health care quality improvement. The NQF has broad representation from all segments of the health care industry and provides an equitable way of addressing the disparate priorities of health care's many stakeholders. Agreement and implementation of standardized health care performance measures and achievement of quality improvement in the emerging era of consumerism will be facilitated by (1) establishing national goals for health care quality; (2) embracing public policy that recognizes the complementary roles of quality improvement, cost control, and improved access; (3) giving greater priority to measuring and reporting the performance of those aspects of the health care system that directly affect consumers; (4) focusing on creating a health care culture of excellence; and (5) promoting the active collaboration of all stakeholders.
Emanuel, E J; Emanuel, L L
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
Hacker, Karen; Anies, Maria; Folb, Barbara L; Zallman, Leah
With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant's fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts
Robinson, J C
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.
Ramirez, Bernardo; West, Daniel J; Costell, Michael M
This paper aims to examine the concept of sustainability in health care organizations and the key managerial competencies and change management strategies needed to implant a culture of sustainability. Competencies and management development strategies needed to engrain this corporate culture of sustainability are analyzed in this document. This paper draws on the experience of the authors as health care executives and educators developing managerial competencies with interdisciplinary and international groups of executives in the last 25 years, using direct observation, interviews, discussions and bibliographic evidence. With a holistic framework for sustainability, health care managers can implement strategies for multidisciplinary teams to respond to the constant change, fine-tune operations and successfully manage quality of care. Managers can mentor students and provide in-service learning experiences that integrate knowledge, skills, and abilities. Further empirical research needs to be conducted on these interrelated innovative topics. Health care organizations around the world are under stakeholders' pressure to provide high quality, cost-effective, accessible and sustainable services. Professional organizations and health care providers can collaborate with university graduate health management education programs to prepare competent managers in all the dimensions of sustainability. The newly designated accountable care organizations represent an opportunity for managers to address the need for sustainability. Sustainability of health care organizations with the holistic approach discussed in this paper is an innovative and practical approach to quality improvement that merits further development.
Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), pa...
The purpose of this paper is to help public health actors with an interest in health promotion and health care professionals involved in therapeutic education to develop and implement an educational strategy consistent with their vision of health and health care. First, we show that the Ottawa Charter for Health Promotion and the French Charter for Popular Education share common values. Second, an examination of the career and work of Paulo Freire, of Ira Shor's pedagogical model and of the person-centered approach of Carl Rogers shows how the work of educational practitioners, researchers and theorists can help health professionals to implement a truly "health-promoting" or "therapeutic" educational strategy. The paper identifies a number of problems facing health care professionals who become involved in education without reflecting on the values underlying the pedagogical models they use.
Chandler, William U.
Least-cost health strategies designed to attack the world's leading causes of unnecessary death are explored. Section 1 emphasizes the value of primary health-care procedures--midwifery, maternal education on breastfeeding and weaning, vaccinations, oral rehydration of victims of diarrhea, and antibiotics against respiratory infections--in…
France, K R; Grover, R
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.
Henke, K D
Although the health care system has to deal with huge financial problems one cannot neglect that this labour-intensive service branch creates the most jobs with social security obligations. Corrective strategies will have to increase the orientation of health care to patients' needs which requires better information and more decision-making autonomy for the insured people as well as a maximising of efficiency. Competition needs to be strengthened in order to improve quality and reduce costs. This requires more contractual freedom for insurance funds and a dismantling of the current monopolistic structures. Finally, adequate remuneration schedules and patients' individual responsibility play a major role to meet the future challenges in the European internal market.
According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…
O'Hagan, Joshua; Persaud, David
Improving customer-service in health care organizations has been linked to better patient care, satisfied staff, a reduction in preventable medical errors, fewer malpractice lawsuits and improved revenue. However, it has been observed that there is sometimes a gap between the level of customer-service provided by health care organizations and their clients' expectations. This paper integrates, synthesizes and extends theory and practice from existing literature to provide health care organizations with strategies for closing this gap. Methods are also outlined for creating, implementing and evaluating an organizational plan for improving customer-service.
Deshpande, Satish P; Deshpande, Samir S
The purpose of this study was to examine factors that impact consumer satisfaction with health care. This is a secondary analysis of the Center for Studying Health System Change's 2010 Health Tracking Household Survey. Regression analysis was used to examine the impact of treatment issues, financial issues, family-related issues, sources of health care information, location, and demographics-related factors on satisfaction with health care. The study involved 12280 subjects, 56% of whom were very satisfied with their health care, whereas 66% were very satisfied with their primary care physician. Fourteen percent of the subjects had no health insurance; 34% of the subjects got their health care information from the Web. Satisfaction with primary care physician, general health status, promptness of visit to doctor, insurance type, medical cost per family, annual income, persons in family, health care information from friends, and age significantly impacted satisfaction with health care. The regression models accounted for 23% of the variance in health care satisfaction. Satisfaction with primary care physicians, health insurance, and general health status are the 3 most significant indicators of an individual's satisfaction with health care.
Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. PMID:21447469
Reynolds, Carl J; Wyatt, Jeremy C
Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy.
Tanenbaum, Sandra J
In health care, particularism asserts the primacy of the individual case. Moral particularists, such as Jonsen and Toulmin, reject deduction from universal moral principles and instead seek warrants for action from the multiple sources unique to a given patient. Another kind of health care particularism, here referred to as the knowledge of particulars, is offered as a corrective to evidence-based medicine (EBM), its influence on health care practice and policy, and specifically to EBM's reliance on the aggregate. This paper describes the knowledge of particulars and identifies strategies for its legitimation in health care policy and practice. First, the paper documents the ascendancy of the aggregate through EBM's definition of 'what works' in health care. Second, it delineates the limits of health care knowledge based on the analysis of aggregates, not only for the care of individual patients but for the formulation of policies about patient care. Third, the paper analyses prominent rejections of the particular in contemporary health policy discourse and relates them to larger political purposes. Finally, it depicts the knowledge of particulars as the basis for clinical prudence and offers three potential strategies for promoting particularism as essential to high-quality care.
Brooks, J P; Dempsey, J
Health care managers are being required to respond to the growing concerns of the public about alcohol and drug use in the health care workplace. To this end, the following recommendations are offered. A drug testing policy should be developed with input from and support of employees and unions. "For cause" testing should be used because it results in more definitive results and better employee acceptance. Unless there are compelling reasons for random testing, "for cause" testing is the preferable method. All levels of employees and the medical staff should be subject to the drug-testing policy. Rehabilitation rather than punishment should be emphasized in dealing with employees with alcohol and drug problems.
In this article, I explore what happens when specialist palliative care staff meet together to discuss patients under their care. Many studies (e.g., Atkinson) have discussed how health care practitioners in various settings use rhetorical strategies when presenting cases in situations such as ward rounds and team meetings. Strategies for arguing and persuading are central to medical practice in the interprofessional context. The context of specialist palliative care is an interesting place...
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...... these to a discussion of future challenges in the form of an aging population, increased privatization and increased inequity...
Edler, A A
Over the last decade, development aid has increasingly used a more collaborative model, with donors and recipients both contributing ideas, methods and goals. Though many examples of collateral aid projects exist in agriculture, business administration and banking, few have found their way into health care and health education, a typically donor-dominated model. The following case report describes a collateral project in health care education. This case report analyzes data-inducing project proposals, personal interviews and project reports obtained through standard archival research methods. The setting for this joint project was the collaboration between international nongovernmental (NGO) aid foundations and the faculty of a major sub-Saharan African Medical School's Department of Anesthesia. The initial goal of this project was to improve record keeping for all anesthetic records, both in the operating theatres and outside. Analysis of the data was performed using ethnographic methods of constant comparative analysis. The purpose of the analysis was to critically evaluate both the goals and their results in the Department of Anesthesiology. The findings of this analysis suggested that results included not only quality assurance and improvement programs in the department but also advances in the use of critical incidents as teaching tools, hospital-wide drug and equipment utilization information and the initiation of an outreach program to district hospitals throughout the country for similar projects.
Edler, A. A.
Over the last decade, development aid has increasingly used a more collaborative model, with donors and recipients both contributing ideas, methods and goals. Though many examples of collateral aid projects exist in agriculture, business administration and banking, few have found their way into health care and health education, a typically donor-dominated model. The following case report describes a collateral project in health care education. This case report analyzes data-inducing project proposals, personal interviews and project reports obtained through standard archival research methods. The setting for this joint project was the collaboration between international nongovernmental (NGO) aid foundations and the faculty of a major sub-Saharan African Medical School's Department of Anesthesia. The initial goal of this project was to improve record keeping for all anesthetic records, both in the operating theatres and outside. Analysis of the data was performed using ethnographic methods of constant comparative analysis. The purpose of the analysis was to critically evaluate both the goals and their results in the Department of Anesthesiology. The findings of this analysis suggested that results included not only quality assurance and improvement programs in the department but also advances in the use of critical incidents as teaching tools, hospital-wide drug and equipment utilization information and the initiation of an outreach program to district hospitals throughout the country for similar projects. PMID:10604789
Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto
Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice.
antenatal clinic visits, the level of utilisation of maternal health care, to identify the main service .... number of antenatal care visits which have impact .... to or experience with modern health services may ..... diet/nutrition ..... Human Fertility.
Piper, Llewellyn E
Passion in today's health care leaders is essential as health care organizations face increasing demands for survival. Leaders in health care have been educated, selected, promoted, and retained based on their analytical and creativity skills. Today's health care leaders must also have emotional intelligence. Emotional intelligence is primal for passion. Emotional intelligence, which leads to passion, is crucial to the survivability of today's health care organizations. In order for health care organizations to go from good to great, the leader must inspire followers through passion. This article encourages health care leaders to gain awareness of emotional intelligence and to use emotional intelligence as part of their leadership to inspire passion. Through passion, leaders and followers become more motivated to accomplish the health care mission of serving others.
Gesler, Wilbert M.
This article shows how health care delivery is related to cultural or human geography. This is accomplished by describing health care delivery in terms of 12 popular themes of cultural geography. (JDH)
U.S. Department of Health & Human Services — The Affordable Care Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid...
Chung, Vincent C H; Wong, Samuel Y S; Wang, Harry H X; Wong, Martin C S; Wei, Xiaolin; Wang, Jiaji; Liu, Siya; Ho, Robin S T; Yu, Ellen L M; Griffiths, Sian M
In China, Community Health Centers (CHCs) are major providers of primary care services, but their potential in empowering patients' self-management capacity has not been assessed. This study aims to describe self-care practice patterns amongst CHC attendees in urban China.In this cross-sectional quantitative study, 3360 CHC patients from 6 cities within the Pearl Delta Region were sampled using multistage cluster sampling.Thirty-seven per cent had used with over-the-counter Chinese herbal medicines (OTC CHMs) in the past year and majority of respondents found OTC CHMs effective. OTC CHMs were more popular amongst those who needed to pay out of pocket for CHC services. Less than 10% used vitamins and minerals, and those with a lower socioeconomic background have a higher propensity to consume. Although doubts on their usefulness are expressed, their use by the vulnerable population may reflect barriers to access to conventional health care, cultural affinity, or a defense against negative consequences of illnesses. About 25% performed physical exercise, but the prevalence is lower amongst women and older people. Taiji seems to be an alternative for these populations with promising effectiveness, but overall only 6% of CHC attendees participated.These results suggest that CHCs should start initiatives in fostering appropriate use of OTC CHM, vitamins, and minerals. Engaging community pharmacists in guiding safe and effective use of OTC CHM amongst the uninsured is essential given their low accessibility to CHC services. Prescription of Taiji instead of physical exercises to women and older people could be more culturally appropriate, and the possibility of including this as part of the CHC services worth further exploration.
Health centres are structurally designed to facilitate the coordination of care. However, evolutions in society have resulted in forms of consumption of health care which are not necessarily compatible with efficient care coordination. On a local level, teams are nevertheless organising and structuring themselves to offer the right form of care, to the right patient and at the right time.
The right to health care is a right to care that (a) is not too costly to the provider, considering the benefits it conveys, and (b) is effective in bringing about the level of health needed for a good human life, not necessarily the best health possible. These considerations suggest that, where possible, society has an obligation to provide preventive health care, which is both low cost and effective, and that health care regulations should promote citizens' engagement in reasonable preventive health care practices.
Full Text Available BACKGROUND: Determining how migraineurs manage their condition from the viewpoint of health resource utilization (including both medical and personal resources may provide insights that could lead to more effective care strategies.
Druss, Benjamin G; Mauer, Barbara J
The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.
Yeates, Karen E; Sleeth, Jessica; Hopman, Wilma; Ginsburg, Ophira; Heus, Katharine; Andrews, Linda; Giattas, Mary Rose; Yuma, Safina; Macheku, Godwin; Msuya, Aziz; Oneko, Olola
Almost nine of 10 deaths resulting from cervical cancer occur in low-income countries. Visual inspection under acetic acid (VIA) is an evidence-based, cost-effective approach to cervical cancer screening (CCS), but challenges to effective implementation include health provider training costs, provider turnover, and skills retention. We hypothesized that a smartphone camera and use of cervical image transfer for real-time mentorship by experts located distantly across a closed user group through a commercially available smartphone application would be both feasible and effective in enhancing VIA skills among CCS providers in Tanzania. We trained five nonphysician providers in semirural Tanzania to perform VIA enhanced by smartphone cervicography with real-time trainee support from regional experts. Deidentified images were sent through a free smartphone application on the available mobile telephone networks. Our primary outcomes were feasibility of using a smartphone camera to perform smartphone-enhanced VIA and level of agreement in diagnosis between the trainee and expert reviewer over time. Trainees screened 1,072 eligible women using our methodology. Within 1 month of training, the agreement rate between trainees and expert reviewers was 96.8%. Providers received a response from expert reviewers within 1 to 5 minutes 48.4% of the time, and more than 60% of the time, feedback was provided by regional expert reviewers in less than 10 minutes. Our method was found to be feasible and effective in increasing health care workers' skills and accuracy. This method holds promise for improved quality of VIA-based CCS programs among health care providers in low-income countries.
Cavanaugh, Kerri L
SUMMARY The exchange of complex health information among patients, providers, health organizations and the public is often described as health literacy. Low levels of health literacy is common and associated with processes of healthcare and important health outcomes. In diabetes, health literacy is related to diabetes knowledge, self-efficacy and self-care behaviors and glycemic control. Health literacy may also provide a better understanding of racial disparities observed in patients with diabetes. Strategies to address health literacy, based upon this understanding of its role, provide a means to improve diabetes care. This article describes the concept of health literacy and its assessment and the evidence of its impact on patients with diabetes, and offers suggested methods and tools that may be implemented to improve clinical care. PMID:21860659
Cavanaugh, Kerri L
The exchange of complex health information among patients, providers, health organizations and the public is often described as health literacy. Low levels of health literacy is common and associated with processes of healthcare and important health outcomes. In diabetes, health literacy is related to diabetes knowledge, self-efficacy and self-care behaviors and glycemic control. Health literacy may also provide a better understanding of racial disparities observed in patients with diabetes. Strategies to address health literacy, based upon this understanding of its role, provide a means to improve diabetes care. This article describes the concept of health literacy and its assessment and the evidence of its impact on patients with diabetes, and offers suggested methods and tools that may be implemented to improve clinical care.
Brink-Muinen, A. van den
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
Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of
Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of th
Cutler, David M.
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…
Prætorius, Thim; C. Becker, Markus
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...
Kelleher, J Paul
This paper argues that societal duties of health promotion are underwritten (at least in large part) by a principle of beneficence. Further, this principle generates duties of justice that correlate with rights, not merely "imperfect" duties of charity or generosity. To support this argument, I draw on a useful distinction from bioethics and on a somewhat neglected approach to social obligation from political philosophy. The distinction is that between general and specific beneficence; and the approach from political philosophy has at times been called equality of concern. After clarifying the distinction and setting out the basis of the equality of concern view, I argue that the result is a justice-based principle of "specific" beneficence that should be reflected in a society's health policy. I then draw on this account to criticize, refine, and extend some prominent health care policy proposals from the bioethics literature.
Savage, Brittany; Foli, Karen J; Edwards, Nancy E; Abrahamson, Kathleen
The Hispanic older adult population's rapid growth calls for an awareness of values that can affect the rendering and receipt of care. Familism, or familismo, a traditional Hispanic value, places importance of family over the self and can potentially affect health care perceptions and practices for Hispanic older adults. The current article discusses familism, which is upheld by some Hispanic older adults, and the potential for underuse of health care services. The traditional feminine role, marianismo, and masculine role, machismo, are considered, as well as implications for how decision making may be made by family members rather than the patient. Clinical implications for the provision of health care to Hispanic older adults are provided, along with the importance of considering acculturation and ethnic heterogeneity. Health care management strategies that reflect recognition and respect of familism, yet emphasize optimization of adherence and self-care, are described. Copyright 2016, SLACK Incorporated.
Nascimento, Antonio C; Moysés, Simone T; Werneck, Renata I; Moysés, Samuel J
This article presents an integrative literature review that analyses the advances and challenges in oral health care of the Brazilian primary health care system, based on a political agenda that envisages re-organising the unified health system (SistemaÚnico de Saúde - SUS). It is presumed that the actions suggested by the Alma-Ata Conference of 1978 are still up-to-date and relevant when adapted to the situation in Brazil. Several studies and policies are reviewed, including works demonstrating the importance of primary care as an organising platform in an integrated health-care network, Brazil's strategy for reorganising the primary care network known as the Family Health Strategy, and the National Oral Health Policy. This review discusses results obtained over the last twenty years, with special attention paid to changes in oral health-care practices, as well as the funding of action programmes and assistance cover. The conclusion is that oral healthcare in the Brazilian primary health care system has advanced over the past decades; however, serious obstacles have been experienced, especially with regard to the guarantee of universal access to services and funding. The continuous efforts of public managers and society should focus on the goal of achieving universal coverage for all Brazilians. © 2013 FDI World Dental Federation.
A very large percentage of Mexico's population living in rural areas lacks resources for health care. Any new effort to provide such care must emphasize the health of the infant population because of the high percentage of infants in the country. Plans made at the national level have not been correlated with the conditions that exist in rural areas. For example, the majority of university programs are oriented toward urban medical practice, and the construction of more schools of medicine to solve the problem of doctors in rural areas is based on a mistaken premise. This problem has not been solved even in developed countries such as the United States where, as in Mexico, graduates in medicine migrate to the cities where optimal conditions are met for practicing the type of medicine for which they have been trained. Furthermore, it is both expensive and illogical to maintain urban doctors in rural areas where they cannot practice their profession for lack of resources; to do so is to deny the purpose of their education (27). Conventional schools of medicine, for reasons of investment and of structure, should teach only very selected groups of students who, on finishing their training, are fully capacitated to practice specialized medicine. A different system is required if we are to provide adequate health care in the rural communities. A system such as that described herein, adapted to the real need of rural communities, would avoid the necessity to create dysfunctional bureaucracies and would not destroy those institutions which have proved useful in the past. This study should be considered as one of the many pilot programs that should be initiated in order to determine the type of program that would best solve the problem of health care in rural Mexico. Other programs already being considered at the National Autonomous University of Mexico include the A36 plan of the Faculty of Medicine, now in operation; the work of C. Biro carried out in Netzahualcoyotl City
Kepros John P
Full Text Available Abstract Background The health care delivery system in the United States is facing cost and quality pressures that will require fundamental changes to remain viable. The optimal structures of the relationships between the hospital, medical school, and physicians have not been determined but are likely to have a large impact on the future of healthcare delivery. Because it is generally agreed that academic medical centers will play a role in the sustainability of this future system, a fundamental understanding of the relative contributions of the stakeholders is important as well as creativity in developing novel strategies to achieve a shared vision. Discussion Core competencies of each of the stakeholders (the hospital, the medical school and the physicians must complement the others and should act synergistically. At the same time, the stakeholders should determine the common core values and should be able to make a meaningful contribution to the delivery of health care. Summary Health care needs to achieve higher quality and lower cost. Therefore, in order for physicians, medical schools, and hospitals to serve the needs of society in a gratifying way, there will need to be change. There needs to be more scientific and social advances. It is obvious that there is a real and urgent need for relationship building among the professionals whose duty it is to provide these services.
Almeida, Patty Fidelis de; Santos, Adriano Maia Dos
To analyze the breadth of care coordination by Primary Health Care in three health regions. This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. Analisar o alcance da coordenação do cuidado pela Atenção Primária à Saúde em três regiões de saúde. Trata-se de estudo de caso, com abordagem quantitativa e qualitativa. Foram realizadas 31 entrevistas semiestruturadas com gestores municipais, regionais e estaduais e estudo transversal com aplicação de questionários para médicos (74), enfermeiros (127) e amostra representativa de usuários (1.590) da Estratégia Saúde da Família em três municípios-sede de regiões de saúde do estado da Bahia. A função de porta de entrada preferencial pela Atenção Primária à Saúde deparava-se com forte concorrência de servi
Wheeler, Sarahn M; Bryant, Allison S
A health disparity is defined as an increased burden of an adverse health outcome or health determinant within a specific subset of the population. There are well-documented racial and ethnic disparities throughout health care at the patient, provider, and health care system levels. As the minority populations within the United States grow to record numbers, it is increasingly important to invest in efforts to characterize, understand, and end racial and ethnic disparities in health care. Inequities in health outcomes and care pose real threats to the entire nation's well-being. Eliminating health disparities is fundamental to the well-being, productivity, and viability of the entire nation.
Full Text Available Karen Hacker,1,2 Maria Anies,2 Barbara L Folb,2,3 Leah Zallman4–6 1Allegheny County Health Department, Pittsburgh, PA, USA; 2Graduate School of Public Health, 3Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA; 4Institute for Community Health, Cambridge, MA, USA; 5Cambridge Health Alliance, Cambridge, MA, USA; 6Harvard School of Medicine, Boston, MA, USA Abstract: With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase
The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge before conceiving. The preconception period provides an opportunity to intervene earlier to optimize the health of potential mothers (and fathers) and to prevent harmful exposures from affecting the developing fetus. These interventions include birth spacing and preventing teenage pregnancy, promotion of contraceptive use, optimization of weight and micronutrient status, prevention and management of infectious diseases, and screening for and managing chronic conditions. Given existing interventions and the need to organize services to optimize delivery of care in a logical and effective manner, interventions are frequently co-packaged or bundled together. This paper highlights packages of preconception interventions that can be combined and co-delivered to women through various delivery channels and provides a logical framework for development of such packages in varying contexts. PMID:25415178
Ana Lúcia Abrahão
Full Text Available The study was focused on the identification of strategies of care focused on health promotion, used in the work of nurses in family health. It is a descriptive study in a qualitative approach performed in the health units in the city of Iguaba Grande, RJ, Brazil. As a result two categories emerged. The first one, ‘Tension in the area of the caregiver’ found that the work of professionals is guided in a permanent tension between the practice focused on the use of instruments from the biomedical model and actions to create a dialogical care. ‘Production of unique areas’ demonstrated that nurses value the unique needs of the health users. It is concluded that strategies of health promotion from the investigative experience incorporate elements of production of unique areas under tensions from the clinical model of attention, leading to a creative investment and creator of strategies in this setting of primary care.
van der Gulden Joost W
Full Text Available Abstract Background Workers in wet work occupations have a risk for developing hand eczema. Prevention strategies exist, but compliance to the proposed recommendations is poor. Therefore, a multifaceted implementation strategy (MIS is developed to implement these recommendations to reduce hand eczema among health care workers performing wet work. Methods/Design This study is a randomised controlled trial in three university hospitals in the Netherlands. Randomisation to the control or intervention group is performed at department level. The control group receives a leaflet containing the recommendations only. The intervention group receives the MIS which consists of five parts: 1 within a department, a participatory working group is formed to identify problems with the implementation of the recommendations, to find solutions for it and implement these solutions; 2 role models will help their colleagues in performing the desired behaviour; 3 education to all workers will enhance knowledge about (the prevention of hand eczema; 4 reminders will be placed at the department reminding workers to use the recommendations; 5 workers receive the same leaflet as the control group containing the recommendations. Data are collected by questionnaires at baseline and after 3, 6, 9 and 12 months. The primary outcome measure is self-reported hand eczema. The most important secondary outcome measures are symptoms of hand eczema; actual use of the recommendations; sick leave; work productivity; and health care costs. Analyses will be performed according to the intention to treat principle. Cost-effectiveness of the MIS will be evaluated from both the societal and the employer's perspective. Discussion The prevention of hand eczema is important for the hospital environment. If the MIS has proven to be effective, a major improvement in the health of health care workers can be obtained. Results are expected in 2014. Trial registration number NTR2812
Power, Thomas J.; Blum, Nathan J.; Guevara, James P; Jones, Heather A.; Leslie, Laurel K.
Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between healthcare and educational professionals, role restrictions among professionals, and privacy laws. Strategies for...
Conventional approaches to health care workforce planning are notoriously unreliable. In part, this is due to the uncertainty of the future health milieu. An approach to health care workforce planning that accommodates this uncertainty is not only possible but can also generate intelligence on which planning and consequent development can be reliably based. Drawing on the experience of Health Workforce New Zealand, the author outlines some of the approaches being used in New Zealand. Instead of relying simply on health care data, which provides a picture of current circumstances in health systems, the author argues that workforce planning should rely on health care intelligence--looking beyond the numbers to build understanding of how to achieve desired outcomes. As health care systems throughout the world respond to challenges such as reform efforts, aging populations of patients and providers, and maldistribution of physicians (to name a few), New Zealand's experience may offer a model for rethinking workforce planning to truly meet health care needs.
McGibbon, Elizabeth; Etowa, Josephine; McPherson, Charmaine
The social determinants of health (SDH) are recognized as important indicators of health and well-being. Health-care services (primary, secondary, tertiary care) have not until recently been considered an SDH. Inequities in access to health care are changing this view. These inequities include barriers faced by certain population groups at point of care, such as the lack of cultural competence of health-care providers. The authors show how a social justice perspective can help nurses understand how to link inequities in access to poorer health outcomes, and they call on nurses to break the cycle of oppression that contributes to these inequities.
Wood, G M
Information is the lifeblood of the health care organization. In the past, chief information officers were responsible for nothing else but assuring a constant flow of information. Today, they are being asked to do a great deal more. From E-business to E-health strategy, the chief information officer is the focal point of an organization's ability to leverage new technology.
Deutsch, Stephanie Anne; Fortin, Kristine
Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed. Copyright © 2015 Mosby, Inc. All rights reserved.
Fottler, M D; Smith, H L; Muller, H J
This paper analyzes retrenchment in health care organizations in terms of prescriptions in the literature and the actual responses of health care executives to retrenchment. Case studies of five organizations indicate that the range of coping strategies is much more limited than the range of possibilities suggested in the literature. Constraints within the culture of the organization are suggested as an explanation for this disparity.
Nash, David A
Oral Health in America: A Report of the Surgeon General, and the subsequent National Call to Action to Promote Oral Health, contributed significantly to raising awareness regarding the lack of access to oral health care by many Americans, especially minority and low-income populations, with resulting disparities in oral health. The problem is particularly acute among children. The current dental workforce in the United States is inadequate to meet the oral health care needs of children. It is inadequate in terms of numbers of dentists, as well as their geographic distribution, ethnicity, education, and practice orientation. Dental therapists, paraprofessionals trained in a 2 academic-year program of postsecondary education, have been employed internationally to improve access to oral health care for children. Research has documented that utilizing dental therapists is a cost-effective method of providing quality oral health care for children. Dental therapists have recently been introduced in Alaska by the Alaska Native Tribal Health Consortium. Dental therapists could potentially care for children in dental offices, public health clinics, and school systems, as well as in the offices of pediatricians and family physicians. Adding dental therapists to the health care team would be a significant strategy for improving access to care for children and reducing oral health disparities.
Full Text Available A diversity of definitions of quality exists, that frequently contain aspects of complexity, relativity and subjectivity. This paper provides an overview of key components in the quality debate within health care, including different perspectives and dimensions of the quality of care. Definitions of the quality of health care reflect the characteristics of health services, and are useful for measurements and quality improvement. Over time the patient perspective of quality has gotten increasing weight, and in quality improvement there has been a shift from individual responsibility for doctors and health care personnel to systems thinking. We argue that the quality approach in health care should be more standardized and that health care-specific definitions of quality should be used when the relationship between physician professionalism and quality is investigated.Keywords: quality, health care, systems thinking, patient perspective, outcome, indicator, measurement, improvement.
Jensen, Olaf Chresten
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...... 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...
Morrisette, Shelley; Oberman, William D; Watts, Allison D; Beck, Joseph B
The current U.S. health care system, with both rising costs and demands, is unsustainable. The combination of a sense of individual entitlement to health care and limited acceptance of individual responsibility with respect to personal health has contributed to a system which overspends and underperforms. This sense of entitlement has its roots in a perceived right to health care. Beginning with the so-called moral right to health care (all life is sacred), the issue of who provides health care has evolved as individual rights have trumped societal rights. The concept of government providing some level of health care ranges from limited government intervention, a 'negative right to health care' (e.g., prevention of a socially-caused, preventable health hazard), to various forms of a 'positive right to health care'. The latter ranges from a decent minimum level of care to the best possible health care with access for all. We clarify the concept of legal rights as an entitlement to health care and present distributive and social justice counter arguments to present health care as a privilege that can be provided/earned/altered/revoked by governments. We propose that unlike a 'right', which is unconditional, a 'privilege' has limitations. Going forward, expectations about what will be made available should be lowered while taking personal responsibility for one's health must for elevated. To have access to health care in the future will mean some loss of personal rights (e.g., unhealthy behaviors) and an increase in personal responsibility for gaining or maintaining one's health.
Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha
The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.
Abstract Health system financing is a critical factor in securing universal health care and achieving equity in access and payment. The human rights framework offers valuable guidance for designing a financing strategy that meets these goals. This article presents a rights-based approach to health care financing developed by the human right to health care movement in the United States. Grounded in a human rights analysis of private, market-based health insurance, advocates make the case for public financing through progressive taxation. Financing mechanisms are measured against the twin goals of guaranteeing access to care and advancing economic equity. The added focus on the redistributive potential of health care financing recasts health reform as an economic policy intervention that can help fulfill broader economic and social rights obligations. Based on a review of recent universal health care reform efforts in the state of Vermont, this article reports on a rights-based public financing plan and model, which includes a new business tax directed against wage disparities. The modeling results suggest that a health system financed through equitable taxation could produce significant redistributive effects, thus increasing economic equity while generating sufficient funds to provide comprehensive health care as a universal public good. PMID:28559677
This article examines the impact of integrating mental health into primary health care. Mental Health Integration (MHI) within Intermountain Healthcare has changed the culture of primary health care by standardizing a team-based care process that includes mental health as a normal part of the routine medical encounter. Using a quantitative statistical analysis of qualitative reports (mixed methods study), the study reports on health outcomes associated with MHI for patients and staff. Researchers interviewed 59 patients and 50 staff to evaluate the impact of MHI on depression care. Patients receiving MHI reported an improved relationship with caregivers (P approach to improve outcomes.
J.J.M. Barendregt (Jan); L.G.A. Bonneux (Luc); P.J. van der Maas (Paul)
textabstractBACKGROUND: Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs
Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes
.... 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 global health...
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...
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...... presents an analytical model that can analyse the logistical system using a holistic approach, and explore the possibility of using technology to improve the current system. A logistical system is one of the different flows happening at a hospital. Included in the analytical model is a performance...... assessment tool, which has been designed to assess the performance of the logistical system, thereby pinpointing where the system is performing poorly. Additionally the model and tool makes it possible to evaluate various technologies that can be used to improve and optimise the existing system...
Renato Cesar Sato
Full Text Available Markov Chains provide support for problems involving decision on uncertainties through a continuous period of time. The greater availability and access to processing power through computers allow that these models can be used more often to represent clinical structures. Markov models consider the patients in a discrete state of health, and the events represent the transition from one state to another. The possibility of modeling repetitive events and time dependence of probabilities and utilities associated permits a more accurate representation of the evaluated clinical structure. These templates can be used for economic evaluation in health care taking into account the evaluation of costs and clinical outcomes, especially for evaluation of chronic diseases. This article provides a review of the use of modeling within the clinical context and the advantages of the possibility of including time for this type of study.
van Hasselt, Fenneke M.; Schorr, Susanne G.; Mookhoek, Evert J.; Brouwers, Jacobus R. B. J.; Loonen, Anton J. M.; Taxis, Katja
The physical health of outpatients with severe mental illness (SMI) can be improved by changes in the health-care system. Analysis of current practice is necessary to develop these strategies. We compared the number of somatic health problems of outpatients with SMI with the frequency of consulting
The American health care system is experiencing a period of unprecedented change. This paper identifies and discusses the major changes in patient care, research, control of the health care system, and medical education, and their implications for health sciences librarians. These changes have resulted in new demands for effective information delivery and a broader health sciences library clientele. There are both challenges and opportunities for health sciences librarians as they respond to ...
Culturally sensitive health care is not a matter of simple formulas or prescriptions that provide a single definitive answer: rather, it requires understanding of the principles on which health care is based and the manner in which culture may influence those principles. This series of six articles will examine influences that ethnic and cultural background may have on health and health care. Part I outlines the development, importance and relevance of multicultural health care. The author stresses the importance of understanding community needs, cultures and beliefs; the active interest and participation of the patient in his or her own health care; the importance of a good physician-patient relationship; and the benefit of an open-minded approach by physicians and other health-care workers to the delivery of health-care services. PMID:21253247
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894
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.
Andrulis, Dennis P.; Brach, Cindy
Objective To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups’ needs. A vision for integrated care is presented. Conclusion Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. PMID:17931131
Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them
Taveras, Elsie M; LaPelle, Nancy; Gupta, Ruchi S; Finkelstein, Jonathan A
To identify potentially successful strategies, barriers, and facilitators for health promotion in preschool child care settings. We conducted 6 focus groups including each of the following: parents of children attending child care centers and home-based family child care (2 in English, 1 in Spanish) and directors of child care centers and family child care providers (2 in English, 1 in Spanish). Systematic thematic analysis was conducted to generate themes to address study questions. A total of 24 parents and 45 child care providers, serving predominantly urban, low-income children in Boston, participated. Parents and child care providers agreed that in-person group discussions would be the most effective strategy for providing health education information to parents. Several barriers that could affect implementation emerged. First, some providers expressed frustration toward parents' attitudes about child safety and health. Second, there was diversity of opinion among providers on whether conducting health promotion activities was consistent with their training and role. In addition, literacy, language, and cultural barriers were identified as potential barriers to health promotion in child care. In order to be successful, health promotion strategies in child care settings will need to overcome tensions between providers and parents, allow professional growth of child care providers to serve in a health promotion role, and better integrate external health resources and personnel. Group sessions and peer learning opportunities that are culturally and linguistically sensitive are potentially successful strategies for implementation of health promotion interventions for many parents.
van der Geest, S.; Krause, K.
This introduction delineates and discusses the field of social, cultural, and historical studies of health and health care in Ghana. Health and health care are viewed as significant nexuses of social and cultural processes. This overview of studies, mainly from Anglophone medical anthropology, focus
Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo
A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries. Copyright © 2012 Elsevier España, S.L. All rights reserved.
adequacy of contractors’ provider networks and customer - satisfaction outcomes. Overseas, TRICARE is divided into three areas: Eurasia- Africa, Latin...reservists. Page 19 GAO-16-416 Defense Health Care supplementing that MTF’s delivery of care with telehealth services instead of using...inpatient mental health bed days through purchased care. To deliver mental health care, the military services use a range of strategies including
Full Text Available Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in ′Right to Life.′ It is imperative to define ′essential health care,′ which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of ′family physician′ in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery.
Trajkovski, Suza; Schmied, Virginia; Vickers, Margaret; Jackson, Debra
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.
Petra Došenovič Bonča
Full Text Available The following paper analyses the possibilities of forming a single European health care market. This aim is achieved by studying the impact of the differing organisational features of individual European health care systems on the efficiency of health care provision, by examining the relationship between the inputs used to produce health care services and the population’s health status in the analysedcountries and by exploring the link between the quantity of health care services and the health status. The authors hypothesise that the efficiency and organisation of health care systems determine the possibilities of forming an efficient single European health care market. The empirical methodology employed in this paper isdata envelopment analysis (DEA. The results show that differences between health care systems and in the ownership types of health care providers are not so large as to prevent the formation of a single European health care market. However, the formation of a single European health care market would reveal the characteristicsof health care systems in such a way that citizens would be in favour of the public sector in health care and the national health service model.
Chassin, M R
Serious, widespread problems exist in the quality of U.S. health care: too many patients are exposed to the risks of unnecessary services; opportunities to use effective care are missed; and preventable errors lead to injuries. Advanced practitioners of industrial quality management, like Motorola and General Electric, have committed themselves to reducing the frequency of defects in their business processes to fewer than 3.4 per million, a strategy known as Six Sigma Quality. In health care, quality problems frequently occur at rates of 20 to 50 percent, or 200,000 to 500,000 per million. In order to approach Six Sigma levels of quality, the health care sector must address the underlying causes of error and make important changes: adopting new educational models; devising strategies to increase consumer awareness; and encouraging public and private investment in quality improvement.
Pont, Jörg; Stöver, Heino; Wolff, Hans
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.
Stöver, Heino; Wolff, Hans
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
Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho
ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the
Márcia Stefânia Ribeiro Macêdo
Full Text Available ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities, besides the indirect fixed costs (cleaning, security, energy, and water. The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76. The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82 a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding
Gawaine Powell Davies
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.
Nambisan, Priya; Nambisan, Satish
In recent years, consumer participation in health care has gained critical importance as health care organizations (HCOs) seek varied avenues to enhance the quality and the value of their offerings. Many large HCOs have established online health communities where health care consumers (patients) can interact with one another to share knowledge and offer emotional support in disease management and care. Importantly, the focus of consumer participation in health care has moved beyond such personal health care management as the potential for consumers to participate in innovation and value creation in varied areas of the health care industry becomes increasingly evident. Realizing such potential, however, will require HCOs to develop a better understanding of the varied types of consumer value cocreation that are enabled by new information and communication technologies such as online health communities and Web 2.0 (social media) technologies. This article seeks to contribute toward such an understanding by offering a concise and coherent theoretical framework to analyze consumer value cocreation in health care. We identify four alternate models of consumer value cocreation-the partnership model, the open-source model, the support-group model, and the diffusion model-and discuss their implications for HCOs. We develop our theoretical framework by drawing on theories and concepts in knowledge creation, innovation management, and online communities. A set of propositions are developed by combining theoretical insights from these areas with real-world examples of consumer value cocreation in health care. The theoretical framework offered here informs on the potential impact of the different models of consumer value cocreation on important organizational variables such as innovation cost and time, service quality, and consumer perceptions of HCO. An understanding of the four models of consumer value cocreation can help HCOs adopt appropriate strategies and practices to
Martin, J B; Wilkins, A S; Stawski, S K
The evolving health care environment demands that health care organizations fully utilize information technologies (ITs). The effective deployment of IT requires the development and implementation of a comprehensive IT strategic plan. A number of approaches to health care IT strategic planning exist, but they are outdated or incomplete. The component alignment model (CAM) introduced here recognizes the complexity of today's health care environment, emphasizing continuous assessment and realignment of seven basic components: external environment, emerging ITs, organizational infrastructure, mission, IT infrastructure, business strategy, and IT strategy. The article provides a framework by which health care organizations can develop an effective IT strategic planning process.
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
Schaeffer, Leonard D
Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.
In his new book, futurist Russell C. Coile Jr. presents predictions about seven aspects of health care for the next five years. Aided by a panel of health care experts, he analyzes likely developments in health care consumerism, technology, managed care, and other areas that raise a number of issues for health care marketers. Even if only a few of these predictions come true, marketers will be forced to rethink some of their techniques to adapt to this rapidly changing environment.
Health care chaplaincy positions in Canada are significantly threatened due to widespread health care cutbacks. Yet the current time also presents a significant opportunity for spiritual care providers. This article argues that religion and spirituality in Canada are undergoing significant changes. The question for Canadian health care chaplains is, then: how well equipped are they to understand these changes in health care settings and to engage them? This article attempts to go part way toward an answer.
Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A
Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.
O'Mahony, Joyce Maureen; Donnelly, Tam Truong
It is well documented that serious mental health problems such as depression, schizophrenia, and post migration stress disorders exist among immigrant women. Informed by Kleinman's explanatory model, this qualitative exploratory study was conducted with seven health care providers who provided mental health services to immigrant women. Analysis of the data revealed that (a) immigrant women face many difficulties when accessing mental health care services due to cultural differences, social stigma, and unfamiliarity with Western biomedicine, (b) spiritual beliefs and practices that influence immigrant women's mental health care practices, and (c) the health care provider-client relationship, which exerts great influence on how immigrant women seek mental health care. The study also revealed that cultural background exerts both positive and negative influences on how immigrant women seek mental health care. We suggest that although cultural knowledge and practices influence immigrant women's coping choices and strategies, awareness of social and economic differences among diverse groups of immigrant women is necessary to improve the accessibility of mental health care for immigrant women.
Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes
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…
Doherty, William J., Ed.; McCubbin, Hamilton I., Ed.
Discusses research and interventions related to family health care. Topics include health promotion; risk behaviors; vulnerability and illness onset; choosing health care systems; stress; caregiving and coping; family counseling; and family responses to Alzheimer's Disease, pediatric cancer, cystic fibrosis, diabetes, and obesity. (JAC)
Beasley, John W.; Starfield, Barbara; van Weel, Chris; Rosser, Walter W.; Haq, Cynthia L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in pr
Beasley, J.W.; Starfield, B.; Weel, C. van; Rosser, W.W.; Haq, C.L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in pr
Beasley, J.W.; Starfield, B.; Weel, C. van; Rosser, W.W.; Haq, C.L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in
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.
Hall, Mark A
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.
Full Text Available Introduction: Combination antiretroviral therapy (ART significantly decreases morbidity, mortality and HIV transmission. We aimed to characterize the timing of ART initiation based on CD4 cell count from 2000 to 2012 and identify factors associated with late initiation of treatment. Methods: Participants from the Canadian Observational Cohort (CANOC, a multi-site cohort of HIV-positive adults initiating ART naively after 1 January 2000, in three Canadian provinces (British Columbia, Ontario and Québec were included. Late initiation was defined as a CD4 count <200 cells/mm3 or an AIDS-defining illness before ART initiation (baseline. Temporal trends were assessed using the Cochran–Armitage test, and independent correlates of late initiation were identified using logistic regression. Results: In total, 8942 participants (18% female of median age 40 years (Q1–Q3 33–47 were included. The median baseline CD4 count increased from 190 cells/mm3 (Q1–Q3 80–320 in 2000 to 360 cells/mm3 (Q1–Q3 220–490 in 2012 (p<0.001. Overall, 4274 participants (48% initiated ART with a CD4 count <200 cells/mm3 or AIDS-defining illness. Late initiation was more common among women, non-MSM, older individuals, participants from Ontario and BC (vs. Québec, persons with injection drug use (IDU history and individuals starting ART in earlier calendar years. In sub-analysis exploring recent (2008 to 2012 predictors using an updated CD4 criterion (<350 cells/mm3, IDU and residence in BC (vs. Québec were no longer significant correlates of late initiation. Conclusions: This analysis documents increasing baseline CD4 counts over time among Canadians initiating ART. However, CD4 counts at ART initiation remain below contemporary treatment guidelines, highlighting the need for strategies to improve earlier engagement in HIV care.
Porter, Michael E; Teisberg, Elizabeth Olmsted
Today's preoccupation with cost shifting and cost reduction undermines physicians and patients. Instead, health care reform must focus on improving health and health care value for patients. We propose a strategy for reform that is market based but physician led. Physician leadership is essential. Improving the value of health care is something only medical teams can do. The right kind of competition--competition to improve results--will drive dramatic improvement. With such positive-sum competition, patients will receive better care, physicians will be rewarded for excellence, and costs will be contained. Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care. Three principles should guide this change: (1) the goal is value for patients, (2) medical practice should be organized around medical conditions and care cycles, and (3) results--risk-adjusted outcomes and costs--must be measured. Following these principles, professional satisfaction will increase and current pressures on physicians will decrease. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system.
Amen, Maisha M; Pacquiao, Dula F
The study examined experiences of mothers and health care providers with preventive child health care services using qualitative methods at a primary care clinic located in transitional housing for homeless families in an urban community with predominantly Black American residents. Participants were 20 mothers and 4 health care professionals. Three major domains emerged: (a). the infrastructure of the clinic and health care delivery poses barriers to mothers' access and use of services for their children; (b). specialized, biomedical-driven care produces fragmented care delivery not responsive to the comprehensive nature of problems of mothers and their children; and (c). organizational strategies for improving access and use of health care services are directed by health care providers' value orientations. Findings support existence of infrastructural characteristics of the health care system that maintains differential value orientations and power structure, and care delivery processes that are non responsive to racially diverse and poor mothers.
Kulla, Gunilla; Sarvimäki, Anneli; Fagerström, Lisbeth
Research has shown that the Swedish-speaking Finns have better health than the Finnish-speaking majority. The aim of this paper was to explore the health resources and health strategies among home-dwelling Swedish-speaking Finns aged 75 or older. The objective was to develop health-promotive nursing care for this group. Data was collected through recorded semistructured conversations with 22 older persons. The conversations were transcribed and interpreted through a hermeneutic approach. The material was read through several times and compiled into 22 narratives with relevant quotations. The narratives were subsequently summarised into one core narrative under each major category, to present the health resources and health strategies. Six categories were found: the Positive, the Social, the Active, the Adaptable, the Stubborn and the Passive. Within the Positive category, morale played an important role as a health resource and health strategy. Within the Social category, social activities were regarded as both health resources and health strategies, whereas their absence was a health obstacle. Within the Active category, a wide range of physical activities played an important role. Within the Adaptable category, contentment was a health resource. Within the Stubborn category, stubbornness itself was a health resource, whereas strong belief was a health strategy. Within the Passive category, although health obstacles permeated the life context, contentment and caution were seen as health resources. The vision of the future varied from the confidence found in the Positive category to the uncertainty prevalent in the Passive category. The main health resources and strategies used by the elderly Swedish-speaking Finns were related to social and other activities as well as to personality. Transforming health obstacles into resources could be an important health-promotive nursing strategy.
Dauvrin, Marie; Lorant, Vincent
In a context of increasing ethnic diversity, culturally competent strategies have been recommended to improve care quality and access to health care for ethnic minorities and migrants; their implementation by health professionals, however, has remained patchy. Most programs of cultural competence assume that health professionals accept that they have a responsibility to adapt to migrants, but this assumption has often remained at the level of theory. In this paper, we surveyed health professionals' views on their responsibility to adapt. Five hundred-and-sixty-nine health professionals from twenty-four inpatient and outpatient health services were selected according to their geographic location. All health care professionals were requested to complete a questionnaire about who should adapt to ethnic diversity: health professionals or patients. After a factorial analysis to identify the underlying responsibility dimensions, we performed a multilevel regression model in order to investigate individual and service covariates of responsibility attribution. Three dimensions emerged from the factor analysis: responsibility for the adaptation of communication, responsibility for the adaptation to the negotiation of values, and responsibility for the adaptation to health beliefs. Our results showed that the sense of responsibility for the adaptation of health care depended on the nature of the adaptation required: when the adaptation directly concerned communication with the patient, health professionals declared that they should be the ones to adapt; in relation to cultural preferences, however, the responsibility felt on the patient's shoulders. Most respondents were unclear in relation to adaptation to health beliefs. Regression indicated that being Belgian, not being a physician, and working in a primary-care service were associated with placing the burden of responsibility on the patient. Health care professionals do not consider it to be their responsibility to adapt
Günzel-Jensen, Franziska; Jain, Ajay K.; Kjeldsen, Anne Mette
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...
Kulshreshtha, Archana; Zacharia, Anish J; Jarouliya, Urmila; Bhadauriya, Pratiksha; Prasad, G B K S; Bisen, P S
Spirulina is a photosynthetic, filamentous, spiral-shaped and multicellular edible microbe. It is the nature's richest and most complete source of nutrition. Spirulina has a unique blend of nutrients that no single source can offer. The alga contains a wide spectrum of prophylactic and therapeutic nutrients that include B-complex vitamins, minerals, proteins, gamma-linolenic acid and the super anti-oxidants such as beta-carotene, vitamin E, trace elements and a number of unexplored bioactive compounds. Because of its apparent ability to stimulate whole human physiology, Spirulina exhibits therapeutic functions such as antioxidant, anti-bacterial, antiviral, anticancer, anti-inflammatory, anti-allergic and anti-diabetic and plethora of beneficial functions. Spirulina consumption appears to promote the growth of intestinal micro flora as well. The review discusses the potential of Spirulina in health care management.
Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R
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.
Lown, Beth A; McIntosh, Sharrie; Gaines, Martha E; McGuinn, Kathy; Hatem, David S
Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care.
McGrail, Michael P; Calasanz, Marilou; Christianson, Jon; Cortez, Cathy; Dowd, Bryan; Gorman, Robert; Lohman, William H; Parker, David; Radosevich, David M; Westman, Gary
In the spring of 1996, the Minnesota Health Partnership (MHP) received a demonstration grant from the Robert Wood Johnson Foundation Workers Compensation Health Initiative to pilot a model of health care that was designed to combine the best practices of general health and workers' compensation medical care. This paper outlines the genesis of the MHP, and the relationship of its Coordinated Health Care and Disability Prevention model to traditional managed care and 24-h care models. In order to effectively implement disability prevention principles within a primary care clinical setting, it is essential to increase health care provider awareness that the disability relating to a specific impairment can be positively impacted by specific clinical strategies. The basis and specifics of these strategies are also discussed. Plans for the evaluation of this model will also be described.
Motwani, J; Sower, V E; Brashier, L W
This article examines the issue of implementing TQM/CQI programs in the health care industry by grouping the prescriptive literature into four research streams. Based on the literature, a strategic programming model for implementing TQM/CQI in the health care industry is suggested. Finally, issues relating to TQM in the health care sector, which need to be addressed within each research stream in the future, are provided.
Sotelo, J M; Rocabado, F
Taking into account some aspects of the evolution of the health-illness concept, and considering that health depends on four elements--human biology, environment, life styles and health promotion with emphasis on well-being--the intersectorial action, the participation of the population in their own health care and the reorientation of services through the development of local health systems, are evaluated. At the same time mention is made of the importance of the decentralization process and the district's participation in the democratization of the civilian life. Considering all these aspects, the possibility of implementing the healthy district strategy as an alternative and facilitating form of development and well being and as a way to distribute health more equitably, is proposed. To increment the effects of this strategy, support for the creation of a regional movement of healthy districts is suggested.
Malvey, Donna; Alderman, Barbara; Todd, Andrew D
The use of blogs in the workplace has emerged as a communication tool that can rapidly and simultaneously connect managers with their employees, customers, their peers, and other key stakeholders. Nowhere is this connection more critical than in health care, especially because of the uncertainty surrounding health care reform and the need for managers to have access to timely and authentic information. However, most health care managers have been slow to join the blogging bandwagon. This article examines the phenomenon of blogging and offers a list of blogs that every health care manager should read and why. This article also presents a simplified step-by-step process to set up a blog.
Wentzer, Helle; Bygholm, Ann
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...
... 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 ...
Nolan, Elise Jane
Childhood obesity is an increasingly serious issue which causes significant health problems among children. There are numerous causes of childhood obesity. However, the ultimate responsibility for the problems and costs associated with an obese child should be attributed to that child's parents. Parents owe a duty of care to their child and, when their child is obese, have arguably breached that duty. However, if parents were required to pay their child damages, this would arguably be problematic and of little utility. Rather, intervention strategies should be implemented which seek to treat and prevent childhood obesity and to address the identified causes of childhood obesity.
Vanessa Bertoglio Comassetto Antunes de Oliveira
Full Text Available OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS with the Family Health Strategy (ESF units for presence and extent of attributes of Primary Health Care (APS, specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care, but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.
In the immediate postwar era the primary object of health reform among the advanced industrial democracies was to expand, if not universalize, access to a broad spectrum of health services through sustained, high levels of government-mandated spending. The fiscal crises of the 1970s and 1980s ushered in a new generation of policies devoted to balancing the imperatives of guaranteeing access to basic health and social services and to improving the accountability, efficiency, and effectiveness of health care industries. In Canada, the regionalization of health care administration emerged as the most prominent strategy for grappling with the contradictions and paradoxes of contemporary health reform. This essay traces the historical evolution of federal-provincial deliberations that elevated regionalization to the forefront of health policy-making in the new era of fiscal restraint, and further, assesses recent efforts to institutionalize regional health authorities.
Martinez-Vidal, Enrique; Gauthier, Anne K; DiVincenzo, Allison
For the money spent on health care in the United States, far better quality of care should be expected. The Commonwealth Fund and AcademyHealth have created the State Quality Improvement Institute to assist states in implementing sustainable quality improvement strategies. Lessons have emerged about the role of states in advancing fundamental and systemic changes in the way care is delivered, as well as how providers are organized and compensated. The experiences of states participating in the institute may offer insights for other states seeking to achieve similar goals.
Geoffrey A. Cordell
Full Text Available Each day, Earth's finite resources are being depleted for energy, for material goods, for transportation, for housing, and for drugs. As we evolve scientifically and technologically, and as the population of the world rapidly approaches 7 billion and beyond, among the many issues with which we are faced is the continued availability of drugs for future global health care. Medicinal agents are primarily derived from two sources, synthetic and natural, or in some cases, as semi-synthetic compounds, a mixture of the two. For the developed world, efforts have been initiated to make drug production "greener", with milder reagents, shorter reaction times, and more efficient processing, thereby using less energy, and reactions which are more atom efficient, and generate fewer by-products. However, most of the world's population uses plants, in either crude or extract form, for their primary health care. There is relatively little discussion as yet, about the long term effects of the current, non-sustainable harvesting methods for medicinal plants from the wild, which are depleting these critical resources without concurrent initiatives to commercialize their cultivation. To meet future public health care needs, a paradigm shift is required in order to adopt new approaches using contemporary technology which will result in drugs being regarded as a sustainable commodity, irrespective of their source. In this presentation, several approaches to enhancing and sustaining the availability of drugs, both synthetic and natural, will be discussed, including the use of vegetables as chemical reagents, and the deployment of integrated strategies involving information systems, biotechnology, nanotechnology, and detection techniques for the development of medicinal plants with enhanced levels of bioactive agents.
... Administration Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage... designated as primary medical care, mental health, and dental health professional shortage areas (HPSAs) as... seven health professional types (primary medical care, dental, psychiatric, vision care,...
Kinzie, Mable B
To help health educators build upon the best of different health behavior change theories, this paper offers a unified set of instructional design strategies for health education interventions. This set draws upon the recommendations of Rosenstock (Health Belief Model), Bandura (Social Cognitive Theory), and Dearing (Diffusion Theory), and uses a modified Events of Instruction framework (adapted from Robert Gagne): gain attention (convey health threats and benefits), present stimulus material (tailor message to audience knowledge and values, demonstrate observable effectiveness, make behaviors easy-to-understand and do), provide guidance (use trustworthy models to demonstrate), elicit performance and provide feedback (to enhance trialability, develop proficiency and self-efficacy), enhance retention and transfer (provide social supports and deliver behavioral cues). Sample applications of these strategies are provided. A brief review of research on adolescent smoking prevention enables consideration of the frequency with which these strategies are used, and possible patterns between strategy use and behavioral outcomes.
Fernandez, Leonor; Irby, David M.; Harleman, Elizabeth; Fernandez, Alicia
Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner’s need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching. PMID:20352501
De Geest, S.; Krause, K
This introduction delineates and discusses the field of social, cultural, and historical studies of health and health care in Ghana. Health and health care are viewed as significant nexuses of social and cultural processes. This overview of studies, mainly from Anglophone medical anthropology, focuses on developments around "traditional" medicine and various themes relating to biomedicine, including hospital ethnography, pharmaceuticals, health insurance, reproductive technology, and HIV/AIDS...
Full Text Available Abstract Background Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. Aims The aim of this paper was to explore health providers' views about mental health integration into primary health care. Methods A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka and one rural setting (Mumbwa. Results There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. Recommendations It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. Conclusion Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia.
Upton, R L
In this article, a health care marketing executive takes an opposing view: That the consumer will not only continue to exercise choice but also, at annual renewal time, veto power. In part, that is because the consumers are feeling the rising cost of health care much more directly than in the past, through ever-higher premiums, deductibles and copayments. As they assumed more of the burden of medical care delivery, consumers are becoming more knowledgeable about and discriminating toward the health care system and provider plans they are offered. They understand--as does their employer--that no longer are all health care plans alike or at parity with each other. The consumer is also demanding greater access to freedom of provider choice, quality of health care coverage.
France, George; Taroni, Francesco; Donatini, Andrea
Italy's national health service is statutorily required to guarantee the uniform provision of comprehensive care throughout the country. However, this is complicated by the fact that, constitutionally, responsibility for health care is shared between the central government and the 20 regions. There are large and growing differences in regional health service organisation and provision. Public health-care expenditure has absorbed a relatively low share of gross domestic product, although in the last 25 years it has consistently exceeded central government forecasts. Changes in payment systems, particularly for hospital care, have helped to encourage organisational appropriateness and may have contributed to containing expenditure. Tax sources used to finance the Servizio Sanitario Nazionale (SSN) have become somewhat more regressive. The limited evidence on vertical equity suggests that the SSN ensures equal access to primary care but lower income groups face barriers to specialist care. The health status of Italians has improved and compares favourably with that in other countries, although regional disparities persist.
Estrategias utilizadas por un grupo de mujeres mexicanas para cuidar su salud emocional: autoatención y apoyo social Strategies for taking care of emotional health among the Mexican women population: self-care and social support
Full Text Available OBJETIVO: Conocer las prácticas de autocuidado/autoatención utilizadas por un grupo de mujeres para aliviar malestares emocionales. MATERIAL Y MÉTODOS: Participaron 23 mujeres, habitantes de la Ciudad de México. Se realizaron entrevistas focalizadas mediante la técnica de entrevista de investigación social,cuyo propósito es favorecer la producción del discurso continuo sobre un tema determinado. La información se analizó con la técnica de categorización de significados, que consiste en clasificar el contenido de cada entrevista en categorías mutuamente excluyentes. RESULTADOS: Las prácticas de autoatenciónreúnen: conductas de autocontrol, remedios caseros, automedicación y actividades de relajación. El apoyo social proviene principalmente de otras mujeres; la pareja no se considera un apoyo significativo. CONCLUSIONES: Las mujeres encuentran estrategias que, si bien no solucionan por completo sus malestares emocionales, les permiten sobrellevar las situaciones vinculadas con éstos.OBJECTIVE: To describe what kind of self care practices a group of women use to alleviate their emotional disorders. MATERIAL AND METHODS: A group of 23 women living in Mexico City answered open-ended questions about self care strategies. Focused interviews were carried out using a social research interview technique designed to encourage continuous discourse on a set topic. Data was analyzed using a significant classification technique, which involves placing the contents of each interview in mutually exclusive categories. RESULTS: Self care practices reported included self-control, home remedies, self-medication, relaxing activities and social support. Social support is mainly obtained from other women, since partners were not regarded as providing meaningful support. CONCLUSIONS: Self care practices start once the malaise begins and stop when the malaise ends. Although the strategies women use do not entirely solve their emotional disorders, they
Chen, Chin-Shyan; Peng, Yu-I; Lee, Ping-Chang; Liu, Tsai-Ching
Whether provision of free preventive care for the elderly under National Health Insurance has reduced the risk for curative care use raises much concern in Taiwan. This study analyzes the relationship by examining the impact of health examination utilization on the utilizations of outpatient care and inpatient care. Data come from the 2005 National Health Interview Survey and National Health Insurance Research Database. A two-stage method is used in the estimation. We found a negative relationship between the utilization of preventive care and hospitalization care in terms of length of stay and medical expenditures. On average, the elderly people who used preventive care tended to have 16 shorter hospitalization stays and NTD64,220 lower hospitalization expenditures than their counterparts. In order to improve the health of the elderly and reduce the escalation of medical expenditures due to aging, including preventive care in the health insurance is a very effective strategy.
Williams, Shanita D; Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis
It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators-health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work-both within and outside the nursing field-that is necessary to answer these important but largely unanswered questions.
Daaleman, Timothy P
To introduce a health services framework of spiritual care that addresses the empirical and applied issues surrounding spirituality and nursing practice. Despite over 20 years of study, the concept of spirituality is still under development, which limits application to nursing practice. Three studies using a health services framework are reviewed: (1) a survey study of dying patients and family that describes the providers, types and outcomes of spiritual care; (2) an exploratory study of the process of spiritual care; and (3) a multi-level study of the structure and outcomes of spiritual care in long-term care facilities. Spiritual care recipients identify family or friends (41%), clergy (17%) and health care providers (29%) as spiritual care providers. The most frequently reported type of spiritual care was help in coping with illness (87%). Just over half (55%) were satisfied with the care that they received. The processes of spiritual care involved: (1) presence, (2) opening eyes, and; (3) co-creating, which was a mutual and fluid activity between patients, family members and care providers. In long term care facilities, decedents who received spiritual care were perceived as receiving better overall care in the last month of life, when compared with those decedents who did not receive spiritual care. A health services framework provides a holistic view of spiritual care, one that is consistent with integrated nursing models. By focusing on the structure, process and outcome elements of spiritual care within organisational settings, nursing management can develop feasible approaches to implement, improve and evaluate the delivery of this unique type of care. © 2012 Blackwell Publishing Ltd.
Pallesen, Bodil; Engberg, Axel; Barlach, Anders
This innovative study relates patient empowerment to strategies for education and e-health information to support self-care to patients with knee surgery in a Danish university hospital outpatient clinic. Interdisciplinary teamwork and Information and Communication Technology are integral parts...... of the programme for self-care. Empowerment core values and themes in the programme were analysed in a qualitative study including focus-group interviews from patients and the interdisciplinary team. Findings qualified following workshops, where the professionals participated in web design of a prototype website....... The website was evaluated for the implemented effects and factors for empowering interactions between health professionals and patients....
Full Text Available Abstract Background The increasing diversity of population in European Countries poses new challenges to national health systems. There is a lack of data on accessibility and use of health care services by migrants, appropriateness of the care provided, client satisfaction and problems experienced when confronting the health care system. This limits knowledge about the multiple determinants of the utilization of health services. The aim of this study was to describe the access of migrants to health care and its determinants in Portugal. Methods The study sample included 1513 immigrants (53% men, interviewed at the National Immigrant Support Centre, in Lisbon. Data were collected using questionnaires. The magnitude of associations between use of National Health Service and socio-demographic variables was estimated by means of odds ratios (OR at 95% confidence intervals, calculated using logistic regression. Results Among participants, 3.6% stated not knowing where to go if facing a health problem. Approximately 20% of the respondents reported that they had never used the National Health Service, men more than women. Among National Health Service users, 35.6% attended Health Centres, 12% used Hospital services, and 54.4% used both. Among the participants that ever used the health services, 22.4% reported to be unsatisfied or very unsatisfied. After adjusting for all variables, utilization of health services, among immigrant men, remained significantly associated with length of stay, legal status, and country of origin. Among immigrant women, the use of health services was significantly associated with length of stay and country of origin. Conclusion There is a clear need to better understand how to ensure access to health care services and to deliver appropriate care to immigrants, and that special consideration must be given to recent and undocumented migrants. To increase health services use, and the uptake of prevention programs, barriers must
Kelley, Maureen A; Flocks, Joan D; Economos, Jeannie; McCauley, Linda A
Pregnant farmworkers and their fetuses are at increased risk of negative health outcomes due to environmental and occupational factors at their workplaces. Health care providers who serve farm communities can positively affect workers' health through the informed care they deliver. Yet, interviews with rural health care providers reveal limited knowledge about agricultural work or occupational and environmental health risks during pregnancy. Professional associations, government organizations, academic institutions, and practice settings must renew their efforts to ensure that environmental and occupational health education, especially as it relates to women and their children, is incorporated into academic and practice environments.
Dietrich, C F; Riemer-Hommel, P
The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate.
IN THE 1970s, the World Health Organization(WHO) put forward a community-oriented healthservice model based on the experience of Europeancountries such as Britain. At present, this model hasbeen adopted as the key strategy to make health ser-vices accessible, affordable and socially acceptableand is an important component of health servicesystem in many countries.1,2In the early 1950s, China set out to establish athree-level primary health care network in urban andrural areas in order to provide health care...
Marahatta, Sujan B
The quest for greater efficiency, fairness and responsiveness to the expectation of the people that system serve have brought about three generations of health system reforms in the twentieth century. The first generation saw the founding of national health care systems and extension to middle income nations of social insurance systems in the 1940s and 1950s. By the late 1960s the rising costs of hospital based care, its usage by better off, inaccessibility by the poor and rural population of even the most basic services heralded second generation reforms promoting primary health care as a means of achieving the affordable universal coverage. It included the best public health strategy that is prevention and the highest ethical principle of public health that is equity. It was expected the best system for reaching households with essential and affordable care, and the best route towards universal coverage. The primary health care approach though adopted universally did not materialize its notion of translating ethos of Health for All by 2000. Overall, primary health care movement by the end of 20th century became lifeless. Since the Declaration of Alma-Ata, fundamental changes have occurred affecting health service delivery, such as economic development and financing approaches, globalization of trade and knowledge, and the shift to privatization. This is the time to develop a new vision, taking into consideration the many changes affecting global health and the strategic developments in health of recent years. With this recognition, the third generation of reforms now underway in many countries is driven by the idea of responding more to demand, assuring access for the poor and emphasizing financing rather than just provision within the public sector. The key concern is: how to translate ethos of revitalizing in the reality. Otherwise the revitalizing concept will turn into utopian goal so like HFA by 2000 strategy.
Harris, M S
A number of myths have prevented the development of a formal health care marketing strategy for the 100 million-plus racial and ethnic group members in the United States, despite their relatively greater need for health services. This market continues to grow in numbers, resources, and influence as the majority market level off. Marketers must look to minorities for new business, but traditional health care marketers have a long way to go before they are in a position to truly maximize this opportunity.
Lilian G Perez
Full Text Available OBJECTIVE: To analyze the strengths and limitations of the Family Health Strategy from the perspective of health care professionals and the community. METHODS: Between June-August 2009, in the city of Vespasiano, Minas Gerais State, Southeastern Brazil, a questionnaire was used to evaluate the Family Health Strategy (ESF with 77 healthcare professionals and 293 caregivers of children under five. Health care professional training, community access to health care, communication with patients and delivery of health education and pediatric care were the main points of interest in the evaluation. Logistic regression analysis was used to obtain odds ratios and 95% confidence intervals as well as to assess the statistical significance of the variables studied. RESULTS: The majority of health care professionals reported their program training was insufficient in quantity, content and method of delivery. Caregivers and professionals identified similar weaknesses (services not accessible to the community, lack of healthcare professionals, poor training for professionals and strengths (community health worker-patient communications, provision of educational information, and pediatric care. Recommendations for improvement included: more doctors and specialists, more and better training, and scheduling improvements. Caregiver satisfaction with the ESF was found to be related to perceived benefits such as community health agent household visits (OR 5.8, 95%CI 2.8;12.1, good professional-patient relationships (OR 4.8, 95%CI 2.5;9.3, and family-focused health (OR 4.1, 95%CI 1.6;10.2; and perceived problems such as lack of personnel (OR 0.3, 95%CI 0.2;0.6, difficulty with access (OR 0.2, 95%CI 0.1;0.4, and poor quality of care (OR 0.3, 95%CI 0.1;0.6. Overall, 62% of caregivers reported being generally satisfied with the ESF services. CONCLUSIONS: Identifying the limitations and strengths of the Family Health Strategy from the healthcare professional and
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)
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
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)
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
Full Text Available This research aimed to investigate the coordination of the psychosocial care network (RAPS for mental health crisis care, in its workers’ view. It is a descriptive exploratory study with qualitative approach. The study was carried out from 62 portfolios made by the students of the Mental Health Crisis and Urgency Course, who answered the reflective question: "Considering your workplace as a point of RAPS / RUE, describe, reflect and write a text with the synthesis regarding the articulation with the other network points in the reality of your municipality". The data were analyzed according to Thematic Content Analysis method suggested by Bardin, which comprises three phases: Pre - analysis, Material Exploration and Treatment of the Information, inference and interpretation. As a result, three thematic categories were identified: Referral, the traditional way of referring to specialized care, which is associated to a more fragmented care process; Matrix support, the current proposal of collaborative care, a joint strategy that contributes to the complex care demanded by mental health services users; and new strategies for network care, exemplified by meetings or sessions that discuss new ways to enable the network care.
Flannery, Raymond B
Violence is a complex, multifactorial entity with no single source of explanation. Although much research is underway into the nature and causes of violence, much of this research is done in isolation and published in highly specialized journals. Thus, there has been no journal review article for the administrator, clinician, or safety officer in health care settings who must address issues of safety on a daily basis. This paper provides that review by examining major cultural, biological, sociological, and psychological theories of violence. The review includes risk management strategies for, and the role of, health care facilities as societal institutions to curb violence. Many of the risk management strategies noted for health care settings may also be fielded in schools, courts, businesses, and other settings in which emergency services personnel are asked to respond.
Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad
In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.
Full Text Available Abstract Background Throughout the economic and political reforms in post-communist countries, significant changes have also occurred in public morality. One of the tasks of the Lithuanian health policy is to create mechanisms for strengthening the significance of ethical considerations in the decision-making processes concerning health care of individuals and groups of individuals, as well as considering the positions of physicians and the health care system itself in a general way. Thus, health care ethics could be analyzed at two levels: the micro level (the ethics of doctor-patient relationships and the macro level (the ethics of health policy-making, which can be realized by applying the principles of equal access, reasonable quality, affordable care and shared responsibilities. To date, the first level remains dominant, but the need arises for our attention to refocus now from the micro level to the patterns of managing and delivering care, managing the health care resources, and conducting business practices. Discussion In attempting to increase the efficiency of health services in Lithuania, a common strategy has been in place for the last fifteen years. Decentralization and privatization have been implemented as part of its policy to achieve greater efficiency. Although decentralization in theory is supposed to improve efficiency, in practice the reform of decentralization has still to be completely implemented in Lithuania. Debates on health policy in Lithuania also include the issue of private versus public health care. Although the approach of private health care is changing in a positive way, it is obvious that reduced access to health services is the most vulnerable aspect. In the Lithuanian Health Program adopted in July 1998, the target of equity was stressed, stating that by 2010, differences in health and health care between various socio-economic groups should be reduced by 25%. Summary The restructuring of health care system
Jakusovaite, Irayda; Darulis, Zilvinas; Zekas, Romualdas
Throughout the economic and political reforms in post-communist countries, significant changes have also occurred in public morality. One of the tasks of the Lithuanian health policy is to create mechanisms for strengthening the significance of ethical considerations in the decision-making processes concerning health care of individuals and groups of individuals, as well as considering the positions of physicians and the health care system itself in a general way. Thus, health care ethics could be analyzed at two levels: the micro level (the ethics of doctor-patient relationships) and the macro level (the ethics of health policy-making, which can be realized by applying the principles of equal access, reasonable quality, affordable care and shared responsibilities). To date, the first level remains dominant, but the need arises for our attention to refocus now from the micro level to the patterns of managing and delivering care, managing the health care resources, and conducting business practices. In attempting to increase the efficiency of health services in Lithuania, a common strategy has been in place for the last fifteen years. Decentralization and privatization have been implemented as part of its policy to achieve greater efficiency. Although decentralization in theory is supposed to improve efficiency, in practice the reform of decentralization has still to be completely implemented in Lithuania. Debates on health policy in Lithuania also include the issue of private versus public health care. Although the approach of private health care is changing in a positive way, it is obvious that reduced access to health services is the most vulnerable aspect. In the Lithuanian Health Program adopted in July 1998, the target of equity was stressed, stating that by 2010, differences in health and health care between various socio-economic groups should be reduced by 25%. The restructuring of health care system in Lithuania should be based on a balance between
Nørgaard, Ole; Sørensen, Kristine; Maindal, Helle Terkildsen; Kayser, Lars
A tool for measuring health literacy is desirable when tailoring health care services to individual patients. Existing tools measure the functional aspects of health literacy whereas newly developed tools have a broader scope and measure people's knowledge, motivation and competences to access, understand, appraise and apply health information. Two novel, international health literacy questionnaires have been translated and are being validated in a Danish context. The final questionnaires may assist Danish health professionals in shaping communication with patients and reduce health disparities.
Brink-Muinen, A. van den; Bensing, J.M.; Kerssens, J.J.
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
Grumbach, Kevin; Bodenheimer, Thomas
In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices.
Journal of Community Medicine and Primary Health Care. ... of research findings, reviews, theories and information on all aspects of public health. ... health planning and management, health policy, health care financing, public health nutrition, ...
Andersen, Kim Normann; Agger Nielsen, Jeppe; Kim, Soonhee
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...
E.K.A. van Doorslaer (Eddy); O.A. O'Donnell (Owen); R.P. Rannan-Eliya (Ravi); A. Somanathan (Aparnaa); S.R. Adhikari (Shiva Raj); C.C. Garg (Charu); D. Harbianto (Deni); A.N. Herrin (Alejandro); M.N. Huq (Mohammed); S. Ibragimova (Shamsia); A. Karan (Anup); T-J. Lee (Tae-Jin); G.M. Leung (Gabriel); J-F.R. Lu (Jui-fen Rachel); C.W. Ng (Ng); B.R. Pande (Badri Raj); R. Racelis (Rachel); S. Tao (Tao); K. Tin (Keith); K. Tisayaticom (Kanjana); L. Trisnantoro (Laksono); C. Vasavid (Vasavid); Y. Zhao (Yuxin)
textabstractOut-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that ar
Sluyter, G V
The literature on total quality management or continuous quality improvement in the behavioral health care field is just beginning to emerge. Although most of the evidence on its effectiveness remains anecdotal, it seems clear that it can work in behavioral health care organizations with strong leadership support and a long-term commitment.
Stone, T R; Warren, W E; Stevens, R E
The authors report the results of a segmentation study of the mental health care market. A random sample of 387 residents of a western city were interviewed by telephone. Cluster analysis of the data identified six market segments. Each is described according to the mental health care services to which it is most sensitive. Implications for targeting the segments are discussed.
Leininger, Lindsey; Levy, Helen
It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health.…
E.K.A. van Doorslaer (Eddy); O.A. O'Donnell (Owen); R.P. Rannan-Eliya (Ravi); A. Somanathan (Aparnaa); S.R. Adhikari (Shiva Raj); C.C. Garg (Charu); D. Harbianto (Deni); A.N. Herrin (Alejandro); M.N. Huq (Mohammed); S. Ibragimova (Shamsia); A. Karan (Anup); T-J. Lee (Tae-Jin); G.M. Leung (Gabriel); J-F.R. Lu (Jui-fen Rachel); C.W. Ng (Ng); B.R. Pande (Badri Raj); R. Racelis (Rachel); S. Tao (Tao); K. Tin (Keith); K. Tisayaticom (Kanjana); L. Trisnantoro (Laksono); C. Vasavid (Vasavid); Y. Zhao (Yuxin)
textabstractOut-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that ar
Verheij, R.; Barten, D.J.; Hek, K.; Nielen, M.; Prins, M.; Zwaanswijk, M.; Bakker, D. de
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 ord
Westert, G.P.; Berg, M.J. van den; Koolman, X.; Verkleij, H.
This is the second national report on the performance of the Dutch health care system. Its focus is on quality, access and costs in 2006/7. The Dutch Health Care Performance Report presents a broad picture based on 110 indicators. Where possible, comparisons in time and between countries are
Van Bewer, Vanessa
To analyze the concept of transdisciplinarity and provide an enhanced definition of transdisciplinarity in health care. The term transdisciplinarity is increasingly prevalent in health care research and has been identified as important to improving the effectiveness and efficiency in health care. However, the term continues to be misappropriated and poorly understood by researchers and clinicians alike which hinders its potential use and impact. Walker and Avant's (2005) method of concept analysis was used as a framework for the study of the concept. The databases PubMed, CINAHL, Academic Search Premier, PsycInfo and ERIC were used searching the terms transdisciplinarity, transdisciplinary, interdisciplinary and interdisciplinarity. Transdisciplinarity in health care involves transcending of disciplinary boundaries, a sharing of knowledge, skills and decision-making, a focus on real-world problems and the inclusion of multiple stakeholders including patients, their families and their communities. An enhanced definition of transdisciplinarity in health care emerged from this concept analysis that may provide clarity and direction for health care providers. Nurses, and other health care providers, can look to this definition to understand transdisciplinary health care teams as opposed to multidisciplinary, and interdisciplinary ones. © 2017 Wiley Periodicals, Inc.
Casparie, A.F.; Sluijs, E.M.; Wagner, C.; Bakker, D.H. de
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 fr
Roemeling, Oskar; Land, Martin; Ahaus, C
Purpose – This research investigates the roles that employee-initiated Lean improvement projects play in health care. Lean ideas are introduced to improve flow in health care. Although variability is detrimental to flow performance, it is unclear whether Lean initiatives set out to reduce this varia
Knutz, Eva; Ammentorp, Jette; Kofoed, Poul-Erik
. Furthermore, the data reveal that pediatric patients display a radically different play pattern than children who are not in hospital. The inquiry takes an interdisciplinary approach; it has obvious health care-related objectives and seeks to meet the urgent need for new methods within health care to optimize...
Groenewegen, P.P.; Hutten, J.B.F.
As a result of policy changes and developments on the demand side, the importance of technology in primary health care will grow fast. An approach to the implementation of new technologies in primary health care is presented in this article. First we describe the main problems in Dutch primary healt
Swartwout, Kathryn D
A 2012 Institute of Medicine report calls primary and public healthcare workers to action, tasking them with working together to improve population health outcomes. A Practical Playbook released in 2014 enables this public health/primary care integration. Primary care NPs are in an excellent position to lead the charge and make this integration happen.
Andersen, Kim Normann; Agger Nielsen, Jeppe; Kim, Soonhee
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...